Assessment and validation of a screening questionnaire for the diagnosis of pediatric bladder and bowel dysfunction.

INTRODUCTION: Pediatric bladder and bowel dysfunction (BBD) is a common problem in children. However, the current ability to diagnosis and quantify pediatric BBD is limited as only a few validated instruments exist. In addition, the current questionnaires are limited by their lack of psychometric processing and methods of validation. To address these issues, the authors developed a new questionnaire to objectively diagnose pediatric BBD symptoms. This study aimed to evaluate the performance of this newly devised objective instrument in diagnosing and quantifying the symptomatology of BBD in children. MATERIALS AND METHODS: An 18-item, 5-point questionnaire was developed using both a literature review and expert opinions. The total questionnaire score could range from 0 to 72. Questions were subgrouped into six symptom categories: (1) nocturnal enuresis, (2) lower urinary tract symptoms, (3) urinary holding, (4) infrequent urination, (5) bowel symptoms, and (6) daytime urinary incontinence. The questionnaire also assessed the degree of bother associated with the symptoms. Patients were divided into cases and controls, and these two groups were compared. DISCUSSION/RESULTS: A total of 1265 new patients (758 cases and 507 controls) completed the new BBD questionnaire. The mean age of the whole study cohort was 9.5 years (range, 3-19 years). The total mean questionnaire score was significantly higher at 23 (3-58) in the cases, compared with 8 (0-35) in the controls (p < 0.001) (Summary Figure). Reliability analysis of the 18-item instrument showed a Cronbach's alpha reliability coefficient of 0.80 for the scale. CONCLUSIONS: This new instrument provides a valid and reliable method for diagnosis of pediatric BBD and classification of patients into subcategories of BBD based on their specific symptoms.

Estimated aortic stiffness is independently associated with cardiac baroreflex sensitivity in humans: role of ageing and habitual endurance exercise.

We hypothesised that differences in cardiac baroreflex sensitivity (BRS) would be independently associated with aortic stiffness and augmentation index (AI), clinical biomarkers of cardiovascular disease risk, among young sedentary and middle-aged/older sedentary and endurance-trained adults. A total of 36 healthy middle-aged/older (age 55-76 years, n=22 sedentary and n=14 endurance-trained) and 5 young sedentary (age 18-31 years) adults were included in a cross-sectional study. A subset of the middle-aged/older sedentary adults (n=12) completed an 8-week-aerobic exercise intervention. Invasive brachial artery blood pressure waveforms were used to compute spontaneous cardiac BRS (via sequence technique), estimated aortic pulse wave velocity (PWV) and AI (AI, via brachial-aortic transfer function and wave separation analysis). In the cross-sectional study, cardiac BRS was 71% lower in older compared with young sedentary adults (P<0.05), but only 40% lower in older adults who performed habitual endurance exercise (P=0.03). In a regression model that included age, sex, resting heart rate, mean arterial pressure (MAP), body mass index and maximal exercise oxygen uptake, estimated aortic PWV (ß±s.e.=-5.76±2.01, P=0.01) was the strongest predictor of BRS (model R(2)=0.59, P<0.001). The 8-week-exercise intervention improved BRS by 38% (P=0.04) and this change in BRS was associated with improved aortic PWV (r=-0.65, P=0.044, adjusted for changes in MAP). Age- and endurance-exercise-related differences in cardiac BRS are independently associated with corresponding alterations in aortic PWV among healthy adults, consistent with a mechanistic link between variations in the sensitivity of the baroreflex and aortic stiffness with age and exercise.

Using routine documentation of medical care to observe physician behavior.

This observational study compared the utilization of pulmonary function tests (PFTs) for outpatients at community hospitals in New Hampshire in 1975 and 1980. It was hypothesized that if preliminary care physicians were shifting toward using PFTs for early detection of chronic obstructive airway disease (COAD), an increase in the number of tests ordered, a decrease in the mean age of patients tested, and an increase in the mean lung functions (FEV1/FVC) would be observed. For hospitals providing data for 1975 and 1980, 85% showed an increase in the number of outpatient tests ordered (p = 0.002), the mean age of outpatients tested decreased at 75% of the hospitals (p = 0.019), and the mean FEV1/FVC increased at 67% of the hospitals (p = 0.014). The hypotheses thus confirmed, it is concluded that New Hampshire physicians are using PFTs for early detection of COAD.

Chronic obstructive airway disease. Impact of health education.

We conducted a controlled study of the impact of an education program on the health outcomes and perceptions of patients with varying degrees of airway obstruction in two communities. In one community, patients with chronic obstructive airway disease (COAD) were identified, assessed and offered an educational program. In the other community, patients were identified, assessed and advised of the findings only. Patients at both sites were given the same pretest and, one year later, the same posttest. These tests measured physical and social function, and health outcomes (eg, respiratory symptoms, exercise tolerance, mental health), plus patients' health perceptions. Posttest results showed a significant difference between groups on a health perception measure and locus of control, but no difference on health outcomes. We conclude that education programs for COAD are unlikely to improve patients' health status unless they are part of a comprehensive medical program that includes physical reconditioning.

Chronic obstructive pulmonary disease.

Morbidity and mortality associated with chronic airway disease are expected to continue to rise over the coming years. Accordingly, increased attention will need to be directed toward the diagnosis and treatment of COPD in the elderly population. Cessation of cigarette smoking should be pursued in all patients regardless of age. The goals of bronchodilator therapy are to reduce respiratory symptoms and to improve functional capacity without causing adverse effects. In addition, supplemental oxygen, phlebotomy for polycythemia, general exercise training, and specific respiratory muscle training may further augment exercise tolerance. Complications of COPD, such as upper respiratory infections and right heart failure, should be recognized early and treated appropriately. Implementation of a pulmonary rehabilitation program, as discussed in the next article, should complement medical therapy in the treatment of elderly patients with COPD.

Locating community residents with chronic airway obstruction. A comparison of four strategies.

In the course of establishing and evaluating a patient education program, we compared 4 strategies for locating patients with chronic obstructive airway disease (COAD): (1) search of hospital discharge records (HOSP), (2) referral by physicians (MD), (3) an advertising campaign (AD), and (4) a respiratory symptom questionnaire mailed to households (QUEST). Of 1,834 persons assessed, 923 (50%) had airway obstruction; 43% of the confirmed cases (396 of 923) reported no previous diagnosis of COAD. The HOSP strategy accounted for 75 assessments (4%) and 63 confirmed cases (7%), MD produced 352 assessments (19%) and 247 cases (27%), AD generated 475 assessments (26%) and 204 cases (22%), and QUEST resulted in 932 assessments (51%) and 409 cases (44%); MD was the least expensive strategy ($17.00/case). The mailed questionnaire located the largest number of cases not previously diagnosed.

Idiopathic hypoventilation syndrome: importance of preventing nocturnal hypoxemia and hypercapnia.

This report describes a young woman with unexplained chronic hypoventilation that was greatly exacerbated during sleep. Treatment with nocturnal O2 during a 2-yr period was associated with stable cardiovascular function but severe morning headaches and lethargy, presumably related to nightly bouts of hypercapnia and acidosis during sleep. A subsequent 2-yr period in which ventilation was assisted during sleep by means of a rocking bed, but supplementary O2 was not used, was associated with disappearance of the headaches and improved psychosocial function, but with the insidious development of signs of pulmonary hypertension and right ventricular hypertrophy. This patient's clinical course demonstrates the separate adverse effects of intermittent hypoxemia and hypercapnia and emphasizes the importance of preventing both hypoxemia and hypercapnia during sleep.

A comparison of the prevalence of sensitization to Aspergillus antigens among asthmatics in Cleveland and London.

A survey of the frequency of sensitization to Aspergillus antigens was conducted in a group of asthmatics in Cleveland and compared with a group of asthmatics in London, using common antigens for testing purposes. The two groups were comparable except for earlier onset, longer duration of asthma, and a larger number of males in the London group. Twenty-eight per cent of the asthmatics from Cleveland and 23% from London had immediate skin reactivity to Aspergillus. Seven and one-half percent from the Cleveland group and 10.5% of the London group had Aspergillus precipitins in the serum. Aspergillus skin test reactivity was related to the severity of airways obstruction (p less than 0.01) but was not influenced by other factors. We conclude that sensitization to Aspergillus antigens occur with equal frequency in both the United States and the United Kingdom.