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AIM: The functional constipation (FC) is a source of an expressive suffering in children, negatively affecting their emotional, social, and physical well-being. The objective of this study is to describe the clinical and behavioural characteristics of children/adolescents with FC. METHODS: A cross-sectional, observational, analytical study was conducted in public places by interviewing parents of children/adolescents about their child's bowel habits and psychological profile. Bowel symptoms were investigated using the Rome IV criteria. The Strengths and Difficulties Questionnaire (SDQ) was used to evaluate the emotional and behavioural problems. RESULTS: Of 799 children/adolescents included, 424 (53.1%) were female. Mean age was 9.1 ± 2.7 years. FC prevalence was 20.4%. The most common symptoms in Rome IV criteria were 'painful or hard bowel movements' (n = 110; 67.5%; 95% confidence interval: 60.0-74.3) and 'retentive posturing or excessive volitional stool retention' (n = 89; 54.6%; 95% confidence interval: 46.9-62.1). Median scores for internalising symptoms (7; interquartile range (IQR): 4-9 vs. 5; IQR: 2-7; P < 0.001) and externalising symptoms (7; IQR 4-11 vs. 6; IQR 3-9; P < 0.001) were higher in constipated children compared to non-constipated participants, respectively. The SDQ domains that were associated with FC were emotional symptoms (median 4, P < 0.001) and conduct problems (median 3, P < 0.001). No association was found between faecal incontinence and median scores for the internalising/externalising symptoms. All Rome IV criteria were associated with abnormal overall SDQ scores. CONCLUSION: Children and adolescents with FC had more emotional and behavioural problems irrespective of whether faecal incontinence was present or not, with higher scores for internalising and externalising symptoms compared to non-constipated children.

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INTRODUCTION: There is a large amount of intra and inter observer variability in defining curve shapes. This study aims to evaluate inter and intra rater reliability (RR) on evaluating uroflow curves in a broad spectrum of international practitioners. METHODS: Eight hundred sixty-four questionnaires were sent by email to health professionals that care for children with voiding dysfunction. It included demographic questions and 11 different uroflow curves and two duplicates. RESULTS: Four hundred forty-one emails were opened and 29.5% of those responded. Seventy percent of responders were physicians, including 46% pediatric urologists. Europe, South America, North America, Oceania, and Asia represented respondents. For the repeated bell smooth curve the intra rater agreement was 82.1% utilizing the International Children's Continence Society (ICCS) classification and 92.3% for the shape of the curve (bell, plateau, and tower [BPT]) (P = .04). For the repeated interrupted plateau curve it was 69.5% and 97.5% for ICCS and for the continuity of the curve (smooth or fractionated [SF]) classifications, respectively (P < .001). The curves were then divided into two groups for evaluation of inter RR. For the set of seven smooth curves, the inter RR was low in all classifications with α = .282, .497, and .242 for ICCS, SF, and BPT, respectively. The group of six fractionated curves showed a slightly better agreement with α = .533, .404, and .662 for ICCS, SF, and BPT, respectively. CONCLUSIONS: This is the largest study looking at inter and intra RR of uroflows in a disparate population of readers. It was evident from our findings that inter RR was poor and additionally intra RR was equally poor, indicating the unreliability of uroflow shapes to be used for research purposes.

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INTRODUCTION: Ureteropelvic junction obstruction (UPJO) is a common congenital anomaly leading to varying degrees of hydronephrosis (HN), ranging from no apparent effect on the renal function to atrophy. Evaluation of these children is based on Diuretic Renal Scintigraphy (DRS) and Ultrasonography (US). Recent studies have suggested that new parameters of conventional and color Doppler ultrasonography (CDUS) may be useful in discriminating which kidneys are obstructed. The present study aims to assess the diagnostic accuracy of such parameters in the diagnosis of obstruction in children with UPJO. METHODS: We evaluated 44 patients (33 boys) with a mean age of 6.53 ± 4.39 years diagnosed with unilateral high-grade hydronephrosis (SFU grades 3 and 4). All underwent DRS and index tests (conventional US and CDUS to evaluate ureteral jets frequency) within a maximum interval of two weeks. Hydronephrotic units were reclassified according to the alternative grading system (AGS) proposed by Onen et al. Obstruction in the DRS was defined as a differential renal function <40% on the affected side and/or features indicating poor drainage function like T1/2 >20 minutes after the administration of furosemide, and a plateau or ascending pattern of the excretion curve. RESULTS: Nineteen hydronephrotic units (43.1%) were obstructed. Some degree of cortical atrophy-grades 3 (segmental) or 4 (diffuse)-was present in those obstructed units. AGS grades had 100% sensitivity, 76% of specificity and 86.4% of accuracy. The absence of ureteral jets had a sensitivity of 73.68%, a specificity of 100% with an accuracy of 88.6%. When we analyzed the two aspects together and considered obstructed the renal units classified as AGS grade 3 or 4 with no jets, sensitivity increased to 78.9%, accuracy to 92%, remaining with a maximum specificity of 100%. These features combined would allow us to avoid performing DRS in 61% of our patients, leaving more invasive tests to inconclusive cases. CONCLUSIONS: Although DRS remains the mainstay to distinguishing obstructive from non-obstructive kidneys, grade of hydronephrosis and frequency of ureteral jets, independently or in combination may be a reliable alternative in the mostly cases.This alternative approach has high accuracy, it is less invasive, easily reproducible and may play a role in the diagnosis of obstruction in pediatric population.

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PURPOSE: To translate and culturally adapt the Dysfunctional Voiding Symptom Score (DVSS), questionnaire into Brazilian Portuguese. MATERIALS AND METHODS: The 10-item Dysfunctional Voiding Symptom Score (DVSS) was translated into Brazilian Portuguese according to a standard methodology: translation, synthesis, back-translation, Expert Committee, and pre-testing. After the translation process the final version was pre-tested and patient responses were analyzed to identify necessary modifications. Reliability was evaluated using the test-retest method, and internal consistency was assessed using Cronbach's alpha. RESULTS: The Cronbach's alpha coefficient was calculated in the test and retest phases. Internal consistency was found to be satisfactory, as confirmed by a Cronbach's alpha coefficient of 0.76 for the test and 0.77 for the retest. A high degree of stability was found in the test/retest, with an intraclass correlation coefficient (ICC) of 0.960 (p < 0.001; 95% CI: 0.943-0.972). CONCLUSIONS: The cross-cultural adaptation process of the Dysfunctional Voiding Symptom Score questionnaire to be used on Brazilian children was successfully completed following internationally accepted methodologies.

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PURPOSE: To translate and culturally adapt the Dysfunctional Voiding Symptom Score (DVSS), questionnaire into Brazilian Portuguese. MATERIALS AND METHODS: The 10-item Dysfunctional Voiding Symptom Score (DVSS) was translated into Brazilian Portuguese according to a standard methodology: translation, synthesis, back-translation, Expert Committee, and pre-testing. After the translation process the final version was pre-tested and patient responses were analyzed to identify necessary modifications. Reliability was evaluated using the test-retest method, and internal consistency was assessed using Cronbach’s alpha. RESULTS: The Cronbach’s alpha coefficient was calculated in the test and retest phases. Internal consistency was found to be satisfactory, as confirmed by a Cronbach’s alpha coefficient of 0.76 for the test and 0.77 for the retest. A high degree of stability was found in the test/retest, with an intraclass correlation coefficient (ICC) of 0.960 (p < 0.001; 95 percent CI: 0.943-0.972). CONCLUSION: The cross-cultural adaptation process of the Dysfunctional Voiding Symptom Score questionnaire to be used on Brazilian children was successfully completed following internationally accepted methodologies.

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Los objetivos de la visita del Ing. consultor temporario a Cochabamba puede sintetizarse en lo siguiente: Verificar el grado de desarrollo del diseno del sistema de alcantarillado. Evaluar el progreso y la alta calidad de los trabajos técnicos en relación a lo observado en anterior visita como consultor. Contribuir con su experiencia para la solución de cuestiones que se planteen en el proyecto con la participación de los profesionales locales y del ingeniero OPS/OMS Director del proyecto de proyecto residente en Cochabamba mediante la presentación de sugerencias

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Along with general observations on the importance of sanitation to economic development, the author discusses sanitation conditions in Brazil and points up the major problems faced by the country for lack of a general basic sanitation program.

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