Barros Henrique, Lunet Nuno
Servição de Higiene e Epidemiologia, Faculdade de Medicina do Porto, Porto, Portugal.
Rev Saude Publica. 2003 Oct;37(5):603-8. doi: 10.1590/s0034-89102003000500009. Epub 2003 Oct 9.
To quantify the influence of the type of child-care on the occurrence of acute diarrhea with special emphasis on the effect of children grouping during care.
From October 1998 to January 1999 292 children, aged 24 to 36 months, recruited using a previously assembled cohort of newborns, were evaluated. Information on the type of care and occurrence of diarrhea in the previous year was obtained from parents by telephone interview. The Chi2 and Kruskal-Wallis tests were used to compare proportions and quantitative variables, respectively. The risk of diarrhea was estimated through the calculation of incident odds ratios (OR) and their respective 95% confidence intervals (95% CI), crude and adjusted by unconditional logistic regression.
Using as reference category children cared individually at home, the adjusted ORs for diarrhea occurrence were 3.18, 95% CI [1.49, 6.77] for children cared in group at home, 2.28, 95% CI [0.92, 5.67] for children cared in group in day-care homes and 2.54, 95% CI [1.21, 5.33] for children cared in day-care centers. Children that changed from any other type of child-care setting to child-care centers in the year preceding the study showed a risk even higher (OR 7.65, 95% CI [3.25, 18.02]).
Group care increases the risk of acute diarrhea whatsoever the specific setting.
量化儿童保育类型对急性腹泻发生的影响，特别强调保育期间儿童分组的影响。
对1998年10月至1999年1月招募的292名年龄在24至36个月的儿童进行评估，这些儿童来自先前组建的新生儿队列。通过电话访谈从家长处获取上一年的保育类型和腹泻发生情况的信息。分别使用卡方检验和克鲁斯卡尔-沃利斯检验来比较比例和定量变量。通过计算发病率比值比（OR）及其各自的95%置信区间（95%CI）来估计腹泻风险，包括粗比值比和经无条件逻辑回归调整后的比值比。
以在家单独照料的儿童作为参照组，在家分组照料的儿童发生腹泻的调整后OR为3.18，95%CI[1.49, 6.77]；在日托所分组照料的儿童为2.28，95%CI[0.92, 5.67]；在日托中心照料的儿童为2.54，95%CI[1.21, 5.33]。在研究前一年从任何其他类型的儿童保育环境转变为日托中心的儿童显示出更高的风险（OR 7.65，95%CI[3.25, 18.02]）。
无论具体环境如何，集体照料都会增加急性腹泻的风险。
