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      Prevalence and risk factors of nocturnal enuresis among children ages 5–12 years in Xi’an, China: a cross-sectional study

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          Abstract

          Background

          Nocturnal enuresis (NE) has a negative impact on children’s health and imposes a long-term burden on families. With economic development and cultural improvements, parents and medical professionals pay more attention to NE. The aim of this study was to investigate the prevalence and risk factors of NE among children ages 5–12 years in Xi’an, China.

          Methods

          A stratified cluster sampling method was used to conduct a cross-sectional study of NE in 10 kindergartens and 20 primary schools in Xi’an. We used univariate analysis to compare the prevalences of characteristics such as gender, duration of disposable diaper (DD) use, toilet training onset time, daily living habits, academic performance, and family history of NE. Logistic regression analysis was used to calculate odds ratio and to determine risk factors of NE.

          Results

          The study included 6568 children ages 5–12 years, of which 262 (3.99%) had NE. The prevalence rates of NE decreased with age, with the highest prevalence at age 5 (9.09% for boys; 6.03% for girls). However, the prevalence increased with duration of DD use. Children experienced more NE if they never accepted toilet training (7.83%) or if they drank sugary beverages during the day (5.36%). Sleep disorders, sweets intake, drinking low amounts of plain water during the day, and family history of NE, were statistically associated with NE.

          Conclusion

          NE was closely associated with a family history of NE, being male, long-term use of DD, delayed toilet training, drinking sugary beverages and/or consuming little plain water, and sleep disorders. A supportive parental attitude towards NE and timely medical treatment can improve the quality of life of enuretic children.

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          Most cited references29

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          Neural control of micturition in humans: a working model.

          Results from functional brain scanning have shown that neural control of the bladder involves many different regions. Yet, many aspects of this complex system can be simplified to a working model in which a few forebrain circuits, acting mainly on the midbrain periaqueductal grey (PAG), advance or delay the triggering of the voiding reflex and generate bladder sensations according to the volume of urine in the bladder, the safety of voiding and the emotional and social propriety of doing so. Understanding these circuits seems to offer a route to treatment of conditions, such as urgency incontinence or overactive bladder, in patients without overt neurological disease. Two of these circuits include, respectively, the medial prefrontal cortex and the parahippocampal complex, as well as the PAG. These circuits belong to a well-known network that is active at rest and deactivated when attention is required. Another circuit, comprising the insula and the midcingulate or dorsal anterior cingulate cortex, is activated by bladder filling and belongs to a salience network that generates sensations such as the desire to void. Behavioural treatments of urgency incontinence lead to changes in brain function that support the working model and suggest the mechanism of this type of treatment.
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            The impact of media use on sleep patterns and sleep disorders among school-aged children in China.

            To determine the amount of television viewing and computer use in urban school-aged Chinese children, and to examine their associations with sleep/wake patterns, duration of sleep, and sleep disorders. Students representing 8 Chinese cities were studied during November and December 2005. A total of 19,299 elementary-school children, 49.7% boys and 50.3% girls, with a mean age of 9.00 years, participated in the survey. A parent-administered questionnaire and the Chinese version of the Children's Sleep Habits Questionnaire were completed to quantify media use and to characterize sleep patterns and sleep disturbances. A television or computer was present in the bedroom of 18.5% and 18.3% of Chinese school-aged children, respectively. Media presence in the bedroom and media use were positively correlated with later bedtimes, later awakening times, and a shorter duration of sleep during weekdays and weekends. They were also significantly associated with at least 2 types of sleep disturbances. Overall, the most affected sleep behaviors were bedtime and awakening time on the weekends, the duration of sleep during the weekdays, and sleep disorders of bedtime resistance and sleep anxiety. Television viewing > or = 2 hours/day on weekends, with a prevalence of 48.8%, was the predominant risk factor for all sleep disorders with the exception of the sleep duration disorder. Computer use, however, had no correlation with any sleep disorder. The presence of media in a child's bedroom and media use had a negative effect on children's sleep/wake patterns, duration of sleep, and sleep disorders.
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              Differences in characteristics of nocturnal enuresis between children and adolescents: a critical appraisal from a large epidemiological study.

              To evaluate any differences in the characteristics of primary nocturnal enuresis (PNE) between younger enuretic children and adolescents. In all, 21 000 questionnaires designed to determine the presence or absence of bed-wetting, diurnal incontinence, frequency of wetting, systemic illness, and family history, were sent to children aged 5-19 years from 67 kindergartens, primary schools and secondary schools randomly selected by a computer from different areas in Hong Kong. In addition, questions were asked to evaluate when and how the parents became aware that bed-wetting is a significant medical problem deserving attention in children after the age of 5 years. Of the 21,000 questionnaires distributed, 16 512 (78.6%) were completed. Among the respondents, 512 children (302 boys, 210 girls) had PNE; of these, 106 (20.7%) also had daytime incontinence. There was a marked reduction in the overall prevalence of PNE with advancing age. At 5 years old, 16.1% of children had PNE (20.7% boys, 10.8% girls; at age 9 and 19 years, 3.14% and 2.2% of children had PNE, respectively. However, this reduction was significantly more apparent among those with mild enuretic symptoms (wet 10 years had daytime urinary incontinence than had enuretic children aged 10 years and adolescents have significantly more daytime urinary symptoms and incontinence. The previously reported low prevalence of PNE in Hong Kong was probably due to parental indifference to the problem.
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                Author and article information

                Contributors
                epiwuqian@163.com
                j92106@sina.com
                Journal
                BMC Pediatr
                BMC Pediatr
                BMC Pediatrics
                BioMed Central (London )
                1471-2431
                22 June 2020
                22 June 2020
                2020
                : 20
                : 305
                Affiliations
                [1 ]GRID grid.43169.39, ISNI 0000 0001 0599 1243, Department of Epidemiology and Biostatistics, , School of Public Heath, Xi’an Jiaotong University, ; No.76 West Yanta Road, Xi’an, 710061 Shaanxi China
                [2 ]GRID grid.452438.c, Department of Renal Dialysis, , The First Affiliated Hospital of Xi’an Jiaotong University, ; No.277 West Yanta Road, Xi’an, 710061 Shaanxi China
                [3 ]GRID grid.43169.39, ISNI 0000 0001 0599 1243, Department of Nephrology, , The Affiliated Children Hospital of Xi’an Jiaotong University, ; No.69 Xijuyuan Lane, Xi’an, 710002 Shaanxi China
                [4 ]GRID grid.440201.3, ISNI 0000 0004 1758 2596, Department of Breast Cancer, , Shaanxi Tumor Hospital, ; No.309 West Yanta Road, Xi’an, 710061 Shaanxi China
                [5 ]GRID grid.43169.39, ISNI 0000 0001 0599 1243, Department of Dermatology, , The Affiliated Children Hospital of Xi’an Jiaotong University, ; No.69 Xijuyuan Lane, Xi’an, 710002 Shaanxi China
                [6 ]GRID grid.43169.39, ISNI 0000 0001 0599 1243, Department of Pediatric intensive care unit, , The Affiliated Children Hospital of Xi’an Jiaotong University, ; No.69 Xijuyuan Lane, Xi’an, 710002 Shaanxi China
                [7 ]GRID grid.43169.39, ISNI 0000 0001 0599 1243, Shaanxi Institute of Pediatric Diseases, , The Affiliated Children Hospital of Xi’an Jiaotong University, ; No.69 Xijuyuan Lane, Xi’an, 710002 Shaanxi China
                Author information
                http://orcid.org/0000-0002-0223-1385
                Article
                2202
                10.1186/s12887-020-02202-w
                7310244
                32571248
                d4f67aa8-9472-4152-91ef-8615c976e086
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 5 March 2020
                : 12 June 2020
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Pediatrics
                nocturnal enuresis,children,prevalence,risk factors
                Pediatrics
                nocturnal enuresis, children, prevalence, risk factors

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