title: Day-care centers and diarrhea: a public health perspective.
abstract: OBJECTIVE
  To assess the relation between morbidity from acute diarrhea and the form of day care.
  
  
  METHODS
  The design was a retrospective cohort study. The setting was the city of Espoo, an urban-suburban municipality in southern Finland with a population of 170,000. The study population comprised 2568 randomly selected children aged 1 to 7 years. The main outcome measure was the occurrence of diarrhea.
  
  
  RESULTS
  Children in day-care centers (DCCs) had an increased risk for acute diarrhea compared with children in home care. In the whole group of children in DCCs, the relative risk was 1.20 (95% confidence interval [CI], 1.08 to 1.34). The risk was greatest in 1- and 2-year-old children, for whom the estimated relative risks were 1.76 (95% CI, 1.28 to 2.43) and 1.56 (95% CI, 1.16 to 2.09), respectively. The proportion of diarrhea episodes attributable to DCC care in 1-year-old children was 49% (95% CI, 18% to 91%), in 2-year-old children 37% (95% CI, 11% to 73%), and in the whole group 17% (95% CI, 7% to 29%). The infection risk did not differ between children in home and family care.
  
  
  CONCLUSIONS
  The results provide quantitative evidence that the care in DCCs is a major determinant of acute diarrhea in children, whereas family day care does not increase the infection risk.
authors.affiliation: Department of Public Health, University of Helsinki, Finland.
authors.forename: P J
authors.initials: PJ
authors.lastname: Louhiala
authors.forename: N
authors.initials: N
authors.lastname: Jaakkola
authors.forename: R
authors.initials: R
authors.lastname: Ruotsalainen
authors.forename: J J
authors.initials: JJ
authors.lastname: Jaakkola
mesh_terms: D000208:Acute Disease; D002648:Child; D002654:Child Care / Q000145:classification; D002656:Child Day Care Centers / Q000145:classification; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology*; D005387:Finland / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D009017:Morbidity; D011159:Population Surveillance; D011634:Public Health; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D018881:Suburban Health; D014504:Urban Health