Validation and clinical utility of a bowel habit questionnaire in school-age children.

OBJECTIVES: The aim of the study was to validate a brief Bowel Habit Questionnaire (BHQ) with prospectively obtained data from a 14-day diary and to determine whether the BHQ predicts the development of medically significant constipation (MSC) during the following year. MATERIALS AND METHODS: The BHQ was distributed to parents of children ages 5 to 8 years during health supervision visits. Both the BHQ and subsequent diary were scored to indicate constipation if at least 2 of the following were reported: infrequent bowel movements, stool accidents, straining, avoidance, discomfort with defecation, or passing large stools >25% of the time. One year later, the BHQ was repeated to assess for MSC, defined as medical encounters about constipation or use of enemas, suppositories, laxatives, or stool softeners. RESULTS: MSC was reported for 57 (13.7%) of 416 children on the first BHQ. Paired BHQ and diary data were obtained for 269 children; 54 (20.1%) had diary scores indicating constipation. BHQ had a sensitivity of 59.6% (95% confidence interval [CI] 46.7%-71.4%) and a specificity of 82.6% (95% CI 77.0%-87.1%). One year later, 11 children (5.2%) had developed new-onset MSC; 7 (63.6%) of these children had initial BHQ scores of at least 2. Positive and negative predictive values for MSC were 19.4% (95% CI 9.8%-35.0%) and 97.7% (94.2%-99.1%), respectively. CONCLUSIONS: Parents often do not recognize constipation in young school-age children and most constipated children remain untreated. A brief screening questionnaire in this population proved to be valid but only moderately sensitive; efforts to improve sensitivity are needed before recommending it for routine use.

Correlates of postpartum alcohol use.

OBJECTIVE: The purposes of this investigation are to (1) describe drinking patterns among women attending a postpartum visit, and (2) identify correlates of postpartum "at risk" drinking. METHODS: A survey was completed by 8706 women at their postpartum visit. We identified correlates of "at risk" drinking, defined as binge drinking (4 or more drinks per occasion at least once in the past month) or consuming an average of > or =7 drinks/wk. RESULTS: A total of 997 women (12%) reported "at risk" drinking. At risk drinkers were more likely than other women to have been frequent drinkers prior to pregnancy (> or =7 drinks/wk), scored 1 or 2 on the CAGE, smoked postpartum, and been unmarried. Black women, those over age 35, "stay-at-home mothers," and women having breastfed were less likely to report "at risk" drinking. CONCLUSION: This study supports routine alcohol screening of women attending a postpartum visit with their obstetrician.