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Biomedical subjects

Lynn S Walker

Publications and source records attributed to Lynn S Walker.

26 records · Page 2Linked to original sources
PubMed2004

Recurrent abdominal pain: symptom subtypes based on the Rome II Criteria for pediatric functional gastrointestinal disorders.

OBJECTIVES: Recurrent abdominal pain (RAP) is a common childhood complaint rarely associated with organic disease. Recently, the Pediatric Rome Criteria were developed to standardize the classification of pediatric functional gastrointestinal disorders (FGIDs) using a symptom-based approach. The authors tested the hypothesis that most patients with childhood RAP could be classified into one or more of the symptom subtypes defined by the Pediatric Rome Criteria. METHODS: Using a prospective longitudinal design, new patients with RAP (n = 114) were studied at a tertiary care children's medical center. Before the medical evaluation, parents completed a questionnaire about their child, assessing symptoms defined by the Pediatric Rome Criteria. RESULTS: Of the 107 children for whom medical evaluation revealed no organic etiology for pain, 73% had symptom profiles consistent with the Pediatric Rome Criteria for one of the FGIDs associated with abdominal pain (irritable bowel syndrome, 44.9%; functional dyspepsia,15.9%; functional abdominal pain, 7.5%; abdominal migraine, 4.7%) CONCLUSIONS: This study provides the first systematic empirical evidence that RAP, originally defined by Apley, includes children whose symptoms are consistent with the symptom criteria for several FGIDs defined by the Rome criteria. The pediatric Rome criteria may be useful in clinical research to (1) describe the symptom characteristics of research participants who meet Apley's broad criteria for RAP, and (2) select patients with particular symptom profiles for investigation of potential biologic and psychosocial mechanisms associated with pediatric FGIDs.

Abdominal Pain↗
PubMed2004

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 children's 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, mother's and child's psychological symptoms, child's 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 mother's 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 child's symptom complaints.

Absenteeism↗
PubMed2003

An Internet intervention as adjunctive therapy for pediatric encopresis.

This study evaluated the benefits of enhanced toilet training delivered through the Internet for children with encopresis. Twenty-four children with encopresis were randomly assigned to the Internet intervention group (Web) or no Internet intervention group (No-Web). All participants continued to receive routine care from their primary care physician. The Web participants demonstrated greater improvements in terms of reduced fecal soiling, increased defecation in the toilet, and increased unprompted trips to the toilet (ps<.02). Both groups demonstrated similar improvements in knowledge and toileting behaviors. Internet interventions may be an effective way of delivering sophisticated behavioral interventions to a large and dispersed population in a convenient format.

Behavior Therapy↗
PubMed2002

Social consequences of children's pain: when do they encourage symptom maintenance?

OBJECTIVE: To examine the influence of social factors (e.g., attention, relief from responsibility) and children's perceived competence on pediatric symptom maintenance. METHODS: Participants were 151 pediatric patients (ages 8-18) with recurrent abdominal pain. They were interviewed at a clinic visit and again 2 weeks later. The Social Consequences of Pain questionnaire assessed four types of social consequences: positive attention, negative attention, activity restriction, and privileges. RESULTS: Two types of social consequences (positive attention and activity restriction) predicted greater symptom maintenance, but this effect was moderated by children's perceived self-worth and academic competence. To the extent that children rated their self-worth and academic competence as low, the impact of social factors on symptom maintenance was stronger. CONCLUSIONS: Children's success in their normal social roles may affect the extent to which they identify with the sick role and find it a rewarding alternative to other social roles.

Abdominal Pain↗
PubMed2002

Children's knowledge, anticipatory anxiety, procedural distress, and recall of esophagogastroduodenoscopy.

BACKGROUND: This study evaluates the relations among children's knowledge of esophagogastroduodenoscopy (EGD) and anticipatory anxiety, procedural distress, and the nature of postprocedural recall and evaluations. METHODS: One hundred patients, aged 8 to 17 years, completed self-report measures of knowledge and anxiety before EGD. Parents completed a self-report measure assessing how they prepared their children. Nurses and trained observers completed observational ratings of distress. Children's recall and evaluation of the procedure were assessed by self-report 1 hour after the procedure and by telephone that evening. RESULTS: Most children knew about the major components of EGD. Children with greater knowledge experienced less distress and reported that they would be less anxious and upset when undergoing future EGDs. Children with greater anticipatory anxiety exhibited more procedural distress. Children's distress varied by the phase of the procedure. Children who were more distressed during intravenous line insertion experienced greater distress during esophageal intubation and the endoscopic examination. Approximately 20% of patients reported at least some memory of the procedure even at the end of the day. Children with greater recall reported greater aversion and a more negative attitude toward future EGDs. CONCLUSIONS: This study provides information about children's distress during EGD and the effects of conscious sedation on patients' memories and attitudes toward future procedures. The study indicates that preparation before EGD may reduce patient distress.

Adolescent↗
PubMedDate not supplied

Brief report: Assessment of children's gastrointestinal symptoms for clinical trials.

OBJECTIVE: To conduct a pilot study evaluating a procedure for assessment of daily symptoms and functioning in pediatric patients. METHOD: Participants included 11 parent-child dyads referred to a tertiary care center for evaluation of constipation and abdominal pain. Each family was provided a hand-held computer and modem. For 7 consecutive days, parents and children (ages 6-10 years) responded as a team to questions regarding the level of children's gastrointestinal symptoms and the extent to which symptoms interfered with the day's activities. Parents responded to a telephone interview evaluating the procedure. RESULTS: Parents reported that children understood most questions and that responses entered into the computer were accurate. Parents and children were enthusiastic about the data collection method. Some technical problems arose in use of the computers. CONCLUSIONS: Within the limitations of a small sample, this data collection procedure appears to have promise for evaluating pediatric symptom outcomes.

Abdominal Pain↗
PubMedDate not supplied

The influence of appraisals in understanding children's experiences with medical procedures.

OBJECTIVE: To examine the influence of cognitive appraisals on anticipatory anxiety, procedural distress, and postprocedural evaluations in 100 children (ages 8-17) undergoing esophagogastroduodenoscopy (EGD). METHOD: Children's knowledge about the procedure, appraisals of the procedure's aversiveness, coping ability, and state anxiety prior to the procedure were assessed by self-report. Distress during the EGD was assessed by observer ratings. Postprocedural evaluations were assessed by self-report 1 hour after the procedure. RESULTS: Structural equation modeling indicated that children who knew more about the EGD appraised it as less threatening, and, in turn, children who appraised the procedure as less threatening experienced less anxiety. Decreased anxiety was associated with decreased distress, which, in turn, was associated with decreased pain, evaluations of less aversiveness, and less negative attitudes toward future procedures. CONCLUSIONS: This study has implications for how children are prepared for EGDs and supports the utility of an appraisal-based model in understanding children's experiences with medical procedures.

Adaptation, Psychological↗