Avhandlingens övergripande syfte var att öka kunskapen om utvecklingen av blås-funktion hos barn med fokus på tidig potträning.
Specifi ka syften:
- Att beskriva, longitudinellt, utvecklingen av miktionsmönstret hos friska barn 0-3 år, som är pottränade tidigt (delarbete I och III).
- Att beskriva mammors erfarenhet i en pågående potträningsprocess och hur friska barn kommunicerar sina behov (delarbete II).
- Att jämföra longitudinellt, miktionsmönstret inklusive tömningsförmågan hos friska barn som är pottränade tidigt med barn som är pottränade sent (del-arbete III).
- Att undersöka om potträning redan från spädbarnsåldern kan påverka blås-dysfunktion hos pojkar med posterior urethra valvel (PUV)(delarbete IV). Deltagare: Delarbete I-III. Fyrtiosju friska barn, ålder 0-3 år , följdes longitudinellt var 3:e månad. Delarbete IV. Sjutton barn födda med PUV, ålder 0-4 år, uppföljning efter 18 månader.
Metod: Kvantitativ uppföljning med 4-timmars miktionsobservation tillsammans med kvalitativa intervjuer av mammor. Jämförelser är gjorda mellan olika åldersgrupper av friska barn och en grupp av pojkar med PUV.
Resultat: Små barn i Vietnam använder sällan blöjor; de fl esta pottränades dagligen från att de var 3 månader och alla barn från 12 månaders ålder. När det gäller svenska barn så hade ingen startat vid den åldern (delarbete I och III). Vid 24 månaders ålder hade 98% av de vietnamesiska barnen kunnat avsluta träningen. I jämförelse med den svenska gruppen så hade 5% startat daglig potträning vid den åldern och vid 36 måna-der hade 55% kunnat avsluta träningen. Skillnaden var signifi kant (P<0.001). Daglig potträning påverkade tömningen positivt; vid 9 månaders ålder fanns ingen residualu-rin hos de friska vietnamesiska barnen. Dessa resultat skiljer sig signifi kant från den svenska gruppen av barn. Miktionsfrekvensen var lägre hos de vietnamesiska barnen jämfört med de svenska. Blåsvolymen ökade med ålder hos båda grupperna, men hos de vietnamesiska barnen var den signifi kant lägre jämfört med de svenska barnen. Potträningsprocessen visade på hur kommunikationen mellan mamma och barn ut-vecklades (delarbete II). Redan under den första levnadsmånaden försökte mammor-na känmammor-na igen tecken på att deras barn behövde kissa. Mammormammor-na stödde sedan dessa tecken genom ett speciellt visselljud som hon också använde vid speciella tillfällen för att påminna. Vidare, resultaten från 4-timmars miktionsobservation visade få tecken på dysfunktionell blåsa hos de vietnamesiska barnen med PUV (delarbete IV). Men i jämförelse med friska vietnamesiska barn så fanns det signifi kant fl er tecken på blås-dysfunktion i gruppen med PUV.
Konklusion: Det är möjligt att potträna också små barn genom att lära att kommunice-ra dessa behov. Daglig potträning påverkade tömningsförmågan positivt hos alla barn, inkluderande pojkar med PUV; vid 9 månaders ålder kunde man inte fi nna någon re-sidualurin hos de vietnamesiska friska barnen. Miktionsfrekvensen och blåsvolymen var lägre hos de vietnamesiska barnen än de svenska. Tidig potträning reducerade tecken på blåsdysfunktion hos pojkar med PUV.
ACKNOWLEDGEMENTS
Coming to the completion of my thesis, I would like to thank all the people who taught me, helped me and encouraged me:
I would like to thank all the children and mothers who participated in the study. With-out them this research would have been impossible and I hope these fi ndings will become useful and support them to improve their quality of life.
I would like to thank my main supervisor, Professor Anna-Lena Hellström, you gave me a golden opportunity to attend this PhD studies. With your great experience in this profession and fi eld of research, you taught me enthusiastically and travelled from Sweden to Vietnam many times to help me. You provided me with endless support and encouragement and guided me through all the steps in research and life. You gave me the drive and helped me to make sure I got the best competence in research, strength and faith to overcome all the diffi culties during the time I studied in Sweden.
I would also like to thank my co-supervisor Ulla-Britt Jansson, who taught and sup-ported me the best way imaginable. I learn a lot from your analytical ability and you always encouraged me to give me energy to go ahead. I will always appreciate the fun times we shared.
I am grateful to have had Gundela Holmdahl and Ulla Sillén as my co-supervisors. You always found time to help me write and analyze with quality, despite own tight work schedules.
I am immensely grateful to my “Swedish family” and particularly to my “Swedish dad”, Robert Hellström, you always stayed by my side to let me feel less homesick, helping me, taking care of me and encouraging me during my learning process in Sweden. The time I shared with you and my “Swedish family” is priceless and unfor-gettable.
I would like to thank Nils-Gunnar Pehrsson and Mattias Molin for your excellent help with the statistical analyses and for your patience.
I would like to thank all the staff at the Urotherapy department at the Queen Silvia Children’s hospital for your help and sharing your knowledge to support my study.
I would like to thank the Institute of Health and Care Sciences, the Center for Person-centred Care (GPCC), and Sahlgrenska Academy, University of Gothenburg, for giv-ing me the opportunity to study for PhD.
In Vietnam, I sincerely thank Professor Nguyen Thanh Liem, the former Director of the National Hospital of Pediatrics, you believed in me, encouraged me and helped me to participate in my PhD studies.
I would also like to thank Professor Le Thanh Hai, Director of the National Hospital of Pediatrics, who helped me and encouraged me to try my best.
I would like to thank the Director of the board of the National Hospital of Pediatrics for the support I received to complete the studies.
I would like to thank the Department of Nursing, head nurses and all my colleagues at the National Hospital of Pediatrics for never failing to help and encourage me.
I would also like to thank all my colleagues in Private department B, who gave me an incredible support during my studies and made me always feel welcomed when I was back from Sweden.
Finally, I would like to thank my family, my parents, my siblings and my son for the indispensable encouragement to go on with my studies. Especially, I would like to thank my mother who has done everything for me taking care of my son, while I was in Sweden. I would have never achieved anything without you.
REFERENCES
1. Holmdahl, G., et al., The changing urodynamic pattern in valve bladders during infancy. J Urol, 1995. 153(2): p. 463-7.
2. Holmdahl, G., et al., Four-hour voiding observation in young boys with posterior ure-thral valves. J Urol, 1998. 160(4): p. 1477-81.
3. Jansson, U.B., E. Danielson, and A.L. Hellstrom, Parents’ experiences of their children achieving bladder control. J Pediatr Nurs, 2008. 23(6): p. 471-8.
4. Mota, D.M. and A.J. Barros, Toilet training: situation at 2 years of age in a birth cohort. J Pediatr (Rio J), 2008. 84(5): p. 455-62.
5. deVries, M.W. and M.R. deVries, Cultural relativity of toilet training readiness: a per-spective from East Africa. Pediatrics, 1977. 60(2): p. 170-7.
6. JW, K., Philosophical and theoretical perspectives for advanced nursing practice. 3. ed. Sudbury, Mass: Jones and Bartlett; 2002.
7. Stein, R.E., Children’s Health, the Nation’s Wealth: Assessing and Improving Child Health. Ambul Pediatr, 2005. 5(3): p. 131-3.
8. Onyango-Ouma, W., J. Aagaard-Hansen, and B.B. Jensen, Changing concepts of health and illness among children of primary school age in Western Kenya. Health Educ Res, 2004. 19(3): p. 326-39.
9. Pridmore P, B.G., Images of health: Exploring beliefs of children using the “draw-and-write” technique. Health Education Journal 1995: p. 54, 473-488.
10. Barett, H., Parents and children: facts and fallacies about attachment theory. J Fam Health Care, 2006. 16(1): p. 3-4.
11. Ebba Kostmann, L.N., Children’s perspective on health: What makes children feel good according to themselves. International Journal of Education, 2012. ISSN 1948-5476, Vol.4, No. 1.
12. Owens, J.A. and C. Jones, Parental knowledge of healthy sleep in young children: results of a primary care clinic survey. J Dev Behav Pediatr, 2011. 32(6): p. 447-53.
13. Vereijken, C.M., H. Weenen, and M.M. Hetherington, Feeding infants and young chil-dren. From guidelines to practice-conclusions and future directions. Appetite, 2011.
57(3): p. 839-43.
14. Hockenberry ML, W.D., Winkelstein ML, Kline NE., Wong’s Nursing Care of Infants and Children. Seventh ed, 2003. Seventh ed. S.T Lois: Mosby.
15. Betz CL, H.M., Wright S, Family-centered nursing care of children 1994. Second ed. Philadelphia: W.B. Saunders.
16. Stein, M.T., S.D. Dixon, and C. Cowan, A two-year-old boy with language regression and unusual social interactions. J Dev Behav Pediatr, 2000. 21(4): p. 285-90.
17. Fact sheet: A summary of the rights under the convention of the rights of the child. Avail-able at: www.unicef.org/crc/fi les/Rights_overview.pdf. Accessed 2013-01-10.
18. Erikson, E.H., in The life Cycle completed: A Review1982, New York: W.W. Norton: http://www.psychology.iastate.edu.
19. Bakker, E. and J.J. Wyndaele, Changes in the toilet training of children during the last 60 years: the cause of an increase in lower urinary tract dysfunction? BJU Int, 2000. 86(3): p. 248-52.
20. Hauck, M.R., Mothers’ descriptions of the toilet-training process: a phenomenologic study. J Pediatr Nurs, 1991. 6(2): p. 80-6.
21. Foraldrabalken 6 kap., 1 §., 1979. Available at: http://www.riksdagen.se/sv/Dokument-Lagar/Lagar/Svenskforfattningssamling/Foraldrabalk-1949381_sfs-1949-381/ - K13. Accessed 2013-06-14.
22. Muellner, S.R., Development of urinary control in children: some aspects of the cause and treatment of primary enuresis. J Am Med Assoc, 1960. 172: p. 1256-61.
23. Klackenberg, G., Expectations and reality concerning toilet training. Acta Paediatr Scand, 1971: p. suppl, 224: 85.
24. Brazelton, T.B., A child-oriented approach to toilet training. Pediatrics, 1962. 29: p. 121-8.
25. Foxx, R.M. and N.H. Azrin, Restitution: a method of eliminating aggressive-disruptive behavior of retarded and brain damaged patients. Behav Res Ther, 1972. 10(1): p. 15-27.
26. Stadtler, A.C., P.A. Gorski, and T.B. Brazelton, Toilet training methods, clinical inter-ventions, and recommendations. American Academy of Pediatrics. Pediatrics, 1999. 103(6 Pt 2): p. 1359-68.
27. Hellstrom, A.L. and U. Sillen., Early potty training advantageous in bladder dysfunc-tion. Decreases the risk of urinary infecdysfunc-tion. Lakartidningen, 2001. 98(28-29): p. 3216-9. 28. Kaerts, N., et al., Toilet training in daycare centers in Flanders, Belgium. Eur J Pediatr,
2012. 171(6): p. 955-61.
29. Vietnam Demographics Profi le 2012. Available at: http://www.indexmundi.com/viet-nam/demographics_profi le.html. Accessed 2013-01-10.
30. The National Board of Health and Welfare, befolkningsstatistik. Available at: http:// www.socialstyrelsen.se/ Accessed 2013-01-08.
31. World Health Organization. Vietnam: Health Profi le. 2012. Available at: http://www. who.int/gho/countries/vnm.pdf . Accessed 2012-10-01.
32. The World Factbook. Vietnam. 2012. Available at: https://www.cia.gov/library/publica-tions/the-world-factbook/geos/vm.html . Accessed 2013-01-06.
33. National hospital of pediatrics. About us – National Hospital of Pediatrics. Available at: http://www.nhp.org.vn/list.aspx?cat=001002. Accessed 2012-12-12.
34. Jansson, U.B., et al., Voiding pattern in healthy children 0 to 3 years old: a longitudinal study. J Urol, 2000. 164(6): p. 2050-4.
35. Yeung, C.K., et al., Natural fi lling cystometry in infants and children. Br J Urol, 1995. 75(4): p. 531-7.
36. Mattsson, S.H., Voiding frequency, volumes and intervals in healthy schoolchildren. Scand J Urol Nephrol, 1994. 28(1): p. 1-11.
37. Gladh, G., et al., Voiding pattern in healthy newborns. Neurourol Urodyn, 2000. 19(2): p. 177-84.
38. Jansson, U.B., et al., Voiding pattern and acquisition of bladder control from birth to age 6 years--a longitudinal study. J Urol, 2005. 174(1): p. 289-93.
39. Roberts, D.S. and B. Rendell, Postmicturition residual bladder volumes in healthy ba-bies. Arch Dis Child, 1989. 64(6): p. 825-8.
40. Wennergren, H.M., B.E. Oberg, and P. Sandstedt, The importance of leg support for relaxation of the pelvic fl oor muscles. A surface electromyograph study in healthy girls. Scand J Urol Nephrol, 1991. 25(3): p. 205-13.
41. Sillen, U., et al., The voiding pattern of healthy preterm neonates. J Urol, 2000. 163(1): p. 278-81.
42. Blum, N.J., B. Taubman, and N. Nemeth, During toilet training, constipation occurs before stool toileting refusal. Pediatrics, 2004. 113(6): p. e520-2.
43. Largo, R.H. and W. Stutzle, Longitudinal study of bowel and bladder control by day and at night in the fi rst six years of life. II: The role of potty training and the child’s initiative. Dev Med Child Neurol, 1977. 19(5): p. 607-13.
44. Sillen, U., Bladder dysfunction in children with vesico-ureteric refl ux. Acta Paediatr Suppl, 1999. 88(431): p. 40-7.
45. Hansson, S., et al., Urinary tract infections in children below two years of age: a qual-ity assurance project in Sweden. The Swedish Pediatric Nephrology Association. Acta Paediatr, 1999. 88(3): p. 270-4.
46. Lee, S.D., et al., An epidemiological study of enuresis in Korean children. BJU Int, 2000. 85(7): p. 869-73.
47. Bloom, D.A., et al., Toilet habits and continence in children: an opportunity sampling in search of normal parameters. J Urol, 1993. 149(5): p. 1087-90.
48. Hellstrom, A.L., et al., Micturition habits and incontinence in 7-year-old Swedish school entrants. Eur J Pediatr, 1990. 149(6): p. 434-7.
49. Jarvelin, M.R., et al., Enuresis in seven-year-old children. Acta Paediatr Scand, 1988. 77(1): p. 148-53.
50. “Posterior urethral valves - Disease Information”. Children’s hospital, Boston. Re-trieved January 31, 2011. Available at: http://www.childrenshospital.org/az/Site1471/ mainpageS1471P0.html. Accessed 2013-05-06.
51. Posterior urethral valves. Available at: http://en.wikipedia.org/wiki/Posterior_urethral_ valve. Accessed 2013-05-07.
52. Holmdahl, G., et al., Natural fi lling cystometry in small boys with posterior urethral valves: unstable valve bladders become stable during sleep. J Urol, 1997. 158(3 Pt 2): p. 1017-21.
53. Holmdahl, G., et al., Four-hour voiding observation in healthy infants. J Urol, 1996. 156(5): p. 1809-12.
54. Mantel, N. and W. Haenszel, Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst, 1959. 22(4): p. 719-48.
55. Krippendorff, K., Content analysis: an introduction to its methodology. 2. ed2004, Thou-sand Oaks, Calif.: Sage. xxiii, 413 s.
56. Declaration of Helsinki. Available at: http://www.wma.net/en/30publications/10policies/ b3/index.html.pdf?print-media-type&footer-right page]/[toPage]. Accessed 2013-06-20.
57. Lynch, L. and S. Bemrose, It’s good to talk: pre- and post-birth interaction. Pract Mid-wife, 2005. 8(3): p. 17-20.
58. Hagglof, B., et al., Self-esteem in children with nocturnal enuresis and urinary inconti-nence: improvement of self-esteem after treatment. Eur Urol, 1998. 33 Suppl 3: p. 16-9. 59. Goellner, M.H., E.E. Ziegler, and S.J. Fomon, Urination during the fi rst three years of
life. Nephron, 1981. 28(4): p. 174-8.
60. Hjalmas, K., Micturition in infants and children with normal lower urinary tract. A uro-dynamic study. Scand J Urol Nephrol, 1976. Suppl 37: p. 1-106.
61. Abrams, P.H., et al., The results of prostatectomy: a symptomatic and urodynamic analy-sis of 152 patients. J Urol, 1979. 121(5): p. 640-2.
62. Speakman, M.J., et al., Cystometric, physiological and morphological studies after relief of bladder outfl ow obstruction in the pig. Br J Urol, 1991. 68(3): p. 243-7.
63. Neveus, T., et al., The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the Interna-tional Children’s Continence Society. J Urol, 2006. 176(1): p. 314-24.