A hand hygiene intervention to decrease infections among children attending day care centers: Design of a cluster randomized controlled trial

Background: Day care center attendance has been recognized as a risk factor for acquiring gastrointestinal and respiratory infections, which can be prevented with adequate hand hygiene (HH). Based on previous studies on environmental and sociocognitive determinants of caregivers' compliance with HH guidelines in day care centers (DCCs), an intervention has been developed aiming to improve caregivers' and children's HH compliance and decrease infections among children attending DCCs. The aim of this paper is to describe the design of a cluster randomized controlled trial to evaluate the effectiveness of this intervention.Methods/design: The intervention will be evaluated in a two-arm cluster randomized controlled trial among 71 DCCs in the Netherlands. In total, 36 DCCs will receive the intervention consisting of four components: 1) HH products (dispensers and refills for paper towels, soap, alcohol-based hand sanitizer, and hand cream); 2) training to educate about the Dutch national HH guidelines; 3) two team training sessions aimed at goal setting and formulating specific HH improvement activities; and 4) reminders and cues to action (posters/stickers). Intervention DCCs will be compared to 35 control DCCs continuing usual practice. The primary outcome measure will be observed HH compliance of caregivers and children, measured at baseline and one, three, and six months after start of the intervention. The secondary outcome measure will be the incidence of gastrointestinal and respiratory infections in 600 children attending DCCs, monitored over six months by parents using a calendar to mark th

Contribution of Dairy to Nutrient Intake in the Western Diet

Milk and dairy products play an important role in providing nutrients in both Western and developing countries. Most research in this area focuses on the intake of individual nutrients from food products, like dairy products. However, nutrients are not consumed, and do not function, in isolation. Looking at nutrient intake from the perspective of whole food products, or even whole dietary patterns, may be a more suitable way to quantify the contribution of dairy to the intake of nutrients. A mathematical approach, the nutrient-rich food score, is explained and discussed in this chapter. Such models could in the future even be extended beyond nutrition (e.g., including sustainability or cost parameters) to even better guide healthy eating habits for consumers

Risk factors for secondary transmission of <it>Shigella</it> infection within households: implications for current prevention policy

<p>Abstract</p> <p>Background</p> <p>Internationally, guidelines to prevent secondary transmission of <it>Shigella</it> infection vary widely. Cases, their contacts with diarrhoea, and those in certain occupational groups are frequently excluded from work, school, or daycare. In the Netherlands, all contacts attending pre-school (age 0–3) and junior classes in primary school (age 4–5), irrespective of symptoms, are also excluded pending microbiological clearance. We identified risk factors for secondary <it>Shigella</it> infection (SSI) within households and evaluated infection control policy in this regard.</p> <p>Methods</p> <p>This retrospective cohort study of households where a laboratory confirmed <it>Shigella</it> case was reported in Amsterdam (2002–2009) included all households at high risk for SSI (i.e. any household member under 16 years). Cases were classified as primary, co-primary or SSIs. Using univariable and multivariable binomial regression with clustered robust standard errors to account for household clustering, we examined case and contact factors (<it>Shigella</it> serotype, ethnicity, age, sex, household size, symptoms) associated with SSI in contacts within households.</p> <p>Results</p> <p>SSI occurred in 25/ 337 contacts (7.4%): 20% were asymptomatic, 68% were female, and median age was 14 years (IQR: 4–38). In a multivariable model adjusted for case and household factors, only diarrhoea in contacts was associated with SSI (IRR 8.0, 95% CI:2.7-23.8). In a second model, factors predictive of SSI in contacts were the age of case (0–3 years (IRR_{case≥6 years}:2.5, 95% CI:1.1-5.5) and 4–5 years (IRR_{case≥6 years}:2.2, 95% CI:1.1-4.3)) and household size (>6 persons (IRR_{2-4 persons} 3.4, 95% CI:1.2-9.5)).</p> <p>Conclusions</p> <p>To identify symptomatic and asymptomatic SSI, faecal screening should be targeted at all household contacts of preschool cases (0–3 years) and cases attending junior class in primary school (4–5 years) and any household contact with diarrhoea. If screening was limited to these groups, only one asymptomatic adult carrier would have been missed, and potential exclusion of 70 asymptomatic contacts <6 years old from school or daycare, who were contacts of cases of all ages, could have been avoided.</p

Examining the Impact of Environmental Factors on Quality of Life Across Massachusetts

Several studies indicate that there are significant relationships among quality of life, green vegetation, and socioeconomic conditions, particularly in urban environments. The purpose of this research is twofold: (1) to compare two weighting and aggregation techniques, data envelopment analysis (DEA) and principal components analysis (PCA), in the development of a socioeconomic index; and (2) to test for and explore spatial variation in the relationship between socioeconomic index and environmental variables using geographically weighted regression (GWR). The analysis was conducted at the census block group level in Massachusetts. First, DEA and PCA were used to generate two separate socioeconomic indexes. Second, the relationship between these indexes and environmental variables including percentage impervious surface, percentage industrial land use, percentage land used for waste, and traffic density was modeled using ordinary least squares (OLS) regression and GWR. The GWR models explained more variance in the relationship than the OLS models and indicated that there is considerable spatial variation in the character and the strength of this relationship. The results of the GWR analyses were similar between the models generated using DEA- and PCA-derived indexes, indicating that the results were corroborative. The study concludes that the environmental variables are generally a strong predictor of the socioeconomic conditions at the scale of census block group; however, there is substantial geographical variation in the strength and the character of this relationship. The results of this study also suggest that various weighting and aggregation methods should be tested in every study that uses or creates composite indicators. © 2013 Copyright Taylor and Francis Group, LLC