Introdução: Os idosos representam um segmento demográfico crescente tanto nos países desenvolvidos como nos em desenvolvimento. A constipação intestinal é um sintoma relatado por 24 a 40% desses indivíduos, afetando 26% dos homens e 34% das mulheres. O consumo de uma dieta rica em fibras alimentares e líquidos ajuda na diminuição das queixas relacionadas à constipação intestinal funcional. Os idosos necessitam de atenção especial com intervenções dietéticas diferenciadas por meio de ações educativas específicas. Objetivo: Analisar os efeitos do aconselhamento nutricional centrado no cliente, em idosos com constipação intestinal funcional matriculados em ambulatório geriátrico. Métodos: O estudo foi experimental do tipo ensaio clínico aleatorizado realizado entre abril de 2002 e novembro de 2003. Os idosos foram alocados em grupo intervenção (n=19) e controle (n=21) e os dois grupos participaram de sete consultas mensais. O aconselhamento nutricional centrado no cliente foi o modelo educativo adotado nas consultas com o grupo intervenção. Esse modelo considera a educação como o processo de ensino, treinamento e facilitação, que permite a troca de informações entre o educador e o educando, por meio de uma linguagem entendível, dentro de um ambiente que conduz ao aprendizado. As variáveis analisadas foram: Índice de Massa Corporal (IMC), prática de atividade física, consumo alimentar (energia, carboidratos, lipídios, grupo das frutas, das leguminosas, ingestão de líquidos, grupo dos cereais, consumo de fibras alimentares), uso de medicamentos total e laxante e as queixas que caracterizam a constipação intestinal funcional. O consumo alimentar foi avaliado pelo recordatório de 24 horas em medidas caseiras e a atividade física pelo Questionário de Baecke. Os dados foram analisados por meio da Análise de Variância de Medidas Repetidas (paramétrica ou não paramétrica) e método de Bonferroni. O nível de significância adotado para os testes foi de 5%. Resultados: Os idosos mais jovens do grupo controle eram mais pesados que os mais velhos desde o início do acompanhamento (p=0,001) e os dois grupos não alteraram a prática de atividade física. O grupo intervenção aumentou o consumo de líquidos a partir da quarta consulta até o final do seguimento quando comparado à entrevista inicial (p=0,031) e, no que se refere à ingestão de leguminosas, observou-se aumento no consumo na quarta (p=0,028) e sexta (p=0,042) consultas na comparação intergrupos. Em relação ao uso de medicamentos total, tanto o grupo controle quanto o grupo intervenção não modificaram seu consumo (p=0,650), por outro lado, o grupo controle consumiu mais laxantes durante o acompanhamento quando comparado ao grupo intervenção (p=0,018). Os dois grupos apresentaram redução das queixas que caracterizam a constipação intestinal funcional durante o seguimento. Conclusões: Os resultados desse estudo indicam que o aconselhamento centrado no cliente é eficaz como uma abordagem educativa para a mudança de comportamento alimentar e conseqüente diminuição das queixas intestinais que caracterizam a constipação intestinal funcional. / Introduction: The elderly represent a growing demographic line not only in the developed countries but also the ones in developing. The bowel constipation is a related symptom for 24 to 40% of those persons, affecting 26% men e 34% women. The consumption of diet full in dietary fibers and liquids helps on decreasing of claims related to functional intestinal constipation. The elderly need to a special attention with diversified dietetics intervention through specific educated actions. Objective: Analyze the effects of client-centered nutritional counseling, in elderly with functional bowel constipation enrolled in geriatric ambulatory. Methods: The studying was experimental as a randomized clinic trial carried out between April 2002 and November 2003. Elderly were assigned in intervention group (n=19) and control (n=21) and both groups participated of seven consults, one per month. The client-centered nutritional counseling was the educating model adopted in consults with the intervention group. That model takes into account the education as the process of teaching, training and make it easy, that allows the changing of information between the educator and the student through understanding language inside of a place that lead to learning. The variables analyzed were: Body Mass Index (BMI), practice of physical activity, food intake (energy, carbohydrate, lipids, group of fruits, group of leguminous, ingestion of liquids, group of cereals, intake of dietary fibers), using of total drugs and laxatives and the claims that characterizes the functional bowel constipation. The food intake was evaluated with 24 hours recall on household measures and the physical activity by Baecke Questionnaire. The data were examined critically through Analyses of Variance With Repeated Measures (parametric and non-parametric) and Bonferroni's method. The significance level adopted to the tests was 5%. Results: The youngest elderly of control group were heavier than the oldest since the beginning of accompanying (p=0,001) and both group didn't change the practicing of physical activity. The intervention group increased the consumption of liquids since of fourth consult up the ending of segment when compared with initial interview (p=0,031) and, in what refers to ingestion of leguminous, it was observed an increasing in consumption in forth (p=0,028) and sixth (p=0,042) consults in the comparing between the groups. Relating the using of total drugs, not only the control group but also intervention group didn't change their consumption (p=0,650), on the other hand, the control group consumed more laxatives during the accompanying when compared to intervention group (p=0,018). Both groups presented reduction of claims that characteristic the functional bowel constipation during the segment. Conclusions: The results of that studying indicate that the client-centered counseling is efficient as an educative approach to the changing of alimentary behavior and consequent reduction of intestinal claims that characterize the functional bowel constipation.

No description available.

Orientador: Elizete Aparecida Lomazi da Costa Pinto / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T13:04:46Z (GMT). No. of bitstreams: 1 VerasNeto_MagnoCardoso_M.pdf: 1277080 bytes, checksum: 79819f766291c884cad1299f8efb29ef (MD5) Previous issue date: 2006 / Resumo: A constipação intestinal é um problema freqüente na população pediátrica e sua apresentação clínica expressa grande heterogeneidade. Um grupo de pacientes constipados apresenta constipação refratária ao tratamento habitual e os conceitos fisiopatológicos clássicos pouco contribuíram para os avanços terapêuticos desejáveis a esses pacientes. O reconhecimento de distúrbios da motilidade gastrointestinal pode contribuir para o entendimento da fisiopatologia da constipação intestinal em crianças. Assim, o objetivo deste trabalho foi comparar os valores dos índices de contratilidade da vesícula biliar em crianças com constipação intestinal crônica funcional com aqueles de crianças sadias. Foi realizado estudo observacional, analítico e transversal, sendo selecionados como casos todos os pacientes com diagnóstico de constipação intestinal funcional, na faixa etária de 2 a 16 anos, em acompanhamento no ambulatório de Gastroenterologia Pediátrica do Hospital das Clínicas da UNICAMP no período de janeiro de 2004 a agosto de 2005. Os controles foram selecionados a partir de Unidades Básicas de Saúde de Campinas e região e pareados por sexo e idade. Casos e controles foram incluídos num protocolo de estudo e em seguida, foi realizado exame ultra-sonográfico pelo mesmo observador, mascarado e com registro dos índices de contratilidade. Foi considerado alterado o índice de contratilidade menor que 25%. Foram avaliados 132 casos e o mesmo número de controles. O índice de contratilidade da vesícula biliar apresentou diferença estatisticamente significativa entre os grupos, sendo menor nos pacientes constipados (31,5 ± 16,9 vs. 41,6 ± 12,7; p<0,001). Não houve diferença significativa no índice de contratilidade da vesícula biliar dos pacientes constipados de acordo com a idade de início da constipação, hábito intestinal, presença de escape fecal ou impactação, sintomas digestivos e uso de laxativos. Concluímos que, para o grupo de pacientes estudados, a contratilidade da vesícula biliar mostrou-se menor. Deste modo, a constipação intestinal pode representar um distúrbio mais amplo da motilidade do trato gastrintestinal / Abstract: Intestinal constipation is a frequent condition in pediatric population. Clinical presentation is heterogeneous. A group of children has a refractory outcome despite habitual therapy. Clinical picture in these children may result from physiopathologic mechanisms related to gastrointestinal motility disorders. Gastrointestinal motility investigation in children with functional constipation may add useful information for managing refractory patients. The objective of this study was to evaluate gallbladder motility in constipated children. An observational, cross-sectional study design was conducted. Research period included patients seen from January, 2004 to August, 2005 in a pediatric outclinic of a School Hospital. All patients with functional constipation assisted in the period were included (age range: 2 - 16 years). The control group was selected from Pediatrics Outclinics which usually sent patients to the School Hospital. The control group was matched for sex and age. Patients were interviewed for filling a study protocol. Gallbladder contractility index, calculated from fast and post-prandial area, was calculated in children with refractory functional constipation, using an ultrassonographic method. Data were compared with results obtained in healthy children. Ultrassonography studies were performed by the same physician in a blinded way. One-hundred-thirty-two constipated children and the same number of healthy children were included. Contractility index from constipated children was inferior than index from healthy children (31,5 ± 16,9 vs. 41,6 ± 12,7, p<0,001). There was no significant difference in contractility index from constipated children analyzed for constipation duration, evacuation frequency, and occurrence of soiling or fecal impaction, laxatives use and clinical symptoms. In a group of children with refractory intestinal constipation the gallbladder motility is reduced when compared with healthy children. This phenomenon may light up the understanding about functional constipation in children / Mestrado / Saude da Criança e do Adolescente / Mestre em Saude da Criança e do Adolescente

Title: The path(way) to a clean colon: Improving the management of functional constipation Authors: Sarah Nichols, D.O. Pediatrics Resident, Nathan Justice, M.D. Pediatrics Hospital Medicine, Anjali Malkani, M.D. Pediatric Gastroenterology, David Wood, M.D., MPH General Pediatrics and Adolescent Medicine Purpose / Objectives: Hospitalization for the treatment of functional constipation is a leading cause among encounters that incur a financial loss at our institution. There are few resources that describe best practices or quality improvement efforts in the management of children who are hospitalized with functional constipation. A clinical pathway was implemented to promote interventions that improve hospital resource utilization for this group of children. Design / Methods: A clinical pathway was developed by a multidisciplinary team of stakeholders. The pathway emphasized interventions known to improve resource utilization and believed to facilitate a more effective and efficient cleanout. The inpatient arm of the pathway was implemented on a 24-bed medical/surgical unit; members of the medical and clinical staff of this unit received education with dissemination of the pathway. An electronic order set was implemented concurrently to facilitate practitioners’ application of pathway recommendations. Plan-Do-Study-Act (PDSA) cycles were used to monitor process measures and outcomes. Inpatient utilization was selected as the primary outcome for this effort’s first iteration; length of stay and frequency of readmissions were monitored as a secondary outcome and balancing measure, respectively. Results: Pathway utilization reached 65% within two periods of implementation. Adherence to selected process measures exceeded 80% within two periods. Inpatient utilization demonstrated initial improvement, increasing from 20% at baseline to 50% post-implementation; however, it subsequently fell below baseline performance after third-party payers revised admission criteria during period 6. Length of stay and frequency of readmissions remained unchanged post-intervention. Conclusion / Discussion: A clinical pathway for the treatment of functional constipation was quickly adopted by clinicians within two periods of implementation (spanning two months). The pathway was effective at promoting interventions that improved inpatient utilization; however, these improvements could not be sustained in the face of an unanticipated, external force. Future improvement cycles will be directed at reducing the length of stay to improve hospital resource utilization.

Chronic constipation is a very common problem that negatively affects the quality of life of patients, especially the elderly population. It can also lead to significant health care expenditure. Careful assessment by obtaining a thorough history and physical examination with limited indicated diagnostic testing is important to identify potential underlying etiologies and to treat effectively.

The U.S. health care system is evolving from medical centric to patient centered, augmenting the importance for patients to comprehend and process medical information. The Department of Education indicated that 77 million Americans have a basic or below basic health literacy proficiency and 12% register as health literacy proficient. Animation is a time-tested device for improving health by enhancing comprehension. Chronic constipation (CC) complexity entails physiological, anatomical, and environmental mechanisms. Using the cognitive theory of multimedia learning and dual-channel auditory and visual processing, the primary research question addressed whether an animated educational video improved health literacy for CC more than a traditional written educational pamphlet. A secondary dataset of 100 CC subjects from the University of Michigan was collected using a cross-sectional study design with a convenience sampling strategy of CC patients who underwent anorectal functional testing. Dependent variables were CC Pretest Quiz and CC Posttest Quiz scores, and independent variables included CC education intervention, demographics, health literacy proficiency, and environmental learning variables. Descriptive and analytical statistical methods were employed for data summarization and comparison. The animated educational video had minimal impact (p = 0.20) on improving health literacy; however, pretest scores (p -?¤ 0.001), age (p = 0.03) and highest level of education achievement (p = 0.03) influenced the largest variance between quiz scores. Enhancing health literacy influences social change by empowering individuals with CC to improve quality of life metrics, increase work productivity, and decrease health care utilization costs.

No description available.

Osmotic laxatives produce the best results. Fiber and behavior modification may have a role. Increased fiber and behavior modification are the most often recommended first steps in managing chronic functional constipation (CFC) in children, but only limited evidence supports this approach. For pharmacologic management, the best evidence supports osmotic laxatives.

No description available.

Le Spina Bifida est une maladie congénitale rare due à anomalie de fermeture du tube neural ayant des conséquences physiques et fonctionnelles multiples. La prise en charge des séquelles digestives du Spina Bifida ne fait l’objet d’aucun consensus national ou international. Les objectifs de cette thèse translationnelle étaient de caractériser les plaintes anorectales des patients adultes ayant un Spina Bifida, d’en préciser les mécanismes physiopathologiques sous-jacents à partir des données de la manométrie anorectale et du barostat rectal et en étudiant les fonctions de la barrière épithéliale intestinale. Les plaintes anorectales des patients adultes ayant un Spina Bifida représentent leur deuxième plainte en terme de fréquence et sont l’incontinence fécale, et la constipation. Ces troubles peuvent évoluer au cours du temps ce qui justifie un suivi digestif au long cours. Le niveau lésionnel neurologique n’est ni associé aux troubles digestifs ni à à leur évolution. Les patients ayant un Spina Bifida ont une atteintede la fonction anale (défaut de contraction) et des fonctions rectales (diminution du tonus et de la compliance rectale). Ils ont également une hyperperméabilité paracellulaire et une diminution de la densité du tissu conjonctif; ces 2 anomalies étant corrélées entre elles. L’augmentation de la perméabilité paracellulaire était négativement corrélée avec la compliance rectale. Enfin, les patients ayant un Spina Bifida ont une augmentation de l’expression de TGFBeta1. Les anomalies des fonctions anorectales et de la barrière épithéliale intestinale pourraient être des cibles thérapeutiques potentielles dans la prise en charge des troubles anorectaux des patients adultes ayant un Spina Bifida. / Spina Bifida is a rare congenital disorder caused by an abnormal neural tube closure with multiple physical and functional consequences. The management of the digestive disorders of Spina Bifida is not consensual. The objectives of this present work were to characterize the anorectal complaints of adult patients with Spina Bifida, to specify the underlying pathophysiological mechanisms from the data of anorectal manometry and rectal barostat and to study the functions of the intestinal epithelial barrier. The anorectal complaints of adult patients with Spina Bifida represent their second complaint and are faecal incontinence and constipation. These disorders can change over time which justifies long-term digestive follow-up. The level of neurological lesion is neither associated with digestive disorders nor with their evolution. Patients with Spina Bifida have impaired anal function (lack of contraction) and rectal function (decreased tone and rectal compliance). They also have paracellular hyperpermeability and decreased connective tissue density ; these 2 anomalies are interrelated. The increase in paracellular permeability was negatively correlated with rectal compliance. Finally, patients with Spina Bifida have an increased expression of TGFBeta1. Abnormalities of anorectal function and intestinal epithelial barrier may be potential therapeutic targets in the management of anorectal disorders in adult patients with Spina Bifida.