Investigating factors associated with functional constipation of primary school children in Hong Kong.

AIM: To examine what factors were associated with functional constipation amongst primary school students. BACKGROUND: Constipation in school-age children has also been brought to the attention of health care researchers because this requires long-term therapy. The prognosis of functional constipation is vague because it has many causative factors. In fact, the focus on constipation in the health care system is always placed on medical management, rather than prevention. DESIGN: A descriptive survey. METHOD: The survey was conducted on March 2008 at one primary school in Hong Kong; 383 children who are studying in primary 3-5 aged from 8-10 completed a questionnaire. Three main outcome variables were employed in the study: demographic, constipation assessment scale and dietary and environmental factors. RESULTS: There were 7.3% students with functional constipation. Students who were age ∼10 (p<0.001), with a total daily fluid intake (200 ml/cup) of 3-4 cups (p<0.001) or +5 cups (p<0.001) and preference for eating fruit and vegetables (p<0.001) were less likely to have functional constipation. CONCLUSION: The findings should aid paediatric health care professionals and parents to gain a more profound understanding of the nature and prevention of functional constipation. To help primary school students and their parents to cope with functional constipation, greater familiarity with its prevalence and the characteristics of its contributory factors is needed. It is hoped that this could providing a better understanding and awareness of this issue and that it will encourage setting up strategies to decrease the morbidity and diminish the negative consequences of functional constipation for primary school students. RELEVANCE TO CLINICAL PRACTICE: Nurses can act as advocators for primary school students, parents and school teachers in understanding and preventing functional constipation.

Endocrine gland-derived vascular endothelial growth factor stimulates proliferation and tube formation in human uterine microvascular endothelial cell through the mitogen-activated protein kinase but not through the Akt pathway.

OBJECTIVE: To study the angiogenic functions of endocrine gland-derived vascular endothelial growth factor (EG-VEGF) on a normal myometrial uterine microvascular endothelial cell line (UtMVEC-Myo) and the signaling pathways elicited by EG-VEGF in UtMVEC-Myo. DESIGN: Experimental laboratory study. SETTING: University gynecology unit. PATIENT(S): Infertile women undergoing diagnostic laparoscopy for assessment of tubal patency. INTERVENTION(S): Real-time polymerase chain reaction (PCR) analysis of mRNA of EG-VEGF and its receptors, PKR1 and PKR2, in UtMVEC-Myo and endometrial samples. The effects of EG-VEGF on the cell proliferation, tube formation, and cell signaling pathways of UtMVEC-Myo were studied. MAIN OUTCOME MEASURE(S): Cell proliferation, tube formation, and molecules of cell-signaling pathways in the treated UtMVEC-Myo. RESULT(S): UtMVEC-Myo cells had PKR1 and PKR2 but not EG-VEGF mRNA. EG-VEGF significantly stimulated cell proliferation and tube formation in UtMVEC-Myo cells. EG-VEGF activated p44/42 mitogen-activated protein kinase (MAPK) but not Akt signaling pathway. The effects of EG-VEGF on p44/42 MAPK phosphorylation and cell proliferation were nullified by the specific MAPK inhibitor, PD98059. CONCLUSION(S): EG-VEGF has a direct angiogenic effect on UtMVEC-Myo that expresses EG-VEGF receptors (PKR1 and PKR2) and modulates cell proliferation and sprouting of the endothelial cells. It is suggested that EG-VEGF enhanced cell proliferation through the activation of MAPK pathway but not through the Akt pathway.

Safety of nurse-administered propofol sedation using PCA pump for outpatient colonoscopy in Chinese patients: a pilot study.

BACKGROUND: To determine the safety and effectiveness of nurse-administered propofol sedation using patient-controlled analgesia (PCA) pump in outpatient colonoscopy in a Chinese population. METHODS: From April to June 2005, 50 consecutive ASA class I or II patients aged 18-65 undergoing outpatient colonoscopy in an endoscopy centre of a regional hospital were prospectively recruited in this study. After a loading dose of 40-60 mg intravenous propofol, a mixture containing 14.3 mg propofol and 35 microg alfentanil were delivered via a patient-controlled syringe pump as bolus dose by an endoscopy nurse under the supervision of an endoscopist during the procedure. Lockout time was set to be zero. We aimed to achieve conscious sedation, with an Observers Scale for Sedation and Alertness (OSSA) score of 3. The primary outcome measure was complications from sedation, which included hypotension, bradycardia and desaturation. Other outcome measures included onset time, patients pain score, endoscopists and nurses satisfaction on the level of sedation, patients satisfaction regarding the procedure (measured by 10 cm visual analogue scale), and their willingness to repeat the procedure. RESULTS: The mean lowest systolic blood pressure and mean arterial pressure (MAP) were 103.2 +/- 12.4 mmHg and 78.3 +/- 11.0 mmHg, respectively. The mean percentage drop in MAP was 15.7 +/- 11.9%. Six patients (12.2%) developed transient hypotension. Three patients (6.1%) had bradycardia. There was no episode of desaturation. The median onset time to reach OSSA score of 3 was 1 minute (range, 0.5-20.5). The OSSA score of 3 could be maintained throughout the procedure. The mean loading dose of propofol was 48.9 +/- 6.7 mg. The mean total dosages of propofol and alfentanil given were 124.2 +/- 38.1 mg and 184.3 +/- 93.7 mug, respectively. Endoscopists, endoscopy nurses and patients were highly satisfied with the sedation. The median pain score was 1 (range, 0-10; 0 = no pain, 10 = very painful), and the mean recovery time was 2.8 +/- 2.8 minutes. Most patients (93.9%) were willing to repeat the procedure. CONCLUSION: Nurse-administered propofol sedation using PCA pump is safe and effective in sedation and pain control in outpatient colonoscopy in a healthy Chinese population.

Premedication with orally administered midazolam in adults undergoing diagnostic upper endoscopy: a double-blind placebo-controlled randomized trial.

BACKGROUND: A double-blind placebo-controlled randomized trial was conducted to investigate the safety and the efficacy of orally administered midazolam as premedication for patients undergoing elective EGD. METHODS: A total of 130 patients were randomized to receive either 7.5 mg of midazolam orally (n = 65) or a placebo (n = 65) as premedication. Outcomes measures included the anxiety score (visual analog scale) during EGD, overall tolerance, extent of amnesia, overall satisfaction, patient willingness to repeat the procedure, recovery time, and hemodynamic changes after medication. RESULTS: The median (interquartile range) anxiety score during the procedure in the midazolam group was significantly lower than that in the control group (2.0 [0-4.9] vs. 3.8 [2.1-7.95], p < 0.001). A significantly greater number of patients in the midazolam group graded overall tolerance as "excellent or good" (70.8% vs. 49.2%, p = 0.012) and reported a partial to complete amnesia response (52.3% vs. 32.3%, p = 0.02) when compared with the control group. Patients in the midazolam group were more willing to repeat the procedure if necessary (89.2% vs. 69.2%, p = 0.005). The median (interquartile range) recovery time was significantly longer in the midazolam group than in the control group (5 [5-15] minutes vs. 5 [5-10] minutes, p = 0.014). There were no statistically significant differences in satisfaction score and hemodynamic changes between groups. CONCLUSIONS: Premedication by oral administration of midazolam is a safe and an effective method of sedation that significantly reduces anxiety and improves overall tolerance for patients undergoing EGD.

Premedication with intravenous ketorolac trometamol (Toradol) in colonoscopy: a randomized controlled trial.

OBJECTIVE: We conducted a prospective double-blinded placebo-controlled randomized trial to investigate the effect of ketorolac trometamol (KT) administered intravenously as premedication in colonoscopy. METHODS: One hundred and forty patients undergoing colonoscopy were randomized to receive either 60 mg of KT (KT group (KTG), n=70) or placebo (normal saline group (NSG), n=70) intravenously as premedication 30 min prior to procedure. Patient-controlled sedation (PCS) was used as the mode of sedation. Outcome measures included patient self-assessed pain score in a 10-cm unscaled visual analog scale (VAS), endoscopist assessment of patient pain score in VAS, patient's willingness to repeat colonoscopy, administered and demanded doses of PCS, patient satisfaction score in VAS, and hemodynamic changes during and after the procedure. RESULTS: The mean patient self-assessed pain score (SD) during procedure was significantly lower in KTG than NSG: 5.08 (2.74) vs 6.62 (2.45); p=0.001. The mean endoscopist assessment of patient pain score (SD) was significantly lower in KTG than NSG as well: 3.99 (2.80) vs 5.28 (2.71); p=0.006. More patients in KTG were willing to repeat procedure as compared with NSG (80.0%vs 57.1%; p=0.004). No significant difference was found in the administered and demanded doses of PCS, mean satisfactory scores and hemodynamic changes in both groups. No serious complication related to intravenous (IV) KT was noted. CONCLUSIONS: Premedication with IV KT (Toradol) improves pain control during colonoscopy with no associated serious complications.