Funktionelle somatiske symptomer hos børn. En udviklingsorienteret biopsykosocial tilgang i klinikken

Funktionelle somatiske symptomer hos børn er en hyppig årsag til kontakt til sundhedsvæsenet. Hos børn med kroniske eller tilbagevendende funktionelle somatiske symptomer er der ofte samtidig emotionelle problemer, familiære konflikter, skolefravær og øget forbrug af sundhedsydelser samt risiko for vedvarende fysiske symptomer senere i voksenalderen. En multidimensionel tilgang er derfor påkrævet i den kliniske håndtering af disse bør, frem for en klassisk biomedicinsk tilgang, som reducerer barnets lidelse og funktionshæmning til objektiv sygdom og patofysiologiske processer. Her præsenteres en multidimensionel tilgang ved en udviklingsorienteret biopsykosocial model, hvor et udviklingsmæssigt perspektiv og betydende psykologiske, sociale samt biologiske faktorer for udvikling og vedligeholdelse af symptomerne adresseres. Denne tilgang vil potentielt kunne mindske usikkerheden vedrørende diagnostik og behandling af disse børn. Det forudsætter specifik uddannelse af sundhedspersonale om funktionelle somatiske symptomer og tilstande hos børn, et udbygget samarbejde på tværs af sektor- og faggrænser samt udvikling af specialiserede behandlingssteder

Systemic family therapy for severe functional disorders in youths. A qualitative study in a psychiatric setting

This is the pre-peer reviewed version of the following article: Hulgaard, D.R., Risør, M.B., Lambertsen, G.D. and Rask, C.U. (2021). Systemic family therapy for severe functional disorders in youths: a qualitative study in a psychiatric setting. Journal of Family Therapy, 43, 558-575, which has been published in final form at https://doi.org/10.1111/1467-6427.12319. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.This study aimed to explore participant experiences of systemic family therapy for youths with functional disorders. After completing family therapy, eight youths and thirteen parents participated in qualitative interviews. The analysis was based on interpretative phenomenological analysis and identified two main themes. The first theme was: ‘Challenges of creating meaning and understanding of child symptoms in family therapy’, with symptom understanding and explanation found to be important, though sometimes challenging, themes in therapy. The second theme was: ‘Clinical encounters in family therapy promote dialogue’, which included the finding that the family therapy setting with joint sessions for family members facilitated in-family communicatio

A new deep-sea eelpout of the genus Pyrolycus (Teleostei: Zoarcidae) associated with a hydrothermal seep on the Pacific margin of Costa Rica

A new species of the zoarcid genus Pyrolycus Machida & Hashimoto, 2002, Pyrolycus jaco sp. nov., is described from a hydrothermal seep environment named Jacó Scar in the eastern Pacific of Costa Rica. Four specimens were collected in 2018 between 1746–1795 m among tubeworm colonies around the seep. The new species is differentiated from its two western Pacific congeners by having a shorter head, snout, jaw, and pectoral fins. It is further diagnosed by having three postorbital pores and two occipital pores. Molecular sequences of the cytochrome c oxidase I gene are provided and are the first for the genus. The character states indicating miniaturization in this species are discussed. This is the first vertebrate species known from this composite reducing ecosystem and is the fourth hydrothermally-associated zoarcid from the eastern Pacific

The effectiveness of parent training as a treatment for preschool attention-deficit/hyperactivity disorder : study protocol for a randomized controlled, multicenter trial of the new Forest Parenting Program in everyday clinical practice

Background: Parent training is recommended as the first-line treatment for attention-deficit/hyperactivity disorder (ADHD) in preschool children. The New Forest Parenting Programme (NFPP) is an evidence-based parenting program developed specifically to target preschool ADHD. Objective: The objective of this trial is to investigate whether the NFPP can be effectively delivered for children referred through official community pathways in everyday clinical practice. Methods: A multicenter randomized controlled parallel arm trial design is employed. There are two treatment arms, NFPP and treatment as usual. NFPP consists of eight individually delivered parenting sessions, where the child attends during three of the sessions. Outcomes are examined at three time points (T1, T2, T3): T1 (baseline), T2 (week 12, post intervention), and T3 (6 month follow/up). 140 children between the ages of 3-7, with a clinical diagnosis of ADHD, informed by the Development and Well Being Assessment, and recruited from three child and adolescent psychiatry departments in Denmark will take part. Randomization is on a 1: 1 basis, stratified for age and gender. Results: The primary endpoint is change in ADHD symptoms as measured by the Preschool ADHD-Rating Scale (ADHD-RS) by T2. Secondary outcome measures include: effects on this measure at T3 and T2 and T3 measures of teacher reported Preschool ADHD-RS scores, parent and teacher rated scores on the Strength & Difficulties Questionnaire, direct observation of ADHD behaviors during Child's Solo Play, observation of parent-child interaction, parent sense of competence, and family stress. Results will be reported using the standards set out in the Consolidated Standards of Reporting Trials Statement for Randomized Controlled Trials of nonpharmacological treatments. Conclusions: The trial will provide evidence as to whether NFPP is a more effective treatment for preschool ADHD than the treatment usually offered in everyday clinical practice

Non-specific Health complaints and self-rated health in pre-adolescents:impact on primary health care use

Abstract The objective of the present study was to explore past and future primary health care use in preadolescents reporting frequent non-specific health complaints or a low self-rated health compared to that of preadolescents with no frequent health complaints or with good self-rated health. The study was conducted as a cohort study based within the Danish National Birth Cohort (1996–2002). Information on non-specific health complaints and self-rated health was obtained by an 11-year follow-up questionnaire. Information about number of general practitioner (GP) contacts was obtained from the Health Insurance Service Register. A total of 44,877 pre-adolescents gave complete exposure information. Pre-adolescents who reported frequent non-specific health complaints had a higher use of GP compared to pre-adolescents without complaints across the five years following the index date (somatic complaints: IRR = (1.46 [1.38; 1.55], mental complaints: IRR = 1.16 [1.12; 1.19], both complaints: IRR = 1.58 [1.47; 1.69]). The same pattern was found for the association between low self-rated health and number of GP contacts (IRR = 1.41 (1.36; 1.46)). Non-specific health complaints and a poor self-rated health in pre-adolescents was associated with a higher past and future use of GP, indicating a need for development of early interventions with help for symptom management

Can the bodily distress syndrome (BDS) concept be used to assess functional somatic symptoms in adolescence?

Objective: Bodily Distress Syndrome (BDS) represents a new research concept for adult patients with various functional somatic syndromes. We evaluated the utility of the BDS research concept and the associated BDS-25-checklist as a screening tool for diverse functional somatic symptoms (FSS) in adolescence by investigating: 1) the psychometric and factorial structures of the checklist, 2) symptom cluster patterns and 3) illness classification and associations with emotional psychopathology and sociodemographic factors. Methods: This cross-sectional study obtained data from the 16/17-year follow-up (N = 2542) of the general population Copenhagen Child Cohort 2000 (CCC2000). We used self-reported questionnaires to assess physical symptoms (the BDS-25 checklist), overall health (KidScreen), emotional psychopathology (Spence Children's Anxiety Scale; The Mood and Feelings Questionnaire), and illness worry (Whiteley-6 Index), and utilized data from Danish national registers to assess sociodemographic factors. Results: The BDS-25 checklist items displayed satisfactory psychometric data quality. Factor analyses revealed a similar four-factor model as reported in adults (factor loadings λ ≥0.5), representing distinct BDS symptom clusters: cardio-pulmonary, gastro-intestinal, musculoskeletal and general symptoms. Latent class analyses revealed a model with three latent classes, i.e. probable no to mild BDS, probable moderate, single-organ BDS and probable severe, multi-organ BDS, displaying acceptable class quality (Entropy = 0.904). Trend analyses revealed sociodemographic group differences across latent classes. Increased emotional psychopathology was associated with more pronounced BDS symptoms. Conclusion: Our findings support the BDS concept with four symptom clusters and three illness severity groups (no BDS, single- organ and multi-organ BDS) to screen for FSS in adolescence