Bowel function,mental health,and psychosocial function in adolescents with Hirschsprung's disease

Accepted 2 September 1996
Congenital intestinal malformations are uncommon and may pose lasting somatic difficulties. Patients with anorectal anomalies have a high frequency of persistent faecal dysfunction and psychosocial problems. This study examined whether adolescents with Hirschsprung''s disease have more psychosocial problems than their healthy peers. Nineteen adolescents (mean age 15.7 years) with Hirschsprung''s disease were assessed for bowel function, anorectal physiology, mental health, and psychosocial functioning by physical examinations, semistructured interview, and standardised questionnaires. The adolescents were compared with controls. The parents of 13 adolescents with Hirschsprung''s disease were interviewed and completed questionnaires. Thirty two per cent of the adolescents with Hirschsprung''s disease had significant impairment of continence, but no more psychopathology (16%) nor psychosocial dysfunction as a group than their healthy peers. Faecal incontinence was associated with poorer psychosocial functioning and parental criticism. The fact that a significant number of patients with Hirschsprung''s disease have incontinence into adulthood indicates the need for parental counselling, encouraging realistic expectations about continence.

     

Bowel function and quality of life in adult patients with operated Hirschsprung's disease

Fecal continence and quality of life were evaluated by a questionnaire in 100 patients (mean age 31 years, 88 males, 12 females) who had undergone surgery for Hirschsprung's disease (HD) during the years 1950–1975. The operative methods were Duhamel retrorectal pull-through or modified Duhamel operation in 71 patients, Swenson rectosigmoidectomy in 20, State-Rehbein anterior resection in 5, and Soave endorectal pull-through in 4. The postoperative follow-up period ranged from 15 to 39 years. Fecal continence was assessed by a score described by Holschneider. Eighty-one healthy people with a similar age and sex distribution as the patients were used as controls. All controls and 91 patients had good fecal continence scores. Of the 9 patients who had fair scores, 3 were mentally retarded and 3 had postoperative anastomotic complications. If these 6 patients with an obvious cause for deficient anal function are excluded, there was no statistically significant difference in fecal continence between the patients and the controls. Equally good continence outcomes were achieved with all the operative methods. In adulthood, only 1 patient had chronic constipation. However, during childhood constipation was the main problem in 40 patients who developed a recurrent rectocolonic septum following the Duhamel operation. Constipation subsided after recrushing of the septum. None of the patients had urinary incontinence. All the patients with a good continence outcome reported no limitations in their occupation, social life, or physical activities. We conclude that in adulthood the fecal continence and quality of life of most patients with operated HD do not differ from those of healthy adults.     

Editorial Perspective: Effective mental health and psychosocial interventions for children and adolescents in street situations

Children and adolescents in street situations (CASS) in low‐ and middle‐income countries (LAMIC) could arguably be regarded as the most at‐risk group of children for mental health and psychosocial impairments compared with any other group of children. CASS, street‐connected children and street children are some of the terms used to describe this group of children who have some association with the street; such as living, working or loitering for long periods of time on the street. These children are often described as ‘voiceless’; a vulnerable group of children who experience a considerable amount of adversity from a young age.     

Self-rated health, psychosocial functioning, and health-related behavior among Thai adolescents

Background:  Despite the popularity of self-rated health (SRH) in Western countries as a useful public health tool, it has only rarely been used in Asian countries. The purpose of the current study was to determine whether measures of psychosocial functioning and health-related factors differ according to SRH in a school-based sample of Thai adolescents.
Methods:  The survey was given to 2519 adolescents attending 10 coeducational secondary high schools in Chiang Mai Province, Thailand and included measures of psychosocial functioning (loneliness, hopelessness, shyness, perceptions of social status, self-rated happiness, and perception of physical attractiveness) and certain health-related factors (height/weight, physical activity, eating breakfast, sleep).
Results:  The proportion of boys (5.1%) reporting that they were not healthy was similar to the proportion of girls (4.6%) making the same rating. These adolescents showed a pattern of overall poor health risk. Compared to adolescent peers who rated their health as healthy or very healthy, they were less physically active, got less sleep, were more likely to be overweight, and scored lower on loneliness, shyness, hopelessness, and self-rated happiness.
Conclusions:  The present pattern of poor health risk warrants attention and supports the merit of using SRH in adolescent health assessment. SRH is easy to obtain and simple to assess and single-item assessments of SRH appear to be valid measures of health status in adults and adolescent. Interventions, such as health counseling, mental health counseling, and health education, can target adolescents who rate themselves as 'not healthy' or report poor health status.     

Inflammatory bowel disease in children and adolescents: mental health and family functioning

BACKGROUND: Inflammatory bowel disease in children and adolescents often leads to an extremely complex somatic and psychiatric situation. The psychological effect of inflammatory bowel disease warrants further investigation, especially concerning salutogenetic factors that may lead to good mental health despite bad somatic conditions. METHODS: These studies used a multimethod design comprising both semiquantitative measures, such as rating scales and questionnaires, and qualitative in-depth interviews with both the child and his or her parents. Clinical comparison groups of matched children with diabetes and chronic tension headaches and matched children without chronic physical disease were examined. RESULTS: Inflammatory bowel disease often leads to psychiatric sequelae. Emotional disorders, especially depression and anxiety symptoms, were found to be common. Self-esteem was lowered. A subgroup of children with good mental health despite bad somatic conditions was found. They exhibited certain characteristics, including good knowledge of the disease, an internal locus of control, a good family climate, and an open social network. CONCLUSIONS: This study shows that the well-being of a chronically ill child depends not only on the course of the physical disease but also on the psychological and social complications that often seem to accompany a disease of this kind. The importance of taking good care of the psychosocial aspects of inflammatory bowel disease within the comprehensive treatment program is discussed.     

Mental health and psychosocial functioning in adolescents with congenital heart disease. A comparison between adolescents born with severe heart defect and atrial septal defect

Twenty-six adolescents, aged 13–18 years, with severe congenital heart disease were matched for sex, age and living area with 26 adolescents with repaired atrial septal defect and regarded as physically fit. These two groups were compared according to somatic condition, psychopathology, psychosocial functioning and chronic family difficulties. A higher rate of psychiatric problems in the complex group, an association between psychosocial functioning and physical capacity, as well as an association between psychosocial functioning and chronic family difficulties were observed. These findings suggest that physical capacity is of crucial importance for mental health and functioning of adolescents with congenital heart disease. The association with chronic family difficulties also suggests that a comprehensive biopsychosocial approach is necessary in the treatment and rehabilitation of these patients.     

The complexity of the psychosocial situation in children and adolescents with heart disease

AIM: To describe the psychosocial situation of children/adolescents with heart disease and their families, an inventory method was worked out. METHODS: Ninety-seven children/adolescents with congenital heart disease (CHD) were graded into three categories with respect to complexity of CHD. Group I included 42 patients with malformations requiring standardized operations. Group II included 20 patients with more complicated malformations, and group III included 35 patients with very complex malformations. The patients were compared with controls without heart disease, matched for age and gender. The psychosocial impact of CHD was measured by the inventory. RESULTS: The most frequent problems in the patient group were healthcare and treatment-related needs (71/97) in the external sphere, family symptoms (68/97) in the interpersonal sphere, and somatic symptoms (19/97) in the personal sphere. Corresponding numbers in the controls were treatment-related needs (15/97), family (9/97) and somatic symptoms (25/97). Fifty per cent of the symptoms in the patient groups were mild, 30% moderate and 20% severe. The most severe symptoms were found in the interpersonal sphere, where family symptoms constituted the most severe variable. The frequency of severe problems in the personal sphere was 11% in the patients and 1% in the controls. This inventory method differentiates the grades of medical complexity both regarding number and severity of psychosocial symptoms. It indicates severe personal problems in the most complex group and shows that they have severe personal problems independent of family problems. CONCLUSION: This study elucidates the psychosocial complexity in children/adolescents with CHD, which has clinical implications in developing a psychosocial care programme.     

Clinical outcome and bowel function after surgical treatment in Hirschsprung's disease

Background:

Bowel function has been reported to be adversely affected following surgery in cases of Hirschsprung. We retrospectively studied both the clinical outcome and bowel function status following surgery in patients diagnosed with Hirschprung''s disease (HD). 161 cases, who underwent pull-through operations for HD in Sheikh Pediatric Tertiary Centre, Mashhad, Iran. The specified time bracket spanned between 2006 and 2011.

Materials and Methods:

Data was extracted from Health Information System with the aim of investigating patients for both short and long-term gastrointestinal (GI) complications after surgery bases in addition to the concurrence of any associated anomalies. Three main procedures were analysed in this respect (Swenson, Duhamel and Soave).

Results:

In a study of 96 (59%) boys and 65 (40.3%) girls, mortality rate was reported to be 15.5% (15 males and 10 females). A considerable majority of almost three fourths were detected with both early and late GI complications after surgery. The latter mainly included constipation (30.8%), incontinence (19.8%), enterocolitis (8%), diarrhea (11%) in a declining order of incidence. Down syndrome and others HD-associated anomalies were detected in 3.7% and 24.3% of cases respectively.

Conclusions:

Constipation and foecal incontinence were the most prevalent postoperative complications, which were reported almost as frequent in other studies. Yet, Enterocolitis, was reported slightly less in prevalence. Also mortality rates were considerably higher, compared to developed nations.Key words: Bowel function, constipation, foecal incontinence, Hirschsprung''s disease     

SOX10基因在先天性巨结肠患儿肠壁中的表达

目的研究先天性巨结肠(HD)肠壁中性别决定区Y基因相关高可变区基因10(SOX10)的表达,了解HD在分子基础上的发病机制。方法分别取50例HD病例的手术标本狭窄段、移行段及扩张段为病例组,另随机取50例非HD手术病例标本作为对照组,提取其平滑肌组织总RNA,应用反转录(RT)-PCR扩增目的基因和看家基因片段,观察其病变段和正常段SOX10 mRNA的表达,并与看家基因在病变段和正常段的表达进行比较,并进行统计学分析。结果 SOX10 mRNA在HD患儿痉挛段(0.186 19±0.007 84)呈低表达,在扩张段(0.506 94±0.006 31)及对照组(0.594 35±0.006 29)呈高表达,痉挛段SOX10 mRNA的表达量与移行段(0.314 71±0.016 57)、扩张段及对照组比较,差异有统计学意义(F=16 384.220,P=0.000);而移行段、扩张段与对照组比较,差异亦有统计学意义(F=8 666.046,P=0.000)。结论 HD患儿结肠SOX10 mRNA的异常分布显示SOX10基因是出生后肠神经系统维持正常功能所必需的,SOX10 mRNA表达减少可引起肠管痉挛、狭窄,造成肠功能障碍。     

Diffusion of efficacious interventions for children and adolescents with mental health problems

Background:  Child and adolescent mental health problems are prevalent and require adequate interventions. Despite several evidence-based interventions for these problems described in the literature, few studies addressed strategies to diffuse efficacious interventions for child mental disorders especially in developing countries.
Methods:  An extensive but not systematic review of the literature was performed aiming to identify evidence-based interventions for children and adolescents with mental disorders, professionals to target in disseminating these interventions, and the available strategies to diffuse information.
Results:  Substantial evidence-based information is available to guide preventive, psychosocial and psychopharmacological interventions. The effectiveness of treatments in real-world settings and the cost-effectiveness of interventions are rarely tested. Professionals at different levels (teachers, school counselors, social workers, general practitioners, pediatricians, child psychologists and psychiatrists) should be targeted in diffusing efficacious interventions for child mental health problems worldwide. Telepsychiatry and the internet seem to be the most promising strategies to diffuse knowledge with lower costs.
Conclusions:  Medical and allied professionals must incorporate child and adolescent mental health issues in their under- and postgraduate curricula, and be better prepared to critically evaluate available information. Professionals need to disseminate evidence-based programs to guide parents and teachers in developing countries to deal with child and adolescent difficulties. Countries need to explore internet solutions for dissemination of medical information.     

Self-perceived health among early adolescents: Role of psychosocial factors

BACKGROUND: The authors examined self-perceived health and psychosocial health in 10-15 year old children and the relationship between children's self-perceived health and a set of psychosocial health status measurements. METHODS: Data were collected from middle school students (n = 548; age range, 10-15 years of age; mean, 12.2 years; SD, 1.2 years) using randomly selected classes from four schools in different school districts in Szeged, Hungary. The self-administered questionnaires contained items on sociodemographics; school achievement; height and weight (body mass index); self-perceived health and fitness; health behaviors; and anger and psychosomatic health. The self-perceived health variable was dichotomized and expressed with poor/fair or good/excellent perceptions of one's own health. RESULTS: Most of the children evaluated their own health as excellent or good. Logistic regression analyses revealed that poor academic achievement, socioeconomic status self-assessment, smoking, alcohol use, sports activity, self-perceived fitness, and high levels of anger and psychosomatic symptoms were associated with an increased likelihood of reported poor/fair perceptions of health. CONCLUSIONS: Findings reflect that psychosocial factors are important influences of self-perceived health in an early adolescent population.     

经肛门Soave巨结肠根治术后排便功能的评价

目的 观察经肛门Soave巨结肠根治术后排便功能和结肠切端缩口缝合术的效果.方法 回顾性分析2003年10月至2008年10月130例经肛门Soave巨结肠根治术患儿的术后排便功能恢复情况. 结果 130例中98例行经肛门根治术,32例因长段型和直肠乙状结肠呈直筒状行腹腔镜协助经肛门根治术,其中15例因近端结肠切端扩张与肛门口径大小不符行结肠切端缩口缝合后再行肛门结肠吻合.130例术后电话和信件获访90例,远期并发症3例,其中污粪2例,便秘合并小肠结肠炎1例.对术后恢复时间达3年以上的56例患儿进行排便功能评分,评分为正常组有23例,优组31例,良组2例,无差组病例.行结肠切端缩口缝合术的15例患儿全部获访,排便功能评分正常组6例,优组9例,无并发症.结论 经肛门Soave巨结肠根治术后长期肛门排便功能恢复满意.扩张但功能良好的近端结肠切端管径大于肛门口径时,可行结肠切端缩口缝合术.结肠切端缩口缝合术疗效确切,可与腹腔镜技术协同成为经肛门巨结肠手术的辅助手段.     

Periodontal health and disease in children and adolescents

The prevention and treatment of periodontal diseases in children and adolescents are most desirable and the physician should be involved in the achievement of these goals. Furthermore, cooperation between the physician and the dentist may be imperative for the comprehensive treatment of some patients. One should be aware of the influence of the general growth and development of the periodontium in order to be able to differentiate between health and disease. Periodontal diseases in children and adolescents include chronic gingivitis, gingival recession, chronic periodontitis, prepubertal periodontitis, juvenile periodontitis, and cases with peculiar causes. The main cause for periodontal diseases is the microorganisms in the dental plaque. In addition, the systemic status of the individual may affect the response of the periodontal tissues and vice versa. The physician and dentist should cooperate with the purpose of providing comprehensive prevention, diagnosis, and treatment of periodontal diseases and systemic diseases.     

Esophageal motility in children with Hirschsprung's disease

Esophageal motility was studied in 12 children with Hirschsprung's disease to see if extracolonic motor dysfunction was present in this disorder. Manometric tracings were compared with those from eight children with idiopathic megacolon and from 10 children without esophageal disease or constipation. Amplitude of esophageal contraction waves was significantly higher in children with Hirschsprung's disease than in the other two groups. Swallows that were followed by simultaneous contractions or double-peaked waves were also more common in the group with Hirschsprung's disease (subjects with Hirschsprung's disease, subjects with megacolon, and controls; 57%, 10%, and 8%, respectively). Lower esophageal sphincter characteristics did not differ among the three groups. The increase in simultaneous contractions and double-peaked waves persisted in those children who were reexamined following surgery for Hirschsprung's disease, whereas wave amplitudes fell to a level similar to that observed in the other groups. These data suggest that gastrointestinal motor dysfunction in persons with Hirschsprung's disease is not restricted to the colon, and that some of the observed abnormalities in esophageal motility do not reflect nonspecific responses to megacolon or colonic obstruction.     

Parent-adolescent agreement on psychosocial symptoms and somatic complaints among adolescents with inflammatory bowel disease

Aim: To investigate parent–adolescent agreement on psychosocial and somatic symptoms in adolescents with inflammatory bowel disease (IBD). Methods: A questionnaire‐based postal survey comprising Finnish adolescents aged 10–18 years with IBD (n = 156) and their parents. Emotional, behavioural and somatic symptoms were measured using the Child Behaviour Checklist (parent report) and the Youth Self‐Report. Results: In paediatric IBD, adolescents and parents agreed on the presence of a psychosocial problem (in subclinical/clinical range) in 5% of the cases but disagreed in 21%. In 74% of the dyads, respondents agreed that no problems existed. Agreement in reporting psychosocial or somatic symptoms was poor to low (κ = 0.00–0.38). The lowest agreement was on anxious/depressed mood (κ = 0.02) and thought problems (κ = 0.00) and the highest on social problems. The parents reported more somatic symptoms in their adolescents than the adolescents themselves (p < 0.001). Conclusion: Young IBD patients and their parents disagree in reporting psychosocial and somatic symptoms of the patients. The adolescents as well as their parents need to be involved; otherwise, many symptoms of clinical significance would go unnoticed.     

Self-perceived health among adolescents: the role of gender and psychosocial factors

Since adolescents’ psychosocial health problems may have major implications for adult morbidity and mortality, investigating their self-perceived health deserves priority. In the lack of limiting illness, psychosocial health variables, e.g., psychosomatic health complaints or health behaviors, play a decisive role in determining adolescents’ self-perceived health. Using data on adolescents from Szeged, Hungary (n = 1,114), we examined the relationship between adolescents’ self-perceived health and a set of psychosocial health status measurements. Findings show that psychosomatic and depressive symptoms contributed significantly to adolescents’ poor/fair perceptions of health. Findings also support the relationship between health behaviors and adolescents’ self-perceived health. Among boys, drug use and the lack of physical activity are significant predictors. Among girls, smoking may act in a similar way. Diet control is significant in both cases. Besides academic achievement, SES self-assessment and non-intact family status are strong contributes to health perception. Overall, findings show that psychosocial health variables are important influences on adolescents’ self-perceived health.