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Introduction: The bowel-bladder interaction is well established, as is the fact that constipation can lead to daytime incontinence and/or recurrent urinary tract infections. However, the link between constipation and enuresis is less clear. The bowel's influence on enuresis is possibly important even though fecal disimpaction by itself will not make the child dry at night. Furthermore, parents and patients may be unaware of the child's constipation until the enuresis is evaluated. The same should apply to healthy children. The hypothesis that a full bowel affects bladder function appears to be logical; however, this may not be applicable in enuresis. A crucial question is if constipation is more common among children with enuresis than in the general population.

Aim: To evaluate the prevalence of constipation in children with enuresis as compared to children without bladder problems.

Subjects and methods: In this case-control study the former group was recruited from a pediatric clinic and the latter from the general population in the same geographic area. All children had their horizontal rectal diameter measured via abdominal ultrasound. Their bowel movements over two weeks and bladder function over two days were recorded at home.

Results: We recruited 66 children with enuresis and 58 healthy controls. The ages ranged from 6 to 11 (mean 7.3 ± 1.3) years and 50 (40 %) of them were girls. The groups had no difference in rectal diameter (28.9 ± 7.7 vs 28.2 ± 10.1 mm, P = 0.672) and they had a similar prevalence of constipation according to the Rome IV criteria. The children with enuresis had fewer bowel movements per two weeks (11.2 ± 4.1 vs 14.8 ± 6.9, P < 0.001) than controls, but they had no more constipation symptoms. However, bladder diaries showed that children with enuresis had smaller voided volumes (87.1 ± 31.8 vs 127.5 ± 44.5 % of expected bladder capacity; P < 0.001) than controls.

Conclusion We did not find support for constipation being more prevalent among children with enuresis than controls. But we did find decreased functional bladder capacity in patients with enuresis which may be an indirect sign of detrusor overactivity.

Objective: To compare lower urinary tract (LUT) symptoms in young adults with previous vesico-ureteral reflux (VUR) and healthy controls. VUR is associated with LUT dysfunction in childhood but less is known regarding long-term prognosis.

Methods: A questionnaire was sent to 483 patients treated for VUR between 1993 and 2003 and a control group of 640 healthy young adults. Presence of LUT symptoms was compared by multivariable logistic regression, expressed as odds ratios (OR) and 95% confidence intervals (CI), adjusting for age, sex and body mass index.

Results: The study group response rate was 45.8% versus 41.9% in the controls. There was a female predominance in both groups (77.9% and 74.3%). Overall, 45.7% of the VUR group and 36.6% of the controls reported current LUT symptoms, with unspecified LUT symptoms being significantly more common (OR = 3.86, 95% CI 1.33-11.20), especially in individuals receiving single treatment, and women without a pregnancy history. A larger proportion of those with VUR reported childhood incontinence than controls (20.4% vs. 5.6%, OR = 3.86, 95% CI 1.53-9.79). There were no significant differences in pyelonephritis during adulthood, yet individuals in the VUR group tended to have a higher micturition frequency than controls.

Conclusion: Bladder dysfunction related to VUR during early childhood seems to improve with age, yet voiding difficulties and a higher micturition frequency appeared to remain more common in adults, predominantly females, with previous reflux than in healthy controls.

This study investigated Swedish school nurses experiences, self-perceived knowledge, and attitudes towards HPV vaccination. A cross-sectional repeated questionnaire study was conducted. The results were compared to a previous study conducted in 2016. Additionally, open-ended responses were thematically analysed. A total of 344 nurses participated. Overall, more participants reported good self-perceived knowledge and favourable attitudes towards HPV vaccination compared to 2016. Still, nearly half expressed a need for further education. The thematic analysis revealed barriers including lack of training, inconsistent guidelines for addressing vaccine hesitancy and ensuring children's participation in decision-making, limited access to diverse information materials, and time constraints related to vaccination tasks. Since school nurses in Sweden are responsible for all aspects of school-aged vaccinations within the national immunization program, it is essential that they receive support to feel motivated and confident in addressing vaccine hesitancy. Continued education and the implementation of uniform guidelines are therefore necessary.

Introduction Nocturnal enuresis is a very common and socially distressing condition among children. There are qualitative studies published in children with bowel and bladder problems with a focus on health-related quality of life and the burden of the condition, but there is a lack of knowledge of the experience of managing the treatment procedures at home. From a clinical viewpoint, it can be assumed that the procedures entail a lot of work and have an impact on everyday life apart from the disorders per se, but the actual voices of the children have not been heard.

PurposeTo explore children’s and their parents’ experiences of labor-intensive procedures in the management of enuresis.

Design and methodsA qualitative interview study. Semi-structured interviews were held with fourteen children with enuresis six to nine years of age, together with their parents in Sweden between April 2020 and February 2021. Data were analyzed inductively with qualitative content analysis.

ResultsThe major findings showed both favorable strategies and challenges in labor-intensive management. The results are described in four categories: 1) experiences of how to manage; 2) managing procedures was a favorable experience; 3) managing procedures made it complicated and 4) problematic to remember.

ConclusionManaging the treatment of enuresis at home can be challenging. There were procedures that children did not like and new routines that were difficult to remember. However, the study can suggest strategies in how to manage and overcome these difficulties.

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.

Background

The voiding chart is part of the initial evaluation of enuresis, since the data gathered this way are assumed to carry predictive information. However, there is little evidence that the voiding chart actually does predict therapy response. Lundmark & Nevéus performed a pilot investigation in 2020 and found that anamnestic and voiding chart data did not predict response to second-line therapies. This study aims at evaluating whether these findings could be replicated.

Patients and methods

This is an evaluation of clinical practice. All patients in a tertiary outpatient clinic with enuresis resistant to first-line therapy (i.e. the enuresis alarm and desmopressin medication) during the evaluation period were included in the study. Baseline anamnestic data focused on bladder and bowel habits, were gathered and the families were instructed to complete a voiding chart including measurements of nocturnal urine production. The children were then treated in accordance with international guidelines, which are anticholinergics and antidepressants as second- and third-line treatment, respectively. Desmopressin was added if needed.

Results

In total, 70 patients were included. At the end of the study 37 of these patients were dry, 11 patients were still wetting their beds and 22 patients were lost to follow-up. Of the dry patients 21 became dry on anticholinergics (and/or mirabegron, with or without desmopressin), five on tricyclic antidepressants (with or without desmopressin), seven after a new attempt with the alarm and five became dry spontaneously. The only statistically significant differences between responders and non-responders to the various treatments were that children responsive to anticholinergics had harder and more infrequent stools (p = 0.04 and p = 0.03, respectively).

Conclusion

This study found that anamnestic and voiding chart data do not predict response to treatment in children with therapy-resistant enuresis. Because of this and the fact that we lose some children who need our help by demanding that they complete a voiding chart before initiating treatment, we question the use of this instrument in the evaluation of therapy-resistant enuresis.

Aim

There is limited knowledge about the perceptions of HPV vaccination in middle-school children. This qualitative study aimed to explore their views.

Methods

We 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.

Results

This 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.

Conclusion

We 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.

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.