Anxiety disorders, depression and incontinence in preschool children : A population-based study

Objective The aim was to examine associations of specific anxiety disorders, depressive symptoms, and incontinence in a representative, population-based sample of preschool children. Methods All preschool children of a defined geographical area examined before school-entry were included. Parents completed a questionnaire including the Preschool Feelings Checklist (PFC), eight questions referring to nocturnal enuresis (NE), daytime urinary incontinence (DUI), fecal incontinence (FI) and constipation, and 30 items regarding Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition (DSM-5) diagnostic criteria of separation anxiety disorder (SAD), social phobia (SOC), specific phobia (PHOB), and generalized anxiety disorder (GAD). Data of 1206 children (mean age = 5.7 years; 53.5% boys) are presented. Results 34.6% of incontinent children had an anxiety disorder based on DSM-5 criteria and 13.3% had clinically relevant depressive symptoms (measured by the PFC). Rates of incontinence overall were 14.1% (11.9% NE, 3.1% DUI, and 1.8% FI) and 6.3% for constipation. Rates of SOC and PHOB were increased in NE (20.8% and 25.4%), DUI (39.3% and 34.5%) and FI (35.3% and 50.0%) compared to continent children (13.5% and 17.2%). Children with constipation had higher rates of SOC, PHOB, and GAD than those without. Compared to continent children (9.7%), depressive symptoms were more frequent in children with NE (26.8%), DUI (50.0%), and FI (61.9%). Conclusion Anxiety disorders and depressive symptoms are common in children with incontinence. The most specific DSM-5 disorders associated with incontinence are SOC and PHOB, which can be incapacitating and may require treatment. Due to the high rates of anxiety disorders, it is important to screen all children with incontinence, for example, with specific questionnaires

Psychopathologie und elterlicher Stress bei 3- bis 6-jährigen Kindern mit Ausscheidungsstörungen

Objective: Incontinence and functional gastrointestinal disorders are common in young children and are associated with higher rates of psychological symptoms and mental disorders. This article focuses on the mutual association between incontinence and related toilet refusal syndrome, parental stress, and children’s psychopathology especially in young children. Methods: Children’s psychological symptoms, mental disorders, and parental stress levels were assessed in 38 parent-child dyads involving children with incontinence and 42 dyads of typically developing (TD) children. Results: Compared to TD children, patients had higher internalizing and externalizing CBCL scores and higher rates of clinically relevant externalizing problems. However, the rates of clinically relevant internalizing problems and mental disorders did not differ. The parents of children with incontinence reported signifi cantly higher stress levels regarding child-related stress factors (PSI-CD) than did parents of TD children. However, there were no clinically relevant parental stress scores on a group level, which remained below the clinical range (T-value < 60). When simultaneously analyzed, children’s (comorbid) mental disorders but not incontinence had a major impact on parental stress. Conclusions: Despite moderate stress levels, incontinence symptoms, urinary and fecal incontinence are highly prevalent in young children. However, stress among parents of young children was mainly elicited by any (comorbid) mental disorder.Fragestellung: Ausscheidungsstörungen (AS) wie funktionelle Harn- und Stuhlinkontinenz sind sehr häufi ge Störungen im Vorschulalter und sind mit einer erhöhten Prävalenz von psychopathologischen Symptomen und psychischen Störungen bei den betroffenen Kindern assoziiert. Innerhalb der vorliegenden Arbeit wird der wechselseitige Zusammenhang von funktioneller Harn- und Stuhlinkontinenz sowie dem damit in Verbindung stehenden Toilettenverweigerungssyndrom auf die kindliche Psychopathologie und das elterliche Stresserleben speziell bei jungen Kindern untersucht. Methode: Psychopathologische Symptome, psychische Störungen und elterliche Stressbelastung wurden in 38 Eltern-Kind-Dyaden bei Kindern mit vorhandener AS und in 42 Dyaden bei Kindern ohne AS untersucht. Ergebnisse: Kinder mit AS wiesen höhere Werte von internalisierendem und externalisierendem Problemverhalten auf und waren häufi ger von klinisch relevanter externalisierender Symptomatik betroffen. Nichtsdestotrotz war die Prävalenz psychischer Störungen vergleichbar. Eltern von Kindern mit AS berichteten signifi kant höhere kindbezogene Stresslevel. Dennoch zeigte sich auf Gruppenebene kein klinisch bedeutsamer elterlicher Stress und die mittleren Stresslevel lagen unterhalb des Bereichs der klinischen Auffälligkeit (T-Wert < 60). Bei gleichzeitiger Betrachtung des Einfl usses von AS und psychischen Störungen zeigten sich letztere als ausschlaggebend für den elterlichen Stress. Schlussfolgerungen: Trotz moderater Stresslevel konnte eine generell hohe Prävalenz von AS Symptomen bei 3–6-Jährigen aufgezeigt werden. Elterlicher Stress war jedoch bedeutsamer mit einer (komorbiden) psychischen Erkrankung assoziiert

Areas of improvement in the medical care of SMA : evidence from a nationwide patient registry in Germany

Background Management and treatment of spinal muscular atrophy (SMA) has changed in recent years due to the introduction of novel transformative and potentially curative therapies resulting in the emergence of new disease phenotypes. Yet, little is known about the uptake and impact of these therapies in real-world clinical practice. The objective of this study was to describe current motor function, need of assistive devices, and therapeutic and sup‑ portive interventions provided by the healthcare system, as well as the socioeconomic situation of children and adults with diferent SMA phenotypes in Germany. We conducted a cross-sectional, observational study of German patients with genetically confrmed SMA identifed and recruited via a nationwide SMA patient registry (www.sma-register. de) within the TREAT-NMD network. Study data was recorded directly from patient-caregiver pairs through a study questionnaire administered online via a dedicated study website. Results The fnal study cohort consisted of 107 patients with SMA. Of these, 24 were children and 83 adults. In total, about 78% of all participants were taking medication for SMA (predominantly nusinersen and risdiplam). All children with SMA1 were able to sit and 27% of children with SMA2 were able to stand or walk. Impaired upper limb function, scoliosis and bulbar dysfunction were observed more frequently in patients with reduced lower limb performance. Physiotherapy, occupational therapy, and speech therapy, as well as the use of cough assists were less common than indicated by care guidelines. Family planning and educational and employment status appear to be related to motor skill impairment. Conclusions We show that the natural history of disease has changed in Germany following improvements in SMA care and the introduction of novel therapies. Yet, a non-trivial proportion of patients remain untreated. We also identi‑ fed considerable limitations in rehabilitation and respiratory care, as well as low labour-market participation among adults with SMA, calling for action to improve the current situation

Efeito da presença de contaminantes na água produzida proveniente da extração de petróleo

A produção de petróleo nacional vem crescendo consideravelmente desde 2000 e a PETROBRAS projeta seu plano de negócios até 2040. Com isso, novas tecnologias na extração e produção de petróleo devem surgir a fim de atender aos desafios técnicos desse tipo de negócio. Durante o processo de produção do petróleo, muitos resíduos são gerados e, com o passar dos anos, ocorre um aumento significativo do volume de água produzida e uma diminuição de óleo gerado, derivado da depleção do reservatório. Neste contexto, existem metodologias que agem no incremento do fator de recuperação do reservatório chamadas de Métodos de Recuperação Avançada (EOR), as quais englobam tanto os métodos de recuperação secundários quanto terciários. Os primeiros, têm como objetivo suplementar a energia natural do reservatório. Já o método de recuperação terciária, abordado neste trabalho - método químico de injeção de polímeros - visa aumentar o fator de recuperação do reservatório aumentando a viscosidade do fluido injetado e diminuindo a permeabilidade efetiva da água na rocha- reservatório, tampando as zonas que eram permeáveis a água. A água produzida, por sua vez, deve ser tratada obedecendo a RESOLUÇÃO CONAMA nº 393 de 2007 para descarte no mar. Visando tratar esta água produzida, juntamente com polímero utilizado em técnica de EOR, existem estudos que utilizam os processos de separação por membranas de cerâmica (PSMC). No presente trabalho, foram realizados testes em uma unidade em escala de bancada com uma membrana cerâmica, para avaliar a capacidade da membrana de tratar água produzida com polímero bem como suas condições operacionais. Foram feitos testes preliminares com água produzida sintética avaliando a velocidade de escoamento do fluido (1,6; 2,2; 2,7 m.s-1) no sistema e a concentração de sal (sem sal e com 100.000 mg.L-1). Os testes de polímero foram realizados com soluções de diferentes concentrações (100, 500 e 1000 mg.L-1), avaliando-se também os efeitos da concentração de sal, a velocidade de escoamento (1 e 2 m.s-1), o cisalhamento e o diferencial de pressão (1 e 2 bar) através da membrana. Os resultados, após 1 hora de permeação, demonstraram que o cisalhamento aumenta o fluxo de permeado em todos os casos e que o fluxo é inversamente proporcional à viscosidade do fluido, exceto em soluções de contendo água, polímero e sal. Em amostras com óleo, as velocidades de escoamento tangencial muito altas levaram à diminuição da espessura da região polarizada, aumentando o fluxo de permeado.Since 2000, the national oil production has been growing substantially, along with that, PETROBRAS has its business plan projected until 2040, so new technologies in the oil extraction and production fields must emerge to keep this market rising. During the oil production process, a lot of waste is generated and over the years there is a significant increase in the volume of produced water while the amount of oil decreases, due to reservoir depletion. In this context, there are methodologies that act on increasing the reservoir recovery factor, called Enhanced Oil Recovery (EOR), which includes both secondary and tertiary recovery methods. Secondary recovery methods aim to supplement the reservoir's natural energy. The tertiary recovery method, approached in this work - chemical method of injecting polymers - aiming to increase the reservoir recovery factor by increasing the viscosity of the injected fluid and decreasing the effective permeability of water in the reservoir rock, covering the zones that were permeable to water. In turn, the produced water must be treated according to the RESOLUTION CONAMA Nº 393/2007 for disposal at sea. In order to treat this produced water alongside the polymer used in EOR technique, there are researches that use ceramic membrane separation (PSMC) processes. In the present work, tests were performed on a bench scale unit with a ceramic membrane to evaluate the membrane's ability to treat polymer-produced water as well as its operating conditions. Preliminary tests were performed with synthetic produced water evaluating the fluid’s flow speed (1.6, 2.2, 2.7 m.s-1) in the system and the salt concentration (without salt and with 100,000 mg.L-1). The polymer tests were performed with different concentration solutions (100, 500 and 1000 mg.L-1), also evaluating the effects of salt concentration, flow rate (1 and 2 m.s-1), shearing and the transmembrane pressure (1 and 2 bar) applied in the membrane. Results after 1 hour of permeation showed that shearing increases permeate flux in all cases and that the flux is directly proportional to the fluid viscosity. In oil samples, very high tangential flow velocities leaded to a decreasing in thickness of the polarized region, increasing permeate flux

辅助干预措施是否能改善患有创伤后应激障碍的成年患者接受创伤心理 治疗的治疗效果？一项系统综述

Background: According to clinical guidelines, trauma-focused psychotherapies (TF-PT) such as trauma-focused cognitive behavioural therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) are recommended as first-line treatments for posttraumatic stress disorder (PTSD). TF-CBT and EMDR are equally effective and have large effect sizes. However, many patients fail to respond or have comorbid symptoms or disorders that only partially decline with TF-PT. Thus, there is growing interest in augmenting TF-PT through adjuvant interventions. Objective: The current systematic review aims to assess whether adjuvant interventions improve outcome among adult PTSD patients receiving TF-PT. Methods: We searched the databases PubMed, PILOTS, Web of Science and the Cochrane Library for controlled clinical trials examining whether adjuvant interventions lead to more symptom reduction in adult PTSD patients receiving TF-PT. Thirteen randomized controlled trials fitted the inclusion criteria. These were evaluated for internal risk of bias using the Cochrane Handbook for Systematic Review of Interventions. Results: Most studies have a substantial risk for internal bias, mainly due to small sample sizes. Thus, no strong conclusion can be drawn from the current empirical evidence. Preliminary evidence suggests that exercise and cortisol administration may have an adjuvant effect on PTSD symptom reduction. Breathing biofeedback showed a trend for an adjuvant effect and an effect for accelerated symptom reduction. Conclusions: Currently, it is not possible to formulate evidence-based clinical recommendations regarding adjuvants interventions. While several adjuvant interventions hold the potential to boost the effectiveness of TF-PT, the realization of sufficiently powered studies is crucial to separate plausible ideas from interventions proven to work in practice.Antecedentes: De acuerdo a las guías clínicas, las psicoterapias con foco en el trauma (TF-PT, por su sigla en inglés), así como la terapia cognitivo-conductual con foco en el trauma (TF-CBT, por su sigla en inglés) y la terapia de reprocesamiento y desensibilización por movimientos oculares (EMDR) son recomendadas como tratamientos de primera línea para el Trastorno de Estrés Postraumático (TEPT). TF-CBT y EMDR son igualmente efectivas y tienen grandes tamaños de efecto. Sin embargo, muchos pacientes no responden, tienen síntomas comórbidos u otros trastornos que sólo disminuyen parcialmente con TF-PT. Por lo tanto, hay un creciente interés en aumentar las TF-PT a través de intervenciones auxiliares. Objetivo: La presente revisión sistemática busca evaluar si las intervenciones auxiliares mejoran los resultados entre adultos con TEPT que reciben TF-PT. Métodos: Buscamos en las bases de datos Pubmed, PILOTS, Web of Science y en la Biblioteca Cochrane, estudios clínicos controlados que examinaran si las intervenciones auxiliares llevan a mayor reducción de síntomas en pacientes adultos con TEPT que reciben TF-PT. Trece estudios randomizados controlados cumplieron los criterios de inclusión. En estos se evaluó el riesgo interno de sesgo usando el Manual Cochrane para la Revisión Sistemática de Intervenciones. Resultados: La mayoría de los estudios tuvo un riesgo sustancial de sesgo interno, principalmente debido al pequeño tamaño muestral. Por lo tanrto, no se puede extraer conclusiones fuertes de la evidencia empírica actual. La evidencia preliminar sugiere que el ejercicio y la administración de cortisol puede tener un efecto auxiliar en la reducción de síntomas de TEPT. El biofeedback de la respiración mostró una tendencia hacia un efecto auxiliar y un efecto en la reducción acelerada de los síntomas. Conclusiones: Actualmente, no es posible formular recomendaciones clínicas basadas en la evidencia en relación a intervenciones auxiliares. Mientras varias intervenciones auxiliares mantienen potencial para aumentar la efectividad de las TF-PT, la realización de estudios con suficiente poder es crucial para separar las ideas plausibles de las intervenciones con efectividad probada en la práctica.背景：根据临床指南，创伤型心理治疗（TF-PT）如创伤中心的认知行为疗法（TF-CBT） 和眼球运动脱敏和再加工（EMDR）被推荐为创伤后应激障碍（ PTSD）的一线治疗方 法。 TF-CBT和EMDR同样有效并且具有大的效果量。然而，许多患者对治疗没有反应或患 有TF-PT只能部分减轻的共病症状。因此，人们越来越关注通过辅助干预增强TF-PT。 目的：本系统综述旨在评估辅助干预措施是否能改善接受TF-PT的成人PTSD患者的预后。 方法：我们搜索了PubMed，PILOTS，Web of Science和Cochrane的数据库中的对照临床试 验，考察辅助干预措施是否会导致接受TF-PT的成人PTSD患者症状减轻。有13项随机对照 试验符合纳入标准。使用Cochrane干预系统综述操作手册评估内部偏差风险。 结果：大多数研究存在较大的内部偏差风险，主要是由于样本量较小。因此，目前的经 验证据无法得出有力的结论。初步证据表明，运动和皮质醇给药可能对PTSD症状减轻有 辅助作用。呼吸生物反馈显示出可能有辅助效应的趋势和加速症状减轻的效果。 结论：目前，还不能制定关于辅助干预的循证临床建议。虽然有几种辅助干预措施具有 提高TF-PT有效性的潜力，至关重要的是还需要进行充分的研究将好想法与经证实在实践 中起作用的干预措施区分开来

Psychopathology and Parental Stress in 3–6-Year-Old Children with Incontinence

&lt;jats:p&gt; Abstract. Objective: Incontinence and functional gastrointestinal disorders are common in young children and are associated with higher rates of psychological symptoms and mental disorders. This article focuses on the mutual association between incontinence and related toilet refusal syndrome, parental stress, and children’s psychopathology especially in young children. Methods: Children’s psychological symptoms, mental disorders, and parental stress levels were assessed in 38 parent-child dyads involving children with incontinence and 42 dyads of typically developing (TD) children. Results: Compared to TD children, patients had higher internalizing and externalizing CBCL scores and higher rates of clinically relevant externalizing problems. However, the rates of clinically relevant internalizing problems and mental disorders did not differ. The parents of children with incontinence reported significantly higher stress levels regarding child-related stress factors (PSI-CD) than did parents of TD children. However, there were no clinically relevant parental stress scores on a group level, which remained below the clinical range (T-value &amp;lt; 60). When simultaneously analyzed, children’s (comorbid) mental disorders but not incontinence had a major impact on parental stress. Conclusions: Despite moderate stress levels, incontinence symptoms, urinary and fecal incontinence are highly prevalent in young children. However, stress among parents of young children was mainly elicited by any (comorbid) mental disorder. &lt;/jats:p&gt

On the current psychotherapeutic situation for persons with pornography use disorder in Germany

Background and aims: For the first time, the ICD-11 provides the diagnosis compulsive sexual behavior disorder (CSBD) that can be assigned for pornography use disorder (PUD). This study aimed to es- timate the prevalence of PUD and associated consequences in Germany, to identify the psychotherapy demand among likely PUD (lPUD) cases and the treatment supply in different psychotherapeutic settings, to survey psychotherapists’ level of expertise regarding PUD, and to identify predictors for psychotherapy demand. Methods: Four studies were conducted: 1. Online study in the general population (n 5 2070; m 5 48.9%, f 5 50.8%, d 5 0.2%), 2. Survey among practicing psychotherapists (n 5 983), 3. Survey of psychotherapists in psychotherapeutic outpatient clinics (n 5 185), 4. Interviews with psychotherapeutic inpatient clinics (n 5 28). Results: The estimated prevalence of lPUD in the online study was 4.7% and men were 6.3 times more often affected than women. Compared to individuals without PUD, individuals with lPUD more often indi- cated negative consequences in performance-related areas. Among lPUD cases, 51.2% of men and 64.3% of women were interested in a specialized PUD treatment. Psychotherapists reported 1.2%–2.9% of lPUD cases among their patients. 43.2%–61.5% of psychother- apists stated to be poorly informed about PUD. Only 7% of psy- chotherapeutic inpatient clinics provided specific treatments to patients with PUD. While, among other factors, negative conse- quences attributed to lPUD were predictive for psychotherapy demand, weekly pornography consumption, subjective well-being, and religious attachment were not. Discussion and conclusions: Although PUD occurs quite often in Germany, availability of mental health care services for PUD is poor. Specific PUD treat- ments are urgently needed

Incontinence and constipation in adolescent patients with anorexia nervosa—Results of a multicenter study from a German web‐based registry for children and adolescents with anorexia nervosa

OBJECTIVE: Nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) are common disorders in childhood and are frequently accompanied by comorbid psychiatric disorders. Despite a high association between urinary and fecal incontinence with psychiatric and neurodevelopmental disorders, research on comorbidity between incontinence and anorexia nervosa (AN) remains scarce. Yet, it is well known that somatic consequences of AN include metabolic and gastrointestinal disorders. The study sought to assess the prevalence of incontinence and constipation in children and adolescents with AN and to examine associations of these two symptoms with body weight at admission and with BMI changes during inpatient treatment. METHODS: Data collected between 2015 and 2017 by a multicenter German web-based registry for AN were analyzed. Three hundred and forty-eight patients with AN (96.3% female, mean age = 15.1 ± 1.8 years) were assessed regarding AN subtype, psychiatric comorbidity, body weight, incontinence, and constipation. RESULTS: Overall, 27.6% of patients had constipation, 1.8% had NE and 1.8% DUI. Prevalence of constipation did not significantly differ between AN subtypes. Constipation did not lead to any significant differences in weight/BMI changes during inpatient treatment. DISCUSSION: This is the largest study of incontinence and constipation in patients with AN, so far. Our results indicate that constipation is highly prevalent in adolescent patients with AN and reflects a clinically relevant condition. Despite, patients with AN do not have an increased prevalence of incontinence compared with the general population. Future studies should include medical examinations like ultrasound and physical examination of the lower abdomen to evaluate the severity of constipation