Denise M. Mota

Investigação de disfunção miccional em uma amostra populacional de crianças de 3 a 9 anos

OBJETIVO: Descrever os habitos miccionais e suas disfuncoes em uma amostra populacional de criancas de 3 a 9 anos. METODOS: Delineamento transversal, incluindo 580 criancas. Uma amostra probabilistica de domicilios da zona urbana da cidade de Pelotas (RS) foi selecionada em multiplos estagios. Os habitos miccionais e fecais foram avaliados com o escore de disfuncao miccional proposto por Farhat et al. e modificado pela equipe de pesquisa com acrescimo do sintoma frequencia urinaria superior a oito vezes ao dia. Os meninos com pontuacao maior que oito e as meninas com pontuacao maior que cinco foram reavaliados clinicamente, assim como uma subamostra dos demais. RESULTADOS: Os sintomas miccionais mais frequentes foram nocturia (60,4%), urgencia miccional (49,7%) e manobras de contencao (42,1%). A prevalencia de enurese foi de 20,1% em meninos e 15,1% em meninas. A prevalencia de disfuncao miccional pelo escore Farhat et al. foi de 24,2%. A maioria dos sintomas foi mais frequente entre as meninas e entre criancas mais jovens. As meninas de nivel economico baixo apresentaram maior frequencia de enurese e forca para urinar, enquanto que, entre os meninos, a urgencia miccional foi mais comum entre os mais pobres. Apenas 10,5% dos pais de criancas com disfuncao haviam levado seu filho ao medico por causa dos sintomas. CONCLUSOES: Os sintomas miccionais apresentam prevalencias altas e devem ser investigados ativamente nas consultas de rotina, com perguntas diretas sobre cada sintoma isoladamente, objetivando o diagnostico de disfuncao miccional.

Infant mortality in three population-based cohorts in Southern Brazil: Trends and differentials

We studied time trends in infant mortality and associated factors between three cohort studies carried out in Pelotas, Rio Grande do Sul State, Brazil, in 1982, 1993, and 2004. All hospital births and deaths were determined by means of regular visits to hospitals, registrars offices, and cemeteries. This data was used to calculate neonatal, post-neonatal, and infant mortality rates per thousand live births. Rates were also calculated according to cause of death, sex, birth weight, gestational age, and family income. The infant mortality rate fell from 36.4 per 1,000 live births in 1982 to 21.1 in 1993 and 19.4 in 2004. Major causes of infant mortality in 2004 were perinatal causes and respiratory infections. Mortality among low birth weight children from poor families fell 16% between 1993 and 2004; however, this rate increased by more than 100% among high-income families due to the increase in the number of preterm deliveries in this group. The stabilization of infant mortality in the last decade is likely to be due to excess medical interventions relating to pregnancies and delivery care.

Bed-Sharing at 3 Months and Breast-Feeding at 1 Year in Southern Brazil

Objective To investigate the association between bedsharing at age 3 months and breastfeeding (BF) at age 12 months. Study design Almost all children born in Pelotas, Brazil in 2004 (99.2%) were enrolled in a cohort study. At birth, age 3 months, and age 12 months, mothers were interviewed to gather information on sociodemographic, reproductive, BF, and bedsharing characteristics. Bedsharing was defined as habitual sharing of a bed between mother and child for the entire night or part of the night. The analysis was limited to children from single births who were breastfed at 3 months. Multivariate analyses were carried out using Poisson regression. Results Of 4231 live births, 2889 were breastfed at age 3 months. The prevalence of BF at age 12 months was 59.2% in the children who bedshared at 3 months and 44% in those who did not (adjusted prevalence ratio [PR] for weaning= 0.75; 95% confidence interval [CI] = 0.69-0.81; P < .001). Among children who were exclusively breastfed at 3 months, 75.1% of those who also bedshared were still breastfed at age 12 months, versus 52.3% of those who did not bedshare (adjusted PR = 0.63; 95% CI = 0.53- 0.75; P < .001). The adjusted PR was 0.74 (95% CI = 0.60-0.90; P = .003) in children who were predominantly breastfed and 0.83 (95% CI = 0.76-0.90; P < .001) in those who were partially breastfed. Conclusions Bedsharing at 3 months protected against weaning up to age 12 months.

Toilet training: situation at 2 years of age in a birth cohort.

OBJECTIVES Acquisition of bladder and bowel control is influenced by physiological, psychological and sociocultural factors. The objective of this study was to evaluate the prevalence of children out of diapers by 24 months of age and the factors associated with this finding. METHODS A total of 3,281 children born in Pelotas, RS, Brazil in 2004 were enrolled on a longitudinal study. At 24 months their mothers were visited at home and replied to a questionnaire containing questions about sociodemographic data and the characteristics of their childrens urinary and intestinal evacuation habits, with special attention to toilet training. Multivariate analyses were carried out using Poisson regression. RESULTS From the total, 24.3% were out of diapers during the day, with the female sex predominating (27.8 vs. 21.1%, p < 0.001) and 8.6% were out of diapers at night, also with the female sex predominating (10.6 vs. 6.8%, p < 0.001). The abilities needed to start toilet training were present in 85.5% of the children. Guidance was received from a pediatrician in 10% of cases, and more frequently among richer mothers than among poorer mothers (22.9 vs. 4.8%). Mothers who spent more years in education (13.2%) and were from higher social classes (14%) took their children out of diapers later; a greater number of children living at home (relative risk = 1.32) and being able to communicate the need to go to the toilet (relative risk = 11.74) both increased the probability of being out of diapers; previous unsuccessful attempts delayed removal of diapers (relative risk = 0.59). CONCLUSIONS Although the abilities needed for acquisition of bladder and bowel control were already present at 24 months, indicating that toilet training could be started, the majority of children had not yet started this training. Better-informed mothers delayed training the most.

Epidemiology of co-sleeping and nighttime waking at 12 months in a birth cohort

OBJECTIVE To investigate the prevalence and factors associated with co-sleeping and nighttime waking among the children of the Pelotas 2004 cohort at 12 months of age. METHODS All children born in the city of Pelotas, RS, Brazil during 2004 were enrolled on a longitudinal study. Mothers were interviewed at delivery and once more at 12 months of age to obtain information on their sociodemographic and reproductive characteristics and on their childrens sleep and the environment in which their children sleep. Co-sleeping was defined as habitually sharing the bed with another person. Multivariate analysis was performed using Poisson regression. RESULTS The prevalence of co-sleeping at 12 months was 45.8% (95%CI 44.2-47.3). Co-sleeping was more common among mothers with low socioeconomic status, less education, younger mothers, mothers with more previous births and among children who wake at night. The prevalence of nighttime waking was 46.1% (95%CI 44.6-47.7). Nighttime waking was more common among boys and among the offspring of mothers who had had a greater number of previous pregnancies and of mothers who had been employed while pregnant. CONCLUSION Co-sleeping and nighttime waking are common among this study population, indicating a need to continue follow-up in order to observe how long these habits persist through childhood and to investigate their consequences for child development and behavior.

Gestational age at birth and morbidity, mortality, and growth in the first 4 years of life: findings from three birth cohorts in Southern Brazil

BackgroundWe assessed anthropometric status, breastfeeding duration, morbidity, and mortality outcomes during the first four years of life according to gestational age, in three population-based birth cohorts in the city of Pelotas, Southern Brazil.MethodsTotal breastfeeding duration, neonatal mortality, infant morbidity and mortality, and anthropometric measures taken at 12 and 48 months were evaluated in children of different gestational ages born in 1982, 1993 and 2004 in Southern Brazil.ResultsBabies born <34 weeks of gestation and those born between 34–36 weeks presented increased morbidity and mortality, were breastfed for shorter periods, and were more likely to be undernourished at 12 months of life, in comparison with the 39–41 weeks group. Children born with 37 weeks were more than twice as likely to die in the first year of life, and were also at increased risk of hospitalization and underweight at 12 months of life. Post-term infants presented an increased risk of neonatal mortality.ConclusionThe increased risks of morbidity and mortality among preterm (<37 weeks of gestation) and post-term (>41 weeks) are well known. In our population babies born at 37 also present increased risk. As the proportion of preterm and early term babies has increased markedly in recent years, this is a cause for great concern.

Aquisição do controle esfincteriano em uma coorte de nascimentos: situação aos 2 anos de idade

OBJECTIVES: Acquisition of bladder and bowel control is influenced by physiological, psychological and sociocultural factors. The objective of this study was to evaluate the prevalence of children out of diapers by 24 months of age and the factors associated with this finding. METHODS: A total of 3,281 children born in Pelotas, RS, Brazil in 2004 were enrolled on a longitudinal study. At 24 months their mothers were visited at home and replied to a questionnaire containing questions about sociodemographic data and the characteristics of their childrens urinary and intestinal evacuation habits, with special attention to toilet training. Multivariate analyses were carried out using Poisson regression. RESULTS: From the total, 24.3% were out of diapers during the day, with the female sex predominating (27.8 vs. 21.1%, p < 0.001) and 8.6% were out of diapers at night, also with the female sex predominating (10.6 vs. 6.8%, p < 0.001). The abilities needed to start toilet training were present in 85.5% of the children. Guidance was received from a pediatrician in 10% of cases, and more frequently among richer mothers than among poorer mothers (22.9 vs. 4.8%). Mothers who spent more years in education (13.2%) and were from higher social classes (14%) took their children out of diapers later; a greater number of children living at home (relative risk = 1.32) and being able to communicate the need to go to the toilet (relative risk = 11.74) both increased the probability of being out of diapers; previous unsuccessful attempts delayed removal of diapers (relative risk = 0.59). CONCLUSIONS: Although the abilities needed for acquisition of bladder and bowel control were already present at 24 months, indicating that toilet training could be started, the majority of children had not yet started this training. Better-informed mothers delayed training the most.

Prevalence of enuresis and urinary symptoms at age 7 years in the 2004 birth cohort from Pelotas, Brazil

OBJECTIVE To determine the prevalence of enuresis, urinary, and bowel symptoms and associated factors in children aged 7 years in a birth cohort. METHODS A pre-coded questionnaire was applied to 3,602 children who belonged to a birth cohort initiated in 2004 in Pelotas, Brazil. During home visits at 12, 24, and 48 months and at age 7 years, mothers answered a questionnaire with demographic questions and characteristics of bladder and bowel habits of children using a urinary symptom score. Poisson regression was used for the hierarchical multivariable analysis, with robust variance. RESULTS The prevalence of enuresis was 10.6%;11.7% in males and 9.3% in females; enuresis was monosymptomatic in 9.8% of the children (10.8% of males and 8.3% of females); 37.4% had symptoms up to once a week; 32.9%, two to four times a week; and 26.2%, every day, with no difference between genders. The most common urinary symptoms were urinary urgency (22.7%) and urinary retention maneuvers (38.2%). In the multivariate analysis, it was observed that the number of urinary symptoms and the number of children at home showed a direct association with the presence of enuresis, whereas maternal education was inversely associated. CONCLUSIONS Enuresis is a prevalent condition and should be investigated in clinical practice, especially in children of lower socioeconomic status. A detailed history of urinary habits detects associated urinary symptoms, which is important for adequate classification of enuresis and subsequent management.

Avaliação longitudinal do controle esfincteriano em uma coorte de crianças Brasileiras

OBJETIVOS: Avaliar a trajetoria do controle esfincteriano em uma coorte de nascimento. METODO: Quatro mil duzentos e trinta e uma criancas nascidas no ano de 2004, em Pelotas, RS, foram incluidas em um estudo longitudinal. Em visitas domiciliares realizadas aos 12, 24 e 48 meses, as maes responderam a um questionario com questoes sociodemograficas, caracteristicas dos habitos miccionais e intestinais das criancas, com atencao ao treinamento esfincteriano. RESULTADOS: Aos 48 meses, a maioria das criancas estava sem fraldas durante o dia (98,5%) e a noite (83%), sem diferenca entre os sexos. A idade media de inicio de treinamento esfincteriano foi 22 meses, com inicio mais precoce nas meninas. A duracao media do treinamento foi de 3,2 meses, sem diferenca entre os sexos. Criancas com atraso de desenvolvimento apresentaram controle esfincteriano mais tardio, havendo relacao direta entre a intensidade do desvio da normalidade e a idade da retirada de fraldas. A orientacao medica foi fornecida a 15,9% das maes. O treinamento iniciado antes dos 24 meses esteve relacionado com uma maior idade de controle esfincteriano e maior duracao do treinamento. Criancas prematuras ou com baixo peso nao apresentaram diferenca significativa no tempo de treinamento e idade de aquisicao do controle esfincteriano. CONCLUSOES: Ate os quatro anos de idade, a maioria das criancas, inclusive prematuros e de baixo peso ao nascer, obtem controle esfincteriano independentemente de fatores externos e do sexo. O inicio do treinamento (antes dos 24 meses) nao antecipou o controle esfincteriano, apenas prolongou o tempo de treinamento.

Epidemiologia do co-leito e do despertar noturno aos 12 meses de idade em uma coorte de nascimentos

OBJECTIVE: To investigate the prevalence and factors associated with co-sleeping and nighttime waking among the children of the Pelotas 2004 cohort at 12 months of age. METHODS: All children born in the city of Pelotas, RS, Brazil during 2004 were enrolled on a longitudinal study. Mothers were interviewed at delivery and once more at 12 months of age to obtain information on their sociodemographic and reproductive characteristics and on their childrens sleep and the environment in which their children sleep. Co-sleeping was defined as habitually sharing the bed with another person. Multivariate analysis was performed using Poisson regression. RESULTS: The prevalence of co-sleeping at 12 months was 45.8% (95%CI 44.2-47.3). Co-sleeping was more common among mothers with low socioeconomic status, less education, younger mothers, mothers with more previous births and among children who wake at night. The prevalence of nighttime waking was 46.1% (95%CI 44.6-47.7). Nighttime waking was more common among boys and among the offspring of mothers who had had a greater number of previous pregnancies and of mothers who had been employed while pregnant. CONCLUSION: Co-sleeping and nighttime waking are common among this study population, indicating a need to continue follow-up in order to observe how long these habits persist through childhood and to investigate their consequences for child development and behavior.