Chiozza M L, Bernardinelli L, Caione P, Del Gado R, Ferrara P, Giorgi P L, Montomoli C, Rottoli A, Vertucci P
Italian Club of Nocturnal Enuresis (CIEN), Department of Pediatrics, Padova.
Br J Urol. 1998 May;81 Suppl 3:86-9. doi: 10.1046/j.1464-410x.1998.00015.x.
To estimate the prevalence of enuresis in schoolchildren in Italy.
The Italian Club of Nocturnal Enuresis promoted a prevalence study of nocturnal enuresis using a self-administered questionnaire in seven cities in Northern, Central and Southern Italy. The association between enuresis and potential risk factors, e.g. a family history of enuresis, stress, socio-economic status and abnormal diurnal voiding habits, was investigated. The perceived impact on the child and on the family was also evaluated. A random-cluster sampling scheme was used to obtain a sample of primary and secondary schoolchildren from each city. One primary school and one secondary school for each socio-economic level was sampled in each city, giving a total of 42 schools surveyed; 9086 children were covered by the survey. In a cluster sampling method, the variance of prevalence is divided into two components, binomial and extra-binomial variability. Both the DSM III and DSM IV definitions of enuresis were used because at present, there is no consensus on the diagnostic criteria.
Completed questionnaires were received from 7012 children, an overall response rate of 77.2%. Those aged 6-14 years were analysed, restricting the sample to 6892 children. There were 250 enuretic children using the DSM III definition of enuresis and 112 using the DSM IV definition. The overall prevalence was 3.88% and showed a decreasing trend with increasing age. Bedwetting was more frequent in boys than in girls. The prevalence of enuresis was higher when the child was from a family of low socio-economic status despite the child's age group. The logistic analysis showed that familiality, stress, birthweight, age of attaining diurnal continence, soiling and, for girls, menstruation, were statistically significant variables and thus contributed to predicting the probability of bedwetting, confirming the findings of previous studies. There was a large difference in prevalence using the two DSM definitions; a high percentage of DSM III enuretic children had more than two wet nights per week.
It is important that a consensus about the 'working definitions' of enuresis is reached to avoid bias in the recruitment step, to carry out comparable epidemiological studies and to obtain adequate therapeutic responses.
评估意大利学童尿床症的患病率。
意大利夜间遗尿症俱乐部在意大利北部、中部和南部的七个城市，采用自行填写问卷的方式开展了一项夜间遗尿症患病率研究。调查了尿床症与潜在风险因素之间的关联，如尿床症家族史、压力、社会经济地位以及异常的日间排尿习惯。还评估了尿床症对儿童及其家庭的感知影响。采用随机整群抽样方案，从每个城市获取小学生和中学生样本。每个城市针对每个社会经济水平抽取一所小学和一所中学，共计调查42所学校；9086名儿童参与了此次调查。在整群抽样方法中，患病率的方差分为二项式和超二项式变异性两个部分。由于目前在诊断标准上尚未达成共识，因此同时采用了《精神疾病诊断与统计手册》第三版（DSM III）和第四版（DSM IV）对尿床症的定义。
共收到7012名儿童填写完整的问卷，总体回复率为77.2%。对6 - 14岁儿童进行分析，将样本限制为6892名儿童。按照DSM III对尿床症的定义，有250名尿床儿童；按照DSM IV的定义，有112名尿床儿童。总体患病率为3.88%，且随着年龄增长呈下降趋势。男孩尿床比女孩更频繁。尽管儿童年龄组不同，但来自社会经济地位较低家庭的孩子尿床症患病率更高。逻辑分析表明，家族性、压力、出生体重、实现日间自控的年龄、弄脏衣物以及对女孩而言的月经，都是具有统计学意义的变量，因此有助于预测尿床的可能性，这证实了先前研究的结果。使用两种DSM定义得出的患病率存在很大差异；按照DSM III定义，很大比例的尿床儿童每周尿床超过两个晚上。
重要的是就尿床症的“实用定义”达成共识，以避免在招募环节出现偏差，开展可比较的流行病学研究，并获得充分的治疗反应。
