儿童再发性腹痛与气质特征的关系

目的 探讨儿童再发性腹痛(RAP)与儿童气质特征的关系.方法 选取60名非器质性RAP儿童作为RAP组,60名健康儿童作为健康对照组.RAP组为2004年8月-2007年7月本院腹痛专科门诊诊断并系统管理、符合RAP诊断标准且排除器质性疾病的8～12岁学龄儿童.采用中国学龄儿童气质量表(CSTS)对二组儿童进行气质测查,应用SPSS 13.0软件对结果 进行对比分析.结果 RAP组儿童气质类型分布为:平易型16.67%,中间近平易型11.67%,困难型13.33%,中间近困难型23.33%,发动缓慢型35.0%;健康对照组气质类型分布为:平易型33.33%,中间近平易型26.67%,困难型10.0%,中间近困难型16.67%,发动缓慢型13.33%.二组气质类型分布比较具有显著性差异(X2=33.45 P＜0.01).RAP组在节律性、适应性、心境、持久性气质维度得分显著低于健康对照组,均有显著性差异(Pa ＜0.05);而在活动水平、趋避性、反应强度、注意分散、反应阈5个维度得分与健康对照组儿童均无差异(Pa ＞0.05).结论 RAP与儿童气质有关,发动缓慢型气质类型儿童更易患RAP.对非器质性RAP儿童应采用心理治疗,帮助消除患儿的消极情绪,减少不良刺激;对发动缓慢型气质儿童应警惕非器质性RAP的发生.     

The prevalence and related factors of asthma in Urumqi

目的 调查乌鲁木齐市2010年0 ～ 14岁儿童哮喘患病率及相关因素.方法 采用整群抽样调查方法,选择6个点,抽样人数12 000名,以问卷调查结合现场检查确认儿童哮喘患病情况,统计患病率并进行相关因素分析.结果 实际调查人数11 929名,检出哮喘儿童132例,儿童哮喘患病率为1.11%.其中0 ～ 3岁婴幼儿哮喘患病率为0.42%,～ 6岁学龄前儿童患病率为1.00%,～ 14岁学龄期儿童患病率为1.36%,随着年龄增加,儿童哮喘患病率增高(χ2 ＝ 17.43,P ＜ 0.01).男女儿童的患病率分别为1.46%和0.75%,差异有统计学意义(χ2 ＝ 12.82,P ＜ 0.01).相关因素分析显示,有过喘息(OR ＝ 208.56,95%CI:122.45 ～ 355.24)、持续咳嗽多于1个月(OR ＝ 10.91,95%CI:7.53 ～ 15.80)、1年内患过6次以上呼吸道感染(OR ＝ 10.33,95%CI:7.29 ～ 4.64)、过敏史(OR ＝ 11.02,95%CI:6.69 ～ 18.16)、家族史(OR ＝ 5.84,95%CI:4.13 ～ 8.26)为哮喘患病的主要相关因素(P均＜ 0.01).结论 乌鲁木齐市儿童哮喘患病率有上升趋势,学龄期儿童患病率最高.     

乌鲁木齐市儿童哮喘患病情况调查及相关因素分析

目的调查乌鲁木齐市2010年0～14岁儿童哮喘患病率及相关因素。方法采用整群抽样调查方法,选择6个点,抽样人数12 000名,以问卷调查结合现场检查确认儿童哮喘患病情况,统计患病率并进行相关因素分析。结果实际调查人数11 929名,检出哮喘儿童132例,儿童哮喘患病率为1.11%。其中0～3岁婴幼儿哮喘患病率为0.42%,～6岁学龄前儿童患病率为1.00%,～14岁学龄期儿童患病率为1.36%,随着年龄增加,儿童哮喘患病率增高(χ2=17.43,P<0.01)。男女儿童的患病率分别为1.46%和0.75%,差异有统计学意义(χ2=12.82,P<0.01)。相关因素分析显示,有过喘息(OR=208.56,95%CI:122.45～355.24)、持续咳嗽多于1个月(OR=10.91,95%CI:7.53～15.80)、1年内患过6次以上呼吸道感染(OR=10.33,95%CI:7.29～4.64)、过敏史(OR=11.02,95%CI:6.69～18.16)、家族史(OR=5.84,95%CI:4.13～8.26)为哮喘患病的主要相关因素(P均<0.01)。结论乌鲁木齐市儿童哮喘患病率有上升趋势,学龄期儿童患病率最高。     

青少年有较强的独立上学能力：应用2010年至2017年西班牙青年横断面数据进行的二次分析

目的描述并分析2010年至2017年西班牙6～18岁青少年的年龄和性别与独立上学能力(IM)之间的关系。此外, 也研究了2010年至2017年不同性别和年龄的IM变化率。方法这是从11项西班牙研究中获取的横断面数据。该研究样本包括3 460例儿童和1 523例青少年。采用Logistic回归模型(含有性别和年龄因素的IM)和多层逻辑回归模型(含有各时间段因素的IM)的方法进行分析。结果儿童中男童IM的OR值较女童高(OR:1.86, CI:1.50～2.28, P<0.01), 青少年较儿童有更高的IM(均P<0.05):12～14岁(OR:6.30;CI:1.65～23.97)和14～16岁(OR:7.33;CI:1.18～45.39)的男童较6～8岁的男童有更高的IM。此外, 12～14岁(OR:4.23;CI:1.01～17.81)女童的IM比6～8岁的女童高(P<0.001)。IM与时间段没有相关性。结论男童和青少年的IM较高, 强调对提升女童和儿童IM的策略是必要的, 重要的是这些策略的实施需要来自研究者、公共卫生工作者和家庭的支持, 以实现积极的目标。     

西沙必利治疗儿童功能性腹痛108例疗效分析

再发性腹痛(RAP)是儿科常见性疾病,约占学龄期儿童的10％～30％。其中绝大部分属非器质性病变所致,我们称之为功能性腹痛。由于功能性腹痛病因不明,往往治疗上不力,我院自1996年10月～1999年5月,应用西沙必利治疗,部分病例佐以锌剂取得满意疗效,兹报告如下。     

福建地区女童特发性中枢性性早熟危险因素分析

目的 探讨福建地区女童特发性中枢性性早熟(ICPP)发生的主要危险因素.方法 采用病例-对照研究,选择2011年10月至2013年10月在福建省福州儿童医院内分泌科确诊为ICPP的女童566例以及来源于体检中心的健康女童547例作为研究对象,对儿童的饮食情况、行为方面、父母及家庭情况进行问卷调查,并对相关因素进行Logistic回归分析.结果 单因素分析发现23个变量差异有统计学意义.Logistic回归分析,最终进入模型的变量:母亲初潮年龄＞13岁(B=-1.28,SE =0.17,Wald=59.82,OR=0.278,95％CI:0.201 ～0.384,P＜0.001)、摄入有机水果(B=-1.15,SE=0.36,Wald=10.51,OR=0.316,95％ CI:0.157～0.634,P=0.001)、每天运动时间(B=-0.50,SE=0.11,Wald=19.74,OR=0.609,95％ CI:0.490 ～0.758,P＜0.001)、普通蔬菜(B=0.24,SE=0.08,Wald=9.79,OR=1.275,95％ CI:1.095 ～1.485,P=0.002)、普通家畜(B =0.31,SE =0.07,Wald=22.35,OR=1.364,95％ CI:1.199 ～1.551,P＜0.001)、体质量指数(B =0.47,SE=0.08,Wald=33.74,OR=1.599,95％ CI:1.365 ～1.874,P＜0.001)、父母月收入总和(B=0.51,SE =0.12,Wald=17.89,OR=1.671,95％CI:1.317 ～2.120,P＜0.001)、自觉课业负担沉重(B=0.60,SE=0.25,Wald=5.87,OR=1.818,95％ CI:1.121～2.948,P=0.015)、各种方便食品(快食面)(B=1.10,SE =0.45,Wald=5.96,OR=2.990,95％ CI:1.241～7.203,P=0.015)、服用营养品(B=1.32,SE=0.30,Wald=18.93,OR=3.736,95％ CI:2.063～6.765,P＜0.001)、经常使用成人洗漱护肤品(B=1.67,SE=0.25,Wald =44.5,OR=5.284,95％CI:3.240～8.618,P＜0.001).其中母亲初潮年龄＞13岁、摄入有机水果、每天运动时间长是ICPP的保护因素,其他均为ICPP的危险因素.结论 福建地区女童ICPP相关因素众多,其发病与母亲初潮年龄、饮食行为习惯、体质量指数、家庭经济状况及学习压力相关.     

幽门螺杆菌感染与小儿复发性腹痛的相关性研究

目的：研究幽门螺杆菌 (Hp)感染与小儿复发性腹痛 (RAP)的相关性。 方法：采用13 C 尿素呼气试验 (13 C UBT)检测6 0例健康儿童和187例RAP儿童的Hp感染率,观察Hp根除后RAP患儿的腹痛缓解率,并对RAP儿童在性别、年龄、病程、腹痛方式等方面进行比较。结果：RAP儿童和对照组的Hp感染的阳性率分别为 31.4 % ,15 .0 % ,两组比较差异有显著性 (P <0 .0 5 ),Hp阳性的RAP儿童进行抗Hp治疗后,Hp已根除和未根除的腹痛缓解率分别为78.5 %、37.5 % ,两组比较差异有显著性 (P <0 .0 5 )。3个年龄组的Hp感染率差异无显著性 (P >0 .0 5 )。Hp感染与RAP儿童的性别、病程及腹痛方式之间进行比较,差异亦无显著性 (P >0 .0 5 )。结论：Hp感染与RAP有密切的相关性,可能为RAP的主要致病因素,根除Hp治疗可缓解RAP儿童的腹痛症状     

青少年有较强的独立上学能力:应用2010年至2017年西班牙青年横断面数据进行的二次分析

目的描述并分析2010年至2017年西班牙6~18岁青少年的年龄和性别与独立上学能力(IM)之间的关系。此外, 也研究了2010年至2017年不同性别和年龄的IM变化率。方法这是从11项西班牙研究中获取的横断面数据。该研究样本包括3 460例儿童和1 523例青少年。采用Logistic回归模型(含有性别和年龄因素的IM)和多层逻辑回归模型(含有各时间段因素的IM)的方法进行分析。结果儿童中男童IM的OR值较女童高(OR:1.86, CI:1.50~2.28, P<0.01), 青少年较儿童有更高的IM(均P<0.05):12~14岁(OR:6.30;CI:1.65~23.97)和14~16岁(OR:7.33;CI:1.18~45.39)的男童较6~8岁的男童有更高的IM。此外, 12~14岁(OR:4.23;CI:1.01~17.81)女童的IM比6~8岁的女童高(P<0.001)。IM与时间段没有相关性。结论男童和青少年的IM较高, 强调对提升女童和儿童IM的策略是必要的, 重要的是这些策略的实施需要来自研究者、公共卫生工作者和家庭的支持, 以实现积极的目标。     

功能性遗粪症儿童心理发育特点的病例对照研究

目的探讨功能性遗粪症(FE)儿童的心理行为发育特点,为其心理干预提供理论依据。方法采用分层随机整群抽样法从青岛市城区抽取4044名4～5岁儿童。男2196名,女1848名。应用自制的儿童一般情况与遗粪症影响因素调查问卷、Achenbach儿童行为量表(CBCL)、3～7岁儿童气质量表与家庭环境量表-中文版(FES-CV)调查抽样儿童的家庭环境和生长发育状况,将调查发现的90例FE儿童作为病例组,其他儿童作为健康对照组,采用病例对照研究的方法探讨FE儿童的气质、行为和家庭环境特征。FE诊断依据中国精神疾病分类手册第3版(CCMD-3)标准。结果4～5岁儿童FE的患病率为2.23%(90/4044例),其中男童患病率为1.46%(32/2196例),女童患病率为3.14%(58/1848例)。FE儿童气质维度方面规律性、趋避性、适应度和坚持度的得分均高于健康对照组(Pa<0.05),注意分散度得分低于健康对照组(Pa<0.05);家庭环境特征方面病例组亲密度和组织性得分均低于健康对照组(Pa<0.05),而矛盾性得分高于健康对照组(P<0.01);FE儿童发生行为问题的风险较健康对照组大(OR=1.931)。FE是男童发生不成熟、分裂样、攻击和行为总分异常的危险因素(OR=2.96,3.94,8.26,3.22),是女童发生体诉、攻击性和多动的危险因素(OR=4.35,3.47,2.14);FE儿童患注意缺陷多动障碍(ADHD)的风险大于健康对照组(OR=2.650)。结论FE的实际患病率远远超过临床医师的估计。FE儿童有其气质特点,发生行为问题及患ADHD的风险较高。FE对儿童的行为发展和家庭环境造成不良影响,为改善FE儿童的生命质量,对其进行心理干预是必要的。     

郑州市城区儿童哮喘的流行病学调查及发病相关因素分析

目的 了解郑州市儿童哮喘的流行病学特征、诊治情况及发病的危险因素.方法 以多阶段分层抽样的方法发放初筛问卷.疑似哮喘者二次问卷调查、体检及查阅既往病历、辅助检查,明确诊断;同时根据年龄、性别匹配的原则随机抽取非哮喘患儿调查作为对照.结果 共收集有效调查问卷10 616份,其中男5 444人,女5 172人.哮喘确诊308人,患病率为2.90%.男童患病率高于女童(3.38% vs 2.40%);3岁以下儿童哮喘患病率为10.24%,高于其他年龄组儿童.哮喘儿童发作的前3位诱因包括呼吸道感染(94.2%)、天气变化(89.0%)和运动(35.1%).哮喘患儿发作强度多为中度发作(71.8%),其次为轻度(22.7%).94.8%(292例)吸入糖皮质激素治疗,74.7%(230例)全身使用糖皮质激素治疗,90.9%(280例)使用抗生素治疗.多因素logistic回归分析显示下列因素是哮喘发病的主要危险因素:过敏性鼻炎史(OR=150.285,95%CI:31.934~707.264)、湿疹史(OR=10.600,95%CI:1.054~106.624)、特应性皮炎史(OR=31.368,95%CI:3.339~294.683)、食物过敏史(OR=27.373,95%CI:2.670~280.621)、出生方式(OR=2.853,95%CI:1.311~6.208)、使用抗生素的年龄(OR=0.384,95%CI: 0.172~0.857)、1岁内使用抗生素的次数(OR=9.940,95%CI:6.246~15.820)、家装修墙面材料(OR=2.108,95%CI:1.464~3.036)、冬天是否采暖(OR=6.046,95%CI:1.034~35.362).结论 郑州市儿童哮喘患病率与年龄、性别有关;发作程度以中度为主;哮喘最主要诱因为呼吸道感染.哮喘的治疗较规范,但仍有待提高.过敏性鼻炎史、湿疹史、特应性皮炎史、食物过敏史及剖腹产出生、1岁内使用抗生素的次数多、家墙面使用装修材料、冬天采暖会增加儿童哮喘发病的危险,而使用抗生素时间较晚者哮喘发病的危险性较低.     

The prevalence of recurrent abdominal pain in 11- to 16-year-old Malaysian schoolchildren

OBJECTIVE: To determine the prevalence of recurrent abdominal pain (RAP) among Malaysian school children aged from 11 to 16 years. METHODOLOGY: A preliminary cross-sectional survey in which three urban schools and three rural schools were selected randomly. Two classes were selected randomly from each year. A questionnaire was given to each child asking him or her about whether they had experienced abdominal pain occurring at least three times over a period of at least 3 months, interfering with normal daily activity. 1 Interfering with normal daily activity was defined as missing school and/or having to stop doing a routine daily activity on account of the pain. Girls whose pains were related to periods were excluded. After the forms had been completed, each child was again interviewed to ensure that Apley's criteria1 was fulfilled in cases of RAP. RESULTS: The overall prevalence of RAP among 1549 schoolchildren (764 boys; 785 girls) was 10.2% (95% confidence interval (CI), 8.8-11.8). There appeared to be a higher prevalence in rural schoolchildren (P = 0.008; odds ratio (OR) 1.58), in those with a lower family income (P < 0.001; OR 2.02) and in children whose fathers have a lower educational attainment (P = 0.002; OR 1. 92). There were no significant differences in the prevalence of RAP among children of different sex, age, ethnic group and family size. CONCLUSION:: In spite of differences in time and culture, the overall prevalence of 10.2% found in this study is similar to that determined by Apley.1 There are significant differences in the prevalence of RAP between children from rural and urban schools, among children with different family incomes and among children whose parents have different educational backgrounds.     

Helicobacter pylori infection and abdominal symptoms among Swedish school children

BACKGROUND: The role of Helicobacter pylori infection in the etiology of abdominal symptoms remains unclear. Our aim was to investigate the association between type-specific H. pylori infection and gastrointestinal symptoms among school children in Stockholm, Sweden. METHODS: In a community-based cross-sectional study, 695 children aged 10-12 years participated with a blood sample and a questionnaire on sociodemographic characteristics and gastrointestinal symptoms, including minor abdominal pain not necessitating medical consultation, during the preceding six months. Infection was investigated by an enzyme-linked immuno-sorbent assay and confirmed by immunoblot and urea breath test. RESULTS: Abdominal pain was reported by 440 (63%) children and recurrent abdominal pain (RAP) by 88 (13%). Of 112 (16%) infected children, 73% had antibodies to CagA and 59% to VacA. There was no positive association between H. pylori status and the occurrence of abdominal pain; in fact, the association with any abdominal pain report was inverse (odds ratio [OR] 0,5; 95% Confidence Interval [CI] 0.3-0.8), while RAP was unrelated to the infection (OR 1.0; 95% CI 0.5-2.1) when adjusted for gender, age and family background variables. The prevalence of RAP tended to be lower among children harboring CagA+/VacA+ infections than among the uninfected (adjusted OR 0.3; 95%CI 0.1-1.1). Furthermore, CagA+/VacA+ infected children reported less acid regurgitation (adjusted OR 0.2; 95% CI 0.1-0.5). CONCLUSIONS: Taking background factors into account, the presence of H. pylori is not accompanied by an increased occurrence of abdominal symptoms in Swedish 10-12-year-olds. However, unexpected differential associations with strain specific infections may indicate a so far overlooked complex relationship that needs to be further confirmed.     

An epidemiological survey of recurrent abdominal pain in a rural Malay school

OBJECTIVE: To study the prevalence of complaints of recurrent abdominal pain (RAP) among school children aged 11-12 years in a rural setting in Malaysia. METHODOLOGY: Questionnaires were distributed to all parents and teachers of children aged 11-12 years who attended a small rural school in which all the children were Malays. Complaints of RAP were defined as at least three such complaints occurring over a period of at least 3 months. RESULTS: One hundred and sixty questionnaires were distributed, of which 148 were returned, giving a response rate of 92.5%. Sixty-one children (41.2%) had RAP. Approximately 45.2% of girls and 35.9% of boys reported having RAP. Compared with children without RAP, there was a significantly larger number of children with RAP (85.2%) who had at least one stress factor (P = 0.0109). There were no significant associations between RAP and total family income (P = 0.0573), a history of abdominal pain in at least one parent (P = 0.1686), a history of abdominal pain in at least one sibling (P = 0.0617), academic performance (P = 0.9967) or the degree of sports participation (P = 0.8469). There was an increased incidence of other systemic complaints in children with RAP when compared with children without RAP. CONCLUSION: Recurrent abdominal pain was found to be common among 11- to 12-year-old children in a rural Malay school. There was a significant association found between RAP and the presence of stressful events, as well as with the presence of other systemic complaints.     

Clinical symptoms and social factors in a cohort of children spontaneously clearing Helicobacter pylori infection

In a cohort study of 305 Swedish children, repeated blood samples and structured questionnaires were obtained from 6 mo to 11 y of age. Of the 40 children seropositive for Helicobacter pylori in one or more samples, 32 (80%) had cleared the infection by 11 y of age. No association was found between H. pylori seropositivity at any time and reported antibiotic consumption, size of home and family, type of day-care, history of atopic disease, length of breastfeeding or peptic ulcer disease in the family. Girls reported more (p = 0.002) unspecified abdominal pain during childhood than boys, but the difference in H. pylori infection rate (15/150, 10% for boys and 25/144, 17% for girls) was not significantly different (p = 0.09). Unspecified abdominal pain during childhood was reported more often (OR adjusted for gender = 2.2, 95% CI = 1.0-4.4, p = 0.04) for the children seropositive at some point (17/39, 44%) than for the seronegative children (54/217, 25%). RAP at 11 y of age was more often reported by the 9/36 (25%) children seropositive at some time in life than by the 23/172 (13%) seronegatives, but the difference was not statistically significant (OR adjusted for gender = 2.0, 95% CI = 0.8-4.6, p = 0.1). The study shows that H. pylori seropositivity was associated with a parental report of unspecified abdominal pain during childhood. Also, a history of unspecified abdominal pain was more common (OR = 51.6, 95% CI = 15.6-220, p < 0.001) in children reporting RAP at 11 y of age.     

Recurrent abdominal pain in school children: effect of obesity and diet

AIMS: To study the epidemiology and some of the risk factors of childhood recurrent abdominal pain (RAP) in school age children. METHODS: We used a questionnaire concerning socioeconomic parameters, intensity, frequency, duration, nature of RAP and anthropometric measures. We used several criteria to identify RAP and the Wong-Baker FACES scale for pain intensity and calculated the gender/age-specific body mass index (BMI) Z-score using NCHS standards. Obesity was defined as a BMI>or=95th percentile for age and gender. RESULTS: A total of 925 children mean age of 9.5 years completed and returned the questionnaires. The prevalence of RAP was 24%; 22% among boys versus 26% among girls (p=0.28) and reached its peak among children aged 7-9 (29%) years. Children with BMI>or=95% percentile reported more RAP compared to those not obese (33.3% vs. 22.5%) (OR=1.8, p=0.01). There was an inverse correlation between fruit consumption and RAP prevalence with 20% among children reporting more than three serving of fruit per week compared to 40% of those who did not consume any fruits (p<0.002). Logistic regression analysis confirmed BMI>or=95th percentile and low consumption of fruits are significant risk factors for RAP. CONCLUSIONS: There is a significant association between RAP and obesity and both conditions are prevalent among children in this population. Understanding more about the co-morbidity between RAP and obesity could have important implications on RAP management and treatment.     

Aetiology of recurrent abdominal pain in a cohort of Sri Lankan children

Aims:   Recurrent abdominal pain (RAP) has a multifactorial aetiology with many affected children having no evidence of organic pathology. This study assessed the functional and organic causes for RAP in a cohort of Sri Lankan children.
Methods:   Fifty-five Sri Lankan children (45.5% males, aged 5–15 years) having RAP were screened for organic diseases. RAP was defined using Apley criteria. Children without clinical or laboratory evidence of organic diseases were classified into functional gastrointestinal diseases (FGD) using Rome II and III criteria. Thirty-nine patients with functional RAP and 20 healthy children (50% males, age 5–15 years) from same area were tested for Helicobacter pylori using a stool antigen test.
Results:   Thirteen (23.6%) children had organic RAP. According to Rome II, 33 (60%), and according to Rome III, 39 (71%) (functional abdominal pain 19, irritable bowel syndrome nine, functional dyspepsia nine, abdominal migraine one, aerophagia one) children had FGD. Two (5.1%) patients and one (5%) control tested were positive for Helicobacter pylori ( P  > 0.05). Except for constipation, pain characteristics and associated symptoms were not significantly different between organic and functional RAP.
Conclusions:   Organic pathology accounted for symptoms in less than a quarter of Sri Lankan children with RAP. The majority had functional bowel diseases, of which the commonest was functional abdominal pain. Rome III criteria were more effective than Rome II criteria in identifying FGD. Helicobacter pylori infection did not appear to be associated with RAP.     

Recurrent abdominal pain in children

Eighty five children with recurrent abdominal pain(RAP) were studied. Organic cause was noticed in 70 cases and non-organic in 15 cases. Giardiasis was the commonest organic cause in 57 (67.0 percent), either alone or with other parasitic infestations. Other organic causes include gallstones (4.7 percent), urinary infections (4.7 percent), esophagitis/gastritis (3.5 percent) and abdominal tuberculosis (2.3 percent). Single parent, school phobia, sibling rivalry, RAP in other family members and nocturnal enuresis are significant factors associated with nonorganic causes     

Correlation among academic performance,recurrent abdominal pain and other factors in Year-6 urban primary-school children in Malaysia

OBJECTIVE: The present study aimed to investigate the extent to which recurrent abdominal pain and other factors were associated with academic achievement among Year-6 (12 years of age) schoolchildren. METHODS: The present study was a cross-sectional survey conducted from September to November 2001. Schoolchildren were recruited from primary schools that were selected randomly from a list of all primary schools in Petaling Jaya, Malaysia, using random sampling numbers. Information concerning recurrent abdominal pain, socio-economic status, life events, demographic and other details was obtained using a combination of questionnaires and interviews. Academic achievement was assessed using a score based on the Malaysian Primary School Achievement Examination. An overall score at or above the mean was taken to indicate high academic achievement while a score below the mean indicated poor academic achievement. RESULTS: A total of 1971 children were studied (958 boys and 1013 girls: 1047 Malays, 513 Chinese and 411 Indians). Of these children, 456 (23.1%) fulfilled the criteria for recurrent abdominal pain. Using the method of binary logistic regression analysis, the following factors were found to be independently associated with poor academic performance: a low socio-economic status (odds ratio (OR) 1.30; 95% confidence interval (CI) 1.25-1.35); male sex (OR 1.61; 95% CI 1.26-2.05); the death of a close relative (OR 2.22; 95% CI 1.73-2.85); the divorce or separation of parents (OR 3.05; 95% CI 1.73-5.40); the commencement of work by the mother (OR 1.34; 95% CI 1.02-1.76); hospitalization of the child in the 12 months prior to the study (OR 1.83; 95% CI 1.12-3.01); lack of health-care consultation (OR 1.80; 95% CI 1.36-2.36); missing breakfast (OR 1.47; 95% CI 1.07-2.02); and lack of kindergarten education (OR 1.35; 95% CI 1.04-1.75). CONCLUSIONS: Many factors, such as socio-economic status and recent life events, were associated with poor academic performance. Recurrent abdominal pain did not correlate directly to academic performance. Stress may be a means by which various factors cause children to struggle academically.     

Methodological challenges to treatment trials for recurrent abdominal pain in children

BACKGROUND: Studies evaluating the efficacy of treatments for recurrent abdominal pain (RAP) in children have used a wide range of methods, causing difficulty in the comparison of results. An expert panel on functional gastrointestinal disorders recently made recommendations regarding the standardization of study methods for childhood RAP, but many of their recommendations remain untested or lack supportive evidence. METHODS: During completion of a pilot study and randomized controlled trial for childhood RAP, baseline data were collected regarding the child and parent reports of abdominal pain frequency and intensity, type of abdominal pain, missed activities due to abdominal pain, psychological factors for the parent and child, parenting styles, and referral source (pediatric gastroenterologist vs general pediatrician). RESULTS: Children and parent pain reports showed good agreement in children younger than 13 years (weighted kappa, 0.77; 95% confidence interval [CI], 0.71-0.84), but only marginal agreement in children 13 years or older (weighted kappa, 0.37; 95% CI, 0.30-0.45). We found no significant differences in pain characteristics or psychological factors between children referred by pediatric gastroenterologists in a tertiary care center and those referred by community-based primary care pediatricians. However, children with symptoms consistent with nonspecific functional abdominal pain were reported by their parents to have less frequent pain (P=.003) and fewer missed activities (P=.003) than children with symptoms of irritable bowel syndrome or functional dyspepsia. CONCLUSIONS: Subjects referred by gastroenterologists and general pediatricians were similar, but the subtype of functional gastrointestinal disorder might be an important baseline characteristic of subjects in future RAP studies. We suggest that future interventional studies of childhood RAP measure 2 outcomes with pain reports obtained directly from children. Any child with fewer days of pain and missed activities due to pain after therapy would be considered improved, and those with no missed activities and 4 or fewer days of pain per month at follow-up would be considered healed.     

Irritable bowel syndrome: the commonest cause of recurrent abdominal pain in children

Apley, working in Bristol, UK, defined recurrent abdominal pain (RAP) in 1958. After extensive investigations, he found that 8% of children presenting to his clinic with RAP had an organic pathology. The aims of this study were to identify (1) causes of RAP using modern methodology, (2) factors associated with organic RAP and (3) children with none-organic RAP who fulfill the diagnostic criteria for irritable bowel syndrome (IBS). Children, aged over 3 years, presenting with RAP were prospectively recruited to this study. They had a detailed questionnaire completed, a full examination with screening tests (blood for coeliac screen, Helicobacter pylori antibody titre, inflammatory markers, serum amylase, liver function tests, and full blood count, urine and stool analyses and abdominal ultrasonography). Endoscopy and oesophageal pH monitoring were performed if clinically indicated. IBS was diagnosed if the child had no organic pathology and fulfilled the Rome II criteria. Out of 103 children (median age of 10 years, mean 10.04, SD ±3.44,), 31 children (30%) had organic pathologies. Factors associated with organic pain were nocturnal symptoms (P<0. 01) and abdominal tenderness (P<0.005) and with non-organic pain were periumbilical locality (P<0.002), pain alleviation on defaecation (P<0.04) and low fibre diet (P<0.005). Of children with non-organic pain, 37/52 (51%) fulfilled the criteria for IBS (36% of the total). Conclusion:of children presenting with recurrent abdominal pain in a hospital setting, 30% have a diagnosable organic aetiology compared to 8% in Apleys time. Irritable bowel syndrome, however, may be the commonest cause of recurrent abdominal pain and should be considered.Abbreviations CRP C-reactive protein - GORD gastro-oesophageal reflux disease - IBS irritable bowel syndrome - RAP recurrent abdominal pain