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Children presenting at UK community enuresis clinics--comparison with hospital-based samples
Sarah Anne Redsell1, Jacqueline Collier, Jonathan Evans
1Behavioural Sciences Section, University of Nottingham, UK. sr59@le.ac.uk
Insights
Children with nocturnal enuresis presenting at community services are younger and experience more daytime wetting than those in hospital settings, yet generally maintain adequate self-esteem. Ethnicity significantly influences the perceived impact of bedwetting.
Area of Science:
- Pediatric Urology
- Child Psychology
- Public Health
Background:
- Nocturnal enuresis affects numerous children, with varying presentation and impact based on healthcare setting.
- Understanding differences between community and hospital-based enuresis services is crucial for effective management.
Purpose of the Study:
- To compare clinical and psychosocial characteristics of children with bedwetting in UK community enuresis services versus hospital-based settings.
- To evaluate treatment outcomes and identify factors influencing self-esteem and the impact of bedwetting.
Main Methods:
- A representative sample from 15 UK community enuresis clinics was analyzed.
- Validated scales measured maternal tolerance, impact of bedwetting, and child self-esteem.
- A systematic literature review identified UK hospital-based studies (1966-2002) for comparison.
Main Results:
- Community-based children were younger and had more daytime wetting than hospital-based counterparts.
- No significant difference in self-esteem was observed between the two groups.
- The impact of bedwetting on self-esteem was strongly correlated with maternal tolerance and ethnicity.
Conclusions:
- Primary enuresis referrals to community services are younger with more daytime wetting but typically do not exhibit low self-esteem.
- Ethnicity is a key factor in assessing the psychosocial impact of nocturnal enuresis on children.
- Community services cater to a younger demographic with specific wetting patterns, necessitating tailored management approaches.
Objective:
This study compares the clinical and psychosocial characteristics and the treatment outcomes of bedwetting UK children presenting at a community enuresis service with those from studies conducted in hospital-based settings.
Material And Methods:
Cluster stratification by clinic was applied to ensure that the population attending the 15 enuresis clinics selected was representative. Parents completed the maternal tolerance scale and children completed the impact of bedwetting and Coopersmith self-esteem scales. The electronic databases MEDLINE and CINAHL were searched for the years 1966-2002 for UK-based empirical studies conducted in children aged 5-16 years with nocturnal enuresis.
Results:
Children in the community sample were younger and had more day-time wetting than the hospital-based population but did not have significantly lower self-esteem. The impact of bedwetting had the strongest relationship with the Coopersmith self-esteem score, followed by ethnicity and the maternal tolerance score (beta = -0.49, p < 0.001; beta = 2.83, p < 0.001; and beta = 0.45, p = 0.015; respectively).
Conclusion:
Primary referrals to community enuresis services are younger and have more day-time wetting than those attending hospital-based clinics but the majority do not have low self-esteem. Ethnicity appears to be an important factor in evaluating the impact of wetting on the child.