The Prevalence and Therapeutic Effect of Constipation in Pediatric Overactive Bladder

Purpose Overactive bladder (OAB) is a manifestation of urgency, regardless of urge incontinence, due to involuntary bladder contraction during the storage period. There is a close association between constipation and OAB, but constipation cannot be readily diagnosed. The aims of this study were to evaluate the prevalence of constipation in OAB and the consequent therapeutic effects according to the diagnostic criteria for constipation. Methods We collected clinical data from 40 children (mean age, 71±22 months) with chief complaints of urgency, frequency, and incontinence. A voiding questionnaire and a 2-day voiding diary were collected, and urinalysis, the Bristol stool scale, and plain abdominal radiography were performed. Constipation was defined as conditions satisfying at least one of the following criteria: Rome III diagnostic criteria, Bristol stool scale types I/II, or a Leech score higher than 8 points as determined by plain radiography. Lower urinary tract symptoms, defecation symptoms, and the bladder volume of patients were examined, and the therapeutic outcomes by constipation diagnostic criteria were evaluated. Results Of the 40 OAB patients, 25 had constipation. Among them, 6 had reduced functional bladder capacity (24%; P>0.05). Regarding treatment, in patients who satisfied only one diagnostic criterion, the symptoms improved in 76.9%, 76.9%, and 69.6% of patients meeting the Rome III criteria, Bristol stool scale, and Leech score, respectively (P<0.05). Among the 8 patients satisfying all three criteria, 75% responded to treatment (P<0.05). Conclusions The prevalence of constipation in OAB is high. Constipated patients recruited by use of the Rome III criteria, Bristol scale, and Leech score alone and together showed similar outcomes on OAB improvement after the treatment of constipation, which implies that each criterion has the same strength and can be applied comprehensively and generally

The South African guidelines on enuresis-2017

Introduction: Enuresis (or Nocturnal Enuresis) is defined as discreet episodes of urinary incontinence during sleep in children over 5 years of age in the absence of congenital or acquired neurological disorders. Recommendations: Suggestions and recommendations are made on the various therapeutic options available within a South African context. These therapeutic options include; behavioural modification, pharmaceutical therapy [Desmospressin (DDAVP), Anticholinergic (ACh) Agents, Mirabegron (beta 3-adrenoreceptor agonists), and Tricyclic Antidepressants (TCA)], alternative treatments, complementary therapies, urotherapy, alarm therapy, psychological therapy and biofeedback. The role of the Bladder Diary, additional investigations and Mobile Phone Applications (Apps) in enuresis is also explored. Standardised definitions are also outlined within this document. Conclusion: An independent, unbiased, national evaluation and treatment guideline based on the pathophysiological subcategory is proposed using an updated, evidence based approach. This Guideline has received endorsement from the South African Urological Association, Enuresis Academy of South Africa and further input from international experts within the field

Nocturnal enuresis—theoretic background and practical guidelines

Nocturnal polyuria, nocturnal detrusor overactivity and high arousal thresholds are central in the pathogenesis of enuresis. An underlying mechanism on the brainstem level is probably common to these mechanisms. Enuretic children have an increased risk for psychosocial comorbidity. The primary evaluation of the enuretic child is usually straightforward, with no radiology or invasive procedures required, and can be carried out by any adequately educated nurse or physician. The first-line treatment, once the few cases with underlying disorders, such as diabetes, kidney disease or urogenital malformations, have been ruled out, is the enuresis alarm, which has a definite curative potential but requires much work and motivation. For families not able to comply with the alarm, desmopressin should be the treatment of choice. In therapy-resistant cases, occult constipation needs to be ruled out, and then anticholinergic treatment—often combined with desmopressin—can be tried. In situations when all other treatments have failed, imipramine treatment is warranted, provided the cardiac risks are taken into account

Lättare sagt än gjort. En kvalitativ studie om hur vuxna med Aspergers syndrom upplever nära relationer

Background and aim: Asperger syndrome is a neuropsychiatric disability which is essentially characterized by impairments in social interaction. Little is known about how these individuals experience social interaction and more distinctly close relationships. Therefore the purpose of this present study is to explore how initiating and maintaining close relationships could be facilitated for individuals with Asperger syndrome. Furthermore how these individuals would like others to behave towards them. By assuming an insider perspective the empirical data is based on the participants own descriptions of their experiences, thoughts and ideas about close relationships. Findings: Most respondents state that they experience difficulties initiating social interaction, the main reason being that they don’t know what they are expected to say or how to act in this type of situation. More positively, however, the respondents are able to describe several useful strategies for both initiating as well as maintaining relationships. Conclusions: • The respondents describe acceptance and respect as important both in terms of initiating a relationship and to maintain a close relationship. • A straightforward and honest communication is said to facilitate the social interaction for the respondents. • The results of this study indicate that the respondents have a highly developed ability to describe thoughts and feelings in words. In an overview of the empirical data a dilemma emerged. The data suggested that despite the respondents ability to identify several strategies they had trouble implement these and still experience difficulties in the initiation of social interaction. I call this the implementation dilemma. I find that future research should seek to depart from the traditional perspective on disability research and to a greater extent focus on skills and resources rather than problems and obstacles

Hur mår chefen?: En undersökning om hälsa och socialt stöd hos chefen i mikroföretaget

Att vara chef idag är ofta krävande. Inte minst i det lilla företaget, där man måste vara lite av en allkonstnär. Chefer på småföretag tros arbeta hårt och ha en hög stressnivå, men lite är skrivet om hur de upplever sin hälsa och sin arbetsmiljö. Däremot är kunskapen stor om att socialt stöd på arbetsplatsen kan minska de negativa effekterna av stress och utgöra en buffert mot ohälsa hos de anställda. Syftet med den här studien var att ta reda på hur chefen på ett mikroföretag upplevde sin egen hälsa, sitt sociala stöd och om detta stöd var viktigt för hälsan. Chefer på mikroföretag anslutna till Järnhälsans Företagshälsovård, med 5-9 anställda, valdes ut som undersökningsgrupp. Cheferna var antingen anställda eller ägare/grundare av företaget. Studien genomfördes som en enkätundersökning. I studien framkom att man som chef på ett mikroföretag i något mindre utsträckning upplevede sig ha bra eller mycket bra hälsa jämfört med personer i arbetsför ålder i allmänhet och en tredjedel av cheferna angav att de hade sämre hälsa än folk i allmänhet. Drygt en fjärdedel av cheferna tyckte sig ofta sakna stöd i sin chefsroll, men i de fall man upplevde sig ha stöd var det vanligast att det kom från kollegorna. För de som hade stöd i sin yrkesroll var sannolikheten stor att de även hade bra eller mycket bra hälsa. Saknade man stöd var sannolikheten stor att man hade sämre hälsa. Det verkar finnas ett samband mellan hälsa och socialt stöd på arbetsplatsen, även för chefen