Practice variation in urine collection methods among pre-toilet trained children with suspected urinary tract infection: a systematic review.

BACKGROUND: Urinary tract infections (UTIs) are a common cause of acute illness among infants and young children. There are numerous methods for collecting urine in children who are not toilet trained. This review examined practice variation in the urine collection methods for diagnosing UTI in non-toilet-trained children. METHODS: A systematic review was completed by searching MEDLINE (Ovid), Embase (Ovid), CENTRAL (Ovid), PsycInfo (Ovid), CINAHL (EBSCO), and JBI (Ovid) from January 1, 2000 until October 9, 2021 and updated on May 24, 2023. Studies were included if they were conducted in an acute care facility, examined pre-toilet trained children, and compared one urine collection method with another for relevant health care outcomes (such as length of stay in an ED, or re-visits or readmissions to the ED) or provider satisfaction. Two independent reviewers screened the identified articles independently, and those included in the final analysis were assessed for quality and bias using the Newcastle-Ottawa Scale. RESULTS: Overall, 2535 articles were reviewed and 8 studies with a total of 728 children were included in the final analysis. Seven studies investigated the primary outcome of interest, practice variation in urine collection methods to diagnose a UTI. The seven studies that investigated novel methods of urine collection concluded that there were improved health care outcomes compared to conventional methods. Novel methods include emerging methods that are not captured yet captured in clinical practice guidelines including the use of ultrasound guidance to aid existing techniques. Three studies which investigated healthcare provider satisfaction found preference to novel methods of urine collection. CONCLUSIONS: There is significant practice variation in the urine collection methods within and between countries. Further research is needed to better examine practice variation among clinicians and adherence to national organizations and societies guidelines. PROSPERO registration number CRD42021267754.

Evaluation of the effects of the toilet training process on the children's quality of life.

BACKGROUND: Toilet training is a significant developmental milestone for children. During the process of toilet training, voiding and defecation problems may develop, which have a major adverse impact on the child's quality of life (QoL). The aim of this study was to assess voiding and defecation problems in the process of toilet training and evaluate how these issues influenced the children's QoL. METHODS: The children included in the study were followed up at the Department of Social Pediatrics, Ankara University School of Medicine. Participants were surveyed via a questionnaire that included sociodemographic features, the toilet training process, and the Pediatric Quality of Life Inventory. RESULTS: The study included 177 children and their parents. There was no correlation between the parents' age, sociodemographic features, or the timing of the start of toilet training. Voiding problems were found in 55.6% and defecation problems in 23.6% of the children included in the study. Urinary retention during play and nocturnal enuresis were more frequent in the children toilet trained at 25-36 months of age. The self-reported QoL scores in children with voiding problems and with both voiding and defecation problems were lower than those in children did not have any problems. CONCLUSIONS: Even if a child has been toilet trained, it is essential to investigate daily urination and defecation habits at every follow-up visit and to discuss with families when a physician should be consulted.

Bowel and bladder function in infant toilet training (BABITT) - protocol for a randomized, two-armed intervention study.

BACKGROUND: In the last decades, the average age for toilet training has increased in the western world. It is suggested that the postponed initiation of toilet training is a contributing factor to problems related to bowel and bladder control. Functional gastrointestinal and urinary tract disorders are prevalent in childhood, causing suffering in affected children and for their families, and consuming healthcare resources. To evaluate whether assisted infant toilet training can prevent functional gastrointestinal and urinary tract disorders in young children, we are conducting a randomized intervention study with a 4-year follow-up. METHODS: This randomized two-armed intervention study will include 268 Swedish infants recruited at six child healthcare centers in Region Dalarna located in the central part of Sweden. The intervention entails parents being instructed and practicing assisted infant toilet training with their child. Children are randomized to start assisted infant toilet training at 0-2 months or at 9-11 months of age. The primary objective is to determine the efficacy of assisted infant toilet training initiated at 0-2 months on the prevalence of functional gastrointestinal disorders (defined as infant colic, infant dyschezia and/or functional constipation) up to the age of 9 months. Secondary objectives are to evaluate whether assisted toilet training initiated during the first year of life reduce the prevalence of functional gastrointestinal disorders (defined as functional constipation, gastrointestinal symptoms and/or stool toileting refusal) and urinary tract disorders (defined as bladder dysfunction and/or urinary tract infections) up to the age of 4 years. Furthermore, infant-to-mother attachment, parental stress, the toilet training process and overall parental experiences will be evaluated/explored. DISCUSSION: This protocol article presents the rationale and design of a randomized two-armed intervention study that will determine the efficacy of assisted infant toilet training on functional gastrointestinal disorders up to the age of 9 months. Furthermore, the study will evaluate whether assisted infant toilet training during the first year of life can prevent functional gastrointestinal and urinary tract disorders in children up to 4 years of age. If effective, assisted infant toilet training could be recommended in child healthcare settings and new evidence-based guidelines on infant toilet training could be implemented. TRIAL REGISTRATION: The study protocol was retrospectively registered at ClinicalTrials. gov  ( NCT04082689 ), initial release June 12th, 2019).

Relationship between primary monosymptomatic enuresis and process toilet training: a case-control.

OBJECTIVE: Primary monosymptomatic nocturnal enuresis (PMNE) is a prevalent condition in childhood, and the pathophysiology is multifactorial. This study investigated the relationship between the toilet training process (TT) and PMNE in children and adolescents. PATIENTS AND METHODS: A case-control study was carried out from 2015 to 2020. The presence of PMNE was identified according to International Children's Continence Society criteria. A semi-structured questionnaire was applied to assess TT. RESULTS: The study included 103 children and adolescents with PMNE and 269 participants with normal psychomotor development without PMNE (control group [CG]). Readiness signals were more remembered and less frequent in participants with PMNE (p=0.001) when compared to control group. No differences were found between the groups regarding the onset age of the daytime TT (p= 0.10), the nocturnal TT (p=0.08), the acquisition of daytime continence (p=0.06), and the type of equipment used for the TT (p=0.99). The use of Child-Oriented approach in group of children with enuresis was lower than in controls [87.4% (90/103) versus 94% (250/266)], respectively (OR= 0.44, 95% CI 0.21-0.94, p = 0.039). CONCLUSIONS: The age of onset of TT, acquisition of daytime continence, and the type of equipment were not associated with higher occurrence of PMNE. On the other hand, the Child-Oriented approach was a protective factor for the occurrence of PMNE.

Implementing a new method of group toilet training in daycare centres: a cluster randomised controlled trial.

Despite the existing methods, a trend towards a later initiation and completion of toilet training has been seen in Western society. This study is the first to investigate prospectively the efficacy of intensive group toilet training in daycare centres. The primary outcome of interest is the duration until the child is toilet trained. A cluster randomised controlled trial was established in daycare centres; clusters of participants were randomly allocated to an intervention or control group. Intervention group was subjected to an intensive toilet training session. Innovative aspects of this toilet training method were a 2-h training on two consecutive days, carried out in small groups in daycare centres. Parents of children in the control group were encouraged to start TT in their own manner. Children were monitored until they were considered to be fully toilet trained during the day. Median toilet training duration in the intervention group was 2 weeks compared to 5 weeks in controls (p value log rank test = 0.007). The hazard of being clean during the follow-up of 6 weeks was twice as high in the intervention compared to controls (p = 0.018).Conclusion: The intervention had a significant influence on the duration of toilet training in healthy children, with a median duration of 2 weeks. Our findings are clinically relevant for daycare educators, having a considerable responsibility in the development of children.Trial Registration Number: ClinicalTrials.gov NCT04221776. What is Known: • Despite different existing methods, a later initiation of toilet training has been seen in Western society and coherent to this an increasing age of acquiring full bladder control. • Child daycare centres have a growing role in the toilet training process. What is New: • This is the first prospective report describing the results of a new method of toilet training healthy children in small groups in daycare centres. • The intervention had a significant influence on the duration of toilet training, with a median duration of 2 weeks.

Toilet training children with special needs using a Potty Monkey toy device.

AIM: Toilet training children with special needs can be challenging and can result in long-term consequences if inadequately addressed. This study evaluates the use of a 'Potty Monkey' toy for toilet training children with special needs. METHODS: A pilot study using a 'Potty Monkey' to model timed voiding in children with special needs. We collected parental feedback and examined the experience of families using a 'Potty Monkey' to toilet train their child. Using logistic regression we explored patient factors for association with outcomes. RESULTS: Of 21 children in our study, 15 were male. Age ranged 4-10 years (median 6.3 years). Days that 'Potty Monkey' was used ranged 0-156 (median 22 days). At 6 months, nine children had improved, five were unchanged and four were worse (three were unknown). We found no evidence of association between patient factors (age, gender, days using 'Potty Monkey', baseline toileting ability, Paediatric Incontinence Questionnaire score) and toileting outcome. The experience of families was ambivalent. 10 families reported 'Potty Monkey' had been helpful however many complained it interfered with family schedules. Reasons for the child not responding positively were due to sensory issues, embarrassment and being developmentally not ready. Our study demonstrated the practical challenges of conducting research among children with special needs. CONCLUSION: Although some children's toileting improved after using 'Potty Monkey', we are uncertain 'Potty Monkey' is effective for toilet training children with special needs.

Personal and familial factors associated with toilet training.

PURPOSE: Toilet training (TT) is an important marker in a child's physical and psychosocial development. The present study aimed to evaluate aspects associated to delayed TT. MATERIAL AND METHODS: We interviewed 372 parents of children who had completed TT up to 48 months before the interview. The questionnaires were applied at school exits when parents went to pick their children up and at public parks. Questions included demographics, aspects related to TT, dysfunction voiding symptom score and evaluation of constipation. RESULTS: The interviews were performed at a mean of 15.3±10.4 (0 to 47) months after the end of TT. Girls accounted for 53% of the sample. The mean age at finishing TT was 31.6±9.3 months and similar in both genders (p=0.77). TT occurred before school entry in 45.7% of the children and medical advice for TT was sought only by 4.8% of the parents. No association was observed of age at completing TT and presence of lower urinary tract symptoms (LUTS) (p=0.57) and/or constipation (p=0.98). In the univariate analysis, prematurity (OR=2.7 [95% CI 2.3-3.1], p <0.0001) and mothers who work outside their household (OR=1.8 [95% CI 1.4-2.3], p <0.0001) were associated to delayed TT. CONCLUSION: Children completed TT at a mean of 2 years and 7 months of age. The age of completing TT was not related to LUTS and/or constipation. Premature children and those whose mothers work outside the home finish TT later.

Pediatricians' perceptions and practice of the management of constipation in Thailand.

BACKGROUND: Previous studies have shown that physicians' perception and practice can differ from proposed guidelines with regards to constipation. Most studies were performed in developed countries but only a few in developing nations. We therefore aimed to study Thai pediatricians' perceptions of the management of constipation. METHODS: We performed a national survey using an 37-item online questionnaire that included questions about demographics, perceptions, and practice related to constipation in children. We used a five-point scale to determine perception in each aspect (5 = strongly agreed; 1 = strongly disagreed). RESULTS: We received 275 responses (response rate of 11.0%). Most were female (69.1%), subspecialists (55.6%) and worked in a government-based setting (69.5%). We noted that only 51.8% considered disimpaction if physical examination is suggestive of fecal impaction. Most pediatricians used lactulose for both disimpaction and maintenance phases (83.4 and 91.9%, respectively); however, pediatricians perceived that the caregivers of constipated children were concerned about tolerance or dependence of most commonly used laxatives, ranged from 45.8 to 63.8%. We also found that recently graduated pediatricians were more likely than older individuals to provide advice on fluid intake, toilet training, and laxative use, and to consider polyethylene glycol for disimpaction (P = 0.003, 0.02, 0.004, and 0.02, respectively). CONCLUSIONS: The proportion of pediatricians who consider disimpaction remained suboptimal. Providing appropriate knowledge on pharmacological management, especially disimpaction and issues regarding laxatives, may be helpful for pediatricians and caregivers. Education may also need to be tailored to various pediatricians' experience and work settings.

Non-invasive techniques for stimulating urine production in non-toilet trained children: a systematic review.

BACKGROUND: Urinary tract infection requires collection of a sterile urine specimen for diagnosis, which is difficult and time consuming in pre-continent children. This systematic review summarises evidence of the effectiveness of bladder stimulation techniques on urine collection in pre-continent children, compared with standard techniques. METHODS: MEDLINE, PubMed, EMBASE and CINAHL were searched to May 2019. Selection, data extraction, risk of bias and quality assessment were undertaken by two independent reviewers. Inclusion: (1) all study designs; (2) pre-continent, age <3 years receiving bladder stimulation techniques; (3) outcomes including time to urine collection or contamination rates; (4) English-language articles. Exclusion: coexisting neurological disorders. RESULTS: Three randomised controlled trials (RCTs) were identified using three techniques in 568 participants aged 1 day to 35 months. Two RCTs demonstrated an increased success in voiding within 5 min, one using a finger tapping and lumbar paravertebral massage technique and the other cold saline-soaked gauze rubbed over the suprapubic region, compared with no active intervention. A third RCT using a mechanical vibration device demonstrated no difference in time to voiding from advice alone. Non-randomised studies compared different temperatures for the gauze intervention and tapping alone versus urine bags. Six uncontrolled studies tested the finger tapping and massage technique. Risk of bias was low for one RCT and unclear for two RCTs with the other studies rated poor to fair quality. Overall, the evidence on success rates was graded low for tapping plus massage and moderate for the gauze rubbing intervention. Adverse effects included crying and mild distress. DISCUSSION: The results suggest a positive effect of stimulation techniquesbut lack of replication in rigorous RCTs and heterogeneity of techniques and outcomes assessed prevent conclusive recommendations being made. Further RCTs are required comparing non-invasive stimulation methods and assessing time to successful collection, contamination rates, adverse effects, caregiver and clinical staff acceptability.

Supporting parents of children aged 2-13 with toileting difficulties: Group-based workshops versus individual appointments.

INTRODUCTION: Toileting is a key activity of daily living and an important milestone in children's development. Difficulties with this process can cause stress to both child and parents and negatively affect their wellbeing. This study compared the perceived parental competence and child wellbeing of families attending a group-based workshop on toileting issues with families attending an individual appointment at a continence clinic. METHODS: All parents attending the workshops and attending the clinic between July 2016 and December 2017 were invited to participate in the study. The children were aged between 2 and 13 years. Three measures were used: 1) Parenting Sense of Competence Scale; (2) the Revised Quality of Life Questionnaire for Children (KINDLR) and (3) Parent self-assessment of information and support needs. Participants completed all measures at three points: prior to intervention, 1 week and 1 month post-intervention. RESULTS: Data were collected from 89 parents attending the workshops and 46 parents attending the clinic. Children were not assessed. Non-parametric tests were used to examine between group differences. Within group changes overtime were examined using Friedman's two-way analysis of variance. Parents who attended the workshop showed significant increases in parenting sense of competence and perceived child quality of life post-intervention. Although there were significant differences between and pre- and post-measures for workshop attendees, there were no significant differences found between the two groups indicating that both forms of intervention had beneficial results. CONCLUSION: These results suggest that group-based workshops can positively impact parents' perceived competence in managing their child's toileting issues and wellbeing. Further research is recommended to explore the relationship between parenting competence and child wellbeing and to determine which aspects of the workshops were most beneficial.

Toilet training of preschoolers with disabilities: The perspectives of teacher aides.

AIMS: To examine toilet-training (TT) challenges among children with developmental disabilities (DD), as perceived by teacher aides working in special education preschools, the TT practices they adopt, and their perspectives on TT and parental cooperation. METHODS: A qualitative phenomenological approach was adopted to analyze in-depth interviews conducted with 10 teacher aides, working in special education preschools. Interviews were audio-recorded, transcribed, and analyzed by three researchers according to 20 categories, organized into the themes that emerged from the data. RESULTS: Three themes emerged from the data analysis: (1) The TT process is much more complex for children with DD than for typically developing children. (2) The central role played by teacher aides in the TT process and the TT approaches they adopt. (3) The degree to which the child's family is involved in and cooperates with the preschool staff in the context of TT. CONCLUSIONS: TT among children with DD requires a graded and child-specific mediation process, including the parents and the educational staff. Teacher aides are revealed as an excellent resource for information about the child under their care. From the rich interviews, we obtained: principles and practical guidance as to how to provide gradual tailor-made TT for children with DD; principles to enhance parents' engagement in TT; and appropriate TT outcomes. The ecological theoretical frameworks used to shed light on the teacher aides' and the context role as significant mediators in TT. The study lays the groundwork for further research on TT among children with DD.

The influence of delay elimination communication on the prevalence of primary nocturnal enuresis-a survey from Mainland China.

AIMS: A pilot survey shows that primary nocturnal enuresis (PNE) prevalence has increased significantly during the past decade in Mainland China. Whether it is related to the delay of elimination communication (EC) is unclear. This study retrospectively investigated the influence of delayed EC on the PNE prevalence in children and adolescents in mainland China. METHODS: A cross-sectional study of PNE prevalence was performed by distributing 19 500 anonymous self-administered questionnaires to parents in five provinces of mainland China from July 2017 to October 2017. The questionnaires included sociodemographic data, family caregivers' information, and details about the disposable diapers (DD) usage, EC commencement date, psychological disorders, lower urinary tract symptoms, and family history of PNE in children and adolescents. The 2017 PNE prevalence was compared with that of 2006 in Mainland China. RESULTS: The total response rate was 97.04% (18 631 of 19 500) and 92.39% (18 016 of 19 500) qualified for statistical analysis. The PNE prevalence in 2017 has increased significantly compared to that of 2006 (7.30% vs 4.07%, P < 0.001). The PNE prevalence in children with EC starting before 6 months of age was significantly lower than those who start after 12 months of age. The longer DD were used and the later the beginning of EC, the higher the PNE prevalence was found. CONCLUSIONS: The PNE prevalence in Mainland China has increased significantly during the past 10 years. A longer use of DD and later onset of EC may be risk factors for PNE.

Toilet Training: Common Questions and Answers.

Toilet training is a significant developmental milestone in early childhood. Most U.S. children achieve the physiologic, cognitive, and emotional development necessary for toilet training by 18 to 30 months of age. Markers of readiness for toilet training include being able to walk, put on and remove clothing, and follow parental instruction; expressive language; awareness of a full bladder or rectum; and demonstrated dissatisfaction with a soiled diaper. Other readiness cues include imitating toileting behavior, expressing desire to toilet, and demonstrating bladder or bowel control (staying dry through a nap or through the night). Physicians should provide anticipatory guidance to parents beginning at about 18 to 24 months of age, noting the signs of toilet training readiness, and setting realistic expectations for parents. Parents should be counseled that no training method is superior to another. Parents should choose a method that is best suited to them and their child, and the method should use positive reinforcement. Complications of toilet training include stool toileting refusal, stool withholding, encopresis, hiding to defecate, and enuresis. These problems typically resolve with time, although some may require further investigation and treatment. Medical comorbidities such as Down syndrome, autism spectrum disorder, and cerebral palsy reduce the likelihood of successfully attaining full toilet training and often require early consultation with occupational therapists, developmental pediatricians, or other subspecialists to aid in toilet training.

Information as a crucial factor for toilet training by parents.

BACKGROUND: Toilet training (TT) is a milestone in a child's development. Nowadays, children complete TT later than previous generations. This can have detrimental consequences for the child, the parents, and the environment. TT is experienced as difficult and time-consuming; parents could benefit from guidelines to assist in this process. METHODS: Focus group discussions (FGDs) were used to explore parents' experiences in an inductive approach applying purposive sampling. The FGDs aimed to explore the type of information parents wanted to receive on TT, from whom and how. RESULTS: After six FGDs, including 37 participants with personal experience in TT, data saturation was achieved. The findings of this qualitative study show that reputable agencies, family, friends, day-care workers, and nursery school teachers were considered very helpful and trustworthy sources. TT information should be easily understandable and not contain scientific terms or much text. A colourful and illustrated brochure sent by regular mail is preferred. CONCLUSION: Our study allows to develop a source of correct and wanted information about TT that parents can and want to use, which helps them completing this training more easily and timely.

Effectiveness of Pelvic Physiotherapy in Children With Functional Constipation Compared With Standard Medical Care.

BACKGROUND & AIMS: Functional constipation (FC) is a common childhood problem often related to pelvic floor muscle dysfunction. We compared the effectiveness of pelvic physiotherapy (PPT) vs standard medical care (SMC) in children with FC. METHODS: We performed a multicenter randomized controlled trial of 53 children (age, 5-16 y) with FC according to the Rome III criteria, at hospitals in The Netherlands from December 2009 to May 2014. Group allocation was concealed using a central computer system. SMC consisted of education, toilet training, and laxatives (n = 26), whereas PPT included SMC plus specific physiotherapeutic interventions (n = 27). Results were obtained from written reports from the subjects' pediatricians and parents. The primary outcome was absence of FC, according to Rome III criteria, after a 6-month follow-up period. Secondary outcomes were global perceived effect (range, 1-9; success was defined as a score ≥ 8), numeric rating scales assessing quality of life (parent and child; scale, 1-10), and the strengths and difficulties questionnaire (SDQ). RESULTS: Treatment was effective for 92.3% of the children receiving PPT and for 63.0% of the children receiving SMC (adjusted odds ratio for success of PPT, 11.7; 95% confidence interval, 1.8-78.3) (P = .011). Significantly more children undergoing PPT stopped using laxatives (adjusted odds ratio, 6.5; 95% confidence interval, 1.6-26.4) (P = .009). Treatment success (based on global perceived effect) was achieved for 88.5% of subjects receiving PPT vs 33.3% of subjects receiving SMC) (P < .001). PPT also produced larger adjusted mean differences, before vs after treatment, in numeric rating scales to assess quality of life: an increase of 1.8 points for parents (P = .047) and 2.0 points for children (P = .028). Results from the SDQ did not differ significantly between groups (P = .78). CONCLUSIONS: In a randomized controlled trial of children with FC, PPT was more effective than SMC on all outcomes measured, with the exception of findings from the SDQ. PPT should be considered as a treatment option for FC in children 5-16 years old. Dutch Clinical Trial Registration no: NL30551.068.09.

Physiotherapy plus conventional treatment versus conventional treatment only in the treatment of functional constipation in children: design of a randomized controlled trial and cost-effectiveness study in primary care.

BACKGROUND: Our aim was to design a study to evaluate the effectiveness and cost-effectiveness of adding physiotherapy to conventional treatment for children with functional constipation in primary care. Physiotherapy is focusing on improving the coordination between the pelvic floor and abdominal musculature during bowel movement, while conventional treatment is mainly focusing on symptomatic relief of symptoms, therefore, we expect the effects of physiotherapy will be more sustainable than the effects of conventional treatment. In this paper we describe the final study design and how the design was adapted, to overcome recruitment problems. METHODS: We designed a randomized controlled trial of children aged 4-17 years with functional constipation diagnosed by a general practitioner or pediatrician. Children in the intervention group received physiotherapy plus conventional treatment, and those in the control group received conventional treatment only. Follow-up measurements took place at 4 and 8 months. The primary outcome was treatment success defined according to the Rome-III criteria as the absence of functional constipation, with no laxative use. Secondary outcomes were absence of functional constipation irrespective of laxative use, quality of life, global perceived effect, and costs. Children were recruited from September 2014 to February 2017. Initially, we aimed to include children with recent symptom onset. However, in the first phase of enrollment we were confronted with an unforeseen recruitment problem: many children and their parents refused randomization because physiotherapy was considered too burdensome for the stage of disease. Therefore, we decided to also include children with a longer duration of symptoms. In total 134 children were included. DISCUSSION: The target number of participants is achieved. Therefore, the results may change thinking about the management of functional constipation in children. TRAIL REGISTRATION: Netherlands Trial Register ( NTR4797 ), registered 8 September 2014.

Contact dermatitis to training toilet seat (potty seat dermatitis).

Allergic contact dermatitis from various components of toilet seats has been well described. We report a case of a young boy presenting with an atypical pattern of dermatitis who was found to be allergic to his training toilet seat. This case highlights the importance of recognizing this diagnosis and the role of potty seats as the causative factor.

Toilet training: what can the cookstove sector learn from improved sanitation promotion?

Within the domain of public health, commonalities exist between the sanitation and cookstove sectors. Despite these commonalities and the grounds established for cross-learning between both sectors, however, there has not been much evidence of knowledge exchange across them to date. Our paper frames this as a missed opportunity for the cookstove sector, given the capacity for user-centred innovation and multi-scale approaches demonstrated in the sanitation sector. The paper highlights points of convergence and divergence in the approaches used in both sectors, with particular focus on behaviour change approaches that go beyond the level of the individual. The analysis highlights the importance of the enabling environment, community-focused approaches and locally specific contextual factors in promoting behavioural change in the sanitation sector. Our paper makes a case for the application of such approaches to cookstove interventions, especially in light of their ability to drive sustained change by matching demand-side motivations with supply-side opportunities. Abbreviation: DALY: Disability-adjusted life year; CHC: Community Health Club; CLTS: Community-Led Total Sanitation; HAP: Household air pollution; BM-WASH: Integrated Behavioural Model for Water, Sanitation and Hygiene; ICS: Improved cookstove; LPG: Liquefied petroleum gas; NBA: Nirmal Bharat Abhiyan; NGO: Non:governmental organisation; OD: Open defecation; ODF: Open defecation free; HAST: Participatory Hygiene and Sanitation Transformation; RANAS: Risks, Attitudes, Norms, Abilities and Self-regulation RCT: Randomised controlled trial; (Sani) FOAM: Focus, Opportunity, Ability and Motivation; SBM: Swachh Bharat Mission; TSC: Total Sanitation Campaign; WASH: Water, Sanitation and Hygiene.

[What is new in symptomatic MS treatment: Part 3-bladder dysfunction]. / Neues zur symptomatischen MS-Therapie: Teil 3 ­ Blasenfunktionsstörungen.

The symptomatic treatment of multiple sclerosis (MS) nowadays is of similar importance as immunotherapy within a comprehensive concept of therapy of this chronic disease, since it contributes considerably to the reduction of disabilities in activities of daily living as well as social and occupational life. Moreover, symptomatic treatment is of great importance for amelioration of quality of life. Since our last survey of symptomatic MS treatment in 2004 and publication of the guidelines of the German Neurological Society and the Klinisches Kompetenznetz Multiple Sklerose (KKNMS) in 2014 several developments within the topics of mobility, bladder and sexual function, vision, fatigue, cognition and rehabilitation took place. These new findings together with further aspects of disease measures and overall treatment strategies of the respective symptoms, as well as treatment goals are introduced in a series of six individual contributions. Here, the symptoms of bladder dysfunction will be discussed.

[Voiding disorders in geriatric patients : Correlation with age-related functional impairments]. / Blasenentleerungsstörungen bei geriatrischen Patient(inn)en : Korrelation mit altersassoziierten funktionellen Defiziten.

INTRODUCTION: Voiding disorders are a common problem in elderly people. The highest incidence and prevalence occurs in female patients with a high level of dependency and cognitive impairments. AIM: The aim of the study was to define the correlation between the presence of voiding disorders and age-related functional deficits in hospitalized elderly patients within the framework of a comprehensive geriatric assessment. This is of utmost importance for planning adequate further diagnostic and therapeutic measures. METHODS: This study involved a retrospective cross-sectional assessment of data from 7487 hospitalized patients (74.1 % females, 25.9 % males, mean age 78.9 ± 7.2 years) evaluated by a multidimensional geriatric assessment. Items tested were symptoms of voiding disorders, activities of daily living, cognitive and emotional status, mobility, handgrip strength, need for walking aids, pain, nutritional status and visual function. Data were evaluated with respect to the prevalence of voiding disorders, patient functional status and to the relationship between these findings. RESULTS: Among all patients 4494 (60.0 %) presented with voiding disorders. Of these 95.8 % showed additional relevant functional deficits in three or more test items. Voiding disorders were positively correlated to patient age, dependency in activities of daily living and pain scores and were negatively correlated to cognitive and emotional status, mobility, hand grip strength, nutritional status and visual function. The functional deficits were associated with the severity of voiding disorders. Female patients were more often affected by voiding disorders as well as by functional impairments in comparison to male patients. DISCUSSION: The results showed that more than half of the elderly hospitalized patients suffered from voiding disorders. The high prevalence and correlation between the presence of voiding disorders and functional deficits indicate the need to clearly define and plan diagnostic and therapeutic measures (e. g. bladder diaries and bladder retraining) for these patients, taking the individual functional status into consideration. CONCLUSION: In older patients with voiding disorders, high levels of functional impairment should be considered before planning diagnostic and therapeutic measures in order to ensure the quality of implementation.