RESUMEN
OBJECTIVE: An early start of toilet training, which is related to a younger age of acquiring full bladder control, can generate important health advantages. Children display different 'elimination signals' related to voiding or defaecation. The aim of this systematic review is to map these 'elimination signals' in young, healthy children aged 0-4 years. METHOD: The systematic literature search was performed in two databases and was conducted using the preferred reporting items for systematic reviews and meta-analyses (PRISMA statement). RESULTS: Two main distinctions in elimination signals were made. The first could be classified as visual, auditory and tactile, most frequently involving a change in facial expression, often combined with body movements and verbal expressions such as a short cry or grunting. Secondly significant changes in heart rate, respiratory frequency or EEG frequency could be defined as 'clinically assessed elimination signals'. CONCLUSION: Different 'elimination signals' could be detected in healthy children while voiding or defaecating and should be observed when initiating toilet training. Detection of noticeable visual, auditory and tactile signals will facilitate and shorten this process.
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Control de Esfínteres , Micción , Niño , Preescolar , Bases de Datos Factuales , Humanos , Lactante , Recién NacidoRESUMEN
AIMS: The goals of this research were to investigate parents' perceptions of toilet training and their beliefs and views on how to toilet train children. METHODS: Questionnaires were provided to parents of healthy children, aged 18-72 months, who were or had just finished toilet training. There were 928 questionnaires returned (38% response rate). After correcting for age compliance with the range stated in the study, 832 parents remained. RESULTS: The data confirm a postponement of the age at which children start to potty train and the age at which they are toilet training. Fifty per cent (n=401) of the parents start because the child will soon be attending nursery school and only 27% (n=226) start toilet training because their child shows certain readiness signs. The latter group will significantly end toilet training sooner. Constipation is common and varies considerably in its severity, the complaint should not be ignored. No significant relationship between toilet training and the general family situation - parental status, working status or educational level - was found, suggesting that these factors do not have a significant impact. CONCLUSION: Proper education of parents in toilet training and readiness signs could reduce the uncertainties that exist. In that way, toilet training could be carried out more efficiently and at the right time for the child.
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Padres/psicología , Percepción , Control de Esfínteres , Adulto , Desarrollo Infantil , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Relaciones Padres-Hijo , Encuestas y CuestionariosRESUMEN
Objective: Hyperexcitability of the central nervous system plays an important role in the development and maintenance of chronic pain in adults. This knowledge has led to improved treatment strategies within this population. In children, however, research on the presence of central hyperexcitability is scarce. To further investigate this topic in children with chronic pain, there is a need for a clear literature overview. Design: Systematic review. Methods: The literature search was performed using the electronic databases PubMed and Web of Science. An article was considered eligible if it included children (age two to 12 years) diagnosed with chronic pain. Articles had to report original research outcomes related to central hyperexcitability, and a comparison with a healthy control group was necessary. Characteristics of the study sample, the assessment, and conclusions regarding central hyperexcitability were extracted from each included article. Results: Twelve case-control studies were included with moderate to good methodological quality (510 children with chronic pain and 670 healthy controls). After summarizing the articles' results on indices of central hyperexcitability, we concluded that secondary hyperalgesia might be present in children with recurrent abdominal pain, juvenile fibromyalgia, and juvenile idiopathic arthritis. Preliminary evidence exists for altered cortical nociceptive processing in children with migraine and recurrent abdominal pain. Conclusion: Based on the results of this review, central hyperexcitability might be present in in several pediatric chronic pain conditions. Further research on other manifestations of central hyperexcitability (e.g., bottom-up and top-down mechanisms and nociceptive brain changes) is necessary to provide firm evidence about its presence in children with chronic pain.
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Sensibilización del Sistema Nervioso Central/fisiología , Dolor Crónico/terapia , Fibromialgia/terapia , Hiperalgesia/tratamiento farmacológico , Dolor Abdominal/fisiopatología , Dolor Abdominal/terapia , Ansiedad/fisiopatología , Ansiedad/terapia , Niño , Preescolar , Femenino , Humanos , Hiperalgesia/diagnóstico , MasculinoRESUMEN
Toilet training in Western culture starts between 18 and 24 months. At this age, a child is assumed to have procured the competences needed for bladder control. Since the knowledge of reference values of a normal micturition serves as a guide to diagnose urologic pathology, the aim of this systematic review is to obtain a more comprehensive picture of normal voiding pattern in healthy infants, who have not yet reached bladder control. The systematic literature search was performed in two databases. This systematic review was conducted by the preferred reporting items for systematic reviews and meta-analyses (PRISMA statement). Twenty-one studies were selected that demonstrate factors associated with voiding pattern. Diuresis, interrupted voiding, post-void residual urine and voiding frequency are parameters decreasing with age. Bladder capacity, the lowest volume triggering micturition, flow rate, voiding volume and the level of awake voiding expand with age. CONCLUSION: When evaluating the voiding pattern in infants, the normal evaluation of micturition parameters in healthy normal developing infants must be taken into consideration. WHAT IS KNOWN: ⢠Different voiding parameters in healthy infants who are not yet toilet trained are reported. ⢠Voiding was believed to be induced by a constant bladder volume, while nowadays, it is detected that infants possess a functional spino-pontospinal voiding pathway. WHAT IS NEW: ⢠Arousal was detected in less than 60 % of all preterm micturitions, while it was present in more than 90 % of the micturitions of healthy "term" infants. ⢠Voided volume, bladder capacity, and flow rate tend to increase with age. In contrast, voiding frequency, post-void residual urine, and interrupted voiding diminishes with an increasing age.
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Recien Nacido Prematuro , Vejiga Urinaria/fisiología , Micción/fisiología , Humanos , Lactante , Recién Nacido , Valores de Referencia , Control de Esfínteres , VigiliaRESUMEN
PURPOSE: In the future, budget constraints will make efficient care for stroke patients more important. The cost of hospitalization for stroke is high. It is desirable to consider a patient's discharge destination soon after onset and thereby screen patients for further care. This study aims to review the evidence of factors that determine discharge destinations after acute phase of stroke in adult patients. METHODS: The systematic literature search was performed in seven databases. This systematic review was conducted by the preferred reporting items for systematic reviews and meta-analyses (PRISMA statement). Full-text articles were included and assessed for methodological quality by two independent researchers. RESULTS: Eighteen articles were selected that demonstrate factors defining discharge destination. Younger age, good post-stroke admission to a teaching hospital, and a number of medical factors are determinants to a favorable discharge destination. Determinants for unfavorable discharge destinations were a severe stroke, high body mass index, alcohol abuse, statin withdrawal during hospitalization, the presence of comorbidities like respiratory failure and dementia or having a Medicaid insurance. CONCLUSION: Patient initial medical care, age and sex, neurological and medical complications and environmental/socio-economic factors should be considered in the decision-making process for discharge destination.