Dissertations / Theses on the topic 'Enuresis – Treatment'

Childhood nocturnal enuresis (bedwetting) is a prevalent, clinically demanding condition affecting approximately 500,000 children in the United Kingdom. At the age of 5 years, around 15-20% of all children wet the bed at least twice weekly, this figure falling to 5% at age 10 years. The disorder can have far-reaching social and emotional consequences for both the child and their family if left untreated. The most successful treatments for childhood functional (non-organic) nocturnal enuresis are of behavioural origin, namely urine alarm training and dry-bed training. The former is widely adopted in the treatment of bedwetting; however, it has a high relapse rate. In contrast, the latter tends to have a better long-term remission rate. However, due to the intricate nature of dry-bed training and costs relating to its implementation, it is rarely utilised by healthcare practitioners. Two studies reported in this thesis (the first a pilot investigation, and the second a main investigation) examined the relative efficacy of urine alarm training and a modified version of drybed training in the treatment of childhood functional nocturnal enuresis when both were delivered by identical minimal intervention methods (i.e., biblio-cumvideo therapy combined with telephone and intermittent clinic supervision) at the primary care level of service delivery. The findings demonstrated that modified drybed training was significantly superior to urine alarm training in terms of its long term remission rate. Moreover, families of bedwetting children found the modified dry-bed training programme simple to understand and implement. As a result of these findings, and as an extension into the evaluation of minimal intervention service delivery, a study was conducted to investigate the relative efficacy of modified dry-bed training delivered via video-mediated consultation and face-to-face consultation in the treatment of childhood functional nocturnal enuresis. A further objective was to evaluate patient, parent, and therapist satisfaction with video mediated consultation as compared to face-to-face consultation. The findings revealed that modified dry-bed training was equally efficacious across both consultation modes in terms of its long-term remission rate. Patients and their parents were generally satisfied with both modes of consultation, with few significant differences between the 2 consultation groups on any variable as assessed by a post-treatment patient and parent satisfaction scale. However, the therapist was more satisfied with face-to-face consultation than video-mediated consultation. Results are discussed in terms of their relevance to future research and clinical practice.

Section A examines the association between nocturnal enuresis (NE) and Quality of Life (QoL) in children and young people. This paper systematically reviews the research literature in this area considering relationships between NE and QoL across demographic variables such as gender and age. Future research avenues and implications for clinical practise are discussed. Section B reports on a tailored hypnosis treatment for children and young people with NE. This used a prospective case series with multiple-case AB design with follow-up, and tested the hypothesis that this approach would increase number of dry nights. Changes in child and parent psychosocial variables were also examined. Results indicated that participants improved in nighttime dryness as predicted, and that improvements were sustained at follow up. Self-reported continence specific QoL showed improvement approaching significance from baseline to follow up. Mixed Results were found as to changes in other psychosocial variables as a result of treatment. Limitations of the research and its implications are discussed. Section C is a critical appraisal of the research process as a whole, covering issues such as choice of research and how this developed through clinical practice, training and previous research experiences. It explores issues across the research process at individual, team, systems and organisational levels. It provides a critique of the design and methodology, as well a reflection on personal and professional development. Section D reports on the results of a local questionnaire based service evaluation examining young people’s views of their paediatric diabetes clinics; including examples of good practice valued by young people. It also reports young people’s opinions and ideas about possible future service provision. It makes clear recommendations as to the ways forward in service user led service development.

Worldwide, millions of children 5 years of age and older suffer with nocturnal enuresis, also known as nighttime bedwetting. Nocturnal enuresis is a chronic elimination disorder that while usually benign, too often results in the child being emotionally and physically abused. Efforts to design effective treatments with low relapse rates have thus far been thwarted by the array of organic and psychosocial variables related to its development. Guided by the 5-factor theory of personality, this cross-sectional study investigated whether a parent's personality characteristics significantly predict effective treatment for a child's nocturnal enuresis. Effective treatment was defined as having no relapses of symptoms in the 6 months following initial treatment success. A convenience sample of parents (n = 165) was recruited from the online social network Facebook and other online educational and support forums for parents seeking information on enuresis. Participants completed the NEO-FFI-3 to measure their personality characteristics, and logistic regression analyses were used to determine if parental personality characteristics, parental history of childhood enuresis, and/or the child's gender were significant predictors of effective treatment for a child's enuresis. None of these factors were found to significantly predict effective treatment for enuresis. This study promotes positive social change by identifying the need for an integrated biopsychosocial approach to treating children with enuresis with effective evidence-based treatments. These treatments are expected to result in fewer children exposed to the high rates of abuse and the development of psychosocial disorders often associated with nocturnal enuresis

The focus of this thesis is nocturnal enuresis in the primary care setting. Three aspects have been central: 1) the parental perspective, 2) differences between children with enuresis of varying severity, and 3) to explore whether the universally recommended basic bladder advice have any therapeutic effect.   Study I built on qualitative data from interviews with 13 parents of children with enuresis, focusing on family impact and coping strategies. A common consensus among the participants was that they felt frustrated about the perceived lack of information and help they received from the healthcare system. In study II anamnestic data and voiding chart parameters – reflecting renal and bladder function – were compared between 54 children with enuresis of varying frequency. No measurable differences were found. Study III was a randomised controlled study. Forty children with previously untreated enuresis were recruited and randomised to receive either first bladder advice for one month and then alarm therapy (n=20) or just the alarm therapy (n=20). The bladder advice did neither result in a significant reduction in the number of wet nights, nor improve the effect of subsequent alarm therapy.  Study IV was a cross-sectional questionnaire study of 52 parents, including comparison with normative data and with validated instruments evaluating intra-parental stress and satisfaction. The results showed no significant differences between the parents studied and normative data.    Study I and IV were the first to look at the parents, as opposed to children with enuresis. The results can be used by healthcare professionals when counselling families about strategies to use and attitudes to avoid. Study II aimed at filling a glaring blank in the field of knowledge: we do not know how children with infrequent enuresis differ from those who wet their beds often or every single night. The fact that no differences in bladder or kidney function was found indicates that they may differ in the way they sleep. Study III will probably have the greatest impact on how we should treat children with enuresis. The recommendation that all of them be given bladder training as a first-line therapy can no longer be supported.

The first part of this thesis examines the psychosocial characteristics of a cohort oj 270 bedwetting children attending a community enuresis service for treatment These children were recruited to a stratified cluster randomised controlled trial which forms the second part of this thesis in which additional information wa~ provided via a multimedia computer program and written leaflets. The mail clinical outcome measures were becoming dry and remaining dry six months pos discharge, time to dry, non-attendance and dropout rates. The main psycho socia measures were maternal tolerance, the impact of bedwetting and self-esteem. Th theoretical basis for the intervention(s) was the 'incomplete learning' model c bedwetting.' It was hypothesised that the intervention (s) would improve the sell efficacy of children through the mediation of cognitive, motivational, affectiv and self-selection changes (Bandura 1977). The randomisation procedure was slightly biased with children in the comput( group being sampled from a more affluent population and those in tl control/leaflets group from a more deprived population. There were also few, children from minority ethnic groups in the computer group. Significa differences were found between the ethnic groups in response to the impact bedwetting and maternal tolerance scales, together with parents' reports of th{ child's distress and parental worry. Therefore analysis was conducted on a samI matched by Jarman scores which excluded the children from affluent areas in t computer group and children from deprived areas in the control and leaflets grm Analysis was also conducted on the entire cohort. Bedwetting children had a lower self-esteem than school children. However, selfesteem improved with treatment with the greatest changes occurring for those who became dry. Low self-esteem was significantly related to a high impact of bedwetting. The presence of housing difficulties produced the least positive response on the psychosocial measurement scales. Low parent reported child distress and less severe wetting at initial assessment predicted a successfu: outcome. Although self-esteem was significantly lower for bedwetting children compared t( the school children the mean difference of less than one item suggests this result i not clinically meaningful. Nevertheless there are clearly some bedwettinJ children with less positive psychosocial and clinical situations. Bedwetting seem to be worse psychosocially for children from less affluent backgrounds, measure by the presence of housing difficulties, and those who are most distressed by it ne only have a lower self-esteem, but they are less likely to get dry. Howeve children's self-esteem does improve with treatment. The intervention( s) made no significant difference to any of the clinical outcorr measures or any of the psychosocial measures recorded during and post-treatmel for either the matched sample or the entire cohort. The absence of an intervention effect is disappointing and suggests that it is n sufficient merely to provide novel additional information to bedwetting childre Two main problems with the study design were identified. The large variation bedwetting children's time to dry suggests the outcome measures used may not sufficiently precise to detect a difference if one was present. The computer and the leaflets may have had insufficient power to produce changes in children at the level measured. Future research might wish to use a more intensive program where the computer intervention is combined with the leaflets. Nevertheles~ whilst this intensive training input and measurement is likely to motivate somt children this will not be the case for all.

Uma vez que atraves do uso do alarme de urina nem todas as criancas com enurese obtem os criterios definidos para o sucesso (14 noites secas consecutivas), buscou--se investigar procedimentos complementares para potencializar o seu efeito: a) o diario miccional, utilizado como um instrumento de avaliacao diagnostica da enurese e como uma medida dos efeitos de tratamentos e b) a uroterapia, que consiste de um conjunto de medidas comportamentais que tem como objetivo corrigir dificuldades provavelmente relacionadas a enurese nao corrigidas pelo uso do alarme. O diario miccional e o registro do volume de liquidos ingeridos e eliminados no periodo de dois dias pela crianca, que pode indicar, dentre outros padroes, urgencia miccional, hiperatividade detrusora, poliuria, bem como ingestao irregular de liquidos. As medidas comportamentais que compoe a uroterapia podem ser exemplificadas por: miccoes em horarios regulares; aumento da ingesta de liquidos e evitacao de irritantes vesicais. Neste estudo participaram 65 criancas e adolescentes com enurese distribuidas em dois grupos de tratamento. O primeiro grupo foi exposto a uroterapia e ao tratamento com alarme (grupo Uroterapia), enquanto o segundo grupo foi exposto somente ao tratamento com alarme (grupo Alarme). Por volta de 70% dos participantes de ambos os grupos obtiveram sucesso no tratamento, independentemente da realizacao da uroterapia. Os participantes do grupo Uroterapia apresentaram uma melhora mais acentuada no inicio do tratamento, mas esta nao se manteve como tendencia ao longo do tempo. Os participantes de ambos os grupos tiveram um aumento significativo da porcentagem da capacidade volumetrica da bexiga utilizada. Os participantes do grupo Uroterapia tiveram um aumento significativamente maior dos volumes de ingesta de liquidos e miccional<br>Not all children with enuresis reach 14 consecutive dry nights thought the use of the bell and pad alarm. That considered, we aimed to investigate additional procedures to enhance its success rate: a) the voiding diary, used as a diagnostic tool for evaluating enuresis and to measure overall treatments effects and b) urotherapy, consisting of a set of behavioral measures that aims at problems probably related to enuresis not corrected by the use of the bell and pad alarm. The voiding diary is a two--day record of fluid intake and micturition habits. It may indicate, among other patterns, urgency, detrusor overactivity, polyuria and irregular fluid intake. Urotherapy is composed of behavioral measures such: voiding at regular times; increased fluid intake; and avoidance of bladder irritants. 65 children and adolescents participated in this study. They were assigned to two treatment groups. The first group was exposed to urotherapy and to an alarm treatment (Urotherapy group), while the second was exposed only to an alarm treatment (Alarm group). Around 70% of participants became dry, regardless of the group they were assigned to. Participants from the Urotherapy group showed a more marked improvement early in treatment, but this trend was not maintained over time. Participants from both groups had a significant increase in the percentage of volumetric bladder capacity used and participants from the Urotherapy group had a significantly greater increase of fluid intake and voided volume

A enurese é uma condição caracterizada pela eliminação de urina durante o sono, em crianças com mais de cinco anos, em função da dificuldade de acordar associada à baixa produção do hormônio vasopressina ou à instabilidade da bexiga, sem outra condição clínica que explique os episódios de molhar a cama. A intervenção comportamental com alarme é a mais recomendada pela literatura para a cura da enurese. O acompanhamento do uso do alarme pode ser realizado através de contatos telefônicos, em que são investigados pontos chave do procedimento a ser realizado em casa pelas famílias. Uma pesquisa verificou que o acompanhamento telefônico é uma alternativa eficaz para a população que faz uso do alarme de urina para enurese, mas sem obter clareza na questão da sua validade para crianças com escores clínicos de problemas de comportamento. O presente estudo teve como objetivo geral comparar a eficácia do tratamento para enurese entre dois grupos de participantes que receberam acompanhamento telefônico, sendo previamente classificados pelos pais de duas maneiras: um com índices clínicos de problemas de comportamento e outro sem tais índices. Como objetivos específicos: (1) classificar as crianças quanto aos problemas de comportamento a partir de observação feita por uma pesquisadora; (2) verificar a eficácia do tratamento para crianças com e sem problemas de comportamento, a partir da avaliação da pesquisadora; (3) Verificar a evolução dos problemas de comportamento comparando escores pré e pós tratamento a partir da avaliação dos pais (4) comparar o nível de autoconceito reportado pela criança antes e após a intervenção (5) verificar possíveis correlações entre nível de autoconceito e o resultado do tratamento. Participaram do estudo 31 crianças com idades entre seis a 11 anos, (média=8,3, DP=1,3), sendo 15 do sexo masculino e 16 do sexo feminino e seus pais. Para a inclusão da criança no tratamento, o diagnóstico de enurese foi obtido através do Formulário de Avaliação de Enurese. Para a avaliação dos problemas de comportamento foram aplicados o Inventário de Comportamento para Crianças e Adolescentes (CBCL), destinado aos pais e o Inventário de Observação Direta (DOF), instrumento que permite ao pesquisador observar e qualificar o comportamento infantil em escalas semelhantes às obtidas pelo preenchimento do CBCL durante atividades recreativas. Este último instrumento foi preenchido por uma pesquisadora vinculada ao Projeto Enurese. Para mensurar o autoconceito foi utilizado a Escala de Autoconceito Infanto-Juvenil. Setenta e um por cento dos participantes, independente do grupo (clínico ou não clinico) ao qual pertenciam obtiveram sucesso no tratamento, não havendo correlação entre os problemas de comportamento e os resultados do tratamento. A única variável 8 relacionada com o sucesso foi a menor frequência de episódios de molhadas antes do tratamento. As avaliações feitas pelos pais e pela pesquisadora em relação aos problemas de comportamento apresentaram um ligeiro grau de concordância (57,2%). Conforme esperado, o grupo das crianças que obteve sucesso no tratamento apresentou melhora nos índices de problemas de comportamento totais e autoconceito pessoal e social quando comparado ao daquelas que não obtiveram sucesso<br>Enuresis is a condition defined by urine loss during sleep due to the incapacity to wake up in response to the full bladder signals associated to a lack of vasopressin hormone or dysfunctional bladder activity, when the child is at least five years-old and has no other condition that explains bedwetting. Behavioral intervention with alarm is one of the most effective ways to cure enuresis. One method to monitor the alarm use by the families is periodic phone calls, in which the researcher checks if the treatment procedure is being correctly done. A past research concluded that monitoring the intervention by phone is a effective alternative for the treatment, but it was unclear if children with clinical levels of behavioral problems would benefit of it. This study aimed to compare the treatment efficacy with two groups receiving alarm treatment with phone follow up, one group with clinical levels of behavioral problems and the other without it, according to the parents\' view. Specific objectives were: (1) to use an alternative method to assess behavioral problems, according to a researcher\'s point of view; (2) to verify treatment efficacy for children with and without clinical levels of behavioral problems according to the researcher\'s point of view; (3) to compare behavioral problems levels before and after treatment, according to the parents\' point of view; (4) to compare children\'s self-concept levels before and after treatment; and (5) to investigate correlations between self-concept levels and treatment result. Thirty-one children aged 6 to 11 (mean=8,3, SD=1,3) were included in the study. Fifteen were male and 16 were females. To assess enuresis the Enuresis Assessment Form was used; to assess behavioral problems, the Child Behavior Checklist (CBCL) and the Direct Observation Form (DOF) were applied, the first instrument was filled up by the parents at home and the second by a researcher during recreational activities. The Child Self-Concept Scale was used to assess participants\' self-concept. Seventy-one percent of the children reached the criterion for treatment success. There was no influence of behavioral problems in the treatment result. A higher bedwetting frequency prior to treatment was the only variable related to a better treatment result. The comparison between the parents and the researchers evaluation about the behavioral problems showed a moderated level of agreement (57,2%). As expected, children who were successful in the treatment showed a significantly higher improvement in total behavioral problems levels and personal and social self-concept, when compared to those who did not had success

Introdução: A enurese (EN) é uma condição clínica de etiologia multifatorial com característica de perda de urina intermitente no período noturno que promove uma dificuldade ao convívio social da criança/adolescente e pode ser afetada pela presença de comorbidades e por imaturidade do sistema nervoso na regulação central sobre o funcionamento vesical. O conjunto de eventos promotores do episódio da enurese, desde o enchimento vesical durante o sono até a deflagração do esvaziamento vesical involuntário sem acordar constitui-se no foco principal de abordagem clínico-laboratorial e terapêutica. Objetivo: Estudar o impacto de uma avaliação multidisciplinar do indivíduo com enurese noturna monossintomática (ENM) sobre a eficácia terapêutica dos métodos tradicionalmente utilizados em sua abordagem, assim como comparar, pela polissonografia (PSG), os efeitos da intervenção sobre a estrutura do sono. Método: Estudo prospectivo de crianças de 6 a 17 anos incompletos, com ENM, diagnosticada por avaliação multidisciplinar utilizando anamnese estruturada com enfoque nefropediátrico, exame clínico, diários das eliminações, ultrassonografia de rins e vias urinárias, análises laboratoriais de sangue e urina, exame neurológico, diário do sono, questionários de avaliação do sono e polissonografia, avaliação psicológica de distúrbios do comportamento pelo CBCL e da qualidade de vida pelo PedsQL 4.0 e avaliação fisioterapêutica do equilíbrio. Condições crônicas e genéticas constituíram exclusão do protocolo. O estudo foi aprovado pelo Comitê de Ética em Pesquisa do HCFMUSP de número 0649/10 e apoio da FAPESP (2011/17589-1). Das 140 crianças/adolescentes ingressantes, foram excluídos 58 (41,4%) por comorbidades não tratáveis e/ou não aderência ao protocolo, 82/140 (58,6%) pacientes com ENM foram incluídos para intervenção terapêutica em três grupos de tratamento (alarme, desmopressina e alarme com desmopressina). A resposta à intervenção terapêutica foi avaliada no período pós-intervenção imediato (após seis meses de tratamento) e tardio (após 12 meses da suspensão do tratamento). A PSG foi realizada pré e pós-tratamento para análise comparativa da estrutura do sono. Resultados: Dos 82 pacientes, com idade média de 9,5 anos (? 2,6), 62 eram do sexo masculino (75,6%). Diagnosticou-se antecedente familiar de EN em 91,1% considerando parentes de 1° e 2° graus, constipação em 81,7% e apneia leve/moderada em 40,7%. A avaliação fisioterapêutica realizada na fase pré-intervenção demonstrou presença de alteração no controle do equilíbrio nos pacientes com enurese. A associação entre os fatores reconhecidos na abordagem clínica inicial e a gravidade da enurese (% de episódios/mês) na fase préintervenção, apresentou significância para prematuridade (p=0,03). Previamente à randomização, após abordagem clínica de constipação e/ou terapia comportamental simples, verificou-se cura de 7/82 pacientes. Foram randomizados para tratamento nas três modalidades de intervenção 75 pacientes. Durante a fase de intervenção ocorreram 14/75 (18,7%) desistências, principalmente no grupo alarme (p=0,00). Verificou-se nos 61 pacientes em tratamento, sucesso inicial (resposta completa e parcial) em 56,6% do grupo alarme, 70% do grupo desmopressina e 64% do grupo combinado (p=0,26). Sucesso contínuo (SC) ocorreu em 70% do grupo Alarme, 84,2% do grupo Desmopressina e 100% do grupo combinado (p=0,21). A recidiva ocorreu em 3/20 (15%) pacientes do grupo Alarme e 1/19 (5,2%) do grupo Desmopressina. O sucesso terapêutico se associou a redução nos escores de problemas de comportamento e melhora dos escores de qualidade de vida dos pacientes. A análise comparativa do sono pré e pós-intervenção nos pacientes com e sem alarme demonstrou aumento dos microdespertares (p=0,00), diminuição da eficiência do sono (p=0,02), diminuição de N2 (p=0,00) no grupo alarme. Conclusão: A enurese é um distúrbio multifatorial que exige uma abordagem diagnóstica estruturada. No presente estudo, a abordagem terapêutica utilizando três metodologias de intervenção demonstrou eficácia semelhante. Os benefícios associados ao sucesso terapêutico são amplos, sugere-se, no entanto, que a terapia com alarme possa repercutir negativamente na estrutura do sono<br>Introduction: Enuresis (NE) is a clinical condition of multifactorial etiology with intermittent nocturnal urine loss characteristic at night that leads to difficulties in child / adolescent social interaction. It can be affected by comorbidities and by immaturity of the central nervous system in the regulation of bladder function. The range of events of the bedwetting episode, from bladder filling until the involuntary triggering of bladder emptying during sleep, constitutes the main focus for clinical-laboratory and therapeutic approach. Objective: To study the impact of a multidisciplinary assessment of the patient with monosymptomatic nocturnal enuresis (MNE) on the therapeutic efficacy of the interventions traditionally used in its approach, and to compare, by polysomnography (PSG), the effects of intervention on sleep structure. Method: Prospective study of children, of 6 to 17 incomplete years, with MNE diagnosed by multidisciplinary assessment, based on: pediatric nephrology - oriented structured history, clinical examination, kidney and urinary tract ultrasound, laboratory tests of blood and urine and daily bladder and intestinal elimination diaries; neurological examination, sleep diary and sleep questionnaires and PSG; psychology evaluation using CBCL and PedsQL 4.0 questionnaires; physiotherapic evaluation of balance. The study was approved by the HCFMUSP Ethics Committee in Research of number 0649/10 and was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Grant # 2011/17589-1. Of the 140 children/adolescents entering the study, 58 (41.4%) were excluded because of non - treatable comorbidities and / or nonadherence to study protocol, 82/140 (58.6%) patients with MNE were included for therapeutic intervention in three treatment groups (alarm, desmopressin and alarm with desmopressin). The response to therapeutic intervention was evaluated in the immediate and late post-intervention period, respectively after six of treatment and after 12 months of posttreatment follow-up. Pre and post intervention PSG were compared to evaluate therapy impact on the structure of sleep. Results: Of 82 patients, 62 were male (75.6%) with mean age of 9.5 years (± 2.6). Family history of NE was diagnosed in 91.1% of first and second degree relatives, constipation in 81.7% and mild/moderate apnea in 40.7%. The physical therapy preintervention evaluation identified an alteration in the balance control of the MNE patients. In the pre-intervention phase, an association of prematurity with severity of enuresis (% of episodes/month) (p = 0.03) was identified. Enuresis cure was achieved, prior to randomization, after clinical approach to constipation and / or simple behavioral therapy, by 7/82 patients, 75 patients were randomized to treatment with three modes of intervention. During the intervention phase, a dropout rate of 14/75 (18.7%) patients was verified, especially in the alarm group (p = 0.00). Initial success (complete and partial response) was observed in 56.6% patients of the alarm group, 70% of the desmopressin group and 64% of the combined group (p = 0.26). Continued success (SC) occurred in 70% patients of the alarm group, 84.2% of desmopressin group and 100% of the combined group (p = 0.21). Recurrence occurred in 3/20 (15%) patients of the alarm group and 1/19 (5.2%) of desmopressin group. Therapeutic success was associated with a reduction in scores for behavioral problems and with improvement of patients\' quality of life scores. The comparative analysis between pre and post-intervention sleep structure parameters, in patients treated with and without alarm, showed increased arousals (p=0.00), decreased sleep efficiency (p = 0.02), decreased N2 (p = 0.00) in the alarm group. Conclusion: Enuresis is a multifactorial disorder that requires a structured diagnostic approach. In the present study, three therapeutic intervention methodologies demonstrated similar efficacy. The benefits associated with treatment success are multiple; the present study data suggest, however, that alarm therapy can have a negative effect on sleep structure

Dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic at Technikon Natal, 1996.<br>A few studies have been conducted to investigate the efficacy of chiropractic treatment for enuresis viz: Gemmel et al. (1989), Leboeuf et al. (1991), Blomerth (1994), Reed et al. (1994) and Kreitz et al. (1994). The only controlled study was done by Reed et al. (1994), and even though it did indicate promising results it was not conclusive. Therefore, more evidence is needed to verify the success of chiropractic treatment for enuresis, especially in terms of spinal adjustments.<br>M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Homoeopathy, Durban Institute of Technology, 2003.<br>The purpose of this randomised double blind study was to evaluate the efficacy of the homoeopathic complex (Cantharis vesicatoria 12CH, Equisetum hyemale 12CH, Sarsaparilla 12CH, Delphinium staphysagria 12CH, Uva ursi 12CH) in the treatment of nocturnal enuresis with regard to the number of wet nights per week. It focused on children between the ages offive and eighteen, residing at children's homes in the greater Durban area. It was hypothesised that the homoeopathic medication would reduce the weekly incidences of bed wetting and thus provide a, safe, viable and effective alternative to existing treatment options.<br>M

Since 1904 bedwetting alarms have been developed and scientifically described for the treatment of nocturnal enuresis, also known as bedwetting. Currently, several bedwetting alarms of various designs are available on the overseas market. These can be imported to South Africa at great cost. As affordable alarms were not readily available in South Africa, there was a need to develop and evaluate a new unit. In order to improve the efficacy of this new device, it was accompanied by detailed user guidelines and instructions. The use of this alarm was tested and the observations of thirteen bedwetting children recorded. Additionally, a programme was developed to counsel enuretic children with accompanying problems, and to assist the parents in dealing with their child's bedwetting problem. The observations and findings will be useful in practice and future research.<br>Psychology of Education<br>M. Ed. (Educational Psychology - Specialisation in Guidance and Counselling)

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Homoeopathy, Durban Institute of Technology, Durban, 2002.<br>This study was intended to evaluate the efficacy of homoeopathic similimum in the treatment of nocturnal enuresis. It was part of a group research project, which explored the effectiveness of a homoeopathic complex (Cantharis vesicatoris 12ch, Equisetum hyemnale 12ch, Sarsaparilla 12ch, Staphisagria 12ch, Uva ursi 12ch) as well as Ilex paraguayensis 6x in the treatment of the above-mentioned disorder. The sample group consisted of children between the ages of five and eighteen living in various children's homes in Durban. Nocturnal enuresis is categorised into primary and secondary types. Primary nocturnal enuresis is the failure to achieve consistent dryness, whereas secondary nocturnal enuresis is the return of nocturnal incontinence after an extended period. For the purpose of this study this distinction was largely ignored, as homoeopathic treatment is not reliant on a detailed diagnosis for its efficacy. The children were however screened for chronic urinary tract infections as well as neurological and systemic causes of nocturnal enuresis. Each child received a full physical examination as well as an extensive homoeopathic interview. The aim of this was to exclude any clear aetiology as well as to glean I the information necessary to establish the homoeopathic similimum. The sample size for this trial was 32 children; sixteen received similimum and formed the treatment group, and a further sixteen received placebo and formed.<br>M

Dissertation submitted in partial compliance with the requirements for the Master's degree in Technology: Homoeopathy, Durban Institute of Technology, Durban, 2003.<br>The purpose of this study was to evaluate the efficacy of lIex paraguensis 6x in the treatment of nocturnal enuresis. It was part of a group research project, which intended to explore the effectiveness of a homoeopathic complex (Cantharis vesicatoria 12ch, Equisetum hymenale 12ch, Sarsaparilla 12ch, Staphysagria 12ch, Uva ursi 12ch); as well as the homoeopathic simillimum in the treatment of the above-mentioned disorder. The research focuses on children between the ages of five and eighteen living in various children's homes in Durban. The incidence of nocturnal enuresis in these institutions is high and poses a real problem to both the institutions and the affected children. Nocturnal enuresis is categorised into primary and secondary enuresis. Primary nocturnal enuresis is defined as the failure to achieve dryness consistently and accounts for more than 90 percent of all cases of enuresis (Ullom-Minnich, 1996: 2259). Secondary enuresis refers to the return of incontinence after an extended period of dryness (Ullom-Minnoch, 1996: 2259). For the purpose of this study this distinction was largely ignored as homoeopathic treatment is not reliant on a detailed diagnosis for it's efficacy. The children were however screened for chronic urinary tract infections as well as other neurological and systemic causes e.g. diabetes mellitus. Each child received a full physical examination as well as a detailed homoeopathic case taking. The aim of the above was to exclude any clear aetiologies as well as to establish the homoeopathic simillimum. The sample comprised twenty-six children, five received placebo, and twenty-one received llex paraguensis. This study was part of a larger group research, which comprised of sixty-eight children divided into four groups. Three trial groups of fifteen, sixteen and twenty-one children each, and one placebo group of sixteen children i.e. the placebo group was shared. An observation period of two weeks with the completion of enuresis diaries was used as a baseline for statistical analysis. The following two weeks formed the treatment period with each child receiving a single powder each evening before bed. The remaining four weeks formed the post treatment observation period. Upon completion of the trial, placebo group children were offered free treatment and those who wished to continue with treatment were referred to the Homoeopathic Day Clinic. Results were analysed using descriptive and non-parametric statistical procedures. The average number of wet nights was used and the results analysed both within and across the groups. The Mann-Whitney U test was applied to the inter group comparison and the Wilcoxon's Signed Rank test was applied to the intra group comparison. No statistically significant improvement was noted in either the placebo or treatment group. There was also no statistically significant difference between the two groups. This indicated an absence of response to homoeopathic treatment with lIex paraguensis. This study failed to demonstrate any clinical improvement in symptoms of nocturnal enuresis. Possible wider psychodynamic improvements or clinical improvements over a longer time period were not measured in this study. Further research could be aimed to assess these areas, before final conclusions can be made about the efficacy of homeopathic lIex paraguensis in the management of nocturnal enuresis.<br>M