Prescription of antibiotics to children with acute otitis media in Danish general practice.

BACKGROUND: Acute otitis media (AOM) is a common and most often self-limiting infection in childhood, usually managed in general practice. Even though antibiotics are only recommended when certain diagnostic and clinical criteria are met a high antibiotic prescription rate is observed. The study's objective was to analyse associations between patient- and general practitioner (GP) characteristics and antibiotic prescribing for children with AOM in an effort to explain the high antibiotic prescribing rates. METHODS: All general practices in the Northern, Southern and Central regions of Denmark were invited to record symptoms, examinations, findings and antibiotic treatment for all children ≤7 years of age diagnosed with AOM during a four-week winter period in 2017/2018. Associations were analysed by means of multivariate logistic regressions. The study design was cross-sectional. RESULTS: GPs from 60 general practices diagnosed 278 children with AOM of whom 207 (74%) were prescribed antibiotics, most often penicillin V (60%). About half of the children had tympanometry performed. Antibiotic prescribing rates varied considerably between practices (0-100%). Antibiotic prescribing was associated with fever (odds ratio (OR) 3.69 95% confidence interval (CI) 1.93-7.05), purulent ear secretion (OR 2.35 95% CI 1.01-5.50) and poor general condition (OR 3.12 95% CI 1.31-7.46), and the practice's antibiotic prescribing rate to other patients with symptoms of an acute respiratory tract infection (OR 2.85 CI 95% 1.07-7.60) and specifically to other children with AOM (OR 4.15 CI 95% 1.82-9.47). CONCLUSION: GPs' antibiotic prescribing rates for children with AOM vary considerably even considering the of signs, symptoms, request for antibiotics, and use of tympanometry. Interventions to reduce overprescribing should be targeted high-prescribing practices.

Resources in vulnerable young adults: self-assessments during preventive consultation with their general practitioner in Denmark.

Inequality in health is increasing. People with many problems often lack energy to improve well-being and reduce their problems. This study analyses how psycho-socially challenged younger (20- to 44-year-old) patients described their own resources to reach lifestyle goals or alter life circumstances. Within the context of a randomized controlled trial, Danish participants had two structured preventive person-centred consultations with their general practitioner. Consultations focused on well-being, salutogenesis, resources, barriers and support of autonomy. Using the qualitative method: Systematic Text Condensation, we made thematic cross-analysis of patients' goal-specific resource statements described at the first consultation. Of the 209 patients, 191 (91%) chose one or two goals for a better life next year; nearly all (179) could recall and describe which resources they would use to reach their goal. We categorized resource statements into (i) personal constitution as 'willpower' and 'tenacity'; (ii) network, e.g. family; (iii) personal experience with identical or similar problems. Some patients needed to free up resources by handling psychological problems before being able to focus on lifestyle goals. The study demonstrates that patients with particular psycho-social problems could describe essential resources in a structured, salutogenic, preventive consultation with their general practitioner. Reflecting intrinsic and extrinsic motivation, these resources reflected dimensions of essential health theories like sense of coherence, self-efficacy and self-determination theory. Increased awareness of these resources seems essential for vulnerable patients by improving psychological well-being and optimism, thereby facilitating health-related changes. This may be an important step to reducing inequality in health.

Preschool children in Danish out-of-hours primary care: a one-year descriptive study of face-to-face consultations.

BACKGROUND: The demand for out-of-hours (OOH) primary care has increased during the last decades, with a considerable amount of contacts for young children. This study aims to describe the reasons for encounter (RFE), the most common diagnoses, the provided care, and the parental satisfaction with the general practitioner (GP) led OOH service in a Danish population of children (0-5 years). METHODS: We conducted a one-year cross-sectional study based on data for 2363 randomly selected contacts concerning children from a survey on OOH primary care including 21,457 patients in Denmark. For each contact, the GPs completed an electronic pop-up questionnaire in the patient's medical record. Questionnaire items focussed on RFE, health problem severity, diagnosis, provided care, and satisfaction. The parents subsequently received a postal questionnaire. RESULTS: The most common RFE was non-specific complaints (40%), followed by respiratory tract symptoms (23%), skin symptoms (9%), and digestive organ symptoms (8%). The most common diagnosis group was respiratory tract diseases (41%), followed by general complaints (19%) and ear diseases (16%). Prescriptions were dispensed for 27% of contacts, and about ¾ were for antibiotics. A total of 12% contacts concerned acute otitis media; antibiotics were prescribed in 70%. A total of 38% of contacts concerned fever, and » got antibiotics. A total of 7.4% were referred for further evaluation. The parental satisfaction was generally high, but 7.0% were dissatisfied. Dissatisfaction was correlated with low prescription rate. CONCLUSION: Respiratory tract diseases were the most common diagnoses. The GPs at the OOH primary care service referred children to hospital in 7.4% of the face-to-face consultations, and the provided care was evaluated as non-satisfying by only 7.0% of the parents. Clinical implications of the findings mean room for less prescription of antibiotic to children with ear diseases and a need for research in factors related to dissatisfaction.

Predictors of weight loss in young adults who are over-weight or obese and have psychosocial problems: a post hoc analysis.

BACKGROUND: The aim of this study is in a general practice trial setting to identify predictive factors for weight loss after 1 year among young adults who are over-weight or obese and who have several psychosocial problems. METHODS: Twenty-eight general practitioners recruited 495 patients aged 20-45 years with psychosocial problems for a randomized general preventive study to increase self-efficacy to achieve a self-prioritised goal for a better life by discussions of resources and barriers for reaching the goal. The present study is a post hoc analysis of possible predictors of weight loss among all 218 patients who have over-weight or obesity. A 23-pages questionnaire was completed before and 1 year after randomization. 111 patients had a one-hour preventive health consultation with their general practitioners focused on life coaching and a follow-up consultation within 3 months, and 107 patients had no preventive consultation. RESULTS: Twenty-two patients stated during the preventive consultation that weight loss was a prioritised goal. They had a mean weight loss of 4.7 kgs compared with 1.6 kgs in the group without this goal and 1.6 kgs in the group without preventive consultation. In a logistic regression model, predictors of weight loss or no weight loss were a) pre-interventional consideration of weight loss within 30 days, b) having weight loss as a prioritised goal for improved quality of life, c) being female, d) being in the oldest half of participants, and e) having many psychosocial problems. In a linear regression model, the predictors together explained about 11% of the weight loss. Important predictors were: obesity (explained 4%), pre-interventional consideration of weight loss within 30 days (3%), and having a preventive health consultation with weight loss as a prioritised goal (2%). CONCLUSIONS: Pre-interventional consideration of weight loss within 30 days and having weight loss as a prioritised goal during the health consultation were two important predictors for weight loss. By structured interventions focussing on the patients' priorities, self-chosen goals, their resources and barriers for reaching the goals, changes may be obtained; especially in participants with many problems who often do not accept participation in procedures on risks. CLINICALTRIALS GOV REGISTRATION: NCT 01231256 , Aug. 22. 2010.

Quality of life in children with otitis media--a cohort study.

BACKGROUND: Studies about health-related quality of life (HRQOL) in children with otitis media have primarily focused on short-term effects of the disease, and how treatment with insertion of ventilation tubes (VTs) affects the HRQOL. More knowledge is needed about how long-term HRQOL is associated with different factors like insertion of VT and use of antibiotics. OBJECTIVE: We aimed to analyse HRQOL in children with otitis media 1 year after inclusion and to what extent insertion of VT, use of antibiotics, diagnoses, symptoms in the children, day-care attention, parental absence from work and parental smoking were associated with the long-term HRQOL in children with otitis media. METHODS: A cohort study including 397 children was carried out. The children were followed for 13 months, and symptoms, HRQOL and so on were identified by means of questionnaires. RESULTS: HRQOL in children with otitis media was significantly improved after 13 months. The improvement of HRQOL was significantly lower for children with sleep problems compared with children without sleep problems. The improvement in HRQOL was significantly lower in children whose parents had been absent from work during the preceding 3 months due to the child' s otitis media compared with children with parents not being absent from their work. There were no statistically significant differences in the improvement of HRQOL in children who had received a VT during the follow-up period compared with children without a VT. CONCLUSION: HRQOL in children with otitis media was significantly improved after 13 months. The improvement in HRQOL was significantly lower for children with sleep problems. The improvement in HRQOL was significantly lower in children whose parents had been absent from work due to the child's otitis media. There were no statistically significant differences in the improvement of HRQOL in children who had received a VT during the follow-up period.

Large cohort study finds a statistically significant association between excessive crying in early infancy and subsequent ear symptoms.

AIM: The diagnosis of infantile colic is based on excessive crying. However, several causal factors can account for this disconcerting, nonspecific symptom. The main aim of this study was to investigate a possible association between excessive crying during the first 6 months of life and subsequent ear problems. METHODS: Data from a cohort study of 26 983 Danish children were used. Mothers participated in four telephone interviews and one questionnaire and provided information on crying in the first 6 months of life and ear symptoms at the ages of 6 months, 18 months and 7 years. RESULTS: There was a statistically significant association between excessive crying in infancy and subsequent ear symptoms. A gradual increase in subsequent ear problems was seen with increasing crying time at all the data collection times. CONCLUSIONS: The results of this study suggest a possible link between excessive crying and ear infections. Whether such a link is causal or due to common underlying factors is still unknown. We recommend thorough ear examinations in children with symptoms compatible with infantile colic.

Tympanometry in general practice: use, problems and solutions.

OBJECTIVES: The diagnosis in children with middle ear symptoms is often difficult. Tympanometry is recommended as a supplementary diagnostic tool with a high predictive value for fluid or no fluid in the middle ear. The aim of this study was to examine how tympanometry was used in Danish general practice in 2009, to report common problems general practitioners (GPs) and GP nurses encounter in tympanometry and to evaluate the effect of a practical and theoretical course. METHODS: A 1-year registration of the use of tympanometry in the Danish National Health Service Register in two regions with 40% of all Danish GPs and a survey among 197 participants in a course on diagnosis of otitis media and tympanometry in children were used. The Danish National Health Insurance covers 100% of GPs because they administer reimbursement for their activities, including tympanometry. RESULTS: During the year 2009, 1433 GPs in 702 clinics were on the list. A total of 417 clinics performed 35 529 tympanometries. Some 285 clinics (40.6%) did not perform tympanometry in 2009. The active clinics performed 42 tympanometries per GP. A 1-day course improved the knowledge and practical skills of the participating GPs and nurses. A majority (70%) stated in a self-reported questionnaire that tympanometry often provided important information, especially about middle ear fluid, and 48% reported that tympanometry several times during the past 2 weeks had changed their management of a middle ear problem. Few had not used their tympanometer during the 2 weeks preceding the survey. The response rate was 72%. CONCLUSIONS: The use of tympanometry is very skewed. A 6-hour course could improve GPs' care of patients with middle ear problems by using tympanometry.

The effect of preventive consultations on young adults with psychosocial problems: a randomized trial.

Patients with many problems often face difficulties in modifying their behavior as desired. Uncovered basic needs may be an important barrier. This research tests the effect of patient-centered consultations for 20- to 44-year-old patients with multiple psychosocial and lifestyle problems. We focus on resources and barriers for obtaining self-chosen goals within life circumstances and lifestyle. At 28 general practitioners, 2056 patients aged 20-44 years were screened with a 33-item problem-score on resources, network, lifestyle and social conditions. The 30% who had most problems were invited to complete a more comprehensive questionnaire at home. Intervention was preventive consultation with a 3-month follow-up. A total of 495 patients were randomized. One-year questionnaire follow-up showed significant improvement in Short Form Health-related Quality of Life Mental (MCS-SF12) in the intervention group (7.3) compared with the control group (3.0); the difference was 4.3 (95% confidence interval 1.6-7.0, P = 0.002). The number of problems was reduced significantly more in the intervention than in the control group (1.8 versus 0.8, P = 0.03). Preventive consultation focusing on resources and barriers to self-chosen goals may improve MCS-SF12 and decrease the number of problems in patients with many psychosocial and lifestyle problems. This may be an indicator of improved specific self-efficacy and a key to lifestyle changes.

Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children.

BACKGROUND: Otitis media with effusion (OME; 'glue ear') is common in childhood and surgical treatment with grommets (ventilation tubes) is widespread but controversial. OBJECTIVES: To assess the effectiveness of grommet insertion compared with myringotomy or non-surgical treatment in children with OME. SEARCH STRATEGY: We searched the Cochrane ENT Disorders Group Trials Register, other electronic databases and additional sources for published and unpublished trials (most recent search: 22 March 2010). SELECTION CRITERIA: Randomised controlled trials evaluating the effect of grommets. Outcomes studied included hearing level, duration of middle ear effusion, language and speech development, cognitive development, behaviour and adverse effects. DATA COLLECTION AND ANALYSIS: Data from studies were extracted by two authors and checked by the other authors. MAIN RESULTS: We included 10 trials (1728 participants). Some trials randomised children (grommets versus no grommets), others ears (grommet one ear only). The severity of OME in children varied between trials. Only one 'by child' study (MRC: TARGET) had particularly stringent audiometric entry criteria. No trial was identified that used long-term grommets.Grommets were mainly beneficial in the first six months by which time natural resolution lead to improved hearing in the non-surgically treated children also. Only one high quality trial that randomised children (N = 211) reported results at three months; the mean hearing level was 12 dB better (95% CI 10 to 14 dB) in those treated with grommets as compared to the controls. Meta-analyses of three high quality trials (N = 523) showed a benefit of 4 dB (95% CI 2 to 6 dB) at six to nine months. At 12 and 18 months follow up no differences in mean hearing levels were found.Data from three trials that randomised ears (N = 230 ears) showed similar effects to the trials that randomised children. At four to six months mean hearing level was 10 dB better in the grommet ear (95% CI 5 to 16 dB), and at 7 to 12 months and 18 to 24 months was 6 dB (95% CI 2 to 10 dB) and 5 dB (95% CI 3 to 8 dB) dB better.No effect was found on language or speech development or for behaviour, cognitive or quality of life outcomes.Tympanosclerosis was seen in about a third of ears that received grommets. Otorrhoea was common in infants, but in older children (three to seven years) occurred in < 2% of grommet ears over two years of follow up. AUTHORS' CONCLUSIONS: In children with OME the effect of grommets on hearing, as measured by standard tests, appears small and diminishes after six to nine months by which time natural resolution also leads to improved hearing in the non-surgically treated children. No effect was found on other child outcomes but data on these were sparse. No study has been performed in children with established speech, language, learning or developmental problems so no conclusions can be made regarding treatment of such children.

Validation of a health screening questionnaire for primary care using Rasch models.

BACKGROUND: Health inequality is on the rise due to various social and individual factors. While preventive health checks (PHC) aim to counteract health inequality, there is robust evidence against the use of PHC in general practice. It is unknown which factors can identify persons who will benefit from preventive interventions that are more beneficial than harmful. Hence, valid screening instruments are needed. METHODS: The aim of this study was to assess the psychometric properties of a screening questionnaire (SQ-33), which targets vulnerable persons in primary care practice who can benefit from preventive consultations. Survey data were acquired from 20 primary care clinical practices in the Northern Region of Jutland, Denmark. Respondents were 2056 persons between 20 and 44 years old who, for any reason, consulted their family doctor. The psychometric properties of the SQ-33 were assessed using Rasch item response modelling. Follow-up analysis was performed on a subsample of 364 persons one year subsequent to initial inclusion, in order to assess responsiveness and predictive validity using a general health anchor item. RESULTS: Twenty-three of the SQ-33 items in four subscales fit a Graphical loglinear Rasch model (GLLRM) at baseline and follow-up, thus confirming the scaling properties. The modified 23-item version (HSQ-23) revealed superior responsiveness and predictive validity compared with the SQ-33. CONCLUSIONS: The Health Screening Questionnaire (HSQ-23) was shown to possess adequate psychometric properties and responsiveness and can thus be used as an outcome measure in preventive intervention studies. Future study should address whether the HSQ-23 successfully identifies patients who will benefit from PHC consultations.

Smartphone otoscopy by non-specialist health workers in rural Greenland: A cross-sectional study.

INTRODUCTION: Greenland has one of the highest prevalences of otitis media in the world. However, access to ear specialists throughout Greenland is limited and currently there are no national guidelines for treatment or prevention. Tele-otoscopy may be beneficial in optimizing diagnosis and treatment. The smartphone otoscopy device, Cupris®, has previously been validated when used by medical doctors on a population primarily consisting of adults. In this study we evaluated the usability of the Cupris® otoscope when used by local health care workers with different levels of training and education, examining children aged 1-6 years. METHODS: We conducted a cross-sectional study in three Greenlandic towns. Health care personnel were asked to perform video-otoscopy on children contacting the health clinic for any reason. The videos were sent for remote evaluation by three ear specialists who rated the videos on a five-point Likert scale and provided information on challenges with the videos. The dichotomous outcome "not useful/useful" was defined as 1-3 and 4-5 on the Likert scale, respectively. RESULTS: In total, 142 videos were recorded on 84 patients. Mean proportion of useful videos was 18.1%, with a modified Fleiss' Kappa interrater agreement coefficient of 0.67 95% CI [0.57-0.76] corresponding to substantial agreement among the three raters. CONCLUSIONS: In this study the usefulness of the Cupris® TYM otoscope did not prove to be sufficient with the presented instruction in the hands of local health care workers when examining Greenlandic children. Focus on training and education of local health personnel is crucial and warranted before advantageous implementation for non-specialist health care workers can be expected.

Which children would benefit most from tympanostomy tubes (grommets)? A personal evidence-based review.

UNLABELLED: Otitis media with effusion (OME) is a common condition in young children. OME causes some hearing loss, and can cause permanent changes in the tympanic membrane as well as other symptoms. In most cases OME is of short duration. As long-lasting bilateral OME for decades has been associated with delayed cognitive and language development, parents and ENT specialists have a positive attitude towards treatment with tympanostomy tubes (TT). METHOD: This personal evidence-based review is build on own observations and research combined with newer studies and guidelines. RESULTS: The review argues for a relatively restrictive treatment policy concerning the use of TT in children with OME without signs or symptoms of impaired social or linguistic function. CONCLUSION: Six months with bilateral OME and significant hearing loss should be present before treatment with TT in otherwise healthy children. At the moment we have no evidence for the subgroups of children excluded from the RCTs, i.e. children with speech/language delays, behaviour and learning problems, or syndromes. Clinicians will need to make their own decisions regarding treatment of such children. The situation just now is that some children are over-treated and some are under-treated. There is an urgent need for prospective cohort studies and randomised studies on children with long-lasting OME in an attempt to characterise the children who would benefit most from TT.

Comparison of the Reynell Developmental Language Scale II and the Galker test of word-recognition-in-noise in Danish day-care children.

OBJECTIVE: To search for predictive factors for language development measured by two receptive language tests for children, the Galker test (a word-recognition-in-noise test) testing hearing and vocabulary, and the Danish version of Reynell Developmental Language Scale (2nd revision, RDLS II) test, a language comprehension test. The study analysed if information about background variables and parents and pre-school teachers was predictive for test scores; if earlier middle ear disease, actual hearing loss and tympanometry was important for language development; and if the two receptive tests differed in terms of the degree to which variables were able to predict test scores at the age of three to five years. METHODS: All children aged three and five years attending 20 day-care centres for children without cognitive development issues from the Municipality of Hillerød, Denmark, were invited to participate. We used questionnaires to the parents and day-care teachers and examined the children using tympanometry, hearing test and the two receptive language tests. We performed unadjusted and adjusted analyses of raw and grouped scores and background variables, as well as stepwise regression analysis with group scores as outcome. RESULTS: The results of the two tests were surprisingly similar in relation to background variables. The same variables were predictive for scores in the two receptive language tests. The predictive variables were: age group (22-31%), having no sibling (2-3%), being a boy (1%), information from the parents about the child's vocabulary (3%), phonology (0-2%). information from the pre-school teachers on the child's vocabulary (4-6%), and hearing beyond 25 dB in best ear (mean of four frequencies) (1%). CONCLUSION: We found that nearly the same variables were predictive for the test score and the grouped score in pre-school children in the RDLS II and the Galker test. Information from the pre-school teachers was more predictive of the test score than information from the parents. In the adjusted analysis, beside age group, information about the child's vocabulary was the most predictive information explaining 4-6% of the variation.

Risk of childhood otitis media with focus on potentially modifiable factors: A Danish follow-up cohort study.

INTRODUCTION: Otitis media is the primary cause of antibiotic prescription in children. Two-thirds of all children experience at least one episode of otitis media before the age of 7 years. The aim of this study was to characterise the attributable effect of several modifiable risk exposures on the risk of >3 episodes of otitis media at age 18 months and 7 years within a large prospective national birth cohort. METHODS: The study used the Danish National Birth Cohort comprising information about otitis media and risk exposures from more than 50,000 mother-child pairs from the period 1996-2002. Logistic regression models were used to estimate odds ratios for the risk factors and to calculate the population attributable fraction. RESULTS: Short time with breastfeeding, early introduction to daycare, cesarean section, and low compliance to the national vaccination program were all associated with an increased risk of >3 episodes of otitis media at 18 months of age and at 7 years of age. The fraction of children with otitis media attributed from breastfeeding lasting for less than 6 months was 10%. Introduction to daycare before the age of 12 months attributed with 20% of the cases of >3 episodes of otitis media. CONCLUSIONS: Short duration of breastfeeding, early introduction into daycare, cesarean section, and low compliance with the national vaccination program increased the risk of experiencing >3 episodes of otitis media at 18 months, and at 7 years of age. These are factors that all can be modulated.

Use of antibiotics and penicillin-resistant pneumococci: what can we learn from Iceland?

A few months ago, I evaluated an interesting thesis by Vilhjalmur Ari Arason of Iceland with the title: "Use of antimicrobials and carriage of penicillin-resistant pneumococci in children: Repeated cross-sectional studies covering 10 years." (Available at http://landspitali.openrepository.com/lsh/handle/2336/6005). The results of the thesis deserve further dissemination because we can all learn a great deal about the relationship between use of antibiotics and bacteria susceptability in the community.

Correction: Risk Factors of Early Otitis Media in the Danish National Birth Cohort.

[This corrects the article DOI: 10.1371/journal.pone.0166465.].

Early childhood otitis media and later school performance - A prospective cohort study of associations.

INTRODUCTION: Otitis media (OM) is a common disease in childhood and hearing loss (HL) is the most common complication. Prolonged HL may lead to language delay and cognitive difficulties. However, the consequences of HL due to OM are not fully understood. The aim of this study was to determine the possible association between number of OM episodes in childhood and self-rated school performance controlling for potential confounders. METHODS: Prospectively gathered systematic interview data on OM episodes in early childhood and school performance at 11 years of age were obtained from The Danish National Birth Cohort, involving >100,000 individual pregnancies and their offspring. We defined four exposure groups (0, 1-3, 4-6 and ≥7 OM episodes) and assessed general school performance, mathematics and literacy. Possible confounders were recognized à priori and associations were determined using proportional odds regression. RESULTS: Out of 94,745 successful pregnancies, 35,946 children without malformations and their parents completed a questionnaire at age 11 years. No associations were observed between number of OM episodes and school performance, even in children with ≥7 OM episodes. CONCLUSION: This national birth-cohort study did not support the hypothesis that the number of OM episodes in childhood is associated with reduced self-reported school performance in children at 11 years of age.

The Galker test of speech reception in noise; associations with background variables, middle ear status, hearing, and language in Danish preschool children.

PURPOSE: We tested "the Galker test", a speech reception in noise test developed for primary care for Danish preschool children, to explore if the children's ability to hear and understand speech was associated with gender, age, middle ear status, and the level of background noise. METHODS: The Galker test is a 35-item audio-visual, computerized word discrimination test in background noise. Included were 370 normally developed children attending day care center. The children were examined with the Galker test, tympanometry, audiometry, and the Reynell test of verbal comprehension. Parents and daycare teachers completed questionnaires on the children's ability to hear and understand speech. As most of the variables were not assessed using interval scales, non-parametric statistics (Goodman-Kruskal's gamma) were used for analyzing associations with the Galker test score. For comparisons, analysis of variance (ANOVA) was used. Interrelations were adjusted for using a non-parametric graphic model. RESULTS: In unadjusted analyses, the Galker test was associated with gender, age group, language development (Reynell revised scale), audiometry, and tympanometry. The Galker score was also associated with the parents' and day care teachers' reports on the children's vocabulary, sentence construction, and pronunciation. Type B tympanograms were associated with a mean hearing 5-6dB below that of than type A, C1, or C2. In the graphic analysis, Galker scores were closely and significantly related to Reynell test scores (Gamma (G)=0.35), the children's age group (G=0.33), and the day care teachers' assessment of the children's vocabulary (G=0.26). CONCLUSIONS: The Galker test of speech reception in noise appears promising as an easy and quick tool for evaluating preschool children's understanding of spoken words in noise, and it correlated well with the day care teachers' reports and less with the parents' reports.

Risk Factors of Early Otitis Media in the Danish National Birth Cohort.

OBJECTIVE: To assess risk factors of otitis media (OM) in six-months-old children. METHOD: The sample consisted of 69,105 mothers and their children from the Danish National Birth Cohort. The women were interviewed twice during pregnancy and again 6 months after birth. The outcome "one or more" maternal reported episodes of OM at age six months. In total 37 factors were assessed, covering prenatal, maternal, perinatal and postnatal factors. RESULTS: At age six months 5.3% (95% CI 5.1-5.5) of the children had experienced one or more episodes of OM. From the regression analysis, 11 variables were associated with a risk of OM. When a Bonferroni correction was introduced, gender, prematurity, parity, maternal age, maternal self-estimated health, taking penicillin during pregnancy, and terminating breastfeeding before age six months, was associated with a risk of early OM. The adjusted ORs of OM for boys versus girls was 1.30 (95% CI 1.18-1.44). The OR having one sibling versus no siblings was 3.0 (95% CI 2.64-3.41). If the woman had been taking penicillin during pregnancy, the OR was 1.35 (95% CI 1.15-1.58). Children born before 38th gestational week had an increased OR for early OM of 1.49 (95% CI 1.21-1.82). Children of young women had an increased OR of early OM compared to children of older women. Additionally, children of women who rated their own health low compared to those rating their health as high, had an increased OR of 1.38 (95% CI 1.10-1.74). Finally, children being breastfeed less than 6 months, had an increased OR of 1.42 (95% CI 1.28-1.58) compared to children being breastfeed beyond 6 months. CONCLUSION: These findings indicate that prenatal factors are of less importance regarding early OM before the age of six months. Postnatal risk factors seem to pose the main risk of early OM.