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Warne N, Heron J, von Gontard A, Joinson C. Mental health problems, stressful life events and new-onset urinary incontinence in primary school-age children: a prospective cohort study. Eur Child Adolesc Psychiatry 2024; 33:871-879. [PMID: 37095371 PMCID: PMC10894090 DOI: 10.1007/s00787-023-02211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 04/10/2023] [Indexed: 04/26/2023]
Abstract
Emotional/behaviour problems and exposure to stressful life events are thought to contribute to new onset of urinary incontinence (UI) amongst children who have attained bladder control. However, very few prospective studies have examined these associations. We assessed whether mental health problems and stressful life events were associated with subsequent new onset in UI using multivariable logistic regression in a prospective UK cohort (n = 6408). Mothers provided information on their child's symptoms of common mental disorders (Development and Wellbeing Assessment, 7 years), stressful life events (7-8 years) and wetting (day and night, 9 years). There was strong evidence that separation anxiety symptoms were associated with new-onset UI in the fully adjusted model (OR (95% CI) = 2.08 (1.39, 3.13), p < 0.001). Social anxiety, attention-deficit hyperactivity disorder and oppositional defiant disorder symptoms were associated with new-onset UI, but these associations attenuated following adjustment for child developmental level and earlier emotional/behaviour problems. There was weak evidence for a sex interaction with stressful life events (p = 0.065), such that females experiencing more stressful life events were at higher risk of new-onset UI (fully adjusted model OR (95% CI) = 1.66 (1.05, 2.61), p = 0.029), but there was no association in males (fully adjusted model OR (95% CI) = 0.87 (0.52, 1.47), p = 0.608). These results suggest that separation anxiety and stressful life events in girls may lead to an increase in UI.
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Affiliation(s)
- Naomi Warne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Jon Heron
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alexander von Gontard
- Psychiatric Services Graubünden (PDGR), Outpatient Services for Child and Adolescent Psychiatry, Chur, Switzerland
- Governor Kremers Centre, Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Carol Joinson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Allen ES, Kane Low L. Adolescent Women's Perspectives on Barriers and Facilitators to High School Bathroom Use. J Sch Nurs 2022:10598405221142031. [PMID: 36464801 DOI: 10.1177/10598405221142031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Bathroom access and use in conjunction with biological urge to void is an important part of optimal bladder health. School settings are uniquely positioned to influence the development of bladder habits. The aim of this study was to identify barriers and facilitators to high school bathroom use for adolescent women. A qualitative study design was used to conduct semi-structured interviews focused on experiences with bathroom use while at school. Thirty adolescent women were interviewed, and transcripts were analyzed using thematic analysis methods. Barriers included unpleasant bathroom environments, lack of privacy, and school/teacher policies. Facilitators included clean, private bathrooms and menstruation. Improving bathroom cleanliness, privacy, and eliminating policies aimed at controlling bathroom access may reduce barriers to bathroom use. School nurses have a unique role in educating teachers, administrators, and students about the importance of clean bathrooms and policies that support bathroom use in conjunction with biological urge.
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Affiliation(s)
- Elissa S Allen
- Bronson School of Nursing, 4175Western Michigan University, Kalamazoo, MI, USA
| | - Lisa Kane Low
- School of Nursing, 1259University of Michigan, Ann Arbor, MI, USA
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de Wall LL, Nieuwhof-Leppink AJ, van de Wetering EHM, Leijn E, Trompetter M, de Kort LMO, Feitz WF, Schappin R. Study protocol for a parallel-group randomized controlled multi-center trial evaluating the additional effect of continuous ultrasound bladder monitoring in urotherapy for children with functional daytime urinary incontinence (SENS-U trial). Trials 2022; 23:648. [PMID: 35964045 PMCID: PMC9375366 DOI: 10.1186/s13063-022-06600-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022] Open
Abstract
Background Lower urinary tract dysfunction or functional urinary incontinence is a common condition with a prevalence up to 21% between 6 and 8 year-old children. It is associated with an impaired quality of life, lower self-esteem, and social stigmatization. Urotherapy is the first treatment of choice for functional daytime urinary incontinence (DUI) in children. Alarm therapy can be a part of urotherapy as it provides the child adequate feedback on wetting accidents. Current alarm systems notify either at a set interval or give a notification when wetting has already occurred to prompt the child to go to the toilet. These alarms do not teach the child the interpretation of the bladder sensation preceding wetting accidents. A new wearable bladder sensor, the SENS-U, recently became available. This is a relative small, wireless ultrasonic sensor, which continuously monitors bladder filling. The SENS-U is able to provide an alarm at the exact moment voiding is warranted. It facilitates the child to learn the sensation of bladder filling preceding voiding in an easier way, increasing the learning curve throughout treatment. Its additional effect in urotherapy on continence and cost-effectiveness is to be determined. Methods/design This is a multi-center clinical superiority parallel-group randomized controlled trial including a total of 480 children. Participants between 6 and 16 years of age with functional DUI in which urotherapy is offered as the next treatment of choice are eligible. Four centers, two academic hospitals, and two general care (peripheral) centers are participating. Participants will be randomized at a 1:1:1 ratio into three groups: urotherapy (care as usual), urotherapy with the SENS-U added for 3 consecutive weeks throughout the training, or urotherapy with a SHAM device for 3 weeks. The primary outcome is number of wetting accidents per week after 3 months of training, compared between the SENS-U and the SHAM device. The magnitude of the placebo effect will be assessed by comparing the results of the SHAM group versus the control (care as usual) group. Discussion To our knowledge, this is the first trial studying not only the effect but also the cost-effectiveness of alarm interventions as commonly added in urotherapy. Trial registration ISRCTN44345202. Registered on March 2022
Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06600-6.
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Affiliation(s)
- L L de Wall
- Department of Urology, Division of Pediatric Urology, Radboud University Medical Center, Amalia Children's Hospital, Geert Grooteplein Zuid 10, Nijmegen, 6500 HB, The Netherlands.
| | - A J Nieuwhof-Leppink
- Department of Medical Psychology and Social Work, Wilhelmina Children's Hospital Utrecht, Utrecht, The Netherlands
| | - E H M van de Wetering
- Department of Urology, Division of Pediatric Urology, Radboud University Medical Center, Amalia Children's Hospital, Geert Grooteplein Zuid 10, Nijmegen, 6500 HB, The Netherlands.,Department of Medical Psychology and Social Work, Wilhelmina Children's Hospital Utrecht, Utrecht, The Netherlands
| | - E Leijn
- TOP voor Kinderen Practice, Arnhem, The Netherlands
| | - M Trompetter
- Department of Urology, Isala Clinics, Zwolle, The Netherlands
| | - L M O de Kort
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W F Feitz
- Department of Urology, Division of Pediatric Urology, Radboud University Medical Center, Amalia Children's Hospital, Geert Grooteplein Zuid 10, Nijmegen, 6500 HB, The Netherlands
| | - R Schappin
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands
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Camenga DR, Brady SS, Hardacker CT, Williams BR, Hebert-Beirne J, James AS, Burgio K, Nodora J, Wyman JF, Berry A, Low LK. U.S. Adolescent and Adult Women's Experiences Accessing and Using Toilets in Schools, Workplaces, and Public Spaces: A Multi-Site Focus Group Study to Inform Future Research in Bladder Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3338. [PMID: 31510038 PMCID: PMC6765808 DOI: 10.3390/ijerph16183338] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 01/02/2023]
Abstract
The World Health Organization recognizes access to clean and safe toilets as crucial for public health. This study explored U.S. adolescent and adult cisgender women's lived experiences accessing toilets in schools, workplaces, and public spaces. As part of the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium, we conducted 44 focus groups with female participants (n = 360; ages 11-93). Focus groups were stratified by age (11-14, 15-17, 18-25, 26-44, 45-64, 65+) and conducted across 7 geographically diverse U.S. sites from July 2017-April 2018. Using a transdisciplinary approach, we conducted conventional qualitative coding informed by our PLUS conceptual framework and used content analysis processes to identify salient themes. Across settings, toilet access was restricted by "gatekeepers" (i.e., individuals who control access to toilets). In contrast, self-restricting toilet use (deciding not to use the toilet despite biologic need to urinate) was based on internalized norms to prioritize school and job responsibilities over urination. In public spaces, self-restricting use was largely in response to lack of cleanliness. Across the life course, participants perceived gender disparities in the ability to easily access public toilets. Further research is needed to determine if and how these factors impact bladder health across the life course.
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Affiliation(s)
- Deepa R Camenga
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT 06519, USA.
| | - Sonya S Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN 55454, USA.
| | - Cecilia T Hardacker
- Department of Education, Center for Education, Research and Advocacy, Howard Brown Health, Chicago, IL 60613, USA.
| | - Beverly R Williams
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
| | - Jeni Hebert-Beirne
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL 60612, USA.
| | - Aimee S James
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, MO 63110, USA.
| | - Kathryn Burgio
- Department of Medicine, University of Alabama at Birmingham and Department of Veterans Affairs, Birmingham, AL 35233, USA.
| | - Jesse Nodora
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine & Moores Cancer Center, La Jolla, CA 92093, USA.
| | - Jean F Wyman
- School of Nursing, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Amanda Berry
- Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| | - Lisa K Low
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA.
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Joinson C, Grzeda MT, von Gontard A, Heron J. A prospective cohort study of biopsychosocial factors associated with childhood urinary incontinence. Eur Child Adolesc Psychiatry 2019; 28:123-130. [PMID: 29980842 PMCID: PMC6349792 DOI: 10.1007/s00787-018-1193-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
The objective of the study was to examine the association between biopsychosocial factors and developmental trajectories of childhood urinary incontinence (UI). We used developmental trajectories (latent classes) of childhood UI from 4-9 years including bedwetting alone, daytime wetting alone, delayed (daytime and nighttime) bladder control, and persistent (day and night) wetting (n = 8751, 4507 boys, 4244 girls). We examined whether biopsychosocial factors (developmental level, gestational age, birth weight, parental UI, temperament, behaviour/emotional problems, stressful events, maternal depression, age at initiation of toilet training, constipation) are associated with the trajectories using multinomial logistic regression (reference category = normative development of bladder control). Maternal history of bedwetting was associated with almost a fourfold increase in odds of persistent wetting [odds ratio and 95% confidence interval: 3.60 (1.75-7.40)]. In general, difficult temperament and behaviour/emotional problems were most strongly associated with combined (day and night) wetting, e.g. children with behavioural difficulties had increased odds of delayed (daytime and nighttime) bladder control [1.80 (1.59-2.03)]. Maternal postnatal depression was associated with persistent (day and night) wetting [2.09 (1.48-2.95)] and daytime wetting alone [2.38 (1.46-3.88)]. Developmental delay, stressful events, and later initiation of toilet training were not associated with bedwetting alone, but were associated with the other UI trajectories. Constipation was only associated with delayed bladder control. We find evidence that different trajectories of childhood UI are differentially associated with biopsychosocial factors. Increased understanding of factors associated with different trajectories of childhood UI could help clinicians to identify children at risk of persistent incontinence.
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Affiliation(s)
- Carol Joinson
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol, BS8 2BN, UK.
| | - Mariusz T. Grzeda
- 0000 0004 1936 7603grid.5337.2Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol, BS8 2BN UK
| | - Alexander von Gontard
- grid.411937.9Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Jon Heron
- 0000 0004 1936 7603grid.5337.2Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol, BS8 2BN UK
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Bladder-Bowel Dysfunction in Children: Consequences, Risk Factors and Recommendations for Primary Care Interventions. CURRENT PEDIATRICS REPORTS 2018. [DOI: 10.1007/s40124-018-0178-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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