Use of Dietary Fiber and Stimulus Control to Treat Retentive Encopresis: A Multiple Baseline Investigation

Diet modification and stimulus control training for retentiveencopresis was evaluated in a multiple baseline across subjectsdesign. Three encopretic boys were assessed for 6, 10, and 14weeks of baseline. Diet modification comprised increasing dietaryfiber and water intake through a point contingency, and stimuluscontrol comprised scheduled toileting with limited, contingentuse of suppositories. Diet changes were associated with increasesin appropriate toileting and decreases in accidents. All subjectsattained four consecutive accident-free weeks, and gains weremaintained for 1 year. Only one subject required limited useof suppositories. Results suggest diet change is one alternativeto purgatives in treatment for retentive encopretics. Qualificationsof the approach are noted, and recommendations are made forfuture research.     

Assessment of behavioral mechanisms maintaining encopresis: Virginia Encopresis-Constipation Apperception Test

OBJECTIVE: To develop and test a scale for parent and child, evaluating theoretical and clinical parameters relevant to children with encopresis. Encopretic children were hypothesized to have more bowel-specific, but not more generic, psychological problems, as compared with nonsymptomatic control children. In addition, mothers were also believed to be more discerning than children. METHODS: The Virginia Encopresis-Constipation Apperception Test (VECAT) consists of 9 pairs of bowel-specific and 9 parallel generic drawings. Respondents selected the picture in each pair that best described them/their child. It was administered to encopretic children (N = 87), nonsymptomatic siblings (N = 27), and nonsymptomatic nonsiblings (N = 35). The mothers of all the participants also completed the VECAT. Encopretic children were retested 6 and 12 months posttreatment with Enhanced Toilet Training. RESULTS: The VECAT demonstrated good test-retest reliability and internal consistency. Encopretic children and their mothers reported more bowel-specific, but not more generic, problems. Bowel-specific scores improved significantly posttreatment only for those patients who demonstrated significant symptom improvement. Mothers were significantly more discerning than children. CONCLUSION: The VECAT is a reliable, valid, discriminating, and sensitive test. Bowel-specific problems appear to best differentiate children with and without encopresis.     

Psychological differences between children with and without chronic encopresis

OBJECTIVE: To validate a theoretical model of encopresis in terms of psychological factors that differentiates children with and without chronic encopresis and to identify scales that demonstrate these differences. METHODS: Eighty-six children with encopresis were compared to 62 nonsymptomatic children on five psychometric instruments. Differences in the mean scores and the percentages of children falling beyond preselected clinical thresholds were compared across the patient-control groups. RESULTS: Children with encopresis were found to have more anxiety/depression symptoms, family environments with less expressiveness and poorer organization, more attention difficulties, greater social problems, more disruptive behavior, and poorer school performance (ps =.01 < or =.001 on 15/20 subscales). There were no differences in self-esteem. On those subscales where proportionately more encopretic children exceeded clinical thresholds, approximately 20% more of the encopretic children exceeded thresholds than control children. CONCLUSIONS: As a group, children with encopresis differ from children without encopresis on a variety of psychological parameters. However, only a minority of children with encopresis demonstrated clinically significant elevations in these parameters. Identification and treatment of such clinical issues may enhance treatment efficacy.     

Treatment of A Retentive Encopretic Child Using Contingency Management and Diet Modification with Stimulus Control

This clinical case study utilized a new method of systematicdiet modification in combination with stimulus control trainingand contingency management to treat a 7-year-old retentive encopreticmale. Diet modification comprised increasing the child's intakeof dietary fiber through a point system. Diet change (increasesin "fiber points") was associated with increases in appropriatebowel movements and decreases in soiling accidents. The combinationof diet modification, stimulus control, and contingency managementeliminated soiling accidents, and treatment gains were maintainedat 1-year follow-up. The findings provide preliminary supportfor diet change as a possible alternative to use of purgativesin behavioral treatment for retentive encopresis. Limitationsof the study are discussed, and recommendations for furtherresearch on diet modification are made.     

Evaluation of a Standard Protocol for Retentive Encopresis: A Replication

Replicated the efficacy of a short-term, combined medical andbehavioral intervention protocol for retentive encopresis. Fifty-ninechildren who had failed standard medical management for retentiveencopresis and their parents participated in six 1-hour grouptreatment sessions. Treatment protocol combined the medicalmanagement strategies of enema clean out, increasing dietaryfiber, and daily toilet sitting with the child behavior managementstrategies of differential attention, contingency management,and contracting. For the overall sample, the number of soilingincidents decreased 85%, the weekly frequency of independentbowel movements increased 15%, the weekly frequency of parent-promptedbowel movements increased 9%, and daily dietary fiber intakeincreased 121% pre-to posttreatment. The majority of the sample(86%) stopped soiling by the end of treatment and did not requirefurther treatment. Results are discussed in terms of the comparabilitywith previous findings and the utility of combined medical andpsychological treatments for children with encopresis who havefailed standard medical approaches     

儿童肥胖症的综合干预研究

本文以３３例１２－１４岁的青春前期单纯性肥胖儿童为治疗组，另设同性别、同年龄的肥胖对照组２９例和正常体重对照组３２例作对比研究。治疗前对三组儿童均进行体格测量及生化检测，只对肥胖治疗组儿童进行综合性干预，包括家庭行为疗法、饮食指导和运动训练，为肥胖儿童制定减肥计划，内含中介行为、目标行为、奖惩手段、制约方法等，由专业人员定期家访指导，学校老师监督执行。经过二年的治疗观察，肥胖治疗组儿童肥胖度明显下降，身高的增长与正常对照组儿童一致，接受治疗的肥胖儿童血压、总胆固醇、甘油三酯、体脂含量均有不同程度的降低，不良饮食、运动行为得到不同程度的矫正，体育成绩提高，热卡摄入量比治疗前有所减少，而肥胖对照组儿童上述各指标无明显变化。     

Inpatient treatment for children with obesity: weight loss, psychological well-being, and eating behavior

OBJECTIVE: Evaluated the effects of a 10-month inpatient treatment program and implemented as a nondiet healthy lifestyle approach. In addition, the effects of two extended treatment programs were compared to a standard cognitive-behavioral treatment program for maintenance of the treatment gains. METHODS: A within-subjects design was employed to evaluate treatment outcome, including a 14-month follow-up. Children (N = 122) ranged in age from 7 to 17 years (M = 12.7 years) with a mean Body Mass Index (BMI) of 32.5, expressed as a percentage of overweight (M = 77.4%). RESULTS: The children lost 49.0% of their weight during the course of treatment. Comparing baseline with the 14-month follow-up, a weight loss of 31.7% was maintained. The children continued to show healthy eating behavior at follow-up, and their psychological well-being had improved. No significant interaction effects were found for the extended coping programs. CONCLUSION: An inpatient cognitive-behavioral nondiet approach is a promising treatment option for childhood obesity, with lasting effects throughout the 14-month posttreatment.     

Limitations of behavioral treatment of obesity: Review and analysis

Over 200 articles have been published describing behavior modification programs for weight reduction. We reviewed the group studies that reported weight data at least 1 year posttreatment. Evaluating these studies, we concluded that although changes in weight do occur, these changes are almost always clinically small, variability among patients is large, and further weight losses do not occur following the end of formal treatment. The weight lost during treatment may be explained by changes in specific eating behaviors caused by therapist contact rather than the effect of self-applied behavioral techniques on eating. Support for the effectiveness of each of the specific techniques to produce lasting weight loss or behavioral change was also lacking. Suggestions for future research in this area are given.This work was supported by the National Heart, Lung, and Blood Institute, National Institutes of Health, Grants HL 17269 and IT32 HL07258-01A1.     

青霉噻唑基单克隆抗体的研究——分泌青霉噻唑基单克隆抗体杂交瘤细胞株的建立

Kohler和Milstein于1975年创立的淋巴细胞杂交瘤技术已广泛地应用于生物学,医学等领域的研究,基于单克隆抗体的均一性,为用免疫化学方法检测药物及其中微量     

The use of focus group interviews in pediatric health care research.

OBJECTIVE: To review and synethize the research material on focus groups with children and adolescents and to provide guidelines for future development. METHODS: Psychlit, Medline, and Cinahl electronic databases, as well as the reference lists of those articles consulted, were reviewed for information regarding focus groups with participants under the age of 18 years. Both empirical and methodological articles were part of this review. RESULTS: We review the utility of focus groups for exploratory research, program evaluation, program development, and questionnaire construction or adaptation. Based on previous research, we provide guidelines for focus groups with children and adolescents and outline suggestions for future development. CONCLUSIONS: There is evidence to suggest that focus groups are a valuable means of eliciting children's views on health-related matters, given an appropriate research question. However, empirical research is required in order to investigate systematically the effect of different processes and variables on the final outcome of focus group interviews.     

A controlled study of minimal-contact thermal biofeedback treatment in children with migraine

OBJECTIVE: To evaluate the effectiveness of handwarming biofeedback (HWB) and stress management training in comparison to attention (handcooling, HCB) and wait-list control groups. Thermal biofeedback has been used in many pediatric migraine treatment studies and has demonstrated a consistent therapeutic effect. No published studies to date have compared this treatment modality with credible attention control using biofeedback technology. METHODS: Thirty-six children and adolescents (mean age: 12.8 years), as well as the mothers and fathers of these children enrolled in the study, were randomly assigned to the three groups. Thirty-four children completed treatment. Both treatment groups received four sessions of biofeedback training and a portable biofeedback device for home practice. Ratings of treatment credibility showed that the children rated the two treatments as equally credible. Assessment included anxiety and depression questionnaires for the children and both of their parents. RESULTS: Children who had been assigned to the HWB group were more likely to achieve clinical improvement in migraine after treatment than the children in the HCB group. Treatment gains were maintained up to 6 months after treatment. Home practice data reflected a general increase in temperature in the HWB group and a decrease in temperature for the HCB group. CONCLUSIONS: The results of this study confirm the findings of earlier pediatric migraine biofeedback treatment studies and also provide support for the specific effect of treatments including stress management and HWB. Future studies with larger sample sizes will aid in delineating the appropriateness of HCB as a control treatment.     

Irritable bowel syndrome treatment: cognitive behavioral therapy versus medical treatment

Introduction

The study aims to investigate two kinds of treatment in patients suffering from irritable bowel syndrome (IBS) and consequently compares its efficacy on improving the symptoms and mental health of patients; one with just medical treatment and another through a combination of psychotherapy and medical treatment.

Material and methods

Applying general sampling, 50 IBS patients were selected from among those who used to refer to a Gastroenterology Clinic. After physical and mental evaluations based on ROME-II scale and SCL-90-R questionnaires, the subjects were randomly superseded into: the control group with medical treatment and, the case group with a combination of medical and psychological treatments. The acquired data were then analyzed through t-test and Mann-Whitney U-test.

Results

The findings show that the mental health of patients receiving cognitive behavioral therapy along with the medical treatment was higher than those of the control group at post-test level. It was observed that the therapy reduces the disability caused by IBS. Comparatively, while the cognitive therapy and medical treatments cured 80% of the patients, those receiving cognitive therapy alone showed an extensive reduction of symptoms.

Conclusions

Considering the role of cognitive behavioral therapy, it is therefore recommend that such patients be managed by a combined team of gastroenterologists and psychologists.     

Additive Benefits of Laxative, Toilet Training, and Biofeedback Therapies in the Treatment of Pediatric Encopresis

Compared the additive benefits of laxative, behavior, and biofeedbacktreatments for encopresis, while attempting to identify treatmentmechanisms and predictors of treatment outcome. 44 encopreticchildren, ages 6–15 years, were randomly assigned to eitherlaxative therapy (LAX), LAX plus enhanced toilet training (ETT),or LAX + ETT + anal sphincter biofeedback (BF). Daily symptomdiaries were completed 14 days before, upon initiation of, and3 months following treatment initiation. ETT and BF were superiorto LAX in reducing encopresis. Outcome was significantly predictedby improvement during the initial 14 days of treatment. Reductionof soiling was associated with an increase in bowel movementfrequency, and reductions in defecation pain and parental promptingto use the toilet. Because of its efficacy and minimal relianceon technology, ETT should be the initial treatment of choice.     

小儿遗尿症162例临床特点与治疗

目的分析儿童遗尿症的临床特点并对其治疗方法进行探讨。方法对162例符合小儿遗尿症的患儿行尿常规及选择性地进行实验室和物理检查。明确病因者给予相应治疗,全部患儿行心理行为指导及排尿训练,43例加用盐酸丙米嗪（11例）或去氨加压素（32例）治疗。结果162例中有家族遗传史的72例（44.4%）,隐性脊柱裂（spina bifida occulta,SBO）39例,其他病因23例,无确切病因者28例。157例表现为原发性夜间遗尿症（primary nocturnal enuresis,PNE）。23例病因明确者19例治疗有效;其余139例中78例经单纯心理行为指导及排尿训练有效,31例加用药物治疗有效。结论在遗尿症患儿诊治过程中,应作必要的检查,以排除器质性疾病;对PNE患儿的治疗中要注意心理行为问题的早期发现及干预;采用心理行为及药物的综合治疗可收到良好的效果。     

Group treatment for pain and discomfort

Rheumatic patients very often suffer from chronic pain and impairment and show psychological reactions as a consequence of their physical condition. These reactions may vary from psychophysiological symptoms to anger, anxiety, or depression. We developed a cognitive-behavioral treatment programme in a group setting format with components of relaxation, cognitive restructuring, and the promotion of well-being. Subjects included in the study were given diagnoses of low back pain, tension headache, rheumatoid arthritis, and ankylosing spondylitis. Treatment effects in different diagnostic groups were compared to each other, supporting the assumption that pain reduction is greatest in low back pain and least in ankylosing spondylitis. Subjects with inflammatory rheumatic diseases showed some improvement in self-reported physical complaints and in their feelings of well-being.     

团体心理辅导对农村留守儿童的心理影响

目的:探讨团体心理辅导对农村留守儿童的心理影响.方法:方便选取222位农村留守儿童,随机分为干预组(N=134)和对照组(N=88),对干预组进行8次团体心理辅导.干预前和第7次干预结束(第1次复查)及干预结束后半年(第2次复查)两组各填写1次艾森克个性问卷(Eysenck Personality Questionnaire,EPQ)、流调用儿童抑郁量表(Center for Epidemiological Studies of Depression scale for Children ,CES-DC)、Rutter儿童行为教师问卷(Rutter Children's Behavior questionnaire for completion by teacher)、儿童自我意识量表(Piers-Harris Children's Self-concept Scale ,PHCSS).结果:第1次复查干预组EPQ神经质得分低于对照组[8.2±5.8)vs(10.2±6.1),P=0.015];第2次复查干预组CES-DC得分低于对照组[(15.9±7.3)vs.(18.8±7.7),P= 0.038];PHCSS中焦虑、幸福满足分量表分分别在第1、2次复查中高于对照组[(6.6±3.4)vs.(5.6±2.7),(6.5±1.9)vs.(5.7±1.8);P=0.022,0.005].结论:团体心理辅导可以有效缓解农村留守儿童抑郁情绪,对儿童个性的重塑有一定作用.     

Study of a group treatment program for postnatal adjustment difficulties

Summary This study examined the impact of implementation of a structured 8-session psycho-educational and cognitive behavioural therapy skills group for postnatal adjustment. Forty-five women identified as experiencing antenatal adjustment problems attended the 8-week group. Participants completed the Edinburgh Postnatal Depression Scale, Beck Anxiety Inventory, and the Maternal Attitudes Questionnaire prior to and after attendance, as well as a feedback form in the final session. Following attendance, participant scores on measures of depression, anxiety, and attitudes to mothering improved significantly. Further research is needed to contrast the group to a control condition and to determine group effects are maintained over time. Correspondence: Dr. Suzanne Barker-Collo, Department of Psychology, University of Auckland, Private Bag 92019, Auckland, New Zealand