An outbreak of cryptosporidiosis in a hospital day-care centre

The investigation of an outbreak of cryptosporidiosis in a hospital day-care centre is reported. Twenty-eight (27%) children and one member of the staff were infected. Most of the cases were symptomatic and the major presenting symptom was watery diarrhoea. Shedding of oocysts continued for a mean of 12 days after diarrhoea had subsided and most of the cases were still excreting oocysts when the first follow-up sample was examined. Intermittent shedding or a carrier state were not seen in any of the cases. Giardia intestinalis cysts were detected in 19 children, 7 of whom showing mixed infection with Cryptosporidium sp., but this association was not statistically significant. All cases recovered without specific therapy. No definite proof could be found to demonstrate the source of the outbreak or the route of transmission but some observations suggesting person-to-person transmission are discussed.     

Individual plans for children in transition to pre-school: a case study in one Finnish day-care centre

This paper outlines a case study on teachers’ and parents’ perspectives on children's individual plans in transition from early childhood education to pre-school in Finland. The study was based on the importance of continuity as a part of positive educational transition experiences. The national curricula, educators’ interpretations and parents’ perspectives were investigated in one day-care centre. Individual planning is mandatory in early childhood, but there is little information about using the plans in transition to pre-school. At the local level, individual planning occurred in discussions with parents and various planning forms. Familiarity and good relationships between the educators and the parents were important. The educators and the parents had different perceptions of the usefulness and use of individual planning. On the basis of this study, individual planning can be recommended as an appropriate tool to strengthen continuity in transition, but more discussion between parents and educators is needed to build a shared understanding about it.     

Active immunisation during an outbreak of hepatitis A in a German day-care centre

During an outbreak in a German day-care centre (DCC) caring for 100 children HAV vaccination was recommended for children, employees and household members of cases. A retrospective cohort study was done to evaluate vaccine uptake and identify possible risk factors for disease. Between 19 December 2004 and 30 January 2005 eight DCC children and seven household members fulfilled the case definition, i.e. had clinical hepatitis (14) or were diagnosed with asymptomatic HAV infection (1). Following the recommendation to vaccinate, given on 23 December 2004, 66.7% (46/69) of DCC children, 15.8% (29/184) of household members and 5/5 of employees were vaccinated, and three vaccinated children and two not vaccinated children fell ill. One of 11 children who received human normal immunoglobulin (HNIG) and four of 58 children who did not receive HNIG fell ill. In households in which the DCC child received HAV vaccine and/or HNIG, seven (5.6%) of 125 household members fulfilled the case definition. In households of non-immunised children none of the 59 household members fell ill. We conclude that, although most vaccinations were administered promptly, they may not have been timely enough to impact the course of the outbreak.     

Middle ear effusion in children and the indoor environment: an epidemiological study

A prospective study of 337 children was carried out during a 3-month period. The purpose of the study was to evaluate the importance of indoor environmental factors in homes and day-care institutions for the incidence of middle ear effusion (MEE). The indoor environmental factors measured in institutions were carbon dioxide, temperature, and relative humidity. Conditions in the homes were assessed by a questionnaire. Middle ear effusion was measured by tympanometry. No relationship was found between indoor environmental factors and MEE, with the exception of parental smoking at home, which increased the frequency of MEE in children.     

Middle ear effusion: rate and risk factors in Australian children attending day care

There have been no previous longitudinal studies of otitis media conducted in non-Aboriginal Australian children. This paper describes the rate and risk factors for middle ear effusion (MEE) in children attending day care in Darwin, Australia. A prospective cohort study of 252 children under 4 years was conducted in 9 day care centres over 12 fortnights between 24 March and 15 September 1997. Tympanometry was conducted fortnightly and multivariate analysis used to determine risk factors predicting MEE. The outcome of interest was the rate of type B tympanograms per child detected in either ear at fortnightly examinations. After adjusting for clustering by child, MEE was detected on average 4.4 times in 12 fortnights (37% of all examinations conducted). Risk factors associated with presence of effusion were younger age, a family history of ear infection, previous grommets (tympanostomy tubes), ethnicity and the day care centre attended. A history of wheeze appeared protective. These effects were modest (RR 0.57-1.70). Middle ear effusion is very common in children attending day care in Darwin. This has clinical importance, since MEE during early childhood may affect optimal hearing, learning and speech development. There is little scope for modification for many of the risk factors for MEE predicted by this model. Further study of the day care environment is warranted.     

An outbreak of hepatitis A in a French day-care centre and efforts to combat it

An outbreak of hepatitis A in a French day-care center was identified during a survey of risk factors for such events in a sample of 210 centers. In the period between 29 March and 9 July 1994, 17 cases were diagnosed in the center (anti-HAV IgM serum antibody) including 11 children aged 2--3 (attack rate = 55.5% of class), 2 staff members, 3 parents and 1 educator-parent (secondary attack rate = 27.6%). The source case was probably a classmate of Case 1Õs older brother, who was diagnosed earlier in the spring. Intensive hygiene measures and the organisational features of the clinic limited all transmission except by direct physical contact with infected children. Vaccination of staff was begun too late to be effective; gamma-globulin prophylaxis might have been administered but was not. This is the first documented outbreak of the disease in a French center.     

Relationship between illness-associated absence in day-care children and weather parameters

This 5-year study demonstrated a statistically significant correlation between morbidity among children attending day-care centres and various weather parameters. The study was undertaken in south-central Sweden, where sharp seasonal contrasts in climatic and weather conditions occur. Illness-associated absence (IAA) decreased significantly when the weather was bright, sunny and warm, determined using average monthly weather parameters analysed over 60 months. This may be because good weather encourages outdoor activities which, in turn, reduce the risk of spreading respiratory tract infections as outdoor play areas are larger, body contact is less frequent, and any bacteria and viruses present will be readily dispersed. In multiple regression analysis, outdoor temperature was the most prominent parameter linked with IAA. This may reflect the behaviour of the staff with regard to various weather conditions. It is therefore to be recommended that children attending day-care centres should be allowed and encouraged to play outdoors when conditions allow.     

Pertussis infection in fully vaccinated children in day-care centers, Israel

We tested 46 fully vaccinated children in two day-care centers in Israel who were exposed to a fatal case of pertussis infection. Only two of five children who tested positive for Bordetella pertussis met the World Health Organization's case definition for pertussis. Vaccinated children may be asymptomatic reservoirs for infection.     

Energy balance and physical activity in obese children attending day-care centres

OBJECTIVE: To evaluate energy balance and physical activity in obese preschool children attending day-care centres. DESIGN: Cross-sectional study. SUBJECTS: Twenty-four 3-5 years old obese children selected at random from four different day-care centres in Santiago City, Chile. Total energy expenditure (TEE) was measured by doubly labelled water and physical activity as recorded by TRITRAC R3D motion sensor. Energy intake was assessed by measuring food intake while at the centre, along with the recording of additional food intake in the home. RESULTS: Obese children had a 5.4% higher weighed energy intake than their energy requirements 2001. Energy intake during the week was 7716+/-1092 kJ/day and 7401+/-1023 kJ/day in boys and girls, respectively. Minimal activity was higher in the day-care centres (62%) compared to 52% during the weekend at home. Light activity was higher during the weekend at home than during the week (25 versus 20%), but moderate-intense activity was similar (3-5%). CONCLUSIONS: Reduction in dietary energy provided at the day-care centres helps to balance energy requirements during the week. Obese children had marked sedentary characteristics with regards to physical activity, although children are more active at home in weekends. This situation suggests that educators and parents need to improve children's physical activity levels and nutrition habits.     

中耳测试技术及实施原理

本文阐述了中耳测试技术中三项主要指标“静态声顺值”“鼓室功能”“镫骨肌反射”的测试机理及完成上述功能的电路结构。     

中国六城市日托幼儿园儿童的膳食营养状况

为了解学龄前儿童中潜在缺乏的营养素 ,于 1 998～ 1 999年在北京、上海、广州、成都、长沙和大连分别选择 1～ 2所中等水平的日托幼儿园 ,调查了儿童的膳食营养状况。选择 1 1 70名 3～ 6岁健康儿童 ,其中男 583名 ,女 587名 ,使用称重法连续记录三天在幼儿园内的食物消耗量 ,同时由其看护人提供园外膳食记录 ,使用我国食物成分表计算每个儿童的营养素摄入量。每个年龄组的平均能量、蛋白质、铁、视黄醇、维生素E、硫胺素、核黄素和烟酸的摄入量是适宜的。但是脂肪提供的能量占总能量的百分比超过了建议的高限值。儿童一日能量摄入量在每餐中的分配比例趋势是早餐低 ,晚餐和园外零食高。钙磷比值严重倒置 ,平均值为 0 63 ,钙的摄入量仅达到推荐摄入量的 61 6 % ,而儿童的食盐摄入量较高 ,与适宜摄入量相差较大。锌的平均摄入量达到推荐摄入量的 62 9%。各年龄组维生素C摄入量均低于其推荐摄入量。结果提示 ,在我国城市儿童的膳食中 ,长期某些微量营养素的供给不足或偏食可能与城市日托儿童的生长发育状况与国际标准或发达国家仍有较大差距有关