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  • 1.
    Al-Mashhadi, Ammar
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Barnkirurgisk forskning.
    Häggman, Michael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Läckgren, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Barnkirurgisk forskning.
    Ladjevardi, Sam
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Urologkirurgi.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Pediatrisk inflammationsforskning.
    Stenberg, Arne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Barnkirurgisk forskning.
    Persson, A. Erik G.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Carlstrom, Mattias
    Karolinska Inst, Dept Physiol & Pharmacol, Stockholm, Sweden.
    Changes of arterial pressure following relief of obstruction in adults with hydronephrosis2018Inngår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 123, nr 4, s. 216-224Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: As much as 20% of all cases of hypertension are associated with kidney malfunctions. We have previously demonstrated in animals and in pediatric patients that hydronephrosis causes hypertension, which was attenuated by surgical relief of the ureteropelvic junction (UPJ) obstruction. This retrospective cohort study aimed to investigate: (1) the proposed link between hydronephrosis, due to UPJ obstruction, and elevated arterial pressure in adults; and (2) if elevated blood pressure in patients with hydronephrosis might be another indication for surgery.

    Materials and methods: Medical records of 212 patients undergoing surgical management of hydronephrosis, due to UPJ obstruction, between 2000 and 2016 were assessed. After excluding patients with confounding conditions and treatments, paired arterial pressures (i.e. before/after surgery) were compared in 49 patients (35 years old; 95% CI 29–39). Split renal function was evaluated by using mercaptoacetyltriglycine (MAG3) renography before surgical management of the hydronephrotic kidney.

    Results: Systolic (−11 mmHg; 95% CI 6–15 mmHg), diastolic (−8 mmHg; 95% CI 4–11 mmHg), and mean arterial (-9 mmHg; 95% CI 6–12) pressures were significantly reduced after relief of the obstruction (p < 0.001). Split renal function of the hydronephrotic kidney was 39% (95% CI 37–41). No correlations were found between MAG3 and blood pressure level before surgery or between MAG3 and the reduction of blood pressure after surgical management of the UPJ obstruction.

    Conclusions: In adults with hydronephrosis, blood pressure was reduced following relief of the obstruction. Our findings suggest that elevated arterial pressure should be taken into account as an indication to surgically correct hydronephrosis.

  • 2.
    Al-Mashhadi, Ammar Nadhom Farman
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Barnkirurgi.
    Checa, Antonio
    Karolinska Institute.
    Wåhlin, Nils
    Karolinska Institute.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Pediatrisk inflammationsforskning.
    Fossum, Magdalena
    Karolinska institute.
    Wheelock, Craig E.
    Karolinska Institute.
    Karanikas, Birgitta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Barnkirurgi.
    Stenberg, Arne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Barnkirurgi.
    Persson, A. Erik G.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Carlström, Mattias
    Karolinska Institute.
    Changes in arterial pressure and markers of nitric oxide homeostasis and oxidative stress following surgical correction of hydronephrosis in children2018Inngår i: Pediatric nephrology (Berlin, West), ISSN 0931-041X, E-ISSN 1432-198X, Vol. 33, nr 4, s. 639-649Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective Recent clinical studies have suggested an increased risk of elevated arterial pressure in patients with hydronephrosis. Animals with experimentally induced hydronephrosis develop hypertension, which is correlated to the degree of obstruction and increased oxidative stress. In this prospective study we investigated changes in arterial pressure, oxidative stress, and nitric oxide (NO) homeostasis following correction of hydronephrosis.

    Methods Ambulatory arterial pressure (24 h) was monitored in pediatric patients with hydronephrosis (n = 15) before and after surgical correction, and the measurements were compared with arterial pressure measurements in two control groups, i.e. healthy controls (n = 8) and operated controls (n = 8). Markers of oxidative stress and NO homeostasis were analyzed in matched urine and plasma samples.

    Results The preoperative mean arterial pressure was significantly higher in hydronephrotic patients [83 mmHg; 95% confidence interval (CI) 80–88 mmHg] than in healthy controls (74 mmHg; 95% CI 68–80 mmHg; p < 0.05), and surgical correction of ureteral obstruction reduced arterial pressure (76 mmHg; 95% CI 74–79 mmHg; p < 0.05). Markers of oxidative stress (i.e., 11- dehydroTXB2, PGF2α, 8-iso-PGF2α, 8,12-iso-iPF2α-VI) were significantly increased (p < 0.05) in patients with hydronephrosis compared with both control groups, and these were reduced following surgery (p < 0.05). Interestingly, there was a trend for increased NO synthase activity and signaling in hydronephrosis, which may indicate compensatory mechanism(s).

    Conclusion This study demonstrates increased arterial pressure and oxidative stress in children with hydronephrosis compared with healthy controls, which can be restored to normal levels by surgical correction of the obstruction. Once reference data on ambulatory blood pressure in this young age group become available, we hope cut-off values can be defined for deciding whether or not to correct hydronephrosis surgically.

    Keywords Blood pressure . Hydronephrosis . Hypertension . Nitric oxide . Oxidative stress . Ureteral obstruction 

  • 3.
    Al-Mashhadi, Ammar Nadhom Farman
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Stenberg, Arne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Karanikas, Birgitta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Persson, A. Erik G.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Carlstrom, Mattias
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Wahlin, Nils
    Department of Pediatric Surgery, Astrid Lindgren Hospital, Karolinska Institutet, Stockholm, Sweden.
    Surgical treatment reduces blood pressure in children with unilateral congenital hydronephrosis2015Inngår i: Journal of Pediatric Urology, ISSN 1477-5131, E-ISSN 1873-4898, Vol. 11, nr 2, s. 91.e1-91.e6Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective Renal disorders can cause hypertension, but less is known about the influence of hydronephrosis on blood pressure. Hydronephrosis due to pelvo-ureteric junction obstruction (PUJO) is a fairly common condition (incidence in newborns of 0.5-1%). Although hypertensive effects of hydronephrosis have been suggested, this has not been substantiated by prospective studies in humans [1-3]. Experimental studies with PUJO have shown that animals with induced hydronephrosis develop salt-sensitive hypertension, which strongly correlate to the degree of obstruction [4-7]. Moreover, relief of the obstruction normalized blood pressure [8]. In this first prospective study our aim was to study the blood pressure pattern in pediatric patients with hydronephrosis before and after surgical correction of the ureteral obstruction. Specifically, we investigated if preoperative blood pressure is reduced after surgery and if split renal function and renographic excretion curves provide any prognostic information. Patients and methods Twelve patients with unilateral congenital hydronephrosis were included in this prospective study. Ambulatory blood pressure (24 h) was measured preoperatively and six months after surgery. Preoperative evaluations of bilateral renal function by Tc99m-MAG3 scintigraphy, and renography curves, classified according to O'Reilly, were also performed. Results As shown in the summary figure, postoperative systolic (103 +/- 2 mmHg) and diastolic (62 +/- 2 mmHg) blood pressure were significantly lower than those obtained preoperatively (110 +/- 4 and 69 +/- 2 mmHg, respectively), whereas no changes in circadian variation or pulse pressure were observed. Renal functional share of the hydronephrotic kidney ranged from 11 to 55%. There was no correlation between the degree of renal function impairment and the preoperative excretory pattern, or between the preoperative excretory pattern and the blood pressure reduction postoperatively. However, preoperative MAG3 function of the affected kidney correlated with the magnitude of blood pressure change after surgery. Discussion Correction of the obstruction lowered blood pressure, and the reduction in blood pressure appeared to correlate with the degree of renal functional impairment, but not with the excretory pattern. Thus, in the setting of hypertension, it appears that the functional share of the hydronephrotic kidney should be considered an indicator of the need for surgery, whereas the renography curve is less reliable. The strength of the present study is the prospective nature and that ambulatory blood pressure monitoring was used. Future longitudinal prolonged follow-up studies are warranted to confirm the present findings, and to understand if a real nephrogenic hypertension with potential necessity of treatment will develop. Conclusion This novel prospective study in patients with congenital hydronephrosis demonstrates a reduction in blood pressure following relief of the obstruction. Based on the present results, we propose that the blood pressure level should also be taken into account when deciding whether to correct hydronephrosis surgically or not.

  • 4.
    Austin, Paul F.
    et al.
    Washington Univ, St Louis Childrens Hosp, Div Urol, St Louis, MO 63110 USA..
    Bauer, Stuart B.
    Harvard Univ, Childrens Hosp, Sch Med, Dept Urol, Boston, MA 02115 USA..
    Bower, Wendy
    Skejby Univ Hosp, Pediat Nephrol Sect, Aarhus, Denmark..
    Chase, Janet
    Cabrini Hosp, Childrens Ctr, Melbourne, Vic, Australia..
    Franco, Israel
    New York Med Coll, Valhalla, NY 10595 USA..
    Hoebeke, Piet
    Ghent Univ Hosp, Pediat Urol & Nephrol, Ghent, Belgium..
    Rittig, Soren
    Skejby Univ Hosp, Pediat Nephrol Sect, Aarhus, Denmark..
    Vande Walle, Johan
    Ghent Univ Hosp, Pediat Urol & Nephrol, Ghent, Belgium..
    von Gontard, Alexander
    Saarland Univ Hosp, Dept Child & Adolescent Psychiat, Saarbrucken, Germany..
    Wright, Anne
    St Thomas Hosp, Evelina Childrens Hosp, Pediat, London, England..
    Yang, Stephen S.
    Buddhist Med Fdn, Taipei Tzu Chi Hosp, Div Urol, New Taipei, Taiwan.;Buddhist Tzu Chi Univ, Sch Med, Hualien, Taiwan..
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the standardization committee of the International Children's Continence Society2016Inngår i: Neurourology and Urodynamics, ISSN 0733-2467, E-ISSN 1520-6777, Vol. 35, nr 4, s. 471-481Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AimThe impact of the original International Children's Continence Society (ICCS) terminology document on lower urinary tract (LUT) function resulted in the global establishment of uniformity and clarity in the characterization of LUT function and dysfunction in children across multiple healthcare disciplines. The present document serves as a stand-alone terminology update reflecting refinement and current advancement of knowledge on pediatric LUT function. MethodsA variety of worldwide experts from multiple disciplines within the ICCS leadership who care for children with LUT dysfunction were assembled as part of the standardization committee. A critical review of the previous ICCS terminology document and the current literature was performed. Additionally, contributions and feedback from the multidisciplinary ICCS membership were solicited. ResultsFollowing a review of the literature over the last 7 years, the ICCS experts assembled a new terminology document reflecting current understanding of bladder function and LUT dysfunction in children using the resources from the literature review, expert opinion and ICCS member feedback. ConclusionsThe present ICCS terminology document provides a current and consensus update to the evolving terminology and understanding of LUT function in children.

  • 5.
    Austin, Paul F
    et al.
    Division of Urology, Washington University in St. Louis, St. Louis Children’s Hospital, Missouri.
    Bauer, Stuart B
    Department of Urology, Children’s Hospital and Harvard Medical School, Boston, Massachusetts.
    Bower, Wendy
    Pediatrics (Nephrology Section), Skejby University Hospital, Aarhus, Denmark.
    Chase, Janet
    The Children’s Centre, Cabrini Hospital, Melbourne, Australia.
    Franco, Israel
    New York Medical College, Valhalla, New York.
    Hoebeke, Piet
    Pediatric Urology and Nephrology, Gent University Hospital, Ghent, Belgium.
    Rittig, Søren
    Pediatrics (Nephrology Section), Skejby University Hospital, Aarhus, Denmark.
    Walle, Johan Vande
    Pediatric Urology and Nephrology, Gent University Hospital, Ghent, Belgium.
    von Gontard, Alexander
    Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany.
    Wright, Anne
    Pediatrics, Evelina Children’s Hospital, St Thomas’ Hospital, London, England.
    Yang, Stephen S
    Division of Urology, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    The Standardization of Terminology of Lower Urinary Tract Function in Children and Adolescents: Update Report from the Standardization Committee of the International Children's Continence Society.2014Inngår i: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 191, nr 6, s. 1863-1865Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: The impact of the original International Children's Continence Society (ICCS) terminology document on lower urinary tract (LUT) function resulted in the global establishment of uniformity and clarity in the characterization of LUT function and dysfunction in children across multiple healthcare disciplines. The present document serves as a stand-alone terminology update reflecting refinement and current advancement of knowledge on pediatric LUT function.

    MATERIALS AND METHODS: A variety of worldwide experts from multiple disciplines within the ICCS leadership who care for children with LUT dysfunction were assembled as part of the standardization committee. A critical review of the previous ICCS terminology document and the current literature was performed. Additionally, contributions and feedback from the multidisciplinary ICCS membership were solicited.

    RESULTS: Following a review of the literature over the last 7 years, the ICCS experts assembled a new terminology document reflecting current understanding of bladder function and LUT dysfunction in children using the resources from the literature review, expert opinion and ICCS member feedback.

    CONCLUSIONS: The present ICCS terminology document provides a current and consensus update to the evolving terminology and understanding of LUT function in children.

  • 6. Bader, G
    et al.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Kruse, S
    Sillen, U
    Sleep of primary enuretic children and controls.2002Inngår i: Sleep, Vol. 25, s. 579-Artikkel i tidsskrift (Fagfellevurdert)
  • 7. Bauer, Stuart
    et al.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    von Gontard, Alexander
    Hoebeke, Piet
    Bower, Wendy
    Jørgensen, Troels Munch
    Rittig, Søren
    Vande Walle, Johan
    Yeung, C K
    Djurhuus, Jens Christian
    Standardizing terminology in pediatric urology2007Inngår i: Journal of Pediatric Urology, ISSN 1477-5131, E-ISSN 1873-4898, Vol. 3, nr 2, s. 163-163Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 8.
    Bazargani, Farhan
    et al.
    Senior Consultant, Postgraduate Dental Education Center, Department of Orthodontics, Örebro, Sweden.
    Ring, Ingrid Jönson
    Senior Consultant, Public Dental Service, Uppsala County Council, Department of Orthodontics, Uppsala, Sweden.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Rapid maxillary expansion in therapy-resistant enuretic children: An orthodontic perspective.2016Inngår i: Angle orthodontist, ISSN 0003-3219, E-ISSN 1945-7103, Vol. 86, nr 3, s. 481-486Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE:   To evaluate whether rapid maxillary expansion (RME) could reduce the frequency of nocturnal enuresis (NE) in children and whether a placebo effect could be ruled out.

    METHODS:   Thirty-four subjects, 29 boys and five girls with mean age of 10.7 ± 1.8 years suffering from primary NE, were recruited. All subjects were nonresponders to the first-line antienuretic treatment and therefore were classified as "therapy resistant." To rule out a placebo effect of the RME appliance, all children were first treated with a passive appliance for 4 weeks. Rhinomanometry (RM), acoustic rhinometry (AR), polysomnographic registration, and study casts were made at different time points.

    RESULTS:   One child experienced severe discomfort from the RME appliance and immediately withdrew from the study. Following RME, the long-term cure rate after 1 year was 60%. The RM and AR measurements at baseline and directly after RME showed a significant increase in nasal volume and nasal airflow, and there was a statistically significant correlation between reduction in enuresis and increase in nasal volume. Six months postretention, a 100% relapse of the dental overexpansion could be noted.

    CONCLUSIONS:   RME has a curative effect in some children with NE, which could be connected to the positive influence of RME on the sleep architecture. Normal transverse occlusion does not seem to be a contraindication for moderate maxillary expansion in attempts to cure NE in children.

  • 9.
    Brandstrom, Per
    et al.
    Gothenburg Univ, Sahlgrenska Acad, Queen Silvia Childrens Hosp, Dept Pediat, Gothenburg, Sweden..
    Storby, Kerstin Abelson
    Cent Hosp Vaxjo, Dept Pediat, Vaxjo, Sweden..
    Bekassy, Zivile
    Lund Univ, Dept Pediat, Clin Sci Lund, Lund, Sweden..
    Herthelius, Maria
    Karolinska Inst, Div Paediat, Clintec Dept, Stockholm, Sweden..
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Rundqvist, Simon
    Cty Hosp Ryhov, Dept Pediat, Jonkoping, Sweden..
    Swerkersson, Svante
    Gothenburg Univ, Sahlgrenska Acad, Queen Silvia Childrens Hosp, Dept Pediat, Gothenburg, Sweden..
    WennerstrOm, Martin
    Gothenburg Univ, Sahlgrenska Acad, Queen Silvia Childrens Hosp, Dept Pediat, Gothenburg, Sweden..
    Hansson, Sverker
    Gothenburg Univ, Sahlgrenska Acad, Queen Silvia Childrens Hosp, Dept Pediat, Gothenburg, Sweden..
    Swedish UTI Guidelines2015Inngår i: Pediatric nephrology (Berlin, West), ISSN 0931-041X, E-ISSN 1432-198X, Vol. 30, nr 9, s. 1574-1575Artikkel i tidsskrift (Annet vitenskapelig)
  • 10.
    Brandström, Per
    et al.
    Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden.
    Esbjörner, Elisabeth
    Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Herthelius, Maria
    Department for Clinical Science, Intervention and Technology, Karolinska University Hospital, Huddinge, Sweden.
    Holmdahl, Gundela
    Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden.
    Läckgren, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Sillén, Ulla
    Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden.
    Sixt, Rune
    Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden.
    Sjöberg, Ingrid
    Department of Pediatrics, Children's University Hospital, Lund, Sweden.
    Stokland, Eira
    Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden.
    Jodal, Ulf
    Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden.
    Hansson, Sverker
    Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden.
    The Swedish reflux trial in children: I. Study design and study population characteristics2010Inngår i: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 184, nr 1, s. 274-279Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: We compared the rates of febrile urinary tract infection, kidney damage and reflux resolution in children with vesicoureteral reflux treated in 3 ways, including antibiotic prophylaxis, endoscopic therapy and surveillance with antibiotics only for symptomatic urinary tract infection. MATERIALS AND METHODS: Children 1 to younger than 2 years with grade III-IV reflux were recruited into this prospective, open, randomized, controlled, multicenter study and followed for 2 years after randomization. The main study end points were recurrent febrile urinary tract infection, renal status on dimercapto-succinic acid scintigraphy and reflux status. Outcomes were analyzed by the intent to treat principle. RESULTS: During a 6-year period 128 girls and 75 boys entered the study. In 96% of cases reflux was detected after urinary tract infection. The randomization procedure was successful and resulted in 3 groups matched for relevant factors. Recruitment was slower than anticipated but after patients were entered adherence to the protocol was good. Of the children 93% were followed for the intended 2 years without a treatment arm change. All except 2 patients completed 2-year followup scintigraphy. CONCLUSIONS: Recruitment was difficult but a substantial number of children were entered and randomly assigned to 3 groups with similar basic characteristics. Good adherence to the protocol made it possible to address the central study questions.

  • 11.
    Brandström, Per
    et al.
    Pediatric Uro-Nephrologic Center, The Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Sixt, Rune
    Pediatric Uro-Nephrologic Center, The Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden.
    Stokland, Eira
    Pediatric Uro-Nephrologic Center, The Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden.
    Jodal, Ulf
    Pediatric Uro-Nephrologic Center, The Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden.
    Hansson, Sverker
    Pediatric Uro-Nephrologic Center, The Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden.
    The Swedish reflux trial in children: IV. Renal damage2010Inngår i: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 184, nr 1, s. 292-297Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: We compared the development of new renal damage in small children with dilating vesicoureteral reflux randomly allocated to antibiotic prophylaxis, endoscopic treatment or surveillance as the control group. MATERIALS AND METHODS: Included in the study were 128 girls and 75 boys 1 to younger than 2 years with grade III-IV reflux. Voiding cystourethrography and dimercapto-succinic acid scintigraphy were done before randomization and after 2 years. Febrile urinary tract infections were recorded during followup. Data analysis was done by the intent to treat principle. RESULTS: New renal damage in a previously unscarred area was seen in 13 girls and 2 boys. Eight of the 13 girls were on surveillance, 5 received endoscopic therapy and none were on prophylaxis (p = 0.0155). New damage was more common in children with than without febrile recurrence (11 of 49 or 22% vs 4 of 152 or 3%, p <0.0001). CONCLUSIONS: In boys the rate of new renal damage was low. It was significantly higher in girls and most common in the control surveillance group. There was also a strong association between recurrent febrile UTIs and new renal damage in girls.

  • 12.
    Cederblad, Maria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Ahman, Annika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Österlund Efraimsson, E.
    School of Health and Social Studies, Dalarna University, Falun, Sweden.
    Sarkadi, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    "Nobody Asked Us if We Needed Help": Swedish parents experiences of enuresis2014Inngår i: Journal of Pediatric Urology, ISSN 1477-5131, E-ISSN 1873-4898, Vol. 10, nr 1, s. 74-79Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To explore the everyday dilemmas of parents living with a child with nocturnal enuresis and to describe their support needs in relation to healthcare professionals.

    SUBJECTS AND METHODS: The study was conducted in 2011 in Uppsala County, Sweden. Parents of 13 children with enuresis, 10 mothers and three fathers, participated in qualitative semi-structured in-depth interviews, which were analysed using systematic text condensation.

    RESULTS: The analysis of the material resulted in six themes: enuresis is socially stigmatising and handicapping; all practices and home remedies are tested; it creates frustration in the family; protecting the child from gossip or teasing; support from healthcare providers would have helped; it's something we just have to live with. Two patterns of coping were identified: the Unworried wet-bed-fixers and the Anxious night-launderers.

    CONCLUSION: Having a child with enuresis can be stressful for parents, although they tried hard not to blame their child. Because parents can feel reluctant to bring up enuresis themselves, they want child health nurses to routinely raise the issue of bedwetting at the yearly check-up. Parents' information needs included causes of and available treatment options for enuresis as well as access to aids and other support for affected families.

  • 13.
    Cederblad, Maria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Sarkadi, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Engvall, Gunn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Infrequent enuresis, the uninvestigated majority: comparisons between children with enuresis of varying severity.2015Inngår i: Journal of Pediatric Urology, ISSN 1477-5131, E-ISSN 1873-4898, Vol. 11, nr 1, s. 24.e1-24.e6Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: The main objective was to compare children with frequent enuresis (FE) and children with infrequent enuresis (IE) using anamnestic data and variables related to bladder and kidney function. A secondary aim was to look at the group of children who wet their beds every single night, a phenomenon we chose to call constant enuresis (CE).

    SUBJECTS AND METHODS: The parents recorded the number of wet and dry nights for a period of 14 days, and measured the voided volumes as well as nocturnal urine production for 48 h. History data relevant to bladder and bowel function was also recorded.

    RESULTS: The children could be grouped as follows: IE, n = 14; FE, n = 18; and CE, n = 22. The children with IE were slightly older than the other groups, IE mean 7.57; FE mean 6.22; CE, mean 6.56 (p = 0.004). When comparing the groups in terms of the measured parameters, only one significant difference was found: the FE group had larger average daytime voided volumes, but only when the first morning void was included. The only significantly differing anamnestic variable was previous daytime incontinence, which was more common among the children in the IE group.

    CONCLUSIONS: When comparing children with varying enuresis severity, no major differences regarding bladder function and urine production were found. Furthermore, children with infrequent enuresis tend to be slightly older when they seek medical help.

  • 14.
    Cederblad, Maria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Sarkadi, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Engvall, Gunn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    No effect of basic bladder advice in enuresis: a randomised controlled trial2015Inngår i: Journal of Pediatric Urology, ISSN 1477-5131, E-ISSN 1873-4898, Vol. 11, nr 3, artikkel-id 153.e1Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    There are two firstline, evidence-based treatments available for nocturnal enuresis: desmopressin and the enuresis alarm. Prior to use of these therapies, international experts usually recommend that the children also be given basic bladder training during the daytime. The rationale behind this recommendation is that daytime bladder training or urotherapy, is a mainstay in the treatment of daytime incontinence caused by detrusor overactivity. Still, there is, as yet, no firm evidence that daytime bladder training is useful against nocturnal enuresis.

    Aim

    To explore whether basic bladder advice has any effect against nocturnal enuresis.

    Study design

    The study was prospective, randomized, and controlled. The evaluated intervention was bladder advice, given in accordance with ICCS guidelines and focused on regular voiding, sound voiding posture, and sufficient fluid intake. Forty children aged 6 years or more with previously untreated enuresis, but no daytime incontinence, were randomized (20 in each group) to receive either first basic bladder advice for 1 month and then alarm therapy (group A) or just the alarm therapy (group B). Based on power calculations, the minimum number of children required in each treatment arm was 15.

    Results

    The basic bladder advice did not reduce the enuresis frequency in group A (p = 0.089) and the end result after alarm therapy did not differ between the two groups (p = 0.74) (see Table). Only four children in group A had a partial or full response to bladder training, and two of these children relapsed immediately during alarm therapy.

    Discussion

    This was the first study to evaluate, in a prospective, randomized manner, the value of daytime basic bladder training as a treatment of enuresis. It was found that the treatment neither resulted in a significant reduction in the number of wet nights, nor did it improve the success of subsequent alarm therapy.

    Conclusions

    The recommendation that all children with enuresis be given bladder training as a firstline therapy can no longer be supported. Instead, we recommend that treatment of these children start with the enuresis alarm or desmopressin without delay.

  • 15.
    Frisk, Per
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Arvidson, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Glomerular and tubular function in young adults treated with stem-cell transplantation in childhood2010Inngår i: Pediatric nephrology (Berlin, West), ISSN 0931-041X, E-ISSN 1432-198X, Vol. 25, nr 7, s. 1337-1342Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We evaluated renal function at a median follow-up of 18 (range 10.3-22.1) years after total body irradiation in 18 patients treated with stem-cell transplantation (SCT) (autologous SCT in 15 and allogeneic SCT in three) for hematologic malignancies and compared them with 18 healthy controls. No patient had chronic graft-versus-host disease. We found no difference in glomerular filtration rate estimated from cystatin C (105 vs 111 ml/min/1.73 m(2), p = 0.28). Patients had higher albumin excretion (0.8 vs 0.4 mg/mmol, p = 0.001), but no patient had overt albuminuria (>200 mg/L). Patients had higher diastolic blood pressure (74 vs 67 mmHg, p = 0.003). Two patients (11%) had hypertension. Patients had lower tubular reabsorption of phosphate (0.78 vs 0.91 mmol/L, p = 0.014) and higher excretion of alpha-1-microglobulin (AMG/urine creatinine, 0.4 vs 0.25 mg/mmol, p = 0.038), which correlated with time after SCT (r = 0.6, p = 0.01). We found no difference in fractional excretion (FE) of other electrolytes, amino acid excretion, or urine osmolality. We conclude that renal function was relatively well preserved at a median follow-up of 18 years after childhood SCT. The higher albumin excretion in our patients is of concern, as is the association between excretion of AMG and time after SCT, suggesting that both glomerular and tubular function may deteriorate further.

  • 16. Gepertz, Simon
    et al.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Imipramine for therapy resistant enuresis: a retrospective evaluation.2004Inngår i: J Urol, ISSN 0022-5347, Vol. 171, nr 6 Pt 2, s. 2607-10; discussion 2609Artikkel i tidsskrift (Annet vitenskapelig)
  • 17.
    Grandahl, Maria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning.
    Larsson, Margareta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning.
    Dalianis, Tina
    Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Stenhammar, Christina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Tydén, Tanja
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning.
    Westerling, Ragnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicinsk epidemiologi.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Pediatrisk inflammationsforskning.
    Catch-up HPV vaccination status of adolescents in relation to socioeconomic factors, individual beliefs and sexual behaviour2017Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, nr 11, artikkel-id e0187193Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In 2012, human papillomavirus (HPV) vaccination was introduced free of charge in the Swedish national school-based vaccination programme for 10-12-year-old girls, and as catch-up vaccination for young women. In Sweden, there is an ongoing discussion about including boys in the national vaccination programme. Few studies are undertaken about adolescents' knowledge, beliefs and HPV vaccination status in relation to socioeconomic status and sexual experience. Thus, the aim was to examine HPV catch-up vaccination status in adolescents in relation to 1) socioeconomic factors, 2) beliefs and knowledge about HPV prevention, and 3) sexual behaviour. The Health Belief Model was used as a theoretical framework. Upper secondary school students (n = 832) aged 16, randomly chosen from a larger sample, were invited to participate in conjunction with the general health interview with the school nurse. A total of 751/832 (90.3%), girls (n = 391, 52%) and boys (n = 360, 48%) completed the questionnaire. HPV vaccination was associated with ethnicity and the mothers' education level; i.e. girls with a non-European background and girls with a less educated mother were less likely to have received the vaccine (p<0.01 and p = 0.04 respectively). Vaccinated girls perceived HPV infection as more severe (p = 0.01), had more insight into women's susceptibility to the infection (p = 0.02), perceived more benefits of the vaccine as protection against cervical cancer (p<0.01) and had a higher intention to engage in HPV-preventive behaviour (p = 0.01). Furthermore, boys and girls were almost equally sexually experienced, although fewer girls had used condom during first intercourse with their latest partner (p = 0.03). Finally, HPV vaccinated girls were less likely to have unprotected sex (p<0.01). In summary, catch-up HPV vaccination among young girls was associated with a European background and high maternal education level, as well as more favourable beliefs towards HPV prevention and less sexual risk-taking. Further preventive measures should therefore be directed at the migrant population.

  • 18.
    Grandahl, Maria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Dalianis, Tina
    Larsson, Margareta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Tydén, Tanja
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Stenhammar, Christina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    ‘I also want to be vaccinated!’ –: adolescent boys’ awareness and thoughts, perceived benefits, information sources, and intention to be vaccinated against Human papillomavirus (HPV)2018Inngår i: Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study investigates boys' awareness and thoughts about human papillomavirus (HPV) and HPV vaccination, perceived benefits of vaccinating men, information sources and intention to be vaccinated against HPV. We used a qualitative approach and interviews were conducted with 31 upper secondary school male students. Two main themes 1) Promotion of equal health and 2) Increased knowledge facilitates the decision about HPV vaccination emerged from the analysis. The informants believed that it was important and fair to protect boys and girls equally against HPV. If HPV vaccination could prevent both girls and boys against an HPV-related disease, there was nothing to question or to discuss. It was not a matter of sex; it was a matter of equal rights. Moreover, an important reason for vaccinating boys was to prevent the transmission of the virus. However, the boys felt unsure and stated that they needed to know more. The school nurse and the school health were considered suitable both for distributing information and for providing the vaccinations. In conclusion, the participants were in favor of introducing HPV vaccination also for boys in the national vaccination program. Sex-neutral HPV vaccinations were viewed both as a way to stop the virus transmission and a means to promote equal health for the entire population.

  • 19.
    Grandahl, Maria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Oscarsson, Marie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap. Linnéuniversitetet.
    Stenhammar, Christina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Westerling, Ragnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Tydén, Tanja
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Not the right time: why parents refuse to let their daughters have the human papillomavirus vaccination2014Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, nr 4, s. 436-441Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: To explore why parents refused to allow their 10- to 12-year-old daughters to receive the human papillomavirus (HPV) vaccination from the Swedish school-based vaccination programme.

    Methods: Individual interviews with 25 parents who had been offered, but not consented to, their daughters receiving the HPV vaccination.

    Results: Five themes emerged through the interviews: 1) she is just a little girl, 2) inadequate information, 3) not compatible with our way of life, 4) scepticism about the vaccination and 5) who can you trust? The parents made their decisions with their child’s best interests in mind. This was not considered the right time, and the vaccine as perceived as unnecessary and different from other vaccines. Mistrust in Government recommendations and a lack of evidence or information were other reasons to decline.

    Conclusion: The decision-making process was complex. These parents preferred to wait until their daughter was older and believed the information they received from the school health system was insufficient. The results indicate that a more flexible HPV vaccination schedule may improve vaccine uptake. This includes more transparent information about the virus and the vaccine and information about who to contact to get the daughter vaccinated at a later date.

  • 20.
    Grandahl, Maria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Tydén, Tanja
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Rosenblad, Andreas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Oscarsson, Marie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Stenhammar, Christina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    School nurses’ attitudes and experiences regarding the human papillomavirus vaccination programme in Sweden: a population-based survey2014Inngår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, nr 540, s. 1-9Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Sweden introduced a school-based human papillomavirus (HPV) vaccination programme in 2012, andschool nurses are responsible for managing the vaccinations. The aim of the present study was to investigate theattitudes and experiences of school nurses regarding the school-based HPV vaccination programme 1 year after itsimplementation.Methods: Data were collected using a web-based questionnaire in the spring of 2013, and 83.1% (851/1024) ofnurses responded.Results: There were strong associations between the nurses’ education about the HPV vaccine and their perceivedknowledge about the vaccine and a favourable attitude towards vaccination (both p < 0.001). School nurses whoreceived a high level of education were more likely to have a positive attitude to HPV vaccination compared withnurses with little education about HPV vaccination (adjusted odds ratio [OR] = 9.8; 95% confidence interval [CI]:3.797–25.132). Nurses with high perceived knowledge were more likely to have a positive attitude compared withthose with a low level of perceived knowledge (OR = 2.5; 95% CI: 1.299–4.955). If financial support from thegovernment was used to fund an additional school nurse, nurses were more likely to have a positive attitude thanif the financial support was not used to cover the extra expenses incurred by the HPV vaccination (OR = 2.1; 95% CI:1.051–4.010). The majority, 648 (76.1%), had been contacted by parents with questions about the vaccine, mostlyrelated to adverse effects. In addition, 570 (66.9%) stated that they had experienced difficulties with thevaccinations, and 337 (59.1%) of these considered the task to be time-consuming.Conclusions: A high level of education and perceived good knowledge about HPV are associated with a positiveattitude of school nurses to the HPV vaccination programme. Thus, nurses require adequate knowledge, education,skills and time to address the questions and concerns of parents, as well as providing information about HPV.Strategic financial support is required because HPV vaccination is a complex and time-consuming task.

  • 21.
    Grandahl, Maria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Tydén, Tanja
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Westerling, Ragnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Rosenblad, Andreas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Hedin, Erik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Oscarsson, Marie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap. Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden..
    To Consent or Decline HPV Vaccination: A Pilot Study at the Start of the National School-Based Vaccination Program in Sweden2017Inngår i: Journal of School Health, ISSN 0022-4391, E-ISSN 1746-1561, Vol. 87, nr 1, s. 62-70Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    Parents' beliefs about human papillomavirus (HPV) vaccination influence whether they allow their daughters to be vaccinated. We examined the association between parents' refusal and sociodemographic background, knowledge and beliefs about HPV, and the HPV vaccination in relation to the Health Belief Model.

    METHODS:

    The sample consisted of 200 (55%) parents of children aged 11-12 years in the Swedish national vaccination program. Data were collected using a self-reported questionnaire. Most parents (N = 186) agreed to the vaccination. Pearson's chi-square, Fisher's exact test, and the Mann-Whitney U test were used to analyze data.

    RESULTS:

    Declining parents saw more risks and fewer benefits of HPV vaccination but no differences in beliefs regarding the severity or young girls' susceptibility to HPV were found. There was an association between refusing the HPV vaccine and lower acceptance of previous childhood vaccinations, and their main source of information was the Internet. Parents who declined the vaccine believed it could adversely affect condom use, the age of their daughter's sexual debut, and the number of sexual partners.

    CONCLUSION:

    Parents should have the possibility to discuss HPV and HPV vaccine with a school nurse or other health care professionals, and should have access to evidence-based information on the Internet.

  • 22.
    Jansson, Emil
    et al.
    Avesta Hosp, Dept Internal Med, Avesta, Sweden.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Pediatrisk inflammationsforskning.
    Rectal diameter assessment in enuretic children-exploring the association between constipation and bladder function2018Inngår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 123, nr 3, s. 179-182Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: Detrusor overactivity and constipation often co-exist in children with enuresis. Constipation is known to be linked to detrusor overactivity. The voiding chart is the best non-invasive way to investigate bladder function, whereas the ultrasonographical detection of rectal dilatation is the best way to objectify constipation. We wanted to investigate a possible relationship between the rectal diameter and voiding chart data in enuretic children.

    Methods: Children with therapy-resistant enuresis were retrospectively evaluated. All had completed a voiding chart for at least 48 h. The rectal diameter was assessed ultrasonographically. The cutoff for rectal dilatation was set at 30 mm.

    Results: We evaluated 74 patients (12 girls) aged 10.2 +/- 2.8years, 35 of whom had rectal dilatation. No significant differences in voiding chart parameters were found between children with normal versus dilated rectum. Neither did urgency or a history of daytime incontinence differ between the groups. Boys were more likely to have rectal dilatation than girls (p = 0.02).

    Conclusions: The absence of differences regarding voiding chart data may be explained as two mechanisms neutralizing each other: behavioral factors may make the constipated children void seldom and with large volumes, whereas detrusor overactivity caused by rectal compression of the bladder may have the opposite effect. Another option may be that the voiding chart is too blunt an instrument to detect detrusor overactivity. Constipation, and thus presumably bladder dysfunction, seems to be more important in enuretic boys than girls.

  • 23.
    Jönson Ring, Ingrid
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Bazargani, Farhan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Markström, Agneta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Respiratory changes during sleep in enuretic children treated with rapid maxillary expansionManuskript (preprint) (Annet vitenskapelig)
  • 24.
    Jönson Ring, Ingrid
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Markström, Agneta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lung- allergi- och sömnforskning.
    Magnuson, Anders
    Bazargani, Farhan
    Rapid maxillary expansion in children with nocturnal enuresis: A randomized placebo-controlled trial2019Inngår i: Angle orthodontist, ISSN 0003-3219, E-ISSN 1945-7103Artikkel i tidsskrift (Annet vitenskapelig)
  • 25.
    Kaarme, Johan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Hickman, Rachel A.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Infektionssjukdomar.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Blomberg, Jonas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk mikrobiologi och infektionsmedicin.
    Öhrmalm, Christina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk mikrobiologi och infektionsmedicin.
    Reassuringly low carriage of enteropathogens among healthy Swedish children in day care centres2016Inngår i: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 140, s. 221-227Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: Infectious gastroenteritis is one of the most common diseases among children and has a considerable impact on health and socio-economy. Day care centres are highrisk environments for infections. The aim of this study was to investigate if asymptomatic preschool children constitute a reservoir for potential enteropathogens. Study design: In total, 438 individual diapers were collected from day care centres in Uppsala, Sweden, during spring and autumn, and molecular techniques were used to estimate the prevalence of asymptomatic carriage of multiple enteropathogens. Methods: Faecal samples were analysed with multiplex polymerase chain reaction (PCR) (xTAG® Gastrointestinal Pathogen Panel; Luminex Corporation, Toronto, Canada) targeting 21 different pathogens. Samples with a median fluorescence intensity above threshold were re-analysed with a second PCR assay. Results: Sixteen of the 438 samples were positive for enteropathogens, 1.6% for enteric adenovirus, 0.7% for Campylobacter spp., and 0.7% for norovirus. Conclusions: Preschool children in Uppsala constitute a limited reservoir for potential enteropathogens

  • 26.
    Kaarme, Johan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Pediatrisk inflammationsforskning.
    Riedel, Hilde M.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Infektionsmedicin.
    Schaal, Wesley
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaceutisk biovetenskap.
    Yin, Hong
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Pediatrisk inflammationsforskning.
    Melhus, Åsa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Infektionsmedicin.
    Rapid Increase in Carriage Rates of Enterobacteriaceae Producing Extended-Spectrum β-Lactamases in Healthy Preschool Children, Sweden2018Inngår i: Emerging Infectious Diseases, ISSN 1080-6040, E-ISSN 1080-6059, Vol. 24, nr 10, s. 1874-1881Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    By collecting and analyzing diapers, we identified a >6-fold increase in carriage of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae for healthy preschool children in Sweden (p<0.0001). For 6 of the 50 participating preschools, the carriage rate was >40%. We analyzed samples from 334 children and found 56 containing >1 ESBL producer. The prevalence in the study population increased from 2.6% in 2010 to 16.8% in 2016 (p<0.0001), and for 6 of the 50 participating preschools, the carriage rate was >40%. Furthermore, 58% of the ESBL producers were multidrug resistant, and transmission of ESBL-producing and non-ESBL-producing strains was observed at several of the preschools. Toddlers appear to be major carriers of ESBL producers in Sweden.

  • 27.
    Lackgren, G
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Lilja, B
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Stenberg, A
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Desmopressin in the treatment of severe nocturnal enuresis in adolescents - a 7-year follow up study.1998Inngår i: Br J Urol, Vol. 81, s. 17-Artikkel i tidsskrift (Fagfellevurdert)
  • 28. Lackgren, G
    et al.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Lilja, B
    Stenberg, A
    Desmopressin tablets in the treatment of severe nocturnal enuresis in adolescents - a seven year follow-up study1997Inngår i: British Journal of Urology, Vol. 81, s. 17-Artikkel i tidsskrift (Fagfellevurdert)
  • 29.
    Lackgren, G
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Stenberg, A
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Diurnal vasopressin and urinary output in adolescents with monosymptomatic nocturnal enuresis.1997Inngår i: Acta Paediatr., Vol. 86, s. 385-Artikkel i tidsskrift (Fagfellevurdert)
  • 30. Lackgren, G
    et al.
    Wahlin, N
    Skoldenberg, E
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Stenberg, A
    Endoscopic treatment of vesicoureteral reflux with dextranomer/hyaluronicacid copolymer is effective in either double ureters or a small kidney.2003Inngår i: J Urol, Vol. 170, s. 1551-Artikkel i tidsskrift (Fagfellevurdert)
  • 31.
    Lindgren, Annika
    et al.
    Utbildningsförvaltningen, Malmö.
    Mattson, Gunilla Glad
    Barn- och ungdomssjukhuset, Universitetssjukhuset, Linköping.
    Mattsson, Sven
    Barn- och ungdomssjukhuset, Universitetssjukhuset, Linköping.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Två barn i varje skolklass med7-åringar lider av enures: Skolhälsovården har en nyckelroll: enkät visar att förbättringar behövs2013Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, nr 46, s. 2058-2060Artikkel i tidsskrift (Fagfellevurdert)
  • 32.
    Lundmark, Elisabet
    et al.
    Uppsala Univ, Childrens Hosp, Nephrol Unit.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Reboxetine in therapy-resistant enuresis: a retrospective evaluation2009Inngår i: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 43, nr 5, s. 365-368Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Imipramine is the only evidence-based treatment available for enuretic children resistant to standard therapy. The drug's antienuretic effect is probably due to noradrenergic facilitation. The drug is, however, potentially cardiotoxic. In this study, the non-cardiotoxic noradrenergic antidepressant reboxetine was tested as an alternative to imipramine. PATIENTS AND METHODS: 61 patients, aged 7-19 years, with enuresis-resistant to desmopressin, the alarm, urotherapy and anticholinergics, were given 4-8 mg reboxetine at bedtime, if necessary combined with desmopressin. RESULTS: 32 patients became dry on reboxetine treatment, although 21 of them required combination treatment with desmopressin to achieve this. Eighteen children did not respond and eight children discontinued because of side-effects before treatment could be evaluated. No serious adverse events occurred. CONCLUSIONS: These results need to be confirmed with randomized controlled studies, but indicate that reboxetine will become a safe and efficient treatment alternative for enuretic children resistant to standard therapy.

  • 33.
    Lundmark, Elisabet
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    The prognostic value of voiding chart data in therapy-resistant enuresisManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

     

    Introduction: The case history is the primary tool when investigating the enuretic child. To further determine whether nocturnal polyuria or detrusor overactivity is present, a full voiding chart, as defined by the ICCS, is the method of choice. However, there is no robust evidence that daytime voiding chart data actually do predict nocturnal detrusor function.

    Aim: The aim of this study was to assess the predictive value of anamnestic data and the voiding chart in the treatment of children with therapy-resistant enuresis.

    Patients and Methods: The patients all suffered from therapy-resistant nocturnal enuresis. In accordance with international recommendations, the children were first treated with anticholinergics. If the therapeutic effect was not satisfactory dosage was adjusted and desmopressin was added. If sufficient treatment effect was not achieved, antidepressant therapy was tried next, combined with desmopressin if needed. Since this was an evaluation of clinical practice, not a randomized trial, treatment success was graded according to family satisfaction, not the actual frequency of wet nights. Thus, only children who reported that they were completely dry were regarded as full responders and those who stated that there was a substantial and useful reduction of wet nights were labeled intermediate responders.

    Results: Few and inconsistent differences were found between the groups responding or not responding to the various treatment regimens, and this was true both for anamnestic and voiding chart data. The only statistically significant findings were that responders to antidepressant therapy were older (p=0.013) than non-responders, and patients who benefited from addition of desmopressin had a higher micturition frequency than those who did not (p= 0.027). Surprisingly, the children who needed desmopressin as part of combination treatment to become dry did not have significantly higher nocturnal urine production than those who had no such benefit (p=0.619). Equally surprisingly, neither the presence of urgency nor a history of previous daytime incontinence was significantly  more common in children responding to anticholinergics (p = 0.375 and 0.072, respectively).

    Discussion: No clear and consistent differences in either anamnestic factors or voiding chart data were found between the patients responding or not responding to the various treatment regimens. Not even urgency could predict anticholinergic efficacy. Somewhat surprisingly, no association between nocturnal polyuria and desmopressin benefit was found.

    Conclusion: In this study no prognostic value was found in anamnestic or voiding chart data in children with therapy resistant enuresis.

  • 34.
    Lundmark, Elisabet
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Stenberg, Arne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Hägglöf, Bruno
    Division of Child and Adolescent Psychiatry, Department of Clinical Sciences, Umeå University, SE- 901 87 Umeå, Sweden.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Effects of antidepressant therapy on voiding chart data andnocturnal urine production in children with enuresis – a randomized controlled studyManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

     

    Introduction:

    Since a substantial minority of enuretic children does not respond to either first- or second-line treatment, there is still need for antidepressants in therapy-resistant enuresis. We recently published the results of a placebo-controlled study of the noradrenergic antidepressant reboxetine in this patient group. The drug was found to have a modest but statistically significant antienuretic effect.

     

    Aim:To determine whether reboxetine exerts its antienuretic effect via modulation of either bladder function or nocturnal urine production, as reflected by the voiding chart.

    Patients and Methods:The study had a randomized, double-blind cross-over design, with three treatment periods of four weeks each. The therapies given were 1) placebo, 2) reboxetine 4 mg + placebo and 3) reboxetine 4 mg + desmopressin 0.4 mg, all drugs given orally in the evening. During the last two weeks of each treatment period, the families were asked to complete a voiding chart in which day-time voiding frequency and voided volumes were documented during 48 hours. Nocturnal urine production was assessed via weighing of diapers.

     

    Results:No clear and consistent reboxetine effects were seen on either voiding parameters or nocturnal urine production. Neither did we find any significant difference in the voiding chart data of responders to active treatment, compared to that of non-responders.

    Discussion:This observation may have several different, non-exclusive explanations, one of which is that the anti-enuretic action of reboxetine is explained by the drug’s noradrenergic effects on arousal. It may also be the case that the voiding chart is too blunt an instrument to detect nocturnal, or indeed daytime, detrusor overactivity. It is thus not ascertained that the lack of reboxetine influence on the bladder variables actually precludes that the drug can affect detrusor function. The lack of difference in nocturnal urine production between treatment  periods with and without desmopressin may indicate that nocturnal polyuria is of minor importance in therapy-resistant enuresis.

    Finally, it may obviously be the case that the number of patients was too small, since the power calculations underlying the determination of sample size in this study were made based on treatment response, not voiding chart variables.

    Conclusion:In this randomized, placebo-controlled study we found no effect on daytime voiding parameters or nocturnal urine production that can explain the antienuretic effect of reboxetine. This may indicate that the drug exerts its beneficial effects via noradrenergic modulation of arousal.

  • 35.
    Lundmark, Elisabet
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Stenberg, Arne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Barnkirurgi.
    Hägglöf, Bruno
    Umea Univ, Dept Clin Sci, Div Child & Adolescent Psychiat, Umea, Sweden.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Reboxetine in therapy-resistant enuresis: a randomized, placebo-controlled study2016Inngår i: Journal of Pediatric Urology, ISSN 1477-5131, E-ISSN 1873-4898, Vol. 12, nr 6Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction

    A significant minority of children with enuresis do not respond to either desmopressin or the enuresis alarm. Anticholinergics have not proven as successful as expected. The fourth evidence-based treatment, the tricyclic antidepressant imipramine, is cardiotoxic when overdosed, which has led to diminished use.

    Aim

    The aim was to determine whether there is a role for the noradrenergic antidepressant reboxetine, as monotherapy or combined with desmopressin, in the treatment of enuresis in children who have not responded to standard therapy, and whether there are side effects involved. We also sought prognostic factors in anamnestic data and in the voiding chart.

    Patients and methods

    The study was a randomized placebo-controlled study with a double-blind cross-over design, in which all patients underwent treatment during three 4-week periods, one with reboxetine 4 mg and placebo, one with reboxetine 4 mg and desmopressin, and one with double placebo treatment. The proportion of wet nights out of 14 was compared before treatment and during the last 2 weeks of each treatment period.

    Results

    Eighteen patients were included. The reduction of wet nights was much better with either reboxetine in monotherapy or in combination with desmopressin than during the placebo period (p = 0.002) ( Figure). However, only one patient achieved complete dryness, this during monotherapy. There were three intermediate responders to monotherapy and five to combination treatment. With reboxetine in monotherapy, six children experienced negative side effects compared with three with combination therapy, and two with placebo. All of these side effects were mild and reversible. Only one patient chose to cease treatment because of side effects. No prognostic factors were found in either the case history or in voiding chart data.

    Discussion

    The present study, the first placebo-controlled trial, confirms that reboxetine is an evidence-based alternative to cardiotoxic antidepressant treatment in therapy-resistant enuresis. The fact that few patients achieved complete dryness may be due to the low dosage used. In our clinical practice we increase the dose to 8 mg when dryness is not achieved with the lower dose. Our experience is that this leaves more children with full response, but the evidence of this has yet to be shown.

    ConclusionReboxetine seems to be an alternative in the treatment of enuretic children who have not responded to standard treatment.

  • 36.
    Läckgren, Göran
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Diurnal plasma vasopressin and urinary output in adolescents with monosymptomatic nocturnal enuresis1986Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 4, nr 4, s. 385-90Artikkel i tidsskrift (Fagfellevurdert)
  • 37.
    Läckgren, Göran
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Long term outcome of children with non-neurogenic bladder dysfunction2006Inngår i: Pediatric surgery and urology: long term outcomes / [ed] Mark D. Stringer, Keith T. Oldham, Pierre D. E. Mouriquand, Cambridge: Cambridge University Press , 2006, 2Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 38. Läckgren, Göran
    et al.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Non-neuropathic bladder-sphincter dysfunction2006Inngår i: Pediatric Surgery and Urology, Second Edition: Long-Term Outcomes / [ed] Mark D. Stringer, Keith T. Oldham, Pierre D.E. Mouriquand, Cambridge: Cambridge university press , 2006, s. 643-649Kapittel i bok, del av antologi (Fagfellevurdert)
  • 39.
    Maria, Cederblad
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Engsheden, Natalie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Gaderi, Ata
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Enebrink, Pia
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Engvall, Gunn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Sarkadi, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    No difference in relationship satisfaction between parents of children with enuresis and normative data2016Inngår i: Journal of Child and Family Studies, ISSN 1062-1024, E-ISSN 1573-2843, Vol. 25, nr 4, s. 1345-1351Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this cross-sectional study was to evaluate relationship satisfaction in parents of children with nocturnal enuresis and put it in context by comparisons with normative data. The secondary aim was to investigate the potential differences in feelings of incompetence in the parenting role and parental conflict among parents of children with enuresis of varying severity. Parents (n = 52) of 41 children with enuresis aged between 6 and 12 years participated. The questionnaire consisted of five components: demographic background, The Dyadic Adjustment Scale, The Swedish Parent Stress Questionnaire, The Parent Problem Checklist, and The Depression, Anxiety, and Stress Scale. Normative data was used to provide an age- and gender-stratified sample, with adequate distribution and representation of both sexes and all ages. This sample consisted 1411 parents of 1411 children aged 6-9 years. Parents of children with enuresis reported similar relationship quality as a representative sample of parents with children of the same age. The parents' report of feeling of incompetence and parental conflict were similar among children with enuresis of varying frequency. Mothers reported more problematic areas related to child rearing than fathers. This study shows that to have a child with enuresis doesn't necessarily affect the parents' feeling of competence or the quality of the intra-parental relationship.

  • 40.
    Mattsson, Sven
    et al.
    Barnkliniken vid Linköpings Universitetssjukhus.
    Nevéus, TryggveUppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Sängvätning och annan inkontinens hos barn2011Konferanseproceedings (Annet vitenskapelig)
  • 41.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Can postpyelonephritic renal scarring be prevented?2013Inngår i: Pediatric nephrology (Berlin, West), ISSN 0931-041X, E-ISSN 1432-198X, Vol. 28, nr 2, s. 187-190Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Pyelonephritis in childhood may, in the worst cases, lead to long-term cardiovascular morbidity due to tubulointerstitial renal scarring. Renal damage is the end result of an interplay between (1) urinary tract anatomy and function, (2) bacterial virulence factors, and (3) the host innate immune system, which on the one hand manages bacterial clearance, but on the other causes tubulointerstitial inflammation, which underlies the renal scarring. It is unclear how common postpyelonephritic scarring is, and how many of the "scars" in fact represent congenital renal hypoplasia. We do, however, know that some situations have an increased risk for scars, i.e., large renal-uptake defects on initial renal scintigraphy or pyelonephritis in young girls with dilating vesicoureteral reflux. It seems logical that antiinflammatory or antioxidant therapy given concomitantly with antibiotics should lower the risk of postpyelonephritic scarring. Animal studies give some support to this idea, but research on humans has been surprisingly scant. In this issue of Pediatric Nephrology, we publish a study that indicates that antioxidant therapy with vitamin A or E given to children with pyelonephritis may indeed lower the risk for renal scarring. This is a track that needs to be pursued further.

  • 42.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Commentary to 'Adenotonsillectomy improves quality of life in children with nocturnal enuresis and sleep-disordered breathing'.2015Inngår i: Journal of Pediatric Urology, ISSN 1477-5131, E-ISSN 1873-4898, Vol. 11, nr 5Artikkel i tidsskrift (Fagfellevurdert)
  • 43.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Diagnosis and management of nocturnal enuresis2009Inngår i: Current opinion in pediatrics, ISSN 1040-8703, E-ISSN 1531-698X, Vol. 21, nr 2, s. 199-202Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    PURPOSE OF REVIEW: To highlight recent advances in enuresis research. RECENT FINDINGS: Many discoveries have distanced us from the time when bedwetting was considered a psychiatric disorder. Instead, it is now agreed that nocturnal polyuria, detrusor overactivity, and high arousal thresholds are, in various combinations, central to enuresis pathogenesis. All three mechanisms have been further elucidated during the last year. It has been found that solute diuresis, and not just free-water diuresis due to vasopressin deficiency, may be causative. Sonographical bladder wall measurements have been shown to have prognostic value in detrusor-dependent enuresis, and fascinating proof for the interplay between the bladder and the sleeping brain has been put forward. And, ironically, sleep research has caused psychiatry to make a slight comeback, as studies have indicated that enuretic children may suffer from cognitive problems due to suboptimal sleep. Less has been achieved regarding treatment, but some evidence has finally supported the experience that anticholinergics may be effective in therapy-resistant enuresis. SUMMARY: During the last years, increased insight has been gained into the multifaceted pathogenesis of enuresis, but there is still an irritating lack of proven effective therapies.

  • 44.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Editorial Comment: Inconsistent lower urinary tract symptoms in children with enuresis. The Journal of Urology Sept; 180(3):1085-9; Discussion 1089-902008Inngår i: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 180, nr 3, s. 1090-Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract
  • 45.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Editorial Comments. in: The role of bladder capacity in antidiuretic and anticholinergic treatment for nocturnal enuresis2006Annet (Annet (populærvitenskap, debatt, mm))
  • 46.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Effect of Laser Acupuncture for Monosymptomatic Nocturnal Enuresis on Bladder Reservoir Function and Nocturnal Urine Output EDITORIAL COMMENT2011Inngår i: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 185, nr 5, s. 1862-1862Artikkel i tidsskrift (Annet vitenskapelig)
  • 47.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Enuretic sleep: deep, disturbed or just wet?2008Inngår i: Pediatric nephrology (Berlin, West), ISSN 0931-041X, E-ISSN 1432-198X, Vol. 23, nr 8, s. 1201-2Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Enuretic children sleep "deeply" in the sense that they are difficult to arouse from sleep, but not in the sense that their sleep is necessarily polysomnographically different from other children. The enuretic children's arousal difficulties may be due to a disturbance at the brainstem level and/or to frequent arousal stimuli from the bladder. It may be hypothesised that the sleep disturbance of enuretic children may lead not only to the wetting of the sheets but to disturbances of daytime psychological functioning as well.

  • 48.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Evaluation of the enuretic child2015Inngår i: Pediatric Incontinence: evaluation and clinical management / [ed] I Franco, P Austin, S Bauer, A von Gontard, Y Homsy, Chichester, West Sussex, UK: Wiley-Blackwell Publishing Inc., 2015, 1, s. 221-226Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 49.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Is a combination of alarm and drug therapies effective in nocturnal enuresis?2006Inngår i: Nat Clin Pract Urol, ISSN 1743-4270, Vol. 3, nr 2, s. 80-1Artikkel i tidsskrift (Fagfellevurdert)
  • 50.
    Nevéus, Tryggve
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Kisslarmet försvarar sin plats.2001Inngår i: Läkartidningen, Vol. 98, s. 28-Artikkel i tidsskrift (Annet vitenskapelig)
123 1 - 50 of 101
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