Nocturnal Enuresis Is Associated with Attention Deficit Hyperactivity Disorder and Conduct Problems

Objective

There are no published prevalence estimates of elimination disorders and their association with disruptive-behavior disorders among children in the Asian region using standardized diagnostic interviews. This study was conducted to determine the prevalence of elimination disorders and its association with disruptive-behavior disorders in a representative sample of children in Seoul, Korea.

Methods

The diagnosis of enuresis and encopresis was derived from parent-reported data for "enuresis and encopresis," collected using the Diagnostic Interview Schedule for Children, from a representative sample of 6- to 12-year-old children (n=1,645) who participated in the 2005 Seoul Child and Adolescent Mental Health Survey. Prevalence data for attention deficit and disruptive-behavior disorders were collected from the same sample.

Results

The overall 12-month prevalence of nocturnal enuresis and encopresis was 1.8% and 0.6%, respectively. Enuresis and encopresis prevalence in boys was significantly greater than that in girls. Enuresis and encopresis was most common at 7 to 9 years of age. Enuresis was significantly associated with ADHD (OR 2.6, 95% CI 1.0-6.9) and conduct disorder (CD; OR 4.7, 95% CI 1.0-22.4).

Conclusion

Enuresis is significantly associated with ADHD and CD, so these conditions must be assessed together during the evaluation of children with enuresis.     

The year 1995-1996 in review: genetically re-engineering clinical nephrology

The discipline of medical genetics is rapidly transforming the face of nephrology. A number of important advances have been made during the past year in the identification of the molecular basis of renal diseases. This article will summarize how these new findings have expanded our understanding of whether diseases are homogeneous or heterogeneous entities (Bartter’s syndrome versus Gitelman’s syndrome), the medical basis of certain diseases of unclear etiology (enuresis), and the nature of risk factors for disease occurrence or progression (IgA nephropathy, chronic renal failure, and hemolytic uremic syndrome). It is anticipated that these exciting discoveries will become routine in the near future as medical genetics is fully incorporated into the practice of clinical nephrology. Received June 6, 1996; received in revised form December 10, 1996; accepted December 20, 1996     

温肾止遗方辨治下元虚寒证小儿遗尿的临床效果研究

目的:观察温肾止遗方辨治下元虚寒证小儿遗尿的临床效果。方法:选择我院收治的经临床辨证为下元虚寒证遗尿患儿110例,随机分为对照组和治疗组各55例。对照组患儿给予行为治疗,治疗组患儿则加用温肾止遗经验方内服,2组均连续治疗1个月。观察主要临床症状变化,评价中医证候积分,对比临床疗效,检测治疗前后血浆抗利尿激素(ADH)水平变化,随访3个月统计复发率。结果:治疗组患儿的临床疗效优于对照组患者,其有效率90.9%高于对照组患者74.5%,差异有统计学意义(P0.05);治疗组患儿的临床症状较治疗前、对照组明显改善,其中医各证候积分显著低于对照组患儿,差异有统计学意义(P0.05);2组患者的ADH水平经治疗后有所升高,治疗组的升高程度较对照组更为明显,差异有统计学意义(P0.05);治疗组患儿随访后复发率7.3%显著低于对照组患者30.9%,差异有统计学意义(P0.05)。结论:温肾止遗方辨治下元虚寒证型小儿遗尿疗效肯定,能有效缓解临床症状,降低复发率,其机制与增加患儿夜间血液中抗利尿激素的浓度密切相关,值得临床推广研究。     

1 500例遗尿症的功能性膀胱容量分析

目的：分析了解遗尿症患儿的功能性膀胱容量（FBC）及其与尿床次数的相关性,为遗尿症的治疗提供临床依据。方法：对1 500例遗尿症患儿进行问卷调查及泌尿系B超检查,尤其是功能性膀胱容量的测定。结果：①男∶女=1.3∶1,5~10岁：1 305例（87%）;10~14岁：181例（12%）;15~18岁：14例（1%）。②FBC≤正常值的50％（即FBC减少）的尿床患儿共637例（42.4％）。③1 500例患儿中,按尿床程度分为4组：尿床≥2次/每晚的患儿53例（3.5%）;尿床次数≥7次/周的患儿969例（64.6%）;尿床3~6次/周的患儿380例（25.3%）;尿床1~2次/周的患儿98例（6.5%）;其FBC减少的发生率分别是79.2％,48.3％,29.7％和14.3％,组间比较差异有显著性。结论：在深圳地区就诊的遗尿患儿大多数为每天尿床的重型遗尿症,其中近一半的患儿存在着功能性膀胱容量减少,并且与尿床的程度具有高度的相关性,尿床次数越频繁,FBC减少的比例越高。     

Assessment of toileting difficulties in adults with intellectual disabilities: an examination using the profile of toileting issues (POTI)

A lack of toileting skills is one of many impairments that individuals with intellectual and developmental disabilities experience. Unfortunately, little research has focused on problems in this area including assessment, function, and treatment. A newly developed checklist, the Profile of Toileting Issues (POTI), is being considered for use to screen for toileting issues in this population, and to identify potential functions to target in treatment. The purpose of the current study was to examine the reliability of the POTI. Internal consistency was sound (α = .83) and interrater reliability was significant. The implications of these findings are included.     

Plasma levels of oxybutynine chloride in children

Anticholinergic adverse-effects in children treated with conventional doses of oxybutynine led us to measure plasma oxybutynine levels in children. 18 children, aged 5 to 13 y, who required treatment with oxybutynine chloride for daytime incontinence were studied. Plasma concentrations were measured on the fifth day of a course of treatment in which the dose was adapted to the child's body weight; the dose was given twice daily at 12-hour intervals. In 10 children aged between 5 and 8 y, the mean dose was 0.1 mg · kg^–1. In 8 children aged between 10 and 13 years, the mean dose was 0.15 mg · kg^–1.The highest concentration was usually found between 1 and 2 h after administration. The subsequent fall in concentration was rapid and after 6 h oxybutynine was no longer measurable in 14 of the children. The concentrations found were not different from those seen in adults given equivalent doses.The results show that plasma concentrations in children were not very different from those observed in adults if the dose were adapted to the body weight of the children. No special differences in paediatric use were revealed that might explain the particular adverse-effects. The results of the study argue against the dosage regimen proposed before these adverse events were detected. They strongly favour a dose adapted to the body weight of the child, with a 12-hour interval between doses.     

Enuresis: A maturational lag

Enuresis is not a disease, but a disorder caused by delays in the maturation of three physiological processes: persistence of spontaneous bladder contractions, bladder volume exceeding the nocturnal functional bladder capacity and persistence of elevated sleep/arousal thresholds. Enuresis has been subtyped into two different groups, depending on whether the predominant feature is frequent small voidings (excessive bladder contractions) or large urinary volume (volume-dependent). The clinical pattern demonstrated by the enuretic child depends on the severity of the maturational lag. In practice, a mix of these types is most common.