Gastrointestinal and Respiratory Illness in Children That Do and Do Not Attend Child Day Care Centers: A Cost-of-Illness Study

Background

Gastrointestinal and respiratory diseases are major causes of morbidity for young children, particularly for those children attending child day care centers (DCCs). Although both diseases are presumed to cause considerable societal costs for care and treatment of illness, the extent of these costs, and the difference of these costs between children that do and do not attend such centers, is largely unknown.

Objective

Estimate the societal costs for care and treatment of episodes of gastroenteritis (GE) and influenza-like illness (ILI) experienced by Dutch children that attend a DCC, compared to children that do not attend a DCC.

Methods

A web-based monthly survey was conducted among households with children aged 0–48 months from October 2012 to October 2013. Households filled-in a questionnaire on the incidence of GE and ILI episodes experienced by their child during the past 4 weeks, on the costs related to care and treatment of these episodes, and on DCC arrangements. Costs and incidence were adjusted for socioeconomic characteristics including education level, nationality and monthly income of parents, number of children in the household, gender and age of the child and month of survey conduct.

Results

Children attending a DCC experienced higher rates of GE (aIRR 1.4 [95%CI: 1.2–1.9]) and ILI (aIRR: 1.4 [95%CI: 1.2–1.6]) compared to children not attending a DCC. The societal costs for care and treatment of an episode of GE and ILI experienced by a DCC-attending child were estimated at €215.45 [€115.69–€315.02] and €196.32 [€161.58–€232.74] respectively, twice as high as for a non-DCC-attending child. The DCC-attributable economic burden of GE and ILI for the Netherlands was estimated at €25 million and €72 million per year.

Conclusions

Although children attending a DCC experience only slightly higher rates of GE and ILI compared to children not attending a DCC, the costs involved per episode are substantially higher.     

Comparing pandemic to seasonal influenza mortality: moderate impact overall but high mortality in young children

Background

We assessed the severity of the 2009 influenza pandemic by comparing pandemic mortality to seasonal influenza mortality. However, reported pandemic deaths were laboratory-confirmed – and thus an underestimation – whereas seasonal influenza mortality is often more inclusively estimated. For a valid comparison, our study used the same statistical methodology and data types to estimate pandemic and seasonal influenza mortality.

Methods and Findings

We used data on all-cause mortality (1999–2010, 100% coverage, 16.5 million Dutch population) and influenza-like-illness (ILI) incidence (0.8% coverage). Data was aggregated by week and age category. Using generalized estimating equation regression models, we attributed mortality to influenza by associating mortality with ILI-incidence, while adjusting for annual shifts in association. We also adjusted for respiratory syncytial virus, hot/cold weather, other seasonal factors and autocorrelation. For the 2009 pandemic season, we estimated 612 (range 266–958) influenza-attributed deaths; for seasonal influenza 1,956 (range 0–3,990). 15,845 years-of-life-lost were estimated for the pandemic; for an average seasonal epidemic 17,908. For 0–4 yrs of age the number of influenza-attributed deaths during the pandemic were higher than in any seasonal epidemic; 77 deaths (range 61–93) compared to 16 deaths (range 0–45). The ≥75 yrs of age showed a far below average number of deaths. Using pneumonia/influenza and respiratory/cardiovascular instead of all-cause deaths consistently resulted in relatively low total pandemic mortality, combined with high impact in the youngest age category.

Conclusion

The pandemic had an overall moderate impact on mortality compared to 10 preceding seasonal epidemics, with higher mortality in young children and low mortality in the elderly. This resulted in a total number of pandemic deaths far below the average for seasonal influenza, and a total number of years-of-life-lost somewhat below average. Comparing pandemic and seasonal influenza mortality as in our study will help assessing the worldwide impact of the 2009 pandemic.     

Phytochrome-regulated growth of excised coleoptile tips of Triticum aestivum induced by blue, red and far-red light

The elongation growth of 5-mm tip sections of 3-day-old etiolatedwheat coleoptiles was promoted by light flashes of 436, 650and 750 nm in comparison with the dark control. As short as7/1,000 sec red light (R) of 14,420 W/m² led to saturation ofthe R-induced growth response. At quantum-identical far-redlight (FR) irradiation, a plateau developed at about 9/1,000sec which, however, was interrupted at longer irradiation periods.Varying dark periods between R or FR activation of growth anda second FR flash, a light-independent period with a half-lifeof 45 to 60 sec was found. Only after this light-independentperiod could R or FR activation of growth be reversed by FR.A second light-independent period was found by the followingirradiation schedule: 1 sec R/100 sec darknees(D)/l sec FR/varied D/l sec R. Our experimental conditions enabled us (a) to distinguish betweenactivation and inactivation by FR, (b) to clarify the reactionchain of different phytochrome forms and (c) to determine thehalf-life of light-independent phytochrome reactions.     

Short-term radiorespirometry of cell suspensions

1. An apparatus and method are described with which the oxidation of labelled substrates to (14)CO(2) by cell suspensions may be examined. 2. The use of high-specific-radioactivity substrates at low concentration together with frequent quantitative collection of CO(2) permit a more detailed analysis of the appearance of various substrate carbon atoms as CO(2) than is possible by existing techniques. 3. Typical experiments with various cell types are reported, in which pathways of glucose oxidation are examined.     

Dependence of the detectability of stored growth on the elongation rate in IAA- and acid-induced elongation of wheat coleoptile sections

The detectability of stored growth at various elongation rates(IAA- and acid- induced) was investigated in 5-mm wheat coleoptilesegments. After 20 min turgor reduction by 0.15 M or 0.20 Mmannitol, the detectability of stored growth depended on theelongation rate before turgor reduction. A hypothesis was proposedthat the amount of stored growth is limited. Depending on theelongation rate, this then appears as complete or partial compensationof the growth lost during turgor reduction. The limit for fullcompensation was about 300 µm/hr?segment. At elongationrates of > 600 µm/hr?segment, no stored growth couldbe detected. The elongation of the wheat coleoptile sectionsat low and high elongation rates is assumed to be limited bydifferent rate-determining steps. (Received November 22, 1977; )     

Use of the human hepcidin gene to build a positive-selection vector for periplasmic expression in Escherichia coli

Recombinant proteins are often produced in the periplasm of Escherichia coli because this facilitates the purification process. The oxidizing environment favors the formation of disulfide bridges. We showed that the periplasmic expression of the human hormone hepcidin 25 (Hep25) fused to the maltose-binding protein (MBP) resulted in cell death. This toxicity was not observed when MBP–Hep25 accumulated in the bacterial cytoplasm, or when Hep25 was addressed to the periplasm without the MBP tag. We then modified the periplasmic expression vector pMALp2E to create pMALp2EH, a positive-selection vector with Hep25 as counterselection gene.     

Development of a shuttle vector for screening of strong promoter sequences

A new promoter probe plasmid, pMOL618, has been specifically designed to be selective for strong promoter sequences. The plasmid contains two origins of replication which allow it to replicate both in Bacillus subtilis and Escherichia coli, as well as an indicator gene which also functions in both backgrounds. The plasmid is therefore useful in the screening of promoter sequences in both organisms. The stringency of the promoter selection is demonstrated using a known strong promoter.