RESUMEN
BACKGROUND AND OBJECTIVES: The development of child day care is currently the focus of a public discussion. More and more very young children are cared for in a day-care facility rather than by the family. Therefore, key aspects of education are shifted into these institutions. The aim of this survey was to inquire about the current situation of drinking and voiding management in day-care facilities in the district of Garmisch-Partenkirchen. MATERIALS AND METHODS: In all, 322 questionnaires were sent to employees of 40 child day-care facilities. Organization of drinking and voiding behavior advices and personal assessments of continence education were queried. The evaluation was carried out anonymously. RESULTS: A total of 29 facilities (73%) replied. The average fluid intake was 260â¯ml (50-750â¯ml) at 12 o'clock in all day-care facilities included. The possibility to decide when to have breakfast and when to drink according to the individual thirst is practised in 43% (62/143) of the facilities. A fixed amount of fluid intake was offered by 11% (16/150) of the institutions. Of those responding, 92% (139/151) specifically send the children to the toilet, while 85% of the participants consider a continence education concept would be useful. CONCLUSION: According to a general trend, children attend day-care facilities earlier and spend more time there. This means that educational staff are taking care of children who are not yet continent. A verifiable continence educational concept does not exist in any of the institutions surveyed; however, most participants would favor such a concept. It would be desirable to establish an interprofessional health education program in which drinking and voiding training is integrated according to national recommendations.
Asunto(s)
Educación en Salud , Promoción de la Salud , Niño , Guarderías Infantiles , Preescolar , Humanos , Proyectos Piloto , Encuestas y Cuestionarios , Incontinencia UrinariaRESUMEN
Esophageal atresia with or without tracheoesophageal fistula (EA/TEF) and anorectal malformations (ARM) represent the severe ends of the fore- and hindgut malformation spectra. Previous research suggests that environmental factors are implicated in their etiology. These risk factors might indicate the influence of specific etiological mechanisms on distinct developmental processes (e.g. fore- vs. hindgut malformation). The present study compared environmental factors in patients with isolated EA/TEF, isolated ARM, and the combined phenotype during the periconceptional period and the first trimester of pregnancy in order to investigate the hypothesis that fore- and hindgut malformations involve differing environmental factors. Patients with isolated EA/TEF (n = 98), isolated ARM (n = 123), and the combined phenotype (n = 42) were included. Families were recruited within the context of two German multicenter studies of the genetic and environmental causes of EA/TEF (great consortium) and ARM (CURE-Net). Exposures of interest were ascertained using an epidemiological questionnaire. Chi-square, Fisher's exact, and Mann-Whitney U-tests were used to assess differences between the three phenotypes. Newborns with isolated EA/TEF and the combined phenotype had significantly lower birth weights than newborns with isolated ARM (P = 0.001 and P < 0.0001, respectively). Mothers of isolated EA/TEF consumed more alcohol periconceptional (80%) than mothers of isolated ARM or the combined phenotype (each 67%). Parental smoking (P = 0.003) and artificial reproductive techniques (P = 0.03) were associated with isolated ARM. Unexpectedly, maternal periconceptional multivitamin supplementation was most frequent among patients with the most severe form of disorder, i.e. the combined phenotype (19%). Significant differences in birth weight were apparent between the three phenotype groups. This might be attributable to the limited ability of EA/TEF fetuses to swallow amniotic fluid, thus depriving them of its nutritive properties. Furthermore, the present data suggest that fore- and hindgut malformations involve differing environmental factors. Maternal periconceptional multivitamin supplementation was highest among patients with the combined phenotype. This latter finding is contrary to expectation, and warrants further analysis in large prospective epidemiological studies.
Asunto(s)
Malformaciones Anorrectales/etiología , Atresia Esofágica/etiología , Fístula Traqueoesofágica/etiología , Adolescente , Adulto , Consumo de Bebidas Alcohólicas/efectos adversos , Malformaciones Anorrectales/epidemiología , Peso al Nacer , Distribución de Chi-Cuadrado , Niño , Preescolar , Suplementos Dietéticos/efectos adversos , Atresia Esofágica/epidemiología , Femenino , Alemania/epidemiología , Edad Gestacional , Humanos , Lactante , Recién Nacido , Masculino , Madres/estadística & datos numéricos , Fenotipo , Embarazo , Atención Prenatal/estadística & datos numéricos , Efectos Tardíos de la Exposición Prenatal/etiología , Fenómenos Fisiologicos de la Nutrición Prenatal , Técnicas Reproductivas Asistidas/efectos adversos , Factores de Riesgo , Fumar/efectos adversos , Estadísticas no Paramétricas , Fístula Traqueoesofágica/epidemiología , Vitaminas/efectos adversosRESUMEN
BACKGROUND: In order to prevent stricture of the neoanus after surgical correction, regular dilatation is recommended. There is a lack of knowledge about the performance of anal dilatation and the occurrence of pain. The aim of our investigation was to describe the practice of dilatation and to identify possible risk factors for painful procedures. METHODS: Congenital Uro-Rectal Malformations Network is a German interdisciplinary multicenter research network. With standard questionnaires, physicians interviewed 243 patients and/or their parents at home, additional 103 patients born since 2009 were assessed through their treating physicians. RESULTS: In total, 88 % of the patients received dilatations. Treatment lasted for 7 months in median (range 1-156 months), until the age of 13 months (range 1-171 months). In 69 % painful dilatation was reported; without a significant differences in age or gender. In 32 % bleeding was reported. In 30 % at least one dilatation was performed under general anesthesia. In 11 % some kind of analgesia was used. Type of fistula, dilatations lasting longer than 10 months and Hegar size above 15 were relevant factors for experience of pain. There were about 16 % postoperative strictures of the neoanus, without reported differences in dilatation procedures; but there was a relation to type of malformation. CONCLUSION: Considering the high number of painful treatments, predictors for painful dilatations should be further clarified through standardized documentation and prospective evaluation in order to improve follow-up.