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Aral A, Usta MB, Erguner Aral A. Factors associated with response to simple behavioral intervention in primary enuresis nocturna. Bull Menninger Clin 2022; 86:67-89. [PMID: 35258343 DOI: 10.1521/bumc.2022.86.1.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This 8-week longitudinal study examined predictors of response to simple behavioral intervention in primary enuresis nocturna (PEN). A total of 154 children, aged 8-18 years, diagnosed with PEN were evaluated. The results indicated that lack of constipation, milder enuresis severity, and higher bladder capacity are the primary predictors of good treatment response, and lower family dysfunction is the most robust familial predictor. Lack of constipation is the main predictor with unique variance in multiple regression. Specialists should be aware of conditions that hinder the success of simple behavioral intervention before implementing costly treatments. In treatment-refractory cases, it is important to examine each child for constipation. Family-centered approaches can be helpful if used in parallel with behavioral treatments.
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Affiliation(s)
- Armagan Aral
- Staff physician in the Department of Child and Adolescent Psychiatry, Mental Health Hospital, Samsun, Turkey
| | - Mirac Baris Usta
- Department of Child and Adolescent Psychiatry, Medical Faculty, University of Ondokuz Mayis, Samsun, Turkey
| | - Ayse Erguner Aral
- Psychiatry resident in the Department of Mental Health and Diseases, Medical Faculty, University of Ondokuz Mayis, Samsun, Turkey
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Karamaria S, Ranguelov N, Hansen P, De Boe V, Verleyen P, Segers N, Walle JV, Dossche L, Bael A. Impact of New vs. Old International Children's Continence Society Standardization on the Classification of Treatment Naïve Enuresis Children at Screening: The Value of Voiding Diaries and Questionnaires. Front Pediatr 2022; 10:862248. [PMID: 35419322 PMCID: PMC8995850 DOI: 10.3389/fped.2022.862248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/11/2022] [Indexed: 12/04/2022] Open
Abstract
UNLABELLED Expert consensus papers recommend differentiating enuresis using questionnaires and voiding diaries into non- (NMNE) and monosymptomatic enuresis (MNE) is crucial at intake to decide the most appropriate workout and treatment. This national, Belgian, prospective study investigates the correlation, consistency, and added value of the two methods, the new against the old International Children's Continence Society (ICCS) definitions, and documents the prevalence of the two enuresis subtypes in our population. Ninety treatment-naïve enuretic children were evaluated with the questionnaire, and the voiding diary and the two clinical management tools were compared. Almost 30% of the children had a different diagnosis with each method, and we observed inconsistencies between them in registering Lower Tract Symptoms (κ = -0.057-0.432 depending on the symptom). Both methods had a high correlation in identifying MNE (rs = 0.612, p = 0.001) but not for NMNE (rs = 0.127, p = 0.248). According to the latest ICCS definitions, the incidence of MNE was significantly lower (7 vs. 48%) with the old standardization. CONCLUSION The voiding diary and the questionnaire, as recommended by the ICCS at the screening of treatment-naïve enuretic patients, are considerably inconsistent and have significantly different sensitivities in identifying LUTS and thus differentiating MNE from NMNE. However, the high incidence of LUTS and very low prevalence of MNE suggest that differentiating MNE from NMNE to the maximum might not always correlate with different therapy responses.
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Affiliation(s)
- Sevasti Karamaria
- Department of Internal Medicine and Pediatrics, Ghent University, ERKNET, Ghent, Belgium
| | - Nadejda Ranguelov
- Department of Pediatrics, Cliniques Universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium
| | | | - Veerle De Boe
- Department of Urology, Brussels University Hospital, Brussels, Belgium
| | | | - Nathalie Segers
- Department of Pediatrics, Pediatric Nephrology, Hospital Network Antwerp (ZNA) Koningin Paola Kinderziekenhuis, Antwerp, Belgium
| | - Johan Vande Walle
- Department of Internal Medicine and Pediatrics, Ghent University, ERKNET, Ghent, Belgium.,Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Lien Dossche
- Department of Internal Medicine and Pediatrics, Ghent University, ERKNET, Ghent, Belgium.,Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - An Bael
- Department of Pediatrics, Pediatric Nephrology, Hospital Network Antwerp (ZNA) Koningin Paola Kinderziekenhuis, Antwerp, Belgium.,Faculty of Medicine, University of Antwerp, Antwerp, Belgium
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Watanabe T, Ikeda H, Ono T, Oyake C, Watanabe Y, Fuyama M. Comparison of wireless and wired alarm devices for nocturnal enuresis treatment. Pediatr Int 2022; 64:e15328. [PMID: 36331235 DOI: 10.1111/ped.15328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/07/2022] [Accepted: 08/10/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND In monosymptomatic nocturnal enuresis (MNE) treatment, enuretic alarm devices are the first recommended treatment option. This study aimed to compare retrospectively the effectiveness of wearable wireless and wired alarm devices for MNE treatment in children aged 6-14 years. METHODS All children aged 6-16 with MNE who underwent alarm therapy as outpatients were included. A wired alarm device was used from 2012 to 2015, and a wireless alarm device was used from 2016 to 2019. The primary outcomes were the dropout rates during therapy and at last follow up. The full response(14 consecutive dry nights) and the partial response rate during therapy were also assessed. RESULTS Of the 173 patients enrolled, 75 and 98 used a wired and a wireless alarm device, respectively. The dropout rate at the last visit was significantly lower in the wireless alarm group than that in the wired alarm group (6.1% vs. 20.0%; P = 0.006). The full response(FR) rate was significantly higher in the wireless alarm group than these in the wired alarm group at 4, 12, 24 weeks (4 weeks: 11.2% vs. 1.3%, P = 0.011; 12 weeks: 31.9% vs. 13.5%, P = 0.005; 24 weeks: 72.9% vs. 39.7%, P < 0.0001). CONCLUSIONS Wireless alarm therapy for MNE had lower attrition rates and a higher rate of FR than wired alarm therapy.
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Affiliation(s)
- Tsuneki Watanabe
- Children's Medical Center, Showa University Northern Yokohama Hospital, Yokohama-shi, Kanagawa, Japan
| | - Hirokazu Ikeda
- Children's Medical Center, Showa University Northern Yokohama Hospital, Yokohama-shi, Kanagawa, Japan.,Department of Pediatrics, Showa University Fujigaoka Hospital, Yokohama-shi, Kanagawa, Japan
| | - Takahiro Ono
- Children's Medical Center, Showa University Northern Yokohama Hospital, Yokohama-shi, Kanagawa, Japan
| | - Chisato Oyake
- Children's Medical Center, Showa University Northern Yokohama Hospital, Yokohama-shi, Kanagawa, Japan
| | - Yoshitaka Watanabe
- Children's Medical Center, Showa University Northern Yokohama Hospital, Yokohama-shi, Kanagawa, Japan
| | - Masaki Fuyama
- Department of Pediatrics, Showa University Fujigaoka Hospital, Yokohama-shi, Kanagawa, Japan
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Body-Worn Versus Bell-and-Pad Alarm Device for the Management of Monosymptomatic Nocturnal Enuresis in Children: A Randomized Controlled Trial. J Wound Ostomy Continence Nurs 2020; 47:507-512. [PMID: 32970035 DOI: 10.1097/won.0000000000000678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE The purpose of this study was to compare the effectiveness of bell-and-pad alarm therapy to body-worn alarm therapy for the management of monosymptomatic enuresis in children 6 to 16 years of age. DESIGN A prospective, randomized, adaptive clinical control trial. SUBJECTS AND SETTING The sample comprised 86 children who attended a continence clinic for treatment of monosymptomatic enuresis and met the criteria for enuresis alarm therapy as per International Children's Continence Society (ICCS) guidelines. Subjects were randomly allocated to an experimental group (body-worn alarm, n = 41) or a control group (bell-and-pad alarm, n = 45). The study setting was a single-site specialist continence service in regional Victoria, Australia. Treatment was administered in the child's home. METHODS Alarm therapy was administered by the child and/or parent for an initial period of 8 weeks at which time the child underwent a review with the continence nurse specialist. If the child had achieved 14 consecutive dry nights, the therapy was deemed successful and ceased. Children who had not become dry continued therapy for a further 8 weeks up to a maximum of 16 weeks, with a final review was instituted. Each child kept a diary for the duration of alarm therapy to report on frequency of wet/dry nights, times of alarm, response to alarm, and response to sensation to void (without alarm). The 2 types of alarm devices were compared with respect to categorical variables using dichotomous cross-tabulations and χ tests of independence based on the most positive outcome versus the other outcomes. RESULTS Dryness in accordance with the criteria outlined by the ICCS guidelines was achieved in 18 children (43.9%) in the body-worn alarm group versus 29 children (64.4%) in the routine (bell-and-pad) group (P = .056). The bell-and-pad alarm performed better on 7 out of the 9 indicators, including the primary outcome measure of the child attained dryness for 14 nights or more, nightly alarm use, alarm woke child, alarm woke parent (P = .022), false (positive) alarms (P = .039), child turned alarm off and went back to sleep (P = .003), and child was compliant with alarm use. The body-worn device produced higher proportions of the most positive outcomes for 2 of the 9 indicators: relapse (P = .076) and false (negative) nonalarms (P = .066). CONCLUSIONS Study findings suggests that the bell-and-pad alarm is preferable to the body-worn alarm. Additional research is recommended using other body-worn alarm devices across a larger population in order to establish the more definitive findings needed for clinical decision-making.
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Bastos JM, Rondon AV, de Lima GRM, Zerati M, Schneider-Monteiro ED, Molina CAF, Calado ADA, Barroso U. Brazilian consensus in enuresis-recomendations for clinical practice. Int Braz J Urol 2019; 45:889-900. [PMID: 31408290 PMCID: PMC6844333 DOI: 10.1590/s1677-5538.ibju.2019.0080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/06/2019] [Indexed: 01/14/2023] Open
Abstract
Introduction Enuresis, defined as an intermittent urinary incontinence that occurs during sleep, is a frequent condition, occurring in about 10% of children at 7 years of age. However, it is frequently neglected by the family and by the primary care provider, leaving many of those children without treatment. Despite of many studies in Enuresis and recent advances in scientific and technological knowledge there is still considerable heterogeneity in evaluation methods and therapeutic approaches. Materials and Methods The board of Pediatric Urology of the Brazilian Society of Urology joined a group of experts and reviewed all important issues on Enuresis and elaborated a draft of the document. On September 2018 the panel met to review, discuss and write a consensus document. Results and Discussion Enuresis is a multifactorial disease that can lead to a diversity of problems for the child and family. Children presenting with Enuresis require careful evaluation and treatment to avoid future psychological and behavioral problems. The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies.
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Affiliation(s)
- José Murillo Bastos
- Universidade Federal de Juiz de Fora (UFJF) e Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (HMTJ-SUPREMA), Juiz de Fora, MG, Brasil
| | - Atila Victal Rondon
- Universidade do Estado do Rio de Janeiro (UERJ) e Hospital Federal Cardoso Fontes (HFCF), Rio de Janeiro, RJ, Brasil
| | | | - Miguel Zerati
- Instituto de Urologia e Nefrologia de São José do Rio Preto (IUN) e Faculdade Regional de Medicina(FAMERP), Hospital de Base, São José do Rio Preto, SP, Brasil
| | | | - Carlos Augusto F Molina
- Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brasil
| | | | - Ubirajara Barroso
- Universidade Federal da Bahia (UFBA) e Escola Bahiana de Medicina (BAHIANA), Salvador, BA, Brasil
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Cakiroglu B, Arda E, Tas T, Senturk AB. Alarm therapy and desmopressin in the treatment of patients with nocturnal enuresis. Afr J Paediatr Surg 2018; 15:131-134. [PMID: 32769363 PMCID: PMC7646679 DOI: 10.4103/ajps.ajps_115_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The purpose of this study was to compare the rates of success, relapse, and compliance to treatment in patients undergoing alarm therapy or receiving desmopressin for primary monosymptomatic nocturnal enuresis (PMNE). MATERIALS AND METHODS This retrospective study was performed by reviewing the medical files of patients undergoing alarm therapy (Group 1) or receiving desmopressin (Group 2) for PMNE, between January 2010 and July 2014. Patients undergoing treatment in the 3rd and 6th month as well as 1st year follow-up data were analyzed. Two groups were compared with regard to treatment success, relapse rate, and compliance to treatment. RESULTS Group 1 included 64 and Group 2 included 70 children. Relapse rates at the 3rd month, 6th month, and 1st year were 67.2%, 71.9%, and 17.0% for Group 1 and 74.3%, 80.0%, and 21.4% for Group 2, respectively. There was no statistically significant difference between relapse rates at any point of follow-up. CONCLUSIONS Alarm therapy and desmopressin have the same success rate and relapse rates for PMNE. Compliance with alarm therapy is higher and we recommend it as the first-line treatment. On the other hand, desmopressin has low side effects and can also be used.
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Affiliation(s)
- Basri Cakiroglu
- Department of Urology, Hisar Intercontinental Hospital, Istanbul, Turkey
| | - Ersa Arda
- Department of Urology, Hisar Intercontinental Hospital, Istanbul, Turkey
| | - Tuncay Tas
- Department of Urology, Private Esencan Hospital, Istanbul, Turkey
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Affiliation(s)
- Dong-Gi Lee
- Department of Urology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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Sharifiaghdas F, Sharifiaghdas S, Taheri M. Primary Monosymptomatic Nocturnal Enuresis: Monotherapy vs Combination Therapy. Urology 2016; 93:170-4. [DOI: 10.1016/j.urology.2016.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/26/2016] [Accepted: 02/08/2016] [Indexed: 01/29/2023]
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Goessaert AS, Everaert K, Hoebeke P, Kapila A, Walle JV. Nocturnal enuresis and nocturia, differences and similarities - lessons to learn? Acta Clin Belg 2015; 70:81-6. [PMID: 25379877 DOI: 10.1179/2295333714y.0000000055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This review highlights the current views on and differences and similarities between nocturnal enuresis (NE) in children and nocturia in adults, which might be a guidance to elucidate the missing links in our knowledge. In both conditions, a genetic factor is suspected. Reduced bladder capacity and nocturnal polyuria are the main underlying lower urinary tract-related conditions. There is a link with sleep disorders, although it is not clear whether this is a cause or consequence. Physical and mental health are comprised in both conditions, however, in different ways. In NE, constipation and attention deficit disorder are the most important comorbidities and the effect on mental health and quality of life is mainly through the negative impact on self-esteem. In nocturia, cardiovascular disease and fall injuries are important comorbidities, mainly affecting the older nocturia population; personal distress and depression are consequences of the related poor sleep quality. For both conditions, treatment is often inadequate and a more individualized approach seems to be necessary. The main difference between NE and nocturia seems to be the difference in arousal to bladder stimuli, suggesting that sleep characteristics might be a key factor in these conditions.
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Shiroyanagi Y, Kim W, Suzuki H, Yamazaki Y. Winter is associated with failure in the alarm treatment of nocturnal enuresis. J Pediatr Urol 2014; 10:246-9. [PMID: 24230483 DOI: 10.1016/j.jpurol.2013.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 09/13/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess whether the winter season in Japan is associated with failure in the alarm treatment of nocturnal enuresis (NE). PATIENTS AND METHODS Consecutive patients with NE referred to our center between June 2009 and May 2010 were treated with the enuresis alarm (EA). The EA was used for 16 weeks with each child. Patients were divided into a success group and a treatment failure group. Pretreatment variables were collected, including age, sex, night-time urine volume, severity of enuresis, presence of nocturnal polyuria, presence of daytime incontinence, and treatment initiation season. These variables and initial success rates were retrospectively compared between the two groups. Chi-square, Student t tests, and multivariate regression analysis were used for statistical analysis. RESULTS A total of 67 children with NE were evaluated, 37 (55%) in the success group and 30 (45%) in the failure group. None of the pretreatment variables differed significantly between groups except for season; winter season initiation was an independent risk factor for failure in multivariate regression analysis. CONCLUSIONS Winter was associated with failure in the EA treatment. We recommend that EA be introduced in the summer season in Japan to achieve an optimal success rate.
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Affiliation(s)
- Yoshiyuki Shiroyanagi
- Kanagawa Children's Medical Center, Department of Urology, 2-138-4 Mutsukawa, Minami-ku, Yokohama, Kanagawa 232-8555, Japan.
| | - Woojin Kim
- Kanagawa Children's Medical Center, Department of Urology, 2-138-4 Mutsukawa, Minami-ku, Yokohama, Kanagawa 232-8555, Japan
| | - Hiroko Suzuki
- Kanagawa Children's Medical Center, Department of Urology, 2-138-4 Mutsukawa, Minami-ku, Yokohama, Kanagawa 232-8555, Japan
| | - Yuichiro Yamazaki
- Kanagawa Children's Medical Center, Department of Urology, 2-138-4 Mutsukawa, Minami-ku, Yokohama, Kanagawa 232-8555, Japan
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Abstract
OBJECTIVE Co-sleeping is associated with disturbance of the natural sleep pattern, including sleep fragmentation and daytime sleepiness. Nocturnal enuresis (NE) or bed-wetting, although benign, is a significant cause of distress to affected children and their caregiver(s). This study investigated the relationship between co-sleeping and NE in primary school children from China. METHODS Data from a previous sleep study of primary school children from 8 cities across China were analyzed. Multivariable regression analysis was performed to assess the relationship between co-sleeping and NE while controlling for a number of confounding factors. The prevalence of NE in co-sleeping and non-co-sleeping children in different age groups was evaluated. RESULTS The prevalence of co-sleeping and NE in children aged 5 to 12 years was 22.8% and 4.6%, respectively. Co-sleeping was associated with a higher prevalence of NE in primary school age children (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.27-1.77; p < .001) after adjusting for confounding factors. The differences in the prevalence of NE between co-sleepers and non-co-sleepers were significant in the 9-year age group (OR, 1.49; 95% CI, 1.06-2.11; p = .025) and 11- to 12-year age group (OR, 3.16; 95% CI, 2.19-4.57; p < .001). CONCLUSION Co-sleeping may increase the risk of NE in primary school children, particularly in those aged 11 to 12 years.
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The efficacy of alarm therapy versus desmopressin therapy in the treatment of primary mono-symptomatic nocturnal enuresis: a systematic review. Prim Health Care Res Dev 2013; 16:21-31. [PMID: 24252606 DOI: 10.1017/s146342361300042x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIM To investigate the efficacy of alarm therapy versus desmopressin therapy in treating primary mono-symptomatic nocturnal enuresis (PMNE). BACKGROUND PMNE is a common childhood disorder, which if left untreated can have a significant impact on a child's self-esteem and behaviour. Alarm therapy and desmopressin therapy are the two main treatments currently available in UK-based nurse-led enuresis clinics. METHODS A systematic review of the literature was undertaken to assess the efficacy of PMNE treatments. Following application of inclusion/exclusion criteria eight randomised controlled/clinical trials were identified involving children aged 5-17 years with PMNE receiving either alarm therapy or desmopressin therapy. FINDINGS Seven studies found no statistical difference in nocturnal continence improvement between the two interventions at the point when treatment was stopped. Four studies had a significantly larger relapse rate of nocturnal enuresis with desmopressin compared with alarm therapy when the treatment was withdrawn. Two papers reported that those participating in the alarm therapy intervention of the trials had a higher attrition rate than the desmopressin intervention. The overall findings from the eight studies showed that long term alarm therapy was more effective in treating nocturnal enuresis than desmopressin therapy. The review found that families and children receiving the alarm therapy intervention require more support from health care professionals to comply with treatment than those receiving the desmopressin therapy. However, if nurse-led clinics can support families to persist with the alarm therapy intervention, they are more likely to experience longer term improvement in continence.
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Ahmed AFAM, Amin MM, Ali MM, Shalaby EAM. Efficacy of an enuresis alarm, desmopressin, and combination therapy in the treatment of saudi children with primary monosymptomatic nocturnal enuresis. Korean J Urol 2013; 54:783-90. [PMID: 24255762 PMCID: PMC3830973 DOI: 10.4111/kju.2013.54.11.783] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 09/06/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose We evaluated and compared the effectiveness of an enuresis alarm, desmopressin medication, and their combination in the treatment of Saudi children with primary monosymptomatic nocturnal enuresis (PMNE). Materials and Methods A total of 136 children with PMNE were randomly assigned to receive an enuresis alarm alone (EA group, n=45), desmopressin alone (D group, n=46), or a combination of both (EA/D group, n=45). Patients were followed weekly during treatment and for 12 weeks after treatment withdrawal. Results During treatment, wetting frequencies were significantly reduced in all groups and remained significantly lower than pretreatment values until the end of follow-up. In the D and EA/D groups, an immediate reduction in wetting frequencies was observed, whereas a longer time was required to reach a significant reduction in the EA group. The full and partial response rates were 13.3% and 37.8% in the EA group, 26.1% and 43.5% in the D group, and 40.0% and 33.3% in the EA/D group. A significant difference was observed only between the EA and EA/D groups (p=0.025). Relapse rates were higher in the D group (66.6%) than in the EA (16.6%) and EA/D (33.3%) groups. A significant difference was observed between the D and EA groups only (p=0.019). Conclusions Desmopressin, an enuresis alarm, and combined therapy are effective in the treatment of Saudi children with PMNE. Desmopressin produced an immediate effect but relapses were common. The enuresis alarm provided gradual effects that persisted posttreatment. The combined therapy was superior to the alarm in achieving an immediate response; however, its effect was not better than that of the alarm long term.
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Affiliation(s)
- Abul-Fotouh Abdel-Maguid Ahmed
- Department of Urology, Al-Azhar University, Cairo, Egypt. ; Department of Urology, Salman Bin Abdul-Aziz University, Al-Kharj, Kingdom of Saudi Arabia
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Abstract
Nocturnal enuresis (NE) is increasingly seen as part of a heterogeneous phenomenon that at times will include daytime lower urinary tract symptoms such as urgency, frequency and wetting - with reduced bladder storage, usually due to an overactive bladder. In turn, these may be associated with constipation and/or faecal soiling. This paper discusses these considerations in the management of NE.
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Affiliation(s)
- Michael D Harari
- Continence Clinic and Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
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15
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Children Treated for Nocturnal Enuresis: Characteristics and Trends Over a 15-Year Period. CHILD & YOUTH CARE FORUM 2013. [DOI: 10.1007/s10566-013-9195-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Shapira BE, Dahlen P. Therapeutic Treatment Protocol for Enuresis Using an Enuresis Alarm. JOURNAL OF COUNSELING AND DEVELOPMENT 2011. [DOI: 10.1002/j.1556-6678.2010.tb00017.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Primary nocturnal enuresis is a common childhood disorder. Treatment approaches bridge the psychological and medical fields. A substantial body of literature addresses the various ways of treating enuresis, from pharmaceuticals to behavioural interventions. The medical and psychological literatures have proceeded relatively independently from one another and there has been little interconnection between the US and international literatures, resulting in a lack of discourse and integration among researchers investigating treatment outcomes for enuresis. This review examined the evidence base for treatments of primary nocturnal enuresis in children. Psychological, pharmaceutical and multi-component interventions are discussed. This review sought to provide an integrated interdisciplinary and international perspective on treatment efficacy for nocturnal enuresis by expressly gathering publications from psychological and medical fields, as well as US and international sources. The literature supported the urine alarm as the most effective intervention for nocturnal enuresis and demonstrated the benefit of combining the urine alarm with other components, both behavioural and pharmaceutical. In particular, recent literature showed that the urine alarm, when used in conjunction with antidiuretic medication (i.e. desmopressin), leads to more dry nights earlier in the conditioning process. Disparities between the different literatures were discussed.
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Affiliation(s)
- M L Brown
- Department of Psychology, St. John's University, Jamaica, NY 11439, USA
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Anticholinergics Do Not Improve Cure Rate of Alarm Treatment of Monosymptomatic Nocturnal Enuresis. Urology 2011; 77:721-4. [DOI: 10.1016/j.urology.2010.06.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 06/25/2010] [Accepted: 06/25/2010] [Indexed: 11/20/2022]
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Pereira RF, Silvares EFM, Braga PF. Behavioral alarm treatment for nocturnal enuresis. Int Braz J Urol 2010; 36:332-8. [PMID: 20602826 DOI: 10.1590/s1677-55382010000300010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2010] [Indexed: 11/22/2022] Open
Abstract
PURPOSES To investigate the efficacy of alarm treatment in a sample of Brazilian children and adolescents with nocturnal enuresis and relate treatment success to age and type of clinical support. MATERIALS AND METHODS During 32 weeks, 84 children and adolescents received alarm treatment together with weekly psychological support sessions for individual families or groups of 5 to 10 families. RESULTS 71% of the participants achieved success, defined as 14 consecutive dry nights. The result was similar for children and adolescents and for individual or group support. The time until success was shorter for participants missing fewer support sessions. CONCLUSIONS Alarm treatment was effective for the present sample, regardless of age or type of support. Missing a higher number of support sessions, which may reflect low motivation for treatment, increased the risk of failure.
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Affiliation(s)
- Rodrigo F Pereira
- Behavior Therapy Laboratory, Institute of Psychology, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
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van Poecke AJ, Cunliffe C. Chiropractic treatment for primary nocturnal enuresis: a case series of 33 consecutive patients. J Manipulative Physiol Ther 2010; 32:675-81. [PMID: 19836605 DOI: 10.1016/j.jmpt.2009.08.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Revised: 01/08/2009] [Accepted: 01/21/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effect of a specific type of chiropractic treatment on the wet night frequency of patients between the ages of 3 and 18 years who were treated for primary nocturnal enuresis (PNE) in the chiropractic setting. CLINICAL FEATURES Thirty-three consecutive patient records, dating over a 3-year period, of children 3 to 18 years old who had been treated for PNE using a form of chiropractic treatment method (NeuroImpulse Protocol) were included. INTERVENTION AND OUTCOME All patient records were analyzed for a baseline wet night frequency and at 3, 6, 9, and 12 months after the commencement of treatment. Data were collected regarding the number of treatment visits over the 12-month period and the presence of constipation and/or positive family history at presentation. Data were analyzed using descriptive statistics, Friedman's test, and Dunn's Multiple Comparison test. Of the 33 patient records analyzed, 22 showed resolution of PNE during the 12 months after commencement of chiropractic care. The mean number of treatments in the responders group was 2.05 +/- 1.33. Ten responders presented with constipation and a further 8 with a positive family history of PNE. Resolution of constipation was noted to be essential to the successful response to treatment. A combination of constipation and positive family history at presentation represented a poor prognostic factor. CONCLUSIONS There was a 66.6% resolution rate within 1 year in 33 consecutive children and teenagers who experienced PNE. This study provides an indication for possible effectiveness of chiropractic treatment in patients with PNE.
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Rocha MM, Costa NJ, Silvares EFM. Changes in parents' and self-reports of behavioral problems in Brazilian adolescents after behavioral treatment with urine alarm for nocturnal enuresis. Int Braz J Urol 2009; 34:749-57; discussion 757. [PMID: 19111080 DOI: 10.1590/s1677-55382008000600010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2008] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Compare parents' reports of youth problems (PRYP) with adolescent problems self-reports (APSR) pre/post behavioral treatment of nocturnal enuresis (NE) based on the use of a urine alarm. MATERIALS AND METHODS Adolescents (N = 19) with mono-symptomatic (primary or secondary) nocturnal enuresis group treatment for 40 weeks. Discharge criterion was established as 8 weeks with consecutive dry nights. PRYP and APSR were scored by the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR). RESULTS Pre-treatment data: 1) Higher number of clinical cases based on parent report than on self-report for Internalizing Problems (IP) (13/19 vs. 4/19), Externalizing Problems (EP) (7/19 vs. 5/19) and Total Problem (TP) (11/19 vs. 5/19); 2) Mean PRYP scores for IP (60.8) and TP (61) were within the deviant range (T score > or 60); while mean PRYP scores for EP (57.4) and mean APSR scores (IP = 52.4, EP = 49.5, TP = 52.4) were within the normal range. Difference between PRYP' and APSR' scores was significant. Post treatment data: 1) Discharge for majority of the participants (16/19); 2) Reduction in the number of clinical cases on parental evaluation: 9/19 adolescents remained within clinical range for IP, 2/19 for EP, and 7/19 for TP. 3) All post-treatment mean scores were within the normal range; the difference between pre and post evaluation scores was significant for PRYP. CONCLUSIONS The behavioral treatment based on the use of urine alarm is effective for adolescents with mono-symptomatic (primary and secondary) nocturnal enuresis. The study favors the hypothesis that enuresis is a cause, not a consequence, of other behavioral problems.
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Affiliation(s)
- Marina M Rocha
- Psychology Institute, University of Sao Paulo, USP, Sao Paulo, SP, Brazil
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Influence of pelvic floor muscle exercises on full spectrum therapy for nocturnal enuresis. J Urol 2009; 182:2067-71. [PMID: 19695646 DOI: 10.1016/j.juro.2009.04.080] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2008] [Indexed: 11/20/2022]
Abstract
PURPOSE We investigated the effect of pelvic floor muscle training on the efficacy of full spectrum therapy and maximal voided volume in children with nocturnal enuresis. We also determined factors predicting treatment outcome, full spectrum therapy duration and the relapse rate. Full spectrum therapy is a combination of alarm, reward, timed voiding and drinking, over learning and pelvic floor muscle training. MATERIALS AND METHODS A total of 63 consecutive children were referred to the physiotherapy department for full spectrum therapy to resolve nocturnal enuresis, including 32 in the experimental group who underwent full spectrum therapy with pelvic floor muscle training and 31 in the control group who underwent full spectrum therapy without training. RESULTS There was no significant difference in treatment outcome, duration, maximal voided volume and relapse between the 2 groups. Of all children 89% became dry within 6 months. During the year after treatment 33.3% and 37.9% of the experimental and control groups relapsed, while the relapse rate at 1 year was 7.4% and 20.7%, respectively. Age and child motivation were associated with the duration of success (p = 0.04 and <0.01, respectively). Secondary enuresis and psychosocial problems were factors significantly related to relapse (each p <0.01). CONCLUSIONS There is no beneficial effect of including pelvic floor muscle training in full spectrum therapy. Older children and those with better motivation experienced more rapid success. Factors predicting relapse were secondary enuresis and psychosocial problems.
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Gim CSY, Lillystone D, Caldwell PHY. Efficacy of the bell and pad alarm therapy for nocturnal enuresis. J Paediatr Child Health 2009; 45:405-8. [PMID: 19712175 DOI: 10.1111/j.1440-1754.2009.01528.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM (i) To determine the efficacy of bell and pad alarm therapy as an initial and relapse treatment for nocturnal enuresis; (ii) to explore risk factors for treatment failure; and (iii) to explore risk factors for relapse within 12 months of successful bell and pad alarm therapy. METHODS A 22-item questionnaire was sent to 240 children who received bell and pad alarm therapy in a 6-year period via a community centre. The questionnaire recorded demographic characteristics of the child, length of the first bell and pad alarm therapy, outcome of initial treatment and relapse information. RESULTS The initial response and relapse rates of bell and pad alarm therapy were 84 and 30%, respectively. Female gender, absence of diurnal symptoms and willingness to use alarm therapy were associated with better treatment outcomes. Treatment success was associated with shorter treatment length. The success rate of repeating alarm therapy after relapse was 78%, with an average length of treatment of 10 weeks. CONCLUSION The bell and pad alarm therapy is an effective treatment for nocturnal enuresis both as initial therapy and after relapse. The association between patient characteristics and treatment response found in our study may help inform clinicians of likely treatment outcomes, and identify those who may need a different approach.
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Affiliation(s)
- Cindy S Y Gim
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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26
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The efficacy of the addition of short-term desmopressin to alarm therapy in the treatment of primary nocturnal enuresis. Int Urol Nephrol 2008; 40:583-6. [DOI: 10.1007/s11255-008-9355-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2008] [Accepted: 02/11/2008] [Indexed: 10/22/2022]
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Van Hoeck KJ, Bael A, Lax H, Hirche H, Bernaerts K, Vandermaelen V, van Gool JD. Improving the Cure Rate of Alarm Treatment for Monosymptomatic Nocturnal Enuresis by Increasing Bladder Capacity—A Randomized Controlled Trial in Children. J Urol 2008; 179:1122-6; discussion 1126-7. [PMID: 18206946 DOI: 10.1016/j.juro.2007.10.096] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Koen J. Van Hoeck
- Department of Pediatrics, University Hospital Antwerp, Antwerp, Belgium
| | - An Bael
- Department of Pediatrics, University Hospital Antwerp, Antwerp, Belgium
| | - Hildegard Lax
- Institute for Medical Informatics, Biometry and Epidemiology, Essen University, Essen, Germany
| | - Herbert Hirche
- Institute for Medical Informatics, Biometry and Epidemiology, Essen University, Essen, Germany
| | - Kim Bernaerts
- Department of Pediatrics, University Hospital Antwerp, Antwerp, Belgium
| | | | - Jan D. van Gool
- Department of Pediatrics, University Hospital Antwerp, Antwerp, Belgium
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Butler RJ, Holland P, Gasson S, Norfolk S, Houghton L, Penney M. Exploring potential mechanisms in alarm treatment for primary nocturnal enuresis. ACTA ACUST UNITED AC 2008; 41:407-13. [PMID: 17957577 DOI: 10.1080/00365590701571506] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In the treatment of childhood nocturnal enuresis the enuresis alarm has consistently proved effective. However, the various proposals advanced to explain its therapeutic mechanism generally lack empirical support. In this clinical trial we investigated the hypothesis that the alarm promotes reduced nocturnal urine production through increased urine concentration (enabling the child to sleep through the night). MATERIAL AND METHODS Measurements of urinary vasopressin and osmolality were made pre- and post-alarm treatment in a group (n=12) of outpatient children (aged 7-12 years) with severe (more than four times a week) nocturnal enuresis. RESULTS Of the study group, 75% achieved the success criteria, with 89% predominantly sleeping through the night on dry nights, confirming that arousability is unlikely to be the principal mode of action. All those becoming dry showed an increase in urine concentration post-treatment. For half this was associated with an increase in post-treatment vasopressin whilst for the rest, although increases in osmolality were observed, there was no associated increase in vasopressin. CONCLUSIONS Although based on a small sample this study offers an insight into possible therapeutic mechanisms of an enuresis alarm. It suggests that most children who become dry sleep through the night and that increased nocturnal urine concentration (and thus reduced urine volume) is likely to be the means whereby this is achieved. Furthermore, the study suggests two possible mechanisms whereby nocturnal urine concentration is achieved: either increased production of vasopressin or enhanced water transport across the urothelium.
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Affiliation(s)
- Richard J Butler
- Department of Clinical Psychology, Child & Adolescent Mental Health Services, Leeds Primary Care Trust, Leeds, UK.
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Van Hoeck KJ, Bael A, Van Dessel E, Van Renthergem D, Bernaerts K, Vandermaelen V, Lax H, Hirche H, van Gool JD. Do Holding Exercises or Antimuscarinics Increase Maximum Voided Volume in Monosymptomatic Nocturnal Enuresis? A Randomized Controlled Trial in Children. J Urol 2007; 178:2132-6. [PMID: 17870123 DOI: 10.1016/j.juro.2007.07.051] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Indexed: 12/01/2022]
Abstract
PURPOSE We assessed prospectively the efficacy of holding exercises and/or antimuscarinics (oxybutynin chloride and placebo) for increasing maximum voided volume in prepubertal children with monosymptomatic nocturnal enuresis. MATERIALS AND METHODS We randomly allocated 149 children to 5 groups, namely holding exercises with placebo (group A), holding exercises with oxybutynin (group B), placebo alone (group C), oxybutynin alone (group D) and alarm treatment (controls, group E). Maximum voided volume was the greatest voided volume from a 48-hour bladder diary, and holding exercise volume was the greatest volume produced with postponement of voiding after a fluid load, once daily for 4 days. Study medication, holding exercise procedures and alarm treatment were administered for 12 weeks. RESULTS Holding exercises combined with placebo or oxybutynin significantly increased holding exercise volume and maximum voided volume, by 25% (p <0.001) and 21% (p <0.01), respectively, in group A, and by 43% (p <0.001) and 41% (p <0.001), respectively, in group B. Medication without holding exercises (groups C and D) did not increase holding exercise volume or maximum voided volume, and in these groups oxybutynin was not significantly superior to placebo. A borderline increase in holding exercise volume did not affect maximum voided volume in group E. Monosymptomatic nocturnal enuresis response was significantly lower with all 4 holding exercise volume modulating treatments (7%) compared to alarm therapy (73%). CONCLUSIONS In the treatment of children with monosymptomatic nocturnal enuresis maximum voided volume can be increased significantly through holding exercises, but not with oxybutynin chloride alone. Compared to controls, increasing maximum voided volume had a minimal effect on monosymptomatic nocturnal enuresis.
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Affiliation(s)
- Koen J Van Hoeck
- Department of Pediatrics, University Hospital Antwerp, Antwerp, Belgium.
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Arantes MC, Silvares EFDM. Uma comparação entre crianças e adolescentes com enurese noturna primária: impacto e problemas de comportamento. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2007. [DOI: 10.1590/s0103-166x2007000200002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Esse estudo teve como objetivo comparar crianças e adolescentes com enurese noturna primária quanto ao impacto da experiência da enurese e à presença de problemas de comportamento. A pesquisa foi conduzida com um grupo de crianças (n=76) e adolescentes (n=26) inscritos no Projeto Enurese do Instituto de Psicologia da Universidade de São Paulo. Solicitou-se às mães que preenchessem a Lista de Verificação Comportamental para Crianças e Adolescentes. As crianças e os adolescentes responderam a uma entrevista e a partir de suas respostas foram atribuídos graus de impacto da enurese. Tanto nos escores de problemas de comportamento quanto nos graus de impacto não foram encontradas diferenças significativas entre crianças e adolescentes. Os resultados indicaram apenas tendência de as crianças apresentarem uma maior freqüência de escores na faixa clínica e de serem atribuídos graus de impacto maiores às respostas fornecidas pelos adolescentes.
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