Implementation of the Early-Onset Sepsis Risk Calculator at a Community Level I Nursery.

The objective of this retrospective cohort study was to decrease the frequency of laboratory draws and the number of neonates receiving empiric antibiotics who are born to mothers with chorioamnionitis from 100% to 50% 6 months following implementation of the sepsis risk calculator (SRC) at a level 1 community nursery. Data were compared pre- and post-implementation of the SRC using the Fischer's exact test. The rate of intravenous (IV) antibiotic use decreased from 93% to 7% (P < .0001). The rate of blood culture collection decreased from 100% to 46% (P < .0001). With implementation of the SRC, administration of IV antibiotics, laboratory draws, and IV placement significantly decreased without increasing rates of early-onset sepsis in our patient population. Our study demonstrated that the SRC can be effectively and safely implemented at a level 1 community-based newborn nursery, resulting in a decrease in unnecessary medical treatment without negative patient outcomes.

Musculoskeletal disorders and work-related musculoskeletal diseases among nursery school teachers: analysis in a sample in the city of Venice.

SUMMARY: Objectives. Musculoskeletal disorders (MSD) represent one of the most relevant occupational problems. School teachers and particularly nursery school teachers (NST) are reported to have a high prevalence of MSD. We aimed to estimate frequency of MSD in a sample of NST and to bring out cases of work-related musculoskeletal disorders (WRMSD) among these workers. Design. Cross-sectional prevalence study. Setting and participants. NST applying to the trade union patronage between December 2015 and December 2017 for problems of absence from work for health reasons have been proposed the compilation of the Italian version of the Nordic Questionnaire for musculoskeletal disorders. NST who reported MSD underwent medical examination performed by an occupational physician. In accordance with current legislation, certification of occupational disease was completed when a plausible occupational origin of the pathology could be identified. Main outcome measures. MSD and WRMSD prevalence. Results. Questionnaires were completed by 82 NST: 75 (91.5% of the sample) reported at least one MSD. 71 NST underwent medical examination. In 32 subjects (39% of the sample) a diagnosis of musculoskeletal pathology was formulated. Based on work history, 20 cases of probable occupational pathology were reported. Occupational etiology was ascertained for 12 subjects (14.6%): 11 cases of lumbar discopathy / lumbar disc herniation and 1 case of both lumbar disc herniation and tendinopathy of shoulder rotator cuff. Conclusion. Prevalence of musculoskeletal disorders was high and the most frequently affected body sites were similar to those reported in the literature, confirming NST as a group at risk for developing both MSD and WRMSD. Results indicate the importance of taking primary and secondary prevention actions to protect the health of NST.

Evaluation of the Spot Vision Screener in comparison with the orthoptic examination in visual screening in 3-5 year-old schoolchildren.

PURPOSE: To evaluate the Spot Vision Screener (SVS) compared with the orthoptic examination for detection of amblyopia risk factors in preschools. METHODS: This prospective study included children with a visual screening organized by the department of "le" (PMI) in Côte d'Or (Burgundy, France), between June 2017 and April 2018. All children were evaluated with the SVS followed by a clinical orthoptic examination. Results with the SVS were compared with those obtained by clinical orthoptic examination. RESULTS: A total of 1236 subjects were included in the study from 100 preschools. The mean age of the children was 3.6±0.7 years, and 627 were female (50.7%). The orthoptic examination detected 308 (24.9%) children with subnormal visual acuity for age in one eye or both. In children with a history of prematurity, the orthoptic examination was more frequently abnormal (P=0.002), which was not seen with the SVS (P=0.050). The SVS screened 20 (1.6%) children with strabismus, while 40 (3.2%) were detected by orthoptic examination. At the end of the screening, the SVS detected 182 (14.7%) suspect patients while 311 (25.1%) suspect patients were detected after the orthoptic examination. Comparing SVS with orthoptic examination, agreement was fair (κ=0.4). CONCLUSION: The SVS can be a useful device for visual screening, but agreement with the orthoptic examination was only fair. The Spot vision screener should be used in conjunction with a clinical orthoptic examination.

Level of knowledge and evaluation of perceptions regarding pediatric diabetes among Greek teachers.

AIM: To assess the knowledge and attitudes of nursery school, preschool and primary school Greek teachers regarding pediatric diabetes. METHODS: Our anonymous questionnaire was comprised of three parts: the first part was regarding sociodemographic characteristics; the second part was assessing basic knowledge about diabetes and the third part was about personal perceptions regarding diabetes management in the school setting. A total of 375 fully completed questionnaires were collected (22.67% from males). RESULTS: Males had a higher percentage of correct answers than females (80.71 ± 10.58% versus 80.17 ± 11.77%), but without reaching statistical significance (p = 0.763). Teachers aged over 45 years, tertiary education graduates and teachers in the public sector proved to be more knowledgeable about the disease. Question scoring the lowest percentage of correct answers were those dealing with the management of diabetic emergencies, such as the course of action in case a diabetic pupil is found unconscious. One out of four participants incorrectly declared that a delay in the diagnosis of diabetes mellitus cannot possibly be life-threatening whereas, an embarrassing 7.47% of the participants stated that diabetes is a contagious disease and another 6.67% declared that diabetic children should stop school. CONCLUSIONS: It is evident that there is an urgent need for providing further information, as well as practical training to schoolteachers with emphasis being placed on the initial symptoms of diabetes and also in the detection and management of diabetic emergencies.

Race/ethnicity, human capital, and the selection of young children into early childhood education.

Mexican-origin families face complex ethnic and immigration-based barriers to enrollment in early childhood education programs. As such, reducing barriers to enrollment for this population requires a better understanding of how Mexican-origin families work with, against, or around both general and group-specific constraints on educational opportunities. Using the Early Childhood Longitudinal Study-Birth Cohort, this study tailored broad social theory to the experience of Mexican-origin families to examine associations between human capital considerations and early childhood education enrollment within this population. Results supported the hypothesis that human capital considerations would be associated with early childhood care and education and provide limited evidence for the expectation that this link would be stronger for Mexican-origin families.

Association of nursery and early school attendance with later health behaviours, biomedical risk factors, and mortality: evidence from four decades of follow-up of participants in the 1958 birth cohort study.

BACKGROUND: Although early life education for improved long-term health and the amelioration of socioeconomically generated inequalities in chronic disease is advocated in influential policy statements, the evidence base is very modest. AIMS: To address this dearth of evidence using data from a representative UK national birth cohort study. METHODS: The analytical sample comprised men and women in the 1958 birth cohort study with prospectively gathered data on attendance at nursery or primary school before the age of 5 years who had gone on to participate in social survey at 42 years (n=11 374), or a biomedical survey at 44/5 years of age (n=9210), or had data on vital status from 18 to 55 years (n=17 657). RESULTS: Relative to study members who had not attended nursery, in those who had, there was in fact a higher prevalence of smoking and high alcohol intake in middle age. Conversely, nursery attenders had more favourable levels of lung function and systolic blood pressure in middle age. This apparent association between nursery attendance and lower systolic blood pressure was confined to study members from more deprived social backgrounds of origin (P value for interaction 0.030). There was no apparent link between early school attendance and any behavioural or biological risk factor. Neither nursery nor early school attendance was clearly related to mortality risk. CONCLUSIONS: We found no clear evidence for an association of either attendance at nursery or primary school before the age of 5 years and health outcomes around four decades later.

Asociación entre el tiempo de permanencia en el Programa de Estancias Infantiles para niños en situación de pobreza y el nivel de desarrollo infantil / Association between time of permanence at early education program (Estancias Infantiles) and developmental level for children in situation of poverty

Resumen: Introducción: El Programa de Estancias Infantiles (PEI) se enfoca en padres de niños de 1-3 años en situación de pobreza. Incluye educación y cuidado de los niños por 8 h, 5 días por semana. El objetivo del estudio fue evaluar la asociación entre el tiempo de permanencia en el PEI y el nivel de desarrollo infantil. Métodos: Estudio transversal de base poblacional en dos estados de México. Se incluyeron todos los niños de 12-48 meses inscritos al PEI de noviembre de 2014 a enero de 2015. Se evaluó el nivel de desarrollo con la prueba EDI. Se calculó la razón de momios de prevalencia (RMP) para desarrollo normal por tiempo de estancia, ajustado por sexo, edad y discapacidad, teniendo como referencia a los niños que tenían < 30 días en el PEI. Resultados: Se incluyeron 3387 niños de 177 estancias infantiles: 53% de sexo masculino; 22.3% de 12-24 meses, 37.6% de 25-36 meses y 40.1% de 37-42 meses de edad. El RMP ajustado para desarrollo normal fue de 1.90 (IC95%:1.30-2.78) para 6-11 meses, 2.36 (IC95%:1.60-3.50) para 12-17 meses, 2.78 (IC95%:1.65-4.65) para 18-23 meses y 3.46 (2.13-5.60) para > 24 meses. Por área de desarrollo, se observó una mayor probabilidad de desarrollo normal a partir de 6 meses de estancia para lenguaje y social, y a partir de 12 meses para motor grueso, fino y conocimiento. Conclusiones: El tiempo de permanencia en el PEI a partir de 6 meses incrementa, de forma significativa y progresiva, la probabilidad de tener un desarrollo normal independiente del sexo y edad.

Abstract: Background: Early education program (EEP) was created to support parents with 1 to 3 year olds living in poverty situation in Mexico, and includes education and child daycare for 8 h five days per week. The objective of this study was to evaluate the association between length of stay in EEP and the level of development in children. Methods: Cross sectional, population-based study conducted in two Mexican states. All children aged between 12 to 48 months enrolled in EEP from November 2014 to January 2015 were included. Child Development Evaluation (CDE) test was used to screen early development in every child. Normal early development prevalence odds ratio (OR) was calculated adjusted by gender, impairment and state, using as a reference those children with less than 30 days in the program. Results: The study included 3,387 children from 177 EEP nurseries, from which 53% were male; age by group was divided in 12-24 months (22.3%), 25-36 months (37.6%) and 37-42 months (40.1%). Normal development adjusted OR by age was 1.9 (CI95%: 1.30-2.78) for 6-11 months, 2.36 (CI95%: 1.60-3.50) for 12-17 months, 2.78 (CI95%: 1.65-4.65) for 18-23 months and 3.46 (CI95%: 2.13-5.60) for >24 months. By area of development, a greater probability of having a normal result for language and social areas was observed after 6 months in the program, and for motor (both gross and fine) and knowledge areas after 12 months. Conclusion: The length of the stay in the EEP after 6 months significantly and progressively increases the probability of normal development regardless of gender and age.

Differential Third-Grade Outcomes Associated With Attending Publicly Funded Preschool Programs for Low-Income Latino Children.

This study examined the third-grade outcomes of 11,902 low-income Latino children who experienced public school pre-K or child care via subsidies (center-based care) at age 4 in Miami-Dade County, Florida. Regression and propensity score analyses revealed that children who experienced public school pre-K earned higher scores on standardized assessments of math and reading in third grade and had higher grade point averages than those who attended center-based care 4 years earlier. The sustained associations between public school pre-K (vs. center-based care) and third-grade outcomes were mediated by children's kindergarten entry preacademic and social-behavioral skills, and among English-language learners, English proficiency. Implications for investing in early childhood programs to assist with the school readiness of young Latino children in poverty are discussed.

[Association between time of permanence at early education program (Estancias Infantiles) and developmental level for children in situation of poverty]. / Asociación entre el tiempo de permanencia en el Programa de Estancias Infantiles para niños en situación de pobreza y el nivel de desarrollo infantil.

BACKGROUND: Early education program (EEP) was created to support parents with 1 to 3 year olds living in poverty situation in Mexico, and includes education and child daycare for 8h five days per week. The objective of this study was to evaluate the association between length of stay in EEP and the level of development in children. METHODS: Cross sectional, population-based study conducted in two Mexican states. All children aged between 12 to 48 months enrolled in EEP from November 2014 to January 2015 were included. Child Development Evaluation (CDE) test was used to screen early development in every child. Normal early development prevalence odds ratio (OR) was calculated adjusted by gender, impairment and state, using as a reference those children with less than 30 days in the program. RESULTS: The study included 3,387 children from 177 EEP nurseries, from which 53% were male; age by group was divided in 12-24 months (22.3%), 25-36 months (37.6%) and 37-42 months (40.1%). Normal development adjusted OR by age was 1.9 (CI95%: 1.30-2.78) for 6-11 months, 2.36 (CI95%: 1.60-3.50) for 12-17 months, 2.78 (CI95%: 1.65-4.65) for 18-23 months and 3.46 (CI95%: 2.13-5.60) for >24 months. By area of development, a greater probability of having a normal result for language and social areas was observed after 6 months in the program, and for motor (both gross and fine) and knowledge areas after 12 months. CONCLUSION: The length of the stay in the EEP after 6 months significantly and progressively increases the probability of normal development regardless of gender and age.

Changes and inequalities in early birth registration and childhood care and education in Vietnam: findings from the Multiple Indicator Cluster Surveys, 2006 and 2011.

INTRODUCTION: Early birth registration, childhood care, and education are essential rights for children and are important for their development and education. This study investigates changes and socioeconomic inequalities in early birth registration and indicators of care and education in children aged under 5 years in Vietnam. DESIGN: The analyses reported here used data from the Vietnam Multiple Indicator Cluster Surveys (MICS) in 2006 and 2011. The sample sizes in 2006 and 2011 were 2,680 and 3,678 for children under 5 years of age. Four indicators of childcare and preschool education were measured: birth registration, possession of books, preschool education attendance, and parental support for early childhood education. The concentration index (CI) was used to measure inequalities in gender, maternal education, geographical area, place of residence, ethnicity, and household wealth. RESULTS: There were some improvements in birth registration (86.4% in 2006; 93.8% in 2011), preschool education attendance (57.1% in 2006; 71.9% in 2011), and parental support for early childhood education (68.9 and 76.8%, respectively). However, the possession of books was lower (24.7% in 2006; 19.6% in 2011) and became more unequal over time (i.e. CI=0.370 in 2006; CI=0.443 in 2011 in wealth inequality). Inequalities in the care and education of children were still persistent. The largest inequalities were for household wealth and rural versus urban areas. CONCLUSION: Although there have been some improvements in this area, inequalities still exist. Policy efforts in Vietnam should be directed towards closing the gap between different socioeconomic groups for the care and education of children under 5 years old.

[Prevalence and Risk Factors for Motor Developmental Delays in 3- to 6-Year-Old Preschool Children in Mecklenburg-Western Pomerania]. / Prävalenzen und Risikofaktoren motorischer Entwicklungsgefährdungen bei 3- bis 6-jährigen Kindergartenkindern in Mecklenburg-Vorpommern (M-V).

BACKGROUND: School entry examinations in Mecklenburg-Western Pomerania show a high prevalence of motor developmental delays (13.7%). In this study possible risk factors (RF) were analysed. METHODS: The study was performed as a cluster-randomised, controlled study in 12 preschools in M-V. The "Dortmund Developmental Screening for Preschools DESK 3-6" was used to detect developmental risks. Parents received a standardised questionnaire. RF were analysed in binary logistic regressions for fine (FM) and gross motor (GM) skills. RESULTS: N=599 children were included in the analysis. RF for FM and GM are irregular utilisation of preschools (FM: OR: 2.63; p=0.009; 95% CI: 1.27-5.45; GM: OR: 2.56; p=0.021; 95% CI: 1.15-5.68) and male sex (FM: OR: 2.97; p<0.001; 95% CI: 1.93-4.57; GM: OR: 1.87; p=0.016; 95% CI: 1.12-3.10). A low parental socioeconomic status is an RF for the development of GM (OR: 3.10; p=0.036; 95% CI: 1.08-8.95). An age-adequate development of FM is a protective factor for GM development (OR: 0.17; p<0.001; 95% CI: 0.10-0.29). CONCLUSION: Regular preschool attendance is beneficial for motor development. RESULTS confirm the adequacy of the setting preschool for interventions.

Immigration and the interplay of parenting, preschool enrollment, and young children's academic skills.

This study tested a conceptual model of the reciprocal relations among parents' support for early learning and children's academic skills and preschool enrollment. Structural equation modeling of data from 6,250 children (Ages 2 to 5) and parents in the nationally representative Early Childhood Longitudinal Study-Birth Cohort revealed that parental support for early learning was associated with gains in children's academic skills, which, in turn, were associated with their likelihood of preschool attendance. Preschool experience then was associated with further gains in children's early academic competencies, which were then associated with increased parental support. These patterns varied by parents' nativity status. Specifically, foreign-born parents' support for early learning was directly linked with preschool enrollment, and the association between the academic skills of children and parental support was also stronger for foreign-born parents. These immigration-related patterns were primarily driven by immigrant families who originated from Latin America, rather than Asia, and did not vary by immigrants' socioeconomic circumstances. Together, these results underscore the value of considering the synergistic relations between the home and school systems, as well as "child effects" and population diversity, in developmental research.

Polycyclic aromatic hydrocarbons: levels and phase distributions in preschool microenvironment.

This work aims to characterize levels and phase distribution of polycyclic aromatic hydrocarbons (PAHs) in indoor air of preschool environment and to assess the impact of outdoor PAH emissions to indoor environment. Gaseous and particulate (PM1 and PM(2.5)) PAHs (16 USEPA priority pollutants, plus dibenzo[a,l]pyrene, and benzo[j]fluoranthene) were concurrently sampled indoors and outdoors in one urban preschool located in north of Portugal for 35 days. The total concentration of 18 PAHs (ΣPAHs) in indoor air ranged from 19.5 to 82.0 ng/m(3) ; gaseous compounds (range of 14.1-66.1 ng/m(3)) accounted for 85% ΣPAHs. Particulate PAHs (range 0.7-15.9 ng/m(3)) were predominantly associated with PM1 (76% particulate ΣPAHs) with 5-ring PAHs being the most abundant. Mean indoor/outdoor ratios (I/O) of individual PAHs indicated that outdoor emissions significantly contributed to PAH indoors; emissions from motor vehicles and fuel burning were the major sources.

[Stress and Burnout Risk in Nursery School Teachers: Results from a Survey]. / Stressbelastungen und Burnout-Risiko bei Erzieherinnen in Kindertagesstätten: Ergebnisse einer Fragebogenstudie.

This article presents results from a study of 834 nursery school teachers in Germany, investigating working conditions, stress, and stress-related health problems. In order to evaluate the extent of mental and psychosomatic troubles, as well as the risk of burnout, we used the standardised questionnaire "Burnout Screening Scales" (BOSS I). Data analysis yielded a high percentage of nursery school teachers who reported a remarkably high stress level; nearly 20% can be considered as a high-risk group for burnout. Poor staff conditions in many nurseries turned out to be the crucial stress source, along with large groups, insufficient teacher-child ratio, time pressure and multitasking. In the concluding discussion of the study results, we consider possible measures to reduce stress and to improve working conditions for nursery school teachers.

Assessment of metals pollution and health risk in dust from nursery schools in Xi'an, China.

Concentrations, pollution and health risks of metals in dust from nursery schools in Xi'an, China were determined. In comparison with local soil, dust samples have elevated metals concentrations except for Mn. The results indicate no distinct pollution of Mn, Ni, As and Ba in the dust, while Cu, Co and Zn are moderate pollution, Pb is significant pollution, and Cr with large pollution range. Most samples presented moderately polluted by metals. The non-cancer risks of the studied metals are within the safe range, and the cancer risks of As, Co, Cr and Ni are also within the currently acceptable range.

Prevalence and pattern of early childhood caries in Ibadan, Nigeria.

BACKGROUND: Early childhood caries is a public health problem in a developing country such as Nigeria where there are limited resources to combat the situation. AIM: The aim of the study is to determine the prevalence and pattern of early childhood caries (ECC) among nursery school children aged 3 to 5 years in Ibadan, Nigeria. METHODS: A cross sectional study was conducted on 540 nursery school children aged 3 to 5 years old in nursery schools within Ibadan. Oral examination was performed and dmft (decayed-missing-filled teeth) indices were recorded. Data was analyzed using SPSS 16.0 and descriptive statistics was applied. The level of significance was taken at p value < 0.05. RESULTS: The prevalence of early childhood caries was 23.5% with a total of 353 carious teeth seen in 127 children. The mean dmft was 0.65 ± 1.49 and the decayed (d) component constituted 100% of the dmft scores (all dmft was due to untreated caries). The second mandibular primary molars were the teeth most affected by caries, accounting for 35.4% of all decayed teeth. Severe ECC prevalence was 2.2%. CONCLUSION: The high caries prevalence observed on the second mandibular primary molars reveals the rampant nature of this disease and the absence of any missing or filled tooth in the dmft indices shows poor dental awareness among the parents/guardians of the children.

Caries risk assessment in preschool children in Saudi Arabia.

PURPOSE: Caries is a prevalent condition in Saudi Arabia. At present, knowledge regarding caries risk factors in Saudi Arabia is limited. The present study aimed to identify characteristic features of Saudi preschoolers at high risk for caries, using the American Academy of Pediatric Dentistry caries risk assessment tool (CAT ) and to report the most significant caries risk predictors. MATERIALS AND METHODS: A sample of 407 children aged 4 and 5 years was selected randomly from private and public nursery schools. Their parents answered a questionnaire prepared using the CAT . Each child was examined for the presence of caries and his/her oral hygiene status. RESULTS: According to the CAT , almost all children (89%) were considered to be at high risk. Caries was significantly more prevalent among children attending public than private schools. All CAT variables were significantly related to the presence of caries except general health condition and water fluoridation. Logistic regression analysis showed previous caries experience, enamel demineralisation, and socio-economic status to be the most significant caries risk factors. CONCLUSION: Most of the Saudi children are considered to be at high risk for caries. Previous caries experience, enamel demineralisation and socioeconomic status are the most significant caries risk predictors. These groups should be targeted for inclusion in caries prevention programmes.

[Social inequalities in health in 4 year-old children in the Hauts-de-Seine (France)]. / Inégalités sociales de santé à quatre ans dans les Hauts-de-Seine (France).

The social effects on health described in France on newborn and 5- to 6-year-old children suggest the existence of a social gradient among the youngest children. The favoured, though unequal, social situation of the department of the Hauts-de-Seine (France), makes it particularly adapted to this study. A survey, conducted in 2010 by the departmental service of maternal and infantile protection (PMI) on a representative sample of 1227 children, who received check-ups in their first or second year of nursery school, reveals a significant increase of overweight (from 4.6 to 16.5%), of language disorders (from 8.3 to 25.3%), of the orientations to specialized consultations (from 20.6 to 36.6%), according to the socioprofessional category of the father or the social affiliation of the children in the following subgroups: children speaking or understanding a foreign language (36.6% of the sample), children schooled in priority educational zones (equivalent to education achievement zones in UK, 13.6%), children with limited social health coverage (13.4%). In contrast, the BCG and hepatitis B vaccinal coverage is systematically higher in these various groups. The multivariate analysis investigates for each health problem its links with these various subgroups, and with previous child care experiences, and PMI medical consultations. This study suggests therefore further prospects for different actions according to health problems or regarding vaccinal strategy. The development of such routine indicators of disadvantage should allow territorial health services to target their actions towards the decrease of social disparities in health and to check a posteriori the efficiency of the public systems, which have been implemented.

[Tinea corporis]. / Tinea corporis.

Between February 2011 and April 2012, an outbreak caused 55 episodes of Tinea corporis in a Berlin kindergarten. According to the case definition Tinea corporis was confirmed in 2 cases, 16 cases were dermatologically probable, 24 cases were suspicious, whereas 13 cases were viewed as improbable. 48% (n=32/67) of all children had at least one episode of disease. Of those aged 4-6 years 76% (n=29/38) were affected, compared with 10% (n=3/29) of those younger than 4 years. Despite comprehensive hygienic measures being taken, the outbreak could not be quickly controlled. To stop the outbreak the immediate cooperation of public health service and medical staff, kindergarten employees, parents and children was necessary. The timely involvement of dermatologists along with a uniform treatment approach turned out to be of major importance. The recommended long treatment duration over several weeks affected adherence to treatment. Overall, the extended treatment in the kindergarten of affected skin areas of children proved to be the most effective measure for the control of the outbreak.

Latitude modifies the effect size of factors related to recurrent wheeze in the first year of life.

BACKGROUND: Although the association between latitude and asthma prevalence has been studied to a certain extent, its influence on the magnitude of the association of risk/protective factors with recurrent wheeze in infants has never been reported. METHODS: The adjusted odd ratios (aOR) of various risk/protective factors for recurrent wheeze from 31,920 infants from 19 centres of the "Estudio Internacional de Sibilacias en Lactantes" (EISL) in very different parts of the world were used to build a meta-regression using the strength of the aOR of each factor as dependent variable and centre latitude as explanatory variable. The meta-regression was further adjusted for continent. RESULTS: There was a positive significant correlation between latitude and the magnitude of the aOR between recurrent wheeze and having cold(s) during the first three months of life (p = 0.004); attending a nursery school (p = 0.011); and having additional siblings (p = 0.003). Furthermore, there was a negative correlation for having been breastfed for at least three months (p = 0.044). Heterogeneity (as measured by I2) of the magnitude of aORs between centres was quite high except for breast feeding: 73.1% for colds; 66.9% for nursery school; 52.6% for additional siblings; and 18.1% for breast feeding. Latitude explained a considerable amount of that heterogeneity: 63.8% for colds; 52.8% for nursery school; 86.6% for additional siblings; and 100% for breast feeding, probably as a consequence of its low heterogeneity. CONCLUSION: The magnitude in which some risk/protective factors are associated to recurrent wheeze during the first year of life varies significantly with latitude.