| 1. |
- Al-Mashhadi, Ammar, et al.
(author)
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Changes of arterial pressure following relief of obstruction in adults with hydronephrosis
- 2018
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In: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 123:4, s. 216-224
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Journal article (peer-reviewed)abstract
- Background: As much as 20% of all cases of hypertension are associated with kidney malfunctions. We have previously demonstrated in animals and in pediatric patients that hydronephrosis causes hypertension, which was attenuated by surgical relief of the ureteropelvic junction (UPJ) obstruction. This retrospective cohort study aimed to investigate: (1) the proposed link between hydronephrosis, due to UPJ obstruction, and elevated arterial pressure in adults; and (2) if elevated blood pressure in patients with hydronephrosis might be another indication for surgery.Materials and methods: Medical records of 212 patients undergoing surgical management of hydronephrosis, due to UPJ obstruction, between 2000 and 2016 were assessed. After excluding patients with confounding conditions and treatments, paired arterial pressures (i.e. before/after surgery) were compared in 49 patients (35 years old; 95% CI 29–39). Split renal function was evaluated by using mercaptoacetyltriglycine (MAG3) renography before surgical management of the hydronephrotic kidney.Results: Systolic (−11 mmHg; 95% CI 6–15 mmHg), diastolic (−8 mmHg; 95% CI 4–11 mmHg), and mean arterial (-9 mmHg; 95% CI 6–12) pressures were significantly reduced after relief of the obstruction (p < 0.001). Split renal function of the hydronephrotic kidney was 39% (95% CI 37–41). No correlations were found between MAG3 and blood pressure level before surgery or between MAG3 and the reduction of blood pressure after surgical management of the UPJ obstruction.Conclusions: In adults with hydronephrosis, blood pressure was reduced following relief of the obstruction. Our findings suggest that elevated arterial pressure should be taken into account as an indication to surgically correct hydronephrosis.
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| 2. |
- Al-Mashhadi, Ammar Nadhom Farman, et al.
(author)
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Changes in arterial pressure and markers of nitric oxide homeostasis and oxidative stress following surgical correction of hydronephrosis in children
- 2018
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In: Pediatric nephrology (Berlin, West). - : Springer. - 0931-041X .- 1432-198X. ; 33:4, s. 639-649
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Journal article (peer-reviewed)abstract
- Objective Recent clinical studies have suggested an increased risk of elevated arterial pressure in patients with hydronephrosis. Animals with experimentally induced hydronephrosis develop hypertension, which is correlated to the degree of obstruction and increased oxidative stress. In this prospective study we investigated changes in arterial pressure, oxidative stress, and nitric oxide (NO) homeostasis following correction of hydronephrosis.Methods Ambulatory arterial pressure (24 h) was monitored in pediatric patients with hydronephrosis (n = 15) before and after surgical correction, and the measurements were compared with arterial pressure measurements in two control groups, i.e. healthy controls (n = 8) and operated controls (n = 8). Markers of oxidative stress and NO homeostasis were analyzed in matched urine and plasma samples.Results The preoperative mean arterial pressure was significantly higher in hydronephrotic patients [83 mmHg; 95% confidence interval (CI) 80–88 mmHg] than in healthy controls (74 mmHg; 95% CI 68–80 mmHg; p < 0.05), and surgical correction of ureteral obstruction reduced arterial pressure (76 mmHg; 95% CI 74–79 mmHg; p < 0.05). Markers of oxidative stress (i.e., 11- dehydroTXB2, PGF2α, 8-iso-PGF2α, 8,12-iso-iPF2α-VI) were significantly increased (p < 0.05) in patients with hydronephrosis compared with both control groups, and these were reduced following surgery (p < 0.05). Interestingly, there was a trend for increased NO synthase activity and signaling in hydronephrosis, which may indicate compensatory mechanism(s).Conclusion This study demonstrates increased arterial pressure and oxidative stress in children with hydronephrosis compared with healthy controls, which can be restored to normal levels by surgical correction of the obstruction. Once reference data on ambulatory blood pressure in this young age group become available, we hope cut-off values can be defined for deciding whether or not to correct hydronephrosis surgically.Keywords Blood pressure . Hydronephrosis . Hypertension . Nitric oxide . Oxidative stress . Ureteral obstruction
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| 3. |
- Al-Mashhadi, Ammar Nadhom Farman, et al.
(author)
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Surgical treatment reduces blood pressure in children with unilateral congenital hydronephrosis
- 2015
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In: Journal of Pediatric Urology. - : Elsevier BV. - 1477-5131 .- 1873-4898. ; 11:2, s. 91.e1-91.e6
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Journal article (peer-reviewed)abstract
- Objective Renal disorders can cause hypertension, but less is known about the influence of hydronephrosis on blood pressure. Hydronephrosis due to pelvo-ureteric junction obstruction (PUJO) is a fairly common condition (incidence in newborns of 0.5-1%). Although hypertensive effects of hydronephrosis have been suggested, this has not been substantiated by prospective studies in humans [1-3]. Experimental studies with PUJO have shown that animals with induced hydronephrosis develop salt-sensitive hypertension, which strongly correlate to the degree of obstruction [4-7]. Moreover, relief of the obstruction normalized blood pressure [8]. In this first prospective study our aim was to study the blood pressure pattern in pediatric patients with hydronephrosis before and after surgical correction of the ureteral obstruction. Specifically, we investigated if preoperative blood pressure is reduced after surgery and if split renal function and renographic excretion curves provide any prognostic information. Patients and methods Twelve patients with unilateral congenital hydronephrosis were included in this prospective study. Ambulatory blood pressure (24 h) was measured preoperatively and six months after surgery. Preoperative evaluations of bilateral renal function by Tc99m-MAG3 scintigraphy, and renography curves, classified according to O'Reilly, were also performed. Results As shown in the summary figure, postoperative systolic (103 +/- 2 mmHg) and diastolic (62 +/- 2 mmHg) blood pressure were significantly lower than those obtained preoperatively (110 +/- 4 and 69 +/- 2 mmHg, respectively), whereas no changes in circadian variation or pulse pressure were observed. Renal functional share of the hydronephrotic kidney ranged from 11 to 55%. There was no correlation between the degree of renal function impairment and the preoperative excretory pattern, or between the preoperative excretory pattern and the blood pressure reduction postoperatively. However, preoperative MAG3 function of the affected kidney correlated with the magnitude of blood pressure change after surgery. Discussion Correction of the obstruction lowered blood pressure, and the reduction in blood pressure appeared to correlate with the degree of renal functional impairment, but not with the excretory pattern. Thus, in the setting of hypertension, it appears that the functional share of the hydronephrotic kidney should be considered an indicator of the need for surgery, whereas the renography curve is less reliable. The strength of the present study is the prospective nature and that ambulatory blood pressure monitoring was used. Future longitudinal prolonged follow-up studies are warranted to confirm the present findings, and to understand if a real nephrogenic hypertension with potential necessity of treatment will develop. Conclusion This novel prospective study in patients with congenital hydronephrosis demonstrates a reduction in blood pressure following relief of the obstruction. Based on the present results, we propose that the blood pressure level should also be taken into account when deciding whether to correct hydronephrosis surgically or not.
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| 4. |
- Austin, Paul F., et al.
(author)
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The standardization of terminology of lower urinary tract function in children and adolescents : Update report from the standardization committee of the International Children's Continence Society
- 2016
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In: Neurourology and Urodynamics. - : Wiley. - 0733-2467 .- 1520-6777. ; 35:4, s. 471-481
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Journal article (peer-reviewed)abstract
- AimThe impact of the original International Children's Continence Society (ICCS) terminology document on lower urinary tract (LUT) function resulted in the global establishment of uniformity and clarity in the characterization of LUT function and dysfunction in children across multiple healthcare disciplines. The present document serves as a stand-alone terminology update reflecting refinement and current advancement of knowledge on pediatric LUT function. MethodsA variety of worldwide experts from multiple disciplines within the ICCS leadership who care for children with LUT dysfunction were assembled as part of the standardization committee. A critical review of the previous ICCS terminology document and the current literature was performed. Additionally, contributions and feedback from the multidisciplinary ICCS membership were solicited. ResultsFollowing a review of the literature over the last 7 years, the ICCS experts assembled a new terminology document reflecting current understanding of bladder function and LUT dysfunction in children using the resources from the literature review, expert opinion and ICCS member feedback. ConclusionsThe present ICCS terminology document provides a current and consensus update to the evolving terminology and understanding of LUT function in children.
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| 5. |
- Austin, Paul F, et al.
(author)
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The Standardization of Terminology of Lower Urinary Tract Function in Children and Adolescents : Update Report from the Standardization Committee of the International Children's Continence Society.
- 2014
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In: Journal of Urology. - : Ovid Technologies (Wolters Kluwer Health). - 0022-5347 .- 1527-3792. ; 191:6, s. 1863-1865
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Journal article (peer-reviewed)abstract
- PURPOSE: The impact of the original International Children's Continence Society (ICCS) terminology document on lower urinary tract (LUT) function resulted in the global establishment of uniformity and clarity in the characterization of LUT function and dysfunction in children across multiple healthcare disciplines. The present document serves as a stand-alone terminology update reflecting refinement and current advancement of knowledge on pediatric LUT function.MATERIALS AND METHODS: A variety of worldwide experts from multiple disciplines within the ICCS leadership who care for children with LUT dysfunction were assembled as part of the standardization committee. A critical review of the previous ICCS terminology document and the current literature was performed. Additionally, contributions and feedback from the multidisciplinary ICCS membership were solicited.RESULTS: Following a review of the literature over the last 7 years, the ICCS experts assembled a new terminology document reflecting current understanding of bladder function and LUT dysfunction in children using the resources from the literature review, expert opinion and ICCS member feedback.CONCLUSIONS: The present ICCS terminology document provides a current and consensus update to the evolving terminology and understanding of LUT function in children.
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| 6. |
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| 7. |
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| 8. |
- Bazargani, Farhan, 1969-, et al.
(author)
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Rapid Maxillary Expansion in Therapy-Resistant Enuretic Children : An Orthodontic Perspective
- 2016
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In: Angle orthodontist. - : The EH Angle Education and Research Foundation Inc. - 0003-3219 .- 1945-7103. ; 86:3, s. 481-486
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Journal article (peer-reviewed)abstract
- Objective: To evaluate whether rapid maxillary expansion (RME) could reduce the frequency of nocturnal enuresis (NE) in children and whether a placebo effect could be ruled out. Methods: Thirty-four subjects, 29 boys and five girls with mean age of 10.7 +/- 1.8 years suffering from primary NE, were recruited. All subjects were nonresponders to the first-line antienuretic. treatment and therefore were classified as "therapy resistant." To rule out a placebo effect of the RME appliance, all children were first treated with a passive appliance for 4 weeks. Rhinomanometry (RM), acoustic rhinometry (AR), polysomnographic registration, and study casts were made at different time points. Results: One child experienced severe discomfort from the RME appliance and immediately withdrew from the study. Following RME, the long-term cure rate after 1 year was 60%. The RM and AR measurements at baseline and directly after RME showed a significant increase in nasal volume and nasal airflow, and there was a statistically significant correlation between reduction in enuresis and increase in nasal volume. Six months postretention, a 100% relapse of the dental overexpansion could be noted. Conclusions: RME has a curative effect in some children with NE, which could be connected to the positive influence of RME on the sleep architecture. Normal transverse occlusion does not seem to be a contraindication for moderate maxillary expansion in attempts to cure NE in children.
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| 9. |
- Bergsten, Amadeus, et al.
(author)
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Predictors of response and adherence to enuresis alarm therapy : a confirmatory study
- 2024
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In: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 113:3, s. 573-579
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Journal article (peer-reviewed)abstract
- Aim:To look for predictors to response and adherence to the enuresis alarm while exploring the possibility of families managing therapy independently.Methods: We used a body-worn alarm linked to a smartphone app. Subjects with enuresis were recruited both via paediatric nurses and independently as families bought the alarm and downloaded the app on their own.Results:We recruited 385 nurse-supported and 1125 independent subjects. Many (79.9%) dropped out before 8 weeks, but among adherent subjects 48.2% had a full or partial response. Age was a predictor of non-response (p = 0.019). Daytime incontinence did not influence response. If enuresis frequency did not decrease during the first 4 weeks of therapy the chance of response was very small (p < 0.001). Adherence was higher among subjects supported by a nurse (p < 0.001), but for adherent subjects the outcome was similar regardless of nurse support (p = 0.554).Conclusions:Daytime incontinence is no contraindication to enuresis alarm therapy. Treatment can be managed independently by the families, but adherence is enhanced by nurse support. Alarm treatment should be reassessed after 4 weeks. Enuresis alarm treatment guidelines need to be updated.
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| 10. |
- Borgstrom, Malin, et al.
(author)
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Fecal disimpaction in children with enuresis and constipation does not make them dry at night
- 2022
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In: Journal of Pediatric Urology. - : Elsevier. - 1477-5131 .- 1873-4898. ; 18:4, s. 446.e1-446.e7
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Journal article (peer-reviewed)abstract
- BACKGROUND: Constipation, daytime incontinence and nocturnal enuresis often overlap. Treatment of constipation has been shown to be an important aspect of therapy for children with daytime incontinence. However, the value of fecal disimpaction, as a part of constipation therapy, in children with enuresis has not been evaluated.AIM: Our aim was to evaluate the antienuretic effect of fecal disimpaction in children with enuresis and concomitant constipation.METHODS: The bladder and bowel function was assessed noninvasively in children aged six to ten years who sought help for enuresis for the first time. If they were constipated according to the Rome IV criteria or had a rectal diameter exceeding 30 mm, as assessed by ultrasound, they were given standard evacuation with mini-enemas and macrogol therapy for at least two weeks. Enuresis frequency was documented 14 nights preceding and following therapy.RESULTS: In total, 66 children (20 girls, 46 boys) were evaluated, 23 (35%) of whom were constipated. There were no differences in age, sex or baseline bladder function between the two groups. The enuresis frequency per two weeks was 9.8 ± 4.1 nights before and 9.3 ± 5.1 nights after constipation therapy (p = 0.43).DISCUSSION: This study found that fecal disimpaction in children with enuresis who are also constipated did not alleviate nocturnal enuresis. Bowel problems may still need to be addressed but the child should not be given the false hope that this approach alone will make them dry at night. It might be that evidenced based therapies, such as the enuresis alarm and desmopressin, could be less efficient in children with enuresis and constipation unless their bowel disturbance is first properly addressed.CONCLUSIONS: Fecal disimpaction in children with enuresis and concomitant constipation will, by itself, not make the children dry at night.
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| 11. |
- Borgström, Malin, et al.
(author)
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Daytime urotherapy in nocturnal enuresis : a randomised, controlled trial
- 2022
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In: Archives of Disease in Childhood. - : BMJ Publishing Group Ltd. - 0003-9888 .- 1468-2044. ; 107:6, s. 570-574
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Journal article (peer-reviewed)abstract
- OBJECTIVE: According to international guidelines, children with enuresis are recommended urotherapy, or basic bladder advice, before treatment with evidence-based alternatives such as the enuresis alarm is given. The efficacy of this strategy has, however, not been supported by controlled studies. We wanted to test if basic bladder advice is useful in enuresis.DESIGN: Randomised, controlled trial.SETTING: Paediatric outpatient ward, regional hospital.PATIENTS: Treatment-naïve enuretic children aged ≥6 years, with no daytime incontinence.INTERVENTIONS: Three groups, each during 8 weeks: (A) basic bladder advice-that is, voiding and drinking according to a strict schedule and instructions regarding toilet posture, (B) enuresis alarm therapy and (C) no treatment (control group).MAIN OUTCOME MEASURES: Reduction in enuresis frequency during week 7-8 compared with baseline.RESULTS: The median number of wet nights out of 14 before and at the end of treatment were in group A (n=20) 12.5 and 11.5 (p=0.44), in group B (n=22) 11.0 and 3.5 (p<0.001) and in group C (n=18) 12.5 and 12.0 (p=0.55). The difference in reduction of enuresis frequency between the groups was highly significant (p=0.002), but no difference was found between basic bladder advice and controls.CONCLUSIONS: Urotherapy, or basic bladder advice, is ineffective as a first-line treatment of nocturnal enuresis. Enuretic children who are old enough to be bothered by their condition should be offered treatment with the alarm or desmopressin.TRIAL REGISTRATION NUMBER: NCT03812094.
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| 12. |
- Brandstrom, Per, et al.
(author)
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Swedish UTI Guidelines
- 2015
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In: Pediatric nephrology (Berlin, West). - 0931-041X .- 1432-198X. ; 30:9, s. 1574-1575
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Journal article (other academic/artistic)
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| 13. |
- Brandström, Per, 1959, et al.
(author)
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The Swedish Reflux Trial in Children: I. Study Design and Study Population Characteristics
- 2010
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In: Journal of Urology. - : Ovid Technologies (Wolters Kluwer Health). - 0022-5347 .- 1527-3792. ; 184:1, s. 274-279
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Conference paper (peer-reviewed)abstract
- Purpose: We compared the rates of febrile urinary tract infection, kidney damage and reflux resolution in children with vesicoureteral reflux treated in 3 ways, including antibiotic prophylaxis, endoscopic therapy and surveillance with antibiotics only for symptomatic urinary tract infection. Materials and Methods: Children 1 to younger than 2 years with grade reflux were recruited into this prospective, open, randomized, controlled, multi-center study and followed for 2 years after randomization. The main study end points were recurrent febrile urinary tract infection, renal status on dimercaptosuccinic acid scintigraphy and reflux status. Outcomes were analyzed by the intent to treat principle. Results: During a 6-year period 128 girls and 75 boys entered the study. In 96% of cases reflux was detected after urinary tract infection. The randomization procedure was successful and resulted in 3 groups matched for relevant factors. Recruitment was slower than anticipated but after patients were entered adherence to the protocol was good. Of the children 93% were followed for the intended 2 years without a treatment arm change. All except 2 patients completed 2-year followup scintigraphy. Conclusions: Recruitment was difficult but a substantial number of children were entered and randomly assigned to 3 groups with similar basic characteristics. Good adherence to the protocol made it possible to address the central study questions.
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| 14. |
- Brandström, Per, 1959, et al.
(author)
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The Swedish Reflux Trial in Children: IV. Renal Damage.
- 2010
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In: The Journal of urology. - : Ovid Technologies (Wolters Kluwer Health). - 1527-3792 .- 0022-5347. ; 184:1, s. 292-297
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Journal article (peer-reviewed)abstract
- PURPOSE: We compared the development of new renal damage in small children with dilating vesicoureteral reflux randomly allocated to antibiotic prophylaxis, endoscopic treatment or surveillance as the control group. MATERIALS AND METHODS: Included in the study were 128 girls and 75 boys 1 to younger than 2 years with grade III-IV reflux. Voiding cystourethrography and dimercapto-succinic acid scintigraphy were done before randomization and after 2 years. Febrile urinary tract infections were recorded during followup. Data analysis was done by the intent to treat principle. RESULTS: New renal damage in a previously unscarred area was seen in 13 girls and 2 boys. Eight of the 13 girls were on surveillance, 5 received endoscopic therapy and none were on prophylaxis (p = 0.0155). New damage was more common in children with than without febrile recurrence (11 of 49 or 22% vs 4 of 152 or 3%, p <0.0001). CONCLUSIONS: In boys the rate of new renal damage was low. It was significantly higher in girls and most common in the control surveillance group. There was also a strong association between recurrent febrile UTIs and new renal damage in girls.
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| 15. |
- Cederblad, Maria, 1968-, et al.
(author)
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Infrequent enuresis, the uninvestigated majority : comparisons between children with enuresis of varying severity.
- 2015
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In: Journal of Pediatric Urology. - : Elsevier BV. - 1477-5131 .- 1873-4898. ; 11:1, s. 24.e1-24.e6
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Journal article (peer-reviewed)abstract
- OBJECTIVE: The main objective was to compare children with frequent enuresis (FE) and children with infrequent enuresis (IE) using anamnestic data and variables related to bladder and kidney function. A secondary aim was to look at the group of children who wet their beds every single night, a phenomenon we chose to call constant enuresis (CE).SUBJECTS AND METHODS: The parents recorded the number of wet and dry nights for a period of 14 days, and measured the voided volumes as well as nocturnal urine production for 48 h. History data relevant to bladder and bowel function was also recorded.RESULTS: The children could be grouped as follows: IE, n = 14; FE, n = 18; and CE, n = 22. The children with IE were slightly older than the other groups, IE mean 7.57; FE mean 6.22; CE, mean 6.56 (p = 0.004). When comparing the groups in terms of the measured parameters, only one significant difference was found: the FE group had larger average daytime voided volumes, but only when the first morning void was included. The only significantly differing anamnestic variable was previous daytime incontinence, which was more common among the children in the IE group.CONCLUSIONS: When comparing children with varying enuresis severity, no major differences regarding bladder function and urine production were found. Furthermore, children with infrequent enuresis tend to be slightly older when they seek medical help.
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| 16. |
- Cederblad, Maria, 1968-, et al.
(author)
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No effect of basic bladder advice in enuresis : a randomised controlled trial
- 2015
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In: Journal of Pediatric Urology. - : Elsevier BV. - 1477-5131 .- 1873-4898. ; 11:3
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Journal article (peer-reviewed)abstract
- BackgroundThere are two firstline, evidence-based treatments available for nocturnal enuresis: desmopressin and the enuresis alarm. Prior to use of these therapies, international experts usually recommend that the children also be given basic bladder training during the daytime. The rationale behind this recommendation is that daytime bladder training or urotherapy, is a mainstay in the treatment of daytime incontinence caused by detrusor overactivity. Still, there is, as yet, no firm evidence that daytime bladder training is useful against nocturnal enuresis.AimTo explore whether basic bladder advice has any effect against nocturnal enuresis.Study designThe study was prospective, randomized, and controlled. The evaluated intervention was bladder advice, given in accordance with ICCS guidelines and focused on regular voiding, sound voiding posture, and sufficient fluid intake. Forty children aged 6 years or more with previously untreated enuresis, but no daytime incontinence, were randomized (20 in each group) to receive either first basic bladder advice for 1 month and then alarm therapy (group A) or just the alarm therapy (group B). Based on power calculations, the minimum number of children required in each treatment arm was 15.ResultsThe basic bladder advice did not reduce the enuresis frequency in group A (p = 0.089) and the end result after alarm therapy did not differ between the two groups (p = 0.74) (see Table). Only four children in group A had a partial or full response to bladder training, and two of these children relapsed immediately during alarm therapy.DiscussionThis was the first study to evaluate, in a prospective, randomized manner, the value of daytime basic bladder training as a treatment of enuresis. It was found that the treatment neither resulted in a significant reduction in the number of wet nights, nor did it improve the success of subsequent alarm therapy.ConclusionsThe recommendation that all children with enuresis be given bladder training as a firstline therapy can no longer be supported. Instead, we recommend that treatment of these children start with the enuresis alarm or desmopressin without delay.
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| 17. |
- Cederblad, Maria, et al.
(author)
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"Nobody asked us if we needed help" : Swedish parents experiences of enuresis
- 2014
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In: Journal of Pediatric Urology. - : Elsevier BV. - 1477-5131 .- 1873-4898. ; 10:1, s. 74-79
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Journal article (peer-reviewed)abstract
- Objective: To explore the everyday dilemmas of parents living with a child with nocturnal enuresis and to describe their support needs in relation to healthcare professionals.Subjects and methods: The study was conducted in 2011 in Uppsala County, Sweden. Parents of 13 children with enuresis, 10 mothers and three fathers, participated in qualitative semi-structured in-depth interviews, which were analysed using systematic text condensation.Results: The analysis of the material resulted in six themes: enuresis is socially stigmatising and handicapping; all practices and home remedies are tested; it creates frustration in the family; protecting the child from gossip or teasing; support from healthcare providers would have helped; it's something we just have to live with. Two patterns of coping were identified: the Unworried wet-bed-fixers and the Anxious night-launderers.Conclusion: Having a child with enuresis can be stressful for parents, although they tried hard not to blame their child. Because parents can feel reluctant to bring up enuresis themselves, they want child health nurses to routinely raise the issue of bedwetting at the yearly check-up. Parents' information needs included causes of and available treatment options for enuresis as well as access to aids and other support for affected families. .
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| 18. |
- Cederblad, Maria, 1968-
(author)
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The Family and the Wet Bed : The parents’ perspective and the child’s treatment
- 2015
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Doctoral thesis (other academic/artistic)abstract
- The focus of this thesis is nocturnal enuresis in the primary care setting. Three aspects have been central: 1) the parental perspective, 2) differences between children with enuresis of varying severity, and 3) to explore whether the universally recommended basic bladder advice have any therapeutic effect. Study I built on qualitative data from interviews with 13 parents of children with enuresis, focusing on family impact and coping strategies. A common consensus among the participants was that they felt frustrated about the perceived lack of information and help they received from the healthcare system. In study II anamnestic data and voiding chart parameters – reflecting renal and bladder function – were compared between 54 children with enuresis of varying frequency. No measurable differences were found. Study III was a randomised controlled study. Forty children with previously untreated enuresis were recruited and randomised to receive either first bladder advice for one month and then alarm therapy (n=20) or just the alarm therapy (n=20). The bladder advice did neither result in a significant reduction in the number of wet nights, nor improve the effect of subsequent alarm therapy. Study IV was a cross-sectional questionnaire study of 52 parents, including comparison with normative data and with validated instruments evaluating intra-parental stress and satisfaction. The results showed no significant differences between the parents studied and normative data. Study I and IV were the first to look at the parents, as opposed to children with enuresis. The results can be used by healthcare professionals when counselling families about strategies to use and attitudes to avoid. Study II aimed at filling a glaring blank in the field of knowledge: we do not know how children with infrequent enuresis differ from those who wet their beds often or every single night. The fact that no differences in bladder or kidney function was found indicates that they may differ in the way they sleep. Study III will probably have the greatest impact on how we should treat children with enuresis. The recommendation that all of them be given bladder training as a first-line therapy can no longer be supported.
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| 19. |
- Enskär, Ida, et al.
(author)
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Barriers in the School-Based Pan-Gender HPV Vaccination Program in Sweden : Healthcare Providers' Perspective
- 2023
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In: Vaccines. - : MDPI. - 2076-393X. ; 11:2
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Journal article (peer-reviewed)abstract
- Background: Human papillomavirus (HPV) vaccines effectively prevent, and can even eliminate, HPV-related cancers. Currently, vaccination rates are suboptimal in the national Swedish school-based vaccination program. School nurses play a key role in all aspects of the vaccination process. Therefore, this study aims to explore school nurses' perceived HPV vaccination challenges.Methods: Seven focus group interviews were conducted with school nurses (n = 35) working in nine socio-demographically diverse municipalities in mid-Sweden. Data were analyzed using qualitative content analysis.Results: Participants described difficulties in encountering and handling the diversity of reasons for vaccine hesitancy. Parents known to be skeptical of vaccines in general were seen as most difficult to reach. Uncertainty was expressed concerning the extent of professional responsibility for vaccine promotion. The informants expressed a lack of guidelines for vaccine promotion and described challenges in supporting the child's own wishes. Creating a safe space for the individual child was seen as crucial. Other problems described were the challenges of overcoming children's fear of needles, supporting unvaccinated children, and being confronted with the remaining gender inequities of the pan-gender vaccination program.Conclusions: Our results suggest that school nurses, especially those new to their profession, may benefit from training and guidance22 material on how to address vaccine hesitancy.
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| 20. |
- Enskär, Ida, et al.
(author)
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School children's perceptions about being offered the HPV vaccination : A focus group study
- 2024
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In: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227.
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Journal article (peer-reviewed)abstract
- AimThere is limited knowledge about the perceptions of HPV vaccination in middle-school children. This qualitative study aimed to explore their views.MethodsWe conducted focus group interviews with children, 10–11 years of age, who had been offered HPV vaccination through the school health services in mid-north Sweden in spring of 2023. Data were analysed with qualitative content analysis.ResultsThis study included six focus group interviews with 49 children (boys n = 29; girls n = 20), mean of 11 years of age. Participating children expressed the need to feel safe to be of utmost importance and the means to do so was to be prepared and informed by someone the child trusted. The school nurse was perceived as the expert, best suited to provide factual information, support and motivation, both to children and their parents.ConclusionWe confirm that healthcare providers' recommendations are crucial for HPV vaccine acceptance also from the child's perspective. Improved information about HPV vaccination to children is necessary. Children's right to participate on their own terms is not fulfilled today. Vaccine promotion, both to children and parents, should be actively managed by the school nurse.
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| 21. |
- Frisk, Per, et al.
(author)
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Glomerular and tubular function in young adults treated with stem-cell transplantation in childhood
- 2010
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In: Pediatric nephrology (Berlin, West). - : Springer Science and Business Media LLC. - 0931-041X .- 1432-198X. ; 25:7, s. 1337-1342
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Journal article (peer-reviewed)abstract
- We evaluated renal function at a median follow-up of 18 (range 10.3-22.1) years after total body irradiation in 18 patients treated with stem-cell transplantation (SCT) (autologous SCT in 15 and allogeneic SCT in three) for hematologic malignancies and compared them with 18 healthy controls. No patient had chronic graft-versus-host disease. We found no difference in glomerular filtration rate estimated from cystatin C (105 vs 111 ml/min/1.73 m(2), p = 0.28). Patients had higher albumin excretion (0.8 vs 0.4 mg/mmol, p = 0.001), but no patient had overt albuminuria (>200 mg/L). Patients had higher diastolic blood pressure (74 vs 67 mmHg, p = 0.003). Two patients (11%) had hypertension. Patients had lower tubular reabsorption of phosphate (0.78 vs 0.91 mmol/L, p = 0.014) and higher excretion of alpha-1-microglobulin (AMG/urine creatinine, 0.4 vs 0.25 mg/mmol, p = 0.038), which correlated with time after SCT (r = 0.6, p = 0.01). We found no difference in fractional excretion (FE) of other electrolytes, amino acid excretion, or urine osmolality. We conclude that renal function was relatively well preserved at a median follow-up of 18 years after childhood SCT. The higher albumin excretion in our patients is of concern, as is the association between excretion of AMG and time after SCT, suggesting that both glomerular and tubular function may deteriorate further.
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| 22. |
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| 23. |
- Grandahl, Maria, et al.
(author)
-
A population based survey of school nurses' attitudes to the implemented HPV vaccination programme in Sweden
- 2015
-
In: Eurogin 2015. ; , s. 168-168
-
Conference paper (peer-reviewed)abstract
- Objective: To investigate school nurses’ attitudes to, and experiences of the school-based HPV vaccination programme,one year after its implementation in Sweden.Methods: Data were collected using a web-based questionnaire in spring 2013, and 83.1% (851/1024) of the nursesanswered the questionnaire.Results: The majority (88.9%, n=756) agreed that HPV vaccinations should be the school nurses’ responsibility, and mostalso agreed (81.5%, n=693) that boys also should be offered the vaccine. Two thirds, 66.9% (n=570), stated that they hadexperienced difficulties with the vaccination and of these 59.1% (n=337) considered the task time-consuming. Three outof four nurses, 76.1% (n=648), had been contacted by parents who raised questions regarding the vaccine. The most commonquestions were related to side effects. There were strong associations between the nurses’ received education aboutthe HPV vaccine and perceived knowledge about the HPV vaccine and a favourable attitude towards vaccination (both p<0.001). A school nurse with a high level of received education was 9.8 times more likely to have a positive attitude to HPVvaccination compared to a nurse with a low level of received education (p<0.001). Nurses with high perceived knowledgewere 2.5 times more likely to have a positive attitude compared to those with a low level of perceived knowledge(p=0.006).Conclusions: HPV vaccination is a complex and time-consuming task and the school nurses need adequate knowledge,education, skills and time in order to address questions and concerns from parents, as well as informing about HPV.
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| 24. |
- Grandahl, Maria, et al.
(author)
-
A school-based educational intervention can increase adolescents’ knowledge and awareness about HPV
- 2016
-
Conference paper (peer-reviewed)abstract
- Background / ObjectivesBackground: In Sweden HPV vaccination is offered to girls aged 10-12 years within the school-based vaccination program, while older girls (13-26 years) are offered the vaccine through the primary care. The vaccination rates are substantially lower (59%) among the catch-up group compared to the younger age group (82%). Adolescents have low awareness and knowledge about HPV, especially regarding cancer risks. The providers - school nurses - play a key role in providing such information. Upper secondary school students, aged 16 years, are by the school nurse offered a health interview, which includes a dialogue regarding their health, including sexual health. The health interview does however not include systematic information about HPV.Objectives: To improve adolescents’ knowledge and awareness about primary prevention of high risk HPV infection.MethodsMethods: A cluster-randomised controlled trial among upper secondary schools (n=18) was performed. Schools were first randomised to an intervention or control group, after which individual classes were randomised. In total, 832 students, boys and girls aged 16 years attending theoretical or vocational programs were invited to participate. In the end, 741 (89.1%) students completed the256study. The intervention was based on the Health Belief Model (HBM). School nurses delivered 30 minutes of face-to-face structured information about HPV, including cancer risks and HPV prevention (i.e. condom use and HPV vaccination) to the intervention group. Students in both groups completed questionnaires at baseline and at follow-up after three months. The control group received standard treatment, i.e. the regular health interview with the school nurse. Generalized estimating equation analyses were used for examining the results of the intervention.ResultsResults: The intervention had positive effects on the adolescents’ knowledge (p<0.001), with a 0.582 higher score for the intervention group compared to the control group. There were no differences in knowledge due to sex (p=0.093) or immigrant background (p=0.592). The intervention also increased awareness (p<0.001), with a 0.590 higher score for the intervention compared to the control. Again, there were no differences in awareness due to sex (p=0.183) or immigrant background (p=0.319).ConclusionConclusions: The school-based intervention delivered by school nurses, had favourable effects on knowledge and awareness about primary prevention of HPV among adolescents aged 16 years.
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| 25. |
- Grandahl, Maria, Universitetslektor, Docent, et al.
(author)
-
Barriers towards HPV vaccinations for boys and young men : a narrative review
- 2021
-
In: Viruses. - : MDPI. - 1999-4915. ; 13:8
-
Research review (peer-reviewed)abstract
- BACKGROUND: HPV vaccination of both girls and boys can protect against infection and eliminate the risk for HPV-associated cancer. Due to a common misconception that the virus only poses risks to women, vaccine coverage is suboptimal among men in many countries. It is urgent to identify barriers to vaccination of boys and men.METHODS: We conducted a narrative review of publications examining attitudes and beliefs regarding HPV vaccination for boys and young men. The electronic databases searched were PubMed, PsychInfo and Scopus (December 2020; last update July 2021). A total of 103 original articles were included in the final analysis.RESULTS: The central barriers against vaccination of boys and men are: (1) lack of knowledge, (2) vaccine hesitancy in general, (3) lack of recommendation from and/or discussions with healthcare providers, (4) cost and logistics, and (5) the idea that HPV vaccination may promote promiscuity. Men who have sex with men and families belonging to ethnic minorities express a need for information tailored to their situation.CONCLUSIONS: Boys should be included in national immunization programs and men should also be offered catch-up vaccinations. Future studies should focus on addressing vaccine hesitancy and developing interventions to promote pan-gender HPV vaccination.
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| 26. |
- Grandahl, Maria, et al.
(author)
-
Catch-up HPV vaccination status of adolescents in relation to socioeconomic factors, individual beliefs and sexual behaviour
- 2017
-
In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 12:11
-
Journal article (peer-reviewed)abstract
- In 2012, human papillomavirus (HPV) vaccination was introduced free of charge in the Swedish national school-based vaccination programme for 10-12-year-old girls, and as catch-up vaccination for young women. In Sweden, there is an ongoing discussion about including boys in the national vaccination programme. Few studies are undertaken about adolescents' knowledge, beliefs and HPV vaccination status in relation to socioeconomic status and sexual experience. Thus, the aim was to examine HPV catch-up vaccination status in adolescents in relation to 1) socioeconomic factors, 2) beliefs and knowledge about HPV prevention, and 3) sexual behaviour. The Health Belief Model was used as a theoretical framework. Upper secondary school students (n = 832) aged 16, randomly chosen from a larger sample, were invited to participate in conjunction with the general health interview with the school nurse. A total of 751/832 (90.3%), girls (n = 391, 52%) and boys (n = 360, 48%) completed the questionnaire. HPV vaccination was associated with ethnicity and the mothers' education level; i.e. girls with a non-European background and girls with a less educated mother were less likely to have received the vaccine (p<0.01 and p = 0.04 respectively). Vaccinated girls perceived HPV infection as more severe (p = 0.01), had more insight into women's susceptibility to the infection (p = 0.02), perceived more benefits of the vaccine as protection against cervical cancer (p<0.01) and had a higher intention to engage in HPV-preventive behaviour (p = 0.01). Furthermore, boys and girls were almost equally sexually experienced, although fewer girls had used condom during first intercourse with their latest partner (p = 0.03). Finally, HPV vaccinated girls were less likely to have unprotected sex (p<0.01). In summary, catch-up HPV vaccination among young girls was associated with a European background and high maternal education level, as well as more favourable beliefs towards HPV prevention and less sexual risk-taking. Further preventive measures should therefore be directed at the migrant population.
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| 27. |
- Grandahl, Maria, et al.
(author)
-
‘I also want to be vaccinated!’ – adolescent boys’ awareness and thoughts, perceived benefits, information sources, and intention to be vaccinated against Human papillomavirus (HPV)
- 2019
-
In: Human Vaccines & Immunotherapeutics. - : Informa UK Limited. - 2164-5515 .- 2164-554X. ; 15:7-8, s. 1794-1802
-
Journal article (peer-reviewed)abstract
- This study investigates boys’ awareness and thoughts about human papillomavirus (HPV) and HPV vaccination, perceived benefits of vaccinating men, information sources and intention to be vaccinated against HPV. We used a qualitative approach and interviews were conducted with 31 upper secondary school male students. Two main themes 1) Promotion of equal health and 2) Increased knowledge facilitates the decision about HPV vaccination emerged from the analysis. The informants believed that it was important and fair to protect boys and girls equally against HPV. If HPV vaccination could prevent both girls and boys against an HPV-related disease, there was nothing to question or to discuss. It was not a matter of sex; it was a matter of equal rights. Moreover, an important reason for vaccinating boys was to prevent the transmission of the virus. However, the boys felt unsure and stated that they needed to know more. The school nurse and the school health were considered suitable both for distributing information and for providing the vaccinations.In conclusion, the participants were in favor of introducing HPV vaccination also for boys in the national vaccination program. Sex-neutral HPV vaccinations were viewed both as a way to stop the virus transmission and a means to promote equal health for the entire population.
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| 28. |
- Grandahl, Maria, et al.
(author)
-
Not the right time : why parents refuse to let their daughters have the human papillomavirus vaccination
- 2014
-
In: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 103:4, s. 436-441
-
Journal article (peer-reviewed)abstract
- Aim: To explore why parents refused to allow their 10- to 12-year-old daughters to receive the human papillomavirus (HPV) vaccination from the Swedish school-based vaccination programme.Methods: Individual interviews with 25 parents who had been offered, but not consented to, their daughters receiving the HPV vaccination.Results: Five themes emerged through the interviews: 1) she is just a little girl, 2) inadequate information, 3) not compatible with our way of life, 4) scepticism about the vaccination and 5) who can you trust? The parents made their decisions with their child’s best interests in mind. This was not considered the right time, and the vaccine as perceived as unnecessary and different from other vaccines. Mistrust in Government recommendations and a lack of evidence or information were other reasons to decline.Conclusion: The decision-making process was complex. These parents preferred to wait until their daughter was older and believed the information they received from the school health system was insufficient. The results indicate that a more flexible HPV vaccination schedule may improve vaccine uptake. This includes more transparent information about the virus and the vaccine and information about who to contact to get the daughter vaccinated at a later date.
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| 29. |
- Grandahl, Maria
(author)
-
Prevention of Human Papillomavirus in a school-based setting
- 2015
-
Doctoral thesis (other academic/artistic)abstract
- The overall aim of this thesis was to examine beliefs about human papillomavirus (HPV) prevention, especially vaccination, among parents, immigrant women, adolescents and school nurses, and to promote primary prevention among adolescents.The methods used in the thesis were focus group interviews, individual interviews, a web-based questionnaire, and finally, a randomised controlled intervention study.The immigrant women were largely in favour of HPV prevention, although barriers, such as logistic difficulties, and cultural or gender norms were found. Parents’ decision concerning vaccination of their daughters depended on several factors. Regardless of their final choice, they made the decision they believed was in the best interest of their daughter. The benefits outweighed the risks for parents choosing to vaccinate while parents declining made the opposite judgement. The majority of the school nurses reported that the governmental financial support given because of the vaccination programme had not been used for the intended purpose. Three out of four nurses had been contacted by parents who raised questions regarding the vaccine; most were related to side effects. The educational intervention had favourable effects on the adolescents’ beliefs regarding HPV prevention, especially among those with an immigrant background. Furthermore, the intention to use condom as well as actual vaccination rates among girls was slightly increased by the intervention.Trust in the governmental recommendations and the amounts of information given are important factors in the complex decision about HPV vaccination. Attention given to specific needs and cultural norms, as well as the possibility to discuss HPV vaccination with the school nurse and provision of extra vaccination opportunities at a later time are all strategies that might facilitate participation in the school-based HPV vaccination programme. School nurses need sufficient resources, knowledge and time to meet parents’ questions and concerns. The vaccinations are time-consuming and the governmental financial support needs to be used as intended, for managing the vaccination programme. A school-based intervention can have favourable effects on the beliefs and actual actions of young people and may possibly thus, in the long term, decrease the risk for HPV-related cancer.
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| 30. |
- Grandahl, Maria, et al.
(author)
-
School-based intervention for the prevention of HPV among adolescents : a randomised controlled study
- 2016
-
Conference paper (peer-reviewed)abstract
- Background: Vaccination against human papillomavirus (HPV) is one important factor for preconception health and care. In Sweden a national vaccination programme for girls was implemented in 2012.Aim: To improve primary prevention of HPV infection by promoting vaccination and increased condom use among upper secondary school students at time for the general health interview with the school nurse.Methods: Randomised controlled trial among upper secondary schools (n=18). Participant schools were first randomised to the intervention or the control group, after which individual classes were randomised to be included or not. 832 students, both boys and girls aged 16 were invited to participate and in the end, 741 (89.1%) students completed the study. The intervention was based on the Health Belief Model (HBM). According to HBM a person’s health behaviour can be explained by individual beliefs regarding health actions. School nurses delivered 30 minute face-to-face structured information about HPV, including cancer risks and HPV prevention, i.e. condom use and HPV vaccination. Students in both groups completed questionnaires at baseline and after three months.Results: The intervention had positive effect on behaviour: girls in the intervention group chose to have themselves vaccinated to a significantly higher degree than the controls (p=0.02). There was also a significant effect on HBM total score (p=0.003), students in the intervention group had more favourable beliefs compared to the controls. The influence on the HBM parameters susceptibility and severity were also significant (p<0.001 for both variables). In addition, the intervention had significant effect on the intention to use condom (p=0.004).Conclusion: The school-based intervention increased HPV vaccination rates and had favourable effects on beliefs towards primary prevention of HPV in a diverse population of adolescents. These resultss provide the scientific support for the implication of nation-wide educational interventions with the potential to improve preconception health.
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| 31. |
- Grandahl, Maria, et al.
(author)
-
School-based intervention for the prevention of HPV among adolescents : a cluster randomised controlled study
- 2016
-
In: BMJ Open. - : BMJ. - 2044-6055. ; 6:1
-
Journal article (peer-reviewed)abstract
- Objective: To improve primary prevention of human papillomavirus (HPV) infection by promoting vaccination and increased condom use among upper secondary school students. Design: Cluster randomised controlled trial. Setting: 18 upper secondary schools in Sweden. Participants: Schools were first randomised to the intervention or the control group, after which individual classes were randomised so as to be included or not. Of the 832 students aged 16 years invited to participate during the regular individual health interview with the school nurse, 751 (90.2%) agreed to participate and 741 (89.1%) students completed the study. Interventions: The intervention was based on the Health Belief Model (HBM). According to HBM, a person's health behaviour can be explained by individual beliefs regarding health actions. School nurses delivered 30 min face-to-face structured information about HPV, including cancer risks and HPV prevention, by propagating condom use and HPV vaccination. Students in the intervention and the control groups completed questionnaires at baseline and after 3 months. Main outcome measures: Intention to use condom with a new partner and beliefs about primary prevention of HPV, and also specifically vaccination status and increased condom use. Results: All statistical analyses were performed at the individual level. The intervention had a significant effect on the intention to use condom (p=0.004). There was also a significant effect on HBM total score (p=0.003), with a 2.559 points higher score for the intervention group compared to the controls. The influence on the HBM parameters susceptibility and severity was also significant (p<0.001 for both variables). The intervention also influenced behaviour: girls in the intervention group chose to have themselves vaccinated to a significantly higher degree than the controls (p=0.02). No harms were reported. Conclusions: The school-based intervention had favourable effects on the beliefs about primary prevention of HPV, and increased the HPV vaccination rates in a diverse population of adolescents.
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| 32. |
- Grandahl, Maria, et al.
(author)
-
School nurses’ attitudes and experiences regarding the human papillomavirus vaccination programme in Sweden : a population-based survey
- 2014
-
In: BMC Public Health. - : BioMed Central. - 1471-2458. ; 14:540, s. 1-9
-
Journal article (peer-reviewed)abstract
- Background: Sweden introduced a school-based human papillomavirus (HPV) vaccination programme in 2012, andschool nurses are responsible for managing the vaccinations. The aim of the present study was to investigate theattitudes and experiences of school nurses regarding the school-based HPV vaccination programme 1 year after itsimplementation.Methods: Data were collected using a web-based questionnaire in the spring of 2013, and 83.1% (851/1024) ofnurses responded.Results: There were strong associations between the nurses’ education about the HPV vaccine and their perceivedknowledge about the vaccine and a favourable attitude towards vaccination (both p < 0.001). School nurses whoreceived a high level of education were more likely to have a positive attitude to HPV vaccination compared withnurses with little education about HPV vaccination (adjusted odds ratio [OR] = 9.8; 95% confidence interval [CI]:3.797–25.132). Nurses with high perceived knowledge were more likely to have a positive attitude compared withthose with a low level of perceived knowledge (OR = 2.5; 95% CI: 1.299–4.955). If financial support from thegovernment was used to fund an additional school nurse, nurses were more likely to have a positive attitude thanif the financial support was not used to cover the extra expenses incurred by the HPV vaccination (OR = 2.1; 95% CI:1.051–4.010). The majority, 648 (76.1%), had been contacted by parents with questions about the vaccine, mostlyrelated to adverse effects. In addition, 570 (66.9%) stated that they had experienced difficulties with thevaccinations, and 337 (59.1%) of these considered the task to be time-consuming.Conclusions: A high level of education and perceived good knowledge about HPV are associated with a positiveattitude of school nurses to the HPV vaccination programme. Thus, nurses require adequate knowledge, education,skills and time to address the questions and concerns of parents, as well as providing information about HPV.Strategic financial support is required because HPV vaccination is a complex and time-consuming task.
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| 33. |
- Grandahl, Maria, et al.
(author)
-
To consent or decline HPV vaccination : a pilot study at the start of the national school-based vaccination program in Sweden
- 2017
-
In: Journal of School Health. - : John Wiley & Sons. - 0022-4391 .- 1746-1561. ; 87:1, s. 62-70
-
Journal article (peer-reviewed)abstract
- BACKGROUNDParents' beliefs about human papillomavirus (HPV) vaccination influence whether they allow their daughters to be vaccinated. We examined the association between parents' refusal and sociodemographic background, knowledge and beliefs about HPV, and the HPV vaccination in relation to the Health Belief Model.METHODSThe sample consisted of 200 (55%) parents of children aged 11-12 years in the Swedish national vaccination program. Data were collected using a self-reported questionnaire. Most parents (N = 186) agreed to the vaccination. Pearson's chi-square, Fisher's exact test, and the Mann-Whitney U test were used to analyze data.RESULTSDeclining parents saw more risks and fewer benefits of HPV vaccination but no differences in beliefs regarding the severity or young girls' susceptibility to HPV were found. There was an association between refusing the HPV vaccine and lower acceptance of previous childhood vaccinations, and their main source of information was the Internet. Parents who declined the vaccine believed it could adversely affect condom use, the age of their daughter's sexual debut, and the number of sexual partners.CONCLUSIONParents should have the possibility to discuss HPV and HPV vaccine with a school nurse or other health care professionals, and should have access to evidence-based information on the Internet.
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| 34. |
- Jansson, Emil, et al.
(author)
-
Rectal diameter assessment in enuretic children-exploring the association between constipation and bladder function
- 2018
-
In: Upsala Journal of Medical Sciences. - : TAYLOR & FRANCIS LTD. - 0300-9734 .- 2000-1967. ; 123:3, s. 179-182
-
Journal article (peer-reviewed)abstract
- Objectives: Detrusor overactivity and constipation often co-exist in children with enuresis. Constipation is known to be linked to detrusor overactivity. The voiding chart is the best non-invasive way to investigate bladder function, whereas the ultrasonographical detection of rectal dilatation is the best way to objectify constipation. We wanted to investigate a possible relationship between the rectal diameter and voiding chart data in enuretic children.Methods: Children with therapy-resistant enuresis were retrospectively evaluated. All had completed a voiding chart for at least 48 h. The rectal diameter was assessed ultrasonographically. The cutoff for rectal dilatation was set at 30 mm.Results: We evaluated 74 patients (12 girls) aged 10.2 +/- 2.8years, 35 of whom had rectal dilatation. No significant differences in voiding chart parameters were found between children with normal versus dilated rectum. Neither did urgency or a history of daytime incontinence differ between the groups. Boys were more likely to have rectal dilatation than girls (p = 0.02).Conclusions: The absence of differences regarding voiding chart data may be explained as two mechanisms neutralizing each other: behavioral factors may make the constipated children void seldom and with large volumes, whereas detrusor overactivity caused by rectal compression of the bladder may have the opposite effect. Another option may be that the voiding chart is too blunt an instrument to detect detrusor overactivity. Constipation, and thus presumably bladder dysfunction, seems to be more important in enuretic boys than girls.
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| 35. |
- Jönson Ring, Ingrid, 1971-
(author)
-
Nocturnal enuresis and rapid maxillary expansion : – long-term effect, prognostic variables, respiration during sleep and quality of life
- 2019
-
Doctoral thesis (other academic/artistic)abstract
- Background:The orthodontic technique rapid maxillary expansion (RME) has been reported to have a potentially curative effect on nocturnal enuresis (NE). The mechanism behind this is unknown but could possibly be due to placebo and/or effects on respiration during sleep. Aim: This thesis aims to approach an answer to the following questions, with a randomized, placebo-controlled method: 1) Does rapid maxillary expansion have a curative effect on therapy-resistant NE? 2) Is the potential curative effect due to respiratory events that can be measured during sleep? 3) Do enuretic children have an impaired quality of life (QoL)? Subjects & Methods: In study I we evaluated the QoL in enuretic children while assessing the test re-test reliability of a Swedish version of an established QoL questionnaire. Study II and IV assess respiration during sleep in children with NE; in study II comparisons are made with healthy control children and in study IV we evaluate the respiratory effects of RME. Study III is a randomized placebo-controlled study investigating whether RME is a useful therapy for NE and if the treatment effect is due to placebo.Results: Study I:The Swedish version of the questionnaire proved to be a reliable tool (Chronbach’s alpha 0.87) with excellent test-retest stability (ICC = 0.762). Enuresis affects the children’s QoL and interactions with peers.Study II:The hypopnea index (HI) and the oxygen desaturation index were both significantly higher in the enuretic children compared to the healthy controls, (p=0.04 and p=0.05) but all values fell within the normal range.Study III:RME resulted in a significant reduction in wet nights i.e. the mean number of wet nights out of 14 was 11.4 before and 9.2 after RME. (p=0.003) This was not observed in the placebo group (p=0.40).Study IV:There was a significant reduction of sleep efficiency during RME. (p=0.001) The mean HI was also affected. (p=0.005)Conclusions: • Children with nocturnal enuresis have an impaired self-esteem and their quality of life is affected in their relationship with friends.• There were no major differences in respiration during sleep between enuretic children and controls.• Rapid maxillary expansion reduces the number of wet nights in children with enuresis, but the effect is of limited clinical value.• The antienuretic effect does not seem to be due to a placebo effect of the appliance.• The majority of the children in our study sample did not have sleep disordered breathing as a co-morbidity to their nocturnal enuresis.
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| 36. |
- Jönson Ring, Ingrid, 1971-, et al.
(author)
-
Rapid maxillary expansion in children with nocturnal enuresis: : A randomized placebo-controlled trial
- 2019
-
In: Angle orthodontist. - : The Angle Orthodontist (EH Angle Education & Research Foundation). - 0003-3219 .- 1945-7103. ; 90:1, s. 31-38
-
Journal article (other academic/artistic)abstract
- OBJECTIVE:To investigate whether rapid maxillary expansion (RME) is a useful treatment method for nocturnal enuresis (NE) and whether the treatment effect is due to placebo. The study also aimed to identify prognostic variables in patients responding to treatment.MATERIALS AND METHODS:Thirty-eight children with therapy-resistant NE were recruited and randomized into two groups: the intervention group or placebo group. Both groups were treated with RME, but the placebo group received treatment with a sham appliance for 2 weeks before having the actual treatment. A medical history focused on micturition habits, previous treatment, heredity, and sleep disorders was taken. Daytime voided volumes and nocturnal urine production during wet nights were recorded before the intervention.RESULTS:Of the 38 patients recruited, two dropped out as one patient was unable to take dental impressions and one refused to have the appliance fitted. There was a statistically significant reduction of wet nights after the RME treatment (P < .001). No significant reduction was found after the placebo treatment (P < .40). Eleven patients (35%) had their enuresis frequency reduced by >50%. Large voiding volume and a wide maxilla at baseline had a strong association with positive treatment outcome.CONCLUSIONS:RME has a modest effect on children with therapy-resistant NE. The treatment outcome does not seem to be due to a placebo effect of the appliance. A wide maxillary width and large voiding volume at baseline seem to be positive predictors regarding response to treatment.
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| 37. |
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| 38. |
- Jönsson, Karl-Axel, et al.
(author)
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Improving the Efficacy of Enuresis Alarm Treatment through Early Prediction of Treatment Outcome : A Machine Learning Approach
- 2023
-
In: Frontiers in Urology. - 2673-9828. ; 3, s. 1-13
-
Journal article (peer-reviewed)abstract
- Introduction: Bedwetting, also known as enuresis, is the second most common chronic health problem among children and it affects their everyday life negatively. A first-line treatment option is the enuresis alarm. This method entails the child being awoken by a detector and alarm unit upon urination at night, thereby changing their arousal mechanisms and potentially curing them after 6–8 weeks of consistent therapy. The enuresis alarm treatment has a reported success rate above 50% but requires significant effort from the families involved. Additionally, there is a challenge in identifying early indicators of successful treatment.Methods: The alarm treatment has been further developed by the company Pjama AB, which, in addition to the alarm, offers a mobile application where users provides data about the patient and information regarding each night throughout the treatment. The wet and dry nights are recorded, in addition to the actual timing of the bedwetting incidents. We used the machine learning model random forest to see if predictions of treatment outcome could be made in early stages of treatment and shorten the evaluation time based on data from 611 patients. This was carried out by using and analyzing data from patients who had used the Pjama application. The patients were split into training and testing groups to evaluate to what extent the algorithm could make predictions every day about whether a patient’s treatment would be successful, partially successful, or unsuccessful.Results: The results show that a large number of patient outcomes can already be predicted accurately in the early stages of treatment.Discussion: Accurate predictions enable the correct measures to be taken earlier in the treatment, including increasing motivation, adding pharmacotherapy, or terminating treatment. This has the potential to shorten the treatment in general, and to detect patients who will not respond to the treatment early on, which in turn can improve the lives of children suffering from enuresis. The results show great potential in making the treatment of enuresis more efficient.
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| 39. |
- Kaarme, Johan, 1973-
(author)
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A world inside : Gastrointestinal microbiota in healthy Swedish children at day care centers and aspects on antibiotic resistance, enteric pathogens and transmission
- 2017
-
Doctoral thesis (other academic/artistic)abstract
- Antibiotic resistance is a growing threat to human health and is defined by the World Health Organization as a crisis that must be managed with the utmost urgency. Antibiotic resistant bacteria increase both mortality and morbidity and have a great impact on the global economy. Resistance is not confined to human health care, but is present also among animals and in our environment at large. Indeed, resistant bacterial strains have now been found in virtually all parts of the world, even in locations without direct human contact.The human gastrointestinal tract is populated by a complex, dynamic, diverse and highly interactive collection of microorganisms, including bacteria, archaea, fungi, yeasts and viruses, which constitutes our gastrointestinal microbiota. This microbiota is an important reservoir of resistance genes (our gastrointestinal resistome) and a “melting pot” for transfer of resistance genes between microbes, including potential pathogens.In this thesis I investigated the prevalences of two clinically important kinds of antibiotic resistance: extended-spectrum β-lactamases (ESBL) and vancomycin-resistant enterococci (VRE), as well as asymptomatic carriage of potential enteropathogens among healthy preschool children in Uppsala. Fecal samples from unidentified, individual diapers were collected in 2010 (125+313 samples) and in 2016 (334 samples). In addition, 204 environmental samples from the children’s preschools were collected in autumn 2016.A prevalence of 2.9% ESBL-producing Enterobactericeae was demonstrated in the first samples from 2010. No VRE were found and the occurrence of enteropathogens were reassuringly low. Results on ESBL prevalence in 2016 and transmission of resistance between children will be presented when the manuscript is published and at the dissertation.
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| 40. |
- Kaarme, Johan, et al.
(author)
-
Rapid Increase in Carriage Rates of Enterobacteriaceae Producing Extended-Spectrum β-Lactamases in Healthy Preschool Children, Sweden
- 2018
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In: Emerging Infectious Diseases. - : Centers for Disease Control and Prevention (CDC). - 1080-6040 .- 1080-6059. ; 24:10, s. 1874-1881
-
Journal article (peer-reviewed)abstract
- By collecting and analyzing diapers, we identified a >6-fold increase in carriage of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae for healthy preschool children in Sweden (p<0.0001). For 6 of the 50 participating preschools, the carriage rate was >40%. We analyzed samples from 334 children and found 56 containing >1 ESBL producer. The prevalence in the study population increased from 2.6% in 2010 to 16.8% in 2016 (p<0.0001), and for 6 of the 50 participating preschools, the carriage rate was >40%. Furthermore, 58% of the ESBL producers were multidrug resistant, and transmission of ESBL-producing and non-ESBL-producing strains was observed at several of the preschools. Toddlers appear to be major carriers of ESBL producers in Sweden.
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| 41. |
- Kaarme, Johan, 1973-, et al.
(author)
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Reassuringly low carriage of enteropathogens among healthy Swedish children in day care centres
- 2016
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In: Public Health. - : Elsevier BV. - 0033-3506 .- 1476-5616. ; 140, s. 221-227
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Journal article (peer-reviewed)abstract
- Objectives: Infectious gastroenteritis is one of the most common diseases among children and has a considerable impact on health and socio-economy. Day care centres are highrisk environments for infections. The aim of this study was to investigate if asymptomatic preschool children constitute a reservoir for potential enteropathogens. Study design: In total, 438 individual diapers were collected from day care centres in Uppsala, Sweden, during spring and autumn, and molecular techniques were used to estimate the prevalence of asymptomatic carriage of multiple enteropathogens. Methods: Faecal samples were analysed with multiplex polymerase chain reaction (PCR) (xTAG® Gastrointestinal Pathogen Panel; Luminex Corporation, Toronto, Canada) targeting 21 different pathogens. Samples with a median fluorescence intensity above threshold were re-analysed with a second PCR assay. Results: Sixteen of the 438 samples were positive for enteropathogens, 1.6% for enteric adenovirus, 0.7% for Campylobacter spp., and 0.7% for norovirus. Conclusions: Preschool children in Uppsala constitute a limited reservoir for potential enteropathogens
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- Larsson, Jens, et al.
(author)
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Can enuresis alarm therapy be managed by the families without the support of a nurse? : A prospective study of a real-world sample
- 2023
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In: Acta Paediatrica. - : Wiley-Blackwell. - 0803-5253 .- 1651-2227. ; 112:3, s. 537-542
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Journal article (peer-reviewed)abstract
- Aim: The alarm is the first -line treatment of nocturnal enuresis. However, the therapy is labour-intensive for both families and healthcare providers. Our aim was to see whether the treatment could be successfully used by the families, without support from healthcare providers.Methods: An alarm linked to an application on a parent's smartphone was used. The app recorded enuretic events and gave instructions. Group A were children supported by a nurse. Group B were patients whose families had bought the alarm and down- loaded the app independently.Results: There were 196 children in group A and 202 in group B. The percentages of full responders, partial responders, non-responders and dropouts were 18.4%, 20.4%, 22.4% and 38.8% in group A and 13.4%, 11.4%, 14.9% and 60.4% in group B. The risk for dropping out of therapy was higher in group B (p < 0.001), whereas the chance for adherent children to become dry did not differ between the groups (p = 0.905).Conclusion: For families who are able to adhere to alarm therapy the chance of success is just as good when managed independently as when supported by a nurse. But the latter children will have a greater chance of adhering to the full treatment.
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- Larsson, Jens, et al.
(author)
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The value of case history and early treatment data as predictors of enuresis alarm therapy response
- 2023
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In: Journal of Pediatric Urology. - : Elsevier. - 1477-5131 .- 1873-4898. ; 19:2
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Journal article (peer-reviewed)abstract
- Background and aim: Two central problems with the enuresis alarm are the family workload and the lack of predictors of therapy response. We wanted to look at predictors of alarm response in a setting reflecting clinical reality.Methods: An alarm linked to a smartphone app was provided to enuretic children managed at pediatric outpatient wards. Baseline data (sex, age, daytime in-continence, urgency, previous therapies, arousal thresholds and baseline enuresis frequency) were recorded. Further information, such as enuretic episodes and actual alarm use, was gathered via the app during therapy. Therapy was given for 8-12 weeks or until 14 consecutive dry nights had been achieved.Results: For the 196 recruited children the outcome was as follows: full responders (FR) 18.4%, partial re-sponders (PR) 20.4%, nonresponders (NR) 22.4% and dropouts 38.8%. We found no clear predictors of response or adherence among baseline data. But as treatment progressed responders reduced their enuresis frequency as compared to NR (week two P = 0.003, week three and onwards P < 0.001). This is further illustrated in the Figure below. Further-more, the children unable to complete the full treatment had more non-registered nights already from the second week (week two P = 0.005, week three P = 0.002 and so on).Discussion: Anamnestic data give little predictive information regarding enuresis alarm response or adherence. Contrary to common belief neither daytime incon-tinence nor previous alarm attempts influenced treatment success. But after 2-4 weeks of therapy the children with a good chance of treatment success could be discerned by decreasing enuresis frequency, and the families that would not be able to comply with the full treatment showed incomplete adherence already during the first weeks.Conclusions: Maybe the enuresis alarm strategy should be changed so that the treatment is reassessed after one month and only children with a high chance of success continue. This way, unnecessary frustration for the families of therapy-resistant children may be reduced.
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