Medical problems in adolescents with myelomeningocele (MMC): an inventory of the Swedish MMC population born during 1986-1989.

AIM: To describe the prevalence of myelomeningocele (MMC) and the medical needs of adolescents, 15-18 years, with MMC in Sweden, at a time when they are on the threshold of adulthood, leaving paediatrics. METHODS: In a retrospective study, we identified all adolescents with MMC, born during 1986-1989 and living in Sweden on July 1, 2004. An inventory was agreed upon with questions concerning their medical problems and need for medical care. RESULTS: There were 175 persons 15-18 years of age, born with MMC or lipoMMC (prevalence 3.8 per 10,000). Hydrocephalus was seen in 86%, 31% had been operated because of tethered cord syndrome, and 6% for Chiari malformation symptoms. The majority had motor impairments. Clean intermittent catheterisation for bladder emptying was used by 85%, and 59% used enemas on a regular basis because of the neurogenic bowel dysfunction. Renal dysfunction was seen in 1.7% of the adolescents. CONCLUSION: Lifelong follow-up by many specialists, among others neurologists and neurosurgeons, urotherapists and urologists, orthopaedic surgeons and orthotists, is necessary for individuals with MMC. The complex medical situation, often in combination with cognitive difficulties, makes it necessary to coordinate medical services for this increasing group of adults with multiple impairments.

Self-esteem in children with nocturnal enuresis and urinary incontinence: improvement of self-esteem after treatment.

A study of self-esteem before and after medical treatment was performed in children with primary nocturnal enuresis (NE) and urinary incontinence (UI). The NEUI children and the controls were recruited from the normal population in the town of Umeå, Sweden. In total, 66 NEUI children and 64 controls entered the study. Clinical examination, laboratory and psychological tests were performed before the start of treatment. Follow-up investigations were done 3 and 6 months after the start of treatment. To assess self-esteem we used the Swedish self-esteem questionnaire 'I think I am'. Compared to controls, the NEUI children had significant impairment of self-esteem before the start of treatment. Within the NEUI group, boys had lower self-esteem than girls. After 6 months of treatment, the NEUI children had the same levels of self-esteem as the control group. The NEUI children that had become totally dry had significantly better self-esteem at 6-month follow-up as compared to the NEUI children with persisting NEUI problems. In conclusion, the study shows that NEUI children have low self-esteem and that their self-esteem may be normalized with proper treatment.

Self-esteem before and after treatment in children with nocturnal enuresis and urinary incontinence.

A case control study was designed to study self-esteem in children with nocturnal enuresis and daytime incontinence. The patients and the controls were recruited from the normal population in the town of Umeå, Sweden. Medical and psychological examinations were performed before the start of treatment. Follow up investigations were carried out at 3 and 6 months after starting treatment. Self-esteem was measured using a Swedish self-answering questionnaire that was known to have good psychometric properties. Statistically significant impairment of self-esteem was observed between patients and control children before starting treatment (P < 0.001). After 6 months treatment, the patients had the same levels of self-esteem as the control group. Self-esteem was significantly better in patients that were totally dry at 6 months follow up compared with the patients with persisting urinary problems (P < 0.01). Children from lower socioeconomic groups were found to have lower self-esteem than children from higher socioeconomic groups; boys were also found to have lower self-esteem than girls.