Number Of Diapers Research Articles

Analysis of direct costs of trans anal saline irrigation to pharmacological measures for bowel dysfunction

BackgroundManagement of bowel dysfunction in children is expensive. Pharmacological measures (PM) are the most commonly used treatment option which has shown to have varying outcomes. The next option after failed PM involves invasive surgical procedures like the Malone Antegrade Continence Enema (MACE). Trans Anal Irrigation (TAI) is an efficacious treatment modality between failed medical therapy and invasive surgeries. As no cost analysis of TAI in children has been conducted, this study evaluated the direct costs involved with TAI in comparison to PM from the health care provider perspective. MethodsChildren >4 years with persistent bowel dysfunction despite PM, were divided into three groups: Constipation, Pseudoincontinence and Incontinence group. The costs of existing PM and number of diapers used daily were noted for each patient. In all patients, PM was stopped and TAI was initiated. Improvement in symptoms and reduction in daily diaper usage over six months was recorded. The direct costs of TAI versus the costs that would be involved had PM been continued, were compared using paired ‘t’ test. Results34 patients (20 male, 14 female) with an average age of 76.7 months were divided into three groups: Constipation:12, Pseudoincontinence:15 and Incontinence:7. In all groups, there was a significant reduction in direct costs with TAI in comparison to PM. ConclusionIn children with bowel dysfunction, TAI is an effective and significantly economical treatment modality in comparison to PM and should be considered early on in the management therapy.

Analysis of healthcare waste and factors affecting the amount of hazardous healthcare waste in a university hospital

The ever-increasing amount of waste produced by the healthcare system is a growing burden worldwide. To effectively reduce waste, it is essential to know exactly what it is and to explore the factors influencing its amount. This study aims to analyze the amount of healthcare waste (HCW) and the change in that amount over time, as well as to explore and quantify the factors that influence hazardous healthcare waste (HHCW) in a university hospital. Descriptive statistical analysis, Spearman’s correlation and robust regression were performed to characterize the data. Our analysis revealed that the amount of HCW has been increased annually by 2.11%, and the generation rate ranges between 2.53 and 2.68 kg/bed/day. The amount of HHCW has increased by 20.19% over the 5-year period studied, with a generation rate varying between 1.13 and 1.31 kg/bed/day. It was found that surgical specialisms, anesthesiology and intensive care, and emergency patient care have higher rates of hazardous waste production. A significant positive correlation was found between the amount of hazardous waste and the incidence of healthcare-associated infections (r = 0.704), and the number of diapers used by adults and children (r = 0.555), whose significant predictive role was also confirmed by the robust regression.

A new bladder‐emptying method in females with neurogenic bladder: A randomized, phase II trial

To evaluate the performance of the new device compared with clean intermittent catheterization (CIC). From March 2015 to March 2018, patients who were admitted to the urologic outpatient clinic. A new intraurethral self-retaining device (ISRD) was made of medical grade silicone and it was inspired by similar catheters that use sliding disks to adjust or fix tubes used to drain the bladder. Patients were randomized into two groups (experimental group [GI]-ISRD vs control group [GII]-CIC). The evaluation was performed at the time of enrollment and 6 months after treatment. Intervention was initiated from the antisepsis of the perineal region and subsequent introduction of the device through the external urethral meatus. The primary outcome was quality of life (QOL). Urinary tract infections (UTIs) episodes, data on urodynamic parameters, adverse effects and number of diapers per day. A total of 177 subjects were analyzed. We found a significant improvement on QOL analysis in the ISRD group (P < .01). ISRD group presented an important reduction (two episodes after ISRD use) on number of UTIs (P < .01) and diaper use, and significant improvement on bladder capacity (80 mL of the average improvement) (P < .01) and compliance (P = .01). Among all registered serious adverse effects, ISRD presented with lower proportion. The new device has shown to be a safe and promising alternative for adequate emptying of the neurogenic bladder in female patients. Our study has a limitation that is related to a limited period of observation.

The efficacy of double percutaneous nephrostomy combined with ureter occlusion stent in treating cervical cancer complicated with vesicovaginal fistula after radiotherapy

Objective To evaluate the efficacy of double percutaneous nephrostomy combined with ureter occlusion stent in treating cervical cancer complicated with vesicovaginal fistula after radiotherapy. Method A prospective analysis was taken for 12 patients with cervical cancer complicated with vesicovaginal fistula after radiotherapy who were diagnosed by gynecological examination, imaging and cystoscopy. All patients received concurrent double percutaneous nephrostomy and ureter occlusion stent implantation.The improvement of symptoms and postoperative complications were observed. The number of white blood cells in urine, renal function, number of diapers in daily use (pieces), daily vaginal and urethral exudate, pain score,physical status (ECOG) score and quality of life score (KPS) before and 7 d after the procedure were compare by the paired Student's t test. Results Twelve patients were successfully implanted 24 ureter occlusion stents after successful nephrostomy. Postoperatively, urinary fistula immediately disappeared in all patients. One week after operation, bilateral hydronephrosis disappeared in 4 patients, renal insufficiency and renal function returned to normal in 4 patients. There were significant differences in the number of white blood cells in urine, the number of diapers in daily use, the daily vaginal and urethral exudate, pain score, KPS and ECOG score compared with before and 7 d after the procedure (all P 0.05). No serious complications occurred after the operation. Conclusion Double percutaneous nephrostomy combined with ureter occlusion stent can effectively and safely treat cervical cancer complicated with vesicovaginal fistula after radiotherapy. Key words: Uterine cervical neoplasms; Vesicovaginal fistula; Double percutaneous nephrostomy; Ureter occlusion stent

Investigation of the amount of transdermal exposure of newborn babies to phthalates in paper diapers and certification of the safety of paper diapers

A risk assessment study of seven phthalates in paper diapers for newborn babies produced in Japan was performed. The diapers were purchased and the contents of the seven phthalates were determined and estimated amounts of exposure were calculated based on the eluted rate into artificial medium of urine or sweat, average weight of infants, and frequency of use. Di-2-ethylhexyl phthalate and di-n-butyl phthalate were detected in the topsheets and determined to be 0.6 μg/g and 0.2 μg/g, respectively. The daily estimated exposure volume was calculated to be in the range of 1.86 × 10−10–2.98 × 10−6 mg/kg/day as follows: content of seven phthalates in the topsheet (0.1–1 μg/g) × eluted rate of phthalates into artificial sweat (0.0006–2.4%) × weight of the topsheet of a diaper (1.5 g) × the number of diapers used per day (12 sheets) × skin absorption rate (0.005–0.1)/average body weight (2.9 kg). For hazard assessment, we used 0.2–300 mg/kg/day for the seven phthalates based on the data available at international agencies. The margin of exposure to the seven phthalates was 6.71 × 104–1.99 × 1011, indicating that the risk of exposure to phthalates from the diapers produced in Japan was negligible.

Assessment of Gardening Wastes as a Co-Substrate for Diapers Degradation by the Fungus Pleurotus ostreatus

Waste with high biomass content generated in cities in developing countries is sent to landfills or open dumps. This research aims to degrade biomass content in urban waste through cultivation, at pilot scale, of the edible mushroom Pleurotus ostreatus. First, the number of diapers used by one baby per week was measured with a survey in day care facilities. Then, cellulose content of diapers was assessed. Finally, cultivation of P. ostreatus was carried out using as substrate a mixture of diapers with gardening waste, a co-substrate readily available at urban settings. The factors assessed were strain of P. ostreatus (grey BPR-81, white BPR-5), conditioning of the substrate (diapers with and without plastic) and co-substrate (wheat straw, grass, and withered leaves). Results show that diapers are a valuable source of biomass, as generation of diapers with urine is 15.3 kg/child/month and they contain 50.2% by weight of cellulose. The highest reductions in dry weight and volume (&gt;64%) of substrates was achieved with the substrate diaper without plastic and co-substrate wheat straw. Although diapers with plastic and grass and leaves showed lower degradation, they achieved efficiencies that make them suitable as a co-substrate (&gt;40%), considering that their biomass is currently confined in landfills.

Electrostimulation, response of the pelvic floor muscles, and urinary incontinence in elderly patients post prostatectomy

Objective to investigate the response of the pelvic floor muscles (PFM), and urinary incontinence (UI), in patients having undergone a prostatectomy, after treatment using electrical stimulation. Materials and methods this observational study was conducted in an outpatient urogynecologic physical therapy clinic of Hospital dos Servidores in Rio de Janeiro, Brazil from August to September 2012. Ten patients (aged, 64 ± 7 years) with urinary incontinence resulting from radical prostatectomy, having received surgery within six months of study entry, without urinary infection, and without metallic implants underwent electrical stimulation of the PFM, while in lateral decubitus position with knees and hips flexed. The parameters used were 65 Hz frequency, pulse width of 500 µs, biphasic current, intensity according to the tolerance level reported by the patient, perineal contraction time of four seconds, and rest time of eight seconds for 20 minutes twice a week, totaling 16 sessions of electrical stimulation with active-assisted contraction. Patients were evaluated before and after electrical stimulation through physical therapy evaluation of urinary incontinence, by being asked about the number of disposable guards used daily, using a visual analogue scale (VAS) to measure how the UI interfered with activities of daily living, and by electromyographic biofeedback to measure the work of the PFM. Data were analyzed using Student’s paired t-tests and a significance level of 0.05. Results after 16 sessions of electrical stimulation, the electromyographic biofeedback evaluation showed a significant increase in muscle strength of 10.73 ± 8.64 to 17.16 ± 9.00 µV (t = -3.39, P = 0.008), a significant decrease in the number of diapers used before and after treatment (3.9 ± 1.2 to 1.8 ± 1.5, respectively; t = 5.16, P = 0.0006), and a significant decrease in the interference of urinary incontinence on daily activities of 9.6 ± 0.5 to 4.0 ± 3.8 (t = 5.15, P = 0.0006). Conclusion electrical stimulation may represent a novel way to strengthen the pelvic floor muscles and decrease urinary incontinence resulting from radical prostatectomy.

LCA-measured environmental improvements in Pampers® diapers

The aim of this study was to investigate the factors that influence the sustainability of disposable baby diapers (nappies) using life cycle assessments (LCAs). Size 4 Pampers® Cruisers (North American name) and ActiveFit (European name) from 2007 are compared to new versions made in 2010 to determine if the design and materials changes intended to improve performance also lead to reductions in the most relevant environmental indicators. Cradle-to-grave LCAs, consistent with ISO 14040/14044 Standards, are conducted. The functional unit is “the number of diapers needed to collect excreta over a child’s diapering lifetime.” Input data come from P&G, suppliers, trade association reports, Franklin and ecoinvent databases, and Google. SimaPro 7 is used to model the LCA. Several life cycle impact assessments (LCIA) methods, sensitivity analyses, normalization to annual consumption, and Monte Carlo analysis are used to produce and check results. The consumption normalization identified that the diaper’s “environmental footprint” should include the IMPACT2002+ indicators: nonrenewable energy, global warming potential (GWP), respiratory effects from inorganics, total solid waste, and cumulative energy demand (CED). Other indicators are insignificant. Contribution analysis shows that the sourcing and production of diaper materials contribute most to the environmental indicators evaluated, accounting for ∼84% of all non-renewable energy uses and ∼64% of global warming potential. Diaper disposal is a small contributor (1–12%) to potential environmental impacts. Reductions observed for the 2010 US product are: CED—8%, solid waste—12%, non-renewable energy—1%, GWP500—4%, and respiratory inorganics—6%. For the European product, reductions are: CED—11%, solid waste—8%, non-renewable energy—3%, GWP500—5%, and respiratory inorganics—14%. The new Pampers® diapers sold in the USA and Europe have a reduced environmental footprint versus the previous versions (2007). Significant reductions are achieved in non-renewable energy use and global warming potential, as well as other environmental indicators by optimizing the diaper design and the materials. Although some of the results are single digit reductions, Monte Carlo analysis indicates that there is a high probability that the differences are real. The use of multiple LCIA methods to compare products is helpful to confirm consistency of results. Normalizing the LCIA scores to annual consumption also helps prioritize which environmental indicators can be impactful and affected by changing a product.

Is an Anal Plug Useful in the Treatment of Fecal Incontinence in Children With Spina Bifida or Anal Atresia?

We evaluated the efficacy and tolerance of the Conveen anal plug in children with spina bifida or anal atresia with persistent fecal incontinence necessitating diapers despite bowel management. Seven 4 to 12-year-old patients with high congenital imperforate anus and 9 who were 6 to 13 years old with spina bifida, no mental retardation and no involuntary urine loss on clean intermittent catheterization were included in the study. During a prospective, 6-week crossover descriptive study after a test period to find the most comfortable plug with a diameter of 37 or 45 mm patients and parents completed a diary with the number of soiling episodes, stool frequency, stool consistency and the number of diapers used during 3 weeks without and with the plug, respectively. They provided a final assessment of the device. Two of the 7 patients with congenital imperforate anus discontinued use because of pain and discomfort, 1 had a decrease in soiling episodes and 4 achieved full continence and needed no diapers while using 2 plugs daily (range 1 to 4). All patients preferred the smaller plug. Two of the 9 patients with spina bifida always lost the plug within 1 hour after introduction, 5 had a decrease in soiling episodes but continued to need diapers and 2 achieved full continence using 2 plugs daily (range 1 to 4). All patients preferred the larger plug. The Conveen anal plug is an adjuvant treatment option for fecal incontinence in children with congenital imperforate anus or spina bifida, enabling a minority to stop using diapers. The Conveen anal plug is not a universal solution for fecal incontinence problems in these patients.

Neural Stimulation for Chronic Voiding Dysfunctions

Neural stimulation of the sacral nerve roots could become an acceptable and promising modality in controlling variable forms of difficult voiding dysfunctions. A total of 50 patients who presented with various forms of voiding dysfunction underwent initial screening by percutaneous nerve evaluation of the S3 nerve root guided by movements of the levator ani and toes. Only 17 patients demonstrated a satisfactory response to percutaneous nerve evaluation and subsequent subchronic wire testing for 4 to 5 days, and they were eligible to enter the study. The studied patients (13 women and 4 men) were classified into 2 groups according to presentation. Group 1 included 8 patients who presented mainly with nonobstructive chronic urinary retention. All 8 patients were on intermittent self-catheterization except 1 with a suprapubic tube. The 9 patients in group 2 mainly presented with other forms of voiding dysfunctions, including pain (suprapubic and perineal), frequency and/or urgency. All patients were neurologically free, and had failed pharmacological and surgical attempts to correct the problems. In both groups radiological and ultrasound evaluations of the urinary tract as well as cystourethroscopy were within normal limits. Urodynamic studies were performed preoperatively and postoperatively. Unilateral S3 foramen implantation was performed on the selected side in all patients. Followup ranged from 3 to 52 months.All patients were followed preoperatively and postoperatively by voiding and itemized symptom score diary as well as a quality of life questionnaire. Each symptom and question were given certain grades that reflect the severity or importance to the patient. The symptom scores and the quality of life questionnaires were analyzed preoperatively and postoperatively.In group 1 voided volume (expressed as a percentage of total bladder capacity) was significantly increased at 6 months (23 ± 7.5% preoperatively versus 81.9 ± 7.7% postoperatively, p <0.05) and, accordingly, residual volume (also expressed as a percentage of total bladder capacity) was significantly decreased. The maximum flow rate increased to 18.0 ± 2.6ml. per second postoperatively compared to 7.8 ± 3.1ml. per second preoperatively. The number of intermittent self-catheterizations per day decreased to 1.3 ± 0.8 compared to 4.2 ± 0.6 preoperatively (p <0.05). Uninhibited bladder contractions with vesicosphincteric dyssynergia disappeared in 1 patient, while they persisted in 1 for up to 6 months.In group 2 the average improvement in pain and difficulty to start voiding was 85%, frequency improved by 37%, urgency by 42%, and leaking episodes and number of diapers per day decreased by 50%. Uninhibited bladder contractions disappeared in 1 patient within 6 months. No significant difference was observed in any of the other urodynamic parameters. The impact of voiding problem on patient activities and quality of life was considerably improved. The appliance was well tolerated with no serious complication. The prosthesis was removed in 1 patient due to local pain at the site of the pulse generator. We believe that neural stimulation is a valid option in treating select cases of voiding dysfunction.

Diaper care in nurseries.

The problem of control of so-called epidemic diarrhea in nurseries for newborn infants and in nurseries for sick infants is quite unsolved. The causative organism is not surely known, and its mode of transmission from patient to patient is undetermined. Whatever is revealed by future studies, it is obvious that prevention of the spread of enteric organisms will always be of prime importance. The care of fecal excretions and the laundering of diapers is a very great problem in any nursery or infant ward, and the usual programs, if safe, are both expensive and elaborate. The problem of the preliminary removal of the gross fecal material from diapers before laundering is itself disagreeable, expensive, and dangerous, since all manual techniques involve some degree of splashing and increased risk of spreading disease by droplets, even if carried out at some distance from the nurseries. The number of diapers that must be