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Zeru T, Berihu H, Buruh G, Gebrehiwot H. Magnitude and factors associated with upper respiratory tract infection among under-five children in public health institutions of Aksum town, Tigray, Northern Ethiopia: an institutional based cross-sectional study. Pan Afr Med J 2020; 36:307. [PMID: 33282090 PMCID: PMC7687484 DOI: 10.11604/pamj.2020.36.307.17849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 09/11/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction upper respiratory tract infection is a leading cause of morbidity among under-five, particularly in the developing countries. Delays in the identification and treatment of under-fives are among the main contributors to the complication. The aim of this study was to assess the magnitude and to identify factors associated with upper respiratory tract infection among under-five children, in public health institutions of Aksum City, Tigray Region, North Ethiopia, 2016. Methods institutional based cross-sectional study was done. Cases were under-five children who had get service. The study participants were selected using Systematic random sampling technique. Data were entered, using Epi-info version 7 and analyzed using SPSS version 22.0. Clinical data from the chart were used to diagnose upper respiratory tract infection types. The binary logistic regression model was used to test the association between dependent and independent variables and multivariable logistic regression was used to identify the associated factors to upper respiratory tract infections. Results out of 213 study participants 52.6% identified as having at least one type of upper respiratory tract infection, i.e. sinusitis 22 (10.3%), 37 (17.4%) otitis media, 39 (18.3%) tonsillitis and common cold 83 (39.0%). Multivariable logistic regression analysis shows that rural residence 7.6 [AOR (95%CI) (2.49, 23.58)], civil servant father's children 4.49 [AOR (95%CI) (1.57, 12.83)], non-immunization 6.0 [AOR(95%CI) (1.38, 26.8)], mud house wall 4.58 [AOR (95%CI) (1.74, 12.0)], rental house 5.1 [AOC (95% CI) (1.82, 14.6] and large family size 5.3 [AOC (95%CI) (2.3, 12.1 )], were found to be statistically associated. Conclusion socioeconomic, maternal and environmental factors had contributed to the upper respiratory tract infection. Strengthening of the existing disease prevention policy as well as improvement of institutional health service behavior is crucial.
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Affiliation(s)
- Teklay Zeru
- Department of Nursing, College of Health Sciences, Aksum University, Aksum, Ethiopia
| | - Hagos Berihu
- Department of Nursing, College of Health Sciences, Aksum University, Aksum, Ethiopia
| | - Gerezgiher Buruh
- Department of Nursing, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Haftom Gebrehiwot
- Department of Nursing, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Schellpfeffer N, Collins A, Brousseau DC, Martin ET, Hashikawa A. Web-Based Surveillance of Illness in Childcare Centers. Health Secur 2017; 15:463-472. [PMID: 28937791 DOI: 10.1089/hs.2016.0124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
School absenteeism is an inefficient and unspecific metric for measuring community illness and does not provide surveillance during summertime. Web-based biosurveillance of childcare centers may represent a novel way to efficiently monitor illness outbreaks year-round. A web-based biosurveillance program ( sickchildcare.org ) was created and implemented in 4 childcare centers in a single Michigan county. Childcare providers were trained to report sick children who required exclusion or had parent-reported absences due to illness. Deidentified data on age range, number of illnesses, and illness categories were collected. Weekly electronic reports were sent to the county public health department. Data for reports were gathered beginning in December 2013 and were summarized using descriptive statistics. A total of 385 individual episodes of illness occurred during the study period. Children with reported illness were infants (16%, n = 61), toddlers (38%, n = 148), and preschoolers (46%, n = 176). Illness categories included: fever (30%, n = 116), gastroenteritis (30%, n = 115), influenzalike illness (8%, n = 32), cold without fever (13%, n = 51), rash (7%, n = 26), conjunctivitis (1%, n = 3), ear infection (1%, n = 5), and other (10%, n = 37). The majority of reports were center exclusions (55%, n = 214); others were absences (45%, n = 171). The detection of a gastroenteritis outbreak by web-based surveillance during winter 2013-14 preceded county health reports by 3 weeks; an additional outbreak of hand-foot-mouth disease was detected during June 2014 when standard school-based surveillance was not available. Web-based biosurveillance of illness in childcare centers represents a novel and feasible method to detect disease trends earlier and year-round compared to standard school-based disease surveillance.
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Schuez-Havupalo L, Toivonen L, Karppinen S, Kaljonen A, Peltola V. Daycare attendance and respiratory tract infections: a prospective birth cohort study. BMJ Open 2017; 7:e014635. [PMID: 28877939 PMCID: PMC5588939 DOI: 10.1136/bmjopen-2016-014635] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE We explored the burden of respiratory tract infections (RTIs) in young children with regard to day-care initiation. DESIGN Longitudinal prospective birth cohort study. SETTING AND METHODS We recruited 1827 children for follow-up until the age of 24 months collecting diary data on RTIs and daycare. Children with continuous daycare type and complete data were divided into groups of centre-based daycare (n=299), family day care (FDC) (n=245) and home care (n=350). Using repeated measures variance analyses, we analysed days per month with symptoms of respiratory tract infection, antibiotic treatments and parental absence from work for a period of 6 months prior to and 9 months after the start of daycare. RESULTS We documented a significant effect of time and type of daycare, as well as a significant interaction between them for all outcome measures. There was a rise in mean days with symptoms from 3.79 (95% CI 3.04 to 4.53) during the month preceding centre-based daycare to 10.57 (95% CI 9.35 to 11.79) at 2 months after the start of centre-based daycare, with a subsequent decrease within the following 9 months. Similar patterns with a rise and decline were observed in the use of antibiotics and parental absences. The start of FDC had weaker effects. Our findings were not changed when taking into account confounding factors. CONCLUSIONS Our study shows the rapid increase in respiratory infections after start of daycare and a relatively fast decline in the course of time with continued daycare. It is important to support families around the beginning of daycare.
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Affiliation(s)
- Linnea Schuez-Havupalo
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Turku Institute for Child and Youth Research, University of Turku, Turku, Finland
| | - Laura Toivonen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Turku Institute for Child and Youth Research, University of Turku, Turku, Finland
| | - Sinikka Karppinen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Turku Institute for Child and Youth Research, University of Turku, Turku, Finland
| | - Anne Kaljonen
- Turku Institute for Child and Youth Research, University of Turku, Turku, Finland
| | - Ville Peltola
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Turku Institute for Child and Youth Research, University of Turku, Turku, Finland
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Hashikawa AN, Brousseau DC, Singer DC, Gebremariam A, Davis MM. Emergency department and urgent care for children excluded from child care. Pediatrics 2014; 134:e120-7. [PMID: 24958578 DOI: 10.1542/peds.2013-3226] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Children in child care are frequently unnecessarily excluded for illness. We investigated parental use of urgent medical evaluation for sick children unable to attend child care. METHODS In May 2012, authors conducted a nationally representative survey of parents, who completed online questions regarding child illness causing absence from child care and their medical care-seeking behavior. Main outcome was parents' use of emergency department or urgent care (ED/UC). RESULTS Overall survey participation rate was 62%. Of participating parent cohort with children 0 to 5 years old, 57% (n = 357) required child care, of which 84% (n = 303) required out-of-home child care. Over 88% of parents sought acute medical care for their sick children unable to attend child care. Approximately one-third of parents needed a doctor's note for employers and/or child care. Parents sought medical evaluation (>1 option possible) from primary care (81%), UC (26%), or ED (25%). ED/UC use was most common for rash (21%) and fever (15%). Logistic regression indicated ED/UC use was significantly higher among single/divorced parents (odds ratio [OR] = 4.3; 95% confidence interval [CI]: 2.5-13.5); African American parents (OR = 4.2; 95% CI: 1.2-14.6); parents needing a doctor's note (OR = 4.2; 95% CI: 1.5-11.7); and those with job concerns (OR = 3.4; 95% CI: 1.2-9.7). CONCLUSIONS A substantial proportion of parents whose sick children cannot attend child care seek care in ED/UC. Training child care professionals regarding appropriate illness exclusions may decrease ED/UC visits by lowering child care exclusions.
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Affiliation(s)
| | - David C Brousseau
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Dianne C Singer
- Child Health Evaluation and Research Unit, University of Michigan Medical School, Ann Arbor, Michigan
| | - Achamyeleh Gebremariam
- Child Health Evaluation and Research Unit, University of Michigan Medical School, Ann Arbor, Michigan
| | - Matthew M Davis
- Child Health Evaluation and Research Unit, University of Michigan Medical School, Ann Arbor, Michigan;Institute of Healthcare Policy and Innovation and Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan
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de Hoog MLA, Venekamp RP, van der Ent CK, Schilder A, Sanders EA, Damoiseaux RA, Bogaert D, Uiterwaal CS, Smit HA, Bruijning-Verhagen P. Impact of early daycare on healthcare resource use related to upper respiratory tract infections during childhood: prospective WHISTLER cohort study. BMC Med 2014; 12:107. [PMID: 24965189 PMCID: PMC4098954 DOI: 10.1186/1741-7015-12-107] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 05/23/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Daycare attendance is an established risk factor for upper respiratory tract infections (URTI) and acute otitis media (AOM). Whether this results in higher use of healthcare resources during childhood remains unknown. We aim to assess the effect of first year daycare attendance on the timing and use of healthcare resources for URTI and AOM episodes during early childhood. METHODS In the Wheezing-Illnesses-STudy-LEidsche-Rijn birth cohort, 2,217 children were prospectively followed up to age six years. Children were categorized according to first-year daycare attendance (yes versus no) and age at entry when applicable (age 0 to 2 months, 3 to 5 months and 6 to 12 months). Information on general practitioner (GP) diagnosed URTI and AOM, GP consultations, antibiotic prescriptions and specialist referral was collected from medical records. Daycare attendance was recorded by monthly questionnaires during the first year of life. RESULTS First-year daycare attendees and non-attendees had similar total six-year rates of GP-diagnosed URTI and AOM episodes (59/100 child-years, 95% confidence interval 57 to 61 versus 56/100 child-years, 53 to 59). Daycare attendees had more GP-diagnosed URTI and AOM episodes before the age of one year and fewer beyond the age of four years than non-attendees (Pinteraction <0.001). Daycare attendees had higher total six-year rates for GP consultation (adjusted rate ratio 1.15, 1.00 to 1.31) and higher risk for specialist referrals (hazard ratio: 1.43, 1.01 to 2.03). The number of antibiotic prescriptions in the first six years of life was only significantly increased among children who entered daycare between six to twelve months of age (rate ratio 1.32, 1.04 to 1.67). This subgroup of child-care attendees also had the highest overall URTI and AOM incidence rates, GP consultation rates and risk for specialist referral. CONCLUSIONS Children who enter daycare in the first year of life, have URTI and AOM at an earlier age, leading to higher use of healthcare resources compared to non-attendees, especially when entering daycare between six to twelve months. These findings emphasize the need for improved prevention strategies in daycare facilities to lower infection rates at the early ages.
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Affiliation(s)
- Marieke L A de Hoog
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, STR 6,131, PO Box 85500, 3508 GA Utrecht, The Netherlands.
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Relationship of environmental tobacco smoke to otitis media (OM) in children. Int J Pediatr Otorhinolaryngol 2012; 76:989-93. [PMID: 22510576 PMCID: PMC3894111 DOI: 10.1016/j.ijporl.2012.03.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 03/15/2012] [Accepted: 03/16/2012] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Many, but not all, studies have found a correlation between environmental tobacco smoke (ETS) and acute otitis media (AOM) and other adverse otologic outcomes. Given its high personal and societal costs and the divergent findings of the effect of ETS on middle ear disease, the aim of the current study was to assess the impact and possible determinant factors of ETS on recurrent (two or more) episodes of AOM. METHODS The study was performed at Heim Pal Children's Hospital, Ear, Nose and Throat (ENT) Department, Budapest, Hungary. Caregivers of a convenience sample of 412 children attending the ENT outpatient clinic were surveyed via a 22-item questionnaire regarding demographics, socioeconomics, and smoking behaviours of the child's family; as well as care-givers' self report of the number of AOM episodes of the child. RESULTS Of the 412 participants, 155 (38%) children's parents smoked. In bivariate analysis, two or more episodes of AOM correlated with reported hearing problems, day care enrolment, parental employment and increased age of the child. In multivariate logistic regression, parental smoking more than doubled a child's risk for recurrent AOM while increased maternal employment (e.g. part-time or full-time versus unemployed) boosted risk up to fourfold. Among children whose parents smoked, half-packs of cigarettes smoked per day and day care attendance doubled or nearly tripled, respectively, the risk of recurrent AOM episodes. CONCLUSIONS Childhood exposure to ETS is high among an ENT clinic population of Hungarian children. Such exposure correlates with AOM episodes, ENT operations and conductive hearing loss. Data such as these argue for strict laws smoke-free laws not only in Hungary, but also in Europe and around the world.
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Affiliation(s)
- Timothy R Shope
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. timothy.
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Infections Associated with Group Childcare. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2012. [PMCID: PMC7152480 DOI: 10.1016/b978-1-4377-2702-9.00102-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ertmann RK, Siersma V, Reventlow S, Söderström M. Infants' symptoms of illness assessed by parents: impact and implications. Scand J Prim Health Care 2011; 29:67-74. [PMID: 21591836 PMCID: PMC3347950 DOI: 10.3109/02813432.2011.576863] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES. Some parents with a sick infant contact a doctor, while others do not. The reasons underlying such parental decisions have not been thoroughly studied. The purpose of this study was to explore how the actual symptoms in the infant were associated with parent-rated illness, illness severity, and the probability of the parents contacting a doctor. DESIGN. A retrospective questionnaire and a prospective diary study covering 14 months of the participating infants' lives. SETTING AND SUBJECTS. The 194 participating infants were followed for three months prospectively from the age of 11 to 14 months using diary cards, and retrospectively from birth until the age of 11 months by a questionnaire. RESULTS. During the three months of the diary card prospective follow-up, the infants had symptoms on average every second day, and the vast majority (92%) had 10 or more days with at least one symptom; 38% of the infants were reported to have had five or more symptoms for more than five days. Fever, earache, and vomiting were the symptoms most likely to cause parents to rate their infant as ill. Earache was the symptom that triggered doctor contact most immediately. The parent-rated illness severity was strongly related to the tendency to contact a doctor. However, this association was markedly weaker when adjustment was made for the infant not eating normally, having a cough, or running a fever. CONCLUSION. Specific symptoms such as fever, earache, and vomiting were strongly associated with the probability of parents rating the infant as ill. An earache would cause the parents to contact a doctor. Fever and vomiting were other symptoms triggering doctor contacts. First, these symptoms could cause the parents to want a doctor's expert evaluation of the infant's illness; second, the parents could expect medication to be necessary; or third, it could just be difficult for the parents to handle the ill infant.
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Affiliation(s)
- Ruth K Ertmann
- Department of General Practice and the Research Unit for General Practice in Copenhagen, University of Copenhagen, Denmark
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Beijers R, Jansen J, Riksen-Walraven M, de Weerth C. Nonparental care and infant health: do number of hours and number of concurrent arrangements matter? Early Hum Dev 2011; 87:9-15. [PMID: 20934281 DOI: 10.1016/j.earlhumdev.2010.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 09/09/2010] [Accepted: 09/15/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Previous research found that centre-based childcare is related to more illnesses early in life. The goal of this longitudinal study is to determine whether infant health in the first year of life is also related to the amount of time spent in non-parental care and the number of concurrent non-parental care arrangements. METHODS Information on infant health and non-parental care was obtained through monthly maternal interviews across the first year of life. The occurrences of respiratory, digestive, general, and skin illnesses and complaints were used as dependent variables, while the number of hours and the number of arrangements per week were used as predictors. Analyses were done separately in infants for whom centre-based childcare is included in their arrangements (n=107), and for those which it is not (n=61). RESULTS Infants spending more hours in non-parental care had more respiratory and general illnesses. Infants who were cared for in more concurrent arrangements had fewer respiratory and general, but more skin illnesses. These results only applied to infants that included centre-based childcare in their arrangements. In the group of infants that did not attend centre-based childcare, health was not related to either the number of hours or the number of arrangements. CONCLUSIONS Number of hours and number of arrangements do matter in relation to infant health early in life, but only for infants who attend centre-based childcare. While more hours were related to more illnesses, more arrangements were related to both fewer and more illnesses, depending on the type of illnesses.
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Affiliation(s)
- Roseriet Beijers
- Department of Developmental Psychology-Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, Nijmegen, The Netherlands.
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Shane AL, Pickering LK. Infections Associated with Group Childcare. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASE 2008. [PMCID: PMC7310925 DOI: 10.1016/b978-0-7020-3468-8.50009-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Paterson JE, Carter S, Wallace J, Ahmad Z, Garrett N, Silva PA. Pacific Islands Families Study: risk factors associated with otitis media with effusion among Pacific 2-year-old children. Int J Pediatr Otorhinolaryngol 2007; 71:1047-54. [PMID: 17467064 DOI: 10.1016/j.ijporl.2007.03.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Revised: 03/18/2007] [Accepted: 03/19/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study examined the risk factors associated with middle ear disease in a cohort of Pacific 2-year-old children residing in New Zealand. METHODS The data were gathered as part of the Pacific Island Families: first 2 years of life (PIF) study in which 656 2-year-old were screened using tympanometry to identify children at risk for otitis media with effusion (OME) and other otological disorders. RESULTS Within this 2-year-old cohort of Pacific children, one set of factors significantly associated with OME was clustered around the respiratory and auditory health of the child over the past year. OME was more likely for children who were regularly suffering from fluid/pus discharge from ears (OR=2.10, 95% CI: 1.01-4.35), children with five or more coughs/colds in the last year (OR=1.90, 95% CI: 1.22-3.00), and children who frequently/constantly snored (OR=2.60, 95% CI: 1.09-6.23) to have OME. Those children who were treated at home for breathing problems were more that two times more likely to have OME (OR=2.61, 95% CI: 1.55-4.42). A second set of factors was clustered around environmental risks that exposed children to a large number of other children. Children who attended a day care centre for more than 20h were five times more likely (OR=5.21, 95% CI: 2.90-9.35) and those who regularly attended church (OR=2.78, 95% CI: 1.05-7.40) were almost three times more likely to have OME. CONCLUSIONS These findings portray a child compromised by persistent ear infections and general coughs and colds as being at increased risk of contracting OME. In line with international research these findings raise questions about the negative child health effects associated with the day care environment for young children.
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Affiliation(s)
- J E Paterson
- Auckland University of Technology, Auckland, New Zealand.
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Delour M, Caparros N, Rufat P, Desplanques L, Bonnefoi MC, Patris S, Brodin M. [Organisational factors associated with the repetition of infections among children in Parisian day-care setting]. Arch Pediatr 2006; 13:1215-21. [PMID: 16930964 DOI: 10.1016/j.arcped.2006.03.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2005] [Accepted: 03/16/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study analyzes the organisational factors linked with episodes of infections in children attending child day-care setting in Paris. POPULATION AND METHODS A sample of children who attended parisian municipal child day-care setting, stratified on the type and the size of the day-care setting, was achieved. This cohort was followed from September 2000 to June 2001. We compared the risk of repeated infections according to the type of day-care setting (family day-care or day-care centre), and for the day-care centre according to the size (< or =60 or >60 places) and the structure of groups (mixing age groups or not). The events studied were the occurrence of at least: 6 episodes of any infection, 2 otitis, 2 gastroenteritis, 2 conjunctivitis or 5 upper respiratory tract infections. RESULTS Nine hundred and ninety-three children were included in this study. The 878 children attending a day-care centre had a significant higher risk of infections compare to children in family day-care (RR = 2.92[1.58-5.38]) except for gastroenteritis and conjunctivitis. This relationship between the type of day-care setting and the repeated infections was especially shown for children younger than 1 year. The mixing of ages only increased the risk of conjunctivitis (RR = 1.98[1.15-3.42]). No significant relationship between the size of the day care centre and the repetition of every studied infection was found. CONCLUSION This study strengthens the orientation of the more vulnerable children towards the family day-care centers.
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Affiliation(s)
- M Delour
- Service de PMI, direction des familles et de la petite enfance, 94-96 quai de la Râpée, 75570 Paris cedex 12, France
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Rovers MM, de Kok IMCM, Schilder AGM. Risk factors for otitis media: an international perspective. Int J Pediatr Otorhinolaryngol 2006; 70:1251-6. [PMID: 16481051 DOI: 10.1016/j.ijporl.2006.01.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Revised: 01/04/2006] [Accepted: 01/05/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND Opinions about otitis media (OM) as an illness and about the need for antibiotic or surgical treatment vary internationally. It is not known how this is to be explained, whether by cultural differences or by other factors, such as variation in environmental risk factors for OM. OBJECTIVES To report on variation in environmental risk factors for OM across Western countries, and on the organisation of health care in these countries. METHODS Main environmental risk factors for OM were identified by searching Pubmed. Data on the distribution of these risk factors and the organisation of health care across countries were obtained from the OECD and WHO websites. RESULTS Main risk factors for OM were day-care, number of siblings, smoking, breastfeeding, birth weight, socio-economic status (SES) and air pollution. Data were available for several European countries, the United State, Canada and Australia. Large international differences were found regarding the proportion of children attending day-care (Sweden 75% versus Italy 6%) and being breastfed at age 6 months (Norway 80% versus Poland 6%), and the rate of female smokers (Germany, France and Norway 30-40% versus Portugal <10%). CONCLUSION It appears that differences in risk factor exposure between populations are often overshadowed by other culturally or demographically significant factors. Attempts to discern these factors within populations and between countries may be important in the management of OM and warrants further study.
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Affiliation(s)
- Maroeska M Rovers
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.139, P.O. Box 85060, 3508 AB Utrecht, The Netherlands.
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Rosenbaum PF, Buck GM, Brecher ML. Allergy and infectious disease histories and the risk of childhood acute lymphoblastic leukaemia. Paediatr Perinat Epidemiol 2005; 19:152-64. [PMID: 15787890 DOI: 10.1111/j.1365-3016.2005.00634.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Infectious disease histories were evaluated in a population-based case-control study of childhood acute lymphoblastic leukaemia (ALL) as it has been hypothesised that delays in early infections are associated with an increased risk of disease. Allergy histories were also assessed as part of a broader evaluation of the role of immune factors in ALL. Cases (n = 255) were diagnosed between 1980 and 1991 at one of four referral centres in a 31-county area of New York State; controls (n = 760) were a random sample of live births from the same region, frequency matched to cases by sex, race and birth year. Data were collected by mailed questionnaire, completed by case and control parents in 1995. Allergy and infectious histories before the age at leukaemia diagnosis for cases and an equivalent age for controls were evaluated. The adjusted odds ratio and 95% confidence interval [CI] associated with a positive history of any allergy was 0.58 [95% CI 0.38, 0.88] compared with a negative allergy history. The occurrence of several common childhood illnesses before 25 months of age and ALL were assessed, with both weak positive and weak inverse associations observed. Overall, these analyses provide little support for the hypothesis that infection delay in early life is associated with an increased risk of ALL. Children with positive allergy histories reported significantly more infections than those with negative histories; however, effect modification of the infection-ALL associations by child allergy history was not observed. Nonetheless, these observations suggest the importance of assessing both allergy and infectious histories and their possible interactions when evaluating the association between these immune factors and childhood ALL.
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Affiliation(s)
- Paula F Rosenbaum
- Center for Outcomes Research and Evaluation, State University of New York Upstate Medical University, Syracuse, NY 13210, USA.
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Curry MD, Mathews HF, Daniel HJ, Johnson JC, Mansfield CJ. Beliefs about and responses to childhood ear infections: a study of parents in eastern North Carolina. Soc Sci Med 2002; 54:1153-65. [PMID: 11993452 DOI: 10.1016/s0277-9536(01)00086-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Middle ear infection, also known as otitis media (OM), is a major public health problem among American children. Although clinical and epidemiological aspects of OM have been intensely studied, cultural factors that may be contributing to the problem of OM have received less attention. This article presents findings from an ethnographic study exploring beliefs about OM and responses to the illness among parents from eastern North Carolina. In-depth interviews were conducted with a convenience sample of nine mothers in order to learn more about parents' explanatory models of OM, the source of their beliefs, and how they respond to the illness. A survey instrument based on their statements was then constructed and administered to a convenience sample of 79 parents. The survey consisted of belief statements about OM, as well as questions pertaining to sources of beliefs, the home management of the disease, and the effects of the illness on families. A cultural consensus analysis of responses to belief statements indicates that parents shared a common model of OM. Beliefs about risks, symptoms, and causes of OM were similar to the current biomedical model of the illness, but their divergent beliefs about the diagnosis, prognosis and treatment of OM could lead to unnecessary use of health care services. Clinicians, family, and friends were reported to be important sources of information about OM. Parents also reported using similar home management strategies and care seeking behaviors to minimize the impact of the illness on their children and families. While these findings need to be replicated in studies with larger, more representative samples, this study suggest that ethnographic approaches may provide new insights into the cultural dimension of the problem of OM.
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Affiliation(s)
- Matthew D Curry
- Center for Health Services Research and Development, Physicians Quadrangle, East Carolina University, Greenville, NC 27858, USA.
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Carabin H, Gyorkos TW, Soto JC, Joseph L, Collet JP. Comparison between two common methods for reporting cold and diarrhoea symptoms of children in daycare centre research. Child Care Health Dev 2000; 26:471-85. [PMID: 11091263 DOI: 10.1046/j.1365-2214.2000.00168.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The increasing number of children attending day care centres (DCCs) in industrialized countries has refocused attention on the occurrence of infections and infectious diseases in these settings. OBJECTIVE To evaluate the agreement between two methods (parent method vs. educator method) for reporting the occurrence of respiratory and diarrhoeal infections. METHODS Fifty-two DCCs in Quebec, Canada, participated. Both educators and parents were invited to fill in calendars on which they would indicate the occurrence of colds and diarrhoea. For the parents' method, parents were telephoned biweekly to record their calendar information. For the educators' method, educators returned their calendar pages monthly (following prompting by phone, when necessary). RESULTS Three hundred and thirty-three parents of toddlers participated in the 15-month reporting period between September 1996 and November 1997. The average agreement between the two methods was low (13.5% for colds and 9.8% for diarrhoea). Overall estimates of the incidence rates of respiratory and diarrhoeal infections based on parents' method were higher than those based on educators' method. CONCLUSIONS Parents' data lead to larger estimations of incidence rates and are probably more valid than educators' data.
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Affiliation(s)
- H Carabin
- Department of Epidemiology and Biostatistics, McGill University, Montréal, Canada.
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Dewey C, Midgeley E, Maw R. The relationship between otitis media with effusion and contact with other children in a british cohort studied from 8 months to 3 1/2 years. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood. Int J Pediatr Otorhinolaryngol 2000; 55:33-45. [PMID: 10996234 DOI: 10.1016/s0165-5876(00)00377-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE It is generally acknowledged that otitis media with effusion is more prevalent among children attending grouped day care. This study aimed to refine this by determining the relationships with the numbers of children at the place of day care, the age of the child and the number of siblings he/she had. METHODS ALSPAC (the Avon Longitudinal Study of Pregnancy and Childhood) is a population based longitudinal study starting early in pregnancy and following the children throughout their lives. Nested within this study, a randomly selected group of 1590 children, the Children in Focus, were invited to attend a clinic for hands on examinations. Tympanometry was carried out at ages 8, 12, 18, 25, 31, 37 and 43 months of age. Bilateral otitis media with effusion (OME) was identified if both ears showed a flat trace. Multi-level modelling with logistic regression adjusted for a number of social and environmental influences. RESULTS Of the 1590 children invited to the 8-month clinic, 300 (19%) were excluded from the analysis because of failure to attend or because of missing data. The analyses were based on 1290 children. The prevalence of bilateral OME decreased with age, from 24.6% at 8 months to 11.9% at 43 months. Children with older siblings and those attending day care with four or more other children were at an increased risk of OME. The adjusted odds ratios (AOR) were 1.52 (95% confidence interval [CI] = 1.23, 1.88) and 1.36 (95% CI = 1.02, 1.82), respectively. The risk associated with older siblings declined with age and by 3 years these children were no longer more likely to have OME than children with no older siblings. No such interaction with age was found for children in group day care and these children continued to be at an increased risk over the entire age period of the study. There was no increased risk associated with day care when no other children attended (AOR = 1.18, 95% CI = 0.88, 1.58) or when one to three others were present (AOR = 1.10, 95% CI = 0.85, 1.42). Although there was no relationship with the number of hours spent in day care, children who had started attending group care with four or more other children before 9 months of age did have an increased risk compared with children starting later AOR = 1.88, 95% CI = 1.12, 3.14. CONCLUSIONS These results provide evidence that early contact with other children increases the risk of OME and that children attending day care with four or more other children remain at an increased risk of OME at least until 31/2 years.
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Affiliation(s)
- C Dewey
- Unit of Paediatric and Perinatal Epidemiology, University of Bristol, Bristol, UK.
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St Sauver J, Marrs CF, Foxman B, Somsel P, Madera R, Gilsdorf JR. Risk factors for otitis media and carriage of multiple strains of Haemophilus influenzae and Streptococcus pneumoniae. Emerg Infect Dis 2000; 6:622-30. [PMID: 11076721 PMCID: PMC2640914 DOI: 10.3201/eid0606.000611] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We studied genetic diversity in Streptococcus pneumoniae and Haemophilus influenzae in throat culture isolates from 38 children attending two day-care centers in Michigan. Culture specimens were collected weekly; 184 S. pneumoniae and 418 H. influenzae were isolated from the cultures. Pulsed-field gel electrophoresis identified 29 patterns among the S. pneumoniae isolates and 87 among the H. influenzae isolates. Of the cultures, 5% contained multiple genetic types of S. pneumoniae, and 43% contained multiple types of H. influenzae. Carriage of multiple H. influenzae isolates, which was associated with exposure to smoking, history of allergies, and age 36 to 47 months, may increase risk for otitis media in children.
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Affiliation(s)
- J St Sauver
- University of Michigan, Ann Arbor, Michigan, USA
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Celedon JC, Litonjua AA, Weiss ST, Gold DR. Day care attendance in the first year of life and illnesses of the upper and lower respiratory tract in children with a familial history of atopy. Pediatrics 1999; 104:495-500. [PMID: 10469775 DOI: 10.1542/peds.104.3.495] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the relationship between day care attendance and illnesses of the upper and lower respiratory tract in the first year of life. STUDY DESIGN Prospective birth cohort study. METHODS Children (N = 498) who had at least 1 parent with a history of allergy or asthma were enrolled at birth and followed prospectively for the first year of life. A home visit at 2 to 3 months of age and bimonthly telephone questionnaires were used to obtain information on day care arrangements, home characteristics, respiratory symptoms, and physician-diagnosed illnesses of the upper and lower respiratory tract. RESULTS Day care attendance in the first year of life was associated with two or more doctor-diagnosed ear infections (OR: 2.4; 95% CI: 1.7-3.6), three or more parental reports of runny or stuffed nose (OR: 3.2; 95% CI: 1.9-5.5), a doctor's diagnosis of sinusitis (OR: 2.2; 95% CI: 1.1-4.2), and doctor-diagnosed lower respiratory illnesses (croup, bronchitis, bronchiolitis, and pneumonia; OR: 1.6; 95% CI: 1.0-2.4). For children attending day care, exposure to pets in day care, the presence of a rug or carpet in the area where the child slept in day care, and a nonresidential setting for day care all were independent predictors of two or more doctor-diagnosed ear infections. CONCLUSIONS The results suggest that day care increases the risk of illnesses of the upper and lower respiratory tract in the first year of life for children with a familial history of atopy. Specific environmental exposures within day care, such as the presence of pets or having a rug or carpet in the area where children sleep, may increase the risk of recurrent ear infections in the first year of life among children with familial history of atopy who attend day care.
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Affiliation(s)
- J C Celedon
- Channing Laboratory and Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Homøe P, Christensen RB, Bretlau P. Acute otitis media and sociomedical risk factors among unselected children in Greenland. Int J Pediatr Otorhinolaryngol 1999; 49:37-52. [PMID: 10428404 DOI: 10.1016/s0165-5876(99)00044-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the sociomedical risk factors associated with episodes of acute otitis media (AOM), recurrent AOM (rAOM), and chronic otitis media (COM) in Greenlandic children and especially to point out children at high risk of rAOM (defined as > 5 AOM episodes since birth) and COM which are prevalent among Inuit children all over the Arctic. METHODS The study design was cross-sectional and included 740 unselected children, 3, 4, 5, and 8-years-old, living in two major Greenlandic towns, Nuuk and Sisimiut. All children were otologically examined and the parents answered a questionnaire containing sociomedical variables including ethnicity, family history of OM, housing, insulation, crowding, daycare, passive cigarette smoking, breast feeding, type of diet, allergy, and chronic diseases. Historical data were cross-checked in medical records which also formed the basis for the drop-out analyses. Statistical analyses included frequency tests, calculation of odds ratio (OR), and multiple logistic regression. RESULTS The attendance rate was 86%. Former episode of AOM was reported by 2/3 of the children, rAOM by 20%, and COM by 9%. The following variables were found significantly more often in children with AOM by simple frequency testing: Parental (OR = 1.83), sibling (OR = 1.62), and parental plus sibling (OR = 2.56) history of OM, crowding (OR = 5.55), long period of exclusive breast feeding ( > 4 months) (OR = 2.47), and recent acute disease (P = 0.034). The following variables were found significantly more often in children with rAOM or COM by simple frequency testing: Parental history of OM (OR = 1.60; OR = 2.11, respectively) and no recall of breast feeding (P = 0.005; P = 0.003, respectively). Also, COM was found significantly more often in children with two Greenlandic parents (OR = 3.07). A multiple logistic regression test denoted only parental history of OM (OR = 1.82) and long period of exclusive breast feeding (OR = 1.14) as significant predictors of AOM. CONCLUSIONS Many of the risk factors usually associated with AOM could not be confirmed as risk factors in this survey. Parental history of OM and long period of exclusive breast feeding were the strongest factors associated with AOM in Greenlandic children and ethnicity was associated with COM. However, the study confirms that AOM is a multifactorial disease determined by a number of genetic and environmental factors.
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Affiliation(s)
- P Homøe
- Department of Otolaryngology, Head & Neck Surgery, Rigshospitalet, University of Copenhagen, Denmark.
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Engel J, Anteunis L, Volovics A, Hendriks J, Marres E. Risk factors of otitis media with effusion during infancy. Int J Pediatr Otorhinolaryngol 1999; 48:239-49. [PMID: 10402121 DOI: 10.1016/s0165-5876(99)00037-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
UNLABELLED Associations of possible risk factors with prevalence of otitis media with effusion (OME) were prospectively studied in a cohort of 250 infants, aged 0-2 years. In order to determine OME, otoscopy and tympanometry were performed at 3-monthly intervals beginning at term date. Eighteen epidemiologically relevant features were inventoried by means of standardized questionnaires. Multivariate analysis controlled for possible confounding factors. Prevalence of OME was most strongly associated with age (P-value < 0.001). Other factors significantly associated with the prevalence of OME (P-value < 0.05) were gestational age, birth weight, breastfeeding, day-care attendance, number of siblings, season, and parent-reported ear infection, hearing loss, mouth breathing and common cold. No significance was found for gender, date of birth, passive smoking, family history of otitis media, parental socio-economic status and histories of snoring and consultation of a physician. IN CONCLUSION both intrinsic and extrinsic factors appear to play an important role in the prevalence of OME. Some of the risk factors appeared to be time-dependent.
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Affiliation(s)
- J Engel
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Maastricht, The Netherlands.
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Zeisel SA, Roberts JE, Neebe EC, Riggins R, Henderson FW. A longitudinal study of otitis media with effusion among 2- to 5-year-old African-American children in child care. Pediatrics 1999; 103:15-9. [PMID: 9917433 DOI: 10.1542/peds.103.1.15] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To prospectively document the prevalence of otitis media with effusion (OME) in 86 African-American children between ages 2 and 5 years. STUDY DESIGN Eighty-six children in center-based child care whose ear status had been followed from infancy continued to be observed. Middle ear status was assessed by pneumatic otoscopy and tympanometry biweekly. RESULTS The prevalence of OME decreased as children became older. The mean proportion of examinations demonstrating bilateral OME (BOME) ranged from 12% between 24 to 30 months to 4% between 54 to 60 months of age. The mean proportion of exams revealing bilateral normal ears increased from 77% at 24 to 30 months to 88% at 54 to 60 months of age. Although 60 children had experienced BOME that lasted 4 months or longer in the 6- to 24-month age period, only 8 of these children experienced at least 4 months of continuous BOME between 24 to 60 months. CONCLUSIONS The proportion of time with BOME decreased progressively with increasing age in this population. Only 8 of 60 children who had experienced more than 4 consecutive months of BOME before 2 years of age continued to manifest persistent effusion or experience recurrences of prolonged BOME after 2 years of age.
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Affiliation(s)
- S A Zeisel
- Frank Porter Graham Child Development Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Affiliation(s)
- H Faden
- Department of Pediatrics, State University of New York School of Medicine and Biomedical Sciences at Buffalo, USA.
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Abstract
This article outlines the perioperative and long-term management of children undergoing tonsillectomy, adenoidectomy, tympanostomy with tube insertion, and sinus surgery. Indications for complications of each of the procedures is reviewed in this article. The authors also cover the management of children with tracheostomies. Several questions frequently asked by parents of children with a tracheostomy are addressed.
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Affiliation(s)
- M P Pizzuto
- State University of New York at Buffalo, School of Medicine and Biomedical Sciences, USA
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Affiliation(s)
- R M Rosenfeld
- State University of New York Health Science at Brooklyn, USA.
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Abstract
OBJECTIVE To study the effect of day care and tube type, as well as other risk factors related to ventilation tube insertion and reinsertion. DESIGN A case series of 456 consecutive cases with 162 controls from a well-baby examination group evaluated for age, sex, smoking history and day care attendance. SETTING Private practice in a mid-sized, southeastern university town. PATIENTS AND CONTROLS This was a referred sample of patients who were entered consecutively in a private-practice setting. All children were age five or less at entry into the study. INTERVENTIONS Children underwent ventilation tube insertion with or without adenoidectomy, using standing indications. MAIN OUTCOME MEASURES The primary outcome measures were whether or not a child had the need for a second set of tubes, and also determining the status of the child's ears for at least 1 year after tubes had extruded. RESULTS Day care and younger age were both identified as risk factors associated with initial ventilation tube insertion. Only 11% (seven out of 63) of home care children, as compared with 31% (108 out of 346) day care children, had the insertion of ventilation tubes (P = 0.000). Day care children who had tubes inserted and adenoidectomy (with or without tonsillectomy) had a significantly lower rate of reintubation than children who had tube insertion alone (P = 0.00). Day care and young age are significant risk factors for any child, both with a first set of tubes and for ventilation tube reinsertion. Children in day care had a reintubation rate of 36% as compared to 11% for those in home care. Parents should be aware that day care can represent a two-fold hazard both in the observed connection between day care and tube insertion and the demonstrated increased probability of reinsertion. Any studies looking at ventilation tube outcomes need to make certain to monitor for day care attendance.
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Affiliation(s)
- D S Postma
- University of North Carolina, Chapel Hill School of Medicine 27599, USA
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Abstract
OBJECTIVE To describe parents' opinions and concerns about antibiotics and to contrast these opinions with those of pediatricians. DESIGN Parents were surveyed using an interviewer-administered questionnaire and pediatricians were mailed a self-administered questionnaire. RESULTS Parents from two private practices (N = 300) were largely white (84%) and had completed college (81%). The parents from a community health center (N = 100) were mostly black (80%) and had not completed college (91%). Twenty-nine percent of parents were worried that their children were receiving too many antibiotics. Eighty-five percent believed there were problems with receiving too many antibiotics, with 55% mentioning resistance or immunity as concerns. Eighteen percent of parents had given their child an antibiotic at home before consulting a physician. Parents believed that antibiotics were always or sometimes required for ear infections (93%), throat infections (83%), colds (32%), cough (58%), and fever (58%). Fourteen percent of parents believed that their child had required an antibiotic when the doctor did not prescribe one, with clinic parents significantly more likely to report this issue (22%) than private practice parents (12%). Nine percent believed that their doctor had prescribed an antibiotic unnecessarily (private practice = 12%, community health center = 3%). Parents from the private practices were also more likely to report requesting a specific antibiotic (34%) in comparison with 19% of clinic parents. Sixty-one percent of the physician surveys were returned after two mailings and a follow-up phone call. The pediatricians had been in practice for a median of 12 years, seeing a median of 110 patients per week. Fifty-eight percent of pediatricians reported that some, many, or most of the parents in their practices were worried that their children were receiving too many antibiotics. Seventy-one percent indicated that four or more times during the previous month, a parent had requested an antibiotic when the physician believed it was unnecessary, and 35% said that at least occasionally they went along with these requests. Sixty-one percent reported that parents requested a different antibiotic from the one they were going to prescribe at least four times in the previous month, and 30% of pediatricians said that they agreed to parents' requests often or most of the time. CONCLUSIONS Both the parent and the physician surveys suggest that parents are concerned about the overuse of antibiotics, but often request them when their physicians believe they are unnecessary. Parents often administer antibiotics without physician knowledge, and many parents have misconceptions about which illnesses warrant antibiotic therapy. Understanding parents' concerns and beliefs about antibiotics and the range of physician practice styles with respect to antibiotics may direct the development of intervention strategies to reduce the inappropriate use of oral antibiotics.
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Affiliation(s)
- D A Palmer
- Division of General Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA 02118, USA
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Curry MD, Andrews AW, Daniel HJ. A community-based nursing approach to the prevention of otitis media. J Community Health Nurs 1997; 14:81-110. [PMID: 9170756 DOI: 10.1207/s15327655jchn1402_2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Otitis media (OM), a disease of the middle ear, is one of the most common diseases of childhood. Although the medical and surgical treatment of the disease by physicians is covered at length in the literature, information about the role of nurses in dealing with OM is scant. The purpose of this article is to propose a community-based nursing prevention plan for OM based on what is known about its prevalence and pathogenesis.
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Affiliation(s)
- M D Curry
- Department of Community Health Nursing, East Carolina University, Greenville, NC 27858-4353, USA
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Abstract
More than 20 years ago, a shrewd clinician remarked, "There is little evidence that those antimicrobial agents which hypothetically or in vitro are more effective ... are superior in the treatment of otitis when compared to penicillin alone." Several hundred clinical trials later, the advantages of broad spectrum drugs remain unproved, and questions remains as to whether antibiotics are required for most episodes of AOM. Further, antibiotics have been demoted to the status of optional therapy for OME. This situation is unlikely to change as new studies with new antibiotics proliferate. What is clear, however, is that accelerated patterns of bacterial resistance mandate an evidence-based approach to managing otitis media. Bacteria have an uncanny ability to learn new mechanisms of antibiotic resistance. A large part of bacterial "education" has undoubtedly been fueled by antibiotic prescriptions from well-intentioned physicians, with unrealistic expectations of drug efficacy. A judicious approach to antibiotic treatment of otitis media can result only from knowing the spontaneous course of the disorder and incremental effect of antibiotics on clinical outcomes. In this article, a series of unifying concepts are developed to help practicing clinicians with an evidence-based approach to managing otitis media. Critical review of the published evidence suggests that the most favorable outcomes from medical treatment will occur if practitioners: appreciate the favorable natural history of untreated otitis media realize that OME may take months to resolve following a single AOM episode modify risk factors to improve the odds of spontaneous resolution use pneumatic otoscopy and confirmatory tympanometry to diagnose OME recognize the limited impact of antibiotic therapy on treatment and prevention balance the benefits of antibiotics against the risk of accelerated bacterial resistance avoid repetitive, prolonged, or prophylactic antibiotic treatment of chronic OME avoid ineffective therapy, such as antihistamine/decongestant preparations An important aspect of management is helping caregivers understand the natural history of otitis media and the impact of medical treatment on shortterm and long-term outcomes. Realistic expectations on the part of all involved parties should facilitate rational decisions about watchful waiting, medical therapy, and the need for surgical intervention.
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Affiliation(s)
- R M Rosenfeld
- Department of Otolaryngology, State University of New York Health Science Center at Brooklyn, USA
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Kvaerner KJ, Nafstad P, Hagen JA, Mair IW, Jaakkola JJ. Early acute otitis media and siblings' attendance at nursery. Arch Dis Child 1996; 75:338-41. [PMID: 8984924 PMCID: PMC1511727 DOI: 10.1136/adc.75.4.338] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
To assess the relation between early acute otitis media and exposure to respiratory pathogens mediated by siblings and other children, a prospective cohort of 3754 Norwegian children born in 1992-3 was followed up from birth to 12 months. Of these, 25% had one or more episodes of acute otitis media during the first year. Results from multiple logistic regression analysis adjusted for confounding showed that siblings' attendance at daycare is the most important risk factor for early acute otitis media (adjusted odds ratio, ORadj = 1.9). The total number of children in the daycare setting is another determinant for early acute otitis media (ORadj = 2.0 in groups of four or more other children and ORadj = 1.3 in groups of one to three other children, as compared to those who are cared for alone). Having siblings in daycare outside the home and the number of children in the daycare setting are the most important determinants for early acute otitis media.
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Affiliation(s)
- K J Kvaerner
- Section of Epidemiology, National Institute of Public Health, Oslo, Norway
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