Nocturnal enuresis is one of the most common and pervasive childhood problems. Without effective intervention, the child's nocturnal enuresis may persist. This may result in possible distress and even psychological problems in the child. The current study had two aims. The first aim was to examine the effectiveness of retention control training, and the urine alarm if necessary, as an intervention for primary nocturnal enuresis. The second aim was to explore children's attributions for the therapeutic outcome of the intervention method regarding their nocturnal enuresis. The first aim was important, as previous research has revealed contradictory findings. The second aim was also important, as to date, research has neglected to explore this topic. Six children aged 8 to 12 years and their primary caregivers participated in the current study. Attribution data was obtained at three intervals through one-on-one semi-structured interviews between the researcher and child. Results found that with retention control training: one child achieved nocturnal urinary continence, three children decreased the number of their wet nights, and two children failed to respond. The addition of the urine alarm enabled three more children to achieve nocturnal urinary continence. In terms of attributions, results found that brief psycho-education appeared to have influenced these children‟s attributions. However, overall attribution findings suggested that children perceived researcher assistance, unknown factors, and the techniques used in retention control training to have influenced their success in the achievement of nocturnal urinary continence. These results would help to inform general practitioners and psychologists in terms of intervention recommendations for evidence-based practice, and future research.

The first part of this thesis examines the psychosocial characteristics of a cohort oj 270 bedwetting children attending a community enuresis service for treatment These children were recruited to a stratified cluster randomised controlled trial which forms the second part of this thesis in which additional information wa~ provided via a multimedia computer program and written leaflets. The mail clinical outcome measures were becoming dry and remaining dry six months pos discharge, time to dry, non-attendance and dropout rates. The main psycho socia measures were maternal tolerance, the impact of bedwetting and self-esteem. Th theoretical basis for the intervention(s) was the 'incomplete learning' model c bedwetting.' It was hypothesised that the intervention (s) would improve the sell efficacy of children through the mediation of cognitive, motivational, affectiv and self-selection changes (Bandura 1977). The randomisation procedure was slightly biased with children in the comput( group being sampled from a more affluent population and those in tl control/leaflets group from a more deprived population. There were also few, children from minority ethnic groups in the computer group. Significa differences were found between the ethnic groups in response to the impact bedwetting and maternal tolerance scales, together with parents' reports of th{ child's distress and parental worry. Therefore analysis was conducted on a samI matched by Jarman scores which excluded the children from affluent areas in t computer group and children from deprived areas in the control and leaflets grm Analysis was also conducted on the entire cohort. Bedwetting children had a lower self-esteem than school children. However, selfesteem improved with treatment with the greatest changes occurring for those who became dry. Low self-esteem was significantly related to a high impact of bedwetting. The presence of housing difficulties produced the least positive response on the psychosocial measurement scales. Low parent reported child distress and less severe wetting at initial assessment predicted a successfu: outcome. Although self-esteem was significantly lower for bedwetting children compared t( the school children the mean difference of less than one item suggests this result i not clinically meaningful. Nevertheless there are clearly some bedwettinJ children with less positive psychosocial and clinical situations. Bedwetting seem to be worse psychosocially for children from less affluent backgrounds, measure by the presence of housing difficulties, and those who are most distressed by it ne only have a lower self-esteem, but they are less likely to get dry. Howeve children's self-esteem does improve with treatment. The intervention( s) made no significant difference to any of the clinical outcorr measures or any of the psychosocial measures recorded during and post-treatmel for either the matched sample or the entire cohort. The absence of an intervention effect is disappointing and suggests that it is n sufficient merely to provide novel additional information to bedwetting childre Two main problems with the study design were identified. The large variation bedwetting children's time to dry suggests the outcome measures used may not sufficiently precise to detect a difference if one was present. The computer and the leaflets may have had insufficient power to produce changes in children at the level measured. Future research might wish to use a more intensive program where the computer intervention is combined with the leaflets. Nevertheles~ whilst this intensive training input and measurement is likely to motivate somt children this will not be the case for all.

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.

Since 1904 bedwetting alarms have been developed and scientifically described for the treatment of nocturnal enuresis, also known as bedwetting. Currently, several bedwetting alarms of various designs are available on the overseas market. These can be imported to South Africa at great cost. As affordable alarms were not readily available in South Africa, there was a need to develop and evaluate a new unit. In order to improve the efficacy of this new device, it was accompanied by detailed user guidelines and instructions. The use of this alarm was tested and the observations of thirteen bedwetting children recorded. Additionally, a programme was developed to counsel enuretic children with accompanying problems, and to assist the parents in dealing with their child's bedwetting problem. The observations and findings will be useful in practice and future research. / Psychology of Education / M. Ed. (Educational Psychology - Specialisation in Guidance and Counselling)

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.

Conclusion. Impairment in bladder and brain functions was identified in children with severe NE. Post-treatment studies indicated that brain function normalized in parallel with amelioration of bladder dysfunction. Interaction between brain and bladder dysfunction is likely to have an important implication in the pathophysiology and resolution of NE. / Objective. To (1) investigate sleep pattern and cortical arousals in enuretic children; (2) assess brain and bladder function in enuretic children; (3) evaluate post-treatment brain and bladder functional changes in enuretic children and correlate these with the treatment outcomes. / Part II. Fifty-two patients with severe PNE and 15 normal controls were recruited. Bladder and brain functions (sleep arousal threshold, P300 ERPs latency and PPI of startle amplitude) in enuretic children were evaluated, and brain function was compared with normal controls. / Part II. Markedly reduced nocturnal FBC and impaired brain function were found in enuretic patients. Higher sleep arousal threshold was negatively correlated to lower FBC. Prolonged P300 ERPs and higher PPI of startle amplitude were positively correlated to a higher sleep arousal threshold. / Part III. NE episodes and bladder function were re-evaluated in 52 severely enuretic children (Part II) at 3 and 6 months on treatment. Brain function was re-evaluated in 41/52 enuretic children at 6 months on treatment. / Part III. Post-treatment FBC significantly increased, and sleep arousal threshold, number of awakenings, P300 ERPs latency and PPI of startle amplitude normalized in treatment responders. NE episodes reduction was significantly correlated to the improvement in FBC and brain function. Greater decrease in sleep arousal threshold was positively correlated to higher FBC increase. Higher P300 ERPs latency and PPI of startle amplitude reduction were positively correlated to greater decrease in sleep arousal threshold. / Patients and methods. Part I. Thirty-five children with refractory PNE and 21 normal controls were recruited. Overactive bladder contractions, NE episodes and volume in enuretic children, sleep stages and cortical arousals in all children were recorded. / Results. Part I. Underlying bladder dysfunction, abnormal sleep architecture and increased cortical arousal index were found in enuretic children. Cortical arousal index was positively correlated to the frequency of overactive bladder contractions. / Diao Mei. / "May 2005." / Adviser: Chung-Kwong Yeung. / Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3693. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 135-159). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.

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

Since 1904 bedwetting alarms have been developed and scientifically described for the treatment of nocturnal enuresis, also known as bedwetting. Currently, several bedwetting alarms of various designs are available on the overseas market. These can be imported to South Africa at great cost. As affordable alarms were not readily available in South Africa, there was a need to develop and evaluate a new unit. In order to improve the efficacy of this new device, it was accompanied by detailed user guidelines and instructions. The use of this alarm was tested and the observations of thirteen bedwetting children recorded. Additionally, a programme was developed to counsel enuretic children with accompanying problems, and to assist the parents in dealing with their child's bedwetting problem. The observations and findings will be useful in practice and future research. / Psychology of Education / M. Ed. (Educational Psychology - Specialisation in Guidance and Counselling)

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-03-29T15:40:49Z No. of bitstreams: 1 raqueldoamaralrangel.pdf: 158084 bytes, checksum: a4206ccf31e141318c8421c1501b66ae (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-03-30T11:22:35Z (GMT) No. of bitstreams: 1 raqueldoamaralrangel.pdf: 158084 bytes, checksum: a4206ccf31e141318c8421c1501b66ae (MD5) / Made available in DSpace on 2017-03-30T11:22:35Z (GMT). No. of bitstreams: 1 raqueldoamaralrangel.pdf: 158084 bytes, checksum: a4206ccf31e141318c8421c1501b66ae (MD5) Previous issue date: 2009-07-27 / A enurese noturna é uma desordem crônica que gera inúmeros problemas para a criança e seus pais e afeta cerca de 10% das crianças de sete anos de idade. O molhar a cama tem impactos negativos significantes, na auto estima e performance das crianças. O objetivo do presente estudo foi avaliar a qualidade de vida de crianças enuréticas, bem como sua associação com sexo e idade. Crianças enuréticas e crianças não-enuréticas responderam ao questionário AUQEI. Participaram do estudo 88 crianças, sendo 39 enuréticas (23 meninos) e 49 nãoenuréticas (27 meninos), com idade entre 6 e 11 anos de idade. As crianças enuréticas apresentaram prejuízo da qualidade de vida quando comparadas às crianças não enuréticas (35,9% x 16,3%, p=0,035). Não foram encontradas diferenças significativas, nas associações entre sexo e qualidade de vida e idade e qualidade de vida. Esses resultados sugerem que, as crianças com enurese noturna, têm 187% a mais de chances de ter prejuízo na qualidade de vida, quando comparadas com crianças não enuréticas. / Nocturnal enuresis is a chronic disorder that generates countless problems to the child and their parents affecting about 10% of seven-year-old children. “Bedwetting” has significantly negative impacts on the self-esteem and the performance of children. The aim of the current study is to assess the quality of like in enuretic children, as well as its association to sex and age. Enuretic and non-enuretic children answered the “AUQEI” questionnaire. The total number of participants was 88, 39 of which were enuretic (23 boys), and 49 non-enuretic (27 boys), from ages between 6 and 11. Enuretic children displayed loss in quality of life when compared to nonenuretic (35,9% x 16,3%, p=0,035). No significant differences were found, in the association of sex, gender and quality of like. These results suggest that, children with nocturnal enuresis have 187% more chances of having loss in quality of life, when compared to non-enuretic ones.

Introdução: A enurese noturna (EN) é considerada como a eliminação de urina no período noturno, de forma involuntária, em indivíduos com cinco ou mais anos de idade em pelo menos duas noites no mês até todas as noites. EN pode ser do tipo monossintomática, quando ocorre na ausência de outros sintomas, ou não monossintomática, na presença de sintomas de vesicais diurnos. Apesar de historicamente conhecida com uma desordem psiquiátrica, a EN monossintomática está incluída na Classificação Internacional dos Transtornos de 2012 como uma parassonia podendo ocorrer em qualquer fase do sono, porém predominantemente no sono não REM. Está comumente associada a hiperatividade vesical, produção excessiva de urina e falha em acordar após o enchimento vesical. Apesar de ocorrer no sono, a avaliação do sono pelos padrões usuais falhou em encontrar justificativa para este processo patológico. A análise da microestrutura do sono é uma ferramenta mais refinada e precisa que pode auxiliar na busca do mecanismo neurofisiológico que justifica este processo. Objetivo: Analisar os padrões de microarquitetura de sono atrvés do Padrão alternante Cíclico (CAP) nas crianças com EN monossintomática para melhor compreensão das bases neurofisiológicas da EN. Metodologia: Trinta e seis crianças sendo, 22 enuréticos e 14 controles com idade variando entre sete e 17 anos de idade, que satisfizeram os critérios de inclusão, foram submetidas a triagem clínica e laboratorial, avaliados quanto aos aspectos do sono, com uso de diários de sono, das escalas de Berlin, Sleep Scale for Children (SDSC) e Escala de Sonolência de Epworth e posteriormente submetidos ao de estudo polissonográfico completo de noite inteira, com a avaliação do CAP. Resultados: As escalas de sonolência e de Berlin não evidenciaram anormalidades, o SDSC evidenciou apneia em 11/22 (50%), hiperidrose em 2/22 (9%) e transtorno da transição vigília-sono, do despertar e do início e manutenção de sono em 1/22 (4,5%) cada. A análise da estrutura do sono mostrou maiores números de despertares (p < 0,001) e de sono N2 (p=0,0025) além de maior quantidade de sono N3 (p < 0,0001) do que nos controles. A microestrutura do sono evidenciou aumento da fase A1 (p=0,05), porém de forma mais contundente, redução das fases A2 e A3 (p < 0,0001), mesmo com a taxa de CAP igual à dos controles normais.Conclusão: Crianças com EN possuem sono com comorbidades (avaliado pelo SDSC) e menos fases CAP A2 e A3, significando uma redução no seu mecanismo de despertar e que ainda não havia sido demonstrado num estudo de PSG com análise das variáveis comuns. Este é o primeiro estudo que demonstra tal fenômeno / Introduction: Nocturnal enuresis (NE) is defined as the lack of nocturnal urine control, in individuals with five or more years old for at least two nights in a month, but up to every night. EN can be monosymptomatic (ENM), when it occurs in the absence of other symptoms or non monosymptomatic in the presence of diurnal renal symptoms. Although historically known as a psychiatric disorder, ENM is included in the International Classification of Sleep Disorders 2012 as a parasomnia. It can occur at any sleep stage but predominantly in non-REM sleep. EN is commonly associated to bladder hyperactivity, excessive urine production and/or failure to wake up after bladder filling. Despite the occurrence in sleep, standard sleep evaluation has failed to find abnormalities. The analysis of sleep microstructure is a refined and more accurate tool that can help find the neurophysiological mechanism underlying this process. Purpose: To evaluate sleep microarchitecture through Clyclic Altenating Pattern (CAP) analysis in children with monosymptomatic NE and provide a better understanding of the neurophysiological basis of EN. Methods: After IRB approval, 36 children, 22 with NE and 14 controls aged between seven and 17 years old who met the inclusion criteria were submitted to clinical and laboratory screening, evaluated for aspects of sleep, using sleep logs, Berlin Questionnaire (BQ), Sleep Scale for Children (SDSC) and Epworth Sleepiness Scale (ESS) and submitted to a full polysomnographic study, with evaluation of CAP. Results: ESS and BQ evidenced no abnormalities, the SDSC showed mild sleep apnea in 11/22 (50%), hyperhidrosis in 2/22 (9%) and disorder of the sleep-wake transition, awakening and initiation and maintenance sleep in 1/22 (4.5%) each. Analysis of sleep macrostructure showed higher numbers of awakenings (p < 0.001) and N2 sleep (p = 0.0025) as well as greater amount of sleep N3 (p < 0.0001) when compared to controls. Sleep microstructure showed an increase in A1 phase (p = 0.05), and reduction of A2 and A3 (p < 0.0001). CAP rate was the same for both enuretic and controls. Conclusion: Children with EN may present sleep comorbidities (measured by SDSC) and less A2 and A3 CAP phases, meaning a reduction in its wake regulation. This is the first study to acknowledge this phenomenon