title: Understanding of endocarditis risk improves compliance with prophylaxis.
abstract: BACKGROUND
  Congenital heart disease (CHD) is the most common predisposing cause for childhood infective endocarditis (IE), accounting for 80% of cases. Knowledge about the disease and its complications is a key factor in promoting adherence to prophylaxis recommendations.
  
  
  OBJECTIVE
  To assess the level of understanding among caregivers of children with CHD of their disease, risks of IE and attitudes concerning oral health and antibiotic prophylaxis of IE.
  
  
  METHODS
  Caregivers' knowledge was assessed during outpatient visits using a 15-item questionnaire developed for this study. Answers were related to patients' age, cardiac condition and risk of IE and respondents' age and education level.
  
  
  RESULTS
  Of the 97 questionnaires completed, 83 were considered valid. The mean age of patients was 7.7 +/- 5.9 years (range 1 to 24 years). Eleven (13%) patients were at high risk for IE and 30 (36%) at moderate risk. Most respondents (80%) alleged that they knew the patient's cardiac condition but only 37% described it correctly. Twenty-nine respondents (35%) were aware of the risk of IE, while only 13 related that risk to dental procedures. Knowledge of IE risk was associated with respondents' education level (p = 0.03) but not with respondents' age or patients' actual risk of IE. Most respondents (76%) recalled having been advised on oral hygiene measures and declared that their child brushed their teeth at least once a day (92%). Forty-three children (52%) had already been to the dentist and 27 had done so in the previous six-month period. Almost all (42 out of 43) informed the dentist about the child's CHD, but only 20 (48%) reported having received antibiotics before dental procedures. Antibiotic prophylaxis was associated with patients' age (p = 0.04) but not with respondents' education level or actual risk of IE. Being aware of IE risk was significantly associated with better oral hygiene (p = 0.001) and more frequent dental appointments (p = 0.03), independently of education level.
  
  
  CONCLUSIONS
  The results of this survey support the need to reinforce information about risks of IE and prophylaxis recommendations among caregivers of children with CHD.
authors.affiliation: Serviço de Cardiologia Pediátrica, Departamento de Pediatria, Hospital de S. João, Porto. joaobarreira@mail.telepac.pt
authors.forename: João Luís
authors.initials: JL
authors.lastname: Barreira
authors.forename: Maria João
authors.initials: MJ
authors.lastname: Baptista
authors.forename: Jorge
authors.initials: J
authors.lastname: Moreira
authors.forename: Ana
authors.initials: A
authors.lastname: Azevedo
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Areias
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004697:Endocarditis, Bacterial / Q000209:etiology* / Q000517:prevention & control*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006331:Heart Diseases / Q000150:complications* / Q000151:congenital*; D006801:Humans; D007223:Infant; D008297:Male; D010290:Parents; D010349:Patient Compliance; D012307:Risk Factors; D011795:Surveys and Questionnaires