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To characterize SARS-CoV-2 transmission following a COVID-19 outbreak in an emergency childcare centre (ECCC) in April 2020 in Quebec, Canada.The study population consisted of all the children and employees who attended the ECCC as well as household contacts of the confirmed COVID-19 cases. Of the 120 individuals in the study, five cases were confirmed by epidemiological link and 25 were identified as COVID-19 by RT-PCR among which 19 were analyzed by viral whole genome sequencing. Descriptive epidemiology, social network visualization, and phylogenetic analysis were used to characterize viral transmission.Phylogenetic analysis identified two separate introductions of distinct lineages of SARS-CoV-2 and estimated an average effective reproductive number of RThe analyses carried out showed the probable origin and direction of the transmission of the infection (adult-child, child-adult, and child-child), thus highlighting how asymptomatic children can efficiently transmit SARS-CoV-2.RéSUMé: OBJECTIF: Caractériser la transmission du SRAS-CoV-2 à la suite d’une éclosion de COVID-19 dans un service de garde d’urgence en milieu scolaire (SGUMS) en avril 2020 au Québec, Canada. MéTHODES: La population à l’étude était composée de tous les enfants et employés ayant fréquenté le SGUMS ainsi que les contacts familiaux des cas confirmés de COVID-19. Sur les 120 personnes à l’étude, cinq cas ont été confirmés par lien épidémiologique et 25 par RT-PCR. Parmi ces derniers, 19 ont été analysés par séquençage viral du génome entier. La caractérisation de la transmission a été réalisée à l’aide d’analyses descriptives et phylogénétiques ainsi que de la visualisation de réseaux sociaux. RéSULTATS: L’analyse phylogénétique a identifié deux introductions de lignées distinctes du SRAS-CoV-2 et un taux de reproduction net R

Background To evaluate the safety, feasibility of mini-percutaneous nephrolithotomy (mPCNL) being carried out as a daycare surgery and to study the re-admission, stone clearance rate and complication rates following mPCNL. We also sought to find out the rate of requirement of ancillary procedure, after mPCNL. Methods In this prospective observational study, easily accessible patients above 18 years of age with renal and/or upper ureteric calculi, who underwent mPCNL between September 2018 and February 2020, were included. Seventy patients were selected, as per statistical methods. Preoperative evaluation including history, blood and urine investigations and radiological images was collected. Intra-operative and post-operative events were analyzed. Written consent was obtained from the patients to participate in the study and to publish their data. Institutional Ethical and scientific committee clearance was obtained. Results Out of 70 patients who underwent mPCNL in the study, in the age group ranging from 24–68 years, most of the cases were partial staghorn with maximum size of stone up to about 3.5 cm. Inferior calyx was most frequently punctured. Six cases had multipuncture mPCNL, four patients had bilateral procedure, and two had supra-costal puncture. Eighteen patients had tubeless mPCNL, of which four were totally tubeless procedures. Four patients had hematuria, none requiring transfusion. Two patients had sepsis, managed with higher antibiotics. Limitation of the study was the sample size. To derive a sturdy conclusion, large scale studies are recommended. Conclusions We can conclude that mPCNL can be safely done as daycare or ambulatory surgery in properly selected patients. In centers with experienced urologists, bilateral and multipuncture mPCNL can be done as an ambulatory surgery. Thus, this addresses the stone disease as well as cost containment, without patient safety being compromised. Bed occupancy rate is reduced, helping effective utilization of hospital resources.

We report a cluster of surprisingly high spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) associated with a single nursery in Poland. Our findings contrast with the presumed negligible role of children in driving the SARS-CoV-2 pandemic. Children 1–2 years of age might be effective SARS-CoV-2 spreaders.

Breastfeeding has an important impact on maternal and child health, and is affected by several factors influencing its initiation and continuation. This qualitative study aimed to assess the main promoting and hindering factors for breastfeeding support in Lebanese daycare centers (DCCs), through the perspective of their directors and employees. The study was based on semi-structured interviews with 13 directors and 9 employees. It explored the influence of various cognitive factors as well as different environment types (physical, economic, political, and sociocultural) on their breastfeeding support. Findings suggested the directors and employees valued improving breastfeeding support in DCCs and the physical set-up of the DCCs allowed for this. However, various other factors restricted their abilities to support breastfeeding in the DCC, including limited knowledge and training on the topic, absence of written internal policies on breastfeeding, lack of enforcement in the application of national policies, and the current mothers’ work policies that negatively influenced the decision to breastfeed. Improvements could be achieved through integrated interventions, targeting the interaction of internal DCCs factors and national and DCCs breastfeeding policies, as well as several social factors, to create a multilevel approach targeting breastfeeding continuation support in breastfeeding-friendly DCCs in Lebanon and the region.

Background: There are several possible facilities for the treatment of eating disorders (EDs). Specifically, there is the issue of the use of specialized daycare and ambulatory services over inpatient settings and the place of daycare programs following inpatient treatment.Aim: We sought to examine the contribution of post-hospitalization daycare program to the treatment of adolescents hospitalized with an ED.Methods: We assessed 61 female adolescents hospitalized with an ED. All but three were diagnosed with clinical or subthreshold anorexia nervosa (AN). Three were diagnosed with bulimia nervosa. Thirty-seven patients continued with a post-hospitalization daycare program for at least 5 months, whereas 24 did not enter or were enrolled in the program for Results: BMI was within normal range at follow-up, whether completing or not completing daycare treatment, and around 75% of the patients had menstrual cycles. By contrast, when using comprehensive composite remission criteria, less than a quarter of former inpatients not entering/not completing daycare program achieved remission vs. almost a half of the completers. In addition, a greater percentage of completers continued with psychotherapy following discharge. Fifty percent of both groups showed good post-discharge social functioning. No between-group differences were found in the BMI and the scores of the self-rating questionnaires at admission to, and discharge from, inpatient treatment.Conclusion: Adolescent females with EDs can maintain a normal-range BMI from discharge to 1-year follow-up, even if not completing daycare treatment. By contrast, completion of a post-hospitalization daycare program may improve the 1-year follow-up ED-related outcome of former ED inpatients.

Actual surveys in kindergartens on SARS-CoV-2 infections are rare. At the beginning of the second pandemic wave, we screened 12 randomly selected kindergartens in Berlin, Germany. A total of 720 participants (pre-school children, staff and connected household members) were briefly examined and interviewed, and SARS-CoV-2 infections and anti-SARS-Cov-2 IgG antibodies were assessed. About a quarter of the participants showed common cold-resembling symptoms. However, no SARS-CoV-2 infection was detected, and only one childcare worker showed IgG seroreactivity. Against a backdrop of increased pandemic activity in the community, this cross-sectional study does not suggest that kindergartens are silent transmission reservoirs.

BACKGROUND: The role of hydrolyzed infant formulas in the prevention of asthma and allergies remains inconsistent. We tested whether extensively hydrolyzed casein formula compared to conventional cow's milk-based formula prevented asthma, allergic rhinitis, or atopic eczema. METHODS: In the randomized double-blind Trial to Reduce IDDM in Genetically at Risk (TRIGR), comparing extensively hydrolyzed to standard cow's milk-based infant formula during the first 6-8 months of life, we assessed the effect of the intervention on the incidence of asthma, allergic rhinitis, and eczema when the children were 9- to 11-years old. The asthma, allergic rhinitis, and eczema occurrence was assessed using online standardized and validated ISAAC questionnaire. Of the 1106 children who participated in this Ancillary study, 560 had been randomized to the experimental (extensively hydrolyzed casein formula) and 546 to the control arm (cow's milk-based formula). RESULTS: The risk of persistent asthma, allergic rhinitis, or atopic eczema did not differ by treatment, the hazard ratios (95% CI) being 1.00 (0.66-1.52), 0.95 (0.66-1.38), and 0.89 (0.70-1.15), respectively, in the intention-to-treat analysis. Neither were there any differences in the per-protocol analysis. CONCLUSIONS: Extensively hydrolyzed casein formula did not protect from asthma, rhinitis, or eczema in this population carrying genetic risk for type 1 diabetes. publishedVersion

International audience; BACKGROUND: Most preschool children in Western industrialized countries attend child care during the day while parents work. Studies suggest that child care may be stressful to young children, perhaps because they still lack the social skills to interact daily in a group setting away from parents. This gap in social abilities may be greater for children in lower-income families, who may face more adversity at home, with fewer resources and more social isolation. METHODS: We conducted a cluster-randomized controlled trial in 2013-2014 to test whether a social skills intervention led by early childhood educators within the child care center could reduce diurnal cortisol levels to more typical patterns expected of children this age. We randomized 19 public child care centers (n = 361 children) in low-income neighborhoods of Montreal, Canada, to either: 1) the Minipally program - intervention group (n = 10 centers; 186 children), or 2) waiting list - control group (n = 9 centers; 175 children). Saliva samples for cortisol levels were collected 3 times/day, pre- and post-implementation. The Minipally puppet program consists of 2 workshops/month for 8 months for the development of social skills and self-regulation in 2-5-year-olds, with reinforcement activities between workshops. Educators received 2-days' training and 12 h' supervision in Minipally. RESULTS: Linear mixed models for repeated measures revealed a significant interaction between intervention status and time of day of cortisol sampling (beta = -0.18, p = 0.04). The intervention group showed patterns of decreasing diurnal cortisol secretion (beta = -0.32, p < 0.01), whereas the control group showed increasing slopes (beta = 0.20, p < 0.01). Moreover, family income was a moderator; children in lower-income families benefited most from the intervention. CONCLUSION: Results suggest that a social skills training program, when integrated into a preschool education curriculum, can foster an environment more conducive to typical childhood patterns of cortisol secretion.

Objectives This study aimed at revealing the caregiving challenges of the caregivers of people with dementia (PwD) during the COVID‐19 pandemic when daycare service was stopped as an infection control measure, and discussed ways to help PwD and their family caregivers to maintain their well‐being in the era of the pandemic. Methods Between April and May 2020, a cross‐sectional survey was conducted in 152 family caregivers of PwD who were clients of daycare service prior to the pandemic. The survey examined caregivers' stress and challenges faced during daycare service cessation, their perceived needs for continuation of daycare service, and observed changes in functional status of PwD. Regression analyses were performed to explore the associated factors of caregiving stress and preference for continuation of daycare service. Results Family caregivers of PwD experienced greater caregiving stress after cessation of daycare service. Infection was their main challenge in caregiving, and their physical and emotional health was adversely affected by the longer time commitment with PwD under the stay‐home policy. Older age of caregivers, greater emotional and communication problems of PwD, and more time spent with PwD were associated with greater caregiving stress. More than one‐third of the participants preferred the continuation of daycare service during the pandemic. Conclusions Policy makers should consider the well‐being of PwD and their caregivers when planning infection control measures. Daycare service with enhanced infection controlled measures should remain available to PwD during the COVID‐19 pandemic., Key points Family caregivers of PwD experienced greater caregiving stress during the COVID‐19 pandemic due to anxiety of infection and longer time commitment with PwD.The cognitive function and mobility of PwD deteriorated after daycare service cessation because of the lack of cognitive, social, and physical activities with the stay‐home policy.More than a third of family caregivers thought that continuation of daycare service during the COVID‐19 pandemic was important because it provided useful respite for the caregivers and a safer place for PwD to go to.Online intervention could be an alternative form of social stimulation for PwD and may reduce caregiving stress.

Background This paper estimates the impact on childhood drowning rates of community-based introduction of crèches or playpens or both in rural Bangladesh for children aged 0–47 months. Methods A baseline census of the whole population of 270,387 households in 51 unions, 451 villages from 7 rural sub-districts in Bangladesh was conducted in 2013. The baseline census determined retrospective, age-specific, and cumulative drowning incidence rates (IR) experienced in the target households in the 12 months prior to the intervention. Beginning in late 2013, creches for drowning prevention were established across the study area. Acceptance into creches was provided and written assent to attend a creche was obtained for all children aged 9–47 months in all participating unions. Playpens were provided to 45,460 of these children, of which 5981 children received only the playpens. All children were followed-up until their 48-month birthday or administrative censoring (fixed timepoint to stop observing the drowning deaths), after a two-year implementation period (2014–2016). Drowning IR were estimated for children and compared to corresponding baseline rates from 2012. Age-specific drowning IR under different “as treated” categories (playpen-only, creche-only, and playpen-plus-creche) were compared to the baseline rates experienced by the categorized households prior to intervention. Results A total of 3205 creches (average of 7 creches per village) were established, and 116,054 children aged 9–47 months were exposed to the intervention packages. Aggregated drowning IRs between age 0 and 47 were estimated per 100,000 population per year at 86.73 (95% CI: 69.67–107.97) and 43.03 (95% CI: 35.55–52.10) in the baseline and post implementation period, respectively. Risk ratios were 0.40 (95% CI: 0.28–0.57) overall, and 0.34 (95% CI: 0.13–0.90), 0.09 (95% CI: 0.02–0.36), and 0.04 (95% CI: 0.002–0.60) in children under the creche-only, aged, 1, 2, and 3 years old respectively. Inexplicably, drowning rates were statistically significantly higher post-intervention in children 0-11 months. There was no mortality reduction with playpen use (alone or in combination), and this group may actually have had a higher risk of drowning. Conclusions Creches are effective for preventing childhood drowning in rural Bangladesh for children above age 1-year, and should be considered for further scale-up.

Made available in DSpace on 2020-12-10T19:54:55Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-01. Added 1 bitstream(s) on 2021-07-15T14:37:17Z : No. of bitstreams: 1 S0036-46652020000100212.pdf: 528985 bytes, checksum: e49eb9e7bf3c4b584b9dde356cf84316 (MD5) Giardia duodenalis is one of the most important and widespread gastrointestinal parasites in the world. Despite its relevance as a causative agent of diarrhea, asymptomatic giardiasis occurs frequently. especially in low resources settings in which children are exposed to many risk factors. Based on microscopic examination and the polymerase chain reaction (PCR) amplification and sequencing of beta-giardin (bg), triose phosphate isomerase (tpi) and glutamate dehydrogenase (gdh) genes, we assessed G. duodenalis occurrence and genetic diversity in isolates of children attending a daycare center and living in low income families, in an economically successful region. Considering both, microscopic examination and PCR/sequencing methods, the overall prevalence of Giardia infection was 51.4%, with the highest frequency in children aged 1-4 years old (p

The article asks whether daycare can alleviate work–family tensions in the dual-earner society or if perceptions of 'care gaps' will hamper women's careers. Using survey data from Swedish parents with pre-school children (n ≈ 2250) and qualitative interviews of survey respondents (n = 40), we explore how children’s daycare hours and parents’ reflections on daycare hours are related to mothers’ and fathers’ involvement in paid and unpaid work and to their perceptions of stress. The results show that parents have a strong ambition to limit daycare hours. This ambition provides a stressful dilemma for mothers but for fathers, daycare is not a source of stress. Maternal part-time work is an important tool for managing daycare hours, but collides with ideals of gender equality. Full-time work can be combined with short daycare hours, provided that the parents take shifts in the home and share care responsibilities. Sharing of care work also reduces mothers' stress. However, such arrangements require flexible schedules which are more available to parents in high-skill jobs. Single parents have little opportunity to keep daycare hours short.

To gain knowledge about the role of young children attending daycare in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic, a random sample of children (n = 84) aged between 6 and 30 months attending daycare in Belgium was studied shortly after the start of the epidemic (February 29th) and before the lockdown (March 18th) by performing in-house SARS-CoV-2 real-time polymerase chain reaction. No asymptomatic carriage of SARS-CoV-2 was detected, whereas common cold symptoms were common (51.2%). Our study shows that in Belgium, there was no sign of early introduction into daycare centers at the moment children being not yet isolated at home, although the virus was clearly circulating. It is clear that more evidence is needed to understand the actual role of young children in the transmission of SARS-CoV-2 and their infection risk when attending daycare.

While SARS-CoV-2 infection activity in German kindergartens during the first year of the pandemic appeared to be overall low, outbreaks did occur. We retrospectively investigated an outbreak in November and December 2020 in a Berlin kindergarten participating in the Berlin Corona School and Kindergarten Study (BECOSS). Interviews were conducted with affected families regarding symptomatology, contact persons and possible sources of infection, as well as relevant information on the conditions on-site and infection prevention measures. A chronology of the outbreak was elaborated, and based on data on contacts and symptoms, we mapped the most likely chains of infection. Overall, 24 individuals, including ten educators, seven children, and seven household members, were infected with SARS-CoV-2 in a four-week time interval. Courses of infection ranged from asymptomatic to severe, with children less affected by symptoms. Viral spread within the facility seemed to occur mainly through kindergarten staff, while children primarily transmitted infections within their families. Interviewees reported that hygiene measures were not always adhered to inside the facility. To prevent outbreaks in kindergartens, especially in the light of current and newly emerging viral variants of concern, strict compliance to hygiene rules, staff vaccinations against SARS-CoV-2, and immediate reaction to suspected cases by quarantining and frequent testing seem reasonable measures.

Background: Pre-school children's daycare is associated with increased incidence of respiratory and diarrhoeal illnesses. While the incidence might be reduced if all unwell children were kept at home, parental employment pressures make this difficult when children are marginally unwell.Methods: A discrete choice experiment (DCE) was conducted to identify what aspects of daycare policy and provision would affect parents' decisions to keep marginally unwell children home. Prior qualitative research informed parameter choice. The DCE was accompanied by a best-worst scaling task examining preferences for four modifiable aspects of care: swapping unused daycare sessions, reimbursing unused sessions, daycare paracetamol policy and presence of a 'quiet room'.Results: Paracetamol guidelines and the presence of a quiet room had the strongest predicted influence on parents' decision-making. Conditional on assumptions about the set-up of the daycare, introducing a 'no paracetamol' policy would result in a fall from 62 to 25% in mean predicted probabilities of a parent sending a marginally unwell child to nursery, while introducing a quiet room would increase the mean probability from 34 to 53%.Conclusions: Daycare policy, particularly the use of paracetamol prior to attendance, could impact parents' decisions to send unwell children to daycare, potentially influencing the transmission of children's infectious illness.

The aims of this study were to quantify and examine differences in preschoolers&rsquo, indoor and outdoor sedentary time and physical activity intensity at child care using GPS devices and accelerometers. We conducted an observational study of 46 children (mean age 4.5 years, 30 boys, 16 girls) from five child care centers who wore accelerometers and GPS devices around their waists for five days during regular child care hours. GPS signal-to-noise ratios were used to determine indoor vs. outdoor location. Accelerometer data were categorized by activity intensity. Children spent, on average, 24% of child care time outdoors (range 12&ndash, 37% by site), averaging 74 min daily outdoors (range 30&ndash, 119 min), with 54% of children spending &ge, 60 min/day outdoors. Mean accelerometer activity counts were more than twice as high outdoors compared to indoors (345 (95) vs. 159 (38), (p &lt, 0.001)), for girls and boys. Children were significantly less sedentary (51% of time vs. 75%) and engaging in more light (18% vs. 13%) and moderate-to-vigorous (MVPA) (31% vs. 12%) activity when outdoors compared to indoors (p &lt, 0.001). To achieve a minute of MVPA, a preschooler needed to spend 9.1 min indoors vs. 3.8 min outdoors. Every additional 10 min outdoors each day was associated with a 2.9 min increase in MVPA (2.7 min for girls, 3.0 min for boys). Preschool-age children are twice as active and less sedentary when outdoors compared to indoors in child care settings. To help preschoolers achieve MVPA recommendations and likely attain other benefits, one strategy is to increase the amount of time they spend outdoors and further study how best to structure it.

Background and Objectives Recognizing the important role that dementia-specific adult day centers have in maintaining persons with a neurocognitive disorder in their home, this article examines three critical indicators at the time when people first enroll in such a center: cognitive and functional impairment of the enrollee, and burden reported by their family caregivers. We also considered variations in these 3 indicators by race/ethnicity and by the relationship of caregiver to the new enrollee. Research Design and Methods We conducted a secondary analysis of data collected by a nonprofit organization operating 11 dementia-specific adult day centers located on the east coast of Florida. Nursing staff conducted intake interviews with enrollees and their caregivers, and assessed functional status within one month of admission. Instruments included the Zarit Burden Scale and components of the Minimum Data Set: the Brief Interview for Mental Status (BIMS) and 4 measures of functional status. Results On average the cognitive scores of newly enrollees were well-within the range indicated for severe impairment, and these levels did not differ by race/ethnicity. Burden reported by caregivers however differed significantly, with Latinx caregivers reporting the greatest burden and African American/Black caregivers reporting the least. Further, while daughters generally reported higher levels of burden than other family caregivers, Black daughters reported the least. Discussion and Implications Results suggest a need for greater dissemination efforts about adult day programs to the Latinx community, as well as attention to the disparate burden placed upon differing family relationships of caregivers to enrollees.

IntroductionAsthma is a common health condition for children in childcare. National recommendations for asthma in childcare exist. However, no studies have investigated the extent to which childcare centers adhere to these recommendations. We aimed to assess childcare center adherence to National Asthma Education and Prevention Program (NAEPP) recommendations for asthma care and preparedness and to identify characteristics associated with increased adherence to national asthma recommendations.MethodsWe developed a standardized instrument. Each childcare center received a score of 0 through 7 based on number of recommendations met. We conducted t-tests, chi square tests and linear regression to identify childcare center factors associated with increased asthma preparedness.Results36 out of 40 eligible childcare centers (90%) participated. These sites served 1570 children primarily between the ages of 2 to 5years. On average, centers met 3.8 out of 7 (SD = 1.3) recommendations. Staff familiarity caring for children with asthma (p

BACKGROUND: In the last decade, laparoscopic cholecystectomy (LC) has become a regular daycare surgery at many centres across the world. However, only a few centres in India have a dedicated daycare surgery centre, and very few of them have reported their experience. Concerns remain regarding the feasibility, safety and acceptability of the introduction of daycare laparoscopic cholecystectomy (DCLC) in India. There is a need to assess the safety and acceptability of the implementation of short-stay DCLC service at a centre completely dedicated to daycare surgery. PATIENTS AND METHODS: Comprehensive care and operative data were retrospectively collected from a daycare centre of our hospital. Postoperative recovery was monitored by telephone questionnaire on days 0, 1 and 5 postoperatively, including adverse outcomes. RESULTS: A total of 211 patients were admitted for DCLC during the period from November 2011 till November 2014, of whom 211 were discharged on the day of surgery. Two hundred and two patients could be discharged within 6 h of surgery. Mean operation time was 72 min. No patient required admission. No patient needed conversion to open surgery. Only 1 patient was re-admitted due to bilioma formation and was managed with minimal intervention. CONCLUSION: The introduction of short-stay DCLC in India is feasible and acceptable to patients. High body mass index (BMI) in otherwise healthy patients and selective additional procedures are not contraindications for DCLC.

Background : Parent-reported 24-h diet recalls are an accepted method of estimating intake in young children. However, many children eat while at childcare making accurate proxy reports by parents difficult. Objective : The goal of this study was to demonstrate a method to impute missing weekday lunch and daytime snack nutrient data for daycare children and to explore the concurrent predictive and criterion validity of the method. Design : Data were from children aged 2-5 years in the My Parenting SOS project ( n =308; 870 24-h diet recalls). Mixed models were used to simultaneously predict breakfast, dinner, and evening snacks (B+D+ES); lunch; and daytime snacks for all children after adjusting for age, sex, and body mass index (BMI). From these models, we imputed the missing weekday daycare lunches by interpolation using the mean lunch to B+D+ES [L/(B+D+ES)] ratio among non-daycare children on weekdays and the L/(B+D+ES) ratio for all children on weekends. Daytime snack data were used to impute snacks. Results : The reported mean (± standard deviation) weekday intake was lower for daycare children [725 (±324) kcal] compared to non-daycare children [1,048 (±463) kcal]. Weekend intake for all children was 1,173 (±427) kcal. After imputation, weekday caloric intake for daycare children was 1,230 (±409) kcal. Daily intakes that included imputed data were associated with age and sex but not with BMI. Conclusion : This work indicates that imputation is a promising method for improving the precision of daily nutrient data from young children. Keywords: nutrition; daycare; children; missing data; methods (Published: 17 December 2015) Citation: Food & Nutrition Research 2015, 59: 28626 - http://dx.doi.org/10.3402/fnr.v59.28626

Made available in DSpace on 2018-12-11T16:59:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-05-01 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. Parasitology Department Institute of Bioscience São Paulo State University (UNESP) Campus de Botucatu, PO Box 510 Parasitology Department Institute of Bioscience São Paulo State University (UNESP) Campus de Botucatu, PO Box 510

Purpose: Diaper dermatitis is uncommon in children older than 2 years because the majority of these children are diaper independent. However, diaper dermatitis still occurs, especially in children in daycare settings. This study attempted to determine the prevalence of diaper dermatitis and its associated factors among children aged 2 to 4 years attending daycare centers. Cross-sectional analysis and tests for correlation were conducted to determine the factors associated with diaper dermatitis among the study population. Results: The prevalence of diaper dermatitis during the study period was 17.2%. Factors significantly correlated with the occurrence of diaper dermatitis were beginning toilet training later than 2 years of age (odds ratio [OR] = 2.84, 95% CI = 1.17-6.86, P = .02) and the use of oral antibiotics (OR = 15.92, 95%CI = 3.57-70.94, P < .001). Conclusion: Two major adjustable factors for preventing diaper dermatitis in the study population were toilet training before 2 years of age and avoiding the use of unnecessary oral antibiotics. These results may help in devising a preventive protocol for diaper dermatitis among this age group in the future.

The study explored the associations between various childcare staff food practices and children’s dietary intake at childcare. A total of 398 one- to four-year-old children and 24 childcare staff members from 24 Dutch childcare centers participated in the study. Children’s dietary intake (fruit, vegetable, sweet snack, savory snack, water, and sweet drink intake) at childcare was registered on two weekdays, using observations by dieticians and childcare staff. Thirteen childcare staff practices were assessed using questionnaires administered by dieticians. Data were analyzed using multilevel regression analyses. Children consumed relatively much fruit and many sweet snacks at childcare, and they mainly drank sweet drinks. Various staff practices were associated with children’s dietary intake. When staff explained what they were doing to the children during food preparation, children ate significantly more fruit. Children ate less sweet snacks when they were allowed to help prepare the meals. When staff encouraged children to continue eating, they ate more vegetables. In conclusion, the study showed the importance of childcare staff food practices for children’s food intake at childcare. More research is needed to examine the specific conditions under which food practices can have a positive impact on children’s dietary intake.

The Developmental Study is part of a larger intervention on “saving of lives from drowning (SoLiD)” where children were enrolled either into crèches (daycare centers) or playpens to prevent drowning in rural Bangladesh. Sampling ~1000 children between the ages of 9–17 months, we compared problem-solving, communication, motor and personal-social outcomes assessed by the Ages and Stages Questionnaire in the two interventions. After controlling for variables such as home stimulation in multivariate regressions, children in crèches performed about a quarter of a standard deviation better in total scores (p < 0.10) and 0.45 standard deviations higher in fine motor skills (p < 0.05). Moreover, once the sample was stratified by length of exposure to the intervention, then children in crèches performed significantly better in a number of domains: those enrolled the longest (about 5 months) have higher fine motor (1.47, p < 0.01), gross motor (0.40, p < 0.05) and personal-social skills (0.95, p < 0.01) than children in playpens. In addition, children in crèches with the longer exposure (about 5 months) have significantly higher personal-social and problem-solving scores than those in crèches with minimum exposure. Enrollment in crèches of very young children may be positively associated with psychosocial scores after accounting for important confounding variables.

Background The prevention of overweight and obesity during infancy is a highly relevant public health topic given the significant impact of childhood obesity on acute and chronic diseases, general health, and well-being in later stages of life. Apart from the family setting, daycare facilities (DFs) represent a key setting for health promotion among children under the age of six years. “JolinchenKids – Fit and Healthy in Daycare” is a multi-component program promoting physical activity (PA), healthy eating, and mental well-being in 3- to 6-year-old preschoolers at DFs, originally designed by the German health insurance AOK. To evaluate program effectiveness, a cluster-controlled trial involving 68 DFs is currently conducted. The objective of this article is to describe the background, study design, and aims of this trial. Methods/design Sixty-eight DFs across Germany will be recruited to take part in the study, half of them serving as intervention DFs and half of them as delayed intervention control DFs (which receive the program upon completion of the study). At each DF, height, weight, and body composition, as well as motor skills, will be assessed in twenty 3- to 6-year-old children. Children’s eating and PA habits, and mental well-being will be assessed via parental questionnaires. A subsample of children (i.e., at 24 DFs which are randomly selected within a geographic region) will be asked to wear accelerometers at their wrists to objectively measure PA over the course of seven days. To compare changes in body composition, motor skills, eating and PA habits, and mental well-being of children at intervention DFs with those observed among children at delayed intervention control DFs over one year, all measurements will take place at baseline and twelve months after the launch of the program at all DFs. Discussion This study investigates the influence of a health promotion program in the daycare setting on various outcomes, including body composition and objectively measured PA, in a nationwide sample of 3- to 6-year-old preschoolers. This study will provide evidence regarding the effectiveness of a multi-component program for health promotion in this setting and may provide insights into new strategies for preventing obesity in early life. Trial registration German Clinical Trials Register DRKS00011065 (Date of registration 16–09-2016).

Background The rising prevalence of obesity, particularly in childhood, is a global public health emergency. There is some evidence that exposure to non-parental childcare before age 6 years is associated with subsequent development of obesity and obesity-related behaviours such as physical activity, sedentary behaviour, sleep, diet and stress, although these findings are inconsistent. It is possible that the relationship between early childcare and later obesity and obesity-related behaviours depends on characteristics of childcare exposure such as type (i.e. informal versus formal care), duration (i.e. number of years spent in childcare), intensity (e.g. number of hours per week) and timing (i.e. age of onset of childcare) of care received. The relationship may also be moderated by socio-demographic characteristics of children and their families. We will conduct a systematic review exploring longitudinal associations between childcare (type, duration, intensity and timing) and measures of adiposity and body mass, physical activity, sedentary behaviour, sleep, diet and stress. We will also assess whether these relationships vary by socio-demographic factors. Methods We will include studies that explore longitudinal associations between childcare attendance in children aged

Enteroaggregative Escherichia coli (EAEC) has been associated with persistent diarrhea, reduced growth acceleration, and failure to thrive in children living in developing countries and with childhood diarrhea in general in industrialized countries. The clinical implications of an EAEC carrier-status in children in industrialized countries warrants clarification. To investigate the pathological significance of an EAEC carrier-state in the industrialized countries, we designed a 1-year dynamic cohort study and performed follow-up every second month, where the study participants submitted a stool sample and answered a questionnaire regarding gastrointestinal symptoms and exposures. Exposures included foreign travel, consumption of antibiotics, and contact with a diseased animal. In the capital area of Denmark, a total of 179 children aged 0-6 years were followed in a cohort study, in the period between 2009 and 2013. This is the first investigation of the incidence and pathological significance of EAEC in Danish children attending daycare facilities. Conventional microbiological detection of enteric pathogens was performed at Statens Serum Institute, Copenhagen, Denmark, and at Hvidovre Hospital, Copenhagen, Denmark. Parents completed questionnaires regarding gastrointestinal symptoms. The EAEC strains were further characterized by serotyping, phylogenetic analysis, and susceptibility testing. EAEC was detected in 25 (14%) of the children during the observational period of 1 year. One or more gastrointestinal symptoms were reported from 56% of the EAEC-positive children. Diarrhea was reported in six (24%) of the EAEC positive children, but no cases of weight loss, and general failure to thrive were observed. The EAEC strains detected comprised a large number of different serotypes, confirming the genetic heterogeneity of this pathotype. EAEC was highly prevalent (n = 25, 14%) in Danish children in daycare centers and was accompanied by gastrointestinal symptoms in 56% of the infected children. No serotype or phylogenetic group was specifically linked to children with disease.

Highlights ► We compared the amounts of otitis media episodes in OPV vs. IPV vaccinated children. ► OPV provides some protection against otitis media. ► The protective effect is strongest at the age of 6–18 months., Background The goal of this study was to evaluate whether a live attenuated poliovirus vaccine (OPV) has clinically relevant interfering effect with non-polio infections causing otitis media in young children. Methods Open trial in which the intervention group (64 children) received OPV at the age of 2, 3, 6 and 12 months. The control group (250 children) received IPV (inactivated polio vaccine) at the age of 6 and 12 months. Clinical symptoms were recorded by a questionnaire at the age of 3, 6, 12, 18 and 24 months. Results Otitis media episodes were less frequent in the OPV than in the control group. A significant difference was seen at the age of 6–18 months (IRR = 0.76 [95% CI 0.59–0.94], P = 0.011) and was particularly clear among children, who attended daycare (IRR 0.37 [95% CI 0.19–0.71], P = 0.003). Conclusions OPV provides some protection against otitis media. This effect may be mediated by viral interference with non-polio viruses.

Background The epidemiology of respiratory tract infections (RTIs) in a daycare cohort has not been explored using molecular techniques. Objectives (1) Determine the overall incidence of RTIs in a daycare cohort using real-time reverse transcriptase polymerase chain reaction (RT-PCR). (2) Determine the relative incidence and impact of specific respiratory viruses, and characterize and compare clinical features associated with these pathogens. Study design In this prospective cohort study conducted from February 2006 to April 2008, nasal swabs were obtained from symptomatic children ages 0–30 months enrolled in fulltime daycare. RT-PCR was performed to detect respiratory syncytial virus (RSV), human metapneumovirus (MPV), influenza (Flu) viruses A and B, parainfluenza (PIV), adenovirus (AdV), human coronaviruses (CoV) and rhinovirus (RhV). Symptom diaries were completed for each illness. Results We followed 119 children (mean age 10 months; range 2–24 months) for 115 child years. The mean annual incidence of RTI per child was 4.2 the first year and 1.2 the second year of the study. At least 1 virus was identified in 67% RTIs. Co-infections were common (27% RTIs), with RhV, CoV, and AdV the most common co-pathogens. PIV was identified in 12% of RTIs with a high incidence of PIV4. The viruses with the greatest impact on our population were RSV, RhV and AdV. Conclusions Using molecular techniques, viruses were identified in approximately twice as many RTIs as previously reported in a daycare cohort. Infections with newly identified viruses, such as HMPV and CoV subtypes were less frequent and severe than infections with RSV, AdV and RhV.

Objective The aim of this study was to investigate whether working as a daycare employee increases the risk of perinatal death, pre-term birth, low birth weight, smallness for gestational age, or congenital malformations. Methods We conducted a register-based cohort study among daycare employees and women from various occupations of healthcare (reference group). Study subjects were identified from the files of Finnish trade unions and the National Authority for Medicolegal Affairs. Pregnancy outcomes, antenatal occupation, and working status were obtained by linkage to national registers. The final data consisted of 13 299 and 12 182 singleton births in the study and reference groups, respectively. We analyzed pregnancy outcome data using generalized estimating equations and linear regression. Results The occurrences of pre-term birth [odds ratio (OR) 0.91, 95% confidence interval (95% CI) 0.79–1.06], perinatal death (OR 0.91, 95% CI 0.62–1.34), smallness for gestational age (OR 1.01, 95% CI 0.91–1.12), and congenital malformation (OR 1.10, 95% CI 0.92–1.32) were similar among the children of the daycare employees and the reference group. The adjusted mean birth weight of the children of the daycare employees was slightly higher (14 g, 95% CI -1–29) than that of the reference group, but the difference was attenuated to 6 g in the subset of the first births. Conclusion Daycare employees were not, in general, at an increased risk of an adverse pregnancy outcome. However, efforts should nevertheless be made to prevent their exposure to harmful viruses and heavy physical load during pregnancy.

Background and Aims: Breast cancer surgery can be carried out as day-care procedure to increase patient turnover, decrease disease progression and financial burden. The present study was carried out to assess the role of dexmedetomidine in breast cancer surgery as a day-care procedure. Methods: This prospective randomised, double-blind study was carried out on 100 patients screened for day-care breast cancer surgery. They were divided into two groups of 50 each; who received either normal saline (Group NS) or 0.6 μg/kg/h dexmedetomidine (Group D) infusion from 10 min before induction until skin closure. All patients were given general anaesthesia. The incidence of discharge, post-operative pain (POP), average rescue analgesia (fentanyl) required and side effects were noted. Statistical analysis was performed using Student's t-test and Chi-square test. Results: Incidence of discharge in group NS was 60% compared to 88% in Group D (P = 0.001). Average rescue analgesia requirement by group NS was 136.07 ± 43.06 μg, whereas it was 77.5 ± 29.86 μg in Group D (P = 0.01). The incidence of POP in 6 h and within 2 h of expected discharge time in Group NS was 56% and 28%, respectively, and in Group D, it was 8% in both the periods (P < 0.001 and 0.01). Side effects such as post-operative nausea, vomiting and bleeding were encountered in eight and two patients, respectively, in Group NS and two and one patients, respectively, in Group D. Conclusion: Dexmedetomidine as an anaesthetic adjuvant makes breast cancer surgery feasible on day-care basis.

Rationale: Daycare exposes young children to more infections early in life and may thereby prevent the development of asthma and allergy. Objectives: To prospectively study the effect of daycare on the development of asthma and allergic sensitization during the first 8 years of life.Methods: In the Prevention and Incidence of Asthma and Mite Allergy birth cohort 3,963 newborn children were followed prospectively for 8 years. Daycare use and respiratory health were assessed yearly by questionnaires. At 8 years, sensitization to airborne allergens and airway responsiveness were measured. Daycare was defined as early (aged 0-2 yr), late (aged 2-4 yr), or none (no daycare before age 4 yr). Associations of daycare and/or older siblings with asthma symptoms (wheezing, shortness of breath, and inhaled steroids taken in the last year), airway responsiveness, and allergic sensitization were assessed in a longitudinal repeated-event analysis.Measurements and Main Results: Children with early daycare had more wheezing in the first years of life, but less wheezing and steroid use between 4 and 8 years of age. At the age of 8 years, early daycare was not protective for asthma symptoms (adjusted odds ratio [aOR], 0.99; 95% confidence interval [CI], 0.74-1.32), allergic sensitization (aOR 0.86; 95% CI, 0.63-1.18), or airway hyperresponsiveness (aOR, 0.80; 95% CI, 0.57-1.14). The transient reduction in airway symptoms between age 4 and 8 years was only observed in children without older siblings.Conclusion: Early daycare is associated with an increase in airway symptoms until the age of 4 years, and fewer symptoms between the ages of 4 and 8 years. We found no protection against asthma symptoms, hyperresponsiveness, or allergic sensitization at the age of 8 years.

ObjectiveTo explore how people with dementia, their informal caregivers and their professionals participate in decision making about daycare and to develop a typology of participation trajectories.DesignA qualitative study with a prospective, multiperspective design, based on 244 semistructured interviews, conducted during three interview rounds over the course of a year. Analysis was by means of content analysis and typology construction.SettingCommunity settings and nursing homes in the Netherlands.Participants19 people with dementia, 36 of their informal caregivers and 38 of their professionals (including nurses, daycare employees and case managers).ResultsThe participants’ responses related to three critical points in the decision-making trajectory about daycare: (1) the initial positive or negative expectations of daycare; (2) negotiation about trying out daycare by promoting, resisting or attuning to others; and (3) trying daycare, which resulted in positive or negative reactions from people with dementia and led to a decision. The ways in which care networks proceeded through these three critical points resulted in a typology of participation trajectories, including (1) working together positively toward daycare, (2) bringing conflicting perspectives together toward trying daycare and (3) not reaching commitment to try daycare.ConclusionShared decision making with people with dementia is possible and requires and adapted process of decision making. Our results show that initial preferences based on information alone may change when people with dementia experience daycare. It is important to have a try-out period so that people with dementia can experience daycare without having to decide whether to continue it. Whereas shared decision making in general aims at moving from initial preferences to informed preferences, professionals should focus more on moving from initial preferences to experienced preferences for people with dementia. Professionals can play a crucial role in facilitating the possibilities for a try-out period.

To the Editor: Carriage of Staphylococcus aureus sequence type (ST) 398 has primarily been reported as occurring among persons in contact with livestock, including swine and cattle (1,2). This association has given rise to the characterization of this strain as livestock associated (3). However, ST398 colonization or infection in persons lacking identified livestock-associated risk factors have been reported (4,5). We report ST398 colonization in a childcare worker in Iowa, USA. As part of a surveillance study of S. aureus carriage in child daycare facilities, samples were collected from employees, children, and environmental surfaces. Nasal samples were taken from participating children, and nasal and pharyngeal samples were taken from participating employees. All samples were cultured, and S. aureus isolates were examined by pulsed-field gel electrophoresis, spa typing, and antimicrobial drug susceptibility testing and tested for the Panton-Valentine leukocidin gene. One participant was colonized in the nose and throat with t571, a spa type previously reported to correspond to ST398 (1). The isolates were nontypeable when SmaI was used, also a characteristic of ST398 (6). They were digested with Cfr9I and found to be closely related to an ST398 isolate of spa type t034 of swine origin but distinct from S. aureus isolated from 2 other employees at the facility (Figure). Both ST398 isolates were susceptible to methicillin. Figure Pulsed-field gel electrophoresis of Staphylococcus aureus. Isolates were digested with Cfr9I. Lanes 1 and 7, molecular mass ladder; lane 2, t034 sequence type (ST) 398 isolate from pig; lane 3, t571 ST398 nasal isolate from colonized childcare employee; ... The colonized employee was a 24-year-old woman who had worked at the facility for ≈5 years. She reported a history of melanoma but was not currently taking any chemotherapy drugs and had not been hospitalized in the previous 12 months. She reported having a family member who worked in a hospital and had direct contact with patients, but the employee lived alone and responded negatively to questions about whether she or immediate family members had had contact with animals or worked in a processing plant. ST398 may be transmitted from livestock to community members and then from person to person. It can potentially be transmitted in food; several studies have documented ST398 in raw meats (7,8), and we identified this strain in retail meat products in Iowa (T.C. Smith et al., unpub. data). Secondary transmission of ST398 from colonized persons to contacts has also been suggested, but the few publications reporting this suggest that ST398 seems to be less transmissible by this route than are common human strains (9). We cannot be sure whether either of these routes played a role in acquisition of ST398 by this employee. Although no other tested persons in this childcare facility were found to carry ST398, only 24 (40%) of the 60 employees and 8 (4.8%) of the 168 children participated, suggesting the possibility of a reservoir in the facility among those who were not tested. Of the 24 employees who participated, 2 reported occupational contact with any animals, 2 reported contact with swine, and 3 reported contact with cattle. However, no participant reported having animals other than cats or dogs on their property. It is possible that >1 sampled employee may have been a transient ST398 carrier but negative at the time of our sampling. Reports of ST398 in persons who had no direct contact with livestock in the United States are rare (10). To provide a better understanding of the epidemiology of this novel strain, further examination of the emergence of this isolate in community settings and on farms is needed.

Background Daycare attendance is an established risk factor for upper respiratory tract infections (URTI) and acute otitis media (AOM). Whether this results in higher use of healthcare resources during childhood remains unknown. We aim to assess the effect of first year daycare attendance on the timing and use of healthcare resources for URTI and AOM episodes during early childhood. Methods In the Wheezing-Illnesses-STudy-LEidsche-Rijn birth cohort, 2,217 children were prospectively followed up to age six years. Children were categorized according to first-year daycare attendance (yes versus no) and age at entry when applicable (age 0 to 2 months, 3 to 5 months and 6 to 12 months). Information on general practitioner (GP) diagnosed URTI and AOM, GP consultations, antibiotic prescriptions and specialist referral was collected from medical records. Daycare attendance was recorded by monthly questionnaires during the first year of life. Results First-year daycare attendees and non-attendees had similar total six-year rates of GP-diagnosed URTI and AOM episodes (59/100 child-years, 95% confidence interval 57 to 61 versus 56/100 child-years, 53 to 59). Daycare attendees had more GP-diagnosed URTI and AOM episodes before the age of one year and fewer beyond the age of four years than non-attendees (Pinteraction

This paper investigates the role of preschool quality for children's school performance at the end of primary school. We construct five structural quality indicators based on unique Danish administrative register data. 30,444 children finishing primary school's 9th grade in 2008 and who attended a formal preschool institution in 1998 are used in the analyses. OLS analyses show that three out of five quality indicators, a higher staff-per-child ratio, a higher share of male staff, and a higher share of staff with formal preschool teacher training are associated with significant improvements in children's test results in Danish. Boys benefit more from preschool quality than girls. Ethnic minority children benefit from higher staff stability.

Background: Establishment of daycare blood transfusion service in a licensed blood transfusion center of Dhaka city for patients needed blood transfusion is a milestone for improving blood service of Bangladesh. Aim: The aim of this study is to assess the daycare blood transfusion service of a licensed blood transfusion center in Dhaka city and evaluation of patients receiving blood transfusion and to determine the pattern of blood groups of the patients. Materials and Methods: This cross-sectional study was done in a licensed blood transfusion center in Dhaka city. The study reveals that 383 patients of various modalities of ailments had their blood transfusion from August 2012 to January 2014. The patient age, sex, diagnosis, and levels of hemoglobin were taken into consideration. The patterns of their blood groups were determined for the study. Results: This cross-sectional study revealed that among 383 patients, 148 were male and 235 were female. With the age range of 14–80 years, mean age was 53.9 ± 2.77 years. Among them, most (148) were in the age range of 55–64 years. Among the patients, 47.00% (180) were suffering from anemia according to severe, moderate, and mild anemia with various diseases. Out of 383 patients, 31.33% (120) were suffering from carcinomas. Among those carcinomas, breast, colon, lung, larynx, tongue, stomach, and esophagus carcinoma and cholangiocarcinoma were prevalent. Others such as chronic kidney disease and leukemia 7.31% (28) were next to take transfusion. Maximum of them, i.e. 235 (61.36%), were in the hemoglobin range of 5.81–7.80 g/dl range and 60 (15.67%) had their hemoglobin level at 3.81–5.80 g/dl range. Out of them, 160 were of A group, 106 were B group, 88 were O group, and 29 were AB group. Conclusion: Although daycare transfusion centers are very few in licensed blood transfusion centers, the need for daycare transfusion is increasing gradually. We recommend establishing more daycare transfusion services for the transfusion needed patients.

In London, Ontario, approximately 45 percent of preschoolers are insufficiently active.With the large number of preschoolers who attend childcare (54%), and the low levels of physical activity among preschool-aged children, daycare centers may be an appropriate avenue to intervene. This study sought to collect childcare providers’ suggestions for improving physical activity during daycare hours and their perspectives regarding the feasibility of meeting the physical activity guidelines currently set out for preschoolers. This qualitative study targeted a heterogeneous sample of childcare providers (n = 54) working at YMCA daycare centers in London, Ontario. Eight focus groups were conducted. Saturation was reached by the fifth focus group; however, three additional focus groups were completed to confirm that the researchers continued hearing the same responses. Focus groups were audio-recorded and transcribed verbatim. Inductive content analysis was used to code and categorize emerging themes. Strategies were incorporated to ensure data trustworthiness. Childcare providers believed the children in their care were quite active and when asked what would be required to increase the physical activity participation among the preschoolers in their care, participants discussed: staff training/workshops; guest physical activity instructors; additional equipment and resources; and increased funds for physical activity. The majority of focus group participants also felt it was feasible for the preschoolers in their care to meet or exceed the preschooler physical activity guidelines. Developing programs and resources that are informed by childcare providers may be an effective way to target sedentary behaviors among the preschool-aged population. Accordingly, childcare providers’ suggestions of how to maximize the opportunities for physical activity during daycare hours should be considered when developing and revising childcare curriculum, resources and policies.

Danone Research OBJETIVO: Estimar o consumo de energia e de macronutrientes no domicílio e na escola em tempo integral em crianças de 2 a 6 anos e pesquisar diferenças no consumo entre as crianças de escolas públicas e particulares. MÉTODOS: Estudo transversal realizado com 362 pré-escolares em Caxias do Sul (RS). O estado nutricional foi avaliado pela razão peso para estatura. O consumo na escola foi avaliado por meio do método de pesagem direta individual dos alimentos consumidos pelas crianças e, no domicílio, por meio do método de registro alimentar realizado pelos pais ou responsáveis. Para as análises estatísticas utilizou-se o teste U de Mann-Whitney (p < 0,05). RESULTADOS: Observou-se que 28 crianças (7,7%) apresentaram excesso de peso, 92 (25,4%), risco para excesso de peso e sete (1,9%), baixo peso para a estatura. A avaliação da ingestão alimentar em 24 horas mostrou que 51,3% da energia, 60,3% dos lipídios e 51,6% das proteínas foram consumidos nos domicílios, apesar de as crianças permanecerem em período integral nas escolas. Observou-se maior ingestão de energia (p = 0,001), carboidratos (p < 0,001) e lipídios (p = 0,04) nos pré-escolares de escolas particulares em relação aos de escolas públicas, porém o consumo total diário se mostrou similar nas diferentes instituições. CONCLUSÕES: Os achados sugerem que as crianças consomem proporcionalmente mais energia, proteínas e lipídios nas refeições complementares dos domicílios em relação às refeições diárias nas escolas infantis. Apesar das diferenças de consumo entre as escolas públicas e particulares, a ingestão diária mostrou-se similar entre as crianças. OBJECTIVE: To estimate the energy and macronutrient intake at home and at all-day in the kindergarten programs in children aged 2 to 6 and to investigate differences in consumption and intake between children at public and private kindergartens. METHODS: This was a cross-sectional study of 362 preschool children from Caxias do Sul, Brazil. Nutritional status was assessed in terms of weight to height ratios. Foods consumed in the kindergarten were evaluated by weighing the actual foods eaten by the children and home intakes were calculated from a food diary kept by parents or guardians. Statistical analyses were performed using the Mann-Whitney U test (p < 0.05). RESULTS: It was found that 28 children (7.7%) were overweight, 92 (25.4%) were at risk of becoming overweight and seven (1.9%) were classified as having wasting. Analysis of 24-hour nutritional intake demonstrated that 51.3% of the energy, 60.3% of the lipids and 51.6% of the proteins consumed by children were eaten at home, despite the children spending the whole day in the kindergarten programs. Preschool children at kindergartens ate greater quantities of energy (p = 0.001), carbohydrates (p < 0.001), and lipids (p = 0.04) than did children at public kindergartens, but their total daily intakes were similar, irrespective of which type of kindergarten program children attended. CONCLUSIONS: The findings suggest that these children eat proportionally more energy, proteins and lipids in their extra meals at home than they do in their daytime meals in the kindergarten programs. Despite the differences in intake between public and private kindergarten, daily intakes were similar. Universidade Federal de Ciências da Saúde de Porto Alegre Programa de Pós-Graduação em Ciências da Saúde UFCSPA Universidade de São Paulo Faculdade de Saúde Pública Departamento de Nutrição Universidade Federal de São Paulo (UNIFESP) Departamento de Pediatria UNIFESP, Depto. de Pediatria SciELO

OBJETIVO: Descrever o aumento do risco para aquisição de doenças infecciosas associado ao cuidado da criança fora do domicílio e a efetividade das medidas de controle para a prevenção da transmissão de doenças nas creches e pré-escolas. FONTES DE DADOS: Revisão das bases de dados MEDLINE, LILACS e Cochrane Library, através dos descritores creches, infecção, controle de infecção e doenças infecciosas, focalizada em estudos que comparam o risco de doença infecciosa em crianças cuidadas dentro e fora de casa, associam o risco às características do cuidado fora de casa e avaliam a efetividade de medidas de prevenção. SÍNTESE DE DADOS: As crianças cuidadas em creches ou pré-escolas apresentam risco de adquirir infecções aumentado em até duas a três vezes, com impacto na saúde individual e na disseminação das doenças à comunidade. O risco está associado, entre outros fatores, às características das creches, e medidas de prevenção simples são efetivas para diminuir a transmissão de doenças. Entre estas, recomenda-se: lavagem apropriada das mãos após exposição; utilização de precauções padrão; rotina padronizada para troca e descarte de fraldas usadas, localização e limpeza da área de troca, limpeza e desinfecção de áreas contaminadas; uso de lenços descartáveis para assoar o nariz; funcionários e área exclusivos para a manipulação de alimentos; notificação das doenças infecciosas; treinamento de funcionários e orientação dos pais. CONCLUSÕES: Diante da utilização crescente de creches e pré-escolas e da associação com risco aumentado de adquirir infecções, medidas de controle são imprescindíveis para a prevenção e controle das doenças transmissíveis. OBJECTIVE: To describe the increased risk of acquiring infectious diseases associated with out-of-home childcare and the effectiveness of measures for the control and prevention of diseases transmission at daycare and preschool education centers. SOURCES: A review of literature in the MEDLINE, LILACS and Cochrane Library databases, found using the descriptors daycare, infection, infection control and infectious diseases and focusing on studies that have compared the risk of infectious diseases for children cared for in and out of the home, related risk to the type of out-of-home care and assessed the effectiveness of preventative measures. SUMMARY OF THE FINDINGS: Children cared for at daycare or in preschool education exhibit a two to three times greater risk of acquiring infections, which impacts both on individual health and on the dissemination of diseases through the community. Among other factors, the risk is associated with the characteristics of daycare centers, and simple preventative measures are effective for reducing transmission of diseases. Recommended measures include: appropriate hand washing after exposure; employment of standard precautions; standardized routines for changing and disposal of used diapers, location and cleanliness of changing area, cleaning and disinfection of contaminated areas; use of disposable tissues for blowing noses; separate workers and area for handling foods; notification of infectious diseases; training of workers and guidance for parents. CONCLUSIONS: In the face of growing utilization of daycare and preschool education and their association with increased risk of acquired infections, control measures are indispensable to the prevention and control of infectious diseases.

Summary Objective Analysis of a clinical population referred for language analysis in terms of background variables and extent of language problems. Design Descriptive study. Materials and methods Children referred to a speech and hearing clinic because of assumed language problems were analyzed with standardized tests for language comprehension (Dutch version of the Reynell Developmental Comprehension Scale) and language production (Schlichting test for sentence development). A language problem was defined when the language quotient score differed 1.3S.D. from the mean (quotient scores ≤ 80). Furthermore, potential risk factors for language problems were compiled (gender, prematurity, birth weight, family composition, familial aggregation, parental education and daycare/home care). Results Two hundred forty children, aged between 2 and 5 years of age were included in the study. A reliable language comprehension quotient (LCQ) was obtained in 204 children (85%) and a reliable sentence development quotient (SDQ) in 206 children (85%). In 35% of the children who were assumed to have language problems, adequate language development was found. The children with language problems differed from the children without language problems with regard to language problems in the family (more family aggregation). Also the former more frequently had parents with a low level of education and more often did not attend daycare. The total referred group differed from the Dutch population with regard to gender (more boys), more instances of low birth weight, more parents with middle and high educational level, more two-parent households, fewer siblings, and more frequent attendance at daycare. Conclusion Parents with a low level of education more frequently have children with language problems. However, parents with a middle and high level of education are more often concerned about the language development of their child. As a consequence, the overestimation of language problems is a real issue in clinical practice. Normal variations in language development often are not considered. The analysis of compiled background variables indicates that language problems are genetically influenced (gender and family aggregation). Language input also is of importance (interactions with a language-competent parent or caregiver and peers): children with language problems less often attended daycare.

The relationship between daycare/preschool (‘daycare’) attendance and the risk of acute lymphoblastic leukaemia was evaluated in the Northern California Childhood Leukaemia Study. Incident cases (age 1–14 years) were rapidly ascertained during 1995–1999. Population-based controls were randomly selected from the California birth registry, individually matched on date of birth, gender, race, Hispanicity, and residence, resulting in a total of 140 case–controls pairs. Fewer cases (n=92, 66%) attended daycare than controls (n=103, 74%). Children who had more total child–hours had a significantly reduced risk of ALL. The odds ratio associated with each thousand child–hours was 0.991 (95% confidence interval (CI): 0.984–0.999), which means that a child with 50 thousand child–hours (who may have, for example, attended a daycare with 15 other children, 25 h per week, for a total duration of 30.65 months) would have an odds ratio of (0.991)50=0.64 (95% CI: 0.45, 0.95), compared to children who never attended daycare. Besides, controls started daycare at a younger age, attended daycare for longer duration, remained in daycare for more hours, and were exposed to more children at each daycare. These findings support the hypothesis that delayed exposure to common infections plays an important role in the aetiology of childhood acute lymphoblastic leukaemia, and suggest that extensive contact with other children in a daycare setting is associated with a reduced risk of acute lymphoblastic leukaemia. British Journal of Cancer (2002) 86, 1419–1424. DOI: 10.1038/sj/bjc/6600274 www.bjcancer.com © 2002 Cancer Research UK

Coproparasitological analyses were performed on 191 daycare children and 434 elementary school children from urban and rural areas in Rolândia, Parana State, Brazil. The overall prevalence of enteroparasites was 15.2 % for daycare children and 52.5% for elementary school children. Risk factors are discussed. Exames coproparasitológicos realizados em 191 crianças de creches e em 434 alunos da primeira à quarta série das áreas urbana e rural da rede municipal de Rolândia, PR, evidenciaram enteroparasitas em prevalência de 15,2% nas creches e de 52,5% entre os escolares. Fatores de risco são discutidos.

Percutaneous renal biopsy (PRB) is an important diagnostic tool in pediatric nephrology units. But controversy exists whether the procedure can be done in the day care setting. This study was done to document complications of PRB done with automated gun under continuous ultrasonographic guidance and to find whether the procedure can be undertaken as a day care procedure. Retrospective analysis of 67 PRBs is presented. A total of 44% (n = 30) minor and 12% (n = 8) major complications such as gross hematuria, perinephric hematoma, and hemodynamic instability were observed through the study period. All major and 90% of minor complications were detected within four hours in the current study. The procedure may be undertaken in the day care setting with strict pre and postprocedure monitoring up to eight hours in children with normal blood pressures, renal functions, hemoglobin concentrations, and coagulation parameters.