The course of mental health problems in children presenting with abdominal pain in general practice

Objective. To investigate the course of mental health problems in children presenting to general practice with abdominal pain and to evaluate the extent to which abdominal pain characteristics during follow-up predict the presence of mental health problems at 12 months' follow-up. Design. A prospective cohort study with one-year follow-up. Setting. 53 general practices in the Netherlands, between May 2004 and March 2006. Subjects. 281 children aged 4-17 years. Main outcome measures. The presence of a depressive problem, an anxiety problem, and multiple non-specific somatic symptoms at follow-up and odds ratios of duration, frequency, and severity of abdominal pain with these mental health problems at follow-up. Results. A depressive problem persisted in 24/74 children (32.9%; 95% CI 22.3-44.9%), an anxiety problem in 13/43 (30.2%; 95% CI 17.2-46.1%) and the presence of multiple non-specific somatic symptoms in 75/170 children (44.1%; 95% CI 36.7-51.6%). None of the abdominal pain characteristics predicted a depressive or an anxiety problem at 12 months' follow-up. More moments of moderate to severe abdominal pain predicted the presence of multiple nonspecific somatic symptoms at follow-up. Conclusions. In one-third of the children presenting to general practice for abdominal pain, anxiety and depressive problems persist during one year of follow-up. Characteristics of the abdominal pain during the follow-up period do not predict anxiety or depressive problems after one-year follow-up. We recommend following over time children seen in primary care with abdominal pain

Growth of anaerobic methane-oxidizing archaea and sulfate reducing bacteria in a high pressure membrane-capsule bioreactor

Communities of anaerobic methane-oxidizing archaea (ANME) and sulfate-reducing bacteria (SRB) grow slowly, which limits the ability to perform physiological studies. High methane partial pressure was previously successfully applied to stimulate growth, but it is not clear how different ANME subtypes and associated SRB are affected by it. Here, we report on the growth of ANME-SRB in a membrane capsule bioreactor inoculated with Eckernförde Bay sediment that combines high-pressure incubation (10.1 MPa methane) and thorough mixing (100 rpm) with complete cell retention by a 0.2-m-pore-size membrane. The results were compared to previously obtained data from an ambient-pressure (0.101 MPa methane) bioreactor inoculated with the same sediment. The rates of oxidation of labeled methane were not higher at 10.1 MPa, likely because measurements were done at ambient pressure. The subtype ANME-2a/b was abundant in both reactors, but subtype ANME-2c was enriched only at 10.1 MPa. SRB at 10.1 MPa mainly belonged to the SEEP-SRB2 and Eel-1 groups and the Desulfuromonadales and not to the typically found SEEP-SRB1 group. The increase of ANME-2a/b occurred in parallel with the increase of SEEP-SRB2, which was previously found to be associated only with ANME-2c. Our results imply that the syntrophic association is flexible and that methane pressure and sulfide concentration influence the growth of different ANME-SRB consortia. We also studied the effect of elevated methane pressure on methane production and oxidation by a mixture of methanogenic and sulfate-reducing sludge. Here, methane oxidation rates decreased and were not coupled to sulfide production, indicating trace methane oxidation during net methanogenesis and not anaerobic methane oxidation, even at a high methane partial pressure.This work was supported in part by the EET program of the Dutch Ministries of Economic Affairs; Education, Culture and Science; and Environment and special planning through the Anaerobic Methane Oxidation for Sulfate Reduction project. This research was also supported by the Dutch Technology Foundation STW, which is part of the Netherlands Organization for Scientific Research (NWO) and which is partly funded by the Ministry of Economic Affairs. The research of A.J.M.S. is supported by an ERC grant (project 323009) and a Gravitation grant (project 024.002.002) of the Netherlands Ministry of Education, Culture and Science and the Netherlands Science Foundation (NWO)

Childhood abdominal pain in primary care: design and patient selection of the HONEUR abdominal pain cohort

Background: Abdominal pain in children is a common complaint presented to the GP. However, the prognosis and prognostic factors of childhood abdominal pain are almost exclusively studied in referred children. This cohort study aims at describing prognosis and prognostic factors of childhood abdominal pain in primary care. In this paper we describe methods used for data-collection and determine possible selective recruitment. Methods/Design: We conducted an observational, prospective cohort study with a 1-year follow-up. From May 2004 to March 2006, 53 Dutch GPs recruited consecutive children aged 4-17 years with a new episode of abdominal pain not preceded by a consultation for this complaint in the previous 3 months. Participants filled in standardized questionnaires, and faeces and urine were sampled. To evaluate selective recruitment, the electronic medical records of participating GPs were retrospectively searched for eligible non-included children. Discussion: This study allows us to describe prognosis and prognostic factors of childhood abdominal pain in primary care. A total of 305 children were included of whom 142 (46.6%) met predefined criteria for chronic/recurrent abdominal pain at presentation; from the total group of eligible children identified from the electronic medical record, 27% were included. The included children were significantly younger than non-included children (mean age 8.49 and 9.20 years). In proportion to identified eligible children, significantly less children diagnosed with "gastroenteritis" (6.8%) and significantly more children with "generalized abdominal pain" (39%) were included compared to the 27% that was expected. This cohort represents young school-aged children consulting GPs for a new episode of abdominal pain, not diagnosed as gastroenteritis. Almost half of them fulfil the criteria for chronic abdominal pain at presentation

Stimulation of Methanol Degradation in UASB Reactors: In Situ Versus Pre-Loading Cobalt on Anaerobic Granular Sludge

The effect of pre-loading and in situ loading of cobalt onto a cobalt-limited granular sludge on the performance of methanol fed bioreactors was investigated. One upflow anaerobic sludge bed (UASB) reactor was inoculated with cobalt pre-loaded sludge (24h; 30degreesC; 1 mM CoCl2) and a second UASB with unloaded sludge. The UASB reactors (30degreesC; pH 7) were operated for 77 days at 8 h hydraulic retention time and organic loading rates ranging from 5 to 20 g COD . L reactor(-1) . d(-1). Cobalt pre-loading clearly stimulated the methanogenic activity of the sludge with methanol as the substrate, e.g., after 30 days of reactor operation this activity was 5.8 times higher than that of the cobalt unloaded sludge. During the experiment, part of the cobalt leached from the pre-loaded sludge, i.e., 54% of the cobalt content was lost during the 77 days of reactor operation. Sequential metal extraction showed that losses mainly occurred from the exchangeable and carbonate fraction and in the sludge remaining cobalt was mainly present in the organic/sulfide fraction of the sludge. In situ loading of cobalt in the unloaded UASB reactor on day 57 by adding 31 muM cobalt to the influent for a 24-h period (16% of the cobalt present in the loaded sludge at day 11) resulted in a 4 time increase of the methanogenic activity of the sludge with methanol as the substrate at the end of the reactor experiment, while the accumulated amount of cobalt in the sludge only amounted to 6% of the cobalt accumulated in the loaded sludge (on day 11). This study showed that both pre-loading sludge and in situ loading are adequate for achieving an increased reactor performance of methanol fed UASB reactors operating under cobalt limitation. However, the in situ dosing procedure needs substantially lower amounts of cobalt, while it also gives significantly smaller losses of cobalt with the effluent. (C) 2004 Wiley Periodicals, Inc

Chronic abdominal pain in children

Chronic abdominal pain is a common disorder in children and adolescents worldwide. It affects the child’s wellbeing, and the costs from missed school days and use of healthcare resources are high. Children with chronic abdominal pain represent a heterogeneous population comprising both organic and functional gastrointe

Granular sludge in full scale anaerobic bioreactors: trace element content and deficiencies

To study whether trace element limitations are present in methanogenic granular sludge from full-scale anaerobic bioreactors, four different anaerobic granular sludges (Nedalco, Eerbeek, Hoogeveen and Heineken) were screened for their metal content and their response to the addition of a metal cocktail and more specifically to cobalt. Three different methanogenic substrates (methanol, acetate and H2/CO2) were used and the response to trace metal addition was monitored by on-line measurement of the changes in the specific methanogenic activity (SMA) of the sludge. A significant increase of the SMA due to trace metal addition was observed only with the substrate methanol, especially addition of only cobalt had a great effect: the SMA with methanol of the Nedalco and Hoogeveen sludge increased from, respectively, 306 and 155 mg CH4-COD g VSS¿1 d¿1 to 535 and 334 mg CH4-COD g VSS¿1 d¿1 upon the addition of solely 5 ¿M cobalt. In the Heineken sludge, a limitation for another element was present as well. The cobalt concentrations in the sludges were low compared to the other trace elements and could not be directly related to the response of the SMA. With acetate as the substrate and in the presence of cobalt (5 ¿M) a reduction of the lag-phase was observed for the Nedalco, and more pronounced for the Heineken sludge. This indicates that cobalt is also important for the onset of the activity/growth of the acetotrophic methanogenic population. Screening of the trace metal content of anaerobic granular sludge in combination with the response of the SMA to trace metal addition is therefore a valuable tool to prevent and foresee trace metal limitation in anaerobic bioreactor

Effect of Sulfur Source on the Performance and Metal Retention of Methanol-Fed UASB Reactors

The effect of a sulfur source on the performance and metal retention of methanol-fed upflow anaerobic sludge bed (UASB) reactors was investigated. For this purpose, two UASB reactors were operated with cobalt preloaded granular sludge (1 mM CoCl2; 30° C; 24 h) at an organic loading rate (OLR) of 5 g COD·L reactor-1·d-1. One UASB reactor (R1) was operated without a sulfur source in the influent during the first 37 days. In this period the methanol conversion to methane remained very poor, apparently due to the absence of a sulfur source, because once cysteine, a sulfur-containing amino acid, was added to the influent of R1 (day 37) a full conversion of methanol to methane occurred within 6 days. The second reactor (R2) was operated with sulfate (0.41 mM) in the influent during the first 86 days of operation, during which no limitation in the methanol conversion to methane manifested. Cobalt washed out from the sludge at similar rates in both reactors. The leaching of cobalt occurred at two distinct rates, first at a high rate of 22 ¿g·g TSS-1·d-1, which proceeded mainly from the exchangeable and carbonate fraction and later at a relatively slow rate of 9 ¿g·g TSS-1·d-1 from the organic/sulfide fraction. This study showed that the supply of the sulfur source L-cysteine has a pronounced positive effect on the methanogenic activity and the retention of metals such as iron, zinc and molybdenum