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configura&#231;&#227;o&#44; participantes e recrutamento</span><p id="par0025" class="elsevierStylePara elsevierViewall">De acordo com a aprova&#231;&#227;o do conselho de revis&#227;o institucional &#40;&#35;943&#44;437&#44; 3 de fevereiro de 2015&#41;&#44; foi feito um estudo descritivo em um hospital&#8208;escola terci&#225;rio&#46; Esse hospital &#233; reconhecido nacionalmente como um centro especializado para tratamento de OI&#44; no qual as crian&#231;as das regi&#245;es Norte&#44; Nordeste e Centro&#8208;Oeste do Brasil s&#227;o internadas na unidade hospitalar&#46; O bifosfonato &#233; administrado durante a interna&#231;&#227;o hospitalar como um protocolo de atendimento institucional padr&#227;o&#46; Os poss&#237;veis participantes do estudo foram recrutados e inscritos durante quatro meses &#40;de fevereiro a maio de 2015&#41;&#44; enquanto eles receberam tratamento com bifosfonato no local do estudo&#46; As crian&#231;as eleg&#237;veis para participar do estudo foram aquelas&#58; &#40;a&#41; entre tr&#234;s e 18 anos&#44; &#40;b&#41; diagnosticas com qualquer tipo de OI&#44; &#40;c&#41; treinadas para ir o banheiro e &#40;d&#41; internadas em uma unidade hospitalar no local do estudo durante a coleta de dados&#46; Os principais cuidadores eleg&#237;veis para participar do estudo foram aqueles&#58; &#40;a&#41; cujos filhos atenderam aos crit&#233;rios de inclus&#227;o&#44; &#40;b&#41; que tinham mais de 18 anos e &#40;c&#41; eram os principais cuidadores da crian&#231;a durante o tempo de treinamento para usar o banheiro&#46; As crian&#231;as exclu&#237;das foram aquelas que n&#227;o foram treinadas para usar o banheiro e&#47;ou com menos de tr&#234;s anos&#46; Durante a interna&#231;&#227;o hospitalar agendada de sua crian&#231;a&#44; todos os principais cuidadores eleg&#237;veis foram inicialmente abordados por um profissional da sa&#250;de designado&#46; Quando um principal cuidador mostrou interesse&#44; um membro da equipe de pesquisa abordou os principais cuidadores para fornecer uma explica&#231;&#227;o do estudo e&#44; caso concordassem&#44; foi obtido um consentimento informado&#44; seguido do assentimento da crian&#231;a&#46; Portanto&#44; todos os participantes abordados foram inscritos para participar e recrutados&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Coleta de dados e instrumentos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Um &#250;nico assistente de pesquisa entrevistou os pares de pais&#8208;filhos de forma presencial&#44; conclui tr&#234;s instrumentos como ferramentas de coleta de dados em uma sala privada no local do estudo&#46; Vale observar que o assistente de pesquisa adotou as seguintes diretrizes de estudo para entrevistar os pares&#44; enquanto preenchiam cada um dos formul&#225;rios&#46; Os dados foram coletados basicamente a partir de um ponto de vista dos pais e foram combinados somente com o ponto de vista da crian&#231;a para problemas espec&#237;ficos relacionados aos h&#225;bitos da crian&#231;a de ir ao banheiro&#44; como frequ&#234;ncia di&#225;ria de mic&#231;&#227;o&#44; de que a maioria dos pais n&#227;o tinha conhecimento&#46; Os instrumentos consistiram no que segue&#58;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085"><span class="elsevierStyleItalic">Dysfunctional Voiding Scoring System</span> &#40;DVSS&#41;</span><p id="par0035" class="elsevierStylePara elsevierViewall">O DVSS foi usado para identificar comportamentos de mic&#231;&#227;o anormais&#46; O DVSS consiste em dez itens&#58; nove para avaliar os sintomas urin&#225;rios e intestinais e um para avaliar os problemas sociais e familiares&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> A pontua&#231;&#227;o 6 para meninas e 9 para meninos&#44; do DVSS&#44; sugere que a crian&#231;a sofre de comportamentos de mic&#231;&#227;o anormais&#46; A presen&#231;a de comportamentos de mic&#231;&#227;o anormais foi confirmada quando o participante relatou sentir um sintoma &#8220;metade do tempo&#8221; ou &#8220;quase todo o tempo&#8221; em um per&#237;odo de 30 dias&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Crit&#233;rios de Roma III para Diagn&#243;stico Cl&#237;nico da Constipa&#231;&#227;o Funcional</span><p id="par0040" class="elsevierStylePara elsevierViewall">Esse instrumento foi usado para captar uma vis&#227;o geral dos problemas intestinais da crian&#231;a&#44; em associa&#231;&#227;o com o Gr&#225;fico de Bristol para Consist&#234;ncia de Fezes&#46; A presen&#231;a de duas ou mais respostas positivas das seis perguntas indicou constipa&#231;&#227;o funcional&#46; As perguntas inclu&#237;ram&#58; &#40;1&#41; duas ou menos defeca&#231;&#245;es por semana&#59; &#40;2&#41; pelo menos um epis&#243;dio de incontin&#234;ncia fecal por semana&#59; &#40;3&#41; hist&#243;rico de reten&#231;&#227;o postural de fezes ou reten&#231;&#227;o volitiva excessiva&#59; &#40;4&#41; hist&#243;rico de evacua&#231;&#227;o de fezes duras ou com dor&#59; &#40;5&#41; presen&#231;a de massa fecal de grande dimens&#227;o no reto&#59; e &#40;6&#41; hist&#243;rico de fezes de grande dimens&#227;o que podem entupir o vaso sanit&#225;rio&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> O gr&#225;fico de Bristol para consist&#234;ncia de fezes foi usado para facilitar o entendimento dos participantes sobre a consist&#234;ncia das fezes&#46; Esse gr&#225;fico cont&#233;m um desenho de ajuda designado para classificar as fezes em sete tipos&#58; 1&#8208;2 &#40;indicativo de constipa&#231;&#227;o&#41;&#44; 3&#8208;4 &#40;fezes ideais&#41; e 5&#8208;7 &#40;indicativo de diarreia e urg&#234;ncia&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Formul&#225;rio Sociodemogr&#225;fico e Cl&#237;nico</span><p id="par0045" class="elsevierStylePara elsevierViewall">Formul&#225;rio com base no instrumento usado em um estudo feito por Martins et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> e adaptado para fins deste estudo&#46; Essa ferramenta tamb&#233;m foi um estudo&#8208;piloto com tr&#234;s fam&#237;lias com OI para entendimento&#46; O formul&#225;rio incluiu perguntas relacionadas aos dados sociodemogr&#225;ficos&#44; caracter&#237;sticas familiares e outras informa&#231;&#245;es clinicamente relevantes sobre a OI da crian&#231;a&#46; Tamb&#233;m formam feitas perguntas adicionais relacionadas ao treino para usar o banheiro &#40;TT&#41; &#40;n&#227;o feitas pelo DVSS e pelos Crit&#233;rios de Roma III&#41;&#44; como o m&#233;todo &#40;por abordagem com base nos pais ou na crian&#231;a&#41;&#44; a dura&#231;&#227;o e as dificuldades de TT enfrentadas pelos pais no momento do TT &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">As crian&#231;as com OI foram diagnosticadas com DUI caso respondessem positivamente pelos menos duas das seis perguntas dos crit&#233;rios de Roma III&#44; al&#233;m de pelo menos uma pontua&#231;&#227;o total de 6 pontos no DVSS para meninas e 9 pontos para meninos&#44; que representou os seguintes sintomas urin&#225;rios&#58; sintomas de armazenamento &#40;aumento ou redu&#231;&#227;o da frequ&#234;ncia de mic&#231;&#227;o&#44; incontin&#234;ncia&#44; urg&#234;ncia e noct&#250;ria&#41;&#44; sintomas de mic&#231;&#227;o &#40;hesita&#231;&#227;o&#44; for&#231;ar durante as evacua&#231;&#245;es&#44; fluxo fraco e intermit&#234;ncia&#41; e&#47;ou outros sintomas &#40;segurar&#44; esvaziamento incompleto&#44; dribles ap&#243;s mic&#231;&#227;o e dor genital&#47;no trato urin&#225;rio inferior&#41;&#46; Vale observar que nossa amostra foi composta por crian&#231;as acima de quatro anos&#59; portanto&#44; nossos achados est&#227;o alinhados ao uso das duas ferramentas validadas&#58; os crit&#233;rios de Roma III&#44; que estabelecem a idade de quatro anos&#44; e o DVSS&#44; que adota a idade de tr&#234;s anos&#44; ou&#44; caso a crian&#231;a j&#225; tenha sido treinada para usar o banheiro&#44; conforme seus valores de corte de diagn&#243;stico&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">An&#225;lise de dados</span><p id="par0055" class="elsevierStylePara elsevierViewall">As an&#225;lises de dados descritivas foram feitas com o SPSS &#40;IBM SPSS Statistics for Windows&#44; vers&#227;o 19&#46;0&#44; Armonk&#44; NY&#44; EUA&#41; com o uso de meios&#44; frequ&#234;ncias e percentuais para estimar a preval&#234;ncia e a apresenta&#231;&#227;o de sintomas urin&#225;rios&#44; intestinais e de DUI na amostra e descrevem ainda caracter&#237;sticas dos participantes&#44; como vari&#225;veis sociodemogr&#225;ficas &#40;sexo da crian&#231;a&#44; idade&#44; dist&#226;ncia at&#233; o hospital&#44; renda familiar anual&#44; ordem de nascimento&#44; n&#250;mero de filhos&#41;&#44; cl&#237;nicas &#40;tipo de OI&#44; fraturas at&#233; a data de entrevista&#44; unidade ambulatorial ou n&#227;o&#44; dispositivos de assist&#234;ncia &#224; mobilidade&#44; pontua&#231;&#227;o Roma III e DVSS&#41; e relacionadas ao TT &#40;idade de in&#237;cio&#44; dura&#231;&#227;o&#44; presen&#231;a de dificuldades&#44; m&#233;todo&#44; caracter&#237;sticas da aquisi&#231;&#227;o de controle urin&#225;rio e intestinal&#41;&#46; Essas vari&#225;veis foram escolhidas com base em uma revis&#227;o da literatura&#44; pois elas s&#227;o associadas ao desenvolvimento de DUI durante a inf&#226;ncia&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">11&#8211;14</span></a></p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Resultados</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Caracter&#237;sticas da amostra</span><p id="par0060" class="elsevierStylePara elsevierViewall">Todos os poss&#237;veis participantes eleg&#237;veis foram inscritos e recrutados para participar de nosso estudo&#46; No total&#44; 21 m&#227;es&#44; seis pais e quatro principais cuidadoras de 31 crian&#231;as &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#44; meninas&#41;&#44; com m&#233;dia de 11&#44;2 anos&#44; varia&#231;&#227;o entre 5&#8208;14 anos &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; Todas essas principais cuidadoras foram as principais cuidadoras durante o tempo de treinamento para usar o banheiro&#46; As crian&#231;as apresentaram OI tipo I &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&#44; tipo III &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&#44; tipo IV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41; ou tipo desconhecido &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">O treinamento para usar o banheiro sempre come&#231;ou nos primeiros 18&#8208;30 meses de vida da crian&#231;a e durou at&#233; seis meses para a maior parte das crian&#231;as &#40;71&#37;&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&#41;&#46; Praticamente todos os pais &#40;97&#37;&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41; optaram pela remo&#231;&#227;o das fraldas da crian&#231;a durante o dia conforme seu m&#233;todo de TT preferencial&#46; Oito pais &#40;25&#44;8&#37;&#41; encontraram desafios durante o treinamento de usar o banheiro de suas crian&#231;as &#40;tr&#234;s meninas com OI tipo III &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41; e desconhecida &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; e cinco meninos com OI tipo IV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; tipo I &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; tipo III &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; e desconhecida &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#41;&#46; Os desafios inclu&#237;ram&#58; &#40;a&#41; sinais atrasados de prontid&#227;o para contin&#234;ncia noturna e uso do banheiro de forma independente&#59; &#40;b&#41; lidar com m&#250;ltiplas fraturas e constipa&#231;&#227;o grave&#59; e &#40;c&#41; uso de fraldas durante o per&#237;odo escolar&#44; devido ao preju&#237;zo grave da mobilidade e infraestrutura escolar ruim &#40;ou seja&#44; aus&#234;ncia de banheiros acess&#237;veis na escola&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Preval&#234;ncia de constipa&#231;&#227;o funcional &#40;Crit&#233;rios Diagn&#243;sticos de Roma III&#41;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Mais da metade da amostra &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#44; 51&#37;&#41; relatou hist&#243;rico de fezes duras ou evacua&#231;&#227;o dolorosa&#46; Oito crian&#231;as &#40;26&#37;&#41; relataram fezes de grande di&#226;metro que entupiram o vaso sanit&#225;rio&#46; Mais de um ter&#231;o das crian&#231;as &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#44; 38&#37;&#41; relatou pelo menos dois dos seis sintomas para constipa&#231;&#227;o funcional &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; Os sintomas intestinais foram mais prevalentes do que os sintomas do trato urin&#225;rio inferior&#46; Esse achado sugere que a constipa&#231;&#227;o funcional foi uma comorbidade comum associada &#224; OI&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Preval&#234;ncia e apresenta&#231;&#227;o de sintomas urin&#225;rios&#44; intestinais e de DUI &#40;<span class="elsevierStyleItalic">Dysfunctional Voiding Scoring System</span> &#91;DVSS&#93; e Crit&#233;rios Diagn&#243;sticos de Roma III para Constipa&#231;&#227;o Funcional&#41;</span><p id="par0075" class="elsevierStylePara elsevierViewall">A maior parte da amostra n&#227;o apresentou relatos sugestivos de sintomas do trato urin&#225;rio inferior&#46; Em nossa amostra&#44; a m&#233;dia da pontua&#231;&#227;o do DVSS para meninas &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#44; 81&#37;&#41; foi inferior a 6 pontos e para meninos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#44; 80&#37;&#41; foi inferior a 9 pontos&#46; O relato com pontua&#231;&#227;o mais alta obtido pelo DVSS para toda a amostra foi associado &#224; pergunta &#8220;Precisa fazer for&#231;a para evacuar&#8221; para meninos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#44; 53&#37;&#41; e meninas &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44; 37&#37;&#41; e se essa situa&#231;&#227;o aconteceu em mais da metade do tempo ou todo o tempo nos &#250;ltimos 30 dias &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; A pontua&#231;&#227;o m&#233;dia do DVSS de todas as crian&#231;as sintom&#225;ticas foi 6 pontos &#40;DP&#58; 1&#44;5&#41;&#44; que foi considerada leve&#44; j&#225; que ela foi muito pr&#243;xima ao valor de corte de diagn&#243;stico<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> para meninas&#46; Essas crian&#231;as relataram problemas urin&#225;rios como segurar e urg&#234;ncia&#44; juntamente com sintomas intestinais sugestivos de constipa&#231;&#227;o funcional&#46; A preval&#234;ncia de incontin&#234;ncia urin&#225;ria &#40;3&#44;2&#37;&#41; e fecal &#40;9&#44;7&#37;&#41; foi muito baixa em nossa amostra &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; A idade das tr&#234;s meninas sintom&#225;ticas variou de cinco a 14 anos e elas apresentaram OI tipo III &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41; ou desconhecida &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; e pontua&#231;&#245;es do DVSS de 7 a 10&#46; A idade dos tr&#234;s meninos sintom&#225;ticos variou de seis a 14 anos e eles apresentaram OI tipo I &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; ou III &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41; e pontua&#231;&#245;es do DVSS que variam de 10 a 11 pontos&#46; Os problemas intestinais e urin&#225;rios foram mais comuns em pacientes com OI tipo 3&#44; apesar de n&#227;o ter sido encontrada correla&#231;&#227;o estatisticamente significativa com qualquer tipo espec&#237;fico de OI &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discuss&#227;o</span><p id="par0080" class="elsevierStylePara elsevierViewall">Nossos achados mostram que a preval&#234;ncia de constipa&#231;&#227;o funcional &#40;38&#44;7&#37;&#41; foi maior em compara&#231;&#227;o com a popula&#231;&#227;o pedi&#225;trica geral&#44; considerou&#8208;se que a preval&#234;ncia global de constipa&#231;&#227;o funcional pedi&#225;trica foi estimada entre 0&#44;3&#37; e 29&#44;6&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> Com rela&#231;&#227;o &#224;s taxas de preval&#234;ncia&#44; a preval&#234;ncia de sintomas urin&#225;rios em crian&#231;as com constipa&#231;&#227;o funcional varia de 37&#37; a 64&#37;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> e nosso estudo mostrou que as crian&#231;as com OI apresentam preval&#234;ncia inferior de 19&#44;4&#37; para co&#8208;ocorr&#234;ncia de sintomas urin&#225;rios e intestinais&#46; Al&#233;m disso&#44; nosso estudo mostrou que as crian&#231;as com OI n&#227;o relataram sintomas urin&#225;rios isolados&#46; A preval&#234;ncia relatada de incontin&#234;ncia urin&#225;ria &#40;3&#44;2&#37;&#41; e fecal &#40;9&#44;7&#37;&#41; foi menor em crian&#231;as com OI&#44; em compara&#231;&#227;o com crian&#231;as com defici&#234;ncias neurol&#243;gicas &#40;38&#37; com incontin&#234;ncia urin&#225;ria e 19&#37; com incontin&#234;ncia fecal&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> bem como com dificuldades intelectuais &#40;39&#44;2&#37; com incontin&#234;ncia urin&#225;ria e fecal durante o dia&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a> Apesar de nosso estudo ter mostrado menores taxas de preval&#234;ncia de incontin&#234;ncia urin&#225;ria e fecal em crian&#231;as com OI&#44; a preval&#234;ncia de constipa&#231;&#227;o funcional foi maior em compara&#231;&#227;o com as crian&#231;as saud&#225;veis&#46; Por exemplo&#44; um estudo de base populacional australiano com crian&#231;as em idade escolar constatou as seguintes taxas gerais de preval&#234;ncia&#58; 16&#44;9&#37; de incontin&#234;ncia urin&#225;ria durante o dia&#44; 9&#44;4&#37; de constipa&#231;&#227;o e 21&#37; de incontin&#234;ncia fecal&#47;encoprese&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Em crian&#231;as cronicamente doentes&#44; qualquer preju&#237;zo &#224; mobilidade &#233; considerado um fator de risco potencial para TT malsucedida e incontin&#234;ncia posterior&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">20&#44;21</span></a> Em nosso estudo&#44; 35&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41; fam&#237;lias que come&#231;aram o TT ap&#243;s os 18 meses relataram a presen&#231;a de dificuldades com rela&#231;&#227;o a isso&#46; Esse achado destaca o fato de que algumas crian&#231;as podem sofrer de mic&#231;&#227;o disfuncional e apresentar sintomas como mic&#231;&#227;o ocasional&#44; constipa&#231;&#227;o e infec&#231;&#245;es do trato urin&#225;rio antes de iniciar o TT&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> De acordo com Hodges et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> comportamentos anormais de evacua&#231;&#227;o podem ser associados &#224; idade de in&#237;cio do TT e a presen&#231;a de constipa&#231;&#227;o&#46; Como a constipa&#231;&#227;o tamb&#233;m leva a TT demorado e dificultoso&#44; Hodges et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> propuseram que foi essa combina&#231;&#227;o de fatores que levou &#224; DUI&#46; Em nosso estudo&#44; 26&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41; dos pais que relataram enfrentar dificuldades com o TT de seu filho relataram a presen&#231;a de constipa&#231;&#227;o grave e m&#250;ltiplas fraturas como os principais motivos para TT malsucedido&#46; Nossos achados est&#227;o alinhados com o trabalho de Hodges et al<span class="elsevierStyleItalic">&#46;</span> e mostram que a constipa&#231;&#227;o pode contribuir para o desenvolvimento de DUI mais tarde na vida&#44; e n&#227;o somente na inf&#226;ncia&#44; quando o TT &#233; iniciado&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Al&#233;m disso&#44; a constipa&#231;&#227;o geralmente &#233; associada a dificuldades neurol&#243;gicas e fatores de confus&#227;o como imobilidade&#44; bem como dor&#44; pelo fato de a crian&#231;a viver com defici&#234;ncia f&#237;sica&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> No caso de crian&#231;as com OI&#44; os motivos subjacentes para constipa&#231;&#227;o est&#227;o relacionados a preju&#237;zos &#224; mobilidade&#44; deformidades &#243;sseas&#44; transpira&#231;&#227;o excessiva e efeitos colaterais associados ao tratamento com bifosfonato&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> Al&#233;m disso&#44; as fraturas podem levar a remodela&#231;&#227;o &#243;ssea e estreitamento p&#233;lvico&#44; esse associado a protrus&#227;o acetabular em at&#233; dois ter&#231;os dos adultos com OI tipo III&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> Sabe&#8208;se que esses adultos com OI sofrem de constipa&#231;&#227;o cr&#244;nica e dor abdominal&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> Recentemente&#44; a OI Foundation identificou condi&#231;&#245;es de sa&#250;de subestimadas em adultos com OI e 65&#8208;97&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>623&#8208;930 de 959&#41; dos entrevistados relataram o &#8220;sistema do trato urin&#225;rio&#8221; ou &#8220;gastrointestinal&#8221; como os sistemas de &#243;rg&#227;os que levaram ao impacto negativo mais significativo sobre sua qualidade de vida&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> Adicionalmente&#44; os problemas gastrointestinais s&#227;o citados entre as principais causas de mortalidade em indiv&#237;duos com OI&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> Assim&#44; a dete&#231;&#227;o precoce de problemas intestinais e o encaminhamento oportuno para um especialista g&#225;strico &#233; essencial para evitar esses sintomas no futuro&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Apesar de nosso estudo ser o primeiro a estimar a preval&#234;ncia e a apresenta&#231;&#227;o de sintomas urin&#225;rios&#44; intestinais e de DUI em uma amostra de crian&#231;as com OI&#44; nossa pesquisa tem algumas limita&#231;&#245;es&#46; Primeiro&#44; nossos achados n&#227;o exploraram o papel dos fatores psicossociais&#44; como eventos de vida estressantes&#44; que comprovadamente contribuem para os transtornos de evacua&#231;&#227;o anormal em crian&#231;as&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> Talvez&#44; a presen&#231;a de sintomas de DUI pode ter um maior impacto sobre as vidas das crian&#231;as que sua fragilidade &#243;ssea e os preju&#237;zos &#224; mobilidade em si&#44; mais precisamente devido ao estigma associado&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">29&#44;30</span></a> Adicionalmente&#44; devido a seu pequeno tamanho da amostra e seu modelo descritivo&#44; nossos achados devem ser interpretados com cautela&#46; H&#225; um risco de vi&#233;s de sele&#231;&#227;o&#44; pois este estudo foi feito em uma &#250;nica institui&#231;&#227;o terci&#225;ria&#46; H&#225; tamb&#233;m um risco de vi&#233;s de mem&#243;ria&#44; pois os dados coletados dependeram da precis&#227;o da mem&#243;ria dos participantes com rela&#231;&#227;o a eventos anteriores e isso pode ser consider&#225;vel para os pais de crian&#231;as mais velhas&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Em nosso conhecimento&#44; este &#233; o primeiro estudo a investigar a preval&#234;ncia de DUI em crian&#231;as com OI&#46; Em nossa amostra&#44; n&#227;o houve relato de problemas urin&#225;rios isolados&#59; contudo&#44; 38&#44;7&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41; relataram sintomas intestinais e 19&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41; uma combina&#231;&#227;o de problemas urin&#225;rios &#40;como segurar e urg&#234;ncia&#41; e sintomas intestinais &#40;como fezes duras ou evacua&#231;&#245;es dolorosas e fezes de grande di&#226;metro&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Considerando a variabilidade nas necessidades e nos resultados relacionados ao controle urin&#225;rio e intestinal de crian&#231;as com OI&#44; os m&#233;dicos devem monitorar os comportamentos de contin&#234;ncia e evacua&#231;&#227;o anormais nessas crian&#231;as&#44; mesmo antes ou assim que o TT &#233; iniciado&#46; Vale observar que os principais motivos para TT malsucedido em crian&#231;as com OI&#44; relatados pelos cuidadores neste estudo&#44; foram constipa&#231;&#227;o grave e preju&#237;zos &#224; mobilidade associados a m&#250;ltiplas faturas&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Portanto&#44; &#233; preciso aumentar a conscientiza&#231;&#227;o sobre a ocorr&#234;ncia dos sintomas de DUI&#44; principalmente constipa&#231;&#227;o&#44; em crian&#231;as com OI&#46; Considerando o maior conhecimento sobre as complica&#231;&#245;es dos sintomas de DUI n&#227;o tratados em indiv&#237;duos com OI&#44; as interven&#231;&#245;es conservadoras&#44; inclusive mudan&#231;as no estilo de vida e terapias comportamentais&#44; n&#227;o foram examinadas especificamente em crian&#231;as com OI que sofrem de DUI e representam uma oportunidade ideal para fornecer al&#237;vio e melhor qualidade de vida&#46; Pesquisas adicionais tamb&#233;m devem explorar as perspectivas de crian&#231;as com OI e de seus cuidadores para obter um entendimento das cren&#231;as e comportamentos comuns associados ao tratamento urin&#225;rio e intestinal como os principais motivadores de busca de tratamento&#44; bem como o impacto desses sintomas sobre sua qualidade de vida&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflitos de interesse</span><p id="par0115" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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                  "titulo" => "Crit&#233;rios de Roma III para Diagn&#243;stico Cl&#237;nico da Constipa&#231;&#227;o Funcional"
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                  "titulo" => "Formul&#225;rio Sociodemogr&#225;fico e Cl&#237;nico"
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              "titulo" => "Caracter&#237;sticas da amostra"
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              "titulo" => "Preval&#234;ncia de constipa&#231;&#227;o funcional &#40;Crit&#233;rios Diagn&#243;sticos de Roma III&#41;"
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              "titulo" => "Preval&#234;ncia e apresenta&#231;&#227;o de sintomas urin&#225;rios&#44; intestinais e de DUI &#40;Dysfunctional Voiding Scoring System &#91;DVSS&#93; e Crit&#233;rios Diagn&#243;sticos de Roma III para Constipa&#231;&#227;o Funcional&#41;"
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    "fechaRecibido" => "2018-11-05"
    "fechaAceptado" => "2018-12-21"
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            0 => "Children"
            1 => "Osteogenesis imperfecta"
            2 => "Lower urinary tract symptoms"
            3 => "Constipation"
            4 => "Bowel and bladder dysfunction"
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          "palabras" => array:5 [
            0 => "Crian&#231;as"
            1 => "Osteog&#234;nese imperfeita"
            2 => "Sintomas do trato urin&#225;rio inferior"
            3 => "Constipa&#231;&#227;o"
            4 => "Disfun&#231;&#227;o intestinal e urin&#225;ria"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To estimate the prevalence and presentation of bladder&#44; bowel&#44; and combined bladder and bowel symptoms experienced by children with osteogenesis imperfecta and to describe the socio&#8208;demographic and clinical profile of these children&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A descriptive study was conducted with a convenience sample of parent&#8208;child pairs of toilet&#8208;trained children aged from 3 to 18 years&#46; Pairs were interviewed using three tools&#58; &#40;1&#41; Socio&#8208;Demographic and Clinical Questionnaire&#59; &#40;2&#41; Dysfunctional Voiding Scoring System&#59; &#40;3&#41; Rome III Criteria along with the Bristol Stool Scale&#46; Data were stratified by socio&#8208;demographic and clinical variables and analyzed using descriptive statistics&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Thirty&#8208;one parent&#8208;child pairs participated in the study&#59; 38&#46;7&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41; children reported bowel symptoms&#44; 19&#46;4&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41; reported a combination of bladder issues &#40;such as holding maneuvers and urgency&#41; and bowel symptoms &#40;such as hard or painful bowel movements and large diameter stools&#41;&#46; There were no reports of isolated bladder issues&#46; Among the child participants&#44; 16 &#40;51&#46;7&#37;&#41; identified as female and 20 &#40;64&#46;5&#37;&#41; were 5&#8211;14 years old&#46; The most prevalent type of osteogenesis imperfecta was type III &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#59; 38&#46;7&#37;&#41; and eight &#40;25&#46;8&#37;&#41; children reported using a wheelchair&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This is the first study to examine the prevalence and presentation of bladder&#44; bowel&#44; and combined bladder and bowel symptoms in children with osteogenesis imperfecta&#44; offering a preliminary socio&#8208;demographic and clinical profile of these children&#46; This research is an important step toward effective screening&#44; detection&#44; and access to care and treatment&#44; especially for clinicians working with this group of very fragile patients&#46;</p></span>"
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            "identificador" => "abst0005"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Estimar a preval&#234;ncia e a apresenta&#231;&#227;o de sintomas urin&#225;rios&#44; intestinais e urin&#225;rios e intestinais combinados sofridos por crian&#231;as com osteog&#234;nese imperfeita e descrever o perfil sociodemogr&#225;fico e cl&#237;nico dessas crian&#231;as&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Foi realizado um estudo descritivo com uma amostra de conveni&#234;ncia de pares de pais&#8208;filhos de crian&#231;as treinadas para usar o banheiro com idades entre tr&#234;s e 18 anos&#46; Os pares foram entrevistados utilizando tr&#234;s instrumentos&#58; 1&#41; o Question&#225;rio Sociodemogr&#225;fico e Cl&#237;nico&#59; 2&#41; o question&#225;rio <span class="elsevierStyleItalic">Dysfunctional Voiding Scoring System</span>&#59; 3&#41; os Crit&#233;rios de Roma III juntamente com a Escala de Bristol para Consist&#234;ncia de Fezes&#46; Os dados foram estratificados por vari&#225;veis sociodemogr&#225;ficas e cl&#237;nicas e analisados com estat&#237;sticas descritivas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Participaram do estudo 31 pares de pais&#8208;filhos&#44; 38&#44;7&#37; &#40;n &#61; 12&#41; crian&#231;as relataram sintomas intestinais&#44; 19&#44;4&#37; &#40;n &#61; 6&#41; relataram uma combina&#231;&#227;o de problemas urin&#225;rios &#40;como segurar e urg&#234;ncia miccional&#41; e sintomas intestinais &#40;como fezes duras ou evacua&#231;&#245;es dolorosas e fezes de grande dimens&#227;o&#41;&#46; N&#227;o houve relatos de problemas urin&#225;rios isolados&#46; Entre as crian&#231;as&#44; 16 &#40;51&#44;7&#37;&#41; eram meninas e 20 &#40;64&#44;5&#37;&#41; tinham entre 5 e 14 anos&#46; O tipo mais prevalente de osteog&#234;nese imperfeita foi o III &#40;n &#61; 12&#59; 38&#44;7&#37;&#41; e 8 &#40;25&#44;8&#37;&#41; crian&#231;as relataram usar cadeira de rodas&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Este &#233; o primeiro estudo a examinar a preval&#234;ncia e a apresenta&#231;&#227;o de sintomas urin&#225;rios&#44; intestinais e urin&#225;rios e intestinais combinados em crian&#231;as com osteog&#234;nese imperfeita e que mostra um perfil sociodemogr&#225;fico e cl&#237;nico preliminar dessas crian&#231;as&#46; Nossa pesquisa &#233; um passo importante com rela&#231;&#227;o ao efetivo rastreamento&#44; detec&#231;&#227;o e acesso ao cuidado e tratamento&#44; principalmente para os profissionais de sa&#250;de que trabalham com esse grupo de pacientes t&#227;o fr&#225;geis&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Como citar este artigo&#58; Martins G&#44; Siedlikowski M&#44; Coelho AK&#44; Rauch F&#44; Tsimicalis A&#46; Bladder and bowel symptoms experienced by children with osteogenesis imperfecta&#46; J Pediatr &#40;Rio J&#41;&#46; 2020&#59;96&#58;472&#8211;8&#46;</p>"
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                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Feminino</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Masculino</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Principal cuidador</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#227;e&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pai&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Respons&#225;vel &#40;sexo feminino&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Idade da crian&#231;a quando iniciado o treinamento para usar o banheiro</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antes dos 18 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Entre 18 e 30 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>More than 30 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o tem certeza&#47;n&#227;o sabe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Dura&#231;&#227;o do treinamento para usar o banheiro</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;3 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Entre 3 e 6 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;6 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o tem certeza&#47;n&#227;o sabe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Relat&#243;rio das dificuldades enfrentados no treinamento para usar o banheiro</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o tem certeza&#47;n&#227;o sabe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Preval&#234;ncia de sintomas unit&#225;rios&#47;intestinais avaliados pelo DVSS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Incontin&#234;ncia urin&#225;ria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1 &#40;3&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diminui&#231;&#227;o da frequ&#234;ncia de evacua&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">9 &#40;29&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Precisa fazer for&#231;a para evacuar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;29&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Segura&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;12&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urg&#234;ncia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;19&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Precisar fazer for&#231;a para urinar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;6&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dor ao urinar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;6&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presen&#231;a de eventos estressantes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;48&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presen&#231;a de sintomas sugestivos de mic&#231;&#227;o anormal&#44; medidos pelo DVSS<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;19&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2350628.png"
              ]
            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Preval&#234;ncia de sintomas intestinais avaliados pelos crit&#233;rios de ROMA III<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Duas ou menos evacua&#231;&#245;es por semana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;9&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pelo menos um epis&#243;dio de incontin&#234;ncia fecal por semana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;9&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hist&#243;rico de reten&#231;&#227;o postural ou reten&#231;&#227;o volunt&#225;ria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;12&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hist&#243;rico de fezes duras ou evacua&#231;&#227;o dorolosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;51&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presen&#231;a de massa fecal de grande dimens&#227;o no reto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;16&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fezes de grande di&#226;metro que podem entupir o vaso sanit&#225;rio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;25&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presen&#231;a de sintomas sugestivos de constipa&#231;&#227;o funcional&#44; medidos pelos Crit&#233;rios de Roma III<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;38&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2350625.png"
              ]
            ]
            2 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Preval&#234;ncia de sintomas urin&#225;rios e intestinais combinados &#40;DVSS<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Roma III<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presen&#231;a de sintomas sugestivos de disfun&#231;&#227;o urin&#225;ria e intestinal &#40;DUI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;19&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2350626.png"
              ]
            ]
          ]
          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Pontua&#231;&#227;o total do DVSS &#40;pontua&#231;&#227;o feminina<span class="elsevierStyleHsp" style=""></span>&#62; 6 pontos&#59; pontua&#231;&#227;o masculina<span class="elsevierStyleHsp" style=""></span>&#62; 9 pontos&#41;&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Presen&#231;a de pelo menos 2 dos 6 sintomas intestinais&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Preval&#234;ncia de sintomas urin&#225;rios&#44; intestinais e urin&#225;rios e intestinais combinados</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabela 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Vari&#225;veis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Categorias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Taxas de preval&#234;ncia</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dintomas urin&#225;rios &#40;DVSS&#41;<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a></th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sintomas intestinais &#40;ROMA III&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a></th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sexo da crian&#231;a</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Faixa et&#225;ria</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#60;<span class="elsevierStyleHsp" style=""></span>8 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#60;<span class="elsevierStyleHsp" style=""></span>18 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ordem de nascimento da crian&#231;a</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#176; filho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#176; filho e mais novo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#250;mero de crian&#231;as na fam&#237;lia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#8211; 2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dist&#226;ncia at&#233; o hospital</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mesma cidade do hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cidade diferente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Renda familiar&#47;ano &#40;&#36;&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">At&#233; 7&#46;900&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36;7&#46;920&#8208;13&#46;200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36;13&#46;200&#8208;39&#46;600&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tipo de OI</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Desconhecido&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">Unidade ambulatorial</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ambulatorial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o ambulatorial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">Dispositivos de assist&#234;ncia &#224; mobilidade</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
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                  """
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            0 => array:3 [
              "identificador" => "tblfn0025"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Pontua&#231;&#227;o total do DVSS &#40;pontua&#231;&#227;o feminina<span class="elsevierStyleHsp" style=""></span>&#62; 6 pontos&#59; pontua&#231;&#227;o masculina<span class="elsevierStyleHsp" style=""></span>&#62; 9 pontos&#41;&#46;</p>"
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        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas demogr&#225;ficas e cl&#237;nicas na preval&#234;ncia de sintomas urin&#225;rios e intestinais</p>"
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      ]
    ]
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        0 => array:2 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Quality of life in osteogenesis imperfecta&#58; a mixed&#8208;methods systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46; Dahan-Oliel"
                            1 => "S&#46; Oliel"
                            2 => "A&#46; Tsimicalis"
                            3 => "K&#46; Montpetit"
                            4 => "F&#46; Rauch"
                            5 => "M&#46;J&#46; Dogba"
                          ]
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                    0 => array:2 [
                      "doi" => "10.1002/ajmg.a.37377"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med Genet A"
                        "fecha" => "2016"
                        "volumen" => "170A"
                        "paginaInicial" => "62"
                        "paginaFinal" => "76"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26365089"
                            "web" => "Medline"
                          ]
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            1 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The psychosocial experience of individuals living with osteogenesis imperfecta&#58; a mixed&#8208;methods systematic review"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Tsimicalis"
                            1 => "G&#46; Denis-Larocque"
                            2 => "A&#46; Michalovic"
                            3 => "C&#46; Lepage"
                            4 => "K&#46; Williams"
                            5 => "T&#46;R&#46; Yao"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1007/s11136-016-1247-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Qual Life Res"
                        "fecha" => "2016"
                        "volumen" => "25"
                        "paginaInicial" => "1877"
                        "paginaFinal" => "1896"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26894269"
                            "web" => "Medline"
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              "etiqueta" => "3"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Results of a bone splint technique for the treatment of lower limb deformities in children with type I osteogenesis imperfecta"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46; Lin"
                            1 => "W&#46; Zhai"
                            2 => "K&#46; Lian"
                            3 => "Z&#46; Ding"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/0019-5413.114922"
                      "Revista" => array:6 [
                        "tituloSerie" => "Indian J Orthop"
                        "fecha" => "2013"
                        "volumen" => "47"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23960282"
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                    0 => array:2 [
                      "titulo" => "Charting the territory&#58; symptoms and functional assessment in children with progressive&#44; non&#8208;curable conditions"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Steele"
                            1 => "H&#46; Siden"
                            2 => "S&#46; Cadell"
                            3 => "B&#46; Davies"
                            4 => "G&#46; Andrews"
                            5 => "L&#46; Feichtinger"
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                    0 => array:2 [
                      "doi" => "10.1136/archdischild-2013-305246"
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                        "tituloSerie" => "Arch Dis Child"
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                        "volumen" => "99"
                        "paginaInicial" => "754"
                        "paginaFinal" => "762"
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                          0 => array:2 [
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                      "titulo" => "Do we manage incontinence in children and adults with special needs adequately&#63; ICI&#8208;RS 2014"
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                          "autores" => array:6 [
                            0 => "A&#46; von Gontard"
                            1 => "T&#46;P&#46; de Jong"
                            2 => "A&#46; Rantell"
                            3 => "A&#46; Nieuwhof-Leppink"
                            4 => "L&#46;K&#46; Badawi"
                            5 => "L&#46; Cardozo"
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                    0 => array:2 [
                      "doi" => "10.1002/nau.22823"
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                        "tituloSerie" => "Neurourol Urodyn"
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                        "volumen" => "35"
                        "paginaInicial" => "304"
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                    0 => array:2 [
                      "titulo" => "Bladder and bowel dysfunction in children&#58; an update on the diagnosis and treatment of a common&#44; but underdiagnosed pediatric problem"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;D&#46; Santos"
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                            2 => "M&#46;A&#46; Koyle"
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                      "doi" => "10.5489/cuaj.4411"
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                        "tituloSerie" => "Can Urol Assoc J"
                        "fecha" => "2017"
                        "volumen" => "11"
                        "paginaInicial" => "S64"
                        "paginaFinal" => "S72"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28265323"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Mortality and causes of death in patients with osteogenesis imperfecta&#58; a register&#8208;based nationwide cohort study"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Folkestad"
                            1 => "J&#46;D&#46; Hald"
                            2 => "V&#46; Canudas-Romo"
                            3 => "J&#46; Gram"
                            4 => "A&#46;P&#46; Hermann"
                            5 => "B&#46; Langdahl"
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                    0 => array:2 [
                      "doi" => "10.1002/jbmr.2895"
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                        "tituloSerie" => "J Bone Miner Res"
                        "fecha" => "2016"
                        "volumen" => "31"
                        "paginaInicial" => "2159"
                        "paginaFinal" => "2166"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27345018"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The dysfunctional voiding scoring system&#58; quantitative standardization of dysfunctional voiding symptoms in children"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "W&#46; Farhat"
                            1 => "D&#46;J&#46; Bagli"
                            2 => "G&#46; Capolicchio"
                            3 => "S&#46; O&#8217;Reilly"
                            4 => "P&#46;A&#46; Merguerian"
                            5 => "A&#46; Khoury"
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                    0 => array:2 [
                      "doi" => "10.1097/00005392-200009020-00023"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Urol"
                        "fecha" => "2000"
                        "volumen" => "164"
                        "paginaInicial" => "1011"
                        "paginaFinal" => "1015"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10958730"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rome III&#58; new standard for functional gastrointestinal disorders"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Drossman"
                            1 => "D&#46; Dumitrascu"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Gastrointestin Liver Dis"
                        "fecha" => "2006"
                        "volumen" => "15"
                        "paginaInicial" => "237"
                        "paginaFinal" => "241"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17013448"
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            9 => array:3 [
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Artigo Original
Bladder and bowel symptoms experienced by children with osteogenesis imperfecta
Sintomas urinários e intestinais apresentados por crianças com osteogênese imperfeita
Gisele Martinsa,
Autor para correspondência
martinsgise@gmail.com

Autor para correspondência.
, Maia Siedlikowskib, Anna Kristina Silva Coelhoa, Frank Rauchc, Argerie Tsimicalisb,c
a Universidade de Brasília, Faculdade de Ciências da Saúde, Departamento de Enfermagem, Brasília, DF, Brasil
b McGill University, Medical School, Ingram School of Nursing, Montreal, Canadá
c Shriners Hospital for Children, Montreal, Canadá
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introdu&#231;&#227;o</span><p id="par0010" class="elsevierStylePara elsevierViewall">A osteog&#234;nese imperfeita &#40;OI&#41;&#44; tamb&#233;m conhecida como doen&#231;a dos ossos de vidro&#44; &#233; uma doen&#231;a gen&#233;tica rara &#91;preval&#234;ncia 1&#58;10&#46;000&#93; caracterizada por fragilidade &#243;ssea&#46; N&#227;o h&#225; cura para a OI&#59; contudo&#44; os bisfosfonatos s&#227;o amplamente usados para melhorar a for&#231;a &#243;ssea&#44; diminuir a ocorr&#234;ncia de fraturas e melhorar a qualidade de vida&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">As crian&#231;as com OI podem sofrer m&#250;ltiplas fraturas e deformidades nos membros que podem levar a mobilidade prejudicada&#44;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;3</span></a> um fator de risco para problemas gastrointestinais&#44; como constipa&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a> Esse &#233; um sintoma comumente relatado em crian&#231;as que vivem com uma defici&#234;ncia f&#237;sica&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> Al&#233;m disso&#44; a presen&#231;a de constipa&#231;&#227;o tem um impacto grave sobre a fun&#231;&#227;o urin&#225;ria devido &#224; proximidade anat&#244;mica da bexiga e do intestino&#44; o que pode desenvolver disfun&#231;&#227;o urin&#225;ria e intestinal &#40;DUI&#41;&#46; Em geral&#44; as pessoas com DUI n&#227;o recuperam adequadamente a fun&#231;&#227;o intestinal e urin&#225;ria&#44; a menos que a constipa&#231;&#227;o seja tratada de forma imediata e efetiva&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Parece haver uma escassez de comprova&#231;&#227;o sobre o t&#243;pico de padr&#245;es de evacua&#231;&#227;o em crian&#231;as com OI&#46; De fato&#44; a literatura sobre os padr&#245;es de evacua&#231;&#227;o em crian&#231;as com defici&#234;ncia em grande parte est&#225; relacionada &#224;quelas com dificuldades intelectuais ou comprometimento neurol&#243;gico&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> Especificamente&#44; crian&#231;as com OI podem n&#227;o somente correr risco de desenvolver DUI devido &#224; sua mobilidade prejudicada&#44; mas tamb&#233;m correr risco de sofrer problemas intestinais&#44; que est&#227;o entre as principais causas de mortalidade em pacientes com OI&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> Considerando isso&#44; uma investiga&#231;&#227;o sobre a ocorr&#234;ncia de problemas urin&#225;rios e intestinais em crian&#231;as com OI oferece um passo adiante&#46; Este estudo visou a estimar a preval&#234;ncia e a apresenta&#231;&#227;o de sintomas urin&#225;rios&#44; intestinais e urin&#225;rios e intestinais combinados sofridos por crian&#231;as com OI e descrever o perfil sociodemogr&#225;fico e cl&#237;nico dessas crian&#231;as&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Modelo do estudo&#44; configura&#231;&#227;o&#44; participantes e recrutamento</span><p id="par0025" class="elsevierStylePara elsevierViewall">De acordo com a aprova&#231;&#227;o do conselho de revis&#227;o institucional &#40;&#35;943&#44;437&#44; 3 de fevereiro de 2015&#41;&#44; foi feito um estudo descritivo em um hospital&#8208;escola terci&#225;rio&#46; Esse hospital &#233; reconhecido nacionalmente como um centro especializado para tratamento de OI&#44; no qual as crian&#231;as das regi&#245;es Norte&#44; Nordeste e Centro&#8208;Oeste do Brasil s&#227;o internadas na unidade hospitalar&#46; O bifosfonato &#233; administrado durante a interna&#231;&#227;o hospitalar como um protocolo de atendimento institucional padr&#227;o&#46; Os poss&#237;veis participantes do estudo foram recrutados e inscritos durante quatro meses &#40;de fevereiro a maio de 2015&#41;&#44; enquanto eles receberam tratamento com bifosfonato no local do estudo&#46; As crian&#231;as eleg&#237;veis para participar do estudo foram aquelas&#58; &#40;a&#41; entre tr&#234;s e 18 anos&#44; &#40;b&#41; diagnosticas com qualquer tipo de OI&#44; &#40;c&#41; treinadas para ir o banheiro e &#40;d&#41; internadas em uma unidade hospitalar no local do estudo durante a coleta de dados&#46; Os principais cuidadores eleg&#237;veis para participar do estudo foram aqueles&#58; &#40;a&#41; cujos filhos atenderam aos crit&#233;rios de inclus&#227;o&#44; &#40;b&#41; que tinham mais de 18 anos e &#40;c&#41; eram os principais cuidadores da crian&#231;a durante o tempo de treinamento para usar o banheiro&#46; As crian&#231;as exclu&#237;das foram aquelas que n&#227;o foram treinadas para usar o banheiro e&#47;ou com menos de tr&#234;s anos&#46; Durante a interna&#231;&#227;o hospitalar agendada de sua crian&#231;a&#44; todos os principais cuidadores eleg&#237;veis foram inicialmente abordados por um profissional da sa&#250;de designado&#46; Quando um principal cuidador mostrou interesse&#44; um membro da equipe de pesquisa abordou os principais cuidadores para fornecer uma explica&#231;&#227;o do estudo e&#44; caso concordassem&#44; foi obtido um consentimento informado&#44; seguido do assentimento da crian&#231;a&#46; Portanto&#44; todos os participantes abordados foram inscritos para participar e recrutados&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Coleta de dados e instrumentos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Um &#250;nico assistente de pesquisa entrevistou os pares de pais&#8208;filhos de forma presencial&#44; conclui tr&#234;s instrumentos como ferramentas de coleta de dados em uma sala privada no local do estudo&#46; Vale observar que o assistente de pesquisa adotou as seguintes diretrizes de estudo para entrevistar os pares&#44; enquanto preenchiam cada um dos formul&#225;rios&#46; Os dados foram coletados basicamente a partir de um ponto de vista dos pais e foram combinados somente com o ponto de vista da crian&#231;a para problemas espec&#237;ficos relacionados aos h&#225;bitos da crian&#231;a de ir ao banheiro&#44; como frequ&#234;ncia di&#225;ria de mic&#231;&#227;o&#44; de que a maioria dos pais n&#227;o tinha conhecimento&#46; Os instrumentos consistiram no que segue&#58;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085"><span class="elsevierStyleItalic">Dysfunctional Voiding Scoring System</span> &#40;DVSS&#41;</span><p id="par0035" class="elsevierStylePara elsevierViewall">O DVSS foi usado para identificar comportamentos de mic&#231;&#227;o anormais&#46; O DVSS consiste em dez itens&#58; nove para avaliar os sintomas urin&#225;rios e intestinais e um para avaliar os problemas sociais e familiares&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> A pontua&#231;&#227;o 6 para meninas e 9 para meninos&#44; do DVSS&#44; sugere que a crian&#231;a sofre de comportamentos de mic&#231;&#227;o anormais&#46; A presen&#231;a de comportamentos de mic&#231;&#227;o anormais foi confirmada quando o participante relatou sentir um sintoma &#8220;metade do tempo&#8221; ou &#8220;quase todo o tempo&#8221; em um per&#237;odo de 30 dias&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Crit&#233;rios de Roma III para Diagn&#243;stico Cl&#237;nico da Constipa&#231;&#227;o Funcional</span><p id="par0040" class="elsevierStylePara elsevierViewall">Esse instrumento foi usado para captar uma vis&#227;o geral dos problemas intestinais da crian&#231;a&#44; em associa&#231;&#227;o com o Gr&#225;fico de Bristol para Consist&#234;ncia de Fezes&#46; A presen&#231;a de duas ou mais respostas positivas das seis perguntas indicou constipa&#231;&#227;o funcional&#46; As perguntas inclu&#237;ram&#58; &#40;1&#41; duas ou menos defeca&#231;&#245;es por semana&#59; &#40;2&#41; pelo menos um epis&#243;dio de incontin&#234;ncia fecal por semana&#59; &#40;3&#41; hist&#243;rico de reten&#231;&#227;o postural de fezes ou reten&#231;&#227;o volitiva excessiva&#59; &#40;4&#41; hist&#243;rico de evacua&#231;&#227;o de fezes duras ou com dor&#59; &#40;5&#41; presen&#231;a de massa fecal de grande dimens&#227;o no reto&#59; e &#40;6&#41; hist&#243;rico de fezes de grande dimens&#227;o que podem entupir o vaso sanit&#225;rio&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> O gr&#225;fico de Bristol para consist&#234;ncia de fezes foi usado para facilitar o entendimento dos participantes sobre a consist&#234;ncia das fezes&#46; Esse gr&#225;fico cont&#233;m um desenho de ajuda designado para classificar as fezes em sete tipos&#58; 1&#8208;2 &#40;indicativo de constipa&#231;&#227;o&#41;&#44; 3&#8208;4 &#40;fezes ideais&#41; e 5&#8208;7 &#40;indicativo de diarreia e urg&#234;ncia&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Formul&#225;rio Sociodemogr&#225;fico e Cl&#237;nico</span><p id="par0045" class="elsevierStylePara elsevierViewall">Formul&#225;rio com base no instrumento usado em um estudo feito por Martins et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> e adaptado para fins deste estudo&#46; Essa ferramenta tamb&#233;m foi um estudo&#8208;piloto com tr&#234;s fam&#237;lias com OI para entendimento&#46; O formul&#225;rio incluiu perguntas relacionadas aos dados sociodemogr&#225;ficos&#44; caracter&#237;sticas familiares e outras informa&#231;&#245;es clinicamente relevantes sobre a OI da crian&#231;a&#46; Tamb&#233;m formam feitas perguntas adicionais relacionadas ao treino para usar o banheiro &#40;TT&#41; &#40;n&#227;o feitas pelo DVSS e pelos Crit&#233;rios de Roma III&#41;&#44; como o m&#233;todo &#40;por abordagem com base nos pais ou na crian&#231;a&#41;&#44; a dura&#231;&#227;o e as dificuldades de TT enfrentadas pelos pais no momento do TT &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">As crian&#231;as com OI foram diagnosticadas com DUI caso respondessem positivamente pelos menos duas das seis perguntas dos crit&#233;rios de Roma III&#44; al&#233;m de pelo menos uma pontua&#231;&#227;o total de 6 pontos no DVSS para meninas e 9 pontos para meninos&#44; que representou os seguintes sintomas urin&#225;rios&#58; sintomas de armazenamento &#40;aumento ou redu&#231;&#227;o da frequ&#234;ncia de mic&#231;&#227;o&#44; incontin&#234;ncia&#44; urg&#234;ncia e noct&#250;ria&#41;&#44; sintomas de mic&#231;&#227;o &#40;hesita&#231;&#227;o&#44; for&#231;ar durante as evacua&#231;&#245;es&#44; fluxo fraco e intermit&#234;ncia&#41; e&#47;ou outros sintomas &#40;segurar&#44; esvaziamento incompleto&#44; dribles ap&#243;s mic&#231;&#227;o e dor genital&#47;no trato urin&#225;rio inferior&#41;&#46; Vale observar que nossa amostra foi composta por crian&#231;as acima de quatro anos&#59; portanto&#44; nossos achados est&#227;o alinhados ao uso das duas ferramentas validadas&#58; os crit&#233;rios de Roma III&#44; que estabelecem a idade de quatro anos&#44; e o DVSS&#44; que adota a idade de tr&#234;s anos&#44; ou&#44; caso a crian&#231;a j&#225; tenha sido treinada para usar o banheiro&#44; conforme seus valores de corte de diagn&#243;stico&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">An&#225;lise de dados</span><p id="par0055" class="elsevierStylePara elsevierViewall">As an&#225;lises de dados descritivas foram feitas com o SPSS &#40;IBM SPSS Statistics for Windows&#44; vers&#227;o 19&#46;0&#44; Armonk&#44; NY&#44; EUA&#41; com o uso de meios&#44; frequ&#234;ncias e percentuais para estimar a preval&#234;ncia e a apresenta&#231;&#227;o de sintomas urin&#225;rios&#44; intestinais e de DUI na amostra e descrevem ainda caracter&#237;sticas dos participantes&#44; como vari&#225;veis sociodemogr&#225;ficas &#40;sexo da crian&#231;a&#44; idade&#44; dist&#226;ncia at&#233; o hospital&#44; renda familiar anual&#44; ordem de nascimento&#44; n&#250;mero de filhos&#41;&#44; cl&#237;nicas &#40;tipo de OI&#44; fraturas at&#233; a data de entrevista&#44; unidade ambulatorial ou n&#227;o&#44; dispositivos de assist&#234;ncia &#224; mobilidade&#44; pontua&#231;&#227;o Roma III e DVSS&#41; e relacionadas ao TT &#40;idade de in&#237;cio&#44; dura&#231;&#227;o&#44; presen&#231;a de dificuldades&#44; m&#233;todo&#44; caracter&#237;sticas da aquisi&#231;&#227;o de controle urin&#225;rio e intestinal&#41;&#46; Essas vari&#225;veis foram escolhidas com base em uma revis&#227;o da literatura&#44; pois elas s&#227;o associadas ao desenvolvimento de DUI durante a inf&#226;ncia&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">11&#8211;14</span></a></p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Resultados</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Caracter&#237;sticas da amostra</span><p id="par0060" class="elsevierStylePara elsevierViewall">Todos os poss&#237;veis participantes eleg&#237;veis foram inscritos e recrutados para participar de nosso estudo&#46; No total&#44; 21 m&#227;es&#44; seis pais e quatro principais cuidadoras de 31 crian&#231;as &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#44; meninas&#41;&#44; com m&#233;dia de 11&#44;2 anos&#44; varia&#231;&#227;o entre 5&#8208;14 anos &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; Todas essas principais cuidadoras foram as principais cuidadoras durante o tempo de treinamento para usar o banheiro&#46; As crian&#231;as apresentaram OI tipo I &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&#44; tipo III &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&#44; tipo IV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41; ou tipo desconhecido &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">O treinamento para usar o banheiro sempre come&#231;ou nos primeiros 18&#8208;30 meses de vida da crian&#231;a e durou at&#233; seis meses para a maior parte das crian&#231;as &#40;71&#37;&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&#41;&#46; Praticamente todos os pais &#40;97&#37;&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41; optaram pela remo&#231;&#227;o das fraldas da crian&#231;a durante o dia conforme seu m&#233;todo de TT preferencial&#46; Oito pais &#40;25&#44;8&#37;&#41; encontraram desafios durante o treinamento de usar o banheiro de suas crian&#231;as &#40;tr&#234;s meninas com OI tipo III &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41; e desconhecida &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; e cinco meninos com OI tipo IV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; tipo I &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; tipo III &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; e desconhecida &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#41;&#46; Os desafios inclu&#237;ram&#58; &#40;a&#41; sinais atrasados de prontid&#227;o para contin&#234;ncia noturna e uso do banheiro de forma independente&#59; &#40;b&#41; lidar com m&#250;ltiplas fraturas e constipa&#231;&#227;o grave&#59; e &#40;c&#41; uso de fraldas durante o per&#237;odo escolar&#44; devido ao preju&#237;zo grave da mobilidade e infraestrutura escolar ruim &#40;ou seja&#44; aus&#234;ncia de banheiros acess&#237;veis na escola&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Preval&#234;ncia de constipa&#231;&#227;o funcional &#40;Crit&#233;rios Diagn&#243;sticos de Roma III&#41;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Mais da metade da amostra &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#44; 51&#37;&#41; relatou hist&#243;rico de fezes duras ou evacua&#231;&#227;o dolorosa&#46; Oito crian&#231;as &#40;26&#37;&#41; relataram fezes de grande di&#226;metro que entupiram o vaso sanit&#225;rio&#46; Mais de um ter&#231;o das crian&#231;as &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#44; 38&#37;&#41; relatou pelo menos dois dos seis sintomas para constipa&#231;&#227;o funcional &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; Os sintomas intestinais foram mais prevalentes do que os sintomas do trato urin&#225;rio inferior&#46; Esse achado sugere que a constipa&#231;&#227;o funcional foi uma comorbidade comum associada &#224; OI&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Preval&#234;ncia e apresenta&#231;&#227;o de sintomas urin&#225;rios&#44; intestinais e de DUI &#40;<span class="elsevierStyleItalic">Dysfunctional Voiding Scoring System</span> &#91;DVSS&#93; e Crit&#233;rios Diagn&#243;sticos de Roma III para Constipa&#231;&#227;o Funcional&#41;</span><p id="par0075" class="elsevierStylePara elsevierViewall">A maior parte da amostra n&#227;o apresentou relatos sugestivos de sintomas do trato urin&#225;rio inferior&#46; Em nossa amostra&#44; a m&#233;dia da pontua&#231;&#227;o do DVSS para meninas &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#44; 81&#37;&#41; foi inferior a 6 pontos e para meninos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#44; 80&#37;&#41; foi inferior a 9 pontos&#46; O relato com pontua&#231;&#227;o mais alta obtido pelo DVSS para toda a amostra foi associado &#224; pergunta &#8220;Precisa fazer for&#231;a para evacuar&#8221; para meninos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#44; 53&#37;&#41; e meninas &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44; 37&#37;&#41; e se essa situa&#231;&#227;o aconteceu em mais da metade do tempo ou todo o tempo nos &#250;ltimos 30 dias &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; A pontua&#231;&#227;o m&#233;dia do DVSS de todas as crian&#231;as sintom&#225;ticas foi 6 pontos &#40;DP&#58; 1&#44;5&#41;&#44; que foi considerada leve&#44; j&#225; que ela foi muito pr&#243;xima ao valor de corte de diagn&#243;stico<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> para meninas&#46; Essas crian&#231;as relataram problemas urin&#225;rios como segurar e urg&#234;ncia&#44; juntamente com sintomas intestinais sugestivos de constipa&#231;&#227;o funcional&#46; A preval&#234;ncia de incontin&#234;ncia urin&#225;ria &#40;3&#44;2&#37;&#41; e fecal &#40;9&#44;7&#37;&#41; foi muito baixa em nossa amostra &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; A idade das tr&#234;s meninas sintom&#225;ticas variou de cinco a 14 anos e elas apresentaram OI tipo III &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41; ou desconhecida &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; e pontua&#231;&#245;es do DVSS de 7 a 10&#46; A idade dos tr&#234;s meninos sintom&#225;ticos variou de seis a 14 anos e eles apresentaram OI tipo I &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; ou III &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41; e pontua&#231;&#245;es do DVSS que variam de 10 a 11 pontos&#46; Os problemas intestinais e urin&#225;rios foram mais comuns em pacientes com OI tipo 3&#44; apesar de n&#227;o ter sido encontrada correla&#231;&#227;o estatisticamente significativa com qualquer tipo espec&#237;fico de OI &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discuss&#227;o</span><p id="par0080" class="elsevierStylePara elsevierViewall">Nossos achados mostram que a preval&#234;ncia de constipa&#231;&#227;o funcional &#40;38&#44;7&#37;&#41; foi maior em compara&#231;&#227;o com a popula&#231;&#227;o pedi&#225;trica geral&#44; considerou&#8208;se que a preval&#234;ncia global de constipa&#231;&#227;o funcional pedi&#225;trica foi estimada entre 0&#44;3&#37; e 29&#44;6&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> Com rela&#231;&#227;o &#224;s taxas de preval&#234;ncia&#44; a preval&#234;ncia de sintomas urin&#225;rios em crian&#231;as com constipa&#231;&#227;o funcional varia de 37&#37; a 64&#37;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> e nosso estudo mostrou que as crian&#231;as com OI apresentam preval&#234;ncia inferior de 19&#44;4&#37; para co&#8208;ocorr&#234;ncia de sintomas urin&#225;rios e intestinais&#46; Al&#233;m disso&#44; nosso estudo mostrou que as crian&#231;as com OI n&#227;o relataram sintomas urin&#225;rios isolados&#46; A preval&#234;ncia relatada de incontin&#234;ncia urin&#225;ria &#40;3&#44;2&#37;&#41; e fecal &#40;9&#44;7&#37;&#41; foi menor em crian&#231;as com OI&#44; em compara&#231;&#227;o com crian&#231;as com defici&#234;ncias neurol&#243;gicas &#40;38&#37; com incontin&#234;ncia urin&#225;ria e 19&#37; com incontin&#234;ncia fecal&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> bem como com dificuldades intelectuais &#40;39&#44;2&#37; com incontin&#234;ncia urin&#225;ria e fecal durante o dia&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a> Apesar de nosso estudo ter mostrado menores taxas de preval&#234;ncia de incontin&#234;ncia urin&#225;ria e fecal em crian&#231;as com OI&#44; a preval&#234;ncia de constipa&#231;&#227;o funcional foi maior em compara&#231;&#227;o com as crian&#231;as saud&#225;veis&#46; Por exemplo&#44; um estudo de base populacional australiano com crian&#231;as em idade escolar constatou as seguintes taxas gerais de preval&#234;ncia&#58; 16&#44;9&#37; de incontin&#234;ncia urin&#225;ria durante o dia&#44; 9&#44;4&#37; de constipa&#231;&#227;o e 21&#37; de incontin&#234;ncia fecal&#47;encoprese&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Em crian&#231;as cronicamente doentes&#44; qualquer preju&#237;zo &#224; mobilidade &#233; considerado um fator de risco potencial para TT malsucedida e incontin&#234;ncia posterior&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">20&#44;21</span></a> Em nosso estudo&#44; 35&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41; fam&#237;lias que come&#231;aram o TT ap&#243;s os 18 meses relataram a presen&#231;a de dificuldades com rela&#231;&#227;o a isso&#46; Esse achado destaca o fato de que algumas crian&#231;as podem sofrer de mic&#231;&#227;o disfuncional e apresentar sintomas como mic&#231;&#227;o ocasional&#44; constipa&#231;&#227;o e infec&#231;&#245;es do trato urin&#225;rio antes de iniciar o TT&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> De acordo com Hodges et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> comportamentos anormais de evacua&#231;&#227;o podem ser associados &#224; idade de in&#237;cio do TT e a presen&#231;a de constipa&#231;&#227;o&#46; Como a constipa&#231;&#227;o tamb&#233;m leva a TT demorado e dificultoso&#44; Hodges et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> propuseram que foi essa combina&#231;&#227;o de fatores que levou &#224; DUI&#46; Em nosso estudo&#44; 26&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41; dos pais que relataram enfrentar dificuldades com o TT de seu filho relataram a presen&#231;a de constipa&#231;&#227;o grave e m&#250;ltiplas fraturas como os principais motivos para TT malsucedido&#46; Nossos achados est&#227;o alinhados com o trabalho de Hodges et al<span class="elsevierStyleItalic">&#46;</span> e mostram que a constipa&#231;&#227;o pode contribuir para o desenvolvimento de DUI mais tarde na vida&#44; e n&#227;o somente na inf&#226;ncia&#44; quando o TT &#233; iniciado&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Al&#233;m disso&#44; a constipa&#231;&#227;o geralmente &#233; associada a dificuldades neurol&#243;gicas e fatores de confus&#227;o como imobilidade&#44; bem como dor&#44; pelo fato de a crian&#231;a viver com defici&#234;ncia f&#237;sica&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> No caso de crian&#231;as com OI&#44; os motivos subjacentes para constipa&#231;&#227;o est&#227;o relacionados a preju&#237;zos &#224; mobilidade&#44; deformidades &#243;sseas&#44; transpira&#231;&#227;o excessiva e efeitos colaterais associados ao tratamento com bifosfonato&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> Al&#233;m disso&#44; as fraturas podem levar a remodela&#231;&#227;o &#243;ssea e estreitamento p&#233;lvico&#44; esse associado a protrus&#227;o acetabular em at&#233; dois ter&#231;os dos adultos com OI tipo III&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> Sabe&#8208;se que esses adultos com OI sofrem de constipa&#231;&#227;o cr&#244;nica e dor abdominal&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> Recentemente&#44; a OI Foundation identificou condi&#231;&#245;es de sa&#250;de subestimadas em adultos com OI e 65&#8208;97&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>623&#8208;930 de 959&#41; dos entrevistados relataram o &#8220;sistema do trato urin&#225;rio&#8221; ou &#8220;gastrointestinal&#8221; como os sistemas de &#243;rg&#227;os que levaram ao impacto negativo mais significativo sobre sua qualidade de vida&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> Adicionalmente&#44; os problemas gastrointestinais s&#227;o citados entre as principais causas de mortalidade em indiv&#237;duos com OI&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> Assim&#44; a dete&#231;&#227;o precoce de problemas intestinais e o encaminhamento oportuno para um especialista g&#225;strico &#233; essencial para evitar esses sintomas no futuro&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Apesar de nosso estudo ser o primeiro a estimar a preval&#234;ncia e a apresenta&#231;&#227;o de sintomas urin&#225;rios&#44; intestinais e de DUI em uma amostra de crian&#231;as com OI&#44; nossa pesquisa tem algumas limita&#231;&#245;es&#46; Primeiro&#44; nossos achados n&#227;o exploraram o papel dos fatores psicossociais&#44; como eventos de vida estressantes&#44; que comprovadamente contribuem para os transtornos de evacua&#231;&#227;o anormal em crian&#231;as&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> Talvez&#44; a presen&#231;a de sintomas de DUI pode ter um maior impacto sobre as vidas das crian&#231;as que sua fragilidade &#243;ssea e os preju&#237;zos &#224; mobilidade em si&#44; mais precisamente devido ao estigma associado&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">29&#44;30</span></a> Adicionalmente&#44; devido a seu pequeno tamanho da amostra e seu modelo descritivo&#44; nossos achados devem ser interpretados com cautela&#46; H&#225; um risco de vi&#233;s de sele&#231;&#227;o&#44; pois este estudo foi feito em uma &#250;nica institui&#231;&#227;o terci&#225;ria&#46; H&#225; tamb&#233;m um risco de vi&#233;s de mem&#243;ria&#44; pois os dados coletados dependeram da precis&#227;o da mem&#243;ria dos participantes com rela&#231;&#227;o a eventos anteriores e isso pode ser consider&#225;vel para os pais de crian&#231;as mais velhas&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Em nosso conhecimento&#44; este &#233; o primeiro estudo a investigar a preval&#234;ncia de DUI em crian&#231;as com OI&#46; Em nossa amostra&#44; n&#227;o houve relato de problemas urin&#225;rios isolados&#59; contudo&#44; 38&#44;7&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41; relataram sintomas intestinais e 19&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41; uma combina&#231;&#227;o de problemas urin&#225;rios &#40;como segurar e urg&#234;ncia&#41; e sintomas intestinais &#40;como fezes duras ou evacua&#231;&#245;es dolorosas e fezes de grande di&#226;metro&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Considerando a variabilidade nas necessidades e nos resultados relacionados ao controle urin&#225;rio e intestinal de crian&#231;as com OI&#44; os m&#233;dicos devem monitorar os comportamentos de contin&#234;ncia e evacua&#231;&#227;o anormais nessas crian&#231;as&#44; mesmo antes ou assim que o TT &#233; iniciado&#46; Vale observar que os principais motivos para TT malsucedido em crian&#231;as com OI&#44; relatados pelos cuidadores neste estudo&#44; foram constipa&#231;&#227;o grave e preju&#237;zos &#224; mobilidade associados a m&#250;ltiplas faturas&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Portanto&#44; &#233; preciso aumentar a conscientiza&#231;&#227;o sobre a ocorr&#234;ncia dos sintomas de DUI&#44; principalmente constipa&#231;&#227;o&#44; em crian&#231;as com OI&#46; Considerando o maior conhecimento sobre as complica&#231;&#245;es dos sintomas de DUI n&#227;o tratados em indiv&#237;duos com OI&#44; as interven&#231;&#245;es conservadoras&#44; inclusive mudan&#231;as no estilo de vida e terapias comportamentais&#44; n&#227;o foram examinadas especificamente em crian&#231;as com OI que sofrem de DUI e representam uma oportunidade ideal para fornecer al&#237;vio e melhor qualidade de vida&#46; Pesquisas adicionais tamb&#233;m devem explorar as perspectivas de crian&#231;as com OI e de seus cuidadores para obter um entendimento das cren&#231;as e comportamentos comuns associados ao tratamento urin&#225;rio e intestinal como os principais motivadores de busca de tratamento&#44; bem como o impacto desses sintomas sobre sua qualidade de vida&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflitos de interesse</span><p id="par0115" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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              "titulo" => "Caracter&#237;sticas da amostra"
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              "titulo" => "Preval&#234;ncia de constipa&#231;&#227;o funcional &#40;Crit&#233;rios Diagn&#243;sticos de Roma III&#41;"
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              "titulo" => "Preval&#234;ncia e apresenta&#231;&#227;o de sintomas urin&#225;rios&#44; intestinais e de DUI &#40;Dysfunctional Voiding Scoring System &#91;DVSS&#93; e Crit&#233;rios Diagn&#243;sticos de Roma III para Constipa&#231;&#227;o Funcional&#41;"
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            0 => "Children"
            1 => "Osteogenesis imperfecta"
            2 => "Lower urinary tract symptoms"
            3 => "Constipation"
            4 => "Bowel and bladder dysfunction"
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            0 => "Crian&#231;as"
            1 => "Osteog&#234;nese imperfeita"
            2 => "Sintomas do trato urin&#225;rio inferior"
            3 => "Constipa&#231;&#227;o"
            4 => "Disfun&#231;&#227;o intestinal e urin&#225;ria"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To estimate the prevalence and presentation of bladder&#44; bowel&#44; and combined bladder and bowel symptoms experienced by children with osteogenesis imperfecta and to describe the socio&#8208;demographic and clinical profile of these children&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A descriptive study was conducted with a convenience sample of parent&#8208;child pairs of toilet&#8208;trained children aged from 3 to 18 years&#46; Pairs were interviewed using three tools&#58; &#40;1&#41; Socio&#8208;Demographic and Clinical Questionnaire&#59; &#40;2&#41; Dysfunctional Voiding Scoring System&#59; &#40;3&#41; Rome III Criteria along with the Bristol Stool Scale&#46; Data were stratified by socio&#8208;demographic and clinical variables and analyzed using descriptive statistics&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Thirty&#8208;one parent&#8208;child pairs participated in the study&#59; 38&#46;7&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41; children reported bowel symptoms&#44; 19&#46;4&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41; reported a combination of bladder issues &#40;such as holding maneuvers and urgency&#41; and bowel symptoms &#40;such as hard or painful bowel movements and large diameter stools&#41;&#46; There were no reports of isolated bladder issues&#46; Among the child participants&#44; 16 &#40;51&#46;7&#37;&#41; identified as female and 20 &#40;64&#46;5&#37;&#41; were 5&#8211;14 years old&#46; The most prevalent type of osteogenesis imperfecta was type III &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#59; 38&#46;7&#37;&#41; and eight &#40;25&#46;8&#37;&#41; children reported using a wheelchair&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This is the first study to examine the prevalence and presentation of bladder&#44; bowel&#44; and combined bladder and bowel symptoms in children with osteogenesis imperfecta&#44; offering a preliminary socio&#8208;demographic and clinical profile of these children&#46; This research is an important step toward effective screening&#44; detection&#44; and access to care and treatment&#44; especially for clinicians working with this group of very fragile patients&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Estimar a preval&#234;ncia e a apresenta&#231;&#227;o de sintomas urin&#225;rios&#44; intestinais e urin&#225;rios e intestinais combinados sofridos por crian&#231;as com osteog&#234;nese imperfeita e descrever o perfil sociodemogr&#225;fico e cl&#237;nico dessas crian&#231;as&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Foi realizado um estudo descritivo com uma amostra de conveni&#234;ncia de pares de pais&#8208;filhos de crian&#231;as treinadas para usar o banheiro com idades entre tr&#234;s e 18 anos&#46; Os pares foram entrevistados utilizando tr&#234;s instrumentos&#58; 1&#41; o Question&#225;rio Sociodemogr&#225;fico e Cl&#237;nico&#59; 2&#41; o question&#225;rio <span class="elsevierStyleItalic">Dysfunctional Voiding Scoring System</span>&#59; 3&#41; os Crit&#233;rios de Roma III juntamente com a Escala de Bristol para Consist&#234;ncia de Fezes&#46; Os dados foram estratificados por vari&#225;veis sociodemogr&#225;ficas e cl&#237;nicas e analisados com estat&#237;sticas descritivas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Participaram do estudo 31 pares de pais&#8208;filhos&#44; 38&#44;7&#37; &#40;n &#61; 12&#41; crian&#231;as relataram sintomas intestinais&#44; 19&#44;4&#37; &#40;n &#61; 6&#41; relataram uma combina&#231;&#227;o de problemas urin&#225;rios &#40;como segurar e urg&#234;ncia miccional&#41; e sintomas intestinais &#40;como fezes duras ou evacua&#231;&#245;es dolorosas e fezes de grande dimens&#227;o&#41;&#46; N&#227;o houve relatos de problemas urin&#225;rios isolados&#46; Entre as crian&#231;as&#44; 16 &#40;51&#44;7&#37;&#41; eram meninas e 20 &#40;64&#44;5&#37;&#41; tinham entre 5 e 14 anos&#46; O tipo mais prevalente de osteog&#234;nese imperfeita foi o III &#40;n &#61; 12&#59; 38&#44;7&#37;&#41; e 8 &#40;25&#44;8&#37;&#41; crian&#231;as relataram usar cadeira de rodas&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Este &#233; o primeiro estudo a examinar a preval&#234;ncia e a apresenta&#231;&#227;o de sintomas urin&#225;rios&#44; intestinais e urin&#225;rios e intestinais combinados em crian&#231;as com osteog&#234;nese imperfeita e que mostra um perfil sociodemogr&#225;fico e cl&#237;nico preliminar dessas crian&#231;as&#46; Nossa pesquisa &#233; um passo importante com rela&#231;&#227;o ao efetivo rastreamento&#44; detec&#231;&#227;o e acesso ao cuidado e tratamento&#44; principalmente para os profissionais de sa&#250;de que trabalham com esse grupo de pacientes t&#227;o fr&#225;geis&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todo"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#227;o"
          ]
        ]
      ]
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Como citar este artigo&#58; Martins G&#44; Siedlikowski M&#44; Coelho AK&#44; Rauch F&#44; Tsimicalis A&#46; Bladder and bowel symptoms experienced by children with osteogenesis imperfecta&#46; J Pediatr &#40;Rio J&#41;&#46; 2020&#59;96&#58;472&#8211;8&#46;</p>"
      ]
    ]
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sexo da crian&#231;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">51&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Masculino</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">48&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Principal cuidador</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#227;e&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pai&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Respons&#225;vel &#40;sexo feminino&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Idade da crian&#231;a quando iniciado o treinamento para usar o banheiro</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antes dos 18 meses&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Entre 18 e 30 meses&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>More than 30 months&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o tem certeza&#47;n&#227;o sabe&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Dura&#231;&#227;o do treinamento para usar o banheiro</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;3 meses&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Entre 3 e 6 meses&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;6 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o tem certeza&#47;n&#227;o sabe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Relat&#243;rio das dificuldades enfrentados no treinamento para usar o banheiro</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o tem certeza&#47;n&#227;o sabe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2350624.png"
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas descritivas da amostra</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabela 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabela "
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        "tabla" => array:2 [
          "tablatextoimagen" => array:3 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Preval&#234;ncia de sintomas unit&#225;rios&#47;intestinais avaliados pelo DVSS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Incontin&#234;ncia urin&#225;ria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;3&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diminui&#231;&#227;o da frequ&#234;ncia de evacua&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;29&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Precisa fazer for&#231;a para evacuar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;29&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Segura&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;12&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urg&#234;ncia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;19&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Precisar fazer for&#231;a para urinar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;6&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dor ao urinar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;6&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presen&#231;a de eventos estressantes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;48&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presen&#231;a de sintomas sugestivos de mic&#231;&#227;o anormal&#44; medidos pelo DVSS<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;19&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Preval&#234;ncia de sintomas intestinais avaliados pelos crit&#233;rios de ROMA III<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Duas ou menos evacua&#231;&#245;es por semana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;9&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pelo menos um epis&#243;dio de incontin&#234;ncia fecal por semana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;9&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hist&#243;rico de reten&#231;&#227;o postural ou reten&#231;&#227;o volunt&#225;ria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;12&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hist&#243;rico de fezes duras ou evacua&#231;&#227;o dorolosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;51&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presen&#231;a de massa fecal de grande dimens&#227;o no reto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;16&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fezes de grande di&#226;metro que podem entupir o vaso sanit&#225;rio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;25&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presen&#231;a de sintomas sugestivos de constipa&#231;&#227;o funcional&#44; medidos pelos Crit&#233;rios de Roma III<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;38&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2350625.png"
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            ]
            2 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Preval&#234;ncia de sintomas urin&#225;rios e intestinais combinados &#40;DVSS<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Roma III<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presen&#231;a de sintomas sugestivos de disfun&#231;&#227;o urin&#225;ria e intestinal &#40;DUI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;19&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Pontua&#231;&#227;o total do DVSS &#40;pontua&#231;&#227;o feminina<span class="elsevierStyleHsp" style=""></span>&#62; 6 pontos&#59; pontua&#231;&#227;o masculina<span class="elsevierStyleHsp" style=""></span>&#62; 9 pontos&#41;&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Presen&#231;a de pelo menos 2 dos 6 sintomas intestinais&#46;</p>"
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          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Preval&#234;ncia de sintomas urin&#225;rios&#44; intestinais e urin&#225;rios e intestinais combinados</p>"
        ]
      ]
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        "identificador" => "tbl0015"
        "etiqueta" => "Tabela 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
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        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Vari&#225;veis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Categorias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Taxas de preval&#234;ncia</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dintomas urin&#225;rios &#40;DVSS&#41;<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a></th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sintomas intestinais &#40;ROMA III&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a></th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sexo da crian&#231;a</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Faixa et&#225;ria</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#60;<span class="elsevierStyleHsp" style=""></span>8 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#60;<span class="elsevierStyleHsp" style=""></span>18 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ordem de nascimento da crian&#231;a</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#176; filho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#176; filho e mais novo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#250;mero de crian&#231;as na fam&#237;lia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#8211; 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dist&#226;ncia at&#233; o hospital</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mesma cidade do hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cidade diferente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Renda familiar&#47;ano &#40;&#36;&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">At&#233; 7&#46;900&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36;7&#46;920&#8208;13&#46;200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36;13&#46;200&#8208;39&#46;600&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Tipo de OI</td><td class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Desconhecido&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unidade ambulatorial</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ambulatorial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o ambulatorial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">Dispositivos de assist&#234;ncia &#224; mobilidade</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "imagenFichero" => array:1 [
                0 => "xTab2350627.png"
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          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Pontua&#231;&#227;o total do DVSS &#40;pontua&#231;&#227;o feminina<span class="elsevierStyleHsp" style=""></span>&#62; 6 pontos&#59; pontua&#231;&#227;o masculina<span class="elsevierStyleHsp" style=""></span>&#62; 9 pontos&#41;&#46;</p>"
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            1 => array:3 [
              "identificador" => "tblfn0030"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Presen&#231;a de pelo menos dois dos seis sintomas intestinais&#46;</p>"
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          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas demogr&#225;ficas e cl&#237;nicas na preval&#234;ncia de sintomas urin&#225;rios e intestinais</p>"
        ]
      ]
    ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Quality of life in osteogenesis imperfecta&#58; a mixed&#8208;methods systematic review"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46; Dahan-Oliel"
                            1 => "S&#46; Oliel"
                            2 => "A&#46; Tsimicalis"
                            3 => "K&#46; Montpetit"
                            4 => "F&#46; Rauch"
                            5 => "M&#46;J&#46; Dogba"
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                    0 => array:2 [
                      "doi" => "10.1002/ajmg.a.37377"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med Genet A"
                        "fecha" => "2016"
                        "volumen" => "170A"
                        "paginaInicial" => "62"
                        "paginaFinal" => "76"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26365089"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The psychosocial experience of individuals living with osteogenesis imperfecta&#58; a mixed&#8208;methods systematic review"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Tsimicalis"
                            1 => "G&#46; Denis-Larocque"
                            2 => "A&#46; Michalovic"
                            3 => "C&#46; Lepage"
                            4 => "K&#46; Williams"
                            5 => "T&#46;R&#46; Yao"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1007/s11136-016-1247-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Qual Life Res"
                        "fecha" => "2016"
                        "volumen" => "25"
                        "paginaInicial" => "1877"
                        "paginaFinal" => "1896"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26894269"
                            "web" => "Medline"
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              "identificador" => "bib0165"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Results of a bone splint technique for the treatment of lower limb deformities in children with type I osteogenesis imperfecta"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46; Lin"
                            1 => "W&#46; Zhai"
                            2 => "K&#46; Lian"
                            3 => "Z&#46; Ding"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/0019-5413.114922"
                      "Revista" => array:6 [
                        "tituloSerie" => "Indian J Orthop"
                        "fecha" => "2013"
                        "volumen" => "47"
                        "paginaInicial" => "377"
                        "paginaFinal" => "381"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23960282"
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            3 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Charting the territory&#58; symptoms and functional assessment in children with progressive&#44; non&#8208;curable conditions"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Steele"
                            1 => "H&#46; Siden"
                            2 => "S&#46; Cadell"
                            3 => "B&#46; Davies"
                            4 => "G&#46; Andrews"
                            5 => "L&#46; Feichtinger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/archdischild-2013-305246"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dis Child"
                        "fecha" => "2014"
                        "volumen" => "99"
                        "paginaInicial" => "754"
                        "paginaFinal" => "762"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24833792"
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                      "titulo" => "Do we manage incontinence in children and adults with special needs adequately&#63; ICI&#8208;RS 2014"
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                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; von Gontard"
                            1 => "T&#46;P&#46; de Jong"
                            2 => "A&#46; Rantell"
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