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Smith AL, Berry A, Brubaker L, Cunningham SD, Gahagan S, Low LK, Mueller M, Sutcliffe S, Williams BR, Brady SS. The brain, gut, and bladder health nexus: A conceptual model linking stress and mental health disorders to overactive bladder in women. Neurourol Urodyn 2024; 43:424-436. [PMID: 38078701 PMCID: PMC10872494 DOI: 10.1002/nau.25356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/28/2023] [Accepted: 11/25/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVE A small, but growing literature links stressors and mental health disorders (MHDs) across the life course to overactive bladder (OAB) and urinary incontinence symptoms. Mechanisms by which stressors and MHDs may impact bladder health are not fully understood, limiting novel prevention and treatment efforts. Moreover, potential biopsychosocial mechanisms involving the brain and gut have not been considered in an integrated, comprehensive fashion. METHODS Members of the prevention of lower urinary tract symptoms Research Consortium developed conceptual models to inform research on biopsychosocial mechanisms through which stress and MDHs may impact bladder health among girls and women, focusing on brain and gut physiology. RESULTS Two conceptual models were developed-one to explain central (brain-based) and peripheral (gut-based) mechanisms linking stressors and MHDs to OAB and bladder health, and one to highlight bidirectional communication between the brain, gut, and bladder. Traumatic events, chronic stressors, and MHDs may lead to a maladaptive stress response, including dysregulated communication and signaling between the brain, gut, and bladder. Gut bacteria produce molecules and metabolites that alter production of neurotransmitters, amino acids, short-chain fatty acids, and inflammatory immune response molecules that mediate communication between the gut and brain. Microbiota signal neurogenesis, microglia maturation, and synaptic pruning; they also calibrate brain-gut-bladder axis communication through neurotransmission and synaptogenesis, potentially influencing bladder symptom development. Life course trajectories of risk may be prevented or interrupted by central and peripheral resources for neuropsychological resilience. CONCLUSIONS Depicted pathways, including brain-gut-bladder communication, have implications for research and development of novel prevention and treatment approaches.
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Affiliation(s)
- Ariana L. Smith
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Amanda Berry
- Division of Urology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Linda Brubaker
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, University of California San Diego, La Jolla, California
| | - Shayna D. Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT
| | - Sheila Gahagan
- Department of Pediatrics, UC San Diego School of Medicine, University of California, San Diego CA
| | - Lisa Kane Low
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan
| | - Margaret Mueller
- Department of Ob/Gyn, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO
| | - Beverly R. Williams
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham (UAB) and Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs
| | - Sonya S. Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN
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Carvalho TA, Vasconcelos MMDA, Guimarães ICDO, Dutra MF, Lima EM, Bastos Netto JM, de Bessa Junior J, Simões E Silva AC, de Carvalho Mrad FC. Relationship between toilet training process and primary nocturnal enuresis in children and adolescents - A systematic review. J Pediatr Urol 2022; 18:554-562. [PMID: 35987679 DOI: 10.1016/j.jpurol.2022.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/06/2022] [Accepted: 07/28/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Primary nocturnal enuresis (PNE) affects the quality of life of children and families and may lead to low self-esteem and social isolation. The pathophysiology of enuresis is multifactorial. This systematic review aimed to investigate the relationship between toilet training (TT) and PNE in children and adolescents. METHODS We searched for articles about TT and PNE in MEDLINE (via PubMed), SCOPUS and WEB of SCIENCE databases. The Preferred Reporting Items for Systematic Reviews (PRISMA) statement was used to guide the systematic review. Prior to the study, the review protocol was registered and approved in PROSPERO under the protocol CRD42021270976. The Risk of Bias in Non-Randomized Studies of Exposures (ROBINS-E) was used to analyze the biases of the select studies. RESULTS A total of 570 studies were initially selected. Of these, eight articles were included in this systematic review, with a total number of 5990 participants aged between 5 and 18 years diagnosed with PNE. Seven of the eight articles reported that prolonged use of disposable diapers for more than one-year, late initiation of the TT process or non-acceptance of the Assisted Infant TT or Elimination Communication approach, use of coercive approaches, and complete of TT after 24 months of age increase the risk of enuresis. Only one of the selected studies did not find an association between the start of TT after 24 months of age and the presence of isolated PNE. Three studies did not mention the approach used in the TT process. CONCLUSION Most of the articles reviewed showed that prolonged diaper use, delay in the start or completion of the TT and use of coercive approaches increase the risk of enuresis. On the other hand, one study showed no relationship between the start of TT after 24 months of age and the presence of isolated enuresis.
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Affiliation(s)
- Tânia Antunes Carvalho
- Universidade Federal de Minas Gerais (UFMG), Faculty of Medicine- Pediatrics Department, Pediatric Nephrology Unit- Hospital Das Clínicas da UFMG, Brazil.
| | - Mônica Maria de Almeida Vasconcelos
- Universidade Federal de Minas Gerais (UFMG), Faculty of Medicine- Pediatrics Department, Pediatric Nephrology Unit- Hospital Das Clínicas da UFMG, Brazil.
| | - Isabela Cristina de Oliveira Guimarães
- Universidade Federal de Minas Gerais (UFMG), Faculty of Medicine- Pediatrics Department, Pediatric Nephrology Unit- Hospital Das Clínicas da UFMG, Brazil.
| | - Melissa Faria Dutra
- Federal University of Minas Gerais (UFMG), Faculty of Medicine- Pediatrics Department, Pediatric Nephrology Unit- Hospital Das Clínicas da UFMG, Brazil.
| | - Eleonora Moreira Lima
- Universidade Federal de Minas Gerais (UFMG), Faculty of Medicine- Pediatrics Department, Pediatric Nephrology Unit- Hospital Das Clínicas da UFMG, Brazil.
| | - José Murillo Bastos Netto
- Universidade Federal de Juiz de Fora, School of Medicine, Urology Department, Brazil; Faculdade de Ciências Médicas de Juiz de Fora e Maternidade Therezinha de Jesus, Urology Department, Brazil.
| | | | - Ana Cristina Simões E Silva
- Universidade Federal de Minas Gerais (UFMG), Faculty of Medicine- Pediatrics Department, Pediatric Nephrology Unit- Hospital Das Clínicas da UFMG, Brazil; Interdisciplinary Laboratory of Medical Investigation, UFMG, Brazil.
| | - Flávia Cristina de Carvalho Mrad
- Universidade Federal de Minas Gerais (UFMG), Faculty of Medicine- Pediatrics Department, Pediatric Nephrology Unit- Hospital Das Clínicas da UFMG, Brazil.
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Acikgoz A, Baskaya M, Cakirli M, Cemrek F, Tokar B. The evaluation of urinary incontinence in secondary school children and risk factors: An epidemiological study. Int J Clin Pract 2021; 75:e14657. [PMID: 34322969 DOI: 10.1111/ijcp.14657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/26/2021] [Indexed: 01/17/2023] Open
Abstract
AIM Urinary incontinence is an important problem that can arise due to neurogenic or functional reasons and negatively affect the psychological, social and personality development of children. This study was conducted on secondary school students to determine the prevalence and risk factors of urinary incontinence at night and/or in the daytime. METHODS The study universe included all secondary school students attending public elementary schools in the city centre of Eskişehir (N = 34 000). Ethics Committee and Provincial Directorate of National Education approvals were obtained before conducting the study. A data collection form prepared by the researchers and a consent form were delivered in a sealed envelope to the parents via the students. The study data were collected over the period 09 May 2018-30 May 2018. A total of 6957 questionnaires that were fully completed among the 7370 surveys were taken into consideration. The statistical analysis was carried out using the SPSS software package. RESULTS The number of children found to have urinary incontinence was 215 (3.1%). It was seen that 33 children had urinary incontinence only in the daytime, 61 children experienced it both at night and during the day and 121 children at night. It was observed that 56% of the children suffering from urinary incontinence had not applied to any health facility for treatment prior to the study. It was found that among the risk factors for urinary incontinence were young age, late start of toilet training and presence of a family history of urinary incontinence. CONCLUSIONS Children with urinary incontinence and their families need medical information and support to reach the root of the problem and seek solutions. Accompanying pathologies in detected cases can be determined in the early period by means of school screenings, and medical evaluation and support can prevent adverse effects on children's psychosocial and personality development.
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Affiliation(s)
- Ayfer Acikgoz
- Faculty of Health Sciences, Department of Child Health and Disease Nursing, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Mukaddes Baskaya
- Faculty of Health Sciences, Department of Nursing, Gazi University, Ankara, Turkey
| | - Merve Cakirli
- Faculty of Health Sciences, Department of Child Health and Disease Nursing, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Fatih Cemrek
- Faculty of Science and Art, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Baran Tokar
- Faculty of Medicine, Department of Paediatric Surgery, Osmangazi University, Eskisehir, Turkey
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Vasconcelos MMDA, Bastos JM, Arana IE, Teixeira IB, Lima EM, Carvalho TA, de Bessa J, Mrad FCDC. Association between Attention Deficit Hyperactivity Disorder and lower urinary tract symptoms in children and adolescents in a community setting. Int Braz J Urol 2021; 47:969-978. [PMID: 34260173 PMCID: PMC8321464 DOI: 10.1590/s1677-5538.ibju.2020.0978] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 04/07/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The present study aims to investigate the prevalence of lower tract urinary symptoms (LUTS) and symptoms of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents and their association in a community setting using validated scoring instruments. MATERIALS AND METHODS A cross-sectional study was carried out from February 2015 to December 2019, during which the parents or guardians of 431 children and adolescents from 5 to 13 years of age, attending a general pediatric outpatient clinic were interviewed. RESULTS The prevalence of ADHD symptoms and LUTS were 19.9% and 17.9%, respectively. Of the 82 children and adolescents with ADHD, 28% (23) had LUTS (OR 2.31, 95% CI 1.28 to 3.75, p=0.008). Mean total DVSS score in children in the group of children presenting ADHD symptom was significantly higher than those without ADHD symptom (10.2±4.85 vs. 4.9±2.95, p=0.002). Urgency prevailed among LUTS as the most frequent symptom reported by patients with ADHD symptoms (p=0.004). Analyzing all subscales of the DVSS, the items "When your child wants to pee, can't he wait? "Your child holds the pee by crossing his legs, crouching or dancing?" were higher in those with ADHD symptoms (p=0.01 and 0.02, respectively). Functional constipation was present in 36.4% of children with LUTS and 20.7% without LUTS (OR 4.3 95% CI 1-5.3 p=0.001). CONCLUSION Children and adolescents with ADHD symptoms are 2.3 times more likely to have LUTS. The combined type of ADHD was the most prevalent among them.
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Affiliation(s)
- Mônica Maria de Almeida Vasconcelos
- Universidade Federal de Minas GeraisUnidade de NefrologiaDepartamento de PediatriaBelo HorizonteMGBrasilDepartamento de Pediatria, Unidade de Nefrologia, Universidade Federal de Minas Gerais, Unidade de Nefrologia, Belo Horizonte, MG, Brasil
| | - José Murillo Bastos
- Faculdade de Ciências Médicas e da Saúde de Juiz de ForaDepartamento de UrologiaJuiz de ForaMGBrasilDepartamento de Urologia, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Juiz de Fora, MG, Brasil
- Hospital e Maternidade Terezinha de JesusJuiz de ForaMGBrasilHospital e Maternidade Terezinha de Jesus, Juiz de Fora, MG, Brasil
| | - Isaac Eduardo Arana
- Faculdade de Ciências Médicas e da Saúde de Juiz de ForaDepartamento de UrologiaJuiz de ForaMGBrasilDepartamento de Urologia, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Isabela Benevenuto Teixeira
- Faculdade de Ciências Médicas e da Saúde de Juiz de ForaDepartamento de UrologiaJuiz de ForaMGBrasilDepartamento de Urologia, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Eleonora Moreira Lima
- Universidade Federal de Minas GeraisUnidade de NefrologiaDepartamento de PediatriaBelo HorizonteMGBrasilDepartamento de Pediatria, Unidade de Nefrologia, Universidade Federal de Minas Gerais, Unidade de Nefrologia, Belo Horizonte, MG, Brasil
| | - Tânia Antunes Carvalho
- Universidade Federal de Minas GeraisUnidade de NefrologiaDepartamento de PediatriaBelo HorizonteMGBrasilDepartamento de Pediatria, Unidade de Nefrologia, Universidade Federal de Minas Gerais, Unidade de Nefrologia, Belo Horizonte, MG, Brasil
| | - José de Bessa
- Universidade Estadual de Feira de SantanaDepartamento de UrologiaSantanaBABrasilDepartamento de Urologia, Universidade Estadual de Feira de Santana, BA, Brasil
| | - Flávia Cristina de Carvalho Mrad
- Universidade Federal de Minas GeraisUnidade de NefrologiaDepartamento de PediatriaBelo HorizonteMGBrasilDepartamento de Pediatria, Unidade de Nefrologia, Universidade Federal de Minas Gerais, Unidade de Nefrologia, Belo Horizonte, MG, Brasil
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Sanchez Russo R, Gambello MJ, Murphy MM, Aberizk K, Black E, Burrell TL, Carlock G, Cubells JF, Epstein MT, Espana R, Goines K, Guest RM, Klaiman C, Koh S, Leslie EJ, Li L, Novacek DM, Saulnier CA, Sefik E, Shultz S, Walker E, White SP, Mulle JG. Deep phenotyping in 3q29 deletion syndrome: recommendations for clinical care. Genet Med 2021; 23:872-880. [PMID: 33564151 PMCID: PMC8105170 DOI: 10.1038/s41436-020-01053-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/20/2020] [Accepted: 11/20/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To understand the consequences of the 3q29 deletion on medical, neurodevelopmental, psychiatric, brain structural, and neurological sequalae by systematic evaluation of affected individuals. To develop evidence-based recommendations using these data for effective clinical care. METHODS Thirty-two individuals with the 3q29 deletion were evaluated using a defined phenotyping protocol and standardized data collection instruments. RESULTS Medical manifestations were varied and reported across nearly every organ system. The most severe manifestations were congenital heart defects (25%) and the most common were gastrointestinal symptoms (81%). Physical examination revealed a high proportion of musculoskeletal findings (81%). Neurodevelopmental phenotypes represent a significant burden and include intellectual disability (34%), autism spectrum disorder (38%), executive function deficits (46%), and graphomotor weakness (78%). Psychiatric illness manifests across the lifespan with psychosis prodrome (15%), psychosis (20%), anxiety disorders (40%), and attention deficit-hyperactivity disorder (ADHD) (63%). Neuroimaging revealed structural anomalies of the posterior fossa, but on neurological exam study subjects displayed only mild or moderate motor vulnerabilities. CONCLUSION By direct evaluation of 3q29 deletion study subjects, we document common features of the syndrome, including a high burden of neurodevelopmental and neuropsychiatric phenotypes. Evidence-based recommendations for evaluation, referral, and management are provided to help guide clinicians in the care of 3q29 deletion patients.
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Affiliation(s)
| | - Michael J Gambello
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Melissa M Murphy
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Katrina Aberizk
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Emily Black
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - T Lindsey Burrell
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Marcus Autism Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA
| | - Grace Carlock
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Joseph F Cubells
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael T Epstein
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, GA, USA
| | - Roberto Espana
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Katrina Goines
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Ryan M Guest
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Cheryl Klaiman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Marcus Autism Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA
| | - Sookyong Koh
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Elizabeth J Leslie
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Longchuan Li
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Marcus Autism Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA
| | - Derek M Novacek
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Desert Pacific Mental Illness, Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Celine A Saulnier
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Neurodevelopmental Assessment & Consulting Services, Atlanta, GA, USA
| | - Esra Sefik
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Sarah Shultz
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Marcus Autism Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA
| | - Elaine Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Stormi Pulver White
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Marcus Autism Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer Gladys Mulle
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Bastos JM, de Paula JC, Bastos CR, Soares DG, de Castro NCT, Sousa KKDV, do Carmo AV, de Miranda RL, Mrad FCDC, de Bessa J. Personal and familial factors associated with toilet training. Int Braz J Urol 2021; 47:169-177. [PMID: 33047922 PMCID: PMC7712689 DOI: 10.1590/s1677-5538.ibju.2020.0129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/30/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose: Toilet training (TT) is an important marker in a child's physical and psychosocial development. The present study aimed to evaluate aspects associated to delayed TT. Material and Methods: We interviewed 372 parents of children who had completed TT up to 48 months before the interview. The questionnaires were applied at school exits when parents went to pick their children up and at public parks. Questions included demographics, aspects related to TT, dysfunction voiding symptom score and evaluation of constipation. Results: The interviews were performed at a mean of 15.3±10.4 (0 to 47) months after the end of TT. Girls accounted for 53% of the sample. The mean age at finishing TT was 31.6±9.3 months and similar in both genders (p=0.77). TT occurred before school entry in 45.7% of the children and medical advice for TT was sought only by 4.8% of the parents. No association was observed of age at completing TT and presence of lower urinary tract symptoms (LUTS) (p=0.57) and/or constipation (p=0.98). In the univariate analysis, prematurity (OR=2.7 [95% CI 2.3-3.1], p <0.0001) and mothers who work outside their household (OR=1.8 [95% CI 1.4-2.3], p <0.0001) were associated to delayed TT. Conclusion: Children completed TT at a mean of 2 years and 7 months of age. The age of completing TT was not related to LUTS and/or constipation. Premature children and those whose mothers work outside the home finish TT later.
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Affiliation(s)
- José Murillo Bastos
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora - SUPREMA, Juiz de Fora, MG, Brasil.,Faculdade de Medicina da Universidade Federal de Juiz de Fora - UFJF, Juiz de Fora, MG, Brasil
| | | | | | | | | | | | | | | | - Flávia Cristina de Carvalho Mrad
- Unidade de Nefrologia Pediátrica, Faculdade de Medicina de Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, MG, Brasil
| | - José de Bessa
- Faculdade de Medicina de Universidade Estadual de Feira de Santana - UEFS, Feira de Santana, BA, Brasil
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Axelrod MI, Larsen RJ, Jorgensen K, Stratman B. Psychological differences between toilet trained and non-toilet trained 4-year-old children. J SPEC PEDIATR NURS 2021; 26:e12319. [PMID: 33140518 DOI: 10.1111/jspn.12319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 10/12/2020] [Accepted: 10/20/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Late to complete toilet training has been associated with many psychological factors including behavior and mood problems. Unfortunately, the majority of the research is specific to children with elimination disorders or children identified as incontinent after the age of 7 years. The current study addressed gaps in the literature by comparing the psychological functioning of children not toilet trained by their 4-year-old well child care visit with their toilet trained peers. DESIGN AND METHODS Parent reports of internalizing and externalizing behavior using the Child Behavior Checklist (CBCL) were compared across groups, non-toilet trained and toilet trained, for 150 children recruited during their 4-year-old well child health care visit. Independent samples t tests of group means and χ2 analyses were performed on all CBCL scales. RESULTS Results found no clinically or statistically significant differences between groups on parents' reports of internalizing and externalizing behavior. The current study provides no evidence that delays in successfully completing toilet training by 4 years of age were related to psychological problems for this sample of children. PRACTICE IMPLICATIONS Nursing professionals in primary care settings are positioned to provide anticipatory guidance to parents of children not yet toilet trained. Findings from the current study offer evidence that delays in toilet training might not be related to psychopathology, and these children are not likely to require intervention outside the pediatric setting and could be effectively managed by primary care health providers employing evidence-based toilet training protocols.
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Affiliation(s)
- Michael I Axelrod
- Department of Psychology, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Ray J Larsen
- Department of Allergy and Infectious Disease, University of Washington School of Medicine, Seattle, Washington, USA
| | - Keith Jorgensen
- Department of Dermatology, CentraCare Clinic Health Plaza, St. Cloud, Minnesota, USA
| | - Bobbie Stratman
- College of Podiatric Medicine and Surgery, Des Moines University, Des Moines, Iowa, USA
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Hamed SA, Fawzy M, Hamed EA. Behavioral problems in children with primary monosymptomatic nocturnal enuresis. Compr Psychiatry 2021; 104:152208. [PMID: 33186836 DOI: 10.1016/j.comppsych.2020.152208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/21/2020] [Accepted: 09/24/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Primary monosymptomatic nocturnal enuresis (PMNE) is a common distressing condition to children and parents. This study aimed to determine frequencies, severities and characteristics of behavioral problems with PMNE. METHODS This cross-sectional study included 80 children with PMNE (age: 12.58 ± 1.24 yrs.; boys = 58, girls = 22) and 60 healthy children. Behavioral symptoms were assessed by Strength and Difficulties Questionnaire (SDQ). RESULTS This study included 80 children (boys/girls ratio = 2.64:1) with PMNE. They had mean age of 12.58 ± 1.24 yrs. The majority (70%) had good response to medical treatment. Compared to controls, children with enuresis had higher frequencies of emotional, conduct and hyperactivity-inattention symptoms and peer relationship and prosocial problems and higher total (P = 0.001) and different subscales' scores of SDQ. There was an overlap of behavioral problems in 52.2% of children with nocturnal enuresis. Compared to children without behavioral symptoms, children with behavioral symptoms were significantly older at age at presentation (P = 0.046) regardless of gender, residence and type or response to medications. Multiple regression analysis showed that emotional [β = 0.053 (95%CI = 0.037-0.084), P = 0.024] and hyperactivity-inattention symptoms [β = 0.063 (95%CI = 0.028-0.097), P = 0.001] were significantly associated with enuresis independent to other problems. CONCLUSION PMNE is associated with higher risk of behavioral problems particularly emotional and hyperactivity-inattention symptoms indicating externalizing and internalizing problems, therefore, the importance of early non-pharmacological or/and drug interventions. The comorbid behavioral disorders should be treated separately according to evidence-based recommendations to prevent persistence of enuresis and the development of psychiatric disorders in the future.
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Affiliation(s)
- Sherifa Ahmed Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt.
| | - Mohamed Fawzy
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
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Mota DM, Matijasevich A, Santos IS, Petresco S, Mota LM. Psychiatric disorders in children with enuresis at 6 and 11 years old in a birth cohort. J Pediatr (Rio J) 2020; 96:318-326. [PMID: 30726712 PMCID: PMC9432106 DOI: 10.1016/j.jped.2018.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/03/2018] [Accepted: 11/19/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Enuresis may have a negative impact on the self-image in childhood and adolescence. The objective of this study was to evaluate the association between enuresis and psychiatric disorders at 6 and 11 years of age. METHOD 3,356 children of a birth cohort were evaluated. A standard questionnaire on urinary habits and mental health (Development and Well-Being Assessment [DAWBA]), was used. The prevalence of psychiatric disorders pursuant to the existence of enuresis and its subtypes (monosymptomatic and non-monosymptomatic), stratified by sex, was described. A logistic regression was used for adjusted analysis. RESULTS The prevalence of enuresis at age 6 years was of 10.2% (9% non-monosymptomatic) and, at 11 years old, of 5.4% (4.5% non-monosymptomatic). At age 6 years, boys with non-monosymptomatic enuresis showed more hyperactivity disorders than those without enuresis (6.2% vs. 2.7%, p=0.017). At 11 years old, after adjustment, among the boys with non-monosymptomatic enuresis, the prevalence of any psychiatric disorder, hyperactivity disorders, and oppositional disorders was, respectively, 3.2, 3.4, and 2.6 times higher than in boys without enuresis; and, among the girls with non-monosymptomatic enuresis, the prevalence of any psychiatric disorder and oppositional disorders was, respectively, 4 and 5.5 times higher than among girls without enuresis. CONCLUSION There is a strong association between non-monosymptomatic enuresis and psychiatric disorders at 6 and 11 years old.
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Affiliation(s)
- Denise M Mota
- Universidade Federal de Pelotas (UFPel), Departamento Materno-Infantil, Pelotas, RS, Brazil.
| | - Alicia Matijasevich
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), Departamento de Medicina Preventiva, São Paulo, SP, Brazil
| | - Iná S Santos
- Universidade Federal de Pelotas (UFPel), Programa de Pós-graduação em Epidemiologia, Pelotas, RS, Brazil
| | - Sandra Petresco
- Psiquiatra da Infância e Adolescência, Porto Alegre, RS, Brazil
| | - Laís Marques Mota
- Universidade Federal do Rio Grande do Sul (UFRGS), Medicina Interna, Porto Alegre, RS, Brazil Received 22 Agust 2018; accepted 6 November 2018
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Mota DM, Matijasevich A, Santos IS, Petresco S, Mota LM. Psychiatric disorders in children with enuresis at 6 and 11 years old in a birth cohort. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Lukacz ES, Bavendam TG, Berry A, Fok CS, Gahagan S, Goode PS, Hardacker CT, Hebert-Beirne J, Lewis CE, Lewis J, Low LK, Lowder JL, Palmer MH, Smith AL, Brady SS. A Novel Research Definition of Bladder Health in Women and Girls: Implications for Research and Public Health Promotion. J Womens Health (Larchmt) 2018; 27:974-981. [PMID: 29792542 DOI: 10.1089/jwh.2017.6786] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Bladder health in women and girls is poorly understood, in part, due to absence of a definition for clinical or research purposes. This article describes the process used by a National Institutes of Health funded transdisciplinary research team (The Prevention of Lower Urinary Tract Symptoms [PLUS] Consortium) to develop a definition of bladder health. METHODS The PLUS Consortium identified currently accepted lower urinary tract symptoms (LUTS) and outlined elements of storage and emptying functions of the bladder. Consistent with the World Health Organization's definition of health, PLUS concluded that absence of LUTS was insufficient and emphasizes the bladder's ability to adapt to short-term physical, psychosocial, and environmental challenges for the final definition. Definitions for subjective experiences and objective measures of bladder dysfunction and health were drafted. An additional bioregulatory function to protect against infection, neoplasia, chemical, or biologic threats was proposed. RESULTS PLUS proposes that bladder health be defined as: "A complete state of physical, mental, and social well-being related to bladder function and not merely the absence of LUTS. Healthy bladder function permits daily activities, adapts to short-term physical or environmental stressors, and allows optimal well-being (e.g., travel, exercise, social, occupational, or other activities)." Definitions for each element of bladder function are reported with suggested subjective and objective measures. CONCLUSIONS PLUS used a comprehensive transdisciplinary process to develop a bladder health definition. This will inform instrument development for evaluation of bladder health promotion and prevention of LUTS in research and public health initiatives.
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Affiliation(s)
- Emily S Lukacz
- 1 Division of Female Pelvic Medicine and Reconstructive Surgery, University of California San Diego , San Diego, California
| | - Tamara G Bavendam
- 2 National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health , Bethesda, Maryland
| | - Amanda Berry
- 3 Division of Urology, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania
| | - Cynthia S Fok
- 4 Department of Urology, University of Minnesota , Minneapolis, Minnesota
| | - Sheila Gahagan
- 5 Division of Academic General Pediatrics, University of California San Diego , San Diego, California
| | - Patricia S Goode
- 6 Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham , Birmingham, Alabama.,7 Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center , Birmingham, Alabama
| | - Cecilia T Hardacker
- 8 Howard Brown Health, Rush University College of Nursing , Chicago, Illinois
| | - Jeni Hebert-Beirne
- 9 Division of Community Health Sciences, University of Illinois at Chicago , School of Public Health, Chicago, Illinois
| | - Cora E Lewis
- 10 Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Jessica Lewis
- 11 Yale School of Public Health , New Haven, Connecticut
| | - Lisa Kane Low
- 12 University of Michigan School of Nursing , Ann Arbor, Michigan
| | - Jerry L Lowder
- 13 Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University in St. Louis School of Medicine , St. Louis, Missouri
| | - Mary H Palmer
- 14 School of Nursing, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Ariana L Smith
- 15 Division of Urology, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Sonya S Brady
- 16 Division of Epidemiology and Community Health, University of Minnesota School of Public Health , Minneapolis, Minnesota
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