All Posts tagged functional

Children who don’t like fruit and vegetables are 13 times more likely to be constipated

Primary school children who don't like eating fruit and vegetables are 13 times more likely to develop functional constipation than children who do, according to a study in the December issue of the Journal of Clinical Nursing. Drinking less than 400ml of fluid a day also significantly increases the risk. Dr Moon Fai Chan, assistant professor at the National University of Singapore, teamed up with Yuk Ling Chan, from the Hong Kong Polytechnic University, to study the diet and toileting habits of 383 children aged from eight to ten from a school in Hong Kong. Fifty-one per cent were boys and children who were on regular medication or who paid regular hospital or clinic visits were excluded. Seventy per cent of the children who took part in the study were ten-years-old, 22 per cent were nine and eight per cent were eight.

“A number of studies have suggested that functional constipation – which is due to dietary habits, environmental habits and psychosocial factors rather than a particular health problem – is getting worse among school-age children” says Dr Moon Fai Chan from the Alice Lee Centre for Nursing Study at the University. “It is estimated that functional constipation accounts for 95 per cent of cases of constipation affecting children once they pass infancy. The condition has serious consequences, as it can cause a wide range of distressing emotional and physical problems such as stress, soiling, problems at school, damaged self-confidence and reduced social interaction.”

Key findings of the study included:

  • Seven per cent of the children who took part suffered from functional constipation and there were clear dietary differences between the children who did and did not have problems.
  • Girls were more likely to have functional constipation than boys (8.2 per cent versus 6.6 per cent) and nine-year-olds were more likely to report problems (13.3 per cent) than eight-year-olds (10 per cent) and ten-year-olds (5.2 per cent).
  • Children who only drank 200ml to 400ml of fluid a day were eight times more likely to experience problems than children who drank 600ml to 800ml and 14 times more likely than children who drank a litre or more.
  • Children who said they did not like fruit or vegetables were 13 times more likely to suffer from functional constipation than children who did.
  • Nine out of ten children refused to use the school toilets for bowel movements and the figure was the same for children with and without constipation.

The biggest problems with school toilets were that children preferred to go at home. They also cited lack of toilet paper and dirty toilets. “When we compared our findings with previous studies we found that the levels of functional constipation among Hong Kong school children was higher than those in the USA and UK, but similar to Italy” says Dr Chan. The authors have made a number of recommendations that they feel would help to tackle the problem. They suggest that:

  • Primary schools should work with healthcare professionals to make children more aware of the problem, with regular healthcare education sessions in classrooms and at assemblies.
  • Parents need to be educated about functional constipation so that they can spot problems in their children and make sure that their diet provides sufficient fluid, vegetables and fruit. They should also remind their children to pay regular toilet visits at school.
  • School tuck-shops should stock high-fibre snacks such as popcorn, fresh food and dried fruit, instead of crisps and sweets.
  • Children should be encouraged to drink plain water during lessons and drinking fountains should be installed.
  • School toilets should be more user-friendly, private and well stocked with paper so that children feel more comfortable using them.

“We hope that this study will help to raise awareness of functional constipation, which can cause children real physical and emotional distress and seriously affect their quality of life” says Dr Chan.

Source: Investigating factors associated with functional constipation of primary school children in Hong Kong. Chan MF and Chan YL. Journal of Clinical Nursing. 19, pp3390-3400. (December 2010). DOI: 10.1111/j.1365-2702.2010.03366.x

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Older Patients Offer Insight

Dr. Nick and his colleagues analyzed epidemiological and health data on 156 CF patients over 40 year of age who receive care at National Jewish Health, the largest adult cystic fibrosis clinic in the nation. In addition, data were analyzed on nearly 3,000 patients from around the nation who were included in the Cystic Fibrosis Foundation Patient Registry from 1992-2007.

The researchers found that the fate of females changes considerably in the older CF population. It has long been recognized that a “gender gap” is present in CF, favoring males. Historically, females have been diagnosed later, had a poorer prognosis, and survived fewer years than males.

Accordingly, Dr. Nick's analysis showed that fewer females diagnosed as children survived to age 40. However, among those diagnosed as adults, females represented a significant majority, accounting for 72 percent of patients in Colorado and 54 percent nationally. Among the adult diagnosed patients, females survived on average 9 to 14 years longer than males.

The complex factors that account for the differential fate of female CF patients is not understood, although Dr. Nick believes it could be a mixture of behavioral and biological factors.

Dr. Nick's findings also indicate that patients diagnosed as adults do not really have milder diseases — as is commonly believed — just a delayed onset of an equally severe form of the disease. Although patients diagnosed as adults live longer than those diagnosed as children, the adult-diagnosed patients lose lung function as rapidly those diagnosed in childhood, and approximately 85% die of respiratory failure or post-transplant complications.

Dr. Nick believes there is a significant number of adults whose CF remains undiagnosed. His analysis indicates that once those patients are accurately diagnosed, proper care can significantly improve their health. Patients diagnosed as adults and subsequently followed at a CF center reversed progressive lung function decline and improved their lung function for at least four years. Older patients commonly do not get specialized CF care. It is generally recognized that the team approach to treatment provided by the 112 CF Foundation-accredited Care Centers results in better clinical outcomes. However, less than half of long-term CF survivors continued to be seen at CF Centers as they pass 40 years, with the fewest among the adult-diagnosed patients.

“In the coming years, more and more cystic fibrosis patients will be living into their 40s, 50s and beyond,” said Dr. Nick. “Our findings concerning the role of gender, in survival, progression of disease, and type of care in current long-term survivors provides important insights that will help us prepare for better treatment of the steadily aging CF population.”

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