Child Care Center Hand Hygiene Programs' Cost-Effectiveness in Preventing Respiratory Infections.

BACKGROUND: We previously demonstrated that a hand hygiene program, including hand sanitizer and educational measures, for day care center (DCC) staff, children, and parents was more effective than a soap-and-water program, with initial observation, in preventing respiratory infections (RIs) in children attending DCCs. We analyzed the cost-effectiveness of these programs in preventing RIs. METHODS: A cluster, randomized, controlled and open study of 911 children aged 0 to 3 years, attending 24 DCCs in Almeria. Two intervention groups of DCC-families performed educational measures and hand hygiene, one with soap-and-water (SWG) and another with hand sanitizer (HSG). The control group (CG) followed usual hand-washing procedures. RI episodes, including symptoms, treatments, medical contacts, complementary analyses, and DCC absenteeism days, were reported by parents. A Bayesian cost-effectiveness model was developed. RESULTS: There were 5201 RI episodes registered. The adjusted mean societal costs of RIs per child per study period were CG: €522.25 (95% confidence interval [CI]: 437.10 to 622.46); HSG: €374.53 (95% CI: 314.90 to 443.07); SWG: €494.51 (95% CI: 419.21 to 585.27). The indirect costs constituted between 35.7% to 43.6% of the total costs. Children belonging to the HSG had an average of 1.39 fewer RI episodes than the CG and 0.93 less than the SWG. It represents a saving of societal cost mean per child per study period of €147.72 and €119.15, respectively. The HSG intervention was dominant versus SWG and CG. CONCLUSIONS: Hand hygiene programs that include hand sanitizer and educational measures for DCC staff, children, and parents are more effective and cost less than a program with soap and water and initial observation in children attending DCCs.

[Antibiotics prescription and complementary tests based on frequency of use and loyalty in Primary Care]. / Prescripción de antibióticos y realización de pruebas complementarias en función de la frecuentación y de la fidelización en Atención Primaria.

OBJECTIVE: To assess whether there is a relationship between the prescription of antibiotics and the performance of complementary tests with frequency of use and loyalty in Primary Care. METHODS: Analytical descriptive study performed through a network of Primary Care sentinel paediatricians (PAPenRed). Each paediatrician reviewed the spontaneous visits (in Primary Care and in Emergency Departments) of 15 patients for 12 months, randomly chosen from their quota. The prescription of antibiotics and the complementary tests performed on these patients were also collected. RESULTS: A total of 212 paediatricians took part and reviewed 2,726 patients. It was found that 8.3% were moderate over-users (mean + 1-2 standard deviations) and 5.2% extreme over-users (mean + 2 standard deviations). Almost half (49.6%) were high-loyalty patients (more than 75% of visits with their doctor). The incidence ratio of antibiotic prescriptions for moderate over-users was 2.13 (1.74-2.62) and 3.25 (2.55-4.13) for extreme over-users, compared to non-over-user children. The incidence ratio for the diagnostic tests were 2.25 (1.86-2.73) and 3.48 (2.78-4.35), respectively. The incidence ratios for antibiotic prescription were 1.34 (1.16-1.55) in patients with medium-high loyalty, 1.45 (1.15-1.83) for medium-low loyalty, and 1.08 (0.81-1.44) for those with low loyalty, compared to patients with high loyalty. The incidence ratios to perform diagnostic tests were 1.46 (1.27-1.67); 1.60 (1.28 - 2.00), and 0.84 (0.63-1.12), respectively. CONCLUSIONS: Antibiotics prescription and complementary tests were significantly related to medical overuse. They were also related to loyalty, but less significantly.

Infectious morbidity and resource use in children under 2 years old at childcare centres.

AIM: To analyse the associations between childcare centres and infectious morbidity and resource consumption. METHODS: Cohort study from birth to 2 years. OUTCOME VARIABLE: number and types of infections, drug consumption and medical visits. Exposure variable: attending or not attending a childcare centre. School age: 6-12, >12-18, >18-24 months. RESULTS: The initial cohort comprised 445 children, and the final cohort comprised 419 children. The mean number of recurrent infections and wheezing was higher in children attending childcare centres in all age groups with significant differences. Recurrent acute otitis media was observed in the 12- to 18-month group with an odds ratio of 6.04 (95% confidence interval, 1.3-27.6; P = 0.001) in the children attending childcare centres. In children older than 6 months, there was greater consumption of antibiotics, inhaled bronchodilators, oral and inhaled corticosteroids and montelukast. CONCLUSIONS: Attending a childcare is associated with an increased frequency of recurrent infections and wheezing, as well as the consumption of antibiotics, bronchodilators, corticosteroids and montelukast.

[Acute bacterial gastroenteritis: 729 cases recruited by a Primary Care national network]. / Gastroenteritis aguda bacteriana: 729 casos reclutados por una red nacional de atención primaria.

OBJECTIVE: To determine the main clinical and epidemiological features of bacterial gastroenteritis in our environment. PATIENTS AND METHODS: An observational study of a Spanish population in 17 Autonomous Communities. Questionnaires of children with a stool positive culture to bacteria were collected over a one year period. A bivariate analysis was performed on the variables involved, as well as two multivariate models (for antibiotic treatment variables, and comparison Campylobacter/Salmonella). RESULTS: A total of 729 bacterial gastroenteritis episodes were recorded in the 17 Spanish autonomous regions, of which 41.2% were girls and 58.8% boys. The median age was 3.41 years old (interquartile range 1.55 to 6.72). The bacteria isolated were 59.9% Campylobacter, 31.8% non-Typhi Salmonella, 2.7% Aeromonas, 2.4% Yersinia, and 1.5% had more than one strain. Most infections (70%) were direct contacts, and food poisoning was less probable (25.9%). Salmonella is significantly less frequent than Campylobacter in children under the age of 3 years (adjusted OR 0.61; 95%CI: 0.43 to 0.86; P=.005), and Campylobacter is more frequent in rural areas (adjusted OR 1.48; 95%CI: 1.07 to 2.07; P=.012). Antibiotic was prescribed in 33.2% of cases. There was a greater significant difference if stools contained blood or mucus (adjusted OR 1.53; 95%CI: 1.04 to 2.27; P=.031), if the symptoms lasted more than 7days (adjusted OR 2.81; 95%CI: 2.01 to 3.93; P<.000), or if the child was admitted to hospital (adjusted OR 1.95; 95%CI: 1.08 to 3.52; P=.027). CONCLUSIONS: The aetiology of bacterial diarrhoea in paediatrics is typical of that of a developed country. The transmission mechanism is mainly direct, and more cases than appropriate are treated with antibiotics.