ABSTRACT
Resumo Introdução: Distúrbios do Trato Urinário Inferior (DTUI) de causa funcional são disfunções vesicais sem defeitos anatômicos ou neurológicos. O diagnóstico é principalmente clínico, com sintomas padronizados pela International Children's Continence Society. Poucos estudos relacionam qualidade de vida destes pacientes ao nível cognitivo e aproveitamento escolar. Objetivos: Avaliar marcos do controle miccional, dificuldades cotidianas, qualidade de vida (QV), nível cognitivo e desempenho escolar de crianças portadoras de DTUI. Método: Série de casos de pacientes acompanhados na Nefrologia Pediátrica de hospital terciário com avaliação da QV (Pediatric Quality of Life Inventory - Peds-QL), Teste de Desempenho Escolar (TDE) e teste de matrizes progressivas de Raven. Resultados: Meninas de classe social menos favorecida foram 90,9% das crianças elegíveis. A média de idade foi 9,1 ± 4,8 anos. Os sintomas mais frequentes foram urge-incontinência (81%), manobras de contenção (77,3%) e enurese (59,1%) associados à síndrome do distúrbio de eliminações (63,6%). Cuidadores consideravam as perdas urinárias e/ou sintomas como voluntários, brigavam e/ ou batiam na criança. As crianças já tinham sido submetidas a situações constrangedoras e advertências de professores, escondiam sintomas e/ou roupas sujas. O escore médio de QV foi 71,0 ± 12,6 com menor média na dimensão escolar. No TDE 55% tiveram desempenho inferior e nas Matrizes de Raven 60% estavam intelectualmente em nível médio. Observaram-se escores menores de QV no nível médio e inferior do TDE e capacidade intelectual média/abaixo da média nas Matrizes de Raven. Conclusão: DTUI pode influenciar negativamente relações familiares e sociais, desempenho escolar e qualidade de vida das crianças portadoras.
Abstract Introduction: Lower urinary tract dysfunction (LUTD) are voiding dysfunctions without anatomical or neurological defects. The diagnosis is primarily clinical, with symptoms standardized by the International Children's Continence Society. Few studies relate quality of life of patients with cognitive and school performance. Objective: To evaluate milestones of bladder control, daily problems, quality of life (QoL), cognitive function and school performance of children with LUTD. Methods: Case series of patients followed in the Pediatric Nephrology tertiary hospital with assessment of QoL (Pediatric Quality of Life Inventory - PedsQoL version 4), School Performance Test (TDE) and Raven Progressive Matrices test. Results: Girls of lower social class were (90.9%) of eligible children. The mean age was 9.1 ± 4.8 years old. The most common symptoms were urge incontinence (81%), holding maneuvers (77.3%) and enuresis (59.1%) associated with the elimination disorder syndrome (63.6%). Caregivers considered volunteers urinary losses and/ or symptoms, and fought and/or beat the child. Children had been subjected to embarrassing situations such as warnings of teachers, they hid symptoms and/or the dirty clothes. Mean score of QoL was 71.0 ± 12.6 with the lowest mean score on the school dimension. In TDE 55% had lower performance and in Raven Matrices 60% were intellectually in the medium level. It was observed lower QoL scores in the medium and lower level of TDE and average intellectual capacity/below average in Raven matrices. Conclusion: LUTD may negatively affect family and social relationships, school performance and QoL of children with the dysfunction.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Quality of Life , Urination Disorders/psychology , Cognition , Academic Performance , Urination Disorders/physiopathologyABSTRACT
PURPOSE: To evaluate the impact of lower urinary tract symptoms (LUTS) on the quality of life (QoL) in a group of elderly men. MATERIALS AND METHODS: Observational clinical study contained 200 men recruited between March-September 2008 in the community and Urology and Geriatrics ambulatories. The data collected included health and sociodemographic conditions; the International Prostate Symptom Score (IPSS); an anxiety/depression inventory; the World Health Organization Quality of Life -Bref and -Old questionnaires (WHOQoL). Participants were classified according to IPSS: Group I (moderate/severe symptoms) and Group II (absence/mild symptoms) and 100 men were included in each group. RESULTS: The groups were statistically similar in sociodemographic, morbidity, and anxiety/depression scores. Both QoL scales showed significant lower median scores in group I in all parameters, except the global subjective self-evaluation of QoL. The domains social and environmental relations presented the most significative differences (p < 0.0005) in both questionnaires, and final mean WHOQoL-OLD score was lower in group I (p < 0.0005). CONCLUSIONS: For elderly men, moderate to severe LUTS do significantly impact almost all parameters of QoL proposed by the WHO, especially social and environmental relations.
Subject(s)
Aged , Aged, 80 and over , Humans , Male , Health Status , Lower Urinary Tract Symptoms/psychology , Quality of Life/psychology , Surveys and Questionnaires , Urination Disorders/psychology , Severity of Illness Index , Socioeconomic Factors , World Health OrganizationSubject(s)
Humans , Male , Young Adult , Cognitive Behavioral Therapy , Defecation , Phobic Disorders/therapy , Urination Disorders/psychology , Antidepressive Agents, Second-Generation/therapeutic use , Combined Modality Therapy , Paroxetine/therapeutic use , Phobic Disorders/drug therapy , Urination Disorders/therapyABSTRACT
La autora intenta mostrar desde la clínica, parte del proceso analítico de un niño de seis años de edad en el momento de comenzar el análisis. Se transcriben dos sesiones consecutivas, de los ocho meses de comenzado el proceso analítico, para dar cuenta de cómo coexisten en el paciente aspectos fusionales, junto a una riqueza y creatividad poco comunes en estos cuadros. Se manifiesta cómo hay niveles de simbolización logrados que por momentos colapsan. Posteriormente se describe brevemente la evolución del proceso analítico.
The paper shows part of the analytic process of a child who was six at the beginning of his analysis. Two consecutive sessions, dated eight months after the beginning of his analytic process, are provided to try to account for the coexistence in the patient of aspects of fusion, side by side with a richness and creativity which are very unusual in this kind of clinical presentation. Certain levels of symbolization achieved can collapse at times. The evolution of the analytic treatment it briefly described.