Attending Day Care Centers Research Articles

Sociolinguistic factors associated with the subjectively and objectively measured language development in German preschoolers in three follow-up studies

AbstractThe study aimed at an analysis of sociolinguistic variables associated with the language acquisition progress between the first and the second test sessions in three follow-up studies with German preschool children. In all three samples, children acquiring German, both Germans and immigrants, were tested twice with validated language tests within a time span of several months. Furthermore, language skills of children were judged by daycare center teachers. The language competence of normally developed test subjects did not change much between two test sessions, whereas children acquiring German under more challenging circumstances were still in the process of active development, mostly due to the daycare center attendance, language courses, and medical therapies. Therefore, contra-intuitively at first sight, the following factors were associated with the quick progress in language development (floor effect): bad school marks for the language competence at the beginning of the daycare attendance, low age at the first test session, not regular attendance of the daycare centers, late contact to the German language, foreign language(s) spoken at home, medical issues, and some other unfavorable language acquisition conditions.

Paediatric antibiotic prescriptions in primary care in the Alpes-Maritimes area of southeastern France between 2008 and 2013.

France has remained among the top five European countries for ambulatory antibiotic consumption since such monitoring began in 1998. Young children are major antibiotic consumers, in spite of the viral origin of most infections in this population. Recommendations were updated in 2011 to limit prescriptions. In order to assess their impact, diagnoses and prescriptions were compared in a population of children attending daycare centres in southeastern France in 2008 and 2012. Trends in the reimbursement of paediatric antibiotic prescriptions by the national health insurance (NHI) for the whole area were also studied. Distribution of diagnoses accounting for antibiotic treatment and type of antibiotic prescribed over the previous 3months to children below 4years of age attending daycare centres in the Alpes-Maritimes area in southeastern France were compared between 2008 and 2012 prior to and following the availability of these new recommendations. Trends in reimbursed ambulatory antibiotic prescriptions by general practitioners and paediatricians in the area were studied for this age group from 2008 to 2012 and in 2013. The majority of recorded diagnoses concerned upper respiratory tract infections (URTI). Inappropriate antibiotic prescription persisted for colds and bronchitis in similar proportions during both surveys. Improvement in the choice of antibiotic with fewer prescriptions for third-generation cephalosporins was observed both in daycare centres and according to NHI data; however, this was mainly recorded among paediatricians. The management of paediatric URTI still needs improvement, pointing to the need to investigate and adequately address the reasons for inappropriate antibiotic prescription.

ESBL/AmpC-producing Enterobacteriaceae in households with children of preschool age: prevalence, risk factors and co-carriage.

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. 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. 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). 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.

Giardiasis in daycare centers at Rancabali tea plantation, Bandung District, Indonesia

Background In developing countries, the prevalence of giardia-sis in daycare centers is considerably high. There had been inad-equate report of giardiasis in Indonesia.Objective To know the prevalence of giardiasis in children andthe number of children with symptomatic and asymptomatic giar-diasis who attended daycare centers at Rancabali tea plantation,Bandung district.Methods This descriptive study was conducted in daycare cen-ters between August to October 2002. Giardiasis was defined asthe occurrence of G. lamblia cyst in stool specimen independentfrom the presence or absence of symptoms. Four of 12 daycarecenters were chosen by cluster random sampling. All children aged1 to 60 months attending daycare and staying for at least 2 weekswere included in this study. Three consecutive stool specimen pre-served by 10% formalin, concentrated by formalin ether, were ex-amined microscopically to find the G. lamblia cyst.Results Giardia lamblia cysts were found in 27 (29%) of the 92children attending the daycare centers at Rancabali tea plantation(95%CI 20;38.6%). Of these children, 15 showed symptoms suchas diarrhea episodes (8 children), diarrhea (5 children), bloating (5children), abdominal cramp (5 children), and vomiting (3 children).Three children showed mild to moderate malnutrition. Ten childrenaged 13 to 36 month-old with G. lamblia-positive stool showed suchsymptoms.Conclusion The prevalence of G. lamblia infection in children at-tending daycare centers at Rancabali tea plantation was almostsimilar with other place in developing countries. More than half ofpatients had symptomatic disease

Regular day-care center attendance – an influencing factor on developmental risks in the domain of social skills of 3 to 6 year old children?

Background: Social-emotional skills are associated with subsequent school success [1,2,3,4]. Therefore, it is necessary to early promote these skills in the child development. The federal state law for child day care and preschools Mecklenburg-Western Pomerania (MWP) regulates documentation and observation of the children's development [5]. Day-care teachers shall assess developmental motor, language, cognitive, and social risks by conducting the standardized, objective and valid “Dortmunder Entwicklungsscreening für den Kindergarten DESK 3 – 6” [6,7,8]. In the event of deviations from an age-appropriate development, the law stipulates funds to offer targeted individualized support to children prone to developmental delays. Mandatory criteria for claiming benefits based on the law are (1.) the annual performance of the screening and (2.) the participation in a scientific evaluation (n = 143 day-care centers (dcc); 05.04.2016).

Different risk factors for infection with Giardia lamblia assemblages A and B in children attending day-care centres.

Giardia lamblia is a major cause of diarrhoea in children, especially those attending day-care centres (DCCs). Only Giardia assemblages A and B infect humans. Given the lack of assemblage-specific epidemiological data, we aimed to identify risk factors for infection by assemblages A and B in DCC attendees. During 2010-2013, 5,015 faecal samples from ≤4-year-old children attending 40 DCCs participating in laboratory surveillance in the Netherlands were tested for Giardia using RT-PCR. Giardia-positive samples were typed for identification of assemblages A and B. We compared child- and DCC-level characteristics of Giardia-positive children with those of Giardia-negative children using mixed-effects logistic regression. Overall, 226 samples (4.5%) tested positive for Giardia, and assemblages were determined for 138 of them: 62 (45%) were assemblage A and 76 (55%) were B. The only risk factor for assemblage A infection was attending DCCs with indoor sandpits and cats during spring/summer (odds ratio [OR] 13.5; 95%CI 1.8-101.3). For assemblage B, risk factors were attending DCCs with dedicated diaper-changing (OR 3.6; 95%CI 1.7-7.6) and laundry (OR 2.3; 95%CI 1.1-4.9) areas. Preventing sick children from attending day-care and having cloth-towels at the DCC decreased the risk of assemblage B infection (OR 0.0; 95%CI 0.0-0.5 and OR 0.3; 95%CI 0.1-0.6 respectively). Risk factors for assemblages A and B infection in DCC-attending children were different, with assemblage B being mainly related to anthroponotic transmission, and assemblage A being related to zoonotic transmission. Given these differences, interventions to reduce the burden of childhood giardiasis cannot ignore those assemblage-specific preferred reservoirs and transmission routes.

Xylitol for preventing acute otitis media in children up to 12 years of age.

Acute otitis media (AOM) is the most common bacterial infection among young children in the United States. There are limitations and concerns over its treatment with antibiotics and surgery and so effective preventative measures are attractive. A potential preventative measure is xylitol, a natural sugar substitute that reduces the risk of dental decay. Xylitol can reduce the adherence of Streptococcus pneumoniae (S pneumoniae)andHaemophilus influenzae (H influenzae) to nasopharyngeal cells in vitro. This is an update of a review first published in 2011. To assess the efficacy and safety of xylitol to prevent AOM in children aged up to 12 years. We searched CENTRAL (to Issue 12, 2015), MEDLINE (1950 to January 2016), Embase (1974 to January 2016), CINAHL (1981 to January 2016), LILACS (1982 to January 2016), Web of Science (2011 to January 2016) and International Pharmaceutical Abstracts (2000 to January 2016). Randomised controlled trials (RCTs) or quasi-RCTs of children aged 12 years or younger where xylitol supplementation was compared with placebo or no treatment to prevent AOM. Two review authors independently selected trials from search results, assessed and rated study quality and extracted relevant data for inclusion in the review. We contacted trial authors to request missing data. We noted data on any adverse events of xylitol. We extracted data on relevant outcomes and estimated the effect size by calculating risk ratio (RR), risk difference (RD) and associated 95% confidence intervals (CI). We identified five clinical trials that involved 3405 children for inclusion. For this 2016 update, we identified one new trial for inclusion. This trial was systematically reviewed but due to several sources of heterogeneity, was not included in the meta-analysis. The remaining four trials were of adequate methodological quality. In three RCTs that involved a total of 1826 healthy Finnish children attending daycare, there is moderate quality evidence that xylitol (in any form) can reduce the risk of AOM from 30% to around 22% compared with the control group (RR 0.75, 95% CI 0.65 to 0.88). Among the reasons for dropouts, there were no significant differences in abdominal discomfort and rash between the xylitol and the control groups. Xylitol was not effective in reducing AOM among healthy children during a respiratory infection (RR 1.13, 95% CI 0.83 to 1.53; moderate quality evidence) or among otitis-prone healthy children (RR 0.90, 95% CI 0.67 to 1.21; low-quality evidence). There is moderate quality evidence showing that the prophylactic administration of xylitol among healthy children attending daycare centres can reduce the occurrence of AOM. There is inconclusive evidence with regard to the efficacy of xylitol in preventing AOM among children with respiratory infection, or among otitis-prone children. The meta-analysis was limited because data came from a small number of studies, and most were from the same research group.

Potential causative agents of acute gastroenteritis in households with preschool children: prevalence, risk factors, clinical relevance and household transmission.

Acute gastroenteritis (AGE) morbidity remains high amongst preschool children, posing a significant societal burden. Empirical data on AGE-causing agents is needed to gauge their clinical relevance and identify agent-specific targets for control. We assessed the prevalence, risk factors and association with symptoms for enteropathogens in households with preschool children. A monthly-repeated cross-sectional survey of enteropathogens in households with preschool children was performed. A parent-child pair per household (n = 907 households) provided faecal samples and reported their symptoms and potential risk exposures. Samples were tested by multiplex reverse transcription polymerase chain reaction (RT-PCR) for 19 enteropathogens. Associations were assessed using logistic regression. 28.3% of children (n = 981) and 15.6% of parents (n = 971) carried pathogenic bacteria and/or Escherichia coli-associated pathogenicity genes, and 6.5% and 3.3% carried viruses, respectively. Giardia lamblia (4.6% of children, 2.5% of parents) and Dientamoeba fragilis (36%, 39%, respectively) were the main parasites, and were associated with pet exposure. Living in rural areas was associated with carriage of pathogenic E. coli, norovirus I and D. fragilis. Pathogenic E. coli was associated with summertime and livestock exposure. Attending day-care centres increased the risk of carrying norovirus, sapovirus and G. lamblia. Viruses occurred mainly in winter and were associated with AGE symptoms. Child-parent associations were found for bacterial pathogenicity genes, viruses, G. lamblia and D. fragilis. Enteropathogens spread widely in households with preschool children, particularly viruses, which more often cause symptoms. While bacteria predominate during summer and in those exposed to livestock, viruses predominate in wintertime and, like G. lamblia, are widespread amongst day-care centre attendees.

Characteristics of child daycare centres associated with clustering of major enteropathogens.

Insights into transmission dynamics of enteropathogens in children attending daycare are limited. Here we aimed at identifying daycare centre (DCC) characteristics associated with time-clustered occurrence of enteropathogens in DCC-attending children. For this purpose, we used the KIzSS network, which comprises 43 DCCs that participated in infectious disease surveillance in The Netherlands during February 2010-February 2013. Space-time scan statistics were used to identify clusters of rotavirus, norovirus, astrovirus, Giardia lamblia and Cryptosporidium spp. in a two-dimensional DCC characteristic space constructed using canonical correlation analysis. Logistic regression models were then used to further identify DCC characteristics associated with increased or decreased odds for clustering of enteropathogens. Factors associated with increased odds for enteropathogen clustering in DCCs were having indoor/outdoor paddling pools or sandpits, owning animals, high numbers of attending children, and reporting outbreaks to local health authorities. Factors associated with decreased odds for enteropathogen clustering in DCCs were cleaning child potties in designated waste disposal stations, cleaning vomit with chlorine-based products, daily cleaning of toys, extra cleaning of toys during a suspected outbreak, and excluding children with gastroenteritis. These factors provide targets for reducing the burden of gastrointestinal morbidity associated with time-clustered occurrence of major enteropathogens in DCC attendees.

Improving hand hygiene compliance in child daycare centres: a randomized controlled trial.

Gastrointestinal and respiratory infections in children attending daycare centres (DCCs) are common and compliance with hand hygiene (HH) guidelines to prevent infections is generally low. An intervention was developed to increase HH compliance and reduce infections in DCCs. The objective of this paper was to evaluate the effectiveness of this intervention on HH compliance. The intervention was evaluated in a two-arm cluster randomized controlled trial in 71 DCCs in The Netherlands. Thirty-six DCCs received the intervention including: (1) HH products; (2) training about HH guidelines; (3) two team training sessions aimed at goal setting and formulating HH improvement activities; and (4) reminders and cues for action (posters/stickers). Intervention DCCs were compared to 35 control DCCs that continued usual practice. HH compliance of caregivers and children was observed at baseline and at 1, 3 and 6 months follow-up. Using multilevel logistic regression, odds ratios (ORs) with 95% confidence intervals (CIs) were obtained for the intervention effect. Of 795 caregivers, 5042 HH opportunities for caregivers and 5606 opportunities for supervising children's HH were observed. At 1 month follow-up caregivers' compliance in intervention DCCs was 66% vs. 43% in control DCCs (OR 6·33, 95% CI 3·71-10·80), and at 6 months 59% vs. 44% (OR 4·13, 95% CI 2·33-7·32). No effect of the intervention was found on supervising children's HH (36% vs. 32%; OR 0·64, 95% CI 0·18-2·33). In conclusion, HH compliance of caregivers increased due to the intervention, therefore dissemination of the intervention can be considered.

Health Assessment of Elderly Attending Daycare Centers in Bahrain

Objective: to perform a multidimensional health assessment for Bahraini elderly and identify areas of need. Design: Cross sectional study. Setting: Elderly 60 years and more who are attending elderly daycare centers in Bahrain. Method: A total of four hundred and fifteen men and women attending elderly daycare centers were interviewed. Mini mental state examination, depression scale, activities of daily living and instrumental activities of daily living were assessed through a questionnaire designed for the purpose of this study. Furthermore, body mass index (BMI), blood pressure and random blood sugar were measured. Results: 76.8% of the women and 57.3% of the men were hypertensive. The prevalence of diabetes was 58.8% in women and 57.4% in men. Overweight was present among 22.4% of elderly. Three quarters of the elderly had an unremarkable mental status based on the mental and functional assessment scale. Conclusion: Attendees of elderly daycare centers in Bahrain were generally independent. However, counseling on lifestyle modification and monitoring of their health status is required.

Genotyping of Giardia duodenalis isolates in asymptomatic children attending daycare centre: evidence of high risk for anthroponotic transmission.

Giardia duodenalis is a common intestinal parasite infecting children attending daycare centres. This study aimed to verify Giardia occurrence and the genotypes of isolates infecting children aged 0-6 years and workers at a daycare centre in the state of São Paulo, Brazil. The families of children who tested positive for Giardia, were asked to provide stool samples from household members and their dogs. Samples (123 children, 14 centre employees, 44 household members, 19 children after treatment, and 20 dogs) were examined for intestinal parasites using concentration methods. DNA extracted from all samples was submitted for polymerase chain reaction (PCR) testing and the amplicons generated were used for multilocus sequence typing of beta-giardin (bg), triose phosphate isomerase (tpi) and glutamate dehydrogenase (gdh) genes. Giardia was detected in 15·9% and 28·6% of the 220 samples by microscopy and PCR, respectively. Analysis of sequences retrieved from 29 isolates revealed both assemblages A (31%) and B (69%). Sub-assemblages AII, BIII and BIV were identified and the alignment of the bg, gdh and tpi sequences revealed the presence of some single nucleotide polymorphisms, especially in assemblage B sequences. The higher predominance of assemblage B and the identification of the AII type support the view that anthroponotic transmission appears to be an important route of transmission in environments that concentrate children at an age when poor hygiene practices make them more vulnerable to such infection.

Effects of Lactobacillus rhamnosus HN001 on acute respiratory infections and intestinal secretory IgA in children.

Acute respiratory infections (ARI) are one of the main health problems in children, particularly in those under 5 years of age. The aim of this study was to evaluate whether the regular intake of the probiotic Lactobacillus rhamnosus HN001 affects the frequency, severity or duration of ARI in children attending day care centers during the winter season. A double-blind, placebo-controlled trial was carried out in 398 children (1 to 5 years old) who were randomized into two groups to receive daily for 3 months either 100 mL of a product containing HN001 (1010 bacteria/day) or a control without the probiotic. ARI episodes and symptoms, absenteeism and antibiotic administration were registered. In a sub-group of children, oropharyngeal and fecal samples were obtained to detect pathogens, total Lactobacillus counts and secretory IgA, respectively. When comparing groups, neither the number nor the duration of the ARI, nor the days of absenteeism or antibiotic administration were statistically different. No differences between the groups in the detection rates of Staphylococcus aureus, Streptococcus pneumoniae and Streptococcus pyogenes in the oropharyngeal samples were observed along the study. Fecal Lactobacillus counts as well as sIgA levels increased significantly during the study in the HN001 group, compared to the control (P = 0.027 and P = 0.048, respectively). In the conditions in which this study was carried out, the regular intake of L. rhamnosus HN001 modulated the intestinal immune responses without affecting the frequency or severity of ARI in children.

Prevalence and Risk Factors for Colonization With Extended-Spectrum Cephalosporin-ResistantEscherichia coliin Children Attending Daycare Centers: A Cohort Study in the Netherlands

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. 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. 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). 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.

Trends in antibiotic resistance of Streptococcus pneumoniae and Haemophilus influenzae isolated from nasopharyngeal flora in children with acute otitis media in France before and after 13 valent pneumococcal conjugate vaccine introduction.

BackgroundAfter the implementation of pneumococcal conjugate vaccines (PCVs), the marked shift in Streptococcus pneumoniae (Pnc) serotype distribution led to a modification in pneumococcal antibiotic susceptibility. In 2011, the pattern of antibiotic prescription in France for acute otitis media in infants was greatly modified, with decreased use of third-generation cephalosporins and amoxicillin–clavulanate replaced by amoxicillin alone. To assess antibiotic strategies, here we measured the antibiotic susceptibility of Pnc and Haemophilus influenzae (Hi) isolated from nasopharyngeal flora in infants with acute otitis media in the 13-valent PCV (PCV13) era in France.MethodsFrom November 2006 to June 2013, 77 pediatricians obtained nasopharyngeal swabs from infants (6 to 24 months old) with acute otitis media. The swabs were sent for analysis to the national reference centre for pneumococci in France. Demographics, medical history, and physical examination findings were recorded.ResultsWe examined data for 7200 children, 3498 in the pre-PCV13 period (2006–2009) and 3702 in the post-PCV13 period (2010–2013). The Pnc carriage rate decreased from 57.9 % to 54.2 % between the 2 periods, and the proportion of pneumococcal strains with reduced susceptibility to penicillin or resistant to penicillin decreased from 47.1 % to 39 % (P < 0.0001). The Hi carriage rate increased from 48.2 % to 52.4 %, with the proportion of ß-lactamase–producing strains decreasing from 17.1 % to 11.9 % and the proportion of ß-lactamase–nonproducing, ampicillin-resistant strains remaining stable, from 7.7 % to 8.2 %. We did not identify any risk factor associated with carriage of ß-lactamase–producing Hi strains (such as daycare center attendance, otitis-prone condition or recent antibiotic use).ConclusionIn France, the nasopharyngeal carriage rate of reduced-susceptibility pneumococcal strains and ß-lactamase–producing Hi strains decreased in children with acute otitis media after 2010, the year the PCV13 was introduced. Accordingly, amoxicillin as the first-line drug for acute otitis media requiring antibiotics remains a valid choice.

손자녀를 돌보는 조모의 역할특성과 생성감이 노년기 우울감에 미치는 영향

This study examines the relationships between grandparenting roles, elderly generativity, and depressive symptoms. Data were collected from 129 grandmothers who helped raise grandchildren attending daycare centers. Grandparenting roles were assessed as generational transferers, caretakers, emotional supporters, and educators. Elderly generativity and depressive symptoms were evaluated based on the Loyola Generativity Scale and CES-D (Center for Epidemiological Studies on Depression Scale), respectively. Data were analyzed using t-test, ANOVA, and regression analysis methods. According to the results, grandmothers were most likely to play a role as caretakers, and there were differences across factors correlated with grandparenting roles. More specifically, daily hours spent on grandparenting and years of grandparenting were related to the caretaker role, and a high level of education was related to the educator role. Poor health was correlated with the generational initiator role. According to correlation and regression analyses, grandmothers who had access to more economic resources and who served as educators, emotional supporters, or generation initiators were more likely to show generativity. In addition, the higher the generativity, the less likely the depressive symptom was. These results have important implications for developing programs that can help grandparents raise preschool-aged grandchildren and suggest some interesting avenues for future research.

Childhood acute lymphoblastic leukemia and indicators of early immune stimulation: a Childhood Leukemia International Consortium study.

The associations between childhood acute lymphoblastic leukemia (ALL) and several proxies of early stimulation of the immune system, that is, day-care center attendance, birth order, maternally reported common infections in infancy, and breastfeeding, were investigated by using data from 11 case-control studies participating in the Childhood Leukemia International Consortium (enrollment period: 1980-2010). The sample included 7,399 ALL cases and 11,181 controls aged 2-14 years. The data were collected by questionnaires administered to the parents. Pooled odds ratios and 95% confidence intervals were estimated by unconditional logistic regression adjusted for age, sex, study, maternal education, and maternal age. Day-care center attendance in the first year of life was associated with a reduced risk of ALL (odds ratio = 0.77, 95% confidence interval: 0.71, 0.84), with a marked inverse trend with earlier age at start (P < 0.0001). An inverse association was also observed with breastfeeding duration of 6 months or more (odds ratio = 0.86, 95% confidence interval: 0.79, 0.94). No significant relationship with a history of common infections in infancy was observed even though the odds ratio was less than 1 for more than 3 infections. The findings of this large pooled analysis reinforce the hypothesis that day-care center attendance in infancy and prolonged breastfeeding are associated with a decreased risk of ALL.

A hand hygiene intervention to reduce infections in child daycare: a randomized controlled trial.

Infections are common in children attending daycare centres (DCCs). We evaluated the effect of a hand hygiene (HH) intervention for caregivers on the incidence of gastrointestinal and respiratory infections in children. The intervention was evaluated in a two-arm cluster randomized controlled trial. Thirty-six DCCs received the intervention including HH products, training sessions, and posters/stickers. Thirty-five control DCCs continued usual practice. Incidence of episodes of diarrhoea and the common cold in children was monitored by parents during 6 months. Using multilevel Poisson regression, incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were obtained. Diarrhoeal incidence was monitored in 545 children for 91 937 days. During follow-up, the incidence was 3·0 episodes per child-year in intervention DCCs vs. 3·4 in control DCCs (IRR 0·90, 95% CI 0·73-1·11). Incidence of the common cold was monitored in 541 children for 91 373 days. During follow-up, the incidence was 8·2 episodes per child-year in intervention DCCs vs. 7·4 in control DCCs (IRR 1·07, 95% CI 0·97-1·19). In this study, no evidence for an effect of the intervention was demonstrated on the incidence of episodes of diarrhoea and the common cold.

PS-349 Tell Me How You Sleep: Sleep Habits And Disturbances In Portuguese Pre-scholar And Scholar Children

Background and aims Given the risk of significant medical and behavioural morbidity, it is crucial to evaluate sleep disorders in clinical practice. We aimed to evaluate sleep habits and disturbances in pre-scholar and scholar children from a Northern region of Portugal and compare the results with other studies. Methods Children’s Sleep Habits Questionnaire Portuguese version (CSHQ-PT) was applied to parents of healthy children (4–10 years old) attending daycare centres and elementary schools in our city. Results 107 pre-scholar and 122 scholar children were included (n = 229), mean age 6,3 years. 54,1% were boys. Prevalence of co-sleeping was 37,3%. Mean bedtime was 9:41 pm and mean wake-up time was 7:20 am. Mean sleep duration was 9.7 h, being longer in pre-scholars (p < 0.001).75,7% of children suffered from global sleep disturbances and the mean CSHQ-PT total score was 47,05, being higher in pre-scholars (p = 0,001). Pre-scholars also scored higher on bedtime resistance (p < 0,001), sleep onset delay (p = 0,046) and night wakening (p < 0,001). Bedtime resistance and sleep anxiety scores were higher in only children (p = 0.003). The prevalence of enuresis was 7,7%, restless sleep 52,7% and bruxism 22,2%. Pre-scholars scored higher in night terrors (p = 0,04). It was hard to get the children out of bed in 56.7% and the children seemed tired during the day in 22.9%. Conclusion Included children tend to fall asleep later and sleep less than in other studies. A high prevalence of sleep disturbances was found, specially in pre-scholar children, which claims a different approach of this subject in our clinical practice.

Dynamics of pneumococcal carriage among day-care center attendees during the transition from the 7-valent to the higher-valent pneumococcal conjugate vaccines in Greece

BackgroundIn Greece recently, higher-valent pneumococcal conjugate vaccines (PCVs) replaced the 7-valent (PCV7); the 10-valent (PCV10) became available in May 2009 and the 13-valent (PCV13) in June 2010. MethodsWe investigated the nasopharyngeal colonization with Streptococcus pneumoniae in day-care center attendees in Athens and the prefecture of Viotia. Between December 2010 and June 2011, nasopharyngeal cultures were obtained 4 times, at enrollment and then every 6 to 8 weeks. ResultsAmong the 233 children, 225 (96.6%) had been vaccinated with ≥1 dose of PCV7. One tenth of the PCV7 vaccinated attendees had also received ≥1 dose of PCV13 or PCV10. During the 4 samplings, 358 isolates were recovered from a total of 874 samples. Of the 233 children, 183 (78.5%) were found to carry S. pneumoniae at least once. The overall serotype distribution among carriers was similar regardless of the time lapsed since the last PCV7 dose. A high frequency of 19A (17.1%) coincided with a low frequency of 19F (1.4%). Non-PCV13 serotypes accounted for 73.1% of the isolates; 23B, 15B/C, 16F, 21, 11A, 15A, 6C, 10A, 22F and 23A were the most common. Among attendees aged 24–59 months (median age 42 months), prolonged carriage of a non-PCV13 serotype was relatively common, mainly for 21 and 16F. One out of 4 cases of colonization with the prevalent non-PCV13 serotypes was followed by persistent carriage for 5 to 14 weeks. ConclusionsDuring this period of transition to the higher-valent PCVs in the day-care center setting, non-PCV13 serotypes dominated and exhibited prolonged colonization. The frequency and the duration of prolonged carriage tends to be increased, if sampling frequency increases and the carriage time before and after positive cultures is taken into consideration. Further studies regarding the fitness of the colonizing non-PCV13 serotypes will likely to be seen in the future.