Background and Purpose: Primary nocturnal enuresis (PNE) is a heterogeneous disorder with various underlying pathophysiological mechanisms. Results of our recent studies focused on the relationship of bladder function, sleep and brain function demonstrated a simultaneous occurrence of bladder and brain dysfunction in children with severe refractory PNE. We therefore proposed to use an animal model with altered bladder function to evaluate if abnormalities in bladder function induce functional derangement in brainstem micturition centers and/or sleep-arousal centers. / Materials and methods: In general, the study was divided in to 6 parts. Male Wistar rats (~ 1.5 months) were used for the study. / Study I: Establishment of animal model —— Male Wistar rats (200-220 g) underwent either Sham surgery or surgical reduction of bladder volume (RBV). Animals were used for further Cystometry, EEG, MRS and Cognitive function studies 4-5 weeks postoperatively. / Study II: Conventional Fill Cystometry (CFC) to evaluate bladder functional changes in response to surgical bladder volume reduction —— Twenty-four rats (RBV=12, SHAM 12) were used for the study. CFC was performed under conscious condition for evaluating the functional changes in response to surgical bladder capacity reduction. / Study III: Radiotelemetered EEG study to assess the impact of bladder dysfunction on sleep architecture and cortical arousals in rats —— Twenty-four rats (RBV=12, SHAM 12) were used for the study. Radiotelemeters were implanted in both groups 4 weeks post-operatively. The EEG biopotential and bladder pressure were monitored for 48 hours. Sleep architecture and cortical arousals were then evaluated manually. / Study IV: Evaluation of cognitive function following surgical bladder volume reduction —— Ninety eight rats (RBV=50, SHAM =48) were used for the study. / Morris Water Maze task: A circular plastic translucent pool half-filled with 26 ± 2ºC water, was used in the Morris Animals were given 9 consecutive training (2/day) sessions of Morris Water Maze (MWM) at 4 weeks postoperatively. / 8-arm Radial Maze: Food pellets were randomly placed inside each arm of the maze and the rats were allowed to explore the maze freely for 5 minutes. The rat was allowed to explore the maze for 5 minutes. Total time spent in each arm, total distance traveled in the maze was recorded. / Study V: Magnetic Resonance Spectroscopy to detect functional changes in brain in response to bladder dysfunction elicited by surgical bladder volume reduction —— Proton magnetic resonance spectroscopy was employed to examine brain metabolic changes in 24 rats (RBV=12, SHAM=12). Single voxel 1 H MRS experiments were performed using a 7 T MRI scanner. MR spectra were then processed using the jMRUI software. / Phase VI: Enzyme -linked immunosorbent assay for the assessment of associated changes in neurotransmitters —— Animals were euthanized after MRS study and brain samples were collected. Serotonin and dopamine levels were assessed in 10 mg of tissue extracts from brainstem and cortex, with ELISA kits. / Results: Study I: Bladder reduction surgery did not affect the increase in body weight post -operatively. Average body weight of the RBV and the sham groups were 340.2 ± 47.2 g and 340.5 ± 67.9 g respectively at 4 weeks post operatively. / Study II: Compared to sham group, the maximum cystometric capacity in animals with RBV was remarkably reduced at week 4 (0.78 ± 0.12 ml vs. 1.46 ± 0.22 ml, RBV vs. Sham respectively; p<0.005). Moreover, maximum detrusor pressure during voiding was significantly increased in RBV group at week 4 post operatively (32.4± 2.14 vs.23.27±1.2 5 cm H2O, RBV vs. Sham respectively). / Study III: Light non-repaid eye movement sleep occurred significantly more in RBV rats compared to sham group (61.8% vs 35%). Deep sleep and rapid eye movement sleep occurred significantly less in RBV group compared to that of sham group (30.7% vs 53.4%). / Study IV: Results showed that the RBV group used a significantly longer latency to locate the platform compared to Sham group (24.4s vs 17.19s, RBV vs. Sham respectively, p<0.001).. Moreover, significantly more animals from the RBV group could not complete the visit of the 8 arms of radial maze than that of the sham group. / Study V: Seven metabolites were detected and quantified. The results demonstrated significant changes in the lactate (Lac) metabolism in some specific regions of rat brain. At 4 weeks post - operatively, level of lactate significantly decreased in the hippocampus (43%, P<0.001) cingulate and retrosplenial cortex (29%, p<0.05) of RBV rats compared to that of sham rats. / Study VI: Results demonstrated a significant increase in Serotonin level in the brainstem of RBV rats compared to that of SHAM rats (23.726 + 0.88 ng/ml vs. 1.88 + 0.302 ng/ml). Dopamine levels decreased significantly in brainstem samples of RBV group compared to sham group (2.85 + 0.10 ng/ml vs. 6.85 + 0.84 ng/ml). / Conclusion: Surgical bladder volume reduction of bladder capacity can induce functional changes in the central nervous system. An alteration of the sleep architecture occurred in response to surgical reduction of bladder volume in rats, suggesting that there exists a potential for central consequences of bladder dysfunction. Bladder disorder chronically altered brain energy metabolism. Furthermore, bladder disorder altered the central neurotransmission in the brainstem and cortex. The finding of bladder dysfunction induced significant impairments in cognitive function in RBV rats, suggesting that the alteration in brain energy metabolism may contribute to the behavioral and attention problems, impaired learning and cognitive performance. / 研究背景： 原發性夜間遺尿症（PNE）是一種異質性疾病，涉及多種潛在的病理生理機制。我們最近的研究主要集中在膀胱功能，睡眠和腦功能的關係，結果顯示膀胱和腦功能障礙同時出現在患有嚴重難治性的PNE的兒童。因此，我們建議採用一種已改變膀胱功能的動物模型來評估膀胱功能異常會否引起腦幹排尿中心和/或睡眠 - 覺醒中心的功能紊亂 / 研究工具和方法： 研究被分成6個部分。雄性Wistar大鼠（約1.5個月）被用於研究。 / 研究I： 動物模型的建立 —— 雄性Wistar大鼠（200-220克），會先接受假手術或手術降低膀胱容量（RBV）。手術後4至5週，動物會進行進一步的膀胱測壓，腦電圖，MRS和認知功能研究。 / 研究II： 以常規填充膀胱測壓（CFC）評估減少膀胱容量手術對膀胱功能的變化 —— 二十四隻大鼠（RBV=12，對照=12）被用於研究。 CFC是用以評估在有意識的條件下，膀胱因膀胱容量減少的手術而引起的功能變化。 / 研究III： Radiotelemetered腦電圖研究，以評估在大鼠膀胱功能失調對睡眠結構和皮質覺醒的影響 —— 二十四隻大鼠（RBV=12，對照=12）被用於研究。膀胱容量減少的手術4週後，Radiotelemeters被植入在兩個組別的大鼠，並監測其腦電生物電勢和膀胱內壓48小時，然後手動評估睡眠結構和皮層覺醒。。 / 研究IV： 評估在膀胱容量減少的手術後對認知功能的影響 —— 103個大鼠（RBV=56，對照= =47）被用於研究。 / Morris水迷宮任務： 一個圓形的塑料半透明池盛載半滿的水，溫度介乎26 - ±2℃，手術4週後，該池被用在莫里斯動物進行連續9次Morris水迷宮（MWM）培訓（每天2次）。 / 八臂迷宮： 食物顆粒被隨機放置在迷宮的每個臂內，大鼠可以自由地探索迷宮5分鐘。大鼠被允許探索迷宮5分鐘。在每個手臂所用的總時間，以及在迷宮行走的總距離都會被記錄。 / 研究V： 以磁共振波譜檢測膀胱容量減少的手術所引起的膀胱功能障礙對腦功能的改變 —— 以質子磁共振波譜研究24隻大鼠腦內的代謝變化(RBV=12，對照==12）。以7 T MRI掃描儀進行磁共振波譜實驗，然後使用jMRUI軟件處理MR譜。 / 第六期： 以酶聯免疫吸附測定法評估神經遞質的相關變化 —— 動物在進行MRS研究後實施安樂死，並收集其腦樣品。從腦幹和皮層提取10毫克組織提取物，使用ELISA試劑盒，以評估羥色胺和多巴胺水平。 / 結果： 研究I： 膀胱容量減少手術並沒有影響體重增加。手術4週後，利巴韋林和對照實驗組的平均體重分別為340.2±47.2克和340.5±67.9克。 / 研究II： 相比起對照實驗組的動物，RBV組的最大膀胱容量顯著降低（0. 0.78 ± 0.12毫升對1.46±0.22毫升），排尿頻率顯著增加（2.53±0.30 對.0.53±0.05/hr）。此外，排尿時最大逼尿肌壓力亦顯著升高（32.0.8±2.19 比.20.37±1.2 5厘米水分子） / 研究III： 相比起對照實驗組的動物，光非快速動眼期睡眠顯著地較多發生於RBV大鼠身上（61.8％對35.6％），深層睡眠和快速動眼期睡眠顯著地較少發生在RBV組（32.3％對52.8％） / 研究IV： 結果表明，RBV組使用了顯著較長的時間來定位平台（24.4s vs. vs.17.19s）。而且，在RBV組，顯著地較多動物無法完成行走8臂的放射狀迷宮。 / 研究V： 進行檢測和定量七種代謝物。結果顯示乳酸（LAC）代謝在大鼠大腦的某些特定區域出現顯著變化。在手術4週後，相比起對照實驗組的動物，RBV組大鼠在海馬體（43％，P <0.001），扣帶和夾肌皮質（29％，P <0.05）的乳酸水平均顯著減少。 / 研究VI： 結果顯示RBV大鼠腦幹的血清素水平較對照實驗組的顯著增加（23.726+0.88納克/毫升與1.88±0.302ng/ml）。RBV大鼠腦幹的多巴胺水平則較對照實驗組的顯著下降（2.850.10納克/毫升與6.85+0.84毫微克/毫升）。 / 結論： 外科膀胱容量減少可誘導中樞神經系統的功能變化。以外科手術減少膀胱容量的大鼠亦引起睡眠結構改變，這顯示膀胱功能障礙對中樞有潛在影響。膀胱疾病長期改變大腦的能量代謝。此外，膀胱疾病亦改變了在腦幹和大腦皮層的中樞神經遞質傳遞。研究發現膀胱功能障礙顯著地損害RBV大鼠的認知功能，顯示改變大腦的能量代謝亦可導致行為和專注力的問題，從而損害學習和認知能力。 / Yeung, Chung Kwong. / Thesis Ph.D. Chinese University of Hong Kong 2014. / Includes bibliographical references (leaves 199-230). / Abstracts also in Chinese. / Title from PDF title page (viewed on 14, September, 2016). / Yeung, Chung Kwong. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only.

Enuresis (bed-wetting) and encopresis (fecal soiling) mean elimination disorder and the children suffering from these disorders are often isolated from their contemporaries. The summer camp for the children suffering from enuresis and encopresis held by Faculty of Health and Social Studies at University of South Bohemia in České Budějovice provides the children with i. a. the only possibility of experiencing life without worries and shame, which is the way of life that the majority of children take for granted. In the theoretical part of the dissertation work the author deals with the issue of enuresis and encopresis from various angles. The main goal of the dissertation work is to analyse and describe the impact of the rehabilitative stay at the summer camp for the children suffering from enuresis and encopresis on the disorder of the children. The research question aims to answer: ``In what way and in which fields the rehabilitative stay at the summer camp for the children suffering from enuresis and encopresis contributes to the improvement or the total reduction of the problems linked to the disorder``. The qualitative research was carried out both at the summer camp and home background in years 2006 {--} 2008. The following methods of data collection have been used: interrogation method, observation, document review and the methods within the psychological examination. The research emerged from findings that the camp for the children suffering from enuresis and encopresis improves psychosocial state of the children predominantly due to their self-confidence building, self-identity and self-evaluating. The camp helps the children with their problems in the field of setting boundaries, rules and regime, in the field of experience and hygiene. The camp is also meaningful regarding the field of children`s contacts with other affected children and adults and the field of psychic and physical resistance. Due to the above mentioned aspects the camp contributes not only to problem reduction linked to emptying disorders but also to the children{\crq}s total reduction of enuresis and encopresis. The research results demonstrate two hypotheses: The first is based on the notion that the camp contributes to the improvement of psychosocial state of the children suffering from enuresis and encopresis. The second hypothesis proves that the camp positively influences the frequency of bed-wetting and fecal soiling.

Introduction: Enuresis involves involuntary emptying of the bladder at night, completely orpartially, from five years of age. If it occurs twice or more/week for at least three months and it causes suffering, the diagnosis is enuresis. Enuresis is divided into primary and secondary enuresis.In the past, enuresis was interpreted as a psychiatric symptom. Today, psychological disorders are seen as secondary to enuresis. Aim: The purpose of this literature study was to describe the quality of life of children and adolescents with enuresis. Method: A literature study was performed to compile the current state of knowledge regarding quality of life in connection with enuresis. Scientific articles for the study has been searched via PubMed and Cinahl. Results: The results were put together under four of WHO’s six themes, physical health/ psychological health/independence/ social relationships. These are linked to quality of life. As well as a fifth theme emerged from the analysis of the scientific articles, cultural aspects. Children and adolescents with enuresis experienced their life situation mainly as having poor self-esteem, after that it affected mental health, body image, independence, family and social interaction. Conclusion: This literaturestudy demonstrated that children and adolescents were influenced by the quality of life of their enuresis. Among other things, related to social relations, where the boys experienced a greater impact on the quality of life than the girls. In particular, adolescents experienced a worse quality oflife than the younger children, affecting self-esteem. In the clinical activity, it is necessary as apediatric nurse to take into account the experiences and feelings of children and adolescents regarding the daily life of enuresis, in order to achieve optimal enuresis treatment and thus increase their quality of life.

Não há consenso entre os estudos quanto à associação entre a presença de problemas de comportamento e resultados piores no tratamento com alarme para enurese. O objetivo do presente estudo foi investigar a ocorrência de associações entre a presença de problemas de comportamento e os resultados do tratamento com alarme para enurese primária com acompanhamento semanal de um terapeuta. Os participantes foram 20 crianças com enurese primária, 13 do sexo masculino e 7, do sexo feminino, com idades entre seis e dez anos. Metade das crianças apresentava escores clínicos indicativos de problemas de comportamento segundo o Child Behavior Checklist. As oito crianças sem problemas de comportamento que concluíram o tratamento alcançaram o critério de sucesso inicial (14 noites secas consecutivas) e apenas duas desistiram. Das dez crianças com problemas de comportamento, somente metade atingiu o sucesso inicial, quatro desistiram e uma completou o período de tratamento e não obteve sucesso. Essas diferenças nos resultados finais não foram significativas em termos estatísticos. Também não foram encontradas diferenças significativas nas taxas de recaídas entre as crianças com e sem problemas de comportamento. Quatro das oito crianças sem problemas de comportamento que haviam alcançado o critério de sucesso inicial apresentaram recaídas e quatro conseguiram manter o controle noturno adquirido. Das cinco crianças com problemas de comportamento que alcançaram o sucesso inicial, três, apresentaram recaídas e duas, enquadraram-se no critério de sucesso continuado. A única diferença estatística encontrada entre os dois grupos de crianças foi no tempo de tratamento necessário para alcance do critério de sucesso inicial. Em 12 semanas de tratamento, a probabilidade de atingir o sucesso inicial foi de 86,11% para as crianças sem problemas de comportamento e de 10% para as crianças com problemas de comportamento; em 20 semanas, a probabilidade foi de 100% para as crianças sem problemas de comportamento e de 40% para as crianças com problemas de comportamento. Pode-se dizer, portanto, que, na amostra de crianças atendidas, os problemas de comportamento parecem ter ocasionado dificuldades para que progressos fossem alcançados no tratamento da enurese com alarme. Na maioria dos casos, entretanto, essas dificuldades não foram suficientes para que as crianças com problemas de comportamento apresentassem ao final do tratamento resultados significativamente diferentes das crianças sem problemas de comportamento. Esses resultados sugerem que as crianças com problemas de comportamento podem beneficiar-se do tratamento com alarme para enurese tanto quanto as crianças sem problemas de comportamento. Considerando o tempo necessário para o alcance do sucesso inicial, os resultados indicam que, provavelmente, as crianças com problemas de comportamento precisam mais de acompanhamento intensivo durante o tratamento com alarme para enurese do que as crianças sem problemas de comportamento. / There is no consensus among the studies regarding the association between behavior problems and worse outcomes in alarm treatment for enuresis. The aim of this study was to investigate the relationship between behavior problems and outcome in alarm treatment for primary enuresis with weekly sessions with a therapist. The participants were 20 children with primary enuresis, 13 boys and 7 girls, between the ages of six and ten. Half of these children presented clinical scores on the Child Behavior Checklist. Eight out of the 10 children without behavior problems who finished the treatment have achieved the criteria for initial success (14 consecutive dry nights) and two of them dropped out. Only half of the children with behavior problems attained initial success, four of them dropped out and one finished without success. These differences on the outcome were not statistically significant. There were also not found significant statistical differences in the occurrence of relapses rates between children with and without behavior problems. Four of the eight children without behavior problems who attained initial success have relapsed, and four have maintained the acquired nocturnal control. Three of the five children with behavior problems who achieved the initial success have relapsed and two of them satisfied the criteria for continued success. The only statistical difference found between the children groups was the time required to achieve initial success. In 12 weeks of treatment, the probability of attaining initial success was 86.11% for children without behavior problems and 10% for children with behavior problems; in 20 weeks, the probability was 100% for children without behavior problems, and 40% for the children with behavior problems. Therefore, it is possible to say that in that sample of children the behavior problems seemed to provide difficulties in achieving progresses in the alarm treatment for enuresis. On most of the cases, those difficulties were not enough to make the outcomes at the end of the treatment of children with behavior problems being statistically different from the children without behavior problems. These results suggest that children with behavior problems may benefit from alarm treatment as well as children without behavior problems. Considering the time required for achieving success, the results indicate that they probably need more intensive support during enuresis treatment with alarm than children without other problems.

A enurese é uma condição caracterizada pela perda de urina durante o sono, em crianças com mais de cinco anos sem outra condição clínica que explique os episódios. A enurese pode ser primária, no caso das crianças que nunca obtiveram controle prévio, ou secundária, em que a enurese cessou por pelo menos seis meses. Também é classificada como monossintomática, na ausência de sintomas diurnos do trato urinário inferior ou não-monossintomática, quando está associada a tais sintomas, como a urgência miccional. A enurese, cujas causas apresentam componentes hereditários ainda pouco claros, tem sua etiologia baseada na combinação de três fatores: a poliúria noturna ou a hiperatividade detrusora ligada á incapacidade de despertar em resposta aos sinais da bexiga cheia. Há tratamentos medicamentosos e psicológicos, sendo que a desmopressina, análogo sintético da vasopressina, que atua na poliúria noturna e o alarme, que atua na incapacidade de despertar, apresentam os níveis mais altos de recomendação e evidência. Embora tais tratamentos estejam consolidados, ainda não há total clareza sobre seus mecanismos de funcionamento e o porquê de não alcançarem todos os casos. Este trabalho teve como objetivo verificar se um conjunto de variáveis atuaria como moderador do resultado do tratamento com alarme, ou seja, em que medida influenciava, positiva ou negativamente, o desempenho dos participantes atendidos. As variáveis avaliadas foram: tipo de acompanhamento (presencial e à distância), frequência inicial de episódios, nível de problemas de comportamento, escolaridade dos pais, sexo e idade. Foram incluídos na amostra 61 crianças e adolescentes de 6 a 17 anos que receberam tratamento com alarme, sendo que 34 foram acompanhados à distância e 27 presencialmente. No total, 37 participantes obtiveram sucesso, caracterizado por 14 noites consecutivas sem episódios, num período de 28 semanas. Doze participantes não obtiveram sucesso e outros 12 desistiram. Caracterizaram-se como moderadoras do resultado do tratamento as seguintes variáveis: tipo de acompanhamento (grupo acompanhado à distância obteve mais sucessos), frequência inicial de episódios (participantes que obtiveram sucesso tinham menos episódios, em média, no início do tratamento) e nível de problemas de comportamento (participantes que não obtiveram sucesso tinham escores maiores de problemas de comportamento externalizantes). Os resultados indicam a efetividade do alarme e apontam para os aspectos que devem receber atenção do clínico ao administrar esse tipo de tratamento / Enuresis is a condition in which children of at least five years of age lose urine during sleep, without another clinical condition that could explain the wetting episodes. Enuresis may be primary, when the child has not obtained previous bladder control, or secondary, when such control was achieved for at least six months. It is also classified as monosymptomatic, when it is not associated with other lower urinary tract symptoms or non monosymptomatic, when these symptoms, such as urgency, are present. Enuresis etiology has unclear hereditary aspects. Its physiology is based on a combination of at least two of three malfunctioning systems: incapacity to wake in response to the full bladder signals plus nocturnal polyuria or detrusor hyperactivity. There are evidence based pharmacological and psychological treatments. Desmopressin, a synthetic version of hormone vasopressin that reduces nocturnal polyuria is the first line pharmacological treatment, whereas the alarm, which acts in the incapacity to wake is the first line psychological treatment. Both have the higher levels of evidence and recommendation by the specialized literature. However, the mechanisms underlying these treatments results and the reasons they are not successful with every enuretic children are not entirely clear. The objective of this work was to verify to what stand a series of variables are moderators of alarm treatment outcome. These variables were: type of support (face-to-face versus long distance), initial bedwetting frequency, behavior problems scores, level of parents education, gender and age. Sixty-one children with ages from 6 to 17 were included. All received full spectrum home training. Thirty-four received long distance support during treatment and 27 received face-to-face support. Success was defined by 14 consecutive dry nights within a 28 weeks treatment period. Success was obtained by 37 children, while 12 did not succeed and other 12 dropped out. Three variables were observed as moderators of treatment outcome: type of support (long distance had better results), initial bedwetting frequency (participants who succeeded had fewer initial wet nights) and behavior problem scores (participants who did not succeed had higher externalizing problems scores). Results indicate alarm effectiveness and aspects that should be focuses of attention when this kind of treatment is administered

Objetivo: Estimar a prevalência de sintomas de apneia obstrutiva do sono (AOS), obstrução nasal (ON) e enurese em crianças com fissura labiopalatina unilateral, não sindrômicas. Local de execução: Unidade de Estudos do Sono do Laboratório de Fisiologia - HRAC/USP. Método: Estudo prospectivo transversal com a participação de 174 sujeitos que atenderam aos critérios de inclusão, de 6 a 12 anos de idade (média de 10,0 ± 1,8 anos, 58,62% do sexo masculino). A prevalência de sintomas de AOS e de ON foi estimada pela análise dos escores obtidos pelos instrumentos: Escala de Distúrbios do Sono em Crianças (EDSC); Índice de Congestão Nasal (CQ-5) e Escala Visual Analógica (EVA). A enurese foi considerada como presente quando relatada incontinência urinária intermitente durante o sono (no mínimo 1 episódio/mês, nos últimos 3 meses). Para caracterizar a enurese como monossintomática ou polissintomática, sintomas de disfunção do trato urinário inferior (DTUI) foram investigados pelo instrumento Dysfunctional Voiding Scoring System (DVSS), em Português. Foram colhidos dados sociodemográficos, antecedentes e comorbidades, índice de massa corpórea (IMC) e razão circunferência abdominal/altura (CA/A). Foram analisadas medidas de posição e dispersão, frequências percentuais e absolutas e razão de prevalências. Diferenças entre subgrupos foram analisadas a um nível de significância de 5%. Resultados: Escore EDSC positivo para AOS foi observado em 60 (34,48%) crianças da amostra; escore CQ-5 positivo para ON em 45 (25,86%), escore DVSS positivo para DTUI em 30 (17,24%) e 29 (16,67%) crianças apresentaram enurese. Ronco habitual foi observado em 75,00% no subgrupo AOS e sensação de nariz obstruído habitual em 75,56% no subgrupo ON. Não foram constatadas diferenças significativas quanto a sexo, raça, IMC e razão CA/A. A ocorrência de enurese foi maior aos 6 e 7 anos, com queda gradativa aos 8 anos e ausência aos 12 anos. Houve predomínio de enurese primária (65,52%), infrequente (68,96%) e polissintomática (72,41%). Comparativamente aos dados da literatura, as razões de prevalências de AOS, do sintoma nariz obstruído e de enurese foram até 6,75 vezes (IC 95% 5,3 - 8,7), 2,14 vezes (IC 95% 1,8 - 2,5) e 3,33 vezes (IC 95% 2,3 - 4,7) maiores, respectivamente. Foi identificada associação entre sintomas de AOS e ON (p=0,0001), com correlação positiva e moderada entre os escores médios do EDSC e do CQ-5 (0,545). Não se verificou maior prevalência de enurese nas crianças com sintomas de AOS. Conclusão: As crianças com FLPUNS tem alta prevalência de obstrução nasal e enurese e estão sob risco para apneia obstrutiva do sono / Objectives: To estimate the prevalence ratios of nasal obstruction (NO) symptoms, OSA-related symptoms and enuresis in Brazilian nonsyndromic children with repaired unilateral cleft lip and palate (UCLP/NS). Setting: Sleep Studies Unit, Laboratory of Physiology, HRAC/USP. Methods: 174 children with repaired UCLP/NS, meeting inclusion criteria, participated in this prospective, cross-sectional study (aged 6-12 y, 58.62% boys). Validated questionnaires were used to predict OSA and subjective NO, Sleep Disturbance Scale for Children (SDSC), Congestion Quantifier Five Item (CQ-5) and Visual Analog Scale (VAS), respectively. Enuresis was defined as intermittent incontinence of urine during sleeping (with a minimum of one episode per month and at least for 3 months). In order to identify non-monosymptomatic enuresis, lower urinary tract dysfunction was assessed by a validated questionnaire, the Dysfunctional Voiding Scoring System (DVSS). Sociodemographic data, medical history, comorbidities, body mass index (BMI) and waist-to-height ratio (WHR) were analyzed. Measures of central tendency and dispersion, absolute and relative frequencies and prevalence ratios were analyzed. Subgroups were compared at 5% significance level. Results: Positive screening for OSAS-related symptoms was seen in 60 (34.48%) children and subjective NO in 45 (25.86%). Enuresis was seen in 29 (16.67%) children and positive DVSS score in 30 (17.24%). Habitual snoring was seen in 75.00% of the children with OSA-related symptoms and sensation of nasal obstruction in 75.56% of the children with positive CQ-5 score. No differences were observed for gender, race, BMI and WHR. The occurrence of enuresis was higher at 6/7 y of age, with a gradual decline at 8 years and absence at 12 y. There was a predominance of primary (65.52%), infrequent (68.96%) and non-monosymptomatic (72.41%) enuresis. Compared to literature data, prevalence ratios of OSA-related symptoms, NO and enuresis were, respectively, 6.75 (95% CI 5.3 - 8.7), 2.14 (95% CI 1.8 - 2.5) and 3.33 (95% CI 2.3 - 4.7) times higher. Association was identified between symptoms of OSA and ON (p=0.0001), with a positive and moderate correlation between the average scores of the EDSC and CQ-5 (0.545). Prevalence of enuresis was not higher in children with symptoms of OSA. Conclusion: Nonsyndromic children with cleft lip and palate have a high prevalence of symptoms of nasal obstruction and enuresis, and are at risk for obstructive sleep apnea

Worldwide, millions of children 5 years of age and older suffer with nocturnal enuresis, also known as nighttime bedwetting. Nocturnal enuresis is a chronic elimination disorder that while usually benign, too often results in the child being emotionally and physically abused. Efforts to design effective treatments with low relapse rates have thus far been thwarted by the array of organic and psychosocial variables related to its development. Guided by the 5-factor theory of personality, this cross-sectional study investigated whether a parent's personality characteristics significantly predict effective treatment for a child's nocturnal enuresis. Effective treatment was defined as having no relapses of symptoms in the 6 months following initial treatment success. A convenience sample of parents (n = 165) was recruited from the online social network Facebook and other online educational and support forums for parents seeking information on enuresis. Participants completed the NEO-FFI-3 to measure their personality characteristics, and logistic regression analyses were used to determine if parental personality characteristics, parental history of childhood enuresis, and/or the child's gender were significant predictors of effective treatment for a child's enuresis. None of these factors were found to significantly predict effective treatment for enuresis. This study promotes positive social change by identifying the need for an integrated biopsychosocial approach to treating children with enuresis with effective evidence-based treatments. These treatments are expected to result in fewer children exposed to the high rates of abuse and the development of psychosocial disorders often associated with nocturnal enuresis

Child-rearing behaviors and attitudes have been implicated by some authors in the persistence of bed-wetting after the age of three. In this study, maternal child-rearing behaviors were evaluated from the point of view of the child. Perceived maternal behaviors were assessed through the use of the Child's Report of Parent Behavior Inventory. Field dependence/independence was measured by Children's Embedded Figures Test scores. Correlational analysis of the data suggested the following conclusions: 1) The rapidity of response to conditioning treatment for enuresis is not related, to scores of Acceptance, Psychological Control, and Lax Control. 2) Degree of field dependence/independence is unrelated to the rapidity of response to conditioning treatment for enuresis. 3) Child's Report of Parent Behavior Inventory factor scores of Acceptance, Psychological Control, and Lax Control are unrelated to Children's Embedded Figures Test scores. 4) Primary enuretic boys do not differ from nonenuretic boys along the dimension of field dependence/independence.

Social situation of children suffering from enuresis In the process of socialization, people often achieve a certain social status (grading on social ladder). The social development and position of the person are principally influenced by their health state. This is the basic determinant of the whole socialisation process and of maintaining the achieved social status of the man/woman, as the social position of a completely healthy and efficient man is completely different than the position of a chronically ill person, with a defect or limitation of movement. Enuresis is one of the most frequent long-term problems in paediatrics. A number of epidemiologic studies has shown that 15-20% of five-year-old and 10% of seven-year-old children have problems with urine leakage. Incontinency brings psychological and social problems to children. These problems may cause considerable handicaps to children. Enuresis may be stressing for children, may initiate the feeling of shame, failure, inferiority. Moreover this means a limitation in the usual activity for a number of them (travelling, participation in camps, school trips etc.) The target of the thesis was to find out if the illness worsens the social status of the child in the society of contemporaries and how. The research was performed at the summer camp for children suffering from enuresis and encopresis, organised by the Faculty of Health and Social Studies of the South Bohemian University in České Budějovice. In the thesis, the following methods and techniques of data collection were applied: method of observation (hidden participant), method of document analysis (contents analysis), method of questioning (non-controlled interview). It was found out by the research that the social status of children suffering from enuresis is endangered. Within social interaction these children avoid the other children on one hand as they are ashamed because of their illness, on the other hand they need social contact with contemporaries. However, all the children with enuresis do not have necessarily such experiences. The thesis has shown that the orientation on the personal identity of the child is necessary in the social work (i.e. the children have to learn to respect their own personality and to strengthen their good and healthy self-confidence).

A enurese é uma condição caracterizada pela perda de urina durante o sono, em crianças com mais de cinco anos sem outra condição clínica que explique os episódios. A enurese pode ser primária, no caso das crianças que nunca obtiveram controle prévio, ou secundária, em que a enurese cessou por pelo menos seis meses. Também é classificada como monossintomática, na ausência de sintomas diurnos do trato urinário inferior ou não-monossintomática, quando está associada a tais sintomas, como a urgência miccional. A enurese, cujas causas apresentam componentes hereditários ainda pouco claros, tem sua etiologia baseada na combinação de três fatores: a poliúria noturna ou a hiperatividade detrusora ligada á incapacidade de despertar em resposta aos sinais da bexiga cheia. Há tratamentos medicamentosos e psicológicos, sendo que a desmopressina, análogo sintético da vasopressina, que atua na poliúria noturna e o alarme, que atua na incapacidade de despertar, apresentam os níveis mais altos de recomendação e evidência. Embora tais tratamentos estejam consolidados, ainda não há total clareza sobre seus mecanismos de funcionamento e o porquê de não alcançarem todos os casos. Este trabalho teve como objetivo verificar se um conjunto de variáveis atuaria como moderador do resultado do tratamento com alarme, ou seja, em que medida influenciava, positiva ou negativamente, o desempenho dos participantes atendidos. As variáveis avaliadas foram: tipo de acompanhamento (presencial e à distância), frequência inicial de episódios, nível de problemas de comportamento, escolaridade dos pais, sexo e idade. Foram incluídos na amostra 61 crianças e adolescentes de 6 a 17 anos que receberam tratamento com alarme, sendo que 34 foram acompanhados à distância e 27 presencialmente. No total, 37 participantes obtiveram sucesso, caracterizado por 14 noites consecutivas sem episódios, num período de 28 semanas. Doze participantes não obtiveram sucesso e outros 12 desistiram. Caracterizaram-se como moderadoras do resultado do tratamento as seguintes variáveis: tipo de acompanhamento (grupo acompanhado à distância obteve mais sucessos), frequência inicial de episódios (participantes que obtiveram sucesso tinham menos episódios, em média, no início do tratamento) e nível de problemas de comportamento (participantes que não obtiveram sucesso tinham escores maiores de problemas de comportamento externalizantes). Os resultados indicam a efetividade do alarme e apontam para os aspectos que devem receber atenção do clínico ao administrar esse tipo de tratamento / Enuresis is a condition in which children of at least five years of age lose urine during sleep, without another clinical condition that could explain the wetting episodes. Enuresis may be primary, when the child has not obtained previous bladder control, or secondary, when such control was achieved for at least six months. It is also classified as monosymptomatic, when it is not associated with other lower urinary tract symptoms or non monosymptomatic, when these symptoms, such as urgency, are present. Enuresis etiology has unclear hereditary aspects. Its physiology is based on a combination of at least two of three malfunctioning systems: incapacity to wake in response to the full bladder signals plus nocturnal polyuria or detrusor hyperactivity. There are evidence based pharmacological and psychological treatments. Desmopressin, a synthetic version of hormone vasopressin that reduces nocturnal polyuria is the first line pharmacological treatment, whereas the alarm, which acts in the incapacity to wake is the first line psychological treatment. Both have the higher levels of evidence and recommendation by the specialized literature. However, the mechanisms underlying these treatments results and the reasons they are not successful with every enuretic children are not entirely clear. The objective of this work was to verify to what stand a series of variables are moderators of alarm treatment outcome. These variables were: type of support (face-to-face versus long distance), initial bedwetting frequency, behavior problems scores, level of parents education, gender and age. Sixty-one children with ages from 6 to 17 were included. All received full spectrum home training. Thirty-four received long distance support during treatment and 27 received face-to-face support. Success was defined by 14 consecutive dry nights within a 28 weeks treatment period. Success was obtained by 37 children, while 12 did not succeed and other 12 dropped out. Three variables were observed as moderators of treatment outcome: type of support (long distance had better results), initial bedwetting frequency (participants who succeeded had fewer initial wet nights) and behavior problem scores (participants who did not succeed had higher externalizing problems scores). Results indicate alarm effectiveness and aspects that should be focuses of attention when this kind of treatment is administered