RESUMO
OBJECTIVE: The aim of the present study was to examine the relationship between nocturnal enuresis (NE) of childhood and nocturia of parents. MATERIAL AND METHODS: The study was conducted across the network of general pediatricians of the ASL NA 1 of Naples, Italy. All the children with NE and their mothers were invited to attend the clinic for the study. Data were collected by personal interview. A 5-day bladder diary was collected from all the children. The mothers with nocturia were given a 3-day frequency-volume chart to assess the presence of nocturnal polyuria or reduced bladder capacity. Both children and mothers underwent a bladder ultrasound scan to measure the bladder wall thickness. RESULTS: A total of 224 mothers (aged between 23 and 45 years, average 33.3±4.1 years) and their 225 children (aged between 7 and 13 years, average 8.35±1.81 years) were investigated. Of the 224 mothers, 90 (40%) had nocturia, of which 55 (61%) clearly remembered that they had suffered from NE in childhood. Only 4 (11%) out of the 35 women without nocturia had NE (p<0.001). Children with persistence of NE beyond 11 years were more likely to have a parent with nocturia. Children with non-monosymptomatic NE were more likely to have mothers with nocturia (odds ratio (OR) 1.7, 95% confidence interval (CI) 1.2-7.1, p<0.01) or overactive bladder symptoms (OR 1.9, 95% CI 1.1-15.2, p<0.01). CONCLUSION: These data suggest that there is a link between NE in childhood and nocturia in adulthood. A strong relationship was found between overactive bladder in children and overactive bladder in their mothers.
RESUMO
BACKGROUND: In an attempt to reduce the burden of influenza-like illness (ILI) on health resources, the Italian Ministry of Health released clinical practice guidelines (CPGs) on ILI management that include specific indications for the admission of children to the hospital. The aim of this study was to evaluate whether application of these CPGs reduced the rate of inappropriate hospital admissions. METHODS: In the first phase, 2 independent observers recorded the number and clinical condition of children presenting with ILI to the emergency department (ED) of a large urban pediatric hospital and the main reasons for hospital admission. The latter were compared with the CPG indications for hospital admission to evaluate appropriateness. One year later (phase 2), we recorded the number of children with ILI admitted to the hospital by pediatricians trained in a 3-hour course on CPGs and by "untrained" control pediatricians. RESULTS: In phase 1 of the study, 854 children accessed the ED; 318 (37.2%) had ILI. Of the latter, 26.2% were admitted to the hospital, and 33.7% of admissions were inappropriate according to CPG criteria. In phase 2, 16% of the children with ILI were admitted by CPG-trained pediatricians and 25.8% by control pediatricians. The number of inappropriate hospital admissions was higher among control than among CPG-trained pediatricians. CONCLUSIONS: ILI in children is associated with a high rate of inappropriate hospital admissions. Training of ED pediatricians in the application of a specific CPG may result in a substantial decrease of the admission rate and of inappropriate admissions.
