Development and validation of a childhood self-efficacy for functional constipation questionnaire

Physiology of lower gastrointestinal tract

BACKGROUND

The lower gastrointestinal (GI) tract, formed from the midgut and hindgut, encompasses the colon, rectum and anal canal.

AIM

The aim of this review is to provide an overview of the anatomy and physiology of the lower GI tract.

METHODS

Literature review on anatomy and physiology of the lower GI tract, including normal motility and phases of defecation. It derives its blood supply from the superior and inferior mesenteric arteries while it is innervated by the extrinsic autonomic (the thoracolumbar and sacral nerves) and the intrinsic enteric nervous system. The colon has four layers: mucosa, submucosa, muscularis externa and serosa. The anal canal ends in the internal and external anal sphincters (EASs) involved in continence and defecation. The lower GI tract is predominantly involved in digestion, absorption, defecation and protection. Defecation is a complex process that requires inter-neural (enteric and autonomic nervous systems), neurohormonal and neuromuscular coordination. It has four phases which include basal, pre-expulsive, expulsive and end phase. High-propagating contractions in the colon propel stool to the rectum leading to rectal distention and the recruitment of the recto-anal inhibitory reflex. Once able, the EAS, under full conscious control, is then relaxed allowing stool to be evacuated. Other defecation reflexes include the gastrocolic, gastroileal and coloanal reflexes.

CONCLUSIONS

Recent advances provide novel techniques to investigate motility patterns including high-resolution manometry protocols with automated assessments, magnetic resonance imaging techniques for defecography, wireless motility capsules and fecobionics.

State of the Art Bowel Management for Pediatric Colorectal Problems: Functional Constipation

BACKGROUND

Functional constipation (FC) affects up to 32% of the pediatric population, and some of these patients are referred to pediatric surgery units to manage their constipation and/or fecal incontinence. The aim of the current paper is to report the recent updates on the evaluation and management of children with FC as a part of a manuscript series on bowel management in patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and FC.

METHODS

A literature search was performed using Medline/PubMed, Google Scholar, Cochrane, and EMBASE databases and focusing on the manuscripts published within the last 5-10 years.

RESULTS

The first step of management of children with FC is to exclude Hirschsprung disease with a contrast study, examination under anesthesia, anorectal manometry (AMAN). If AMAN shows absent rectoanal inhibitory reflex, a rectal biopsy is performed. Internal sphincter achalasia or high resting pressures indicate botulinum toxin injection. Medical management options include laxatives, rectal enemas, transanal irrigations, and antegrade flushes. Those who fail conservative treatment require further assessment of colonic motility and can be candidates for colonic resection. The type of resection (subtotal colonic resection vs. Deloyer's procedure) can be guided with a balloon expulsion test.

CONCLUSION

Most of the patients with FC referred for surgical evaluation can be managed conservatively. Further studies are required to determine an optimal strategy of surgical resection in children unresponsive to medical treatment.

Measuring self-efficacy in defecation: Validation and utilization of a Chinese version of the self-efficacy for functional constipation questionnaire (SEFCQ) in a pediatric population

BACKGROUND

Self-efficacy in defecation plays an important role on behavioral therapy for functional constipation (FC). There is an unmet need for valid child self-report measures of task-specific self-efficacy for pediatric FC. Our aim was to cross-culturally validate the Self-Efficacy for Functional Constipation Questionnaire (SEFCQ) and to explore the salient factor(s) of self-efficacy in defecation that correlate with anxiety and constipation symptom severity among Chinese children.

METHODS

The SEFCQ was adapted to Chinese version following the Rome Foundation guidelines for the translation of questionnaires. Two hundred and three children with FC were involved in psychometric testing. Confirmatory factor analysis was conducted to determine the structure of the SEFCQ. Construct validity was evaluated by testing the relationship between the SEFCQ and both anxiety and the Patient Assessment of Constipation Symptoms (PAC-SYM). Test-retest reliability, internal consistency, and interfactor correlation were used to evaluate reliability. Hierarchical multiple regression was used to identify salient self-efficacy for FC that correlates with anxiety and constipation symptom severity.

KEY RESULTS

Confirmatory factor analysis supports the two-factor structure of the SEFCQ. Adequate test-retest reliability (r = 0.973, p<0.001) and internal consistency (Cronbach's α = 0.871) were obtained. Both self-efficacy factors were significantly associated with anxiety (r = -0.227 to -0.350, p<0.001) and PAC-SYM (r = -0.495 to -0.602, p<0.001), with emotional self-efficacy being the most salient factor for predicting the symptom severity of constipation after controlling for sex, age, quality of parents' marriage, and family history.

CONCLUSION AND INFERENCES

The SEFCQ showed satisfactory psychometric properties. Low self-efficacy in defecation correlates with anxiety and may contribute to poor adherence to behavior change, which exacerbates the symptoms of constipation. Further study is needed to apply social cognitive intervention to increase children's self-efficacy in defecation and assess its effect on treatment outcomes.

Factors influencing career success of clinical nurses in northwestern China based on Kaleidoscope Career Model: Structural equation model

AIM

To explore the relationships among self-efficacy, information literacy, social support and career success of clinical nurses and identify factors influencing clinical nurses' career success in northwestern China.

BACKGROUND

Understanding the influencing factors of career success is important for the professional development of nurses and the improvement of clinical nursing quality. Many influencing factors of career success have been identified, but there is no large-scale research on the relationships among self-efficacy, information literacy, social support and career success of clinical nurses based on Kaleidoscope Career Model. Studies examining the association of the four factors remain limited.

METHODS

A total of 3011 clinical nurses from 30 hospitals in northwestern China were selected in the cross-sectional survey, and the response rate was 94.71%. The clinical nurses completed the online self-report questionnaires including self-efficacy, information literacy, social support rating scale and career success scale. The data were analysed by SPSS23.0 statistical software using t test, analysis of variance, Pearson's correlation and multiple linear regression. Structural equation model (SEM) was used to analyse the influencing factors of career success using Mplus 8.3.

RESULTS

The career success of clinical nurses in northwestern China was at a medium level. The linear multivariate regression analysis showed that self-efficacy (β = .513), social support (β = .230), information support (β = .106), information consciousness (β = -.097), information knowledge (β = .067), information ethics (β = -.053), hospital grade (β = .118), marital status (β = -.071) and age (β = -.037) entered regression equation of clinical nurses' career success (all P < .05). SEM results showed that the career success was negatively correlated with demographic characteristics and positively correlated with social support and self-efficacy.

CONCLUSION

Demographic characteristics, self-efficacy, social support and information literacy are the influencing factors of nurses' career success, which should be considered in the process of promoting nurses' career success.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing managers need to acknowledge the significance of nurses' career success both for the realization of their own value and for the improvement of clinical nursing quality. They should encourage nurses to enhance self-efficacy and render more social support through incentive policies and foster nurses' information literacy through information technology training so as to improve their career success.

Non-pharmacologic approach to pediatric constipation

Functional constipation (FC) is a pervasive problem in pediatrics. Although pharmaceuticals are commonly used for FC, parents and patients show reluctance or find dissatisfaction with available medications at times. Further, patients often have interest in utilizing nutraceutical supplements and botanicals that are available over the counter. This literature review aims to summarize research studies performed on non-pharmacologic approaches to constipation and to evaluate the safety and efficacy of these modalities. Overall data on non-pharmacologic treatments for childhood constipation were sparse, and though some studies were available for adult populations, pediatrics studies were generally limited, lacking or flawed. Certain supplements, such as prebiotics, probiotics and fiber, are safe and are without significant side effects. Though fiber supplements such as glucomannan, green banana mass, cocao husk and various fiber blends have emerging evidence in children, evidence for psyllium, cellulose and flaxseed only have supportive studies in adults. Other than senna, studies of botanicals indicate significant safety concerns (in particular with Aloe vera with aloin and Cascara sagrada) and insufficient evidence. For patients with a significant behavioral or anxiety component to their FC and exhibit dyssynergia, mind-body interventions (e.g. diaphragmatic breathing, biofeedback, cognitive behavioral therapy, and behavioral modifications) are certainly safe and effective. Finally, movement and manipulative interventions such as abdominal massage, reflexology, acupuncture and transcutaneous nerve stimulation show promise in the field of pediatric constipation, and data is accumulating for efficacy. These modalities require further study to determine mechanisms of action and which populations may benefit the most from these therapies.

Self-Efficacy in Children with Functional Constipation Is Associated with Treatment Success

OBJECTIVES

To assess the relationship between self-efficacy, the belief that an individual can succeed at a goal, and short-term treatment outcome in children with functional constipation.

STUDY DESIGN

Patients with functional constipation age 8-16 years completed the Self-Efficacy for Functional Constipation Questionnaire (SEFCQ), consisting of 14 statements about performing tasks needed for defecation. Patients completed SEFCQ before, immediately after, and 3 weeks after their clinic visit. Treatment success was defined as ≥3 bowel movements into the toilet and no fecal incontinence in the third week.

RESULTS

75% of patients had a successful outcome. Scores were higher in the group that was successful than in those that failed before, immediately after the visit, and 3 weeks later (P < .001). Self-efficacy improved at all time points in the group that was successful (P < .001). In the group that failed, scores improved immediately after clinic visit (P < .01) but were unchanged at follow-up (P > .05).

CONCLUSIONS

Improved self-efficacy is associated with successful outcomes in children with functional constipation, thus, it may be beneficial to enhance self-efficacy for defecation during treatment.