Referral from well-child care clinics to dental clinics leads to earlier initiation of preventive dental visits: A quasi-experimental study.

BACKGROUND: An ealy first preventive dental visit for children is recommended no later than twelve months. However, still many children have their first dental visit relatively late. AIM: To evaluate whether active or passive referral by a well-child care (WCC) physician of babies for a first preventive dental visit leads to earlier initiation of dental care. DESIGN: From WCC clinics in two Dutch regions, 629 parents of babies participated. Parents received an active referral from a WCC physician for a dental visit for their babies (n = 204) or received care as usual (CAU) (n = 136) in one region and a passive referral (n = 143) or CAU (n = 146) in the other region. Active referral involved parents receiving a scheduled appointment at the dental practice, and passive referral involved parents making an appointment themselves. During the WCC visit, parents completed a baseline questionnaire. At age 2.5 years, parents received a follow-up questionnaire about dental attendance. RESULTS: Of the active referral intervention group, 59.3% had their first preventive dental visit in their first year compared with 3.7% in the CAU group (p < .001); for the passive referral group, 46.9% compared with 9.6% (p < .001). CONCLUSION: Referral of babies by WCC for their first preventive dental visit leads to earlier initiation of dental care. An active referral had a larger effect than passive referral.

Lead and other toxic metals in plastic play foods: Results from testing citizen science, lead detection tools in childcare settings.

A method development pilot study examining citizen science tools for assessing lead in childcare settings identified plastic food toys as an unexpected potential source of lead and arsenic. Collaborating researchers at three universities sought to develop a low cost, replicable approach for use in childcare centers to identify lead. Through graduate Environmental Health courses at Northeastern and Boston Universities, 197 Plastic Food Toys (PFTs) used in a childcare center were tested for lead using a portable X-Ray fluorescence (XRF) instrument and a colorimetric wipe method for detecting surface lead. The XRF identified concerning levels of lead and co-occurring arsenic in PFTs. The XRF analysis found 8.63% (17/197) of PFTs from the childcare center contained more than 100.00 ppm of lead, the U.S. Consumer Protection Safety Commission's (CPSC) upper regulatory threshold for lead in childrens' products. However, wipes did not detect removable surface lead. Lead concentrations ranged from 6.14 ppm to 11,999.00 ppm with a median of 40.00 ppm. Additionally, 7.10% of all PFTs tested had detectable levels of arsenic which ranged from 9.30 ppm to 1134.42 ppm and had a median value of 113.20 ppm. Arsenic concentrations in 6.60% of PFTs' exceeded the US voluntary standard for arsenic in children's products of 25.00 ppm (adopted from the EU standard). These findings prompted further sampling of similar newly-purchased PFTs. None of the newly-purchased PFTs tested positive for lead or arsenic (0/87). Several other elements were also identified, particularly in the used PFTs. Because these food-like toys are frequently put in children's mouths, we recommend further investigation of PFTs in circulation via citizen science combining the wipe and XRF method as they provide immediate data to participants. Additionally, CPSC should consider a systematic recall of some used PFTs to prevent exposure disparities by socio-economic status and increased surveillance for other toxic metals in new PFTs.

Child Temperament and Total Diurnal Cortisol in Out-of-Home Center-Based Child Care and in At-Home Parental Care.

The association between child temperament characteristics and total diurnal saliva cortisol in 84 children (M = 2.3 years, SD = 0.6) attending out-of-home, center-based child care and 79 children (M = 2.0 years, SD = 0.5) attending at-home parental care was examined. Saliva samples were collected during two consecutive days, that is, Sunday and Monday, with four samples taken per day. While children higher in surgency had higher total diurnal cortisol production, we did not find evidence that temperament moderated the associations between child-care context and total diurnal cortisol. Negative affectivity and effortful control were not related to cortisol output. Our findings suggest that temperamental surgency may be associated with higher total cortisol production in early childhood across child-care settings.

Children's diurnal cortisol output and temperament in two different childcare settings at 2 and 3.5 years of age.

Prior research suggests that child temperament may play an important role in early childhood stress regulation. We compared children's diurnal cortisol and the association between cortisol and temperament in two different childcare settings. Cortisol was measured from saliva samples over 2 days in children (N = 84) attending out-of-home childcare and in children (N = 27), who were cared for at home at the age of 3.5 years. There was no difference between the childcare groups in total diurnal cortisol. However, of the individual measurements, afternoon cortisol levels were higher in the out-of-home childcare group during their childcare day when compared with their home day. Child temperament was not associated with total diurnal cortisol. Comparison with our prior measurements showed that the association between temperamental surgency/extroversion and total diurnal cortisol diminished along with the child age from 2 to 3.5 years in both childcare settings. This may indicate that more extroverted children are physiologically more reactive to environmental stimuli when they are younger, but this association does not appear as the children develop. Our results further suggest that the afternoon hours in the out-of-home childcare may be demanding and accelerate the hypothalamus-pituitary-adrenal axis activation in young children independent of their age.

Attachment and stress regulation in socioeconomically disadvantaged children: Can public childcare compensate?

Children growing up in families experiencing socioeconomic disadvantage (SED) are at greater risk for deficits in attachment and stress regulation as compared to peers in families with more socioeconomic resources. The present study hypothesized that care providers in out-of-home care might help these children to compensate. We therefore investigated 60 children (n = 30 from SED, n = 30 matched counterparts from middle class) and assessed children's Attachment Q-Sort (AQS) toward the mother and the primary care provider in childcare centers. Moreover, children's diurnal cortisol rhythm was measured based on 12 saliva samples taken across three days a week. The disadvantaged children showed lower AQS scores with their mothers than their care providers. Compared to their counterparts, disadvantaged children also displayed heightened cortisol release and flatter cortisol profiles reflecting overall high hypothalamic-pituitary-adrenocortical activities and lower capacities to regulate stress. Most notably however, multilevel path modeling linked higher care provider AQS scores to decreasing cortisol release throughout the week.

Los niños que crecen en familias que experimentan desventajas socioeconómicas (SED) se encuentran bajo mayor riesgo de déficits en la afectividad y regulación del estrés, comparados con compañeros de familias con más recursos socioeconómicos. EL presente estudio presenta la hipótesis de que quienes cuidan a estos niños dentro del sistema público de guarderías pudieran ayudarles a compensar. Nosotros, por tanto, investigamos a 60 niños (n = 30 de SED, n = 30 niños de clase media pareados como contraparte) y evaluamos la afectividad de los niños (AQS) hacia las madres y quienes les proveían el cuidado primario en guarderías infantiles públicas. Es más, se midió el ritmo diurno de cortisol de los niños con base en 12 muestras de saliva tomadas a lo largo de tres días a la semana. Los niños con desventajas mostraron más bajos puntajes de AQS con sus madres que con quienes les prestaban el cuidado. Comparados con su contraparte, los niños con desventajas también mostraron un elevado nivel de emisión de cortisol y perfiles de cortisol más planos lo cual refleja en general un alto nivel de actividades HPA y más bajas capacidades para regular el estrés. Aún más notable, sin embargo, el modelo de trayectoria a múltiples niveles relacionó los más altos puntajes AQS del cuidador con una baja en la emisión de cortisol a lo largo de la semana.

Les enfants grandissant dans des familles faisant l'expérience d'un désavantage socioéconomique (abrégé ici DSE) sont à plus grand risque de déficits dans l'attachement et la régulation du stress comparés aux enfants grandissant dans des familles dotées de plus de ressources socioéconomiques. Cette étude a pris pour hypothèse que les personnes s'occupant des enfants dans les crèches publiques pourraient aider ces enfants à compenser. Nous avons donc étudié 60 enfants (n = 30 de SED, n = 30 homologues issus de la classe moyenne) et évalué l'attachement (AQS) des enfants envers leur mère et envers les personnes prenant soin d'eux dans les crèches publiques. De plus le rythme de cortisol diurne a été mesuré basé sur des échantillons de salive pris au cours de trois jours par semaine. Les enfants de milieu désavantagé ont fait preuve de scores AQS plus bas avec leurs mères qu'avec les personnes prenant soin d'eux dans les crèches. Comparés à leurs homologues, les enfants désavantagés ont aussi fait preuve de sécrétion de cortisol plus élevée et des profils de cortisol plus plats reflétaient des activités HPA dans l'ensemble hautes et des capacités plus basses à réguler le stress. Plus particulièrement cependant une modélisation à plusieurs niveaux a établi un lien entre des scores AQS plus élevés des modes de soin à la crèche à des sécrétions de cortisol décroissantes tout au long de la semaine.

[Collaboration of oral care and well-child care: for better preventive dentistry]. / Samenwerking mondzorg en jeugdgezondheidszorg; voor betere tandheelkundige preventie.

The new Dutch clinical practice guideline Oral Care for Children and Young People advises parents to visit the oral care professional before or from the eruption of the first tooth, because oral care starts with the first deciduous tooth. However, this is not yet standard for everyone. Still, almost all parents of newborns (> 95%) visit well-baby clinics with their newborn. This article describes how well-baby clinics and oral care can collaborate and how in the Netherlands, young children and their parents can be contacted earlier for (preventive) dental care. There are a few examples of projects in which well-child clinics and oral care collaborate, such as the Gezonde Peutermonden project (toddlers' healthy mouths project), the GigaGaaf project (giga whole project) and the case of a practice in Haarlem, in the Schalkwijk district. Because these projects are still in progress, it is not yet clear whether a collaboration between well-child clinics and oral care will also have an effect on the caries prevalence in children.

Plasticizer migration from children's toys, child care articles, art materials, and school supplies.

Dialkyl phthalates, including diisononyl phthalate (DINP), have been used as plasticizers in children's products made from polyvinyl chloride (PVC), such as teethers and toys. Children may be exposed to phthalates when handling or mouthing PVC products because plasticizers are not covalently bound. The Consumer Product Safety Improvement Act of 2008 prohibited certain phthalates from use in child care articles and children's toys. Thus, manufacturers have changed to other plasticizers or non-PVC plastics and there is interest in evaluating the potential health risks of alternative plasticizers. In 2008, CPSC staff purchased 63 children's products comprising 129 individual pieces (articles). Plastics identified FTIR included PVC, polypropylene, polyethylene, and acrylonitrile butadiene styrene. Plasticizers identified by in the 38 PVC articles included acetyltributyl citrate (ATBC) (20); di (2-ethylhexyl) terephthalate (DEHT) (14); 1,2-cyclohexanedicarboxylic acid diisononyl ester (DINX) (13); 2,2,4-trimethyl-1,3-pentanediol diisobutyrate (TPIB) (9); di (2 ethyhexyl) phthalate (DEHP) (1); and DINP (1). Half of the tested articles contained multiple plasticizers. CPSC measured migration rates using the Joint Research Centre method. Migration rates correlated roughly with plasticizer concentration and inversely with the molecular mass of the plasticizer. We then combined the migration rates with data on mouthing duration to estimate children's exposure to plasticizers in toys and child care articles, and estimated margins of exposure. All margins of exposure were >1,000, suggesting a low risk potential. However, the plasticizers in this study have multiple uses. Exposure from other sources and routes of exposure will be considered in future work.

Acceptability, internal consistency and test-retest reliability of scales to assess parental and nursery staff's self-efficacy, motivation and knowledge in relation to pre-school children's nutrition, oral health and physical activity.

OBJECTIVE: To determine the acceptability, internal consistency and test-retest reliability of self-efficacy, motivation and knowledge scales relating to pre-school children's nutrition, oral health and physical activity. DESIGN: An online questionnaire was completed twice with an interval of 7-11d. SETTING: Online questionnaires were sent to participants via email from nursery managers. The parent questionnaire was also available on the parenting website www.netmums.com.ParticipantsEighty-two parents and sixty-nine nursery staff from Bristol, UK who had and worked with 2-4-year-olds, respectively. RESULTS: Response rates were 86·3 and 86·0 % and missing data 15·9 and 14·5 % for the second administration of the parent and nursery staff questionnaires, respectively. Weighted κ coefficients for individual items mostly fell under the 'moderate' agreement category for the parental (75·0 %) and nursery staff (55·8 %) items. All self-efficacy and motivation scales had acceptable levels of internal consistency (Cronbach's α coefficients>0·7). The intraclass correlation coefficients for the self-efficacy, motivation and knowledge scales ranged between 0·48 and 0·82. Paired t tests found an increase between test and retest knowledge scores for the Nutrition Motivation (t=-2·91, df=81, P=0·00) and Knowledge (t=-3·22, df=81, P=0·00) scales in the parent questionnaire. CONCLUSIONS: Our findings demonstrate that the items and scales show good acceptability, internal consistency and test-retest reliability.

Treats are a tool of the trade: an exploration of food treats among grandparents who provide informal childcare.

OBJECTIVE: Globally, grandparents are the main informal childcare providers with one-quarter of children aged ≤5 years regularly cared for by grandparents in Australia, the UK and USA. Research is conflicting; many studies claim grandparents provide excessive amounts of discretionary foods (e.g. high in fat/sugar/sodium) while others suggest grandparents can positively influence children's diet behaviours. The present study aimed to explore the meaning and role of food treats among grandparents who provide regular informal care of young grandchildren. DESIGN: Qualitative methodology utilising a grounded theory approach. Data were collected using semi-structured interviews and focus groups, then thematically analysed. SETTING: Participants were recruited through libraries, churches and playgroups in South Australia. PARTICIPANTS: Grandparents (n 12) caring for grandchild/ren aged 1-5 years for 10 h/week or more. RESULTS: Three themes emerged: (i) the functional role of treats (e.g. to reward good behaviour); (ii) grandparent role, responsibility and identity (e.g. the belief that grandparent and parent roles differ); and (iii) the rules regarding food treats (e.g. negotiating differences between own and parental rules). Grandparents favoured core-food over discretionary-food treats. They considered the risks (e.g. dental caries) and rewards (e.g. pleasure) of food treats and balanced their wishes with those of their grandchildren and parents. CONCLUSIONS: Food treats play an important role in the grandparent-grandchild relationship and are used judiciously by grandparents to differentiate their identity and relationship from parents and other family members. This research offers an alternative narrative to the dominant discourse regarding grandparents spoiling grandchildren with excessive amounts of discretionary foods.

Health needs of regional Australian children in out-of-home care.

AIM: This study aims to identify the health needs of children placed in out-of-home care in regional Queensland and to compare them with the needs of similar children in metropolitan Queensland. METHODS: Retrospective chart review and subsequent analysis of data from the first assessments of the children placed in care from January 2005 to April 2011. Health needs based on assessment recommendations were then compared with needs and recommendations from a similar clinic in metropolitan Brisbane. RESULTS: Two hundred thirty-nine first assessments were reviewed. The average number of health referrals arising out of each assessment was 2. 72% children were between 2 and 12 years of age and accounted for 76% of the health referrals made. The 10-13% of the children needed referrals for medical and surgical specialties, audiology, speech pathology, dental, and ophthalmology/optometry, each. A percentage of 30 needed ongoing paediatric care. The 15% needed immunisation catch up, 35% counselling and behaviour management, and 15% formal mental health referrals. These were comparable to the health needs identified in out-of-home care children residing in metropolitan Queensland. CONCLUSION: Children in care who live in a regional setting have similar health-care needs compared with urban children. Given restricted health services in regional settings, there is difficulty in accessing services to meet these needs.

Background factors of molar-incisor hypomineralization in a group of Finnish children.

OBJECTIVE: Molar-Incisor Hypomineralization (MIH) is a common developmental enamel defect characterized by demarcated opacities in permanent molars and incisors. Its etiology still remains unclear. The aim of this retrospective cohort study was to assess if the socioeconomic environment of the child is associated with MIH. MATERIALS AND METHODS: The study was located in two rural towns and three urban cities in Finland. A total of 818 children, between 7-13 years old, were examined for MIH using the evaluation criteria in line with those of the European Academy of Paediatric Dentistry, but excluding opacities smaller than 2 mm in diameter. The mothers filled in a questionnaire which included questions related to the family's way of living (e.g. area of residency, farming, day care attendance) and socioeconomic status (family income, number of mother's school years, level of maternal education). RESULTS: The prevalence of MIH in the study population was 17.1%. Family income, urban residency and day care attendance were associated with MIH in the univariate analysis. In the multivariate analysis using binary logistic regression, only urban residency during a child's first 2 years of life remained associated with MIH. The prevalence of MIH in urban areas was 21.3% and in rural areas 11.5% (OR = 2.18, CI = 1.35-3.53, p = 0.001). CONCLUSIONS: The prevalence of MIH was related to urban residency and could not be explained by any other factor included in the study.

Fluoride content in toothpastes commercialized for children in Chile and discussion on professional recommendations of use.

BACKGROUND: In Chile, no information is available regarding the soluble fluoride (F) content in the toothpastes commercialized for children and the country's guidelines recommend the use of F in toothpastes in an age-dependent concentration. No global consensus has been reached on this subject. AIM: To determine the soluble F concentration in dentifrices for children sold in Chile and to discuss Chilean guidelines and professional recommendations of use. DESIGN: Three samples of twelve different dentifrices were purchased from drugstores. Toothpastes were analysed in duplicate using an ion-specific electrode. The concentrations of total F (TF) and total soluble F (TSF) were determined (µg F/g). RESULTS: Measured TF was consistent with that declared by the manufacturer in eight products. Two dentifrices showed lower TF and two higher F concentrations than declared. A toothpaste, marketed as low-F (450 ppm), showed F concentration threefold higher. Most dentifrices exhibited TSF concentrations similar to the TF content, except one sample that displayed considerably lower TSF than TF. Recommendations on F toothpastes use in children widely vary from country to country. CONCLUSIONS: Most dentifrices for children match F content in the labelling, but recommendations are not supported by the best evidence available on the benefit/risk of F toothpastes use.

A scoping review on health records for child-in-care.

A scoping review was conducted to determine the current state of knowledge on child-in-care health records in academic literature. Eight studies describing five such health records were found. Different terms were found between countries. A key finding from the studies was that research needs to report on "what worked" to inform policy and practice for positive changes. Complete, accurate and consistent health records for child-in-care are needed that can support care and be aggregated to identify policy and practice gaps and interventions that were effective. Such health records enabled moving from reactive to proactive care for the child. Social work case data elements found in a child-in-care health record not included in a child personal health record include: court dates, dental, abuse, placement, and education. Including these data elements allows looking at the overall wellbeing and development of the child. With the exception of two, all studies reported positively on their implementation. Further, all studies advocated for continued development of a tailored child-in-care health record. The evidence points toward child-in-care health records as a tool toward achieving healthy outcomes and policy development.

Maternal knowledge and awareness of factors affecting oral health in the paediatric population.

AIM: To assess expectant mothers on their knowledge and awareness of factors affecting paediatric oral health. METHOD: Seven hundred and six women in different stages of pregnancy were recruited from the antenatal clinic of the University of Port Harcourt Teaching Hospital over a period of four weeks. A self-administered structured questionnaire on socio-demographic information, oral health knowledge and oral health behaviour was filled by the participants. Data was analyzed using SPSS version 17. RESULTS: The mean age of the subjects was 29.6 (SD + 4.4) years. Seventy percent of them had tertiary education and 63.9% were unemployed. A significant proportion (83.4%) of the women had medium to high score (> 50%) in the knowledge of causal and preventive factors in dental caries and gingivitis. Over seventy nine percent (79.2%) of them acknowledged that primary teeth are important, but 43.6% did not know whether primary teeth should be restored or not. Only 39.3% of the women knew that leaving a feeding bottle/breast in the mouth of a sleeping child could be harmful to the teeth. Knowledge of the role of bacteria in gingivitis (81.3%) and dental caries (86.6%) was high. Over 45% of participants agreed that mothers could transmit cariogenic bacteria to their children. Only 0.7% of the women had taken their children to the dental clinic for routine checkup. CONCLUSION: Most of the participants had medium to high knowledge of the factors that affect paediatric oral health, yet the participants did not demonstrate adequate and proper concomitant oral health practice.

Latent profile analysis of diurnal cortisol patterns at the ages of 2, 3.5, and 5 years: Associations with childcare setting, child individual characteristics, and maternal distress.

This study performed latent profile analysis from more than 4000 saliva cortisol samples collected from children at the ages of 2 (T1), 3.5 (T2), and 5 years (T3). Three clearly different cortisol profiles were identified. The largest group at every age point was the Low/Regular latent profile, in which the cortisol slopes followed typical diurnal variation. A smaller proportion of the children belonged to the latent profile with relatively Low/Flat slope, and a minority belonged to the High/Fluctuating latent group, where the overall cortisol values and variations between the slopes were clearly higher than in the other groups. Most of the children who belonged to the High/Fluctuating group were cared for at home, they had higher temperamental surgency and their mothers had more depressive symptoms than in the other latent profile groups. However, only moderate intraindividual stability in diurnal cortisol profiles was observed across the follow-up period. On average, half of the children moved between the groups from T1 to T3. Neither child temperament, social competence, nor sex explained the stability or movement between the groups across age. Variations in cortisol profiles may be caused by the child's age, and diurnal cortisol rhythm becomes more regular along with development. Methodological issues regarding saliva cortisol research in young children are discussed. Also, more longitudinal research is needed to clarify mechanisms between environmental as well as individual factors and possible dysregulation in a child's HPA axis functioning.

Routine saliva testing for SARS-CoV-2 in children: Methods for partnering with community childcare centers.

While considerable attention was placed on SARS-CoV-2 testing and surveillance programs in the K-12 setting, younger age groups in childcare centers were largely overlooked. Childcare facilities are vital to communities, allowing parents/guardians to remain at work and providing safe environments for both children and staff. Therefore, early in the COVID-19 pandemic (October 2020), we established a PCR-based COVID-19 surveillance program in childcare facilities, testing children and staff with the goal of collecting actionable public health data and aiding communities in the progressive resumption of standard operations and ways of life. In this study we describe the development of a weekly saliva testing program and provide early results from our experience implementing this in childcare centers. We enrolled children (aged 6 months to 7 years) and staff at seven childcare facilities and trained participants in saliva collection using video chat technology. Weekly surveys were sent out to assess exposures, symptoms, and vaccination status changes. Participants submitted weekly saliva samples at school. Samples were transported to a partnering clinical laboratory or RT-PCR testing using SalivaDirect and results were uploaded to each participant's online patient portal within 24 h. SARS-CoV-2 screening and routine testing programs have focused less on the childcare population, resulting in knowledge gaps in this critical age group, especially as many are still ineligible for vaccination. SalivaDirect testing for SARS-CoV-2 provides a feasible method of asymptomatic screening and symptomatic testing for children and childcare center staff. Given the relative aversion to nasal swabs in younger age groups, an at-home saliva collection method provides an attractive alternative, especially as a routine surveillance tool. Results can be shared rapidly electronically through participants' private medical chart portals, and video chat technology allows for discussion and instruction between investigators and participants. This study fosters a cooperative partnership with participating childcare centers, parents/guardians, and staff with the goal of mitigating COVID-19 transmission in childcare centers. Age-related challenges in saliva collection can be overcome by working with parents/guardians to conceptualize new collection strategies and by offering parents/guardians continued virtual guidance and support.

Racial and ethnic differences in diurnal cortisol rhythms in preadolescents: the role of parental psychosocial risk and monitoring.

Racial/ethnic minorities experience persistent health disparities due in part to their exposure to chronic SES and psychosocial risk. The hypothalamic-pituitary-adrenal axis and its hormonal end product, cortisol, are believed to mediate the associations between chronic stress and poor health. In this study, racial/ethnic differences in diurnal salivary cortisol rhythms in 179 preadolescent youths and the contributing roles of SES risk, psychosocial risk, perceived discrimination, harsh parenting, and parental monitoring were examined. The analyses revealed racial/ethnic differences in diurnal cortisol rhythms, with African Americans having significantly flatter morning-to-evening cortisol slopes than Caucasians and with Latinos having significantly lower evening cortisol levels than Caucasians. Greater psychosocial risk and less parental monitoring were associated with flatter cortisol slopes. Racial/ethnic differences on the cortisol measures persisted when controlling for SES, psychosocial risk, and parenting quality. The need to assess chronic risk across the lifespan and disentangle possible genetic from environmental contributors is discussed.

Public preferences for government spending in Canada.

This study considers three questions: 1. What are the Canadian public's prioritization preferences for new government spending on a range of public health-related goods outside the scope of the country's national system of health insurance? 2. How homogenous or heterogeneous is the Canadian public in terms of these preferences? 3. What factors are predictive of the Canadian public's preferences for new government spending? Data were collected in 2008 from a national random sample of Canadian adults through a telephone interview survey (n=1,005). Respondents were asked to rank five spending priorities in terms of their preference for new government spending. Bivariate and multivariable logistic regression analyses were conducted. As a first priority, Canadian adults prefer spending on child care (26.2%), followed by pharmacare (23.1%), dental care (20.8%), home care (17.2%), and vision care (12.7%). Sociodemographic characteristics predict spending preferences, based on the social position and needs of respondents. Policy leaders need to give fair consideration to public preferences in priority setting approaches in order to ensure that public health-related goods are distributed in a manner that best suits population needs.

Hand-to-Face Contact of Preschoolers during Indoor Activities in Childcare Facilities in the Republic of Korea.

PURPOSE: This study aimed to characterize hand-to-face contact (HFC) in children and analyze the factors that affect HFC behaviors of preschoolers in childcare facilities in Korea. METHODS: Thirty preschoolers aged between 13 and 84 months were enrolled with parents' voluntary participation. Videotaping (10 children/childcare center/2 h) and video reading was performed from 23 November 2018 to 7 January 2019. RESULTS: A total of 2719 cases of HFC were observed in 30 participants within 2 h. The average contact with the facial mucosa (frequency/person/2 h) was 55.6 ± 42.2, of which the mouth (25.4 ± 23.9), the nose (20.4 ± 24.5), and the eye (9.8 ± 11.7) were the most frequent contacts, in that order. The average contact duration (sec/person/2 h) with the facial mucosa was 232.6 ± 169.7, of which the mouth (145.2 ± 150), the nose (57.6 ± 62.2), and the eyes (29.7 ± 42.3) were the longest in that order. The density distribution of the frequency and duration of mucosal contact was wider in boys than in girls. The mucosal and non-mucosal contact frequencies were significantly higher in boys (p = 0.027 and p = 0.030, respectively). CONCLUSION: Children's HFC frequency and duration were highest for the mouth, nose, and eyes. Boys tended to have a higher contact frequency than girls for both mucous and non-mucous HFC.

Using the MCRISP Network for Surveillance of Pediatric Exanthema in Child Care Centers.

BACKGROUND: Systematic monitoring of exanthema is largely absent from public health surveillance despite emerging diseases and threats of bioterrorism. Michigan Child Care Related Infections Surveillance Program (MCRISP) is the first online program in child care centers to report pediatric exanthema. METHODS: MCRISP aggregated daily counts of children sick, absent, or reported ill by parents. We extracted all MCRISP exanthema cases from October 1, 2014 through June 30, 2019. Cases were assessed with descriptive statistics and counts were used to construct epidemic curves. RESULTS: 360 exanthema cases were reported from 12,233 illnesses over 4.5 seasons. Children ages 13-35 months had the highest rash occurrence (45%, n = 162), followed by 36-59 months (41.7%, n = 150), 0-12 months (12.5%, n = 45), and kindergarten (0.8%, n = 3). Centers reported rashes of hand-foot-mouth disease (50%, n = 180), nonspecific rash without fever (15.3%, n = 55), hives (8.1%, n = 29), fever with nonspecific rash (6.9%, n = 25), roseola (3.3%, n = 12), scabies (2.5%, n = 9), scarlet fever (2.5%, n = 9), impetigo (2.2%, n = 8), abscess (1.95, n = 7), viral exanthema without fever (1.7%, n = 6), varicella (1.7%, n = 6), pinworms (0.8%, n = 3), molluscum (0.6%, n = 2), cellulitis (0.6%, n = 2), ringworm (0.6%, n = 2), and shingles (0.2%, n = 1). CONCLUSION: Child care surveillance networks have the potential to act as sentinel public health tools for surveillance of pediatric exanthema outbreaks.