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To assess quality of life after continent ileal reservoir diversion in children and adolescents.
Nine boys and 9 girls (10.8-18 years old at surgery) were operated with a Kock reservoir and followed for 5-12 years. They participated in an interview using a questionnaire based on the Swedish self-esteem inventory, "I think I am". The questionnaire c...
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Context 1
... and body image More than half of the patients reported an excellent positive grade (Yes/exact) in their answers to the positive questions (Fig. 2). However, almost all patients reported an excellent negative grade (No/ never) in their answers to all negative questions, except for those questions related to outside looks and fairness of life (Fig. 3). The median of the patients who reported an excellent grade in positive questions was 13 patients and in negative questions 14 ...
Citations
... Question number 2 evaluates the changes in health condition that occurred in the previous year. It needs to be analyzed separately as it does not belong to any specific domain [12,13]. ...
... The reconstruction of anatomic defects and the placement of continent stomas can improve QoL for patients with urinary tract malformations, promoting the participation of the child/adolescent in social activities, as suggested by the studies of Abd-el-Gawad et al. and Merenda et al., with adolescents after continent ileostomy and after Mitrofanoff procedure, respectively [13,14]. ...
The interest in quality of life (QoL) studies has increased as they are useful instruments to evaluate and compare medical care delivery and the impact of health interventions. The perception of QoL differs among individuals. Its characterization is especially difficult in the pediatric age group as each developmental stage presents specific demands. The prevalence of congenital lower urinary dysfunction is high and their management changes the daily routine of the patients and their families. In a cross-sectional study, we evaluated the QoL of 28 children and adolescents with urinary malformations and their caregivers using the Autoquestionnaire Qualité de Vie Enfant Imagé (AUQUEI) and Short-Form 36 (SF-36), respectively, and compared the results with 38 healthy control age-paired children/caregivers. Four questions were added to patients' questionnaire to evaluate issues related to their urological management. Our results show lower AUQUEI total scoring in the patients' group (p<0.0213, Fisher's exact test), who also present problems in dealing with social aspects, such as being at classroom, manifest negative feelings in relation to diurnal urinary losses but seem to be well adapted to intermittent urethral catheterization. A tendency for worse QoL scores in the patients' group caregivers was detected in the SF-36 pain and physical limitation domains.
... The validity and reliability of the scale has been tested and the instrument has been used in earlier studies performed in Sweden, regarding psychosocial and psychological reactions in children with somatic illness [19,20]. ...
To study the long-term relationship between symptoms of Attention Deficit Hyperactivity Disorder and the developing self-esteem in a population-based sample of twins.
The cohort is all twin pair families born in Sweden between May 1985 and December 1986 (n = 1.480). Wave 1 took place in 1994 when the twins were 8 years old and wave 2 in 1999 when the children were 13 years old. In wave 1 and 2 the parents completed questionnaires regarding ADHD-symptoms about their children. In wave 2 the twins completed a questionnaire about self-esteem and Youth Self Report (YSR). ADHD-symptoms and self-esteem were analyzed in the total study group.
There was a long-term relationship between high scores of parental-reported ADHD-symptoms at 8 and 13 years of age and low scores in measures of self-reported self-esteem at 13 years of age. In the cotwin control method controlling for YSR internalizing problem, paired comparisons within the twin pairs revealed that a high score of ADHD-symptoms at age 8 was related to significantly lower scores at age 13 in the self-esteem.
The long-term relationships between ADHD-symptoms and a low self-esteem in a population-based sample were confirmed by the co-twin analyses.
... Exclusion of a bowel segment from the gastrointestinal tract and exposure of intestinal mucosa to urine may lead to metabolic and nutritional disturbances [3,4]. However, the positive perspective regarding self-esteem and body image, freedom of activity and life style and elimination of the external collection devices are the main reasons for offering a continent reservoir to a patient [5]. Since Vitamin B12 is absorbed exclusively by the terminal ileum, some patients with continent urinary reservoirs are at the risk for Vitamin B12 de®ciency due to malabsorption [6,7]. ...
To assess B12 and folate deficiency after continent urinary diversion via a Kock continent urinary reservoir in children and adolescents.
Ten boys and 10 girls (10.8-18 years old at surgery) were operated with a Kock reservoir and followed for 5-12 years (mean 8.5). The follow-up period was divided into early (3 months-5 years, EFU) and late (5-12 years, LFU) follow-up. Patients were investigated for haemoglobin, serum iron, total iron binding capacity (TIBC), serum Vitamin B12, serum and blood folate, methylmalonic acid (MMA), homocystine and glomerular filtration rate.
Two patients developed subnormal B12 values (median 107.5 pmol/l), one at the EFU, and the other at LFW. The B12 value decreased during the LFU compared to the EFU in nine patients, but it was still within the normal range. Two patients with renal impairment had elevated MMA with normal B12 values. Five patients had high values of homocystine with folate deficiency and/or B12 deficiency and renal impairment. Plasma folate mean value was normal during the whole follow-up. Blood folate was below normal in five patients at the EFU. Two of these five patients, in addition to three patients, had low values at the LFU. Three of four patients with remaining short terminal ileum (20-45 cm) had normal B12 values at both the EFU & LFU and one had low values at the LFU. Six patients had subnormal GFR at the LFU.
To a similar degree as in adults, Vitamin B12, folate and iron deficiency can occur in children and adolescents after continent urinary diversion using an ileal segment. Therefore, Vitamin B12 and folate should be monitored regularly in these patients. Serum MMA and homocystine may offer increased detection of Vitamin B12 deficiency, especially in the patients with normal renal function. Vitamin B12 deficiency is neither correlated with the time elapsed since surgery, nor with the ileum length. Patients are usually asymptomatic, so patients with true B12 deficiency should be identified and placed on life-long Vitamin B12 therapy. An adequate synthetic folic acid as supplements or fortified food is recommended for patients with folate deficiency.
... In this study we used the self-esteem questionnaire, which is a Swedish questionnaire (Ouvinen-Birgerstam, 1985). The fact that the self-esteem questionnaire is not an international questionnaire makes it more difficult in terms of validation when comparing the results with other questionnaires that are aimed to measure selfesteem , although the instrument has been thoroughly validated and has been used in numerous studies on Swedish children and adolescents (Gawad et al., 2002; von Essen et al., 2000). There are also other important considerations to bear in mind regarding the use of a twin population. ...
We sought to evaluate the long-term outcomes of Bricker's conduit in children in a contemporary series.
the database of a single tertiary center was retrospectively reviewed for children who had ileal conduits between 1981 and 2011. Patients followed-up for less than one year were excluded. Patients' files were reviewed for demographics, diversion indication, preoperative imaging, surgical details, hospital readmissions and follow-up data. Baseline and last follow-up renal function was assessed by eGFR (calculated using modified Scwartz or MDRD formulas). Growth charts elucidated the children's growth pattern, whereas an internally-designed QoL questionnaire demonstrated patients' and families' satisfaction about the procedure.
A total of 29 children who had Bricker's conduits at a median age of 10(2-18) years and were followed-up for a median of 91(16-389) months were evaluated. Neuropathic bladder was the underlying diagnosis in 72.4%. Hydronephrosis improved/remained stable in 70.9% (39/55) of the studied renal units. Although no statistically significant difference was observed between the mean baseline (64.5+46 mL/min/1.73m(2)) and last follow-up eGFR (54.1+44.9 mL/min/1.73m(2)), 13 patients (44.8%) had worsening of CKD stage, 11 developed ESKD, and nine were deceased. Six patients were undiverted after stabilization of renal functions. Linear growth was negatively affected in 12(41.4%) patients and 85% reported poor QoL. Nineteen hospital readmissions were required in 14 patients to treat diversion-related complications.
Bricker's conduit does not seem to halt renal deterioration in children. Negative impact on growth, QoL and the anticipated rate of complications are significant limitations for the procedure in pediatric population.
Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Objective:
Urinary diversion may be an option in patients with disabling lower urinary tract dysfunction (DLUTD), refractory to conservative and minor invasive treatment. The aim of this study was to evaluate whether urostomy improves quality of life and cost of surgery, in terms of complications, loss of kidney function and hospital stay, in these patients.
Material and methods:
This prospective study included 52 consecutive patients (nine men and 43 women) with various benign disorders. Twenty-six patients received an ileal conduit and 26 a continent cutaneous diversion. The patients completed the general health-related quality of life instrument WHOQOL-BREF and a urinary problem-specific quality of life instrument preoperatively and 6 and 12 months after surgery. Length of hospital stay and complications were registered. Intravenous urography and determination of glomerular filtration rate (GFR) were performed preoperatively and 12 months postoperatively.
Results:
Disease-specific and health-related quality of life improved significantly (p < 0.0005 and p < 0.05) in all domains except for social relationship, from preoperative to 12 months after surgery. There was no difference in improvement between patients with continent and those with incontinent diversion. Mean hospital stay was 14 days. Early and late complications required open surgery in 12 patients (23%). GFR was unchanged postoperatively.
Conclusions:
Urinary diversion improves health-related and disease-specific quality of life in patients with DLUTD refractory to conservative and minor invasive treatments. The burden of surgery is acceptable. Urinary diversion could be recommended more often in such patients.
The aim of the study was to explore resilience among refugee children whose parents had been traumatized and were suffering from Post-Traumatic Stress Disorder (PTSD).
The study comprised 80 refugee children (40 boys and 40 girls, age range 6-17 yrs), divided into two groups. The test group consisted of 40 refugee children whose parents had been tortured in Iraq before coming to Sweden. In accordance with DSM-IV criteria, these children were further divided in two sub-groups, those who were assessed as having PTSD-related symptoms (n = 31) and those who did not have PTSD-related symptoms (n = 9). The comparison group consisted of 40 children from Egypt, Syria and Morocco whose parents had not been tortured. Wechsler Intelligence Scale for Children, 3rd edn. (WISC-III), Diagnostic Interview for Children and Adolescents- Revised (DICA-R), Post-Traumatic Stress Symptoms checklist (PTSS), "I Think I am" (ITIA) and Strengths and Difficulties Questionnaire (SDQ) were used to assess IQ; PTSD-related symptoms; self-esteem; possible resilience and vulnerability.
Children without PTSD/PTSS in the traumatized parents group had more favorable values (ITIA and SDQ) with respect to total scores, emotionality, relation to family, peer relations and prosocial behavior than the children in the same group with PTSD/PTSS and these values were similar to those the children in the comparison group (the non-traumatized parents group). The children in the non-traumatized parents group scored significantly higher on the IQ test than the children with traumatized parents, both the children with PTSD-related symptoms and those without PTSD-related symptoms.
Adequate emotional expression, supportive family relations, good peer relations, and prosociality constituted the main indicators of resilience. Further investigation is needed to explore the possible effects of these factors and the effects of IQ. The findings of this study are useful for treatment design in a holistic perspective, especially in planning the treatment for refugee children, adolescents and their families.
