***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective . To study the effect of an educationally oriented intervention programme , with the recommendations from the National Board of Health and Welfare as a base . Design . A prospect i ve intervention study . Setting . Six day-care centres in Växjö , Sweden . Three centres comprised the  intervention group and three constituted the control group .  Subjects and main outcome measures . The parents and personnel completed a question naire on their views concerning information about infectious diseases . During a nine-month period , parents of all children reported every episode of absence , the number of days absent , the cause of absence , and any contact with doctors or prescription of antibiotics . Results . The guidelines were implementable in routine child day-care . Parents found regular information valuable and felt better informed about infectious diseases . Multilevel analyses showed no statistically significant results of the intervention . “ Infection-prone ” children had more sickness absence , doctor 's consultations , and antibiotic prescriptions than those not “ infection-prone ” . Conclusion . It is possible to implement an educationally oriented intervention programme directed against infectious diseases in child day-care . No significant effect of the intervention was found , which is why a larger intervention study is needed The objective of this study was to assess the effectiveness of a hygiene program in reducing the incidence of respiratory and diarrheal diseases in toddlers attending day care centers . A r and omized field trial was conducted in 52 day care centers in Quebec , Canada , between September 1 , 1996 and November 30 , 1997 . Absences for any reasons and the daily occurrence of colds and /or diarrhea in toddlers were recorded on calendars by the educators . The number of fecal coliforms on children 's h and s and on educators ' h and s was measured during three unannounced visits . Overall , 1,729 children were followed in 47 day care centers for a total of 153,643 child-days . The incidence rate of diarrhea was considerably reduced by the effect of monitoring ( IRR = 0.73 , 95 % CI = 0.54,0.97 ) , and the intervention reduced the incidence rate of upper respiratory tract infections ( IRR = 0.80 , 95 % CI = 0.68,0.93 ) . Monitoring alone also had an important effect in reducing the level of bacterial contamination on children 's and educators ' h and s. The results indicate that both an intervention program and monitoring alone play a role in reducing infections in children attending day care centers OBJECTIVE To evaluate the effectiveness of alcohol-based h and rubs ( ABH ) in reducing  acute diarrheal diseases ( ADD ) and acute respiratory infections ( ARI ) among children 1 - 5 years of age in childcare centers with limited tap water . METHODS This was the first cluster-r and omized controlled trial in a developing country . The study took place at 42 childcare centers with sporadic and limited water availability in six towns in Colombia . Participants were r and omly assigned to use ABH as a complement to h and washing ( intervention arm : 21 centers/794 children ) ; or to continue existing h and washing practice s ( control arm : 21 centers/933 children ) . ADD and ARI cases were identified through teacher-reported signs and symptoms of illness . Adverse events were monitored . Hazard ratios ( HR ) were obtained using Cox proportional hazards multivariate regression shared frailty models . RESULTS  Child-days of surveillance totaled 336 038 . Loss to follow up was 14.5 % . For both ADD and ARI , there were no differences in hazard ratios during the first trimester of the study . In the second and third trimesters , significant reductions in the risk of ADD were found in the intervention compared to control arm ( HR = 0.55 , P < 0.001 and HR = 0.44 , P < 0.001 , respectively ) . There were also significant risk reductions for ARI in the second trimester ( HR = 0.80 , P < 0.05 ) and in the third trimester ( HR = 0.69 , P < 0.001 ) . No adverse events occurred . CONCLUSIONS ABH effectively prevent ADD and ARI , and are safe . Colombia 's national public health policies for prevention of these diseases should include use of ABH , especially in setting s where h and washing with soap and water is limited by water availability OBJECTIVE Child care outside the home increases children 's infections substantially . We have to evaluate the possibilities for reducing the transmission of infections by an infection prevention program . DESIGN AND METHODS A 15-month r and omized controlled trial involving 20 day-care centers was conducted to evaluate the efficacy of an  infection prevention program .  The program was introduced in 10 centers and the other matched 10 centers served as controls . Records were made of the occurrence of infections and absences from care or work because of infections among the children , their parents and the personnel of the day-care centers . RESULTS Both the children and the personnel in the program centers had significantly fewer infections than those in the control centers , the reduction being 9 % [ 95 % confidence interval ( 95 % CI ) , 4 to 16 % , P < 0.002 ] among 3-year-old children and 8 % ( 95 % CI 0 to 14 % , P = 0.049 ) among the older children . The children at the program centers received 24 % fewer prescriptions of antimicrobials  ( 95 % CI 22 to 27 % , P < 0.001 ) . Likewise there were 2.5 man-year fewer absences from work on the part of parents because of a child 's illness during 1 year in the program centers , a 24 % difference ( 95 % CI 18 to 29 % , P < 0.001 ) . CONCLUSIONS Effective prevention of infections is possible in child day-care centers , and this can benefit both the families and the personnel . Such a program is cost-effective even if a specialist nurse implements it Background . Acute upper respiratory infections are common in children who attend child care , and preventing transmission of disease in this setting depends on actions by child care staff . We set out to discover whether transmission of respiratory infections in child care could be reduced by improved infection control procedures . Methods . We performed a cluster , r and omized , controlled trial of an infection control intervention conducted in child care centers in 1 city in Australia . The intervention was training of child care staff about transmission of infection , h and washing , and aseptic nosewiping technique . Implementation of the intervention was recorded by an observer . Illness was measured by parent report in telephone interviews every 2 weeks . Results . There were 311 child-years of surveillance for respiratory  symptoms . By multivariable analysis , there was no significant reduction in colds in intervention center children across the full age range . However , a significant reduction in respiratory illness was present in children 24 months of age and younger . When compliance with infection control practice s was high , colds in these children were reduced by 17 % . Conclusions . This trial supports the role of direct transmission of colds in young children in child care . The ability of infection control techniques to reduce episodes of colds in children in child care was limited to children 24 months of age and under Abstract . Background : The occurrence of contagious diseases among children attending day care centers ( DCCs ) is high . The possibility of reducing absences due to infections with an infection prevention program was investigated . Material s and Methods : The intervention study was conducted as an open , controlled cluster study . It included 60 municipal DCCs in one of the seven districts of the City of Helsinki ; 228 DCCs in the other six districts served as controls .  The main indicator was the occurrence of absences due to upper respiratory tract infections , otitis media , eye infection and diarrhea per child-month . Results : The intervention reduced the absences due to infections by 26 % among under 3-year olds , but not among older children . The same phenomenon was observed when similar paired r and om control DCCs were compared with the intervention DCCs . Conclusion : Effective prevention of absences due to infections is possible among under 3-year olds by implementing a simple and inexpensive infection control program 
    Output:
    
A timely and adequate h and hygiene and an appropriate cleaning of the environment have been uniformly recommended by different guidelines as non-specific prevention measures against respiratory infections .