William E. Whitehead

Increased Somatic Complaints and Health-Care Utilization in Children: Effects of Parent IBS Status and Parent Response to Gastrointestinal Symptoms

OBJECTIVES:Irritable bowel syndrome (IBS) runs in families. The aims of this study were (i) to exclude biased perception by a mother with irritable bowel as the explanation for increased gastrointestinal (GI) symptoms in their children, (ii) to determine whether non-GI as well as GI symptoms run in families, and (iii) to determine whether parent IBS status and solicitous responses to illness exert independent effects on childrens symptom reports, medical clinic visits, and school absences.METHODS:Two hundred and eight mothers with irritable bowel and their 296 children (cases: average age 11.9 yr; 48.6% male) and 241 nonirritable bowel mothers and their 335 children (controls: 11.8 yr; 49.0% male) were interviewed. Other factors assessed were stress, mothers and childs psychological symptoms, childs perceived competence, pain coping style, age, and sex. Children were interviewed apart from their parents.RESULTS:Case children independently reported more frequent stomach aches (F(591) = 9.22; p= 0.0025) and non-GI symptoms (F(562) = 21.03; p < 0.001) than control children. Case children also had more school absences (F(625) = 26.53; p < 0.0001), physician visits for GI symptoms (F(602) = 8.09; p= 0.005), and non-GI clinic visits (F(602) = 27.92; p < 0.001) than control children. Children whose mothers made solicitous responses to illness complaints independently reported more severe stomach aches (F(590) = 11.42; p < 0.001), and they also had more school absences for stomach aches (F(625) = 5.33; p < 0.05), but solicitous behavior did not significantly impact non-GI symptom reporting, clinic visits, or school absences. Differences between cases and controls remained significant after adjusting for potential moderators.CONCLUSIONS:(i) Frequent GI complaints in children whose mothers have irritable bowel are not explained by the mothers biased perceptions; (ii) children of mothers with irritable bowel have more non-GI as well as GI symptoms, disability days, and clinical visits; (iii) and parent IBS status and solicitous responses to illness have independent effects on the childs symptom complaints.

Effects of a Cognitive Behavioral Therapy Intervention Trial to Improve Disease Outcomes in Children with Inflammatory Bowel Disease.

Background:Studies testing the efficacy of behavioral interventions to modify psychosocial sequelae of inflammatory bowel disease in children are limited. This report presents outcomes through a 6-month follow-up from a large randomized controlled trial testing the efficacy of a cognitive behavioral intervention for children with inflammatory bowel disease and their parents. Methods:One hundred eighty-five children aged 8 to 17 years with a diagnosis of Crohns disease or ulcerative colitis and their parents were randomized to one of two 3-session conditions: (1) a social learning and cognitive behavioral therapy condition or (2) an education support condition designed to control for time and attention. Results:There was a significant overall treatment effect for school absences due to Crohns disease or ulcerative colitis (P < 0.05) at 6 months after treatment. There was also a significant overall effect after treatment for child-reported quality of life (P < 0.05), parent-reported increases in adaptive child coping (P < 0.001), and reductions in parents maladaptive responses to childrens symptoms (P < 0.05). Finally, exploratory analyses indicated that for children with a higher level of flares (2 or more) prebaseline, those in social learning and cognitive behavioral therapy condition experienced a greater reduction in flares after treatment. Conclusions:This trial suggests that a brief cognitive behavioral intervention for children with inflammatory bowel disease and their parents can result in improved child functioning and quality of life, and for some children may decrease disease activity.

Longitudinal study of the comparative costs of IBS in an HMO

Background: While tissue cytotoxic assay (toxin B) for C difficile. has been used to diagnose C. difficile disease (CDD), many hospital labs are moving to rapid commercially available kits that use enzyme immunoassay (EIA) technology. Methods: We compared the efficacy of one such test, Biosite, Triage Micro C. difficile Panel, which combines EIA for toxin A with detection of C. difficile common antigen, by correlating test results with toxin B assay and clinical information. Stool assay and chart reviews were performed blindly. Results:98 patients were evaluated. Of these 33 were clinically diagnosed with CDD. Table 1. Test Results for 33 Patients with Clinical CDD