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Several changes have occurred in the toilet training (TT) process in recent decades. There has been an increase in the use of daycare as both parents now often work outside the home. Most children attend daycare centers during the period TT usually takes place, and daytime training has shifted from home to daycare. This study is the first to evaluate the way TT is done in daycare centers. A questionnaire was sent to 1,500 daycare centers, of which 429 replied (response rate of 28.6%). The results show that half of the childcare workers base the decision to start TT on readiness signs. The combination of age and readiness signs is used by 44.5%. The majority of the respondents spent more than 1 h per day on TT (81.8%); 79.8% considered that daycare and parents should play an equal role in TT. However, more than a third of the respondents thought that parents pass the responsibility for TT on to daycare and that not enough attention was paid to TT in the home. Most respondents stated that daycare centers had the facilities and means to be able to give the children proper TT (88.5%). Other research indicated that the outcome of TT is not that good overall and that there is room for improvement in the methods used. More research is needed on the role division and on the interaction between daycare and parents and their combined influence on the process and outcome of TT. [ABSTRACT FROM AUTHOR]

Background: For fifth-year's undergraduates of the medical school, a project with simulated patients (Intimate Examination Associates, IEA) was implemented in 2002 at the University of Antwerp. In this project, students from the new curriculum (NC) learned uro-genital, rectal, gynaecological and breast examination in healthy, trained volunteers and received feedback focused on personal attitude, technical and communication skills. Former curriculum (FC) students however trained these skills only during internship in the sixth year after a single training on manikins. Aims: This study assessed the effect of learning intimate examinations with IEA's by comparing students from FC and NC on four different outcome parameters. Methods: Three groups were compared: FC after internships without IEA training, NC after internships with IEA training and fifth year NC immediately after the IEA training. Four assessment instruments: an OSCE using checklists and global rating scales to assess the technical skills, a score list on students attitudes and performance filled in by the IEA's, a student questionnaire on self-assessed competence and a questionnaire on the frequency of performing intimate skills during internships. Results: Both NC groups scored globally better in the OSCE (significance for male examination). Sub-scores for 'completeness' and 'systematic' approach was significantly higher in both NC groups for male and female examinations. NC students reported better self-assessed competence and performance concerning gynaecological and urological clinical and communication skills during internship. The best results were obtained after IEA training and internship was done for the four outcomes. IEA's are influenced by the 'experienced' students after internship: FC and NC after internship both scored better than the fifth year NC who only received the IEA training so far. Conclusion: Learning intimate examinations with IEA's has a positive effect on the performance of medical students. This beneficial effect is on its turn reinforced during internships. [ABSTRACT FROM AUTHOR]

To analyse the risk factors for recurrent urinary tract infection (UTI) and the possible influence of potty-training, a questionnaire with 41 questions was completed by 4,332 parents of children completing the last 2 years of normal primary school. Statistical analysis was done with the Chi-squared test and Yates correction. Three groups of children emerged: one without any history of UTI (n =3818), a group with one actual or former UTI (n =382) and a group with recurrent UTI (n =132). Mean age was 11.5±0.56 years. A strong correlation between daytime and/or night-time wetting, voiding frequency of more than 10 times a day and nocturia and recurrent UTI was found. No correlation between these factors and a single UTI could be demonstrated. In the 343 bed-wetting children, equal infections for boys and girls were found. Potty-training started significantly earlier in children without UTI. Parents of children with recurrent UTIs insisted more when the first attempt to void was unsuccessful: in the group without UTI, most parents just postponed and had the child try later again. In the group with recurrent UTI, more parents asked the child to strain, made special noises or turned on a tap. Conclusion:daytime with/without night-time wetting, more than 10 voidings a day and nocturia are indicators of recurrent urinary tract infections. If they are simultaneously present, the relative risk for recurrent urinary tract infections is 60%. Consequently, paediatricians should take urinary symptoms very seriously into account, and as incontinence is still a hidden condition, question the child on this topic. [ABSTRACT FROM AUTHOR]

Objective: Pelvic floor muscle training is effective and necessary in the prevention and treatment of pelvic floor dysfunction during pregnancy and after childbirth. But because of the high prevalence of perineal pain observed in women after childbirth, many women and caregivers fear to start pelvic floor muscle training immediately after childbirth. However, it is unknown whether pelvic floor muscle contractions (PFMC) provoke perineal pain in women shortly after childbirth. Therefore, the main objective is to study whether PFMC performed immediately after childbirth is painful or not.Study Design: Observational longitudinal study. Perineal pain was assessed (1-6 days and 9 weeks postpartum) using a visual analogue scale (VAS 0-10) during PFMC and during several activities of daily living (ADL), during micturition and defecation. Descriptive statistics, Wilcoxon and McNemar tests were used.Results: A total of 233 women participated (148 primiparous and 85 multiparous). Immediately postpartum the prevalence and intensity of pain during ADL (73%; VAS 4.9 (±2.3)), micturition (47%; VAS 3.4 (±1.7)) and defecation (19%; VAS 3.6 (±2.2)) were significantly higher (all p<0.000) than during PFMC (8%; VAS 2.2 (±0.9)). At 9 weeks postpartum, 30% experienced perineal pain during sexual intercourse (VAS 4.6 +/- 2.3) and 18% during defecation (VAS 4.7 +/- 2.3), but none during PFMC.Conclusion: Perineal pain is highly prevalent immediately after childbirth during ADL, micturition and defecation, but not during PFMC (only 8%). In case perineal pain occurs during PFMC, the intensity of pain is low (VAS 2). These results show that fear of perineal pain should not discourage women to start pelvic floor muscle training shortly after childbirth. [ABSTRACT FROM AUTHOR]

Presents a letter on how medical students are being taught at University of Antwerp in Belgium. Use of healthy, willing volunteers; Attention given to medical students' personal attitude and on their technical and communication skills; Need for students to pay attention to patients' feelings, integrity, and privacy.

Background: In recent years, the age at which parents start and finish toilet training (TT) their children has increased. To cope with the problems caused by this later completion, it is essential to identify the beliefs and attitudes of the parents., Methods: Two thousand questionnaires were distributed to parents of children aged 30 to 36 months, attending 50 randomly selected schools in Antwerp, Belgium., Results: Too many children are toilet trained after the minimum school age of 30 months. Most parents are not aware of the possible negative consequences this can entail. Mothers with a paid occupation think more often that children should be toilet trained before the age of 30 months, and the higher the mother's educational level, the more likely she will send her child to school toilet trained. More of single parents think that children who are not yet toilet trained should be allowed to go to school and more often send their not fully toilet-trained children to school., Conclusion: Parents should be better informed about the possible negative consequences of a later completion of TT. Single parents, more than other parents, should be assisted in the TT process and offered more support., (© The Author(s) 2013.)

Aims: To investigate how toilet training (TT) is dealt with and what the associated feelings are in Flemish families using day-care at least once a week., Methods: A questionnaire was provided to 256 parents of healthy children between 15 and 35 months old, using day-care every week. Data were analyzed using SPSS18.0., Results: Two hundred twenty-two questionnaires were completed (response rate: 87%), of which 221 were valid. The overall results show that the start of TT and method used are mainly in line with current recommendations, and that the cooperation between parents and day-care is seen as positive, providing support for the parents in guiding their child in the TT-process. Most parents (74%) stated that day-care and parents should play an equal role in the TT-process. However, 17% of the parents experienced uncertainty, stress, and/or frustration related to TT. This percentage increased to 30% when asked about the right moment to start TT. Moreover, 18% of the parents reported a lack of time to guide their child in the TT-process. Eighteen percent of the parents agreed that responsibility for TT is increasingly passed on to day-care, while 46% remained undecided. In addition, 40% of the parents had no idea whether they used the same TT method as the day-care center., Conclusions: The results, in general, reflect a positive image of how TT is dealt with. However, several concerns were raised about the shared TT between parents and day-care, implying that further research on this topic is needed., (© 2013 Wiley Periodicals, Inc.)

Aims: To evaluate the reproducibility of bladder sensation during standardized filling cystometry in female volunteers and overactive bladder (OAB) patients, repeated with weekly interval., Methods: We recruited 13 female nulliparous volunteers (age 21-47) and 17 female patients with OAB between (age 18-72). They participated in three investigation periods, each separated by 7 days to assess reproducibility of sensation related to standardized cystometry. Subjects were asked to report all sensations they felt during bladder filling., Results: The previously described pattern of sensation was reported during bladder filling in all. Consecutive sensations corresponded to statistically higher bladder volumes. Volumes, at which different sensations of bladder filling were reported, were significantly higher in controls than in OAB patients [first sensation of filling (FSF) P = 0.003, first desire to void (FDV) P < 0.0001, and strong desire to void (SDV) P < 0.0001]. The sensation/volume ratios were significantly higher in patients with OAB than in the healthy volunteers: FSF occurred at mean 46% and FDV at mean 73% of SDV in OAB patients, compared to 36% and 64% in healthy volunteers. Sensations proved highly reproducible when determined with weekly interval., Conclusions: Our data demonstrate that cystometric filling sensation determined in a standardized way with weekly interval is highly reproducible in healthy and in OAB patients. This finding has, in our opinion, clinical importance as it shows that the technique is reliable both for a sensory evaluation of the LUT as to study influence of treatment aimed at changing this sensation., (Copyright © 2011 Wiley Periodicals, Inc.)

Aims: The anorectum and the lower urinary tract (LUT) are closely related. Clinically, it is important for caregivers to identify the presence of concomitant pathology as early in the diagnostic process as possible. This study evaluates lower bowel symptoms (LBS) in women with different types of urinary incontinence (UI), and compares the outcome with continent women and with a female control group., Methods: Female patients, consulting at the Functional Unit of our Urology Department, with or without UI, were included in the study (URO patients). A female control group was recruited at the Orthopedic and the General Internal Medicine Consultation and among co-workers from the hospital (CONTROL group). All were asked to complete a validated, self-administered questionnaire, which identified the possible presence of UI, allowed categorization by type of UI, and questioned LBS., Results: URO patients had, regardless of presence and type of UI, more complaints of fecal incontinence (FI) and of constipation than the CONTROL group. Patients with Urge UI and Mixed UI had significantly more difficulty postponing defecation and significantly more FI than Stress UI (SUI) patients and than continent URO patients (27% vs. 8%). More SUI patients reported straining during defecation., Conclusions: Our data confirm that in patients with functional problems of the LUT, the prevalence of LBS is high. Bowel symptoms differ in different types of UI., (Copyright © 2010 Wiley-Liss, Inc.)

Aims: To evaluate, in a randomized controlled way, the use of a daytime wetting alarm in a day-care center during three consecutive weeks in healthy children., Methods: Thirty-nine healthy young children, between 18 and 30 months old, were selected at random for a wetting alarm diaper training (n = 27) or control wearing a placebo alarm (n = 12). Toilet behavior was observed during a period of 10 hr by independent observers before, at the end of, and 2 weeks after training. Children were defined as completing daytime toilet training when the child wore undergarments, showed awareness of a need to void, initiated the toileting without prompts or reminder from the trainer and had maximum one leakage accident per day., Results: Children in the wetting alarm diaper training group achieved independent bladder control in 51.9% and did significantly better than in the control group (8.3%) (P = 0.013). The results were sustained during the following 14 days (P = 0.013)., Conclusion: The wetting alarm diaper training is an effective option for toilet training young healthy children in a day-care center. It offers day-care providers clear guidelines and limits the time to complete toilet training in many children without putting too much burden on the child and the day-care center activities., ((c) 2008 Wiley-Liss, Inc.)

Objectives: Teaching intimate physical examinations in medical schools generates practical, didactical and ethical problems. At the University of Antwerp, a unique program with intimate examination assistants (IEA) was implemented for fifth year's undergraduate students. They learn gynaecological and urological skills in healthy volunteers. Technical, communicative and attitude aspects are taken into account., Methods: Description of the implementation of the project. Assessment of the project by questionnaires, written reflections and round table conferences., Results: The results provide detailed information about the student's perceptions of each component of the program as well as the perceptions of the IEA's and the teachers., Conclusion: The multilevel evaluation of the program supports the surplus value of working with IEA's in medical education. The eye-catcher in this program is the integration of clinical skills with communicative skills and attention for students' attitude., Practice Implications: Working with IEA's for intimate examinations represents a benefit in medical education by lowering the student's threshold to perform the intimate physical examination on both men and women during their fulltime clerkships.