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Vaghela S, Welch VL, Sinh A, Di Fusco M. Caregiver Burden among Patients with Influenza or Influenza-like Illness (ILI): A Systematic Literature Review. Healthcare (Basel) 2024; 12:1591. [PMID: 39201150 PMCID: PMC11353737 DOI: 10.3390/healthcare12161591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/27/2024] [Accepted: 08/07/2024] [Indexed: 09/02/2024] Open
Abstract
Influenza and influenza-like illness (ILI) pose significant clinical and economic burdens globally each year. This systematic literature review examined quantitative studies evaluating the impact of patients' influenza/ILI on their caregivers' well-being, focusing on health-related quality of life (HRQoL), work productivity, and activity impairment. A comprehensive search across six databases, including the Cochrane Database of Systematic Reviews, Embase, MEDLINE via PubMed, Ovid, PsycNet, and Web of Science, yielded 18,689 records, of which 13,156 abstracts were screened, and 662 full-text articles were reviewed from January 2007 to April 2024. Thirty-six studies [HRQoL: 2; productivity: 33; both: 1] covering 22 countries were included. Caregivers of 47,758 influenza or ILI patients across 123 study cohorts were assessed in the review. The mean workday loss among caregivers ranged from 0.5 to 10.7 days per episode, influenced by patients' influenza status (positive or negative), disease severity (mild or moderate-to-severe), age, viral type (influenza A or B), and vaccination/treatment usage. The HRQoL of caregivers, including their physical and emotional well-being, was affected by a patient's influenza or ILI, where the severity and duration of a patient's illness were associated with worse HRQoL. This review shows that the consequences of influenza or ILI significantly affect not only patients but also their caregivers.
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Affiliation(s)
- Shailja Vaghela
- HealthEcon Consulting, Inc., Ancaster, ON L9G 4L2, Canada; (S.V.)
| | | | - Anup Sinh
- HealthEcon Consulting, Inc., Ancaster, ON L9G 4L2, Canada; (S.V.)
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2
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Gerganova M, Schepanski S, Bogdanski M, Kandil FI, Tekath A, Jeitler M, Stritter W, Blakeslee SB, Seifert G. Effect of the health and wellness Kneipp concept on health promotion and reduction of sick days for kindergarten children: a cluster randomized controlled trial protocol. Front Med (Lausanne) 2024; 11:1412971. [PMID: 39131084 PMCID: PMC11309992 DOI: 10.3389/fmed.2024.1412971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 07/10/2024] [Indexed: 08/13/2024] Open
Abstract
Background The holistic health and wellness Kneipp concept, has a long tradition in Europe with demonstrated health benefits. Based on the five elements of the Kneipp concept, kindergartens in and around Germany are used to certify "Kneipp Kindergartens" that practice regular Kneipp applications and activities: cold water applications, exercise, nutrition, herbs and mind-body interventions. Little is known about the potential health benefits for children, however. This study protocol describes our study design and intervention of the Kita Kneipp Study to investigate the effect of the Kneipp concept on kindergarten children aged 2-6 years. Methods and design The Kita Kneipp Study, registered with the German Clinical Trial Register (DRKS-ID: DRKS00029275), is a confirmatory, mixed-method, two-armed, waitlist, clinical, cluster randomized controlled trial (RCT). Kindergartens in Berlin, Germany that would like to implement the Kneipp concept into their facility will be recruited and randomized to the intervention or control group. Changes in the number of kindergarten sick days will be the primary outcome measure. Kindergarten attendance and reason for absence including illness will be collected on a weekly basis at two time points for 6 weeks from the parents and kindergarten directors: baseline and 1 year after baseline. Secondary outcomes will measure cold symptoms through the Common Cold Questionnaire (CCQ) and National Cancer Institute - Common Terminology Criteria for Adverse Events (NCI-CTCAE) Scales describing gastroenterological-based symptoms Kindergarten educator sick days will be aggregately reported for the same time period. Kneipp concept activities will be recorded on a weekly basis over the one-year intervention period. To understand the experience of Kneipp concept implementation and possible changes in the kindergarten, expert interviews will be conducted with intervention kindergarten educators and focused ethnographies will be planned to observe and analyze the intervention activities. Discussion This mixed method study design has potential to help identify if the Kneipp concept can be used for salutogenic purposes among young children and provide insights and experience of the implementation and practicing a holistic health and wellness concept in a kindergarten setting.
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Affiliation(s)
- Marinela Gerganova
- Charité Competence Center for Traditional and Integrative Medicine (CCCTIM), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
- Department of Pediatrics, Division of Oncology and Hematology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
| | - Steven Schepanski
- Charité Competence Center for Traditional and Integrative Medicine (CCCTIM), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
- Department of Pediatrics, Division of Oncology and Hematology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
| | - Martin Bogdanski
- Charité Competence Center for Traditional and Integrative Medicine (CCCTIM), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
- Department of Pediatrics, Division of Oncology and Hematology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
| | - Farid I. Kandil
- Charité Competence Center for Traditional and Integrative Medicine (CCCTIM), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
- Department of Internal Medicine and Nature-Based Therapies, Immanuel Hospital Berlin, Berlin, Germany
| | - Angela Tekath
- Charité Competence Center for Traditional and Integrative Medicine (CCCTIM), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
- Department of Pediatrics, Division of Oncology and Hematology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
| | - Michael Jeitler
- Charité Competence Center for Traditional and Integrative Medicine (CCCTIM), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
- Department of Internal Medicine and Nature-Based Therapies, Immanuel Hospital Berlin, Berlin, Germany
| | - Wiebke Stritter
- Charité Competence Center for Traditional and Integrative Medicine (CCCTIM), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
- Department of Pediatrics, Division of Oncology and Hematology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
| | - Sarah B. Blakeslee
- Charité Competence Center for Traditional and Integrative Medicine (CCCTIM), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
- Department of Pediatrics, Division of Oncology and Hematology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
| | - Georg Seifert
- Charité Competence Center for Traditional and Integrative Medicine (CCCTIM), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
- Department of Pediatrics, Division of Oncology and Hematology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
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Buyukyilmaz G, Koca SB, Turhan B, Adiguzel KT, Goren R, Uzdogan A, Aksu AU, Boyraz M. Benign transient hyperphosphatasemia in the pediatric population: a single center cohort study. J Pediatr Endocrinol Metab 2024; 37:622-629. [PMID: 38800840 DOI: 10.1515/jpem-2024-0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/11/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES Alkaline phosphatase (ALP) can be increased in a benign condition known as benign-transient hyperphosphatasemia (BTH). We aimed to evaluate the demographic, and clinical characteristics of infants and children with BTH. METHODS In our retrospective study, infants and children diagnosed with BTH between September 2019 and September 2023 were included. RESULTS Of 249 children with elevated ALP levels, 95 (38.1 %) had BTH. The mean age at diagnosis of children with BTH was 2.4 ± 1.3 years (min 0.6 - max 6.2 years). ALP mean value was 2,587 ± 1252 U/L (min 972 - max 5757 U/L). ALP value was an average 7.4 ± 3.6 times higher than the corresponding upper limit of normal. The second measurement was made after an average of 13.2 ± 6 days, and a statistically significant difference was detected compared to the first value, with a decrease of 61 ± 23 % in the ALP value (p<0.001). ALP value returned to normal in an average of 44 ± 29.2 days. Elevated ALP was detected during infection in 49 (51.6 %) children. When the sample was divided into those under 2 years of age and aged 2 and over, no statistical difference was observed in ALP levels in the time it took for ALP levels to return to the normal range (p=0.480). CONCLUSIONS BTH should be kept in mind if high serum ALP is detected in children without clinical or laboratory suspicion of bone or liver disease. In the follow up detecting a significant decrease trend compared to the first value may be guiding for BTH.
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Affiliation(s)
- Gonul Buyukyilmaz
- Department of Pediatric Endocrinology, Ankara Bilkent City Hospital, Ankara, Türkiye
| | - Serkan Bilge Koca
- Department of Pediatrics, Division of Pediatric Endocrinology, Health Sciences University, Kayseri City Hospital, Kayseri, Türkiye
| | - Banu Turhan
- Department of Pediatric Endocrinology, Ankara Bilkent City Hospital, Ankara, Türkiye
| | - Keziban Toksoy Adiguzel
- Department of Pediatric Endocrinology, Dr. Burhan Nalbantoğlu State Hospital, Nicosia, Northern Cyprus
| | - Refika Goren
- Department of Pediatric Endocrinology, Ankara Bilkent City Hospital, Ankara, Türkiye
| | - Andac Uzdogan
- Department of Medical Biochemistry, Ankara Bilkent City Hospital, Ankara, Türkiye
| | - Aysel Unlusoy Aksu
- Department of Pediatric Gastroenterology, Ankara Bilkent City Hospital, Ankara, Türkiye
| | - Mehmet Boyraz
- Department of Pediatric Endocrinology, Ankara Bilkent City Hospital, Ankara, Türkiye
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Lifschitz C, Kozhevnikov O, Oesterling C, Anbar A, Walker S. Acute gastroenteritis-changes to the recommended original oral rehydrating salts: a review. Front Pediatr 2023; 11:1294490. [PMID: 38192370 PMCID: PMC10773804 DOI: 10.3389/fped.2023.1294490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/14/2023] [Indexed: 01/10/2024] Open
Abstract
The World Health Organization recommended a formulation of oral rehydration salts as the intervention of choice for the treatment of acute gastroenteritis. While of value for the replacement of fluids and electrolytes, the formulation does not reduce stool volume, frequency, or symptom duration. This may prevent wide acceptance. To increase tolerability, shorten the duration of diarrhea and improve parental quality of life, several modifications to the original formula have been proposed. These include; low osmolarity, rice-based, glucose polymers as an alternative to glucose, the addition of probiotics, prebiotics and/or zinc, and various other ingredients. Here we summarize evidence regarding such changes and additions.
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Affiliation(s)
| | | | - Christine Oesterling
- Eastmead Surgery, Greenford, and Imperial College London, London, United Kingdom
| | | | - Steven Walker
- St. Gilesmedical (London & Berlin) & University of Applied Sciences, Bremen, Germany
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Hyvönen S, Tapiainen T, Pokka T, Solasaari T, Korpela K, de Vos WM, Salonen A, Kolho KL. Perinatal and Other Risk Factors for Common Infections in Infancy: A Prospective Cohort Study. Pediatr Infect Dis J 2023; 42:e447-e453. [PMID: 37751622 PMCID: PMC10629602 DOI: 10.1097/inf.0000000000004112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE Limited data from prospective cohort studies in high-income countries are available on the perinatal risk factors for common infections in children. Our hypothesis was that perinatal factors may be risk factors for infectious episodes during the first year of life. METHODS In this prospective Health and Early Life Microbiota birth cohort study of full-term infants (n = 1052) born in 2016-2018, the number and duration of infection episodes were collected online at weekly to monthly intervals. In a multivariate regression model, the main exposures were perinatal factors such as mode of delivery and intrapartum antibiotics. Environmental factors were additional exposures. The outcomes were the number and duration of infectious episodes in the first year of life. RESULTS The mean number of infection episodes was 4.2 (2.9 SD). The mean duration of infection symptoms was 44 days (40 SD). Upper respiratory infections accounted for 83% of the episodes (3674/4455). Perinatal factors were not associated with the number nor the duration of infection episodes, but cesarean section was associated with an increased occurrence of urinary tract infections in infancy [adjusted odds ratio (aOR): 3.6; 95% confidence interval (CI): 1.13-11.1]. Of the additional exposures male sex (aOR: 1.1; 95% CI: 1.0-1.2) and the presence of siblings (aOR: 1.3; 95% CI: 1.2-1.4) were associated with the number of infection episodes. CONCLUSIONS This prospective cohort study showed that perinatal factors, mode of delivery and intrapartum antibiotics were not associated with the risk of common infections in infancy, but cesarean delivery was associated with a risk of urinary tract infections.
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Affiliation(s)
- Sanni Hyvönen
- From the Department of Pediatrics, Tampere University Hospital, Tampere, Finland
- Department of Pediatrics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Terhi Tapiainen
- Research Unit of Clinical Medicine and Medical Research Centre Oulu, University of Oulu, Oulu, Finland
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Tytti Pokka
- Research Unit of Clinical Medicine and Medical Research Centre Oulu, University of Oulu, Oulu, Finland
- Research Service Unit, Oulu University Hospital, Finland
| | - Terhi Solasaari
- Department of Pediatrics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Pediatric Clinic, Social Services and Health Care Division, City of Helsinki, Helsinki, Finland
| | - Katri Korpela
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Willem M. de Vos
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Laboratory of Microbiology, Wageningen University, the Netherlands
| | - Anne Salonen
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Kaija-Leena Kolho
- From the Department of Pediatrics, Tampere University Hospital, Tampere, Finland
- Department of Pediatrics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Pediatric Gastroenterology, Children’s Hospital, Helsinki University, Helsinki, Finland
- Department of Pediatrics, Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
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Peltonen H, Erkkola M, Abdollahi AM, Leppänen MH, Roos E, Sajaniemi N, Pajari AM, Vepsäläinen H. Associations of dietary patterns with common infections and antibiotic use among Finnish preschoolers. Food Nutr Res 2023; 67:8997. [PMID: 37351020 PMCID: PMC10284098 DOI: 10.29219/fnr.v67.8997] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/20/2023] [Accepted: 05/08/2023] [Indexed: 06/24/2023] Open
Abstract
Background Preschoolers suffer frequently from infections. Although nutrition plays a key role in immune function, very little is known about the impact of overall diet on preschoolers' infections. Objective To assess the associations between dietary patterns, common infections and antibiotic use among Finnish preschoolers. Design The study included 721 3-6-year-old preschoolers participating in the cross-sectional DAGIS survey. Parents retrospectively reported the number of common colds, gastroenteritis episodes and antibiotic courses their children had acquired during the past year. Food consumption outside preschool hours was recorded using a food frequency questionnaire. Dietary patterns were derived from the consumption frequencies using principal component analysis. Associations between the thirds of the dietary pattern scores and the outcomes were analysed using logistic and negative binomial regression models. Results Prevalence of common colds was lower in moderate and high adherence to the sweets-and-treats pattern than in low adherence (prevalence ratio [PR]: 0.89, 95% confidence interval [CI]: 0.80-1.00, and PR: 0.88, 95% CI: 0.79-0.99, respectively) and higher in high adherence to the health-conscious pattern than in low adherence (PR: 1.13, 95% CI: 1.01-1.27) after adjusting for age, sex, number of children living in the same household, frequency of preschool attendance, family's highest education and probiotic use. The risk of ≥1 gastroenteritis episode and the prevalence of antibiotic courses were lower in moderate adherence to the sweets-and-treats pattern than in low adherence (odds ratio [OR]: 0.63, 95% CI: 0.44-0.92 and PR: 0.77, 95% CI: 0.59-1.00, respectively). Conclusions The results were unexpected. Parents who were most health-conscious of their children's diet might also have been more aware of their children's illness.
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Affiliation(s)
- Henna Peltonen
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Maijaliisa Erkkola
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Anna M. Abdollahi
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Marja H. Leppänen
- Folkhälsan Research Center, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Eva Roos
- Folkhälsan Research Center, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Nina Sajaniemi
- Philosophical Faculty, School of Applied Educational Science and Teacher Education, University of Eastern Finland, Joensuu, Finland
| | - Anne-Maria Pajari
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Henna Vepsäläinen
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
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Mameli C, Picca M, Buzzetti R, Pace ME, Badolato R, Cravidi C, Zuccotti GV, Marchisio P. Incidence of acute respiratory infections in preschool children in an outpatient setting before and during Covid-19 pandemic in Lombardy Region, Italy. Ital J Pediatr 2022; 48:18. [PMID: 35115026 PMCID: PMC8812240 DOI: 10.1186/s13052-022-01221-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/21/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction The incidence of acute respiratory tract infections (ARTIs) in children is difficult to estimate because they are typically treated in outpatient settings and the majority of epidemiological data originate from hospital settings and refer to the most severe illnesses. Therefore, the incidence of ARTIs in a real-world setting remains largely unexplored. Therefore, this study aims to estimate the incidence of ARTIs, upper respiratory tract infections (URTIs), and lower respiratory tract infections (LRTIs) in children aged 0–5 years in an outpatient setting. Methods This prospective cohort study was conducted in Lombardy, Italy, from October 1st, 2019, to March 31st, 2021, before and during the COVID-19 pandemic that began in March 2020. Caucasian healthy children aged 0–5 years were recruited from 69 Family Pediatricians (FP) and followed-up in an outpatient setting. Data were collected whenever a child was referred to FP and ARTI was diagnosed (Covid-19 related ARTI were excluded). The primary outcome was an estimate of the incidence of ARTIs. The incidence of ARTIs in different age groups and the effect of the COVID-19 pandemic on the incidence of ARTIs were secondary outcomes. Results We enrolled 484 children, 249 male (51.8%), mean age of 2.39 ± 1.68 years. The mean estimated incidence of ARTIs was 12.1/100 children × 30 days (95% CIs: 9.5–12.9), with the highest value observed in infants aged 1–12 months (24.9/100 children × 30 days; 95% CIs: 17.6–28.9). The mean estimated incidence of URTIs was higher than that of LRTIs (8.3 – CIs: 7.6–8.9 vs 3.8/100 children × 30 days – CIs: 6.4–4.3, respectively). The comparison of ARTIs, which occurred in the pre-pandemic winter, to those measured during the COVID-19 pandemic, revealed an impressive 82.1% drop in the incidence rate (CIs: 77.8–85.7). Conclusions This study showed that infants aged 1–12 months are more likely to develop ARTIs than older children and that COVID-19 pandemic has dramatically altered the epidemiology of ARTIs in children aged 0–5 years. Supplementary Information The online version contains supplementary material available at 10.1186/s13052-022-01221-w.
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Affiliation(s)
- Chiara Mameli
- Department of Pediatrics, V Buzzi Children's Hospital, Milan, Italy. .,Department of Biomedical and Clinical Science L.Sacco, Università di Milano, Milan, Italy.
| | - Marina Picca
- Italian Primary Care Paediatrics Society (SICuPP), Lombardy, ATS Milano, Milan, Italy
| | | | - Maria Elisabetta Pace
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, Milan, Italy
| | - Raffaele Badolato
- Department of Pediatrics, Università di Brescia, "Istituto di Medicina Molecolare Angelo Nocivelli", ASST Spedali civili, Brescia, Italy
| | | | | | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, Milan, Italy.,Università di Milano, Milan, Italy
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Azor-Martinez E, Garcia-Mochon L, Lopez-Lacort M, Strizzi JM, Muñoz-Vico FJ, Jimenez-Lorente CP, Fernandez-Campos MA, Bueno-Rebollo C, Del Castillo-Aguas G, Balaguer-Martinez JV, Gimenez-Sanchez F. Child Care Center Hand Hygiene Programs' Cost-Effectiveness in Preventing Respiratory Infections. Pediatrics 2021; 148:183449. [PMID: 34814193 DOI: 10.1542/peds.2021-052496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We previously demonstrated that a hand hygiene program, including hand sanitizer and educational measures, for day care center (DCC) staff, children, and parents was more effective than a soap-and-water program, with initial observation, in preventing respiratory infections (RIs) in children attending DCCs. We analyzed the cost-effectiveness of these programs in preventing RIs. METHODS A cluster, randomized, controlled and open study of 911 children aged 0 to 3 years, attending 24 DCCs in Almeria. Two intervention groups of DCC-families performed educational measures and hand hygiene, one with soap-and-water (SWG) and another with hand sanitizer (HSG). The control group (CG) followed usual hand-washing procedures. RI episodes, including symptoms, treatments, medical contacts, complementary analyses, and DCC absenteeism days, were reported by parents. A Bayesian cost-effectiveness model was developed. RESULTS There were 5201 RI episodes registered. The adjusted mean societal costs of RIs per child per study period were CG: €522.25 (95% confidence interval [CI]: 437.10 to 622.46); HSG: €374.53 (95% CI: 314.90 to 443.07); SWG: €494.51 (95% CI: 419.21 to 585.27). The indirect costs constituted between 35.7% to 43.6% of the total costs. Children belonging to the HSG had an average of 1.39 fewer RI episodes than the CG and 0.93 less than the SWG. It represents a saving of societal cost mean per child per study period of €147.72 and €119.15, respectively. The HSG intervention was dominant versus SWG and CG. CONCLUSIONS Hand hygiene programs that include hand sanitizer and educational measures for DCC staff, children, and parents are more effective and cost less than a program with soap and water and initial observation in children attending DCCs.
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Affiliation(s)
| | - Leticia Garcia-Mochon
- Escuela Andaluza de Salud Pública, University of Granada, Granada, Spain.,Center for Biomedical Research Network in Epidemiology and Public Health, Madrid, Spain.,Institute of Biomedical Research Granada, University Hospitals of Granada, University of Granada, Granada, Spain
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Ahmad HH, Peck B, Terry D. The influence of probiotics on gastrointestinal tract infections among children attending childcare: A systematic review and meta-analysis. J Appl Microbiol 2021; 132:1636-1651. [PMID: 34796583 DOI: 10.1111/jam.15374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/07/2021] [Accepted: 11/17/2021] [Indexed: 12/11/2022]
Abstract
Current literature related to the impact of probiotics on the incidence of gastrointestinal tract infections (GITIs) has shown mixed results and no systematic review available with pooled analysis exists. Thus, the aim of this systematic review was to provide contemporary evidence regarding the overall and strain-specific influence of probiotics in preventing GITIs among infants and children attending childcare centres. The review shortlisted 18 RCTs after screening through the initial search results of 779 articles. However, only 15 trials were deemed eligible, addressing at least one outcome in the pooled analysis. It is concluded that the supplementation of probiotics (overall effect) may reduce the risk of GITI episode by 26%, with Lacticaseibacillus paracasei, Limosilactobacillus reuteri and Lacticaseibacillus rhamnosus GG being specifically potent probiotic strains in reducing GITI episode, duration of infection and absence from childcare respectively. There is insufficient evidence to determine the effect of Bifidobacterium animalis subsp. lactis BB-12 based on the findings of the trials included in this review.
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Affiliation(s)
- Hafiz H Ahmad
- School of Health, Federation University, Ballarat, Victoria, Australia
| | - Blake Peck
- School of Health, Federation University, Ballarat, Victoria, Australia
| | - Daniel Terry
- School of Health, Federation University, Ballarat, Victoria, Australia
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10
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Hayashi MAL, Eisenberg JNS, Martin ET, Hashikawa AN. The Statewide Economic Impact of Child Care-Associated Viral Acute Gastroenteritis Infections. J Pediatric Infect Dis Soc 2021; 10:847-855. [PMID: 34145893 PMCID: PMC8459090 DOI: 10.1093/jpids/piaa073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 06/17/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION More than 65% of children aged ≤5 years in the United States require out-of-home child care. Child care attendance has been associated with an elevated risk of respiratory illness and acute gastroenteritis (AGE). While child care-associated respiratory disease cases are more numerous, AGE is associated with more severe symptoms and more than double the number of absences from child care. In addition, viral pathogens such as norovirus, rotavirus, and adenovirus are highly infectious and may be spread to parents and other household members. As a result, child care-associated viral AGE may incur substantial economic costs due to healthcare service usage and lost productivity. METHODS We used surveillance data from a network of child care centers in Washtenaw County, Michigan, as well as a household transmission model to estimate the annual cost of child care-associated viral AGE in the state of Michigan. RESULTS We estimated that child care-associated viral AGE in Michigan costs between $15 million and $31 million annually, primarily due to lost productivity. CONCLUSIONS The economic burden of child care-associated infections is considerable. Effective targeted interventions are needed to mitigate this impact.
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Affiliation(s)
- Michael A L Hayashi
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Joseph N S Eisenberg
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Emily T Martin
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Andrew N Hashikawa
- Departments of Emergency Medicine and Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Peeters D, van Geloven N, Visser LE, Bogaert D, van Rossum AMC, Driessen GJA, Verhagen LM. Study protocol for a randomised controlled trial evaluating the clinical effect of antibiotic prophylaxis in children with recurrent respiratory tract infections: the Approach study. BMJ Open 2021; 11:e044505. [PMID: 34326043 PMCID: PMC8323378 DOI: 10.1136/bmjopen-2020-044505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Respiratory tract infections (RTIs) affect children all over the world and are associated with significant morbidity and mortality. In particular, recurrent RTIs cause a high burden of disease and lead to frequent doctor visits. Children with recurrent RTIs generally have no significant alterations or deficits in systemic immunity. In an attempt to treat the assumed bacterial component involved, they are often treated with prolonged courses of prophylactic antibiotics taken on a daily basis. Despite its common use, there is no evidence that this is beneficial. Studies assessing the clinical effectiveness of antibiotic prophylaxis as well as potential adverse effects and antibiotic resistance development, are therefore urgently needed. METHODS AND ANALYSIS We present a protocol for a randomised double-blind placebo-controlled trial comparing co-trimoxazole with placebo treatment in children with recurrent RTIs. A total of 158 children (aged 6 months-10 years) with recurrent RTIs without significant comorbidity will be enrolled from a minimum of 10 Dutch hospitals. One group receives co-trimoxazole 18 mg/kg two times per day (36 mg/kg/day) and the other group receives a placebo two times per day for a period of 3 months. The main objective is to determine whether antibiotic prophylaxis is more effective than placebo to prevent/reduce respiratory symptoms in children with recurrent RTIs. Respiratory symptoms will be scored by parents on a daily basis in both study arms by the use of a mobile phone application. Our primary outcome will be the number of days with at least two respiratory symptoms during the treatment. ETHICS AND DISSEMINATION Ethics approval was obtained from the Medical Ethics Research Committee Zuidwest Holland/LDD. A manuscript with the study results will be submitted to a peer-reviewed journal. All participants will be informed about the study results. The results of the study will inform clinical guidelines regarding the prophylactic treatment of children with recurrent RTIs. TRIAL REGISTRATION NUMBER NL7044.
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Affiliation(s)
- Daphne Peeters
- Department of Paediatrics, Haga Hospital, Juliana Childrens Hospital, Den Haag, Zuid-Holland, The Netherlands
| | - Nan van Geloven
- Department of Biomedical Data Sciences, Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Loes E Visser
- Department of Hospital Pharmacy, Haga Teaching Hospital, Den Haag, The Netherlands
- Department of Hospital Pharmacy and Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Debby Bogaert
- Center for Inflammation Research, Queen Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Department of Paediatric Infectious Diseases and Immunology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | | | - Gertjan J A Driessen
- Department of Paediatrics, Haga Hospital, Juliana Childrens Hospital, Den Haag, Zuid-Holland, The Netherlands
- Department of Paediatrics, Maastricht UMC+, Maastricht, The Netherlands
| | - Lilly M Verhagen
- Department of Paediatric Infectious Diseases and Immunology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Section Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Center for Infectious Diseases, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
- Department of Paediatric Infectious Diseases and Immunology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
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Ngo HKT, Luong LMT, Le HHTC, Dang TN, Le Pham A, Phung D, Thai PK. Impact of temperature on hospital admission for acute lower respiratory infection (ALRI) among pre-school children in Ho Chi Minh City, Vietnam. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2021; 65:1205-1214. [PMID: 33751218 DOI: 10.1007/s00484-021-02104-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 06/12/2023]
Abstract
Changes in ambient temperature have been reported as an important risk factor for respiratory diseases among pre-school children. However, there have been few studies so far on the effects of temperature on children respiratory health in developing countries including Vietnam. This study examined the impact of short-term changes in ambient temperature on hospital admissions for acute lower respiratory infection (ALRI) among children aged less than 5 years old in Ho Chi Minh City (HCMC), Vietnam. Data on daily hospital admissions from 2013 to 2017 were collected from two large paediatric hospitals of the city. Daily meteorological data of the same period were also collected. Time series analysis was performed to evaluate the association between risk of hospitalisations and temperatures categorised by seasons, age, and causes. We found that a 1 °C increase in maximum temperature was associated with 4.2 and 3.4% increase in hospital admission for ALRI among children 3-5 years old during the dry season and the rainy season, respectively. Surprisingly, in the rainy season, a rise of 1°C diurnal temperature range (DTR) was significantly associated with a decrease from 2.0 to 2.5% risk of hospitalisation for ALRI among children <3 years old. These findings suggested that although high temperature is a risk factor for hospital admissions among children in general, other modifiable factors such as age, exposure time, air conditioning usage, wearing protective clothing, socioeconomic status, and behaviour may influence the overall effect of high temperature on hospital admissions of children <5 years old in HCMC. The findings of this study have provided evidence for building public health policies aimed at preventing and minimizing the adverse health effects of temperature on children in HCMC.
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Affiliation(s)
- Hieu K T Ngo
- Department of Environmental Health, University of Medicine and Pharmacy, Ho Chi Minh, Vietnam
| | - Ly M T Luong
- Faculty of Environmental Sciences, VNU University of Science, Vietnam National University, Hanoi, Vietnam
| | - Hong H T C Le
- Department of Environmental Health, University of Medicine and Pharmacy, Ho Chi Minh, Vietnam
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Tran Ngoc Dang
- Department of Environmental Health, University of Medicine and Pharmacy, Ho Chi Minh, Vietnam
| | - An Le Pham
- Department of Environmental Health, University of Medicine and Pharmacy, Ho Chi Minh, Vietnam
| | - Dung Phung
- Centre for Environment and Population Health, Griffith University, Brisbane, Australia
| | - Phong K Thai
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Brisbane, 4102, Australia.
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de Boer PT, Nagy L, Dolk FCK, Wilschut JC, Pitman R, Postma MJ. Cost-Effectiveness of Pediatric Influenza Vaccination in The Netherlands. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:19-31. [PMID: 33431149 DOI: 10.1016/j.jval.2020.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study evaluates the cost-effectiveness of extending the Dutch influenza vaccination program for elderly and medical high-risk groups to include pediatric influenza vaccination, taking indirect protection into account. METHODS An age-structured dynamic transmission model was used that was calibrated to influenza-associated GP visits over 4 seasons (2010-2011 to 2013-2014). The clinical and economic impact of different pediatric vaccination strategies were compared over 20 years, varying the targeted age range, the vaccine type for children or elderly and high-risk groups. Outcome measures include averted symptomatic infections and deaths, societal costs and quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Costs and QALYs were discounted at 4% and 1.5% annually. RESULTS At an assumed coverage of 50%, adding pediatric vaccination for 2- to 17-year-olds with quadrivalent live-attenuated vaccine to the current vaccination program for elderly and medical high-groups with quadrivalent inactivated vaccine was estimated to avert, on average, 401 820 symptomatic cases and 72 deaths per year. Approximately half of averted symptomatic cases and 99% of averted deaths were prevented in other age groups than 2- to 17-year-olds due to herd immunity. The cumulative discounted 20-year economic impact was 35 068 QALYs gained and €1687 million saved, that is, the intervention was cost-saving. This vaccination strategy had the highest probability of being the most cost-effective strategy considered, dominating pediatric strategies targeting 2- to 6-year-olds or 2- to 12-year-olds or strategies with trivalent inactivated vaccine. CONCLUSION Modeling indicates that introducing pediatric influenza vaccination in The Netherlands is cost-saving, reducing the influenza-related disease burden substantially.
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Affiliation(s)
- Pieter T de Boer
- Unit of PharmacoTherapy, -Epidemiology, and -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
| | - Lisa Nagy
- Unit of PharmacoTherapy, -Epidemiology, and -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | | | - Jan C Wilschut
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Richard Pitman
- ICON Health Economics and Epidemiology, Oxfordshire, United Kingdom
| | - Maarten J Postma
- Unit of PharmacoTherapy, -Epidemiology, and -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands; Department of Health Sciences, University Medical Center Groningen, Groningen, The Netherlands; Department of Economics, Econometrics, and Finance, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
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Younie S, Mitchell C, Bisson MJ, Crosby S, Kukona A, Laird K. Improving young children's handwashing behaviour and understanding of germs: The impact of A Germ's Journey educational resources in schools and public spaces. PLoS One 2020; 15:e0242134. [PMID: 33227004 PMCID: PMC7682880 DOI: 10.1371/journal.pone.0242134] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/28/2020] [Indexed: 01/17/2023] Open
Abstract
CONTEXT Effective handwashing can prevent the spread of germs, including Covid-19. However, young children can lack a fundamental understanding of germ transfer. A Germ's Journey educational resources were designed to support young children in learning about germs and handwashing. These resources include a book, website, song, online games and glo-gel activities that are informed by a behaviour change model. RESEARCH GAP Prior research has not evaluated the impacts of these resources on behavioural outcomes. PURPOSE OF THE STUDY Two intervention studies evaluated the impacts of these resources on both knowledge and behavioural outcomes. METHOD In Study 1, children (n = 225) were recruited from four schools and randomly assigned by classrooms to participate in a multicomponent intervention (vs. control). In Study 2, children (n = 104) were recruited from a museum and randomly assigned to participate in a song intervention (vs. control). Trained observers recorded participants' engagement in six handwashing behaviours and their understanding of germs. These behavioural and knowledge outcomes were analysed using regression and related analyses. RESULTS In Study 1, significant improvements were observed between baseline and follow up in the intervention group for both behavioural scores (Est = 0.48, SE = 0.14, t = 3.30, p = 0.001) and knowledge scores (Est = 2.14, SE = 0.52, z = 4.11, p < 0.001), whereas these improvements were not observed in the control group (ts < 1). In Study 2, the intervention group had significantly higher behavioural scores compared to the control group (Est. = -0.71, SE = 0.34, t = -2.07, p = 0.04). CONCLUSION This research demonstrates that specifically designed hand hygiene educational resources can improve handwashing practice and understanding in young children, and could lead to the reduction of the transmission of disease within this group.
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Affiliation(s)
- Sarah Younie
- Institute for Research in Criminology, Community, Education and Social Justice, De Montfort University, Leicester, United Kingdom
| | - Chloe Mitchell
- Institute for Psychological Science, De Montfort University, Leicester, United Kingdom
- * E-mail:
| | - Marie-Josee Bisson
- Institute for Psychological Science, De Montfort University, Leicester, United Kingdom
| | - Sapphire Crosby
- Institute for Research in Criminology, Community, Education and Social Justice, De Montfort University, Leicester, United Kingdom
| | - Anuenue Kukona
- Institute for Psychological Science, De Montfort University, Leicester, United Kingdom
| | - Katie Laird
- Infectious Disease Research Group, Leicester Institute for Pharmaceutical Innovation, De Montfort University, Leicester, United Kingdom
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15
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Peetoom KKB, Crutzen R, Verhoeven R, Bohnen JMHA, Winkens B, Dinant GJ, Cals JWL. Optimizing decision-making among childcare staff on fever and common infections: cluster randomized controlled trial. Eur J Public Health 2020; 29:505-511. [PMID: 30496423 DOI: 10.1093/eurpub/cky246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Children 0-4 years attending childcare are more prone to acquire infections than home-cared children. Childcare illness absenteeism due to fever is mostly driven by fear towards fever in childcare staff and parents. This may cause high childcare absenteeism, healthcare service use, and work absenteeism in parents. This study evaluates a multicomponent intervention targeting determinants of decision-making among childcare staff on illness absenteeism due to fever and common infections. METHODS The multicomponent intervention was developed based on the Intervention Mapping approach and consisted of (i) an educational session, (ii) a decision tool, (iii) an information booklet and (iv) an online video. The intervention was evaluated in a cluster randomized controlled trial in Southern Netherlands. Nine centres received the intervention and nine provided childcare-as-usual. Primary outcome measure was the percentage of illness absenteeism on cluster level, defined as number of childcare days absent due to illness on total of registered childcare contract days in a 12-week period. Secondary outcome measures included intended behaviour, attitude, risk perception, knowledge and self-efficacy of childcare staff. Outcomes were analyzed using linear mixed models accounting for clustering. Knowledge was descriptively analysed. RESULTS Overall illness absenteeism was comparable in intervention (2.95%) and control group (2.52%). Secondary outcomes showed significant improvements in intervention group regarding intended behaviour, two of three attitude dimensions. Knowledge increased compared with control but no differences regarding self-efficacy. CONCLUSION The intervention was not effective in reducing illness absenteeism. However, the intervention improved determinants of decision-making such as intended behaviour, attitude, and knowledge on fever. TRIAL REGISTRATION NTR6402 (registered on 21 April 2017).
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Affiliation(s)
- K K B Peetoom
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - R Crutzen
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - R Verhoeven
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - J M H A Bohnen
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - B Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - G J Dinant
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - J W L Cals
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Bathing Activities and Microbiological River Water Quality in the Paris Area: A Long-Term Perspective. THE HANDBOOK OF ENVIRONMENTAL CHEMISTRY 2020. [DOI: 10.1007/698_2019_397] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AbstractThis chapter presents the historical aspects regarding swimming in rivers in the Paris region since the seventeenth century, including the concept of fecal contamination indicator bacteria (FIBs) developed at the very beginning of the twentieth century, and historical contamination data covering more than one century in the Paris agglomeration. The sources of microbiological contamination of river waters are quantified, showing the importance of rain events. The present contamination levels are presented with reference to the European Directive for bathing water quality. FIB levels show that the sufficient quality for bathing is not reached yet in any of the monitored stations. A comprehensive data set regarding waterborne pathogens (viruses, Giardia, Cryptosporidium) in the Seine and Marne rivers is presented as a necessary complement to the regulatory FIB data to better evaluate health risks. The last section concludes on the actions to be conducted to improve the rivers’ microbiological quality in the coming years.
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Dieterich R, Caplan E, Yang J, Demirci J. Integrative Review of Breastfeeding Support and Related Practices in Child Care Centers. J Obstet Gynecol Neonatal Nurs 2019; 49:5-15. [PMID: 31785280 DOI: 10.1016/j.jogn.2019.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To synthesize the extant research on the support of breastfeeding and breast milk feeding and related practices in child care centers (i.e., daycare centers) in the United States and globally. DATA SOURCES We used key terms to search Ovid, CINAHL, and PubMed for articles that met eligibility criteria. When potentially relevant articles were identified in PubMed, we used the cited by and similar articles features to identify additional articles. We also examined the reference lists of reviewed studies. STUDY SELECTION We included original research articles on breastfeeding or breast milk feeding in child care centers published in 2000 or after and available in English. We reviewed titles and/or abstracts of 1,984 articles and abstracted 37 for full-text review. Of these, 16 studies met eligibility criteria and were included in the review. DATA EXTRACTION We abstracted data from the 16 articles to facilitate comparison and identification of patterns related to support of breastfeeding/breast milk feeding and related practices in child care centers. These data included year of publication, setting, design/methodology (and methodologic limitations), type of respondent/sampling unit (e.g., directors and staff members of child care centers, mothers), sample size, outcome measures, and pertinent study findings. DATA SYNTHESIS We categorized study findings into three themes: Knowledge, Attitudes, and Experiences of Staff Members in Child Care Centers; Implementation and Adherence to Policies, Practices, and Regulations in Child Care Centers; and Prevalence of Breastfeeding in Child Care Centers. Findings indicated staff members generally had positive attitudes toward breastfeeding but tended to remain neutral regarding encouragement and support of breastfeeding. Training and knowledge about breastfeeding among staff members in child care centers appears limited and focused mainly on the storage and preparation of breast milk; however, staff members indicated the desire to obtain additional education about breastfeeding. Few U.S. child care centers or states have comprehensive, evidence-based policies and regulations to address support for breast milk feeding and breastfeeding. The prevalence of breastfeeding in U.S. child care centers is less than that in other child care settings (home-based child care, etc.), child care centers in other developed countries, and national breastfeeding averages. CONCLUSION We found a general lack of policies and practices to support breastfeeding in child care centers, particularly in the United States. The degree to which this policy/practice deficit contributes to suboptimal breastfeeding rates among women who use child care centers requires further study.
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The time has come to invest more in the prevention of day care-associated infection in children. J Pediatr (Rio J) 2019; 95:623-624. [PMID: 30308145 DOI: 10.1016/j.jped.2018.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Day care attendance during the first 12 months of life and occurrence of infectious morbidities and symptoms. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Hojsak I. The time has come to invest more in the prevention of day care‐associated infection in children. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Oliveira PDD, Bertoldi AD, Silva BGCD, Rodrigues Domingues M, Neumann NA, Silveira MFD. Day care attendance during the first 12 months of life and occurrence of infectious morbidities and symptoms. J Pediatr (Rio J) 2019; 95:657-666. [PMID: 31679611 DOI: 10.1016/j.jped.2018.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/17/2018] [Accepted: 05/25/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To investigate the occurrence of infectious morbidities according to day care attendance during the first year of life. METHODS This was a cross-sectional analysis of data from the 12-month follow-up of a medium-sized city birth cohort from children born in 2015, in the Southern Brazil. Main exposure variables were day care attendance from 0 to 11 months of age, type of day care center (public or private), and age at entering day care. Health outcomes were classified as follows: "non-specific respiratory symptoms," "upper respiratory tract infection," "lower respiratory tract infection," "flu/cold," "diarrhea," or "no health problem," considering the two weeks prior to the interview administered at 12 months of life. Associations were assessed using Poisson regression adjusted by demographic, behavioral, and socioeconomic variables. RESULTS The sample included 4018 children. Day care attendance was associated with all classifications of health outcomes mentioned above, except for flu/cold. These were stronger among children who entered day care at an age closer to the outcome time-point. An example are the results for lower respiratory tract infection and diarrhea, with adjusted prevalence ratios of 2.79 (95% CI: 1.67-4.64) and 2.04 (95% CI: 1.48-2.82), respectively, for those who entered day care after 8 months of age when compared with those who never attended day care. CONCLUSIONS The present study consistently demonstrated the association between day care attendance and higher occurrence of infectious morbidities and symptoms at 12 months of life. Hence, measures to prevent infectious diseases should give special attention to children attending day care centers.
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Affiliation(s)
- Paula Duarte de Oliveira
- Universidade Federal de Pelotas, Programa de Pós-graduação em Epidemiologia, Pelotas, RS, Brazil.
| | - Andréa Dâmaso Bertoldi
- Universidade Federal de Pelotas, Programa de Pós-graduação em Epidemiologia, Pelotas, RS, Brazil
| | | | - Marlos Rodrigues Domingues
- Universidade Federal de Pelotas, Programa de Pós-graduação em Epidemiologia, Pelotas, RS, Brazil; Universidade Federal de Pelotas, Programa de Pós-graduação em Educação Física, Pelotas, RS, Brazil
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González-Rábago Y, La Parra D, Puigpinós-Riera R, Pons-Vigués M. [How to measure the migration status of the child and young population? Studies on health and inequalities in health in Europe]. GACETA SANITARIA 2019; 35:81-90. [PMID: 31542314 DOI: 10.1016/j.gaceta.2019.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/25/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To analyse how the migration status of the child and young population is measured in the scientific literature on health and social inequalities in health in Europe. METHOD A systematic search of the literature published in Spanish, English and French between 2007 and 2017 in PubMed and Social Sciences Citation Index was carried out. The included studies analysed health and social inequalities in health of a population under 18 years old according to its migration origin in Europe. The variables used to measure the migration status were described. RESULTS 50 articles were included. Twenty studies analysed perinatal health, eleven mental health, nine dental health, and ten studies other variables. The main variables to define migration status were the country of birth (32 studies), either of the child, the mother, or one of the parents, and sometimes in a complementary way. Less frequent was the use of nationality (15 studies), of the child, or of the parents, especially the mother. Migration status is referred to in very different ways, not always comparable and sometimes the variable used is not clearly explained. CONCLUSIONS There is a great diversity of ways to measure migration status in the child and young population. A better definition and consensus is needed to improve the temporal and geographical comparability of knowledge in this area, which will help to design public policies aimed at reducing social inequalities in health from childhood.
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Affiliation(s)
- Yolanda González-Rábago
- Grupo de Investigación en Determinantes Sociales de la Salud y Cambio Demográfico - OPIK, Leioa (Bizkaia), España; Departamento de Sociología 2, Universidad del País Vasco (UPV/EHU), Leioa (Bizkaia), España.
| | - Daniel La Parra
- Departamento de Sociología II, Universidad de Alicante, Alicante, España
| | - Rosa Puigpinós-Riera
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut de Recerca HSCSP, Barcelona, España
| | - Mariona Pons-Vigués
- Servei Català de la Salut, Barcelona, España; Departament d'Infermeria, Universitat de Girona, Girona, España
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Peetoom K, Crutzen R, Dinant GJ, Cals J. Most preschool children with fever and common infection symptoms do not consult the family physician. Fam Pract 2019; 36:371-373. [PMID: 30256940 DOI: 10.1093/fampra/cmy079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Kirsten Peetoom
- Maastricht University, Care and Public Health Research Institute, Department of Family Medicine, Maastricht, Netherlands
| | - Rik Crutzen
- Maastricht University, Care and Public Health Research Institute, Department of Health Promotion, Maastricht, Netherlands
| | - Geert-Jan Dinant
- Maastricht University, Care and Public Health Research Institute, Department of Family Medicine, Maastricht, Netherlands
| | - Jochen Cals
- Maastricht University, Care and Public Health Research Institute, Department of Family Medicine, Maastricht, Netherlands
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Berber A, Del-Rio-Navarro BE. Cost-effectiveness analysis of OM-85 vs placebo in the prevention of acute respiratory tract infections (ARTIs) in children that attend day-care centers. HEALTH ECONOMICS REVIEW 2019; 9:12. [PMID: 31065886 PMCID: PMC6734393 DOI: 10.1186/s13561-019-0230-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 04/16/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Children that attend day-care centers frequently contract acute respiratory tract infections (ARTIs). ARTIs represent a burden for both children and parents. Systematic reviews on the use of immunostimulants for the prevention of juvenile recurrent ARTIs have provided moderate evidence of efficacy and safety. The aim of the study was to establish whether the immunostimulant, OM-85, was cost-effective in preventing ARTIs in children 2-6 years old that attended day-care centers or preschools in Mexico. We performed a systematic review to evaluate the efficacy of OM-85. For costs, we assumed an institutional perspective, which included the costs of care and supplies over a study period of six months, during the autumn-winter seasons. We created decision trees and constructed a model to identify pharmacoeconomic parameters. We generated 1000 estimations with the bootstrap method to calculate descriptive statistics of pharmacoeconomic parameters. We evaluated cost-effectiveness compared to treatment without immunostimulants. RESULTS The mean (SD) incidences of ARTIs were 5.59 ± 0.29 without immunostimulants and 2.97 ± 0.32 with OM-85, during the study period. The mean (25th, 75th percentile) direct costs of ARTIs were 57.04 (37.11, 76.39) US$ (US dollars) without immunostimulants and 48.53 (37.35, 58.93) US$ with OM-85, with a mean increment of - 8.51(- 17.08, 0.75) US$, and a mean cost-effectiveness of - 17.94 (- 36.48, 1.66) US$. The direct costs plus the cost of one parent missing work to care for the child with ARTI were 125.76 (102.83, 150.16) US$, without immunostimulant and 85.21 (72.15, 98.81) US$, with OM-85. The increment was - 40.55 (- 68.29, - 13.95) US$, and the cost-effectiveness was - 86.89 (- 142.37, - 29.34) US$.Part of the cost reduction was ascribed to the reduced use of medications, particularly antibiotics. CONCLUSIONS Our results were consistent with previous clinical studies conducted in closed institutions in Mexico. OM-85 reduced the number of ARTIs and the frequency of antibiotics use. We concluded that OM-85 was cost-effective for preventing ARTIs in children that attended day-care centers, particularly when parental absenteeism was covered by the institutions.
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Affiliation(s)
- Arturo Berber
- Fundación para el Avance de la Ciencia, Oasis 14, CP 02080 Mexico City, Mexico
| | - Blanca Estela Del-Rio-Navarro
- Allergy & Immunology Service, Hospital Infantil de Mexico “Federico Gomez”, Dr. Marquez 162, CP 06720 Mexico City, Mexico
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Federici C, Cavazza M, Costa F, Jommi C. Health care costs of influenza-related episodes in high income countries: A systematic review. PLoS One 2018; 13:e0202787. [PMID: 30192781 PMCID: PMC6128484 DOI: 10.1371/journal.pone.0202787] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/09/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction This study systematically reviews costing studies of seasonal influenza-like illness (ILI) in high-income countries. Existing reviews on the economic impact of ILI do not report information on drug consumption and its costs, nor do they provide data on the overall cost per episode. Methods The PRISMA-P checklist was used to design the research protocol. Studies included were cost of illness analysis (COI) and modeling studies that estimated the cost of ILI episodes. Records were searched from January 2000 to December 2016 in electronic bibliographic databases including Medline, Embase, Science Direct, the Cochrane Library, the Centre for Reviews and Disseminations of the University of York, and Google scholar. References from the included studies were hand-searched for completion. Abstract screening, full-text analysis and data extraction were performed by two reviewers independently and discrepancies were resolved by discussion with a third reviewer. A standardized, pre-piloted form was used for data extraction. All costs were converted to 2015 US$ Purchasing Power Parities. Results The literature search identified 5,104 records. After abstract and title screening, 76 studies were analyzed full-text and 27 studies were finally included in the review. Full estimates of the cost per episode range from US$19 in Korea to US$323 in Germany. Particularly, the cost per episode of laboratory confirmed influenza cases was estimated between US$64 and US$73. Inpatient and outpatient services account for the majority of the costs. Differences in the estimates may reflect country-specific characteristics, as well as other study-specific features including study design, identification strategy of ILI cases, study populations and types of costs included in the analysis. Children usually register higher costs, whereas evidence for the elderly is less conclusive. Patients risk-profile, co-morbidities and complications are the other important cost-drivers. None of the papers considered appropriateness in resource use (e.g. abuse of antibiotics). Despite cost of illness studies have ultimately a descriptive role, evidence on (in)appropriateness is useful for policy-makers.
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Affiliation(s)
- Carlo Federici
- Cergas (Centre for Research on Health and Social Care Management), SDA Bocconi School of Management, Milan, Italy
| | - Marianna Cavazza
- Cergas (Centre for Research on Health and Social Care Management), SDA Bocconi School of Management, Milan, Italy
| | - Francesco Costa
- Cergas (Centre for Research on Health and Social Care Management), SDA Bocconi School of Management, Milan, Italy
| | - Claudio Jommi
- Cergas (Centre for Research on Health and Social Care Management), SDA Bocconi School of Management, Milan, Italy
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
- * E-mail:
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26
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Laursen RP, Larnkjær A, Ritz C, Hojsak I, Michaelsen K, Mølgaard C. Risks for upper respiratory infections in infants during their first months in day care included environmental and child-related factors. Acta Paediatr 2018; 107:1616-1623. [PMID: 29542189 DOI: 10.1111/apa.14320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/01/2018] [Accepted: 03/09/2018] [Indexed: 01/03/2023]
Abstract
AIM We examined the frequency and potential risk factors for respiratory infections, diarrhoea and absences in infants during their first months in day care. METHODS This prospective cohort study comprised 269 Danish infants aged eight months to 14 months and was part of a study that examined how probiotics affected absences from day care due to respiratory and gastrointestinal infections. The risk factors examined were the household, child characteristics and type of day care facility. Parents registered upper respiratory tract infections (URTIs), lower respiratory tract infections (LRTIs), diarrhoea and day care absences on web-based questionnaires. RESULTS Over a mean of 5.6 months in day care, 36% and 20% of the infants had at least one URTI or LRTI, and 60% had diarrhoeal episodes. The risk of at least one URTI was increased by previous respiratory infections, with an odds ratio (OR) of 2.65, but was inversely associated with having a pet (OR: 0.43), being cared for by registered child minders compared to day care centres (OR: 0.36), birthweight (OR 0.40) and age at day care enrolment (OR: 0.64). No significant risk factors for LRTIs and diarrhoea were found. CONCLUSION Infection risks were associated with environmental factors and factors related to the child.
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Affiliation(s)
- Rikke Pilmann Laursen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Anni Larnkjær
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Iva Hojsak
- School of Medicine, Children's Hospital Zagreb, University of Zagreb, Zagreb, Croatia
- School of Medicine, University J.J. Strossmayer, Osijek, Croatia
| | - Kim Michaelsen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Christian Mølgaard
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
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27
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Vissing NH, Chawes BL, Rasmussen MA, Bisgaard H. Epidemiology and Risk Factors of Infection in Early Childhood. Pediatrics 2018; 141:peds.2017-0933. [PMID: 29794229 DOI: 10.1542/peds.2017-0933] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is a large, unexplained variation in the frequency of childhood infections. We described incidence and risk factors of infections in early childhood. METHODS Simple infections were captured during the first 3 years of life in the Copenhagen Prospective Studies on Asthma in Childhood 2000 birth cohort. Environmental exposures were analyzed by quasi-Poisson regression and sparse principal component analysis. RESULTS The 334 children experienced a median of 14 (range 2-43) infectious episodes at ages 0 to 3 years. The overall rate of infections was associated with the number of children in the day care (adjusted incidence rate ratio [aIRR] 1.09 [1.2-1.16]) and the m2 per child in the day care (aIRR 0.96 [0.92-0.99]). Upper respiratory infections were also associated with the number of children in the day care (aIRR 1.11 [1.03-1.20]) and the m2 per child in the day care (aIRR 0.95 [0.91-0.99]), whereas lower respiratory infections were associated with caesarean section (aIRR 1.49 [1.12-1.99]), maternal smoking (aIRR 1.66 [1.18-2.33]), older siblings (aIRR 1.54 [1.19-2.01]), and the age at entry to day care (aIRR 0.77 [0.65-0.91]). The sparse principal component analysis revealed a risk factor profile driven by tobacco exposure, social circumstances, and domestic pets, but could only be used to explain 8.4% of the infection burden. CONCLUSIONS Children experienced around 14 infections during the first 3 years of life, but incidences varied greatly. Environmental exposures only explained a small fraction of the variation, suggesting host factors as major determinants of infectious burden.
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Affiliation(s)
- Nadja Hawwa Vissing
- Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Bo Lund Chawes
- Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Morten Arendt Rasmussen
- Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Hans Bisgaard
- Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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28
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Lovie-Toon YG, McPhail SM, Au-Yeung YT, Hall KK, Chang AB, Vagenas D, Otim ME, O'Grady KAF. The Cost of Acute Respiratory Infections With Cough Among Urban Aboriginal and Torres Strait Islander Children. Front Pediatr 2018; 6:379. [PMID: 30560110 PMCID: PMC6287573 DOI: 10.3389/fped.2018.00379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/16/2018] [Indexed: 12/01/2022] Open
Abstract
Introduction: Acute respiratory infections with cough (ARIwC) contribute considerably to childhood morbidity, yet few studies have examined the cost of these illnesses among Australian children. Moreover, of the few studies that have, none are inclusive of Aboriginal and/or Torres Strait Islander children, despite this population experiencing a greater burden of respiratory illnesses. This study aimed to determine the costs of ARIwC among urban Aboriginal and/or Torres Strait Islander children from the perspective of caretakers, the public healthcare system, and employers. Methods: This cost of illness study used data collected from Aboriginal and/or Torres Strait Islander children aged <5 years enrolled in a 12 month prospective cohort study conducted through an urban primary healthcare clinic in Queensland, Australia. Illness-related resource use was collected for each episode of ARIwC reported, and costed at market rates. Linear regression was used to (a) examine cost per episode by season of illness onset and cough duration and (b) examine cost per month of observation by baseline child and family characteristics. Results: During the study period, a total of 264 episodes of ARIwC were reported among 138 children. The total mean cost was estimated to be $AU252 per non-hospitalized episode (95%CI 169-334). Caretakers, the public healthcare system and employers incurred 44, 39, and 17% of costs per episode, respectively. After accounting for months of completed follow-ups, the total mean cost per child per year was estimated to be $991 (95%CI 514-1468). Winter episodes and episodes resulting in chronic cough were associated with significantly higher costs per episode. A prior history of wheezing, connections to traditional lands and parent/guardian belief that antibiotics should be given until symptoms resolved were associated with significantly higher cost per child month of observation. Conclusion: The cost of ARIwC in this predominantly disadvantaged population is substantial, particularly for caretakers and this needs to be considered in both clinical management and public health initiatives. The importance of cultural factors on health and burden of illness should not be overlooked. Further research into the prevention of chronic cough may play an important role in reducing the economic burden of pediatric respiratory infections.
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Affiliation(s)
- Yolanda G Lovie-Toon
- Institute of Health and Biomedical Innovation, Queensland University of Technology, South Brisbane, QLD, Australia
| | - Steven M McPhail
- Institute of Health and Biomedical Innovation, Queensland University of Technology, South Brisbane, QLD, Australia.,Centre for Functioning and Health Research, Metro South Health, Woolloongabba, QLD, Australia
| | - Yin To Au-Yeung
- Institute of Health and Biomedical Innovation, Queensland University of Technology, South Brisbane, QLD, Australia
| | - Kerry K Hall
- School of Human Services and Social Work, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | - Anne B Chang
- Institute of Health and Biomedical Innovation, Queensland University of Technology, South Brisbane, QLD, Australia.,Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,Lady Cilento Children's Hospital, Queensland Children's Hospital and Health Services, South Brisbane, QLD, Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, South Brisbane, QLD, Australia
| | - Michael E Otim
- Department of Health Services Administration, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Department of Public Health, Virtual University Uganda, Kampala, Uganda
| | - Kerry-Ann F O'Grady
- Institute of Health and Biomedical Innovation, Queensland University of Technology, South Brisbane, QLD, Australia
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Optimising decision making on illness absenteeism due to fever and common infections within childcare centres: development of a multicomponent intervention and study protocol of a cluster randomised controlled trial. BMC Public Health 2017; 18:61. [PMID: 28747169 PMCID: PMC5530501 DOI: 10.1186/s12889-017-4602-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/17/2017] [Indexed: 12/30/2022] Open
Abstract
Background Evidence has shown that children 0-4 year-old attending childcare are prone to acquire infections compared to children cared for at home, with fever being the most common symptom. Illness absenteeism due to fever and common infections is substantial and mostly driven by unrealistic concerns and negative attitude towards fever of both childcare staff and parents, resulting in illness absenteeism from childcare, work absenteeism among parents and healthcare service use. The objective of this study is to optimise decision making among childcare staff on illness absenteeism due to fever and common infections in childcare. Underlying determinants of behavioural change were targeted by means of a multicomponent intervention. Methods A multicomponent intervention was developed to improve decision making, using the stepwise approach of Intervention Mapping, and in close collaboration with stakeholders and experts. The intervention consisted of 1) a two-hour educational session on fever among childcare staff; 2) an online video for childcare staff and parents emphasising key information of the educational session; 3) a decision tool for childcare staff and parents in the format of a traffic light system to estimate the severity of illness and corresponding advices for childcare staff and parents; 4) an information booklet regarding childhood fever, common infections, and self-management strategies for childcare staff and parents. The multicomponent intervention will be evaluated in a cluster randomised trial with a 12-week follow-up period and absenteeism due to illness (defined as the percentage of childcare days absent due to illness on the total of childcare days during a 12-week period) as primary outcome measure. Secondary outcome measures are: incidence rate and duration of illness episodes, knowledge, attitude, self-efficacy, and risk perception on fever and common infections of childcare staff and parents, healthcare service use in general and paracetamol use, and work absenteeism of parents. Discussion This study aims to develop a multicomponent intervention and to evaluate to what extent illness absenteeism due to fever and common infections can be affected by implementing a multicomponent intervention addressing decision making and underlying determinants among childcare staff and parents of children attending daycare. Trial registration NTR6402 (registered on 21-apr-2017). Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4602-3) contains supplementary material, which is available to authorized users.
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30
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Corsello G, Carta M, Marinello R, Picca M, De Marco G, Micillo M, Ferrara D, Vigneri P, Cecere G, Ferri P, Roggero P, Bedogni G, Mosca F, Paparo L, Nocerino R, Berni Canani R. Preventive Effect of Cow's Milk Fermented with Lactobacillus paracasei CBA L74 on Common Infectious Diseases in Children: A Multicenter Randomized Controlled Trial. Nutrients 2017; 9:E669. [PMID: 28654019 PMCID: PMC5537784 DOI: 10.3390/nu9070669] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/16/2017] [Accepted: 06/21/2017] [Indexed: 12/13/2022] Open
Abstract
Background: Fermented foods have been proposed to prevent common infectious diseases (CIDs) in children attending day care or preschool. OBJECTIVES To investigate the efficacy of dietary supplementation with cow's skim milk fermented with the probiotic Lactobacillus paracasei CBA L74 in reducing CIDs in children attending day care or preschool. Methods: Multicenter, randomized, double-blind, placebo-controlled trial on healthy children (aged 12-48 months) consuming daily 7 grams of cow's skim milk fermented with L. paracasei CBA L74 (group A), or placebo (maltodextrins group B) attending day care or preschool during the winter season. The main outcome was the proportion of children who experienced ≥1 episode of CID during a 3-month follow-up. Fecal biomarkers of innate (α- and β-defensins, cathelicidin) and acquired immunity (secretory IgA) were also monitored. Results: A total of 126 children (71 males, 56%) with a mean (SD) age of 33 (9) months completed the study, 66 in group A and 60 in group B. At intention to treat analysis, the proportion of children presenting ≥1 CID was 60% in group A vs. 83% in group B, corresponding to an absolute risk difference (ARD) of -23% (95% CI: -37% to -9%, p < 0.01). At per-protocol-analysis (PPA), the proportion of children presenting ≥1 CID was 18% in group A vs. 40% in group B, corresponding to an absolute risk difference (ARD) of -22% (95% CI: -37% to -6%, p < 0.01). PPA showed that the proportion of children presenting ≥1 acute gastroenteritis (AGE) was significantly lower in group A (18% vs. 40%, p < 0.05). The ARD for the occurrence of ≥1 AGE was -22% (95% CI: -37% to -6%, p < 0.01) in group A. Similar findings were obtained at PPA regarding the proportion of children presenting ≥1 upper respiratory tract infection (URTI), which was significantly lower in group A (51% vs. 74%, p < 0.05), corresponding to an ARD of -23% (95% CI: -40% to -7%, p < 0.01). Significant changes in innate and acquired immunity biomarkers were observed only in subjects in group A. Conclusions: Dietary supplementation with cow's skim milk fermented with L. paracasei CBA L74 is an efficient strategy in preventing CIDs in children.
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Affiliation(s)
- Giovanni Corsello
- Operative Unit of Pediatrics and Neonatal Intensive Therapy, Mother and Child Department, University of Palermo, 90121 Palermo, Italy.
| | - Maurizio Carta
- Operative Unit of Pediatrics and Neonatal Intensive Therapy, Mother and Child Department, University of Palermo, 90121 Palermo, Italy.
| | - Roberto Marinello
- Federazione Italiana Medici Pediatri Lombardia, 46100 Mantova, Italy.
| | - Marina Picca
- Pediatric Society of Primary Health Care (SICuPP), 20135 Milan, Italy.
| | - Giulio De Marco
- Department of Translational Medical Science-Pediatric Section, University of Naples "Federico II" Via S. Pansini, 5, 80131 Naples, Italy.
| | - Maria Micillo
- Department of Translational Medical Science-Pediatric Section, University of Naples "Federico II" Via S. Pansini, 5, 80131 Naples, Italy.
| | - Dante Ferrara
- Department of Sciences for Health Promotion and Mother and Child Care, University of Palermo, 90121 Palermo, Italy.
| | | | - Gaetano Cecere
- Department of Translational Medical Science-Pediatric Section, University of Naples "Federico II" Via S. Pansini, 5, 80131 Naples, Italy.
| | - Pasqualina Ferri
- Department of Translational Medical Science-Pediatric Section, University of Naples "Federico II" Via S. Pansini, 5, 80131 Naples, Italy.
| | - Paola Roggero
- Department of Clinical Science and Community Health, Neonatal Intensive Care Unit, Fondazione I.R.C.C.S. Cà Granda Ospedale Maggiore Policlinico, University of Milan, 20143 Milan, Italy.
| | - Giorgio Bedogni
- Clinical Epidemiology Unit, Liver Research Center, Basovizza, 34012 Trieste, Italy.
| | - Fabio Mosca
- Department of Clinical Science and Community Health, Neonatal Intensive Care Unit, Fondazione I.R.C.C.S. Cà Granda Ospedale Maggiore Policlinico, University of Milan, 20143 Milan, Italy.
| | - Lorella Paparo
- Department of Translational Medical Science-Pediatric Section, University of Naples "Federico II" Via S. Pansini, 5, 80131 Naples, Italy.
| | - Rita Nocerino
- Department of Translational Medical Science-Pediatric Section, University of Naples "Federico II" Via S. Pansini, 5, 80131 Naples, Italy.
| | - Roberto Berni Canani
- Department of Translational Medical Science-Pediatric Section, University of Naples "Federico II" Via S. Pansini, 5, 80131 Naples, Italy.
- European Laboratory for the Investigation of Food-Induced Diseases, University of Naples "Federico II", 80131 Naples, Italy.
- CEINGE Advanced Biotechnologies, University of Naples "Federico II", 80131 Naples, Italy.
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van den Bunt G, Liakopoulos A, Mevius DJ, Geurts Y, Fluit AC, Bonten MJM, Mughini-Gras L, van Pelt W. ESBL/AmpC-producing Enterobacteriaceae in households with children of preschool age: prevalence, risk factors and co-carriage. J Antimicrob Chemother 2016; 72:589-595. [PMID: 27789683 DOI: 10.1093/jac/dkw443] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/13/2016] [Accepted: 09/20/2016] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES ESBL/AmpC-producing Enterobacteriaceae are an emerging public health concern. As households with preschool children may substantially contribute to the community burden of antimicrobial resistance, we determined the prevalence, risk factors and co-carriage of ESBL/AmpC-producing bacteria in preschool children and their parents. METHODS From April 2013 to January 2015, each month 2000 preschool children were randomly selected from Dutch population registries. The parents were invited to complete an epidemiological questionnaire and to obtain and send a faecal sample from the selected child and from one parent. Samples were tested for ESBL/AmpC-producing bacteria. Logistic regression was used to identify risk factors for ESBL/AmpC carriage in children and parents, and findings were internally validated by bootstrapping. RESULTS In total, 1016 families were included and ESBL/AmpC prevalence was 4.0% (95% CI 3.2%-5.0%); 3.5% (95% CI 2.5%-4.8%) in children and 4.5% (95% CI 3.4%-6.0%) in parents. Attending a daycare centre (DCC) was the only significant risk factor for children (OR 2.1, 95% CI 1.0-4.3). For parents, the only significant risk factor was having one or more children attending DCCs (OR 2.2, 95% CI 1.2-4.8). For parents of ESBL/AmpC-positive children the OR for ESBL/AmpC carriage was 19.7 (95% CI 9.2-42.4). Co-carriage of specific ESBL/AmpC genotypes in child and parent occurred more often than expected by chance (14.6% versus 1.1%, P < 0.001). CONCLUSIONS In this study, intestinal carriage with ESBL/AmpCs was detected in ∼4% of households with preschool children. DCC attendance was a risk factor in both children and parents and co-carriage of specific genotypes frequently occurred in child-parent pairs. These findings suggest household transmission or/and family-specific exposure to common sources of ESBL/AmpC-producing bacteria.
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Affiliation(s)
- G van den Bunt
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands .,Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - A Liakopoulos
- Department of Bacteriology and Epidemiology, Central Veterinary Institute (CVI) of Wageningen University, Lelystad, The Netherlands
| | - D J Mevius
- Department of Bacteriology and Epidemiology, Central Veterinary Institute (CVI) of Wageningen University, Lelystad, The Netherlands.,Faculty of Veterinary Medicine, Department of Infectious Diseases and Immunology, Utrecht University, Utrecht, The Netherlands
| | - Y Geurts
- Department of Bacteriology and Epidemiology, Central Veterinary Institute (CVI) of Wageningen University, Lelystad, The Netherlands
| | - A C Fluit
- Department of Medical Microbiology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - M J M Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - L Mughini-Gras
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Faculty of Veterinary Medicine, Department of Infectious Diseases and Immunology, Utrecht University, Utrecht, The Netherlands
| | - W van Pelt
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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32
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Hullegie S, Bruijning-Verhagen P, Uiterwaal CSPM, van der Ent CK, Smit HA, de Hoog MLA. First-year Daycare and Incidence of Acute Gastroenteritis. Pediatrics 2016; 137:peds.2015-3356. [PMID: 27244798 DOI: 10.1542/peds.2015-3356] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Daycare attendance has been associated with increased acute gastroenteritis (AGE) incidence in the first years of life. We investigated the effects of first-year daycare attendance on AGE incidence and primary care contact rate up to age 6 years. METHODS Children enrolled in the Wheezing Illnesses Study Leidsche Rijn cohort were managed until age 6 years. Data on primary care diagnosed AGE episodes and number of associated contacts per episode were collected from health records. Children were categorized according to first year daycare attendance and age-month at entry when applicable. Generalized estimating equations were used to assess associations between first-year daycare and AGE incidence or primary care contact rate. RESULTS A total of 1344 out of 2220 children (83%) attended daycare before age 1 year. Overall, the 6-year primary care AGE incidence rate (IR) among first-year daycare attendees and nonattendees was comparable (IR: 12.2/100 vs 13.3/100 child-years). First-year daycare attendees had a higher AGE incidence during the first year (IRR: 1.13; 95% confidence interval: 1.06-1.21) and lower during the third to sixth year of age compared with nonattendees (P < .001). The daycare-associated increase in AGE incidence was most pronounced during the first 12 months after enrollment into daycare and demonstrated clear seasonality. A similar pattern was observed for primary care contact rate per AGE episode. CONCLUSIONS First-year daycare attendance advances the timing of AGE infections, resulting in increased AGE disease burden in the first year and relative protection thereafter. Protection against AGE infection persists at least up to age 6 years. Future studies should address whether this protective effect persists during later childhood.
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Affiliation(s)
| | - Patricia Bruijning-Verhagen
- Julius Center for Health Sciences and Primary Care, and National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | | | - Cornelis K van der Ent
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands; and
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Abstract
BACKGROUND Influenza-like illness (ILI) is the leading cause of medical consultation amongst preschool children, who may contribute to spreading ILI-causing agents within the household. We aimed to determine the societal burden (incidence, health-care consumption and productivity loss) and correlates of ILI in households with preschool children. METHODS A survey was performed in the Netherlands during October 2012 to October 2014. Monthly, 2000 households with children younger than 4 years were invited to report their symptoms and related medical care, productivity loss and putative risk exposures for 1 preschool child and 1 parent. RESULTS Eight thousand seven hundred and sixty-eight child-parent pairs were enrolled. ILI incidence was 2.81 episodes/child-year and 1.72 episodes/parent-year. Amongst those with ILI, health-care utilization was 35.7% (children) and 17.7% (parents). Work absenteeism was 45.7% (median 2 workdays lost) and day-care absenteeism was 22.8% (median 1 day missed). Chronic respiratory conditions, developmental disabilities, parental occupation in health care/child care, having a sibling and attending day care for ≤12 months increased childhood ILI risk. Parental ILI risk increased with having chronic respiratory conditions, developmentally disabled day-care-attending children and female gender in interaction with unemployment and multiple day-care-attending children. Breastfeeding infants 6-month-old or younger and attending day care for >24 months decreased childhood ILI risk. Pregnancy, occupation in health care and having ≥3 children decreased parental ILI risk. Parents of ILI-affected children had a concurrent 4-fold higher ILI risk. CONCLUSION ILI in households with preschool children has a considerable societal impact. Risk-mitigating initiatives seem justified for day-care attendees, mothers, people with chronic respiratory conditions, and children with developmental disabilities. Children attending day care for >2 years acquire some protection to ILI.
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Societal Burden and Correlates of Acute Gastroenteritis in Families with Preschool Children. Sci Rep 2016; 6:22144. [PMID: 26917406 PMCID: PMC4768267 DOI: 10.1038/srep22144] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 02/08/2016] [Indexed: 01/30/2023] Open
Abstract
Gastrointestinal infection morbidity remains high amongst preschool children in developed countries. We investigated the societal burden (incidence, healthcare utilization, and productivity loss) and correlates of acute gastroenteritis (AGE) in families with preschoolers. Monthly for 25 months, 2000 families reported AGE symptoms and related care, productivity loss, and risk exposures for one preschooler and one parent. Amongst 8768 child-parent pairs enrolled, 7.3% parents and 17.4% children experienced AGE (0.95 episodes/parent-year and 2.25 episodes/child-year). Healthcare utilization was 18.3% (children) and 8.6% (parents), with 1.6% children hospitalized. Work absenteeism was 55.6% (median 1.5 days) and day-care absenteeism was 26.2% (median 1 day). Besides chronic enteropathies, antacid use, non-breastfeeding, and toddling age, risk factors for childhood AGE were having developmental disabilities, parental occupation in healthcare, multiple siblings, single-parent families, and ≤12-month day-care attendance. Risk factors for parental AGE were female gender, having multiple or developmentally-disabled day-care-attending children, antimicrobial use, and poor food-handling practices. Parents of AGE-affected children had a concurrent 4-fold increased AGE risk. We concluded that AGE-causing agents spread widely in families with preschool children, causing high healthcare-seeking behaviours and productivity losses. Modifiable risk factors provide targets for AGE-reducing initiatives. Children may acquire some immunity to AGE after one year of day-care attendance.
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Nocerino R, Paparo L, Terrin G, Pezzella V, Amoroso A, Cosenza L, Cecere G, De Marco G, Micillo M, Albano F, Nugnes R, Ferri P, Ciccarelli G, Giaccio G, Spadaro R, Maddalena Y, Berni Canani F, Berni Canani R. Cow's milk and rice fermented with Lactobacillus paracasei CBA L74 prevent infectious diseases in children: A randomized controlled trial. Clin Nutr 2015; 36:118-125. [PMID: 26732025 DOI: 10.1016/j.clnu.2015.12.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 11/24/2015] [Accepted: 12/10/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND & AIM Fermented foods have been proposed for the prevention of infectious diseases. We evaluated the efficacy of fermented foods in reducing common infectious diseases (CIDs) in children attending daycare. METHODS Prospective randomized, double-blind, placebo-controlled trial (registered under Clinical Trials.gov identifier NCT01909128) on healthy children (aged 12-48 months) consuming daily cow's milk (group A) or rice (group B) fermented with Lactobacillus paracasei CBA L74, or placebo (group C) for three months during the winter season. The main study outcome was the proportion of children who experienced at least one CID. All CIDs were diagnosed by family pediatricians. Fecal concentrations of innate (α- and β-defensins and cathelicidin LL-37) and acquired immunity biomarkers (secretory IgA) were also evaluated. RESULTS 377 children (193 males, 51%) with a mean (SD) age of 32 (10) months completed the study: 137 in group A, 118 in group B and 122 in group C. Intention-to-treat analysis showed that the proportion of children who experienced at least one CID was lower in group A (51.8%) and B (65.9%) compared to group C (80.3%). Per-protocol analysis showed that the proportion of children presenting upper respiratory tract infections was lower in group A (48.2%) and group B (58.5%) compared with group C (70.5%). The proportion of children presenting acute gastroenteritis was also lower in group A (13.1%) and group B (19.5%) compared with group C (31.1%). A net increase of all fecal biomarkers of innate and acquired immunity was observed for groups A and B compared to group C. Moreover, there was a negative association between fecal biomarkers and the occurrence of CID. CONCLUSION Dietary supplementation with cow's milk or rice fermented with L. paracasei CBA L74 prevents CIDs in children attending daycare possibly by means of a stimulation of innate and acquired immunity.
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Affiliation(s)
- Rita Nocerino
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Lorella Paparo
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Gianluca Terrin
- Department of Gynecology-Obstetrics and Perinatal Medicine, University of Rome "La Sapienza", Rome, Italy
| | - Vincenza Pezzella
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Antonio Amoroso
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Linda Cosenza
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Gaetano Cecere
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Giulio De Marco
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Maria Micillo
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Fabio Albano
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Rosa Nugnes
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Pasqualina Ferri
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Ciccarelli
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Giuliana Giaccio
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Raffaella Spadaro
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Ylenia Maddalena
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | | | - Roberto Berni Canani
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy; European Laboratory for the Investigation of Food Induced Diseases (ELFID), University of Naples "Federico II", Naples, Italy; CEINGE - Advanced Biotechnologies, University of Naples "Federico II", Naples, Italy.
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van Beeck AHE, Zomer TP, van Beeck EF, Richardus JH, Voeten HACM, Erasmus V. Children's hand hygiene behaviour and available facilities: an observational study in Dutch day care centres. Eur J Public Health 2015; 26:297-300. [PMID: 26659412 DOI: 10.1093/eurpub/ckv228] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Children attending day care centres are at increased risk of infectious diseases, in particular gastrointestinal and respiratory infections. Hand hygiene of both caregivers and children is an effective prevention measure. This study examined hand hygiene behaviour of children attending day care centres, and describes hygiene facilities at day care centres. METHODS Data were collected at 115 Dutch day care centres, among 2318 children cared for by 231 caregivers (August to October 2010). Children's hand hygiene behaviour was observed and data on hand hygiene facilities of the day care centres collected by direct unobtrusive observation. National guidelines indicate hand hygiene is required before eating, after toilet use and after playing outside. RESULTS Among 1930 observed hand hygiene opportunities for children, overall adherence to hand hygiene guidelines was 31% (95% CI: 29-33%). Adherence after both toilet use and playing outside was 48%. Hands were less frequently washed before eating, where guideline adherence was 15%. In 38% of the playrooms there was no soap within reach of children and 17% had no towel facilities. In over 40% of the playrooms, appropriate hand hygiene facilities for children were lacking. CONCLUSION Adequate hand washing facilities were available for children in only half of the participating day care centres in our study and children washed their hands in only 15-48% of the occasions defined by official guidelines. More attention is needed to hand hygiene of children attending day care centres in the prevention of infectious diseases.
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Affiliation(s)
- A H Elise van Beeck
- 1 Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Tizza P Zomer
- 2 Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
| | - Eduard F van Beeck
- 1 Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jan Hendrik Richardus
- 1 Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Helene A C M Voeten
- 2 Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
| | - Vicki Erasmus
- 1 Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Koningstein M, Leenen MA, Mughini-Gras L, Scholts RMC, van Huisstede-Vlaanderen KW, Enserink R, Zuidema R, Kooistra-Smid MAMD, Veldman K, Mevius D, van Pelt W. Prevalence and Risk Factors for Colonization With Extended-Spectrum Cephalosporin-Resistant Escherichia coli in Children Attending Daycare Centers: A Cohort Study in the Netherlands. J Pediatric Infect Dis Soc 2015; 4:e93-9. [PMID: 26407274 DOI: 10.1093/jpids/piv042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 06/24/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND The purpose of this study was to determine the prevalence and risk factors for colonization with extended-spectrum cephalosporin-resistant (ESC-R) Escherichia coli in daycare center (DCC)-attending children. METHODS This is a prospective cohort study including 44 DCCs in the Netherlands, combining DCC characteristics and monthly collected stool samples from their attendees, and was performed in 2010-2012. During a 22-month study period, 852 stool samples were collected and screened for ESC-R E coli. Risk factors were studied using logistic regression analysis. RESULTS In DCC-attending children (<4 years old), the overall prevalence of ESC-R E coli was 4.5%, and it was 8% in <1-year-old attendees. Among the 38 children carrying ESC-R E coli, the most common types were blaCMY-2 (26%), blaCTX-M-1 (16%), and chromosomal AmpC type 3 promoter mutants (13%). Extended-spectrum cephalosporin-resistant E coli was less common in DCCs where stricter hygiene protocols were enforced, eg, not allowing ill children to enter the DCC (odds ratio [OR], 0.34; 95% confidence interval [CI], 0.14-0.84), performing extra checks on handwashing of ill children (OR, 0.42; 95% CI, 0.20-0.87), and reporting suspected outbreaks to local health authorities (OR, 0.27; 95% CI, 0.11-0.69). CONCLUSIONS The distribution of ESC-R E coli types in DCCs differs from that of the general population. Extended-spectrum cephalosporin-resistant E coli carriage in DCC-attending children is associated with the hygiene policies enforced in the DCC. Although our results are not conclusive enough to change current DCC practice beyond ensuring compliance with standing policies, they generated hypotheses and defined the degree of ESC resistance among DCC attendees, which may influence empiric antibiotic therapy choices, and tracked the increasing trend in ESC resistance.
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Affiliation(s)
- Maike Koningstein
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Margriet A Leenen
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, the Netherlands Faculty of Medicine, Utrecht University, the Netherlands
| | - Lapo Mughini-Gras
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands Department of Infectious Diseases and Immunology, Utrecht University, Faculty of Veterinary Medicine, the Netherlands
| | - Rianne M C Scholts
- Certe - Laboratory for Infectious Diseases, Department of Research and Development, Groningen, the Netherlands
| | | | - Remko Enserink
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Rody Zuidema
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Mirjam A M D Kooistra-Smid
- Certe - Laboratory for Infectious Diseases, Department of Research and Development, Groningen, the Netherlands Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Kees Veldman
- Department of Bacteriology and TSEs, Central Veterinary Institute of Wageningen UR, Lelystad, the Netherlands
| | - Dik Mevius
- Department of Bacteriology and TSEs, Central Veterinary Institute of Wageningen UR, Lelystad, the Netherlands Department of Infectious Diseases and Immunology, Utrecht University, Faculty of Veterinary Medicine, the Netherlands
| | - Wilfrid van Pelt
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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