Project description:BackgroundAbsenteeism due to communicable illness is a major problem encountered by North American elementary school children. Although handwashing is a proven infection control measure, barriers exist in the school environment, which hinder compliance to this routine. Currently, alternative hand hygiene techniques are being considered, and one such technique is the use of antimicrobial rinse-free hand sanitizers.MethodsA systematic review was conducted to examine the effectiveness of antimicrobial rinse-free hand sanitizer interventions in the elementary school setting. MEDLINE, EMBASE, Biological Abstract, CINAHL, HealthSTAR and Cochrane Controlled Trials Register were searched for both randomized and non-randomized controlled trials. Absenteeism due to communicable illness was the primary outcome variable.ResultsSix eligible studies, two of which were randomized, were identified (5 published studies, 1 published abstract). The quality of reporting was low. Due to a large amount of heterogeneity and low quality of reporting, no pooled estimates were calculated. There was a significant difference reported in favor of the intervention in all 5 published studies.ConclusionsThe available evidence for the effectiveness of antimicrobial rinse-free hand sanitizer in the school environment is of low quality. The results suggest that the strength of the benefit should be interpreted with caution. Given the potential to reduce student absenteeism, teacher absenteeism, school operating costs, healthcare costs and parental absenteeism, a well-designed and analyzed trial is needed to optimize this hand hygiene technique.
Project description:BackgroundThe potential for transmission of infectious diseases offered by the school environment are likely to be an important contributor to the rates of infectious disease experienced by children. This study aimed to test whether the addition of hand sanitiser in primary school classrooms compared with usual hand hygiene would reduce illness absences in primary school children in New Zealand.Methods and findingsThis parallel-group cluster randomised trial took place in 68 primary schools, where schools were allocated using restricted randomisation (1:1 ratio) to the intervention or control group. All children (aged 5 to 11 y) in attendance at participating schools received an in-class hand hygiene education session. Schools in the intervention group were provided with alcohol-based hand sanitiser dispensers in classrooms for the winter school terms (27 April to 25 September 2009). Control schools received only the hand hygiene education session. The primary outcome was the number of absence episodes due to any illness among 2,443 follow-up children whose caregivers were telephoned after each absence from school. Secondary outcomes measured among follow-up children were the number of absence episodes due to specific illness (respiratory or gastrointestinal), length of illness and illness absence episodes, and number of episodes where at least one other member of the household became ill subsequently (child or adult). We also examined whether provision of sanitiser was associated with experience of a skin reaction. The number of absences for any reason and the length of the absence episode were measured in all primary school children enrolled at the schools. Children, school administrative staff, and the school liaison research assistants were not blind to group allocation. Outcome assessors of follow-up children were blind to group allocation. Of the 1,301 and 1,142 follow-up children in the hand sanitiser and control groups, respectively, the rate of absence episodes due to illness per 100 child-days was similar (1.21 and 1.16, respectively, incidence rate ratio 1.06, 95% CI 0.94 to 1.18). The provision of an alcohol-based hand sanitiser dispenser in classrooms was not effective in reducing rates of absence episodes due to respiratory or gastrointestinal illness, the length of illness or illness absence episodes, or the rate of subsequent infection for other members of the household in these children. The percentage of children experiencing a skin reaction was similar (10.4% hand sanitiser versus 10.3% control, risk ratio 1.01, 95% CI 0.78 to 1.30). The rate or length of absence episodes for any reason measured for all children also did not differ between groups. Limitations of the study include that the study was conducted during an influenza pandemic, with associated public health messaging about hand hygiene, which may have increased hand hygiene among all children and thereby reduced any additional effectiveness of sanitiser provision. We did not quite achieve the planned sample size of 1,350 follow-up children per group, although we still obtained precise estimates of the intervention effects. Also, it is possible that follow-up children were healthier than non-participating eligible children, with therefore less to gain from improved hand hygiene. However, lack of effectiveness of hand sanitiser provision on the rate of absences among all children suggests that this may not be the explanation.ConclusionsThe provision of hand sanitiser in addition to usual hand hygiene in primary schools in New Zealand did not prevent disease of severity sufficient to cause school absence.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12609000478213. Please see later in the article for the Editors' Summary.
Project description:IntroductionIn Ecuador, the prevalence of overweight and obesity among school-age children is more than triple that of preschool-age children; however, preschoolers have not been the target of interventions.MethodsWe developed an educational and behavioral intervention that included games, singing, and storytelling. Children were recruited from municipal preschools in Cuenca and were enrolled in the pilot intervention (PI) (N=155) for the 2015-2016 school year, which consisted of a 3-month in-school program. For the 2016-2017 school year, a separate group of children was enrolled in the enhanced intervention (EI) (N=152), which consisted of a 7-month program at both school and home.ResultsParents in both groups reported a post-intervention reduction in their child's daily at-home consumption of sugar-sweetened beverages (PI: -23.2%, P < .001; EI: -16.8%, P < .001). Additional beneficial effects of the EI not observed with the PI were an increase in drinking water daily at home (+8.3%, P = .04) and eating fruits and vegetables daily for snacks at home (+21.8%, P < .001), a reduction in excessive weekend screen time (-7.6%, P = .03), and a reduction of 0.11 in mean BMI-for-age z score (P = .003). When comparing the PI and EI, the EI was associated with a greater difference in mean BMI-for-age z score (-0.25; P < .001) and fruit and vegetable consumption (+15.9%; P = .01).ConclusionOur preschool-based intervention appeared to be successful in promoting healthy lifestyle habits, especially when combined with a household component. Further research is needed to determine if the intervention had long-term effects, as well as to adapt it for different settings.
Project description:To analyze physical activity and sedentary behavior in preschool children during their stay at school and the associated factors.370 preschoolers, aged 4 to 6 years, stratified according to gender, age and school region in the city of Londrina, PR, participated in the study. A questionnaire was applied to principals of preschools to analyze the school infrastructure and environment. Physical activity and sedentary behavior were estimated using accelerometers for five consecutive days during the children's stay at school. The odds ratio (OR) was estimated through binary logistic regression.At school, regardless of age, preschoolers spend relatively more time in sedentary behaviors (89.6%-90.9%), followed by light (4.6%-7.6%), moderate (1.3%-3.0%) and vigorous (0.5%-2.3%) physical activity. The indoor recreation room (OR=0.20; 95%CI 0.05 to 0.83) and the playground (OR=0.08; 95%CI 0.00 to 0.80) protect four-year-old schoolchildren from highly sedentary behavior. An inverse association was found between the indoor recreation room and physical activity (OR=0.20; 95%CI 0.00 to 0.93) in five-year-old children. The indoor recreation room (OR=1.54; 95%CI 1.35 to 1.77), the playground (OR=2.82; 95%CI 1.14 to 6.96) and the recess (OR=1.54; 95%CI 1.35 to 1.77) are factors that increase the chance of six-year-old schoolchildren to be active.The school infrastructure and environment should be seen as strategies to promote physical activity and reduce sedentary behavior in preschool children.
Project description:BackgroundNew Zealand has relatively high rates of morbidity and mortality from infectious disease compared with other OECD countries, with infectious disease being more prevalent in children compared with others in the population. Consequences of infectious disease in children may have significant economic and social impact beyond the direct effects of the disease on the health of the child; including absence from school, transmission of infectious disease to other pupils, staff, and family members, and time off work for parents/guardians. Reduction of the transmission of infectious disease between children at schools could be an effective way of reducing the community incidence of infectious disease. Alcohol based no-rinse hand sanitisers provide an alternative hand cleaning technology, for which there is some evidence that they may be effective in achieving this. However, very few studies have investigated the effectiveness of hand sanitisers, and importantly, the potential wider economic implications of this intervention have not been established.AimsThe primary objective of this trial is to establish if the provision of hand sanitisers in primary schools in the South Island of New Zealand, in addition to an education session on hand hygiene, reduces the incidence rate of absence episodes due to illness in children. In addition, the trial will establish the cost-effectiveness and conduct a cost-benefit analysis of the intervention in this setting.Methods/designA cluster randomised controlled trial will be undertaken to establish the effectiveness and cost-effectiveness of hand sanitisers. Sixty-eight primary schools will be recruited from three regions in the South Island of New Zealand. The schools will be randomised, within region, to receive hand sanitisers and an education session on hand hygiene, or an education session on hand hygiene alone. Fifty pupils from each school in years 1 to 6 (generally aged from 5 to 11 years) will be randomly selected for detailed follow-up about their illness absences, providing a total of 3400 pupils. In addition, absence information will be collected on all children from the school rolls. Investigators not involved in the running of the trial, outcome assessors, and the statistician will be blinded to the group allocation until the analysis is completed.Trial registrationACTRN12609000478213.
Project description:School refusal is a form of school attendance problem (SAP) distinct from truancy, school withdrawal, and school exclusion; it requires specific mental health care. Schools' identification and referral to care of school refusers depends on school personnel's interpretation of the reasons for absences. Because cultural factors can induce misunderstanding of the young people's behavior and of their parents' attitudes toward school attendance, school personnel can have difficulty understanding these reasons for children with transcultural backgrounds (migrants or children of migrants). The aim of this study was to explore the experiences and opinions of school personnel, mainly teachers, related to school refusal among these students. Grounded theory methodology was used to conduct 52 qualitative interviews of school personnel in two regions of France. Their daily practices with students presenting with school refusal were addressed in general (i.e., in response to absence of all youth) and in transcultural contexts (i.e., absence of migrant children or children of migrants). This study analyzed the interviews of the 30 participants who reported working with students from transcultural backgrounds. Many school personnel reported experiencing difficulties, ambivalence, and destabilizing feelings in situations involving immigrant families whose school culture differed from their own. Talking about culture appeared to be taboo for most participants. These situations challenged the participants' usual strategies and forced them to devise new ones to deal with these young people and their families. Although some personnel were at risk of developing exclusionary attitudes, others dealt with school refusal with both commitment and creativity. The tensions experienced by these participants reveal contradictions between the French universalist ideology and the reality of daily life in schools becoming increasingly multicultural. School personnel's attitudes toward children with transcultural backgrounds presenting with school refusal can affect children's access to care and shape social inequalities. Further research should develop, implement, and assess interventions including transcultural training of school personnel, improved use of interpreters at school for migrant families, and the addition of a transcultural dimension to SAP assessment scales, especially for school refusal.
Project description:IntroductionAsthma is a leading cause of chronic disease-related school absenteeism. Few data exist on how information on absenteeism might be used to identify children for interventions to improve asthma control. This study investigated how asthma-related absenteeism was associated with asthma control, exacerbations, and associated modifiable risk factors using a sample of children from 35 states and the District of Columbia.MethodsThe Behavioral Risk Factor Surveillance System Child Asthma Call-back Survey is a random-digit dial survey designed to assess the health and experiences of children aged 0-17 years with asthma. During 2014-2015, multivariate analyses were conducted using 2006-2010 data to compare children with and without asthma-related absenteeism with respect to clinical, environmental, and financial measures. These analyses controlled for sociodemographic and clinical characteristics.ResultsCompared with children without asthma-related absenteeism, children who missed any school because of asthma were more likely to have not well controlled or very poorly controlled asthma (prevalence ratio=1.50; 95% CI=1.34, 1.69) and visit an emergency department or urgent care center for asthma (prevalence ratio=3.27; 95% CI=2.44, 4.38). Mold in the home and cost as a barrier to asthma-related health care were also significantly associated with asthma-related absenteeism.ConclusionsMissing any school because of asthma is associated with suboptimal asthma control, urgent or emergent asthma-related healthcare utilization, mold in the home, and financial barriers to asthma-related health care. Further understanding of asthma-related absenteeism could establish how to most effectively use absenteeism information as a health status indicator.
Project description:BackgroundViral upper respiratory tract infections have been implicated as a major cause of asthma exacerbations among school-aged children. Regular hand washing is the most effective method to prevent the spread of viral respiratory tract infections, but effective hand-washing practices are difficult to establish in schools.ObjectivesThis randomized controlled trial evaluated whether a standardized regimen of hand washing plus alcohol-based hand sanitizer could reduce asthma exacerbations more than schools' usual hand hygiene practices.MethodsThis was a 2-year, community-based, randomized controlled crossover trial. Schools were randomized to usual care and then intervention (sequence 1) or intervention and then usual care (sequence 2). Intervention schools were provided with alcohol-based hand sanitizer, hand soap, and hand hygiene education. The primary outcome was the proportion of students experiencing an asthma exacerbation each month. Generalized estimating equations were used to model the difference in the marginal rate of exacerbations between sequences while controlling for individual demographic factors and the correlation within each student and between students within each school.ResultsFive hundred twenty-seven students with asthma were enrolled among 31 schools. The hand hygiene intervention did not reduce the number of asthma exacerbations compared with the schools' usual hand hygiene practices (P = .132). There was a strong temporal trend because both sequences experienced fewer exacerbations during year 2 compared with year 1 (P < .001).ConclusionsAlthough the intervention was not found to be effective, the results were confounded by the H1N1 influenza pandemic that resulted in substantially increased hand hygiene behaviors and resources in usual-care schools. Therefore these results should be viewed cautiously.
Project description:The purpose of this study was to explore risk factors related to asthma prevalence among preschool and school-aged children using a representative national dataset from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted from 2009-2011. We evaluated the demographic information, health status, household environment, socioeconomic status, and parents' health status of 3,542 children aged 4-12 years. A sex-stratified multivariate logistic regression was used to obtain adjusted prevalence odds ratios (ORs) and 95% confidence intervals after accounting for primary sample units, stratification, and sample weights. The sex-specific asthma prevalence in the 4- to 12-year-old children was 7.39% in boys and 6.27% in girls. Boys and girls with comorbid atopic dermatitis were more likely to have asthma than those without atopic dermatitis (boys: OR = 2.20, p = 0.0071; girls: OR = 2.33, p = 0.0031). Boys and girls with ≥1 asthmatic parent were more likely to have asthma than those without asthmatic parents (boys: OR = 3.90, p = 0.0006; girls: OR = 3.65, p = 0.0138). As girls got older, the prevalence of asthma decreased (OR = 0.90, p = 0.0408). Girls residing in rural areas were 60% less likely to have asthma than those residing in urban areas (p = 0.0309). Boys with ≥5 family members were more likely to have asthma than those with ≤3 family members (OR = 2.45, p = 0.0323). The factors related to asthma prevalence may differ depending on sex in preschool and school-aged children. By understanding the characteristics of sex-based differences in asthma, individualized asthma management plans may be established clinically.