Sample records for center day care

  1. Day Care Centers (United States)

    Department of Homeland Security — This database contains locations of day care centers for 50 states and Washington D.C. and Puerto Rico. The dataset only includes center based day care locations...

  2. Counseling Services in Adult Day Care Centers. (United States)

    Zaki, Gamal; Zaki, Sylvia

    Federal support for adult day care centers began in the United States approximately 10 years ago. To examine the counseling practices in the adult day care centers across the country and to explore how the services are affected by the staffing patterns at these centers, 135 centers completed a questionnaire. The questionnaire addressed…

  3. Evaluation Study of Day-Care Centers in Israel. (United States)

    Korazim, Malka; Trachtenberg, Silvia

    In recent years, day-care centers for the elderly have been playing an increasingly important role in the community service system for the elderly in Israel. ESHEL, one of the leading agencies in developing day-care services in Israel initiated a comprehensive evaluation study of day-care centers to identify variations among different types of…

  4. Screening of Developmental Problem, Day care Centers, Sari, 2006

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    M. Kosaryan, M.D.


    Full Text Available Background and purpose: There has not been enough attention towards the domains of development in pediatrics,so there are many deficiencies in monitoring the achievement of developmental milestones in our country.One of the important ways for the improvement of this problem is to use screening method. PEDS questionnaire is one of the screening tools for development. The aim of this study was to investigate about parents' evaluation of developmental status for their children.Materials and Methods: This was a cross-sectional descriptive study. The population included infants and children under the age of 6 in day care centers of Sari. Sampling method was clustering. The tool for data collection was PEDS questionnaire (Parents' Evaluation of Developmental Status which consisted of 38 questions about demographic data and medical history of children as well as parents' concern about different developmental domains along with ''Yes'' , ''No'' and ''little'' answers. The data were analysed using SPSS11 software. Chi square and Wilcoxon were used. P<0.05 was considered significant.Results: Out of 829 questionnaires, 736 were returned (88.7%. The Sample age was 4.23 ± 1.32 gl . Fifty percent of participants were male. By average, in each developmental domains, 3.2% of parents had major concern and 9.5% had partial concern. The most common domains of concern were communication with others (6.4%, behavior (6.1%, speaking (4.3%, preschool and school education (3.1%, children's understanding (2.5%, the self care (2.1%, the use of fingers (1.4%, the use of legs and arms (1.1%. Parents' concern had a significant relationship with parent's education, residence and history of illness in children (P<0.05. Out of 23.4% of the infants and children who had later returned to the diagnosis center, 80% had behavioral disorder, 87.6% had speech disorder and 16.6% had hearing impairment..Conclusion: A considerable percentage of parents was concerned about developmental

  5. Child Day Care Centers, Day Care Centers in Thomas County, GA, Published in 2010, 1:4800 (1in=400ft) scale, Thomas County BOC. (United States)

    NSGIC GIS Inventory (aka Ramona) — This Child Day Care Centers dataset, published at 1:4800 (1in=400ft) scale, was produced all or in part from Other information as of 2010. It is described as 'Day...


    This data set contains data for CTEPP-OH concerning the potential sources of pollutants at the day care center including the chemicals that have been applied in the past at the day care center by staff members or by commercial contractors. The day care teacher was asked questions...

  7. Child Day Care Centers, Day Care Centers, Published in 2007, 1:2400 (1in=200ft) scale, Iredell County GIS. (United States)

    NSGIC GIS Inventory (aka Ramona) — This Child Day Care Centers dataset, published at 1:2400 (1in=200ft) scale, was produced all or in part from Orthoimagery information as of 2007. It is described as...

  8. Child Day Care Centers, Day Care Center point layer, combined with pre-school points., Published in 2005, 1:4800 (1in=400ft) scale, Reno County. (United States)

    NSGIC GIS Inventory (aka Ramona) — This Child Day Care Centers dataset, published at 1:4800 (1in=400ft) scale, was produced all or in part from Published Reports/Deeds information as of 2005. It is...


    This data collection form is used to identify the potential sources of pollutants at the day care center. The day care teacher is asked questions related to the age of their day care building; age and frequency of cleaning carpets or rugs; types of heating and air conditioning de...

  10. Differences Between Highly Satisfied and Not Highly Satisfied Clients of Day Care Centers. (United States)

    Handler, Ellen; Fredlund, Janet

    This study analyzes the differences between those customers in two types of day care centers who are highly satisfied and who are not. Half were supported by client fees, and half used other sources of funding, e.g. tax support, and private philanthropic support. Parents and teachers of 100 children in day care centers in four different…

  11. Child Day Care Centers, Statewide Day Cares in the LDSS database., Published in 2006, 1:24000 (1in=2000ft) scale, Louisiana State University. (United States)

    NSGIC GIS Inventory (aka Ramona) — This Child Day Care Centers dataset, published at 1:24000 (1in=2000ft) scale as of 2006. It is described as 'Statewide Day Cares in the LDSS database.'. The extent...

  12. Comparison of motor and cognitive performance of children attending public and private day care centers

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    Mariana M. Santos


    Full Text Available BACKGROUND: Given that environmental factors, such as the school environment, can influence child development, more attention should be paid to the development of children attending day care centers. OBJECTIVE: Todetermine whether there are differences in the gross motor, fine motor, or cognitive performances of children between 1 and3 years-old of similar socioeconomic status attending public and private day care centers full time. METHOD: Participants were divided into 2 groups, 1 of children attending public day care centers (69 children and another of children attending private day care centers (47 children. All children were healthy and regularly attended day care full time for over 4 months. To assess cognitive, gross and fine motor performance, the Bayley Scales of Infant and Toddler Development III was used. The Mann-Whitney test was used for comparative analyses between groups of children between 13 and 24 months, 25 and 41 months, and 13 and 41 months. RESULTS: Children in public day care centers exhibited lower scores on the cognitive development scale beginning at 13 months old. The fine and gross motor performance scores were lower in children over the age of 25 months attending public centers. Maternal education was not related to the performance of children in either group. CONCLUSION: The scores of cognitive performance as well as fine and gross motor performance of children of similar socioeconomic status who attend public day care centers are lower than children attending private daycare centers.

  13. Establishing a national research center on day care

    DEFF Research Database (Denmark)

    Ellegaard, Tomas

    The paper presents and discusses the current formation of a national research center on ECEC. The center is currently being established. It is partly funded by the Danish union of early childhood and youth educators. It is based on cooperation between a number of Danish universities and this nati...... current new public management policies. However there is also more conflicting issues that emerge in this enterprise – especially on interests, practice relevance and knowledge paradigms....

  14. Viewpoints of the members of the workers' retirement centers in Tehran about elderly day care centers (2012

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    Hosein Rohani


    Full Text Available Background: There is no documented evidence regarding elderly day care centers in Iran. This needs analysis study was conducted to investigate the demand for elderly day care centers in Tehran. Methods: This cross-sectional study was conducted recruiting 210 participants aged over 60 who were members of the elderly retirement centers in Tehran in 2012. Data were gathered by Kansas state university questionnaire and analyzed using Mann-Whitney and Kruskal-Wallis tests. Results: About 80% of participants were men with the mean age of 67.5±5.23 years. Results showed that male (P<0.001, married (P=0.01 and literate elderly (P<0.001, and those living in rental homes (P<0.001 expressed a greater need for elderly day care centers. There was no statistically significant relationship between the lifestyle (P=0.051 and income (P=0.08 of the participants and demand for elderly day care centers. Conclusion: Given the rising population of the elderly and their high demand for day care centers, it is necessary to establish well-equipped day care centers for this group of people. Also, these centers may reduce the burden of care for the aged people on public services and family care givers.

  15. Factors Related to Depression among Higher Income Mothers with Young Children in Day Care Centers. (United States)

    Fagan, Jay


    Examined the association between maternal depression, maternal separation anxiety, social support, and maternal involvement in the day-care center among 54 upper-income mothers and their infants. Found that higher levels of maternal involvement in day care were associated with lower levels of maternal depression. (MDM)

  16. 7 CFR 226.19a - Adult day care center provisions. (United States)


    ... beneficiaries. Menus and any other nutritional records required by the State agency shall be maintained to... day care centers shall have Federal, State or local licensing or approval to provide day care services... participate in the Program during the renewal process, unless the State agency has information which...

  17. [Policies and standards applied to municipal day care centers in Rio de Janeiro]. (United States)

    de Vasconcelos, Rafaela Moledo; Tancredi, Rinaldini Coralini Philippo; Marin, Victor Augustus


    Day care centers were first established in Brazil with the aim of reducing infant mortality rates, however the incidence of foodborne disease transmission has been on the increase. The World Health Organization (WHO) estimates that each year 1.8 million deaths worldwide occur in children under 5 years of age, which is attributed to the consumption of contaminated food. However, Brazilian legislation does not provide specific rules of operation for day care center kitchens. Thus, the scope of this study is to research the standards relating to the operation of day care centers, discussing the health regulations related to food production. By means of a review of electronic pages of various government organs, the regulations inherent to the operation and production of food in day care centers were examined. After scrutiny of the twenty-seven pieces of legislation found, there is a concern with water quality, supply of food, the control of pests and vectors, structural conditions and food policies. In spite of this, it was seen that not all the surveillance policies for the quality of food offered in day care centers are effective. Also observed was the lack of a specific regulation that establishes the quality criteria for safe handling of food in day care centers.

  18. Child Day Care Centers, Day_care_preschool_providers, Published in 2008, 1:600 (1in=50ft) scale, Buffalo County. (United States)

    NSGIC GIS Inventory (aka Ramona) — This Child Day Care Centers dataset, published at 1:600 (1in=50ft) scale, was produced all or in part from Orthoimagery information as of 2008. It is described as...

  19. Ventilation, indoor air quality, and human health and comfort in dwellings and day-care centers

    Energy Technology Data Exchange (ETDEWEB)

    Ruotsalainen, R.


    The objective of the study was to assess the actual ventilation and indoor air quality in the Finnish building stock (dwellings and day-care centers) with special reference to the existing guideline values. Furthermore, the objective was to evaluate the occurrence of symptoms and perceptions among occupants (adult residents, children, workers) in relation to ventilation system, ventilation rate and dampness. The measurements of ventilation and indoor air quality in the dwellings and day-care centers included ventilation rate, CO{sub 2} concentration, and temperature and humidity. Self- and parent-administered questionnaires were distributed to the occupants inquiring their personal characteristics, occurrence of symptoms of interest, perceived indoor air quality and details of their home and work environments. Airflows and air change rates varied remarkably both in the dwellings and day-care centers. In the majority of the dwellings and day-care centers, the Finnish guideline values of ventilation rates were not achieved. No consistent associations were observed between the magnitude of mechanical ventilation rates and the occurrence of eye, respiratory, skin and general symptoms, that is, symptoms of sick building syndrome (SBS) among the day-care workers. The results indicate that there is much room for improvement in the ventilation and indoor air quality of Finnish dwellings and day-care centers. The control of ventilation, temperature and humidity and the prevention of water damage are important issues on which to concentrate in the future. There is need to improve the quality in all phases of construction: design, installation, adjustment, operation, and maintenance

  20. A longitudinal study of enterobiasis in three day care centers of Havana City. (United States)

    Núñez, F A; Hernández, M; Finlay, C M


    Pinworm infection was prospectively studied during one year in 469 children attending three day care centers. Each child was examined at six months intervals using up to three perianal swabs with adhesive tape. Those found infected were treated with mebendazole. At the beginning of the study we found a prevalence of 28% that dropped to 13% and 12% in the following study periods. The reinfection rate was twice the incidence rate in both study periods. We also found a small percentage (10%) of the children reinfected in most or all study periods. There was a high correlation between reinfection and perianal itching. Our results add further knowledge to the epidemiology of intestinal parasites in day care centers.

  1. Intestinal Parasites Prevalence in Children from Day Care Centers in Sinop City-MT

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    B. Muchiutti


    Full Text Available Abstract: The aim of this study was to investigate the intestinal parasitosis prevalence of children from municipal day care centers in Sinop MT. Respecting ethical principles established by Resolution 196/96 of Health National Council/Ministry of Health of quantitative research, the anonymity of participants, as well accept and signature of parents of the Term of Free and Enlightened Consent were performed. Between Junes to October 2012 were applied coproparasitological methods for investigation. Fecal samples were analyzed by Hoffmans methods. From 103 students examined observed the prevalence rate of 19.42% of intestinal parasites. The intestinal parasites with highest prevalence rate were: Giardia lamblia (9.70% and Endolimax nana (5.82%. The results of this study demonstrate the need for sensitization of the population front of diagnosis importance, treatment and monitoring of positive cases and the necessity of more health professionals attention, especially with children.Key-words: Intestinal parasites, day care centers, children.

  2. Goodness-of-Fit in Center Day Care: Relations of Temperament, Stability, and Quality of Care with the Child's Adjustment (United States)

    De Schipper, J. Clasien; Tavecchio, Louis W. C.; Van IJzendoorn, Marinus H.; Van Zeijl, Jantien


    In this study, the concept of "goodness-of-fit" between the child's temperament and the environment, introduced by Thomas and Chess [Temperament and Development, Brunner/Mazel, New York, 1977], is applied within the setting of center day care. Mothers and primary professional caregivers of 186 children, aged 6-30 months, participated in this…

  3. Management of a Trichophyton tonsurans outbreak in a day-care center. (United States)

    Gray, Robert M; Champagne, Caroline; Waghorn, David; Ong, Eugene; Grabczynska, Sophie A; Morris, Jill


    Trichophyton tonsurans is the leading cause of tinea capitis in the United Kingdom (UK) as well as causing tinea corporis. This organism has been linked to several outbreaks in the UK and abroad, and such outbreaks may be prolonged since T. tonsurans can be difficult to control. There remains an incomplete consensus in the literature on the optimal management of such outbreaks of this infection. Following notification that a child with T. tonsurans was identified at a day-care center in the UK, initial investigations identified nine cases of fungal infection involving children and staff over the previous 7 months. We report on the management of an outbreak of T. tonsurans tinea capitis and tinea corporis among children and staff in a day-care center. An outbreak control team with representatives from dermatology, microbiology, day-care center management, and the Health Protection Agency initiated case ascertainment by scalp inspection and brushing of all children and staff at the nursery. Two complete rounds of screening were required before the outbreak was declared over. Infection control measures included antifungal shampoo use, exclusion of identified cases for a short period, removal of shared items from the center, and enhanced decontamination of fomites. The outbreak, which lasted longer than 12 months, involved 12 children and 7 staff members. Of these, 12 cases were confirmed by positive fungal culture. T. tonsurans is difficult to manage, especially in childcare settings, but case ascertainment, appropriate treatment with oral agents, and sustained infection control measures can be effective in controlling such outbreaks.

  4. Dientamoeba fragilis - a Commensal in Children in Danish Day Care Centers

    DEFF Research Database (Denmark)

    Jokelainen, Pikka; Hebbelstrup Jensen, Betina; Andreassen, Bente Utoft


    Dientamoeba fragilis is an intestinal protozoan of debated clinical significance. Here, we present cross-sectional and longitudinal observations on D. fragilis in children aged 0-6 years from a 1-year multi-day-care-center cohort study set in Copenhagen, Denmark. The inclusion period for the cohort...... factors (age, gender, having siblings, having domestic animals at home, having had infant colic, recent history of intake of antibiotics, and recent history of travel abroad) as well as six reported symptoms (lack of appetite, nausea, vomiting, abdominal pain, weight loss, and diarrhea) and testing...

  5. Consumption of industrialized food by infants attending child day care centers

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    Maysa Helena de A. Toloni


    Full Text Available Objective: To identify the age of introduction of petit suisse cheese and instant noodles in the diet of infants attending nurseries of public day care centers and to compare the nutritional composition of these foods with the healthy recommended diet (breast milk and salt meal for this age, in order to estimate nutritional errors. Methods: Cross-sectional study of 366 children (from nine to 36 months old who attended day care centers, whose mothers were interviewed about the age of introduction of those foods. The means of the nutrients indicated on the labels of the most consumed brands were considered. For the calculation of the percent composition of breast milk and salt meal, Tables of Food Composition were used. To assess the nutritional adequacy, we used the Dietary Reference Intakes by age group. The percentage of adequacy evaluation of the petit suisse cheese and the instant noodles nutritional compositions was made by comparing them with those of the human milk and the salt meal, respectively. Results: The petit suisse cheese and the instant noodles were consumed by 89.6 and 65.3% of the children in the first year of life. The percentages of adequacy for carbohydrates were more than twice and the percentages for sodium were 20 times higher than those found in the recommended foods. Conclusions: Both industrialized products are inappropriate for infants, emphasizing the need for adoption of norms that can inform health professionals, educators and parents about the risks of consumption.

  6. Home-Type Activities at the Day Care Center. (Tipos De Actividades Del Hogar En El Centro De Cuidado Diario.) (United States)

    Aaronson, May; Moberg, Patricia E.

    This paper argues that home activities comprise a valuable unplanned curriculum and that many of these activities can be transferred to the day care center. It is suggested that these activities foster a closer relationship between child and caregiver and bridge the gap between familiar home environment and novel day care setting. Home activities…

  7. Child Day Care Centers, Published in 2008, 1:1200 (1in=100ft) scale, Brown County, WI. (United States)

    NSGIC GIS Inventory (aka Ramona) — This Child Day Care Centers dataset, published at 1:1200 (1in=100ft) scale, was produced all or in part from Published Reports/Deeds information as of 2008. Data by...

  8. The KIzSS network, a sentinel surveillance system for infectious diseases in day care centers: study protocol

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    Enserink Remko


    Full Text Available Abstract Background Day care-associated infectious diseases are widely recognized as a public health problem but rarely studied. Insights into their dynamics and their association with the day care setting are important for effective decision making in management of infectious disease control. This paper describes the purpose, design and potential of our national multi-center, day care-based sentinel surveillance network for infectious diseases (the KIzSS network. The aim of the KIzSS network is to acquire a long-term insight into the syndromic and microbiological aspects of day care-related infectious diseases and associated disease burden and to model these aspects with day care setting characteristics. Methods/design The KIzSS network applies a prospective cohort design, following day care centers rather than individual children or staff members over time. Data on infectious disease symptoms and related morbidity (children and staff, medical consumption, absenteeism and circulating enteric pathogens (children are collected on a daily, weekly or monthly basis. Every two years, a survey is performed to assess the characteristics of participating day care centers. Discussion The KIzSS network offers a unique potential to study infectious disease dynamics in the day care setting over a sustained period of time. The created (biodatabases will help us to assess day care-related disease burden of infectious diseases among attending children and staff and their relation with the day care setting. This will support the much needed development of evidence-based and pragmatic guidelines for infectious disease control in day care centers.

  9. Relationships of oral habits, oral status and lisping among children in day-care centers of Tehran, Iran


    Soudabeh Noori; Jalil Kooh Paiehzadeh; Ramin Mozafari Kermani; Mohammadreza Nateghi


    Background and Aim: Oral habits have hazardous effects on children's speech which are sometimes irreversible and permanent. This study was planned to assess these oral habits among children in day-care centers of Tehran, Iran.Methods: In this descriptive, cross-sectional study, 400 children were selected through multistage sampling from 16 day-care centers in Tehran, Iran, They were 24 to 72-month old. Bottle feeding, pacifier usage and digit sucking were determined. After interviewing parent...

  10. Detection of anti-Giardia lamblia serum antibody among children of day care centers

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    Guimarães Semíramis


    Full Text Available OBJETIVES: To detect anti-Giardia lamblia serum antibodies in healthy children attending public day care centers and to assess serological tests as tools for estimating the prevalence of G. lamblia in endemic areas. METHODS: Three separate stool specimens and filter paper blood samples were collected from 147 children ranging from 0 to 6 years old. Each stool sample was processed using spontaneous sedimentation and zinc sulfate flotation methods. Blood samples were tested by indirect immunofluorescence (IIF and enzyme-linked immunosorbent assay (ELISA for Giardia IgG. RESULTS AND CONCLUSIONS: Of 147 individuals tested, 93 (63.3% showed Giardia cysts in their feces. Using IIF and ELISA, serum antibodies were detected in 93 (63.3% and 100 (68% samples , respectively. Sensitivity of IIF and ELISA was 82% and 72%, respectively. However, ELISA revealed to be less specific (39% than IIF (70%. IIF also showed a higher concordance with microscopic examination than ELISA.

  11. Detection of anti-Giardia lamblia serum antibody among children of day care centers

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    Semíramis Guimarães


    Full Text Available OBJETIVES: To detect anti-Giardia lamblia serum antibodies in healthy children attending public day care centers and to assess serological tests as tools for estimating the prevalence of G. lamblia in endemic areas. METHODS: Three separate stool specimens and filter paper blood samples were collected from 147 children ranging from 0 to 6 years old. Each stool sample was processed using spontaneous sedimentation and zinc sulfate flotation methods. Blood samples were tested by indirect immunofluorescence (IIF and enzyme-linked immunosorbent assay (ELISA for Giardia IgG. RESULTS AND CONCLUSIONS: Of 147 individuals tested, 93 (63.3% showed Giardia cysts in their feces. Using IIF and ELISA, serum antibodies were detected in 93 (63.3% and 100 (68% samples , respectively. Sensitivity of IIF and ELISA was 82% and 72%, respectively. However, ELISA revealed to be less specific (39% than IIF (70%. IIF also showed a higher concordance with microscopic examination than ELISA.

  12. Ventilation in day care centers and sick leave among nursery children. (United States)

    Kolarik, B; Andersen, Z Jovanovic; Ibfelt, T; Engelund, E Hoj; Møller, E; Bräuner, E Vaclavik


    Several studies have reported poor indoor air quality (IAQ) in day care centers (DCCs), and other studies have shown that children attending them have an increased risk of respiratory and gastrointestinal infections. The aim of this study was to investigate whether there is an association between ventilation in DCCs and sick leave among nursery children. Data on child sick leave within an 11-week period were obtained for 635 children attending 20 DCCs. Ventilation measurements included three proxies of ventilation: air exchange rate (ACR) measured with the decay method, ACR measured by the perfluorocarbon tracer gas (PFT) method, and CO2 concentration measured over a 1-week period. All but two DCCs had balanced mechanical ventilation system, which could explain the low CO2 levels measured. The mean concentration of CO2 was 643 ppm, exceeding 1000 ppm in only one DCC. A statistically significant inverse relationship between the number of sick days and ACR measured with the decay method was found for crude and adjusted analysis, with a 12% decrease in number of sick days per hour increase in ACR measured with the decay method. This study suggests a relationship between sick leave among nursery children and ventilation in DCCs, as measured with the decay method.

  13. "Prevalence of Intestinal Parasites among Children in Day-care Centers in Damghan - Iran"

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    A Heidari


    Full Text Available In order to identify the prevalence of parasitic intestinal infections and to determine the impact of some factors, such as age, health houses, education, environmental health etc, on infection, this survey was carried out on 461 stool specimens and scotch tapes obtained from children resident in day-care centers in Damghan city, Semnan province, Iran. The samples were tested using formalin-ether concentration and Graham methods. The analysis of the results showed that at least 68.1 percent of the individuals tested, were infected with one species of pathogen or non-pathogen parasites. The rate of infection for Enterobius vermicularis, Giardia lamblia, Entamoeba histolytica, Ascaris lumbricoides, Hymenolepis nana, Entamoeba coli, Blastocystis hominis, Iodamoeba butschlii and Chilomastix mesnili was 33.8%, 26.2%, 2.4%, 3%, 4.8%, 5.8%, 4.8%, 2.7% and 4% respectively. A significant difference was seen between the rate of infection and parents’ education (P<0.005 but was negative regarding age, sex, and health houses. It is concluded that sanitary measurements should be conducted in such centers to decrease the rate of parasitic infection.

  14. Practice versus politics in Danish day-care centers: how to bridge the gap?

    DEFF Research Database (Denmark)

    Clasen, Line; Jensen de López, Kristine M.


    It is essential that early educators in day-care services possess adequate pedagogical tools for supporting children’s communicative development. Early literacy programmes (ELPs) are potential tools. However, studies investigating the effects of ELPs seldom address implementation processes...

  15. EURISWEB – Web-based epidemiological surveillance of antibiotic-resistant pneumococci in Day Care Centers

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    Sanches Ilda Santos


    Full Text Available Abstract Background EURIS (European Resistance Intervention Study was launched as a multinational study in September of 2000 to identify the multitude of complex risk factors that contribute to the high carriage rate of drug resistant Streptococcus pneumoniae strains in children attending Day Care Centers in several European countries. Access to the very large number of data required the development of a web-based infrastructure – EURISWEB – that includes a relational online database, coupled with a query system for data retrieval, and allows integrative storage of demographic, clinical and molecular biology data generated in EURIS. Methods All components of the system were developed using open source programming tools: data storage management was supported by PostgreSQL, and the hypertext preprocessor to generate the web pages was implemented using PHP. The query system is based on a software agent running in the background specifically developed for EURIS. Results The website currently contains data related to 13,500 nasopharyngeal samples and over one million measures taken from 5,250 individual children, as well as over one thousand pre-made and user-made queries aggregated into several reports, approximately. It is presently in use by participating researchers from three countries (Iceland, Portugal and Sweden. Conclusion An operational model centered on a PHP engine builds the interface between the user and the database automatically, allowing an easy maintenance of the system. The query system is also sufficiently adaptable to allow the integration of several advanced data analysis procedures far more demanding than simple queries, eventually including artificial intelligence predictive models.

  16. Prevalence of overweight preschool children in public day care centers: a cross-sectional study

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    Viviane Gabriela Nascimento

    Full Text Available CONTEXT AND OBJECTIVE: Brazil is undergoing a period of epidemiological transition associated with demographic and nutritional changes. The prevalence of obesity is also increasing in children and is causing numerous health problems that are becoming public health issues. The aim here was to evaluate the prevalence of overweight among children of two and three years of age. DESIGN AND SETTING: Cross-sectional study in municipal day care centers in Taubaté, state of São Paulo, Brazil. METHODS: Weight and height measurements were made on 447 preschool children forming a probabilistic randomized sample. Their body mass index (BMI was calculated. Their nutritional status was classified using the World Health Organization reference cutoff points (2006. Their mean weight, height and BMI were compared according to their age and sex. RESULTS: The mean values for the final sample (n = 447 were as follows: mean age: 38.6 months (± 3.5 and Z scores for: weight/height (W/H: 0.50 (± 1.22; height/age: -0.03 (± 1.07; weight/age (W/A: 0.51 (± 1.23; and BMI: 0.51(± 1.23. The prevalence of overweight children (BMI > 1 z was 28.86%, while the prevalence of underweight children (BMI < -2 z was 0.89%. There were no differences in mean BMI among the two and three-year age groups (P = 0.66. CONCLUSION: A high prevalence of overweight was observed in the sample of two and three-year-old children, with practically no malnutrition, thus showing that a significant nutritional transition may already be occurring, even in medium-sized cities of developing countries.

  17. Malaysia's First Day Care Center for Children with Disabilities: Future Needs in Research in Early Intervention. (United States)

    Bhagwanji, Yash

    This paper describes the development and implementation of the first private nonprofit day care program serving children with disabilities in Malaysia. Preliminary information describes Malaysia's economic, ethnic, and cultural situation. The naturalistic inquiry approach used to prepare this report, involving interviews and observations, is then…

  18. A hand hygiene intervention to decrease infections among children attending day care centers: Design of a cluster randomized controlled trial

    NARCIS (Netherlands)

    T.P. Zomer (Tizza); V. Erasmus (Vicky); N. Vlaar (Nico); E.F. van Beeck (Ed); A. Tjon-A-Tsien (Aimée); J.H. Richardus (Jan Hendrik); H.A.C.M. Voeten (Hélène)


    textabstractBackground: Day care center attendance has been recognized as a risk factor for acquiring gastrointestinal and respiratory infections, which can be prevented with adequate hand hygiene (HH). Based on previous studies on environmental and sociocognitive determinants of caregivers' complia

  19. Sociocognitive determinants of observed and self-reported compliance to hand hygiene guidelines in child day care centers

    NARCIS (Netherlands)

    Zomer, T.P.; Erasmus, V.; Empelen, P. van; Looman, C.; Beeck, E.F. van; Tjon-A-Tsien, A.; Richardus, J.H.; Voeten, H.A.C.M.


    Background: Although hand hygiene (HH) has proven to be an effective measure to prevent infections, HH compliance is generally low. We assessed sociocognitive determinants of caregivers' HH behavior in child day care centers (DCCs) to develop an effective HH intervention. Methods: Caregivers' compli

  20. Effects of Experimentally Imposed Noise on Task Performance of Black Children Attending Day Care Centers Near Elevated Subway Trains. (United States)

    Hambrick-Dixon, Priscilla Janet


    Investigates whether an experimentally imposed 80dB (A) noise affected psychomotor, serial memory words and pictures, incidental memory, visual recall, paired associates, perceptual learning, and coding performance of five-year-old Black children attending day care centers near and far from elevated subways. (HOD)

  1. Media-Educational Habitus of Future Educators in the Context of Education in Day-Care Centers (United States)

    Friedrichs-Liesenkötter, Henrike


    This research explores these questions: (1) How are the forms of media-educational habitus of future educators shaped? (2) What conditions influence whether or not media education is done in day-care centers? The qualitative study consists of six semi-structured interviews with media education teachers in educator training, four focus group…

  2. Using the Infant/Toddler Environment Rating Scale for examining the quality of care for infants and toddlers in Norwegian day care centers

    Directory of Open Access Journals (Sweden)

    Anne-Grethe Baustad


    Full Text Available Abstract: The purpose of the presented study is to explore whether ITERS-R is an appropriate tool to use for examining the quality of care for infants and toddlers in Norwegian day care centers. The study is based on a pedagogical perspective of quality, a perspective which takes into account that it is possible both to define and assess the quality in day care centers. This study indicates that ITERS-R can be an appropriate tool to use in examining pedagogical quality in Norwegian day care centers, and especially the concept of process quality. The fit between the values and goals given in the Norwegian Framework Plan and the areas and quality indicators in the ITERS-R is also good; even if there are differences which need to be dealt with. The results are interpreted and discussed within the Norwegian day care center context and the values and goals of Norwegian day care centers. The following four interacting and interdependent dimensions of pedagogical quality made the basis for the discussion: those of the society, the child, the staff (teacher/ teachers and the learning context (Sheridan, 2007, 2009.

  3. A Study to Determine the Needs for Standards in Army Day Care Centers. (United States)


    child care centers was formalized. At this time Friedrich Froebel , in his book the Education of Man brought out the importance of the early training of...children. According to Froebel , It is highly pernicious to consider the stages of human development - infant, child, boy or girl, youth or maiden, man...being) is seen but vaguely in the idea and word, and scarcely at all considered in life and for life. (46:99) Ia Froebel is known as the "father of the

  4. An evaluation of lead contamination in plastic toys collected from day care centers in the Las Vegas Valley, Nevada, USA. (United States)

    Greenway, Joseph A; Gerstenberger, Shawn


    Childhood exposure to environmental lead continues to be a major health concern. This study examined lead content within the plastic of children's toys collected from licensed day care centers in the Las Vegas valley, Nevada. It was hypothesized that the use of lead as a plastics stabilizer would result in elevated lead (≥600 ppm) in polyvinyl chloride plastics (PVC) compared to non-PVC plastics. It was also hypothesized that, due to the use of lead chromate as a coloring agent, yellow toys would contain higher concentrations of lead (≥600 ppm) than toys of other colors. Toy samples were limited to those found in day care centers in Las Vegas, Nevada. 10 day care centers were visited and approximately 50 toy samples were taken from each center. Of the 535 toys tested, 29 contained lead in excess of 600 parts per million (ppm). Of those 29 toys, 20 were PVC and 17 were yellow. Both of the two hypotheses were strongly supported by the data.

  5. Child Day Care Centers, Child Day Cares as provided by the Department of Children and Family in Miami-Dade - points, Published in 2012, 1:600 (1in=50ft) scale, Miami-Dade County, Information Technology Department. (United States)

    NSGIC GIS Inventory (aka Ramona) — This Child Day Care Centers dataset, published at 1:600 (1in=50ft) scale, was produced all or in part from Other information as of 2012. It is described as 'Child...

  6. Diversity and Adaptation of Human Respiratory Syncytial Virus Genotypes Circulating in Two Distinct Communities: Public Hospital and Day Care Center

    Directory of Open Access Journals (Sweden)

    Gustavo Rocha Garcia


    Full Text Available HRSV is one of the most important pathogens causing acute respiratory tract diseases as bronchiolitis and pneumonia among infants. HRSV was isolated from two distinct communities, a public day care center and a public hospital in São José do Rio Preto – SP, Brazil. We obtained partial sequences from G gene that were used on phylogenetic and selection pressure analysis. HRSV accounted for 29% of respiratory infections in hospitalized children and 7.7% in day care center children. On phylogenetic analysis of 60 HRSV strains, 48 (80% clustered within or adjacent to the GA1 genotype; GA5, NA1, NA2, BA-IV and SAB1 were also observed. SJRP GA1 strains presented variations among deduced amino acids composition and lost the potential O-glycosilation site at amino acid position 295, nevertheless this resulted in an insertion of two potential O-glycosilation sites at positions 296 and 297. Furthermore, a potential O-glycosilation site insertion, at position 293, was only observed for hospital strains. Using SLAC and MEME methods, only amino acid 274 was identified to be under positive selection. This is the first report on HRSV circulation and genotypes classification derived from a day care center community in Brazil.

  7. Quality of post arrest care does not differ by time of day at a specialized resuscitation center. (United States)

    Uray, Thomas; Sterz, Fritz; Weiser, Christoph; Schreiber, Wolfgang; Spiel, Alexander; Schober, Andreas; Stratil, Peter; Mayr, Florian B


    Previous studies suggest worse outcomes after out-of-hospital cardiac arrest (OHCA) at night. We analyzed whether patients admitted after nontraumatic OHCA to a resuscitation center received the same quality post arrest care at day and night and whether quality of care affected clinical outcomes. We analyzed data of OHCA patients with return of spontaneous circulation admitted to the Vienna general hospital emergency department between January 2006 and May 2013. Data reported include admission time (day defined from 8 AM to 4 PM based on staffing), time to initiation of hypothermia, and door-to-balloon time in patients with ST-elevation myocardial infarction. Survival and cognitive performance at 12 months were assessed. In this retrospective observational study, 1059 patients (74% males, n = 784) with a mean age of 58 ± 16 years were analyzed. The vast majority was treated with induced hypothermia (77% of day vs. 79% of night admissions, P = 0.32) within 1 hour of admission (median time admission to cooling 27 (confidence interval [CI]: 10-60) vs. 23 (CI: 11-59) minutes day vs. night, P = 0.99). In 298 patients with ST-elevation myocardial infarction, median door-to-balloon time did not differ between day and night admissions (82 minutes, CI: 60 to 142 for day vs. 86 minutes, CI: 50 to 135 for night, P = 0.36). At 12 months, survival was recorded in 238 of 490 day and 275 of 569 night admissions (49% vs. 48%, P = 0.94%), and a good neurologic outcome was recorded in 210 of 490 day and 231 of 569 night admissions (43% vs. 41%, P = 0.46). Patients admitted to our department after OHCA were equally likely to receive timely high-quality postresuscitation care irrespective of time of day. Survival and good neurologic outcome at 12 months did not differ between day and night admissions. Our results may support the concept of specialized post arrest care centers.

  8. Introduction of soft drinks and processed juice in the diet of infants attending public day care centers

    Directory of Open Access Journals (Sweden)

    Giovana Longo-Silva


    Full Text Available OBJECTIVE: Identifying at what age infants enrolled in public day care centers are introduced to soft drinks and industrialized juice, as well as comparing the nutritional composition of these goods with natural fruit juice. METHODS: A cross-sectional study with the mothers of 636 children (aged 0 to 36 months from nurseries of day care centers, who were asked questions about the age of feeding introduction. This study evaluated the proximate composition of soft drinks and artificial juice, comparing them with those of natural fruit juice regarding energy, sugar, fiber, vitamin C, and sodium values. The chemical composition of fruit juice was obtained by consulting the Table of Food Composition and, for industrialized drinks, the average nutritional information on the labels of the five most consumed product brands. RESULTS: The artificial drinks were consumed before the first year of life by more than half of the children studied, however, approximately 10% consumed them before the age of 6 months. With regard to the comparison among the drinks, artificial fruit juice beverages and soft drinks proved to contain from nine to 13 times higher amounts of sodium, and 15 times less vitamin C than natural juices. CONCLUSIONS: The introduction of soft drinks and industrialized juice in the diet of infants was inopportune and premature.. When compared to natural fruit juice, these have inferior nutritional composition, which suggests the urgent need for measures based on strategies for food and nutrition education in order to promote awareness and the maintenance of healthy eating habits.

  9. An outbreak of gastroenteritis associated with astrovirus serotype 1 in a day care center, in Rio de Janeiro, Brazil

    Directory of Open Access Journals (Sweden)

    AMV Silva


    Full Text Available Between June 4th and June 20th1996 rotavirus, adenovirus, and astrovirus (HAstrV were investigated in fecal samples from 27 children under three years old with acute diarrhea, attending the Bertha Lutz day care center, in Rio de Janeiro. All fecal samples were analyzed by polyacrylamide gel electrophoresis (PAGE, reverse transcriptase polymerase chain reaction (RT-PCR, enzyme immunoassays (EIA, and electron microscopy (EM. Nine of them (33% showed positive results for HAstrV by at least one of the employed methodologies. Eight were positive by RT-PCR and EIA, and six by EM. All positive samples were inoculated onto HT-29 (human colon adenocarcinoma cultured cells for HAstrV isolation and seven were positive after three passages. The sequencing analysis of eight RT-PCR products (449 bp from gene that codifies VP2 protein, showed a total nucleotide identity among them and 98% with HAstrV-1 (strain Oxford type 1. This is the first report of a gastroenteritis outbreak associated with HAstrv-1 in a day care center in Rio de Janeiro and it reinforces the importance of this virus in association with infantile acute gastroenteritis.

  10. Relationships of oral habits, oral status and lisping among children in day-care centers of Tehran, Iran

    Directory of Open Access Journals (Sweden)

    Soudabeh Noori


    Full Text Available Background and Aim: Oral habits have hazardous effects on children's speech which are sometimes irreversible and permanent. This study was planned to assess these oral habits among children in day-care centers of Tehran, Iran.Methods: In this descriptive, cross-sectional study, 400 children were selected through multistage sampling from 16 day-care centers in Tehran, Iran, They were 24 to 72-month old. Bottle feeding, pacifier usage and digit sucking were determined. After interviewing parents, oral examination [using Paediatric oral skills package (POSO] and doing standard Phonetic test, a questionnaire was completed for each child.Results: Sixty eight had one oral habit. The most prevalent habit was digit sucking (52.9%. The prevalence of bottle feeding, both digit sucking with bottle feeding, and pacifier habit were 38.2%, 7.3% and 1.4%, respectively. There were significant relationship between digit sucking and malocclusion (p<0.001, r=0.4 and hard palate malformationand (p<0.001, r=0.39. Besides, a significant relationship between bottle feeding and  malocclusion (p<0.001, r=0.25 was conduted. Digit sucking had significant relationship with lisping, too (p<0.001, r=0.37. There was no gender priority in oral habits.Conclusion: Oral habits cause permanent structural conversion in speech producing and oral status.

  11. Prevalence of Pharyngeal Pneumococcal Carriers and Succeptibility Patterns among Children of Day Care Centers in Yazd District,Iran

    Directory of Open Access Journals (Sweden)

    M Mohammad - Zadeh


    Full Text Available Introduction: Streptococcus pneumoniae is one of the most important causes of pneumonia, meningitis and septicemia. Decades after successful treatment of this infection with penicillin, frequency of penicillin resistance is reportedly on the rise throughout the world. This cross sectional study was designed in Yazd to determine the prevalence of pneumococcal pharyngeal carriers and its succeptibility pattern in children of day care centers. Method & materials : Two hundred children were selected randomly from 10 day care centers and pharyngeal swabs were collected and cultured in February, 2002. Results :51% of our study sample were boys and 49% were girls. Their age range was between 7 and 65 months. Prevalence of pharyngeal carriers was 37.5%. The rate of resistance detected was as follows: 50% to penicillin, 62.5% to erythromycin and TMP,SMX, 30.6% to tetracycline, 15.3 % to cephalothin, 5.6% to ceftizoxime and 4.2% to ciprofloxacin. Conclusion: We conclude that penicillin is not the drug of choice in invasive pneumococcal infections in Yazd and a third gereration cephalosporin should be used instead as the first line of treatment while awaiting the culture and sensitivity results.

  12. Introduction of soft drinks and processed juice in the diet of infants attending public day care centers (United States)

    Longo-Silva, Giovana; Toloni, Maysa Helena de Aguiar; de Menezes, Risia Cristina Egito; Asakura, Leiko; Oliveira, Maria Alice Araújo; Taddei, José Augusto de Aguiar Carrazedo


    OBJECTIVE: Identifying at what age infants enrolled in public day care centers are introduced to soft drinks and industrialized juice, as well as comparing the nutritional composition of these goods with natural fruit juice. METHODS: A cross-sectional study with the mothers of 636 children (aged 0 to 36 months) from nurseries of day care centers, who were asked questions about the age of feeding introduction. This study evaluated the proximate composition of soft drinks and artificial juice, comparing them with those of natural fruit juice regarding energy, sugar, fiber, vitamin C, and sodium values. The chemical composition of fruit juice was obtained by consulting the Table of Food Composition and, for industrialized drinks, the average nutritional information on the labels of the five most consumed product brands. RESULTS: The artificial drinks were consumed before the first year of life by more than half of the children studied, however, approximately 10% consumed them before the age of 6 months. With regard to the comparison among the drinks, artificial fruit juice beverages and soft drinks proved to contain from nine to 13 times higher amounts of sodium, and 15 times less vitamin C than natural juices. CONCLUSIONS: The introduction of soft drinks and industrialized juice in the diet of infants was inopportune and premature.. When compared to natural fruit juice, these have inferior nutritional composition, which suggests the urgent need for measures based on strategies for food and nutrition education in order to promote awareness and the maintenance of healthy eating habits. PMID:25662561

  13. Prisoners of the Method: Breaking Open the Child-Centered Pedagogy in Day Care Centres. (United States)

    Singer, Elly


    Examines basic concepts forming the foundation for professional care and education of young children and how these concepts may impede interaction between teachers or caregivers and children. Critiques the concepts of natural development, developmentally appropriate curriculum, and child centeredness. Advocates increased scaffolding, increased…

  14. Ventilation in day care centers and sick leave among nursery children

    DEFF Research Database (Denmark)

    Kolarik, Barbara; Andersen, Z. Jovanovic; Ibfelt, T.;


    ventilation in DCCs and sick leave among nursery children. Data on child sick leave within an 11 week period was obtained for 635 children attending 20 DCCs. Ventilation measurements included three proxies of ventilation: air exchange rate (ACR) measured with the decay method, ACR measured...... by the perfluorocarbon tracer gas (PFT) method, and CO2 concentration measured over a 1-week period. All but two DCCs had balanced mechanical ventilation system, which could explain the low CO2 levels measured. The mean concentration of CO2 was 643 ppm, exceeding 1000 ppm in only one DCC. A statistically significant...... inverse relationship between the number of sick days and ACR measured with the decay method was found for crude and adjusted analysis, with a 12% decrease in number of sick days per 1 h(-1) increase in ACR measured with the decay method. This study suggests a relationship between sick leave among nursery...

  15. Child Day Care Centers, Published in 2007, 1:63360 (1in=1mile) scale, S-RCAA, Inc. Head Start/Early Head Start. (United States)

    NSGIC GIS Inventory (aka Ramona) — This Child Day Care Centers dataset, published at 1:63360 (1in=1mile) scale, was produced all or in part from Hardcopy Maps information as of 2007. Data by this...

  16. Quality of life assessment in advanced cancer patients treated at home, an inpatient unit, and a day care center

    Directory of Open Access Journals (Sweden)

    Leppert W


    Full Text Available Wojciech Leppert,1 Mikolaj Majkowicz,2 Maria Forycka,1 Eleonora Mess,3 Agata Zdun-Ryzewska2 1Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland; 2Department of Quality of Life Research, Gdansk Medical University, Gdansk, Poland; 3Palliative Care Nursing Department, Wroclaw Medical University, Wroclaw, Poland Aim of the study: To assess quality of life (QoL in cancer patients treated at home, at an in-patient palliative care unit (PCU, and at a day care center (DCC. Patients and methods: QoL was assessed in advanced cancer patients at baseline and after 7 days of symptomatic treatment using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care (EORTC QLQ-C15-PAL, the Edmonton Symptom Assessment System (ESAS, and the Karnofsky Performance Status (KPS scale. Results: A total of 129 patients completed the study, with 51 patients treated at home, 51 patients treated at the PCU, and 27 patients at DCC. In the EORTC QLQ-C15-PAL, improvement in functional and symptom scales was observed except in physical functioning and fatigue levels; patients at DCC had a better physical functioning, global QoL, appetite, and fatigue levels. In the ESAS, improvement in all items was found except for drowsiness levels, which was stable in patients treated at DCC and deteriorated in home and PCU patients. Higher activity, better appetite and well-being, and less drowsiness were observed in patients treated at DCC. KPS was better in DCC patients compared to those treated at home and at the PCU; the latter group deteriorated. Conclusions: QoL improved in all patient groups, with better results in DCC patients and similar scores in those staying at home and at the PCU. Along with clinical assessment, baseline age, KPS, physical and emotional functioning may be considered when assigning patients to care at a DCC, PCU, or at home. Keywords: oncology, patient care

  17. Assessment of Knowledge of Day-Care Center Workers in Basic Aspects of Child Care: A Pilot Study. (United States)


    nineteenth century were patterned upon widespread and successful at- tempts to provide care for children of working mothers in France and England from...due in part to the need to care for and protect children of working mothers and in part to a welfare response which created jobs for unemployed

  18. Reduction of particulates in a child-day-care center; Reductie van de fijn- en ultrafijnstof in een kinderdagverblijf

    Energy Technology Data Exchange (ETDEWEB)

    Broek, R.; Vons, V. [Virus Free Air VFA, Delft (Netherlands); Jacobs, P. [Afdeling Energy and Comfort Systems, TNO, Delft (Netherlands)


    During a practical test an innovative low pressure induct filtration system has been tested on the air inlet of a child day care center. Bottom line is that a significant amount of fine and ultrafine particles were captured from the inlet air while generating little pressure loss. 85% reduction in nano-particles with only 25 Pa pressure drop, is one of the results. This promising filtration system makes it possible to effectively clean the air supply before it is spread throughout the building. Due to low pressure drop larger airflows can be let in a very energy efficient way. This provides a good solution for improving existing as well as new ventilation systems. Conventional F- or H-filters can be replaced or complemented [Dutch] Voldoende frisse lucht in gebouwen is belangrijk. Professionals in de gezondheidszorg adviseren ventilatie om bijvoorbeeld luchtwegklachten te verminderen. Tevens is aangetoond dat productiviteit en welbevinden bevorderd worden naarmate er voldoende frisse lucht aanwezig is. Echter, zomaar buitenlucht direct naar binnen blazen om te ventileren kan in veel gevallen ook negatieve gevolgen hebben, aangezien met de ventilatielucht ook fijnstof naa rbinnenkomt. In de VS is aangetoond dat in gebouwen waarin minder geventileerd werd, mensen minder blootgesteld werden aan fijnstof. Bij deze mensen traden ook minder COPD, hartklachten en longontsteking op. Met name het ultrafijnstof (<0,1 micrometer) is schadelijk. In stedelijke omgeving is dit vooral afkomstig van (diesel) verkeer.

  19. Nutritional assessment of children at the day care center “Marineritos del Sur” in Cienfuegos province, Cuba.

    Directory of Open Access Journals (Sweden)

    Zeida Bárbara Alejo Cruz


    Full Text Available Background: In many countries in the last few years, there has been an increasing interest for the assessment of the Nutritional System which can be defined as a systemic and permanent process of collection, transmission analysis and interpretation of the information that allows to keep updated knowledge of the nutritional state. The follow up of the children´s growth and development has the importance not only to assist the children´s needs at a determined age but also to assist them with a preventive criteria taking into account their dynamic and changing characteristics. Objectives: To assess nutritionally the children gathered at the ages from 2 to 6 years that attend the day care center ¨Marineritos del Sur¨ for more than one year during the period September 1 st - March 2000. Methods: The variables under study were age, sex, weight, folds brachial circumference and past illnesses. Results: According to the indicators weight/size, size/age, weight / age, tricipital fold/ age, brachial circumference / age, patients between 10 and 90 percentile had a predominance. The calculus of the Z point showed that 67,66 % of the children were eutrophic, 27,=6 tended to obesity and 5,28 malnourished. Giardia Lambia was the most frequent isolated parasite.

  20. Maryland Day Care Voucher System. (United States)

    Hildebrand, Joan M.

    This manual was written to assist States and other governmental units wishing to replicate the Maryland Day Care Voucher Program, a system of providing child care subsidies to eligible families. Chapter I provides brief histories of day care in Maryland and that State's grant to demonstrate the viability of a day care voucher system. Chapter II…

  1. Impact of the application of neurolinguistic programming to mothers of children enrolled in a day care center of a shantytown

    Directory of Open Access Journals (Sweden)

    Cláudio Torres de Miranda


    Full Text Available CONTEXT: Of the members of a family, the mother is without doubt the most important one, which provides justification for including an evaluation of her mental health as one of the variables to be considered as determining factors in each child’s level of development. OBJECTIVE: To assess the impact of the application of Neurolinguistic Programming (NLP on child development, home environment and maternal mental health. DESIGN: Randomised controlled trial. SETTING: The study included children enrolled in the municipal day care center of a shantytown in the City of São Paulo. PARTICIPANTS: 45 pairs of mothers and respective children between 18 and 36 months of age. MAIN MEASUREMENTS: Children’s development (Bayley scales; home environment variation (HOME; and maternal mental health (SRQ. Comparison between before and after the intervention was made in terms of children’s psychomotor development, home environment and maternal mental health. INTERVENTION: Application of the NLP technique to the experimental group and comparison with a control group. 1 - Experimental (EG, consisting of 23 children submitted to intervention by NLP; and 2 - Control (CG, with 22 children with no intervention. Length of intervention: 15 sessions of NLP. RESULTS: 37 children remained in the study (EG = 10, CG = 27. Variations in mental development (OR 1.21, IC 95% 0.0 to 23.08 in their home environment (Wilcoxon: p = 0.96 (before and p = 0.09 (after; in maternal mental health: p = 0.26, 2 df. CONCLUSIONS: There was a trend that indicated positive effects on the home environment from the intervention.

  2. How a Young Child Learns How to Take Part in Mealtimes in a Japanese Day-Care Center: A Longitudinal Case Study (United States)

    Ishiguro, Hiroaki


    This research is a longitudinal, ethnographic study that focuses on mealtimes with one boy from 9 to 78 months of age in a day-care center in Japan. It looks at routine interactions between a child, his nursery teachers, and the environment, which is a shared and mutually available communicative space between participants in collaboration. The aim…

  3. Cortisol Patterns at Home and Child Care: Afternoon Differences and Evening Recovery in Children Attending Very High Quality Full-Day Center-Based Child Care (United States)

    Watamura, Sarah E.; Kryzer, Erin M.; Robertson, Steven S.


    Previous work has found that many young children show different patterns of production of the hormone cortisol, which is sensitive to stress and challenge, on days when they are at child care compared with days when they are at home. At home, preschool age children typically show a decreasing pattern of cortisol production across the day which is…

  4. Day Care Services: Industry's Involvement. Bulletin 296. (United States)

    Besner, Arthur

    This bulletin provides an overview of the need for services for the children of working mothers. Topics discussed include historical developments in industry day care programs, alternative roles for industry involvement, costs of operating day care centers, and income tax allowances. Also given are examples of unique programs which suggest various…

  5. Knowledge, attitude and practice of oral health promoting factors among caretakers of children attending day-care centers in Kubang Kerian, Malaysia: A preliminary study

    Directory of Open Access Journals (Sweden)

    Mani S


    Full Text Available Background and Aim: The role of caretakers at day-care centers has become more imperative in promoting oral health care in children since many new mothers opt to work outside their homes, leaving their children at day-care centers. The aim of this study is to assess the knowledge, attitude and practice of oral health promoting factors among secondary caretakers of children attending day-care centers. Settings and Design: This was a cross-sectional exploratory study conducted among secondary caretakers in Kubang Kerian, Malaysia. Materials and Methods: Thirty-four caretakers fulfilling the inclusion and exclusion criteria participated in the study. The data were collected using a self-administered questionnaire addressing various aspects of knowledge, attitude and practice of oral health in children. Analysis was done using SPSS version 12.0. Results: The knowledge of factors causing dental caries was found to be good among majority of the caretakers, but the concepts of transmissibility of caries and effect of hidden sugars were not evident. Seventy one percent did not know that frequent bottle feeding could cause tooth decay. Attitudes seemed to be governed by the cultural practices of the region rather than the knowledge obtained. The knowledge was not translated to practice adequately. Giving sweetened liquid in bottles was practiced by 53% of the caretakers. Conclusion: Implementation of nursery-based oral health promotion programs for secondary caretakers is needed to counteract early childhood caries.

  6. Zoning for Day Care (from Models for Day Care Licensing). (United States)

    Day Care and Child Development Council of America, Inc., Washington, DC.

    Recommendations and regulations regarding the zoning of child development day care programs are discussed. Zoning in general is discussed, as is the treatment of child development day care in zoning ordinance, the background of program planning, modular housing, the impelmentation of zoning, and model provisions regarding characteristics of…

  7. Freqüência à creche e outros condicionantes do estado nutricional infantil Attendance at day-care centers and other conditioning factors in child nutritional status

    Directory of Open Access Journals (Sweden)

    Marina Vieira da Silva


    Full Text Available O estudo descreve o estado nutricional de 2 096 pré-escolares atendidos nos 27 Centros Educacionais e Creches do município de Piracicaba, estado de São Paulo. Observa-se que 5,1% das crianças apresentam déficit de altura/idade (escore ZAI The study describes the nutritional status of 2 096 preschool children attending 27 Educational Centers and Day-Care Centers in Piracicaba, state of São Paulo. Five point one percent of the children are observed to present a height/age deficit (score HAZ<-2.0 and a proportion of 1.2 with weight/height deficit (score WHZ<-2.0. The results reveal that per capita income, mother schooling, type of sewage, type of housing and attendance time at are the variables that cause impact on the HAZ score of the children.The positive association detected between attendance time at and -Z score of height for age stresses the importance of these investments as means to protect children, mainly against chronic malnutrition, as basic care with health, feeding and hygiene is associated with education. The day-care center also provides the participation of mothers in the work market, which is very important in poor families in order to increase family income.

  8. Day-Care in Denmark

    DEFF Research Database (Denmark)

    Bundgaard, Helle


      The chapter explores central notions of appropriate social behavior in what is arguably the most important institution in Denmark when it comes to social integration, namely day-care, also known as pre-school. Moral values guiding everyday practices are generally taken for granted. When...... interacting with ethnic minority children and their parents, however, staff are occasionally forced to make explicit the reasoning behind their actions. A focus on the interaction of ethnic minority children and their parents in day-care centres therefore provides insights into the cultural beliefs and values...... which structure daily socialization practices in a Danish day-care, and by implication in Danish society....

  9. Desempenho motor de lactentes frequentadores de berçários em creches públicas Motor performance of infants attending the nurseries of public day care centers

    Directory of Open Access Journals (Sweden)

    Letícia Baltieri


    Full Text Available OBJETIVO: Analisar o desempenho motor axial, apendicular e global e sua correlação com as características neonatais, familiares e de tempo de exposição à creche em crianças com idade entre 12-24 meses, frequentadoras de creches públicas. MÉTODOS: Estudo transversal com 40 lactentes (idade média 14,3±2,4 meses frequentadores de creches públicas. Os participantes foram avaliados quanto ao desempenho motor com a Bayley Scales of Infant and Toddler Development-III, a qual possibilita análise do desempenho motor e comparação dos domínios motores axial e apendicular. Foram coletados dados neonatais, familiares e de exposição à creche e pesquisou-se a correlação destes fatores ao desempenho motor. Foi utilizado o teste t pareado para comparar médias e a correlação de Pearson. RESULTADOS: O desempenho motor do grupo esteve, em média, abaixo da referência, com 22,5% das crianças classificadas como suspeitas de atraso nos desempenhos axial e global, contrastando com nenhuma no domínio apendicular. A comparação axial e apendicular apontou diferença significativa, com desempenho axial aquém do apendicular, além de 35% do grupo ter apresentado discrepância significativa entre esses domínios. Não foi encontrada correlação linear entre os domínios motores avaliados e as variáveis neonatais, familiares e de exposição à creche. CONCLUSÕES: O desempenho motor global do grupo esteve abaixo da média de referência, com desempenho motor axial inferior ao apendicular e importante discrepância entre esses. Recomenda-se atenção às habilidades motoras axiais e às oportunidades de exploração que o ambiente em creches pode propiciar, especialmente no decorrer dos dois primeiros anos de vida.OBJECTIVE: To analyze gross, fine and global motor performance and its correlation with neonatal and familial variables and day care exposure among children between 12-24 months of age attending public day care centers. METHODS: This

  10. Evaluating the effects of diffused lavender in an adult day care center for patients with dementia in an effort to decrease behavioral issues: a pilot study (United States)

    Moorman Li, Robin; Gilbert, Brian; Orman, Anna; Aldridge, Petra; Leger-Krall, Sue; Anderson, Clare; Hincapie Castillo, Juan


    Abstract Objectives: To evaluate the effects of diffused lavender on the frequency of behavioral issues [BIs], defined as a composite of restlessness/wandering [RW], agitation [AGT], anger [ANG], and anxiety [ANX] in an adult day care center. Secondary objectives evaluate systematic differences on the frequency of BIs between age cohorts, gender, and individual behaviors. Design: Pre-post quasi-experimental study. Setting: Private nonprofit adult day care center for patients with dementia. Participants: Elderly patients older than 65 years of age with a clinical diagnosis of dementia, who require daytime monitoring. Intervention: Lavender aromatherapy twice a day for 20 min during a two-month period during active clinic days. Measurements: Behavioral issues were recorded using the behavior/intervention monthly flow record during the pre- and post-intervention periods. Results: There was no significant difference on frequency of BIs between pre-intervention and post-intervention periods (p = .06). There was a significant difference between pre-intervention and post-intervention total number of AGT occurrences (129 vs. 25; p value < .01). There was no significant difference between age cohorts for computed difference of RW, ANG, and ANX issues. There was a significant difference between age cohorts for computed difference of AGT (p value = .04) as the 70–85 age cohort showed less agitation compared to the 85–100 age cohort. Conclusion: The use of diffused lavender twice daily has shown to reduce the frequency of agitation in elderly patients with dementia, especially in the 70–85 age cohort. Though diffused lavender did not show statistical differences in the frequency of other behaviors (restlessness/wander, anger, anxiety), the study population may have been too small to find a difference.

  11. Emotional Exhaustion in Day-Care Workers (United States)

    Løvgren, Mette


    Although childcare workers have the second-worst occupation for work-related health problems and the number of professional day-care centers is growing throughout Europe, few studies have examined these workers' emotional well-being. This study investigates the effect of position, competence, work role, role clarity, and work tasks on emotional…

  12. Child Day Care Centers, Located during MicroData field address collection 2004-2006. Kept in Spillman database for retrieval., Published in 2004, Vilas County Land Information/Mapping. (United States)

    NSGIC GIS Inventory (aka Ramona) — This Child Day Care Centers dataset, was produced all or in part from Field Observation information as of 2004. It is described as 'Located during MicroData field...

  13. Child Day Care Centers, This dataset contains the licensed daycare center locations in MD. Addresses were provided by the Department of Labor Licensing and Regulation (DLLR), and geocoded using Maryland Statewide Addressing Initiative Centerline., Published in 2012, 1:2400 (1in=200ft) scale, Towson University Center for GIS. (United States)

    NSGIC GIS Inventory (aka Ramona) — This Child Day Care Centers dataset, published at 1:2400 (1in=200ft) scale, was produced all or in part from Other information as of 2012. It is described as 'This...

  14. Gastrointestinal and respiratory illness in children that do and do not attend child day care centers: a cost-of-illness study.

    Directory of Open Access Journals (Sweden)

    Remko Enserink

    Full Text Available 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.


    California State Dept. of Education, Sacramento.


  16. Positive Education Program's Day Treatment Centers (United States)

    Fecser, Frank A.


    The Positive Education Program in Cleveland, Ohio, is grounded in the Re-EDucation philosophy and serves more than 700 students with emotional and behavioral disorders in eight day treatment centers. The centers blend special education with mental health in a school environment in which students and families are both supported and challenged as…

  17. Everyday practice and unnoticed professional competence in day care work

    DEFF Research Database (Denmark)

    Ahrenkiel, Annegrethe; Warring, Niels; Nielsen, Birger Steen

    for the social educators to get recognition for their professional competencies and the societal importance of their work. Neoliberal governance has imposed a lot of demands for documentation, evaluation etc., and a growing focus on children’s learning in day care centers has resulted in national goals......In Denmark more than 9 out 10 children attend day care centers that are publicly funded and regulated. The main part of employees, the social educators, at day care centers have attended a 3½ years educational programme with both theoretical and practical elements. Nevertheless it has been hard...... based workshops) the paper will discuss work practice in an everyday life perspective. This perspective opens for understanding professional competence as part of creating coherence in children’s and families’ lives as well as during the day in the day care centers. It also opens for a discussion of how...

  18. Prevalence of the Precocious Caries in Infancy in Children of 6 the 36 Months in Public Day-Care Centers of Caruaru/PE, Brazil

    Directory of Open Access Journals (Sweden)

    Shirley Suely Veras Vieira MACIEL


    Full Text Available Objective: Describe the prevalence of the precocious caries in infancy in children of 6 the 36 months in public day-care centers of Caruaru-PE, and its association with characteristics of the child, as well as analyzing the knowledge of the responsible parents or related the buccal health. Method: The study drawing is of the type transversal cut (to cross-over. Had been collected through information on knowledge related to the buccal health, as well as had been examined to the dental conditions of the children and through the Sinasc the characteristics of the gestation, the childbirth and the child had been collected. For the tests of association for chi-squared (x2 to evaluate the relationship between the dependent variable (ceo-d and the independent variable, the Program was used Epi-info version 6.04. Results: Of the total of 168 studied children, on average examined 14.65 teeth for child. Of these 62.3% were healthy and carious only 3.3%. 92.9% of the parents had knowledge of that the teeth of its children were of milk and knew of its importance; 78.6% already brushed teeth of the children; 74.4% knew as they were the teeth of the children, although only 16.2% to identify carie would indent and 6.0% to tell that the son had tooth ache. But 12.5% had been to the dentist, being 27.3% for revision and control. Of 22.6% of the children who had caries, 79.4% of them consumed nocturnal baby’s bottle, being that 40.7% of them sweetened; 30.4% consumed candies between the meals increasing this consumption to the 25 months of age. Conclusion: The dental caries increases in function of the age in consequence of the increase of the eruption tooth number and the consumption of sugar in the diet.

  19. Diet as a risk factor for pneumococcal carriage and otitis media: a cross-sectional study among children in day care centers.

    Directory of Open Access Journals (Sweden)

    Terhi Tapiainen

    Full Text Available BACKGROUND: Pharyngeal bacteria are exposed to different sugar conditions depending on the diet of the child. We hypothesized that dietary factors such as daily intake of carbohydrates could be associated with pneumococcal carriage and the occurrence of otitis media in children. METHODS: Our study design was a cross-sectional study among 1006 children attending child day care centers. Parents filled in a food frequency questionnaire. Oropharyngeal swabs were collected from each child. The primary outcome was the occurrence of pneumococcal carriage and the secondary outcome the number of acute otitis media episodes during life. Principal component analysis was used to group dietary intake into nine factors. The models were adjusted for age, gender of the child and educational level of the mother. RESULTS: The dietary factor which included high consumption of sweet pastries and jam was associated with an increased risk of pneumococcal carriage (OR 1.17, 95% CI 1.01 to 1.36, P-value 0.04. The factor including frequent consumption of fruit and berries was associated with a decreased risk of acute otitis (regression coefficient -0.51, 95% CI -0.98 to -0.03, P=0.04. A high intake of consumption of sweets and snacks (OR 1.36, 95% CI 1.03 to 1.80, P=0.03 was associated with an increased risk of caries. CONCLUSIONS: Diet was associated with a risk of pneumococcal carriage and the occurrence of otitis media. Diet may thus be a modifiable risk factor for the occurrence of acute otitis media.

  20. Varicella zoster in children attending day care centers Varicela-zóster em crianças que frequentam creches

    Directory of Open Access Journals (Sweden)

    Ricardo Marcitelli


    Full Text Available OBJECTIVE: To describe morbidity associated to varicella in children attending day care centers. METHODS: Descriptive study carried out through inquiries with parents of 664 children who acquired varicella after admission to day care centers in Taubaté (population: 244,165, census of 2004, a prosperous city in the State of São Paulo. RESULTS: The median age was 36 months (range 6 to 80 months; 8.4% of the children had varicella before 1 year of age. The main symptoms were: exanthema (100.0%, fever (85.4% anorexia (39.6%, and headache (15.3%. 517 children (77.9% had at least 1 medical visit, and 80.6% received at least 1 medication; 73 (11.0% received nonsteroidal antiinflammatory drugs, and 52 (7.8% received antibiotics. Complications occurred in 38 children (5.7%; 95% confidence interval: 3% - 8%; 8 (1.2% were hospitalized, and 5 (0.7% had sequelae. Complications and hospitalizations rates were 3 times more frequent in children with less than 1 year of age than in older children. More than half of the children and of the working parents were absent from their regular activities for more than a week. CONCLUSIONS: Varicella was associated with significant morbidity, affected younger children, was complicated in more than 5%, and left sequelae in 0.7% of children. More than 10% of the children received nonsteroidal antiinflammatory drugs, highlighting the need to warn the population about the risks of these drugs. Although varicella vaccination is not recommended for children younger than 12 months, vaccination of the children older than a year could avoid by herd immunity the transmission to babies. Brazilian public health authorities should be alerted to this issue and offer varicella vaccine to children attending day care centers.OBJETIVO: Descrever a morbidade associada à varicela nas crianças usuárias de creches. MÉTODOS: Estudo descritivo, realizado através de inquérito com pais ou responsáveis por 664 crianças que contra

  1. Qualitative evaluation of the menu and plate waste in public day care centers in São Paulo city, Brazil Avaliação qualitativa do cardápio e desperdício de alimentos em creches públicas do município de São Paulo


    Giovana Longo-Silva; Maysa Toloni; Sara Rodrigues; Ada Rocha; José Augusto de Aguiar Carrazedo Taddei


    OBJECTIVE: This study assessed menu quality and plate waste in public day care centers of São Paulo (SP), Brazil. METHODS: This cross-sectional study collected data from the nurseries of seven day care centers, totaling 366 children aged 12 to 36 months. Each day care center was assessed for three days, totaling 42 days and 210 meals. Menu quality was assessed by the Qualitative Analysis of Menu Preparations method (Análise Qualitativa das Preparações do Cardápio), adapted for day care center...

  2. Differences in epidemiological and molecular characteristics of nasal colonization with Staphylococcus aureus (MSSA-MRSA in children from a university hospital and day care centers.

    Directory of Open Access Journals (Sweden)

    Erika A Rodríguez

    Full Text Available BACKGROUND: Clinical significance of Staphylococcus aureus colonization has been demonstrated in hospital settings; however, studies in the community have shown contrasting results regarding the relevance of colonization in infection by community-associated MRSA (CA-MRSA. In Colombia there are few studies on S. aureus colonization. The aim of this study was to determine the molecular and epidemiological characteristics of nasal colonization by S. aureus (MSSA-MRSA in children from a university hospital and day care centers (DCCs of Medellin, Colombia. METHODS: An observational cross-sectional study was conducted in 400 children (200 in each setting, aged 0 months to 5 years, during 2011. Samples were collected from each nostril and epidemiological information was obtained from the parents. Genotypic analysis included spa typing, PFGE, MLST, SCCmec typing, detection of genes for virulence factors and agr groups. RESULTS: Frequency of S. aureus colonization was 39.8% (n = 159 (hospital 44.5% and DCCs 35.0% and by MRSA, 5.3% (n = 21 (hospital 7.0% and DCCs 3.5%. Most S. aureus colonized children were older than two years (p = 0.005, the majority of them boys (59.1%, shared a bedroom with a large number of people (p = 0.028, with history of β-Lactamase inhibitors usage (p = 0.020. MSSA strains presented the greatest genotypic diversity with 15 clonal complexes (CC. MRSA isolates presented 6 CC, most of them (47.6% belonged to CC8-SCCmec IVc and were genetically related to previously reported infectious MRSA strains. CONCLUSION: Differences in epidemiological and molecular characteristics between populations may be useful for the understanding of S. aureus nasal colonization dynamics and for the design of strategies to prevent S. aureus infection and dissemination. The finding of colonizing MRSA with similar molecular characteristics of those causing infection demonstrates the dissemination capacity of S. aureus and the risk of

  3. Agrupamentos preferenciais e não-preferenciais e arranjos espaciais em creches Preferential and no preferential groups and spatial arrangements in day care centers

    Directory of Open Access Journals (Sweden)

    Mara I. Campos-de-Carvalho


    Full Text Available Para verificar o impacto do arranjo espacial para ocorrência de agrupamentos preferenciais e não-preferenciais, analisou-se a ocupação do espaço por crianças de 2-3 anos de duas creches da região de Ribeirão Preto (SP, que atendem famílias de baixa renda. Os dados foram obtidos por duas câmeras fotográficas automáticas, ativadas a cada 30 segundos, em três fases: I - arranjo aberto: habitual (4 sessões; II - arranjo aberto: introdução de estantes nas laterais (6 sessões; III - arranjo semi-aberto: montagem de duas zonas circunscritas (6 sessões. Proximidade física foi utilizada para registrar os agrupamentos, verificando-se: maior estruturação espacial acarretou aumento significativo nos agrupamentos, especialmente com três ou mais crianças; maior ocorrência de agrupamentos nas áreas das estantes (FII e nas zonas circunscritas (FIII, sendo significativa para os não-preferenciais; maior ocupação da zona do adulto na fase inicial, significativa para os não-preferenciais. Concluindo, há evidências da relevância do arranjo espacial para ocorrência de agrupamentos, principalmente para os não-preferenciais.The role of spatial arrangement in the occurrence of preferential and no preferential groups is examined. The spatial distribution of 2- to 3-year-old children from two day care centers serving low income families in the Ribeirão Preto (SP area was analyzed. Data were collected by two automatic photographic cameras shooting at every 30 seconds, in three phases: I - open arrangement: the usual space (4 sessions; II - open arrangement: inclusion of shelves along the periphery of the space (6 sessions; III - semi-open arrangement: formation of two circumscribed zones (6 sessions. Physical proximity was used to record the peer groups. The analysis showed: a significant increase in the occurrence of peer groups with increased spatial structure, especially with three or more children; a preferential occurrence of peer

  4. Stennis Space Center observes Disability Awareness Day (United States)


    Members of STARC, a non-profit organization in Slidell, La., that seeks to help people with disabilities lead meaningful, productive lives, pose with their appreciation awards during Disability Awareness Day at Stennis Space Center on Oct. 15. The group members received appreciation awards for their dedicated service to the rocket engine testing facility. Disability Awareness Day was hosted by the Stennis Diversity Council and included guest speakers from several area agencies.

  5. Views on Pre-School Education and Day Care. (United States)

    Rambusch, Nancy McCormick

    There is a clear need in our country today for early education programs aimed at accelerating the cognitive development of disadvantaged children. Another need is for centers to care for the children of working mothers. Our traditional nursery schools have deemphasized early cognitive development while day care programs have been focused on…

  6. Family Day Care Zoning. Local Officials Guide. (United States)

    Cohen, Abby; And Others

    This guide discusses city planning issues related to family day care zoning. The guide is divided into five sections. The first section discusses child care as a planning issue and focuses on changes in working patterns of families and in residential neighborhoods. The second section describes components of the child care delivery system, which…

  7. Day Care: Gold Coin or Brass Check? (United States)

    Levenstein, Sidney


    Because a national day care program will probably be instituted soon, the major issues should be debated before policies are set. Thus some program models are analyzed and then related to the needs of various consumer groups. (Author)

  8. Family Day Care Zoning Advocacy Guide. (United States)

    Stevenson, Carol; And Others

    Designed to help family day care providers and the agencies that support them reform local zoning laws that make it difficult or impossible to legally care for children in their homes, this guide outlines the process of obtaining a use permit, changing local laws, and strategizing for the passage of state legislation that preempts local laws. A…

  9. Positioning study on community day-care centers service system for the aged%社区日间托管中心养老服务体系的定位研究

    Institute of Scientific and Technical Information of China (English)

    陈俊羽; 徐桂华


    随着人口老龄化、家庭小型化、机构养老服务缺陷等形势日益突出,加之老年人对社会养老的需求日渐强烈,社区日间托管中心这一模式顺应国际潮流,成为养老事业发展的新趋势。但与发达国家相比,我国在开展日托养老服务方面起步较晚,缺乏经验,还存有空白。本文通过围绕当前社会养老现状,对日托中心养老服务体系进行定位研究,分析我国建立该体系的必要性和可行性,总结其定位和作用,为进一步构建规范、系统的社区日间托管中心养老服务体系打下坚实的基础。%With an aging population , smaller families, institutional care service defects situation increasingly prominent , coupled with the demand for social pension for the elderly increasingly strong , community day-care centers in this mode follow the international trend and become a new trend in the development of pension .However, compared with developed countries , Chinese pension services is of the characteristics of late start in carrying out day-care and lack of experience in some field .In this paper , we focus on the current status of the community pension , and perform locate research on pension service system for day-care centers so as to analyze the necessity and feasibility of the establishment of the system , summarize its position and role , in order to further build standardized , systematic retirement community day-care centers service system and lay a solid foundation .

  10. Unnoticed Professional Competence in Day Care Work

    DEFF Research Database (Denmark)

    Ahrenkiel, Annegrethe; Schmidt, Camilla; Nielsen, Birger Steen


    This article presents a double perspective on social educators’ professional competence: It discusses how everyday life in day care centres (preschools) is dependent on professional competences that can be conceived as “unnoticed.” These aspects of professional competence are embedded in routines......, experiences and embodied forms of knowledge. However, it may be discussed whether these competences are under pressure from increased demands for documentation, standardization and evaluation of children’s learning outcomes. The article will briefly outline this development in the day care sector, followed...... by a discussion of unnoticed professional competence and the related notion of gestural knowledge. The double perspective on social educators’ professional competences will be illuminated by empirical examples from a research project involving social educators from two day care centres in Denmark....

  11. Day-care attendance and child development:

    DEFF Research Database (Denmark)

    Bauchmüller, Robert; Gørtz, Mette; Rasmussen, Astrid Würtz

    Earlier research suggests that children’s development is shaped in their early years of life. This paper examines whether differences in day-care experiences during pre-school age are important for children’s cognitive and language development at the age of 15. The analysis is based on class...... performance at the end of elementary schooling. We assess the effects of attended types and qualities of day-care institutions on various child outcomes as measured by school grades in mathematics, science, English and Danish for the whole Danish population as well as outcomes from the 2006 PISA Denmark......, of total work experiences, ages and hourly wages of staff members. Those indicators show the expected correlations with children’s development outcomes, better day-care quality being linked to better child outcomes ten years later. We use rich administrative information about the children’s background...

  12. The Burn-Out Syndrome in the Day Care Setting (United States)

    Maslach, Christina; Pines, Ayala


    Results of a study of personal job-stress factors among day care center personnel focus on impact of staff-child ratio, working hours, time out, staff meetings and program structure. Recommended institutional changes for prevention of staff "burn-out" involve reduction in amount of direct staff-child contact, development of social-professional…

  13. Day Care: Gold Coin or Brass Check. (United States)

    Levenstein, Sidney

    On the assumption that there will be a national program of day care for preschool children, the author presents the major issues involved. An attempt is made to bring together some figures on current need and available facilities, to examine policy considerations in the implementation of programs, to present some difficulties in providing adequate…

  14. Health: A Key Factor in the Evaluation of Day Care. (United States)

    Bollin, Gail G.

    Research has inadequately examined why health has become a problem in the day care setting. Health regulations for day care have not been researched in the day care setting per se but have been imposed on day care by the medical community working from a hospital model. Day care research has presumed that having antecedent health regulations in…

  15. Conhecimentos de educadores de creches sobre alimentação infantil Knowledge of educators from day care centers about infant feeding

    Directory of Open Access Journals (Sweden)

    Elaine Emy Shimabukuro


    Full Text Available OBJETIVO: Avaliar o conhecimento das educadoras de creches sobre a alimentação nos primeiros anos de vida. MÉTODOS: Estudo transversal com 137 educadoras de oito creches do município de São Paulo, selecionadas no universo de 36 creches pertencentes à Coordenadoria de Santo Amaro, segundo critérios descritos a partir da metodologia proposta por Beghin. Para avaliar o conhecimento sobre alimentação das educadoras, foi construído e aplicado um questionário estruturado e pré-codificado com questões de múltipla escolha e "verdadeiro e falso" durante as reuniões mensais realizadas nas creches. No estudo das associações, utilizou-se o teste do qui-quadrado, selecionando variáveis com nível de significância pOBJECTIVE: To assess daycare centers educators' knowledge on feeding during the first year of life. METHODS: Cross-sectional study comprising 137 educators from eight daycare centers of São Paulo city (Brazil selected from the universe of 36 daycare centers linked to Santo Amaro Coordination. Selection was based on Beghin's methodology. In order to assess educators' knowledge on feeding a structured, previously codified and tested questionnaire was built with true/false and multiple choices questions and applied. Chi-square test was used to test association between selected variables, being significant p<0.05. RESULTS: Educators' ages ranged from 19 to 66, with a median of 38 years; 41.3% had completed university education. Regarding errors for questions on breastfeeding, artificial lactation, complementary feeding and the sum of all questions about infant feeding, the median and standard deviation (sd were respectively: 3 (sd=1.75; 2 (sd=0.87; 2 (sd= 0.96 and 7 (sd=2.65. CONCLUSIONS: Continuous action programs and improvement of intersectorial actions involving multidisciplinary teams and local daycare centers are required, since solely the knowledge incorporated into practice is not sufficient to promote good feeding and

  16. A Study in Child Care (Case Study from Volume II-A): "A Rolls-Royce of Day Care." Day Care Programs Reprint Series. (United States)

    O'Farrell, Brigid

    The Amalgamated Day Care Center is an independent trust established through a collective bargaining agreement between the Amalgamated Clothing Workers of America, AFL-CIO, and the employers of the garment industry. The free center, open from 6:00 a.m. to 6:00 p.m., is located near the Chicago garment industries to minimize transportation problems…

  17. Day care schemes and cash for-care at home

    DEFF Research Database (Denmark)

    Rostgaard, Tine


    The purpose of this chapter is to analyse and compare Nordic day-care policies, i.e. ECEC services as well as cash-for-care for children under school age. The chapter examines the legislative purpose behind the provision of the services and the cash benefits as well as the take-up rates. The review...... of day-care will also look at how the programmes are organised and funded, and at the quality indicators of the care provided. In this context, the Nordic countries will be compared with the EU average. The review of cash-for-care will assess the key elements of the programmes: the length of time...

  18. Estado nutricional e prevalência de enteroparasitoses em crianças matriculadas em creche Nutritional status and enteroparasitosis prevalence among children enrolled in a day care center

    Directory of Open Access Journals (Sweden)

    Terezinha Soares Biscegli


    Full Text Available OBJETIVO: Avaliar o estado nutricional e descrever a prevalência de enteroparasitoses em crianças de uma creche. MÉTODOS: Estudo transversal com 133 crianças (sete a 78 meses de idade matriculadas na Creche "Sinharinha Neto", Catanduva (SP. Avaliou-se o estado nutricional pelas curvas da OMS/2006 e NCHS/2000 (menores e maiores de cinco anos, respectivamente e investigou-se enteroparasitoses por meio de exames parasitológicos de fezes. O escore Z dos índices peso/altura foi aplicado para classificar desnutrição aguda (Z2 e o da altura/idade para desnutrição pregressa e crônica (ZOBJECTIVE: To evaluate the nutritional status and the prevalence of intestinal parasitic diseases among children enrolled in a day care center. METHODS: This cross-sectional study comprised 133 children, aged seven to 78 months, assisted in a nonprofit day care center in Catanduva, SP, Brazil. The nutritional status was classified according to WHO/2006 and NCHS/2000 curves (younger and older than five years, respectively. Faecal samples were collected for parasite examination. Z scores of weight/height were used to classify acute malnutrition (Z2, and height/age to classify past and chronic malnutrition (Z<-2. Statistical analyses were performed by Z test for proportions, beeing significant p<0.05. RESULTS: Among the evaluated children, 0.8% presented acute malnutrition, 1.5% past malnutrition and 6% obesity. Nutritional disorders were more prevalent among boys. The prevalence of intestinal parasites was 29.2%. The parasites identified were Giardia lamblia (73.6%, Entamoeba coli and yeasts (10.5% each and Endolimax nana (7.9%. Children aged 25 to 60 months presented more parasites (60.5%. Entamoeba coli and yeasts were more prevalent among malnourished children in comparison to eutrophic children. CONCLUSIONS: Nutritional transition was observed in this study. Improvement in life conditions contributed to the disappearance of some parasites, but not of

  19. Santa Monica Children's Centers, Santa Monica, California: Low-Cost Day Care Facilities for Children of Working Mothers Made Available Through the Cooperation of the California State Government and Local School District. Model Programs--Childhood Education. (United States)

    American Institutes for Research in the Behavioral Sciences, Palo Alto, CA.

    Two of the four Santa Monica Children's Centers are nursery schools for children aged 3 to 5; the other two centers serve as extended care facilities for children of school age. All centers are concerned with meeting the physical, intellectual, and emotional needs of children on a long-term basis and stress a program offering a variety of play…

  20. Frequência à creche e estado nutricional de pré-escolares: uma revisão sistemática Day care centers attendance and preschool children's nutritional status: a systematic review

    Directory of Open Access Journals (Sweden)

    Alessandra da Silva Pereira


    Full Text Available OBJETIVO: Descrever e comparar estudos longitudinais que permitam inferir sobre a influência da creche no estado nutricional de crianças pré-escolares. FONTES DE DADOS: Revisão sistemática de trabalhos científicos publicados entre janeiro de 1990 e dezembro de 2008. Buscaram-se os estudos nas seguintes bases de dados: Lilacs, Scielo e PubMed. Realizou-se também pesquisa manual dos artigos referenciados. A busca ocorreu no período de março de 2008 a junho de 2009, e os descritores utilizados foram: "creche", "estado nutricional", "antropometria", "consumo alimentar", "anemia" e "alimentação escolar". SÍNTESE DOS DADOS: Na primeira etapa do estudo, obtiveram-se 78 artigos, mas somente sete puderam ser incluídos. Os outros 71 não apresentaram dados para contribuir com o objetivo específico deste estudo. Entre os artigos pesquisados na literatura, existem poucos que permitem inferir sobre a influência que a creche pode ter em relação ao estado nutricional de pré-escolares. Contudo, estudos longitudinais têm mostrado a relação causal entre a presença frequente da criança na creche e a melhoria do estado nutricional. CONCLUSÕES: Existe uma relação positiva entre a frequência da criança na creche e a melhoria do estado nutricional.OBJECTIVE: To describe and compare longitudinal studies on how daycare centers influence preschoolers' nutritional status. DATA SOURCE: Systematic review of scientific papers published from January 1990 to December 2008. Studies were retrieved from the following databases: Lilacs, Scielo and PubMed. Manual search of papers was carried out as well. The review occurred between March 2008 and June 2009, and the searched terms were: "child day care center", "nutritional status", "anthropometry", "food consumption", "anemia" and "food program". DATA SYNTHESIS: In the first stage 78 papers were obtained, but only seven of them could be used. The other 71 did not have data to contribute with the specific

  1. A longitudinal study of enterobiasis in three day care centers of Havana City Estudo longitudinal de enterobíase em três creches da cidade de Havana, Cuba

    Directory of Open Access Journals (Sweden)

    Fidel Angel Núñez


    Full Text Available Pinworm infection was prospectively studied during one year in 469 children attending three day care centers. Each child was examined at six months intervals using up to three perianal swabs with adhesive tape. Those found infected were treated with mebendazole. At the beginning of the study we found a prevalence of 28% that dropped to 13% and 12% in the following study periods. The reinfection rate was twice the incidence rate in both study periods. We also found a small percentage (10% of the children reinfected in most or all study periods. There was a high correlation between reinfection and perianal itching. Our results add further knowledge to the epidemiology of intestinal parasites in day care centers.Infecção por oxiuros foi estudada prospectivamente durante um ano em 469 crianças de três creches. Cada criança foi examinada com intervalos de 6 meses usando até 3 esfregaços perianais com fita adesiva. As que estavam infectadas foram tratadas com mebendazole. No início do estudo foi encontrada prevalência de 28% que caiu para 13% e 12% nos períodos de estudo posteriores. A freqüência de reinfecção foi 2 vezes a incidência em ambos os períodos de estudo. Foi encontrada, também, pequena porcentagem (10% de crianças reinfectadas na maioria ou em todos os períodos de estudo. Existiu elevada correlação entre reinfecção e coceira perianal. Nossos resultados adicionam outros conhecimentos à epidemiología dos parásitos intestinais em creches.

  2. Mortalidade de crianças usuárias de creches no Município de São Paulo Mortality among children enrolled in public day care centers in Brazil

    Directory of Open Access Journals (Sweden)

    Eneida S Ramos Vico


    Full Text Available OBJETIVO: Descrever o comportamento da mortalidade em crianças usuárias de creches. MÉTODOS: Trata-se de estudo descritivo da mortalidade de crianças da faixa etária de zero a seis anos e 11 meses, matriculadas em toda a Rede Pública Municipal de Creches de São Paulo (Br, no período de 1995 a 1999. As variáveis de interesse foram sexo, idade, causa básica de morte, tempo de permanência na creche e sazonalidade. RESULTADOS: O coeficiente médio de mortalidade observado para o período foi de 36,4 por cem mil crianças. Do total das mortes, 32,7% ocorreram em menores de um ano e 78,4% em crianças com até três anos. Quanto ao tempo de permanência, 54,2% não chegaram a completar seis meses, destacando os três meses iniciais que concentraram 36,3% das mortes. A maioria dos óbitos ocorreu nos meses de inverno e outono, respectivamente, 31,8% e 29,6%. As causas de morte mais freqüentes foram de origem infecciosa: pneumonias (29,6%, infecção meningocócica (13,0%, meningites não meningocócicas (8,5%, gastroenterites (7,6%, varicela (5,4%. As causas externas representaram 13,5% devido a quedas, atropelamentos, afogamentos, queimaduras e agressões. CONCLUSÕES: A maior parte das mortes ocorreu em menores de três anos e decorreu de causas evitáveis, algumas delas preveníveis por vacinas.OBJECTIVE: To describe the mortality pattern among children enrolled in public day care centers. METHODS: This was a descriptive study of the mortality pattern among children aged from 0 to 6 years and 11 months who were enrolled in all the public day care centers in the city of São Paulo, Brazil, from 1995 to 1999. The variables of interest were sex, age, underlying cause of death, duration of day care attendance and seasonality. RESULTS: The average mortality rate for the period was 36.4 per 100,000 children. Of the total number of deaths, 32.7% were among children under 1 year old and 78.4% under 3 years old. The deaths of 54.2% of these

  3. Os valores organizacionais e a Síndrome de Burnout: dois momentos em uma maternidade pública Organizational values and Burnout Syndrome: two moments in a public day-care center

    Directory of Open Access Journals (Sweden)

    Livia de Oliveira Borges


    Full Text Available Estudos anteriores têm assinalado a associação da incidência da síndrome de burnout e os valores organizacionais (valores atribuídos às organizações pelos empregados em um nível ideal e real. Em tal contexto, foi desenvolvida pesquisa em uma maternidade pública em 2003, replicando uma pesquisa anterior realizada em 2000, objetivando comparar os resultados. Aplicaram-se o Inventário de Valores Organizacionais e o Inventário de Maslach sobre burnout, numa amostra de 48 profissionais de saúde, e entrevistas, numa sub-amostra. Os resultados indicaram ocorrer uma redução nas diferenças entre níveis de análise ideais e reais dos valores organizacionais, principalmente no pólo de igualitarismo. Esses resultados associam-se às mudanças na gestão organizacional. Os níveis de burnout entre os profissionais de saúde apresentaram-se estáveis. A associação entre os valores organizacionais da maternidade e a síndrome de burnout muda, porém é contraposta pela tensão oriunda no aumento da carga de trabalho e nos salários.Previous studies have shown that the association between the incidence of Burnout Syndrome and organizational values (values attributed by employees to organizations on ideal and real levels. In this context, in 2003, a research at a public day-care center was developed, replicating a previous one accomplished in 2000, with the objective to compare the results. The Inventory of Organizational Values and the Maslasch Burnout Inventory were applied with the samples of 48 health professionals. Interviews were applied too. The results indicate that a reduction of differences between ideal and real levels of organizational values occur, notably in the equalitarian pole. These results associate to changes on organizational management. Levels of burnout were stable among health professionals. The association between organizational values of the day-care center and Burnout Syndrome change, but it is refuted by the

  4. Streptococcus pneumoniae isolates in healthy children attending day-care centers in 12 states in Mexico Aislamientos de S. pneumoniae en niños sanos de estancias infantiles en 12 estados de México

    Directory of Open Access Journals (Sweden)

    Luz Elena Espinosa-de los Monteros


    Full Text Available OBJECTIVE: The aim of this study was to determine the prevalence of asymptomatic nasopharyngeal carriage of Streptococcus pneumoniae, which is a major factor in the transmission of this bacterium. MATERIAL AND METHODS: Nasopharyngeal cultures were performed on children attending 32 day-care centers in 12 states in Mexico. RESULTS: Streptococcus pneumoniae was isolated from the nasopharynx of 829 out of 2 777(29.9% subjects aged two months to six years. All children lived in urban areas and 80% spent more than six hours daily in a day-care center. Streptococcus pneumoniae serotypes most frequently identified were: 19F (23%, 6B (15.6%, 23F (11.2% and 6A (14.9%. Thirty-six percent of the isolates were susceptible to penicillin. CONCLUSIONS: Serotype distribution suggests the possible benefits that could be obtained from the heptavalent pneumococcal conjugate vaccine.OBJETIVO: La intención de este estudio fue determinar la prevalencia de portadores nasofaríngeos asintomáticos de Streptococcus pneumoniae, el cual es el principal factor en la transmisión de esta bacteria. MATERIAL Y MÉTODOS: Los cultivos nasofaríngeos fueron realizados en niños que asisten a 32 estancias infantiles en 12 estados de México. RESULTADOS: Streptococcus pneumoniae fue aislado de la nasofaringe de 829 (29.9% niños de los 2 777 incluidos en el estudio con un rango de edad de 2 meses a 6 años. Todos los niños vivían en áreas urbanas y 80% permanecían más de seis horas diarias en la estancia infantil. Los serotipos de Streptococcus pneumoniae más frecuentemente identificados fueron: 19F (23%, 6B (15.6%, 23F (11.2% y 6 A (14.9%. Treinta y seis por ciento de los aislamientos fueron susceptibles a penicilina. CONCLUSIONES: La distribución de serotipos nos da una idea de los posibles beneficios que podrían obtenerse de la vacuna neumocóccica conjugada heptavalente.

  5. Vouchers for Day Care of Children: Evaluating a Program Model. (United States)

    Parker, Michael D.


    Examined effects of a pilot voucher program on the price, supply, and quality of day care. Findings offered no conclusive evidence concerning expected benefits. Discusses vouchers' potential for easing the day care crisis. (RJC)

  6. The Day Care Challenge: The Unmet Needs of Mothers and Children. (United States)

    Keyserling, Mary Dublin

    An overview of the present shortage of day care facilities in the United States is presented in this speech. Statistics cited on the number of working mothers with children under the age of 6 and the number of day care licensed homes and centers show that the shortage of licensed day care facilities is much more acute than it was five years ago.…

  7. Center to Advance Palliative Care (United States)

    ... Catalogue Membership Brochure Join CAPC Central Registry National Palliative Care Registry™ Enter your data to improve performance, prove ... Members Only) Identifying the Right Patients for Specialty Palliative Care Webinar Amy Kelley, MD and Arta Bakshandeh, DO, ...

  8. Morbidade em creche de Brasília: estudo longitudinal de incidência de enfermidades no ano de 1977 Morbidity in a Brasilia day care center: a longitudinal study of disease incidence in 1977

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    Ana Maria Low


    Full Text Available Foi feito estudo longitudinal de morbidade em creche de Brasília (Brasil freqüentada por crianças com bom estado nutricional. Foram admitidas na creche durante o ano de 1977 o total de 67 crianças (34 do sexo masculino e 33 do sexo feminino, com idade entre 3 e 21 meses. Infecções de vias aéreas superiores (25,4%, diarréia (23,6% e febre não esclarecida (18,4% representaram dois terços dos diagnósticos. A seguir, em ordem de freqüência, apareceram conjuntivite (15,5%, viroses da infância (7,9%, doenças de pele (3,8%, pequenos acidentes (2,6%, hepatite (2,6% e meningococcemia (0,3%. Houve um total de 343 episódios agudos, dando uma taxa de incidência de 14 enfermidades por criança por ano, independente de sexo e idade.A longitudinal morbidity study was carried out in a day care center in Brasilia (Brazil on a sample of 67 (34 male and 33 female, 3 to 21 months of age well-fed children from middle-class families. A pediatrician was on duty daily in the center. The incidence of disease was: upper respiratory, 25.4%; diarrhea, 23.6%; and undetermined fever, 18.4%. These represented 2/3 of the diagnoses. The other diseases found (and here listed in order of frequency were: conjunctivitis, 15.5%; childhood infections, 7.9%; skin diseases, 3.8%; accidents, 2.6%; hepatitis, 2.6%; and meningitis, 0.3%. There were a total of 343 acute illnesses, giving a mean incidence rate of 14 illnesses per child per year, independent of sex and age. Perhaps the incidence of illnesses would have been lower if the children had not been attending the center, a natural factor in the dissemination of communicable diseases.

  9. Program Planning for 6-12 Year-Olds in Day Care Centers: The Record of a Pilot Institute on Planning and Developing Creative Programs for School-Agers' Growth Through Play. (United States)

    Eckstein, Esther

    This pamphlet offers guidelines for directors and teachers interested in providing good after-school day care programs for children 6-12 years of age. The typical school-age child served by after-school programs in New York City is described in the introduction, and the importance of creative play is emphasized. Topics include: (1) the role of the…

  10. Assessment of risk and prophylaxis for deep vein thrombosis and pulmonary embolism in medically ill patients during their early days of hospital stay at a tertiary care center in a developing country

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    Ambarish Pandey


    Full Text Available Ambarish Pandey, Nivedita Patni, Mansher Singh, Randeep GuleriaDepartment of Medicine, All India Institute of Medical Sciences, New Delhi, IndiaAim: Deep vein thrombosis (DVT and pulmonary thromboembolism (PE are important causes of morbidity and mortality in medically ill patients. This study was done to assess risk factors and prophylaxis given for DVT and PE in newly admitted medically ill patients during the first two weeks of their hospital stay at a tertiary care center hospital in India.Methods: All patients within one week of their admission in intensive care unit (ICU and wards were enrolled in the study after an informed written consent. Patients who had DVT prophylaxis within the past month or any contraindications for DVT prophylaxis were excluded. A structured proforma was designed and effective risk stratification for DVT was done. Patients were followed for up to two weeks to record any changes in the risk categories and document any signs of PE or DVT if present. Any prophylaxis given for DVT or PE was noted.Results: Seventy-five percent of patients had the highest risk for DVT and PE. Only 12.5% had DVT prophylaxis within the first two days of admission. Within two weeks of admission, 30.8% of patients were discharged, and 16.2% died. 72.6% of the patients still in the wards belonged to the highest risk category. Clinical signs and symptoms of DVT and PE were present in 25.8% and 9.8% of patients, respectively after the second week of admission. 86% of symptomatic patients belonged to the highest risk category initially and none of them received any prophylaxis. 21.6% of the highest risk category patients died within two weeks of their admission. A statistically significant correlation was found between mortality and risk score of the patients for DVT and between lack of prophylaxis and mortality (p < 0.05.Conclusion: A significant risk for DVT and PE exists in medically ill patients, but only a small proportion of the patients

  11. The supply of day care : Het aanbod van kinderopvang

    NARCIS (Netherlands)

    Turksema, Rudolf Willem


    Previous to the 1990s day-care supply in the Netherlands was lagging behind compared to most other European countries. Therefore, the Dutch government introduced the Stimulative Measures on Child Care at the end of the 1980s. These supply-side subsidies were used to increase day-care supply, especia

  12. Partners HealthCare Center for Connected Health. (United States)

    Ternullo, Joseph; Jethwani, Kamal; Lane, Susan; Myint-U, Khinlei; Havasy, Robert; Carter, Michael; Kvedar, Joseph


    This article reviews the history, current status, and future plans of the Partners HealthCare Center for Connected Health (the Center). Established in 1995 by Harvard Medical School teaching hospitals, the Center develops strategies to move healthcare from the hospital and doctor's office into the day-to-day lives of patients. It leverages information technology to help manage chronic conditions, maintain health and wellness, and improve adherence to prescribed regimen, patient engagement, and clinical outcomes. Since inception, it has served over 30,000 patients. The Center's core functions include videoconference-based real-time virtual visits, home vital sign monitoring, store-and-forward online consultations, social media, mobile technology, and other novel methods of providing care and enabling health and wellness remotely and independently of traditional time and geographic constraints. It offers a wide range of services, programs, and research activities. The Center comprises over 40 professionals with various technical and professional skills. Internally within Partners HealthCare, the role of the Center is to collaborate, guide, advise, and support the experimentation with and the deployment and growth of connected health technologies, programs, and services. Annually, the Center engages in a deliberative planning process to guide its annual research and operational agenda. The Center enjoys a diversified revenue stream. Funding sources include institutional operating budget/research funds from Partners HealthCare, public and private competitive grants and contracts, philanthropic contributions, ad hoc funding arrangements, and longer-term contractual arrangements with third parties.

  13. Understanding Cortisol Reactivity across the Day at Child Care: The Potential Buffering Role of Secure Attachments to Caregivers (United States)

    Badanes, Lisa S.; Dmitrieva, Julia; Watamura, Sarah Enos


    Full-day center-based child care has been repeatedly associated with rising cortisol across the child care day. This study addressed the potential buffering role of attachment to mothers and lead teachers in 110 preschoolers while at child care. Using multi-level modeling and controlling for a number of child, family, and child care factors,…

  14. Early birds in day care: The social gradient in starting day care and children's non-cognitive skills


    Peter, Frauke H.; Pia S. Schober; Spiess, C. Katharina


    In recent years, almost all children below school age in Western industrialized countries have some experience of attending day care institutions. However, the age at which children enter day care and therefore the overall time spent in day carevaries substantially. We investigate the potential impact of later day care entry on the social and emotional behaviour of children, one important aspect of non-cognitive skills. Based on the English sample of the Millennium Cohort Study, we analyse th...

  15. Avaliação do desempenho motor global e em habilidades motoras axiais e apendiculares de lactentes frequentadores de creche Assessment of global motor performance and gross and fine motor skills of infants attending day care centers

    Directory of Open Access Journals (Sweden)

    Carolina T Souza


    assessed at 12 and 17 months of age with the Motor Scale of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III. This scale allows the analysis of global motor performance, fine and gross motor performance, and the discrepancy between them. The Wilcoxon test and Spearman's correlation coefficient were used. RESULTS: Most of the participants showed global motor performance within the normal range, but below the reference mean at 12 and 17 months, with 30% classified as having "suspected delays" in at least one of the assessments. Gross motor development was poorer than fine motor development at 12 and at 17 months of age, with great discrepancy between these two subtests in the second assessment. A clear individual variability was observed in fine motor skills, with weak linear correlation between the first and the second assessment of this subtest. A lower individual variability was found in the gross motor skills and global motor performance with positive moderate correlation between assessments. Considering both performance measurements obtained at 12 and 17 months of age, four infants were identified as having a "possible delay in motor development". CONCLUSIONS: The study showed the need for closer attention to the motor development of children who attend day care centers during the first 17 months of life, with special attention to gross motor skills (which are considered an integral part of the child's overall development and to children with suspected delays in two consecutive assessments.

  16. The Day-Care Debate: A Wider View. (United States)

    Kamerman, Sheila B.; Kahn, Alfred J.


    This article examines five major arguments against day care. Several approaches already in use in other countries are suggested as answers to the problems raised in the debate over care of children of working mothers. (MC)

  17. 75 FR 41793 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service... (United States)


    ..., 2009, at 74 FR 34295. Child and Adult Care Food Program (CACFP) Lunch and Centers Breakfast supper \\1... related notice published at 48 FR 29114, June 24, 1983.) This notice has been determined to be not... Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day...

  18. Playground Hazards in Atlanta Child Care Centers. (United States)

    Sacks, Jeffrey J.; And Others


    Examines 71 of the 605 licensed child care centers in Atlanta for playground hazards and school accidents. Finds 684 hazards in 66 centers, including climbing equipment over 6 feet high with inadequate impact-absorbing undersurfacing that had over twice the rate of fall injuries as climbing equipment under 6 feet high. (FMW)

  19. Detection of anti-Giardia lamblia serum antibody among children of day care centers Detecção de anticorpos séricos anti-Giardia lamblia em crianças de creches

    Directory of Open Access Journals (Sweden)

    Semíramis Guimarães


    Full Text Available OBJETIVES: To detect anti-Giardia lamblia serum antibodies in healthy children attending public day care centers and to assess serological tests as tools for estimating the prevalence of G. lamblia in endemic areas. METHODS: Three separate stool specimens and filter paper blood samples were collected from 147 children ranging from 0 to 6 years old. Each stool sample was processed using spontaneous sedimentation and zinc sulfate flotation methods. Blood samples were tested by indirect immunofluorescence (IIF and enzyme-linked immunosorbent assay (ELISA for Giardia IgG. RESULTS AND CONCLUSIONS: Of 147 individuals tested, 93 (63.3% showed Giardia cysts in their feces. Using IIF and ELISA, serum antibodies were detected in 93 (63.3% and 100 (68% samples , respectively. Sensitivity of IIF and ELISA was 82% and 72%, respectively. However, ELISA revealed to be less specific (39% than IIF (70%. IIF also showed a higher concordance with microscopic examination than ELISA.OBJETIVOS: Detectar anticorpos séricos anti-Giardia lamblia entre crianças atendidas em creches e estimar a freqüência de infecção por Giardia lamblia em área endêmica. MÉTODOS: Foram coletadas três amostras de fezes de cada uma das 147 crianças de três creches da rede municipal de Botucatu, SP, com idade variando de 0 a 6 anos, e as amostras foram processadas pelos métodos de sedimentação espontânea e flutuação pelo sulfato de zinco. Amostras de sangue foram obtidas da polpa digital, coletadas em papel de filtro e testadas pelos métodos de imunofluorescência indireta (IFI e de reação imunoenzimática (Elisa para pesquisa de IgG anti-Giardia. RESULTADOS E CONCLUSÕES: De um total de 147 crianças, 93 (63,3% apresentaram cistos de Giardia nas fezes. Dos 147 eluatos testados, 93 (63,3% e 100 (68% foram positivos para Giardia em IFI e em Elisa, respectivamente. A sensibilidade de IFI foi de 82% e de Elisa, 72%. Contudo, Elisa foi menos específica (39% do que IFI (70

  20. Pesquisas contextuais e seus desafios: uma contribuição a partir de investigações sobre arranjos espaciais em creches Contextual research and its challenges: the contribution of investigations on day care center spatial arrangements

    Directory of Open Access Journals (Sweden)

    Mara I. Campos-de-Carvalho


    Full Text Available Objetivando caracterizar pesquisas ecológicas, diferenciando-as de pesquisas não ecológicas, são apresentados pressupostos compartilhados por vários autores, apesar de suas divergências na análise da relação pessoa-ambiente (nas dimensões focalizadas, metodologia ou teoria. Uma breve visão introdutória da abordagem ecológica em psicologia é descrita. São discutidos dois critérios, interligados entre si e conectados aos pressupostos básicos, que diferenciam pesquisas ecológicas ou contextuais das não ecológicas ou não contextuais. Nossa experiência de condução de pesquisas contextuais, sobre a relação entre arranjo espacial e ocupação do espaço por crianças em creches, ilustra vários aspectos abordados; são descritos, resumidamente, três conjuntos de variáveis contextuais adicionais, estudadas para verificar se afetariam a ocupação espacial. São apresentados certos desafios metodológicos em pesquisas contextuais.The assumptions of the ecological research are presented, with the objective of characterizing the ecological research and its differentiation from nonecological research. These assumptions are shared by several authors, in spite of their divergences in the analysis of man-environment relationship (such as the ones on focused dimensions, methodology and theory. A brief view of the introduction of ecological ideas into psychology is given. Two criteria connected to the shared assumptions are useful to distinguish ecological and nonecological research. Our experience in carrying out contextual research on the relationship between spatial arrangement and the use of space by children in day care centers is used to illustrate many of the focused aspects; three groups of additional contextual variables are briefly presented, which are studied to examine their influence on spatial distribution. Some methodological challenges in contextual research are presented.

  1. 以“垂直农场”景观为依托的都市托老所营建%Urban Senior Day Care Center Construction Supported by "Vertical Farm

    Institute of Scientific and Technical Information of China (English)

    王丽蓉; 杨锐


    Due to rapid urbanization, lots of farmlands have been losing. Consequently the vertical farm emerges as a form of urban agriculture in the future. Currently China has entered an aging society. Owing to the shortage of services in cultural recreation and spiritual consolation, the traditional nursing mode brings negative effect to the old on physical and mental health. Contrast to people's gray impression on nursing home, Urban Senior Day Care Center brings the idea of vertical farms into nursing homes and meanwhile brings psychological joy to the old. Combined with the practice of South Lake Community in Nanjing, the paper explores a new type of community endowment pattern and specific construction of vertical farms landscape under the aging background.%快速城市化造成大量耕地的流失,未来都市农业的发展方向之一是"垂直农场"。当前我国已进入"老龄化"社会,传统的养老院模式由于在文化娱乐、精神慰藉等方面提供的服务相对欠缺,容易使老人的身心健康受到负面影响。而"都市托老所"将"垂直农场"的理念引入到养老院的建设中,观赏结合劳作,为老年人带来身心上的愉悦,改变了人们对传统养老院单调、灰色的印象。笔者结合南京南湖社区的实践,本着"都市托老"的理念,引入全民参与的养老服务体系,运用绿色生态的景观手法,积极探索老龄化背景下以"垂直农场"景观为依托的新型的社区养老模式的营建途径。

  2. Surgical audit in day care myringoplasty. (United States)

    Subramaniam, S; Abdul, R


    Day-case surgery is preferred for adults, allowing post-operative fast recovery in family environment and support. Myringoplasty using the traditional method of underlay temporalis fascia or tragal perichondrium is usually performed as an in-patient. From 2003 to 2004, 22 myringoplasty procedures were performed in a dedicated day surgery unit at the Hospital Melaka. We report the retrospectively review of the outcome results of these procedures. None of the patients need admission overnight. There were no surgical or anesthetic complications noted and this series suggests that day-case surgery is a safe and desirable practice for patients undergoing myringoplasty. However, there should be the facility for admission if required.

  3. Who Are the Clients?: Goal Displacement in an Adult Care Center for Elders with Dementia (United States)

    Abramson, Corey M.


    This ethnographic study of "goal displacement" in an adult day care center explains how and why certain goals come to surpass others in the organizational practices of elder day care settings. Adult day care is often oriented towards providing family caregivers with respite rather than attempting to directly improve the lives of the elders…

  4. Impact of extrinsic factors on fine motor performance of children attending day care (United States)

    Corsi, Carolina; dos Santos, Mariana Martins; de Andrade Perez Marques, Luísa; Rocha, Nelci Adriana Cicuto Ferreira


    Abstract Objective: To assess the impact of extrinsic factors on fine motor performance of children aged 2-years old. Methods: 73 children attending public and 21 private day care centers were assessed. Day care environment was evaluated using the Infant/Toddler Environment Rating Scale-Revised Edition (ITERS-R), fine motor performance was assessed through the Bayley Scales of Infant and Toddler Development-III (BSITD-III), socioeconomic data, maternal education and time of start at the day care were collected through interviews. Spearman's correlation coefficient was calculated to assess the association between the studied variables. Results: The time at the day care was positively correlated with the children's performance in some fine motor tasks of the BSITD-III, showing that the activities developed in day care centers were important for the refinement of specific motor skills, while the overall fine motor performance by the scale was associated with maternal education and the ITERS-R scale sub-item “language and understanding”. Conclusions: Extrinsic factors such as higher maternal education and quality of day care centers are associated with fine motor performance in children attending day care. PMID:27094472

  5. Day care monopolar transurethral resection of prostate: Is it feasible?

    Directory of Open Access Journals (Sweden)

    Altaf Khan


    Full Text Available Introduction: Benign prostatic hyperplasia is a common disease accounting for 30% of our OPD cases and about 25% of our surgery cases. Various treatment options are now available for more efficient care and early return to work. We wanted to determine the safety and feasibility of day care monopolar transurethral resection of prostate (m-TURP, by admitting the patients on the day of surgery and discharging the patient without catheter on the same day. We also compared the morbidity associated with conventional TURP where in the catheter is removed after 24-48 h of surgery and day care TURP where in the catheter is removed on the day of surgery. Materials and Methods: A total of 120 patients who fulfilled the criteria were included in the study which was conducted between November 2008 and December 2010. A total of 60 patients were assigned for day care and 60 for conventional monopolar TURP. There was no significant difference in age, prostatic volume or IPSS score. Day care patients were admitted on day of surgery and discharged the same day after the removal of catheter. Results: Both the groups were comparable in outcome. Stricture rate was less with day care TURP. Mean catheterization time was similar to laser TURP. Conclusion: Monopolar TURP is still the gold standard of care for BPH. If cases are selected properly and surgery performed diligently it remains the option of choice for small and medium sized glands and patients can be back to routine work early.

  6. Interpersonal relationships and group A streptococcus spread in a Mexican day-care center Relaciones interpersonales y diseminación del estreptococo del grupo A (EGA en una guardería de México

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    Alberto Villaseñor-Sierra


    Full Text Available OBJECTIVE: To study the effect of different degrees of centrality on the carrying of identical group A streptococcus (GAS clones in the nasopharynx of children from a Mexican public day-care center. MATERIAL AND METHODS: Nasopharyngeal cultures were performed in children from rooms B (RB (n = 35 and C (RC (n = 37. The Restriction Fragment Length Polymorphism (RFLP patterns were compared among GAS isolates. A social networks questionnaire was filled out for each child and 10 classmates. Structure coefficients were compared among children with and without GAS. RESULTS: Four GAS clones were identified; clone I in five children from RC; clone II in two from RC and one from RB; clone III in one from RB and one from RC; and clone IV in one from RC. Social network structure: Density of RB and RC = 0.40 (± 0.87 and 0.35 (± 0.80, respectively. In RB, the homophily pattern of interaction was different in carriers (0.00, non-carriers (0.47 and both (0.47 p = 0.35. In RC, the homophily pattern was also different in carriers (0.46, non-carriers (0.68 and mixed (0.19, p = .001. In 4/5 with clone I, the values of degree, closeness and betweenness were above the group mean. In 3/3 with clone II, the values of degree and betweenness were also above the mean. In contrast, in those with clone III and IV, the values of degree, closeness and betweenness were below the group mean. CONCLUSION: The spread of specific GAS clones was associated with groups of children having a high proportion of ties and a high centrality level. This is evidence that spread of GAS strains among children attending day-care centers is not random but dependent on the degree of communication and physical contact between pairs.OBJETIVO: Evaluar el efecto de grados diferentes de centralidad con la presencia de clonas idénticas de estreptococo del grupo A (EGA en la nasofaringe de niños de una guardería pública de México. MATERIAL Y MÉTODOS: Se realizaron cultivos nasofaríngeos en ni

  7. Implementing Outcome Measures Within an Enhanced Palliative Care Day Care Model.

    LENUS (Irish Health Repository)

    Kilonzo, Isae


    Specialist palliative care day care (SPDC) units provide an array of services to patients and their families and can increase continuity of care between inpatient and homecare settings. A multidisciplinary teamwork approach is emphasized, and different models of day care exist. Depending on the emphasis of care, the models can be social, medical, therapeutic, or mixed. We describe our experience of introducing an enhanced therapeutic specialist day care model and using both patient- and carer-rated tools to monitor patient outcomes.

  8. Delivery of Services of Day Care Workers In Sta. Maria, Laguna

    Directory of Open Access Journals (Sweden)



    Full Text Available This study focused on the determination of the delivery of services of day care workers in the municipality of Sta. Maria, Province of Laguna during the first semester of school year 2012-2013. Descriptive research was used in this study. Among the key findings were that Day Care Workers with respect to interactional relationship accomplished the functions with outstanding adequacy such as constantly giving feedback and praises on the performance of children, along with workers and parents coordination and cooperation, with verbal interpretation of Always Observe. In terms of instructional quality both group of respondents perceived that day care workers in-charge had adequate abilities and competencies concerning their education and trainings in connection with teaching small children with verbal interpretation of Always Observe. The parents had confidence to the day care workers in-charge of their children aside from regularly consulting the day care workers about their children’s progress with verbal interpretation of Always Observe. There were only 871 households who availed of the services of day care centers in which 27 workers were employed and each of them assigned to handle an average of 33 children. Notable along with other findings was the day care workers and parents had the same perception as to the extent of services provided by the Day Care Center with respect to interactional relationship, instructional quality and parental participation. Subsequently the study ensued with these five factual remarks: Children’s interactions with parents in the centers were the direct mechanisms through which children learn. The educational qualification and the capability of the day care workers to handle small children were the primary essentials in children’s learning. Parents’ participation in the day care centers premises brought harmonious relationship between the Day Care Workers and children as well. The capacity of day care worker

  9. Organizational Structure and Behaviour in Day Care: Differences between Non-Profit and For-Profit Centres. (United States)

    Canning, Patricia M.; Lyon, Mary E.; Kienapple, Kim; Young, Jeffrey


    Examined how Canadian day care centers are operated and managed, to identify differences in organizational structure and behavior between non-profit and for-profit centers and characteristics of structure and management linked with high quality care. Found that non-profit centers were more complex, more formalized, and less centralized than…

  10. Infectious disease burden related to child day care in the Netherlands.

    NARCIS (Netherlands)

    Enserink, R.; Ypma, R.; Donker, G.A.; Smit, H.A.; Pelt, W. van


    Background: Studying day-care–associated infectious disease dynamics aids in formulating evidence-based guidelines for disease control, thereby supporting day-care centers in their continuous efforts to provide their child population with a safe and hygienic environment. The objective of this study

  11. Estado nutricional e consumo de energia e nutrientes de pré-escolares que frequentam creches no município de Manaus, Amazonas: existem diferenças entre creches públicas e privadas? Estado nutricional y consumo de energía y nutrientes de pre-escolares que frecuentan guarderías en el municipio de Manaus, Amazonas (Brasil: ¿existen diferencias entre guarderías públicas y privadas? Nutritional status and energy and nutrients intake of children attending day-care centers in the city of Manaus, Amazonas, Brazil: are there differences between public and private day-care centers?

    Directory of Open Access Journals (Sweden)

    Bruno Mendes Tavares


    consumo alimentar en la guardería fue evaluado por el método de pesaje directo individual de los alimentos y, en el domicilio, por el registro alimentar de un día aplicado a los responsables. Se estimó la frecuencia de niños con ingestión de nutrientes por encima o por debajo de los puntos de corte de Estimated Average Intake (EAR o Adequate Intake (AI. RESULTADOS: Se verificó mayor frecuencia de niños con exceso de peso en las guarderías privadas, por los índices de peso para estatura e IMC para edad. Los niños de las instituciones públicas, cuando comparados a aquellos de las privadas, consumieron más grasas poliinsaturadas, trans, ácido graso omega-6, vitamina C y sodio, y menos zinc. En ambos tipos de guarderías, se observaron consumo elevado de energía y proporción elevada de niños con consumo de vitaminas A y C, zinc y sodio por encima del límite superior tolerable de ingestión. La proporción de niños con inadecuación de consumo de calcio fue mayor en las guarderías públicas que en las privadas (27,6 versus 7,9%; pOBJECTIVES: To assess the nutritional status and dietary intakes of children attending public and private day care centers in Manaus, Brazil. METHODS: The study assessed children aged 24 to 72 months, enrolled at two public (n=217 and two private (n=91 day care centers in Manaus. Nutritional status was classified according to Z scores for weight-for-age, weight-for-height, height-for-age and BMI-for-age. Dietary intakes were measured using the direct food-weighing method for 1 day. A 1-day dietary recall was administered to parents to assess dietary intakes outside the day care centers. The frequencies of children with nutrient intakes above and below the Estimated Average Requirements (EAR or Adequate Intake (AI cutoffs were calculated. RESULTS: There proportion of overweight children was higher at the private day care centers, according to both weight-for-height and BMI-for-age indexes. Children from the public day care centers

  12. Nutritional assessment of children at the day care center “Marineritos del Sur” in Cienfuegos province, Cuba. Evaluación nutricional de los niños del circulo infantil “Marineritos del Sur”. Cienfuegos.

    Directory of Open Access Journals (Sweden)

    Ernesto Martínez Ferrer


    Full Text Available Background: In many countries in the last few years, there has been an increasing interest for the assessment of the Nutritional System which can be defined as a systemic and permanent process of collection, transmission analysis and interpretation of the information that allows to keep updated knowledge of the nutritional state. The follow up of the children´s growth and development has the importance not only to assist the children´s needs at a determined age but also to assist them with a preventive criteria taking into account their dynamic and changing characteristics. Objectives: To assess nutritionally the children gathered at the ages from 2 to 6 years that attend the day care center ¨Marineritos del Sur¨ for more than one year during the period September 1 st - March 2000. Methods: The variables under study were age, sex, weight, folds brachial circumference and past illnesses. Results: According to the indicators weight/size, size/age, weight / age, tricipital fold/ age, brachial circumference / age, patients between 10 and 90 percentile had a predominance. The calculus of the Z point showed that 67,66 % of the children were eutrophic, 27,=6 tended to obesity and 5,28 malnourished. Giardia Lambia was the most frequent isolated parasite.
    Fundamento: En el transcurso de los últimos años está tomando creciente interés en diversos países el Sistema de Vigilancia Alimentaria y Nutricional que puede definirse como un proceso sistemático y permanente de recolección, transmisión, análisis e interpretación de información que permite mantener un conocimiento actualizado de la situación alimentaria y nutricional El seguimiento del crecimiento y desarrollo del niño no solo tiene la importancia de atender sus necesidades del niño a una edad determinada sino el asistirlo con un criterio preventivo y evolutivo teniendo en

  13. Cortisol Levels and Children's Orientation in Day Care (United States)

    Reunamo, Jyrki; Sajaniemi, Nina; Suhonen, Eira; Kontu, Elina


    Children's stress in day care is related to the stressful qualities of the environment and to children's orientations in that environment. The study involved 55 children in five day centres in Finland. Baseline saliva samples for measuring cortisol (stress) levels were collected five times during the day. Children were interviewed to measure their…

  14. Syllabus Outline on Child Care for Day Care Teachers at Family Life Teacher Training Centre in Somalia. African Studies in Curriculum Development and Evaluation No. 103. (United States)

    Ahmed, Mumina M.

    Five day care centers in Mogadiscio, the capital city of Somalia, were studied to (1) identify problems encountered in teaching a course in child care; (2) observe teaching methods and assess their effectiveness; (3) ascertain reasons for the lack of preservice training for day care teachers; and (4) develop a new syllabus for a course in child…

  15. Impact of a half-day multidisciplinary symptom control and palliative care outpatient clinic in a comprehensive cancer center on recommendations, symptom intensity, and patient satisfaction: a retrospective descriptive study. (United States)

    Strasser, Florian; Sweeney, Catherine; Willey, Jie; Benisch-Tolley, Susanne; Palmer, J Lynn; Bruera, Eduardo


    To characterize a new, one-stop multidisciplinary palliative care (MD) clinic which offers standardized multidisciplinary assessment, specific care recommendations, patient and family education, and on-site counseling, we retrospectively compared the assessments of 138 consecutive patients with advanced cancer referred to the MD clinic and 77 patients referred to a traditional pain and symptom management (PSM) clinic. The two groups were similar in tumor type, demographics, and symptom distress. The MD clinic team (physicians; nurses; pharmacists; physical, speech, and occupational therapists; social workers; chaplains; nutritionists; psychiatric nurse practitioner) delivered 1,066 non-physician recommendations (median 4 per patient, range 0-37). The PSM clinic team made no non-physician recommendations, but referred 14 patients to other medical specialists. In 80 (58%) MD-clinic patients with follow-up 9 days (median) after assessment, significant improvement was observed in pain, nausea, depression, anxiety, sleep, dyspnea, and well-being, but not in fatigue, anorexia, or drowsiness. In 83 patients interviewed after the MD clinic, satisfaction was rated as excellent (5 out of 5) in 86-97% of seven areas. Assessment at an MD clinic results in a high number of patient care recommendations, improved symptoms, and high levels of patient satisfaction.

  16. Analysis of the electric heating conventional system replacement by the solar heating in day-care centers at Poco de Caldas - MG; Analise da substituicao de sistema convencional de aquecimento eletrico por aquecimento solar em creches em Pocos de Caldas -MG

    Energy Technology Data Exchange (ETDEWEB)

    Dantas, Carlos Tadeu [Escola Tecnica Limassis, Delfim Moreira, MG (Brazil); Mariotoni, Carlos Alberto [Universidade Estadual de Campinas, SP (Brazil)


    Located in the South of Minas Gerais, average altitude of 1186 m and population about 170.000 inhabitants Pocos de Caldas is one of the most developed tourist cities of Minas Gerais. Beyond this quality, that makes it one of the best cities in quality of life in Brazil, measured for the HDI, the city presents an enviable educational polar region comparing to cities of the south region. With 91 institutions of education, from children's education to superior education, Pocos de Caldas has more than 49,000 students today. From this scholar population, 1870 pupils represent the children's education in particular or municipal day-care centers, called CEI. Pocos de Caldas has its own generation of energy through the Municipal Department of Electricity, DME. The energy production today arrives the house of 58 MW reaching 100% of the population in 2005. The analysis of the substitution of conventional system of electric heating for solar heating in day-care centers has left of an unknown project, with the objective to minimize the consumption of energy unfastened during the children's baths who stay at CEI. In this context, this work presents a study carried through this project, after the implantation of the related system in four of the eleven day-care centers that the initial project composes. The data had been collected in the DME and the City department of Education. The pathological manifestations in the points of water consumption of the related day-care centers as well as the state of conservation of the systems of implanted solar heating had been investigated also. (author)

  17. Designing robots for care: care centered value-sensitive design. (United States)

    van Wynsberghe, Aimee


    The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship--what I refer to as care robots--require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a vulnerable and sensitive time in their lives. The ethical evaluation of care robots requires insight into the values at stake in the healthcare tradition. What's more, given the stage of their development and lack of standards provided by the International Organization for Standardization to guide their development, ethics ought to be included into the design process of such robots. The manner in which this may be accomplished, as presented here, uses the blueprint of the Value-sensitive design approach as a means for creating a framework tailored to care contexts. Using care values as the foundational values to be integrated into a technology and using the elements in care, from the care ethics perspective, as the normative criteria, the resulting approach may be referred to as care centered value-sensitive design. The framework proposed here allows for the ethical evaluation of care robots both retrospectively and prospectively. By evaluating care robots in this way, we may ultimately ask what kind of care we, as a society, want to provide in the future.

  18. Family Care Map: Sustaining family-centered care in Polytrauma Rehabilitation Centers

    Directory of Open Access Journals (Sweden)

    James H. Ford II, PhD


    Full Text Available The study assessed sustainability of the Family Care Map, a family-centered approach to providing care for Veterans with polytrauma-related injuries, in four Department of Veterans Affairs Polytrauma Rehabilitation Centers. We applied a mixed-methods approach. Staff surveys used standardized measures of sustainability, commitment to change, information, and participation during implementation. Qualitative inquiry assessed Family Care Map implementation and facilitators and barriers to sustainability. Staff sustainability perceptions had a significant positive correlation with affective commitment to change, participation, and information received about the change process. Family Care Map integration into standard practices and use of its concepts with patients and families related to staff perceptions about sustainability. The degree of use and integration of the Family Care Map in traumatic brain injury/polytrauma care varied among the Polytrauma Rehabilitation Centers. Some successful sustainability strategies included integration into daily workflow and organizational culture. Examples of sustainability barriers included staff awareness and use and outdated information. Some practices, such as measuring and documenting the use of the Family Care Map in treatment plans, may not routinely occur. The focus on family-centered care will require further evaluation of organization-, staff-, and innovation-level attributes that influence sustainability of changes designed to improve family-centered care.

  19. Nutritional practices in full-day-care pre-schools.

    LENUS (Irish Health Repository)

    Jennings, A


    Full-day-care pre-schools contribute significantly to the nutritional intake and acquisition of dietary habits of the pre-school child. The present study investigated nutritional practices in full-day-care pre-schools in Dublin, Ireland, aiming to determine the nutritional support that pre-school managers deem necessary, thereby facilitating the amelioration of existing pre-school nutritional training and practices.

  20. Day care surgery in a metropolitan government hospital setting--Indian scenario. (United States)

    Dorairajan, Natarajan; Andappan, Anandi; Arun, B; Siddharth, Dorairajan; Meena, M


    Day care surgery has generated a lot of interest, among both surgeons and the common people. This study aims to explore the management and advantages, including the cost benefits and cost effectiveness, of day care surgery in a government hospital setting. A prospective, single-center, single-unit study was carried out over 1 year from August 2006 to January 2008. The total number of patients studied was 327. Surgeries for hernia, hydrocele, fibroadenoma, fissure in ano, and phimosis were included. Patients were admitted on the day of surgery and were discharged the same day or evening. Patients were analyzed with respect to failure to discharge, wound infection, duration of stay in the ward, cost benefits, cost effectiveness, and postoperative pain. A total of 157 patients were treated for hernia, 61 for hydrocele, 52 for fibroadenoma, 34 for fissure in ano, and 23 for phimosis. Day care surgery is a fast growing and well accepted way of providing care to patients. Most of the patients studied had a favorable impression of the day care surgical procedure compared with inpatient care. In a country like India, in spite of problems of financial constraints and insufficient grants for health care, we are able to enjoy all the advantages of day care surgery, even in a government hospital setting.

  1. Norway's Day-Care Initiative: A Municipal Approach (United States)

    Nemeth, Beate; Lokken, Gisle


    Norway is gearing up to provide places in day care centres for all children aged between one and six and the need for more facilities has therefore increased substantially in recent years. In Tromso, the municipality has become closely involved in child-care pedagogics and architecture; a design competition it launched has brought rewarding…

  2. Adult Day Care and Medical and Hospital Claims. (United States)

    Chappell, Neena L.; Blandford, Audrey A.


    Examined effect of adult day care (ADC) on utilization of health care practitioner and inpatient hospital services. Data from three separate ADC studies revealed that, when operative for some time, ADC may result in dramatic decreases in hospital inpatient stays. Findings warrant further research. (Author/NB)

  3. 38 CFR 59.160 - Adult day health care requirements. (United States)


    ... : Program Director 200 Assistant administrator 150 Medical officer, director of nursing or equivalent 150... facility, States must meet the requirements of this section. (a) Each adult day health care program, when it is co-located in a nursing home, domiciliary, or other care facility, must have its own...

  4. Alta prevalência de crianças portadoras de Streptococcus pneumoniae resistentes à penicilina em creches públicas High prevalence of children colonized with penicillin-resistant Streptococcus pneumoniae in public day-care centers

    Directory of Open Access Journals (Sweden)

    Patrícia A. G. Velasquez


    in public day-care centers of the municipality of Umuarama, state of Paraná, Brazil. The susceptibility of the pneumococcal strains to antimicrobial agents was also studied. METHODS: Nasopharyngeal specimens from 212 children were collected from April to October 2008. After the specimens were seeded in blood agar and incubated at 37 °C for 24-48 hours, the colonies suspected of belonging to S. pneumoniae were identified using α-hemolysis, optochin sensitivity, and bile solubility test. Penicillin susceptibility was investigated using the disk diffusion and dilution tests. Susceptibility to the other antimicrobial agents indicated for the treatment of pneumococcal infections was investigated using the disk diffusion test. RESULTS: The prevalence of nasopharyngeal pneumococci was 43.4% (92/212, with higher rates in children between 2 and 5 years old (p = 0.0005. There was no significant difference between sexes. Intermediate and full resistance to penicillin were found in 34.8 (32/92 and 22.8% (21/92 isolates, respectively. Sixty-seven strains (72.8% were resistant to sulfamethoxazole-trimethoprim, eight (8.7% were resistant to erythromycin, and six (6.5% to tetracycline. One strain was resistant to clindamycin (1.1% and another was resistant to chloramphenicol (1.1%. All strains were sensitive to levofloxacin, ofloxacin, rifampicin, telithromycin, linezolid, and vancomycin. Nine strains were considered multiresistant because they were resistant to three or more classes of antimicrobial agents. CONCLUSIONS: The present study detected a high prevalence of healthy children colonized with penicillin-resistant S. pneumoniae strains who may be important reservoirs of this pathogen in the community.

  5. Training Doctors for Person-Centered Care. (United States)

    English, Jeannine


    Person-centered care, in which an individual patient's goals and preferences are treated as paramount, should be the standard throughout the nation. Achieving this ideal will require a change in the culture of health care, and medical schools can play a vital role in helping achieve it. Lack of communication, uncoordinated services, and dealings with sometimes-aloof clinicians and staff all can increase stress and undermine a person's sense of well-being. In a person-centered system, such experiences would be much less common. The cultural shift starts with the idea of "engaging the consumer" rather than "treating the patient." Such engagement requires honoring individuality. The doctor may have a certain way of doing things. But people vary enormously in their values and priorities. They have different goals, different thresholds of pain, different anxieties, different needs for support, different backgrounds, and different resources to draw on. Individuals should feel empowered, aware of their choices, and connected to their health care providers through meaningful communication and understanding. They deserve to feel that their personal dignity and their wishes are a top priority. They should be made to feel that they, along with their caregivers, are members of the care team. This change will benefit not only patients and families but doctors as well. Doctors will benefit from more insight into the individuals they serve, their interactions with consumers and caregivers will be more positive, and the quality of care will improve.

  6. Rapid emergence of day-care anaesthesia: A review

    Directory of Open Access Journals (Sweden)

    S B Gangadhar


    Full Text Available The number of day-care surgeries is increasing every day. The boundaries of day-care surgeries are being redefined on a continual basis. Multi-dimensional benefits to the patient, hospital and national economy are the driving forces behind the changing scenario on the horizon of day surgery. The literature search included Google, medlinx, pubmed and medline. We have attempted to look at the controversies in patient selection with comorbidities, pre-operative assessment and an acceptable ASA grade of patients. An attempt is also made to look at suitable surgical procedures, a pathway of introducing procedures, which are still complex and specialist procedures in challenging environment. The techniques of general anaesthesia, central neuraxial blocks, regional nerve blocks with indwelling catheters and monitoring techniques are deliberated upon. Finally the most important post-operative issues of discharge criteria, including recovery after spinal anaesthetic, oral fluid intake, voiding and travel after day surgery, are considered.

  7. Program Success of Mental Health Clients in Day Reporting Centers. (United States)

    McGregor, Brian; Brown, Eleanor; Yan, Fengxia; Mitchell, Crystal; Robinson, Charles; DeGroot, James; Braithwaite, Ronald


    Day-reporting centers (DRCs) provide programming for probationers with a history of non-compliant behavior related to substance abuse, who are overrepresented among justice-involved men and women. While evaluations of DRCs demonstrate some effectiveness, results are mixed and less is known about predictors of program success. This evaluation compared indicators of program success between adult offenders with a substance use disorder (n = 144) and those with co-morbid mental illness (n = 113) at three DRCs. Analyses examined differences between and within groups on program completion, personal characteristics and subjective measures of well-being. Results indicated that program completers were more likely to be participants with substance use disorders only and to have a drug-related referring charge. No significant differences between groups on most measures of well-being were observed. Future investigations should consider tracking program dropouts to better understand program attrition and explore readiness to change in treatment programming.

  8. Recovering activity and illusion: the nephrology day care unit. (United States)

    Remón Rodríguez, C; Quirós Ganga, P L; González-Outón, J; del Castillo Gámez, R; García Herrera, A L; Sánchez Márquez, M G


    Day Care Units are an alternative to hospital care that improves more efficiency. The Nephrology, by its technical characteristics, would be benefit greatly from further development of this care modality. The objectives of this study are to present the process we have developed the Nephrology Day Care Unit in the Puerto Real University Hospital (Cádiz, Spain). For this project we followed the Deming Management Method of Quality improvement, selecting opportunities, analyzing causes, select interventions, implement and monitor results. The intervention plan includes the following points: 1) Define the place of the Day Care Unit in the organization of our Clinical Department of Nephrology, 2) Define the Manual of organization, 3) Define the structural and equipment resources, 4) Define the Catalogue of services and procedures, 5) Standards of Care Processes. Protocols and Clinical Pathways; and 6) Information and Registration System. In the first 8 months we have been performed nearly 2000 procedures, which corresponds to an average of about 10 procedures per day, and essentially related to Hemodialysis in critical or acute patients, the Interventional Nephrology, the Clinical Nephrology and Peritoneal Dialysis. The development of the Nephrology Day Care Units can help to increase our autonomy, our presence in Hospitals, recover the progressive loss of clinical activity (diagnostic and therapeutic skills) in the past to the benefit of other Specialties. It also contributes to: Promote and develop the Diagnostic and Interventional Nephrology; improve the clinical management of patients with Primary Health Level, promote the Health Education and Investigation, collaborate in the Resources Management, and finally, to make more attractive and exciting our Specialty, both for nephrologists to training specialists.

  9. A Community Day Care Programme for Psychiatric Patients: The Role of Occupational Therapy. (United States)

    Pradad, Akanksha; And Others


    This paper examines the need for and role of occupational therapy in the organization and functioning of a community day care center for psychiatric patients in India. The occupational therapy program involves client evaluation, determination of therapeutic activities, physical exercise, recreational activities, group sessions, family involvement,…

  10. Control of a Non-foodborne Outbreak of Salmonellosis: Day Care in Isolation. (United States)

    Chorba, Terence, L.; And Others


    In this study of a salmonellosis outbreak at a day care center an analysis of five variables revealed that the disease was transferred person to person or by a continuing common source. Successful preventive measures included instruction in proper handwashing and diaper changing procedures and isolation of the infected children. (VM)

  11. Children's attachment relationships with day care caregivers: Associations with positive caregiving and the child's temperament

    NARCIS (Netherlands)

    J.C. de Schipper; L.W.C. Tavecchio; M.H. van IJzendoorn


    In this study, children's attachment relationships with their professional caregivers in center day care were observed for 48 children. We explored whether more positive caregiving was associated with a more secure attachment relationship and whether this association was stronger for more temperamen

  12. Menu Planning, Food Consumption, and Sanitation Practices in Day Care Facilities. (United States)

    Kuratko, Connye N.; Martin, Ruth E.; Lan, William Y.; Chappell, James A.; Ahmad, Mahassen


    In 102 day care centers, data were collected on nutritional content of menus, compliance with guidelines, children's food consumption, and safety/sanitation. Although menus exceeded recommended daily allowances, quantities of food were below recommendations. No menu components were consumed by more than 65% of children. Sanitation problems were…

  13. Dagliga Separationer och Tidig Daghemsstart (Daily Separations and Early Entry into Day Care). (United States)

    Harsman, Ingrid

    The purpose of this thesis [Swedish language with English abstract and summary] was to study the reactions of infants when they started attending day care centers and to elucidate the process of adjustment. The theoretical perspective employed is the J. Bowlby/M. Ainsworth attachment theory. U. Bronfenbrenner's ecological theory of human…

  14. Unnoticed professional competence in day care work and the challenge of neoliberalism

    DEFF Research Database (Denmark)

    Ahrenkiel, Annegrethe; Warring, Niels; Schmidt, Camilla;

    ’s work in day care centers can be explored, developed and potentially democratized acknowledging the unnoticed aspects of daily work practices and professional competence. The paper draws on empirical examples from two research projects (Ahrenkiel et al. 2009, 2011) and discuss how noticing...

  15. Early Retirement in the Day-Care Sector

    DEFF Research Database (Denmark)

    Gørtz, Mette


    This paper studies the role of working conditions and health for elderly female day-care teachers’ decision to enter early retirement. Entry into retirement is analysed in a duration framework that allows for unobserved heterogeneity in the baseline hazard. Data are from a Danish longitudinal data...... the child-to-teacher ratio or the size of the institution and early retirement (ERP). However, working conditions measured by the social background of the children and the share of trained day-care teachers have a significant effect on the probability of early retirement. Finally, a poor health condition...... is associated with a higher propensity to enter early retirement....

  16. Integrative medicine and patient-centered care. (United States)

    Maizes, Victoria; Rakel, David; Niemiec, Catherine


    Integrative medicine has emerged as a potential solution to the American healthcare crisis. It provides care that is patient centered, healing oriented, emphasizes the therapeutic relationship, and uses therapeutic approaches originating from conventional and alternative medicine. Initially driven by consumer demand, the attention integrative medicine places on understanding whole persons and assisting with lifestyle change is now being recognized as a strategy to address the epidemic of chronic diseases bankrupting our economy. This paper defines integrative medicine and its principles, describes the history of complementary and alternative medicine (CAM) in American healthcare, and discusses the current state and desired future of integrative medical practice. The importance of patient-centered care, patient empowerment, behavior change, continuity of care, outcomes research, and the challenges to successful integration are discussed. The authors suggest a model for an integrative healthcare system grounded in team-based care. A primary health partner who knows the patient well, is able to addresses mind, body, and spiritual needs, and coordinates care with the help of a team of practitioners is at the centerpiece. Collectively, the team can meet all the health needs of the particular patient and forms the patient-centered medical home. The paper culminates with 10 recommendations directed to key actors to facilitate the systemic changes needed for a functional healthcare delivery system. Recommendations include creating financial incentives aligned with health promotion and prevention. Insurers are requested to consider the total costs of care, the potential cost effectiveness of lifestyle approaches and CAM modalities, and the value of longer office visits to develop a therapeutic relationship and stimulate behavioral change. Outcomes research to track the effectiveness of integrative models must be funded, as well as feedback and dissemination strategies

  17. High detection rates of enteropathogens in asymptomatic children attending day care.

    Directory of Open Access Journals (Sweden)

    Remko Enserink

    Full Text Available BACKGROUND: Gastroenteritis morbidity is high among children under the age of four, especially amongst those who attend day care. OBJECTIVE: To determine the prevalence of a range of enteropathogens in the intestinal flora of children attending day care and to relate their occurrence with characteristics of the sampled child and the sampling season. METHODS: We performed three years of enteropathogen surveillance in a network of 29 child day care centers in the Netherlands. The centers were instructed to take one fecal sample from ten randomly chosen children each month, regardless of gastrointestinal symptoms at time of sampling. All samples were analyzed for the molecular detection of 16 enteropathogenic bacteria, parasites and viruses by real-time multiplex PCR. RESULTS: Enteropathogens were detected in 78.0% of the 5197 fecal samples. Of the total, 95.4% of samples were obtained from children who had no gastroenteritis symptoms at time of sampling. Bacterial enteropathogens were detected most often (most prevalent EPEC, 19.9%, followed by parasitic enteropathogens (most prevalent: D. fragilis, 22.1% and viral enteropathogens (most prevalent: norovirus, 9.5%. 4.6% of samples related to children that experienced symptoms of gastroenteritis at time of sampling. Only rotavirus and norovirus were significantly associated with gastroenteritis among day care attendees. CONCLUSIONS: Our study indicates that asymptomatic infections with enteropathogens in day care attendees are not a rare event and that gastroenteritis caused by infections with these enteropathogens is only one expression of their presence.

  18. Adult Day Care Program(高二适用)

    Institute of Scientific and Technical Information of China (English)



    David Brown and Anne are two patients in the Adult Day Care Pro-gram at Mercy Hospitals. David Brown is seventy-two years old. He'sfriendly and likes to talk. He lives with his wife in the city. But David is

  19. Valley Interfaith Child Care Center CMS


    Kramolisch, Andrew; Mack, Nate


    Included files:,,, viccc_final_paper.doc. The project consisted of revamping Valley Interfaith Child Care Center's website to be more modern and feature media. The goal was to cater to two diverse audiences: the families that needed their services and the investors who helped them keep running. This system is the result of efforts to do that. To run this software locally requires: Ruby 1.9.2 or newer, the bundler gem and either SQLite or PostgreSQL. The ...

  20. History of the Animal Care Program at Johnson Space Center (United States)

    Khan-Mayberry, Noreen; Bassett, Stephanie


    NASA has a rich history of scientific research that has been conducted throughout our numerous manned spaceflight programs. This scientific research has included animal test subjects participating in various spaceflight missions, including most recently, Space Shuttle mission STS-131. The Animal Care Program at Johnson Space Center (JSC) in Houston, Texas is multi-faceted and unique in scope compared to other centers within the agency. The animal care program at JSC has evolved from strictly research to include a Longhorn facility and the Houston Zoo's Attwater Prairie Chicken refuge, which is used to help repopulate this endangered species. JSC is home to more than 300 species of animals including home of hundreds of white-tailed deer that roam freely throughout the center which pose unique issues in regards to population control and safety of NASA workers, visitors and tourists. We will give a broad overview of our day to day operations, animal research, community outreach and protection of animals at NASA Johnson Space Center.

  1. From Policy to Practice: Implementation of Water Policies in Child Care Centers in Connecticut (United States)

    Middleton, Ann E.; Henderson, Kathryn E.; Schwartz, Marlene B.


    Objective: Child care policies may contribute to healthy beverage consumption patterns. This study documented availability and accessibility of water and correspondence with state and federal policy and accreditation standards in child care centers. Design: One-day observations were conducted in a random sample of 40 Child and Adult Care Food…

  2. Risk factors and prevalence of antibodies against hepatitis A virus (HAV in children from day-care centers, in Goiania, Brazil Fatores de risco e prevalência de anticorpos contra o vírus da hepatite A (VHA em crianças de creche em Goiânia, Brasil

    Directory of Open Access Journals (Sweden)

    D.A.O. Queiróz


    Full Text Available A seroepidemiologic survey about hepatitis A virus (HAV infection was carried out in a group comprising 310 children, ranging in age from 3 months to 9 years, from day-care centers, in Goiania, a middle sized city in the central region of Brazil. The biomarkers employed in the investigation of previous infection include total IgG and IgM anti-HAV antibodies, and for the detection of more recent infection, IgM anti-HAV antibodies were analyzed. The study was performed in 1991 and 1992. According to the results, 69.7% of the children presented total IgG/IgM anti-HAV antibodies, with 60% of the group in the age range of 1 to 3 years. Among 10 day-care centers analyzed, the prevalence of the biomarker IgM anti-HAV was 3.2%, with an uniform distribution of the cases in the group of children ranging in age from 1 to 4 years. Multi-variate analysis was performed to investigate the sociodemographic factors that could influence the results. It was verified that the risk for the infection increased with the length of the attendance in the day-care centers, i.e., the risk for children with attendance of one year or more was 4.7 times higher, when compared with children with one month attendance (CI 95% 2.3-9.9. According to the results, hepatitis A is an endemic infection in day-care centers in the study area. The length of attendance in the day-care settings was demonstrated to be a risk factor for the HAV infection. Such findings suggest that if hepatits A vaccination becomes available as a routine policy in our region, the target group should be children under one year. Moreover, those children should receive the vaccine before they start to attend the day-care centers.Um estudo soroepidemiológico para o vírus da hepatite A (VHA, investigando os marcadores de infecção passada (anti-VHA total - IgG e IgM e infecção recente (anti-VHA IgM, foi realizado entre 1991 e 1992, em crianças de creche de Goiânia-Brasil central. Das 310 crianças com idade

  3. Creche: ambiente expositor ou protetor nas infestações por parasitas intestinais em Aracaju, SE Children day care center: exposition or protection environment to intestinal parasites infestation in Aracaju, SE

    Directory of Open Access Journals (Sweden)

    Ricardo Queiroz Gurgel


    Full Text Available Para avaliar se creches são ambientes protetores ou propiciadores de infestação intestinal, foi feito exame coproparasitológico de crianças de creche e grupo controle. Creche relacionou-se à maior prevalência de parasitoses (63% x 41,4 % ; pThe work aimed to evaluate whether child daycare centers are an environment that protects against or exposes children to intestinal parasite infestation. Stool samples were analyzed from children attending such centers and a control group. It was concluded that attending daycare centers is related to intestinal parasitosis (630% vs. 41.4 %; p <0.01 and the risk of infestation is 1.5 times higher.

  4. Fatores de risco de anemia em lactentes matriculados em creches públicas ou filantrópicas de São Paulo Risk factors for anemia in infants enrolled in public or philanthropic day-care centers in São Paulo city, Brazil

    Directory of Open Access Journals (Sweden)

    Tulio Konstantyner


    Full Text Available OBJETIVO: Identificar e quantificar os fatores de risco de anemia em lactentes matriculados em creches públicas ou filantrópicas no município de São Paulo e discutir o impacto das ações da creche no controle desta carência nutricional específica. MÉTODO: Estudo seccional compreendendo 212 lactentes de duas creches públicas e três filantrópicas. Foram realizadas entrevistas com as mães, coleta de sangue por punção digital e antropometria. Considerou-se como anemia, hemoglobina inferior a 11g/dL. Foi ajustado um modelo de regressão logística para fatores de risco entre grupos de lactentes com e sem anemia. RESULTADOS: A prevalência de anemia foi de 51,9%. O modelo logístico final foi composto por 4 variáveis: presença de 1 ou mais irmãos menores que 5 anos (Odds Ratio=2,57; p=0,005; estar freqüentando creche de administração exclusivamente pública (Odds Ratio=2,12; p=0,020; uso de aleitamento materno exclusivo inferior a 2 meses (Odds Ratio=1,88; p=0,044, e idade inferior a 15 meses (Odds Ratio=2,32; p=0,006. CONCLUSÃO:Concluiu-se que a alta prevalência de anemia evidencia a ineficiência das creches estudadas para controlar e prevenir esta carência nutricional; portanto, cabe ao planejador de saúde considerar os riscos de anemia identificados e quantificados quando da elaboração de programas de controle e prevenção.OBJECTIVE: To identify and quantify the risk factors for anemia in infants enrolled in public or philanthropic day care centers in São Paulo city and discuss the impact of the actions of day care centers in controlling this specific nutritional deficiency. METHODS: Cross-sectional study comprising 212 infants of two public and three philanthropic day care centers. Interviews with the mothers, collection of blood by digital puncture and anthropometry were performed. Anemia was characterized by hemoglobin levels below 11g/dL. A logistic regression model for risk factors between groups of infants with

  5. Parent Run Day Care Centres: The Growth of a French Community Initiative. Studies and Evaluation Papers No. 8. (United States)

    Combes, Josette

    This report examines how parent involvement in running day care centers in France has increased in recent years, and investigates the role that the Association des Collectifs Enfants Parents Professionnels (ACEPP) has played in making this form of child care more acceptable. After a discussion of the historical development and current choices of…

  6. Cognitive and affective assessment in day care versus institutionalized elderly patients: a 1-year longitudinal study

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    Maseda A


    Full Text Available Ana Maseda, Aránzazu Balo, Laura Lorenzo–López, Leire Lodeiro–Fernández, José Luis Rodríguez–Villamil, José Carlos Millán–CalentiGerontology Research Group, Faculty of Health Sciences, University of A Coruña, A Coruña, SpainPurpose: Cognitive decline and depression are two common mental health problems that may create a need for long-term care among the elderly. In the last decade, the percentage of older adults who receive health care in nursing homes, day care centers, or home support services has increased in Europe. The objectives of this descriptive and nonrandomized longitudinal study were to evaluate and to compare the cognitive and affective evolution of day care versus institutionalized older patients through a 1-year period, and to assess the presence of cognitive and affective impairment as a function of the care setting.Patients and methods: Ninety-four patients were assessed at baseline, and 63 (67.0% were reassessed 1 year later. Neuropsychological assessment included measures of cognitive performance (general cognitive status, visuospatial, and language abilities and affective status (depressive symptoms.Results: Our findings indicated that the majority of the participants (day care and institutionalized patients had mild–moderate cognitive impairment at baseline, which significantly increased in both groups after 1-year follow-up. However, the rate of change in global cognitive function did not significantly differ between groups over time. Regarding language abilities, naming function maintained among day care patients in comparison with institutionalized patients, who showed worse performance at follow-up. As regards to affective status, results revealed that institutionalized patients had a significant reduction in depressive symptoms at follow-up, when compared to day care patients. Results also highlight the high frequency of cognitive impairment and depressive symptoms regardless of the care setting

  7. Climate Prediction Center Weekly Corn Growing Degree Days (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — A corn growing degree day (GDD) is an index used to express crop maturity. The index is computed by subtracting a base temperature of 50?F from the average of the...

  8. Respiratory Virus Detection and Clinical Diagnosis in Children Attending Day Care.

    Directory of Open Access Journals (Sweden)

    Nina Moe

    Full Text Available Respiratory viruses often have been studied in children with respiratory tract infection (RTI, but less knowledge exists about viruses in asymptomatic children. We have studied the occurrence of a broad panel of respiratory viruses in apparently healthy children attending day care, taking into account the influence of possible confounding factors, such as age, clinical signs of respiratory tract infection (RTI, location (day-care section and season.We have studied 161 children in two day-care centers, each with separate sections for younger and older children, during four autumn and winter visits over a two-year period. A total of 355 clinical examinations were performed, and 343 nasopharyngeal samples (NPS were analyzed by semi-quantitative, real-time, polymerase chain reaction (PCR tests for 19 respiratory pathogens.Forty-three percent of all NPS were PCR-positive for ≥ 1 of 13 virus species, with high species variation during visits. Rhinovirus 26% (88/343 NPS, enterovirus 12% (40/343 and parechovirus 9% (30/343 were detected in every visit, and the rates varied in relation to age, day-care section and season. Ten other viruses were detected in ≤ 3% of the NPS. Generally, viruses occurred together in the NPS. In 24% (79/331 of the clinical examinations with available NPS, the children had clear signs of RTI, while in 41% (135/331 they had mild signs, and in 35% (117/331 the children had no signs of RTI. Moreover, viruses were found in 70% (55/79 of children with clear signs of RTI, in 41% (55/135 with mild signs and in 30% (35/117 without any signs of RTI (p < 0.001.Positive PCR tests for respiratory viruses, particularly picornaviruses, were frequently detected in apparently healthy children attending day care. Virus detection rates were related to age, presence of clinical signs of RTI, location in day care and season.

  9. FastStats: Hospice Care (United States)

    ... Day Services Centers Home Health Care Hospice Care Nursing Home Care Residential Care Communities Screenings Mammography Pap Tests Disability ... Care National Study of Long-Term Care Providers Nursing Home Care Residential Care Communities Centers for Medicare and Medicaid ...

  10. Caracterização de genótipos de rotavírus em creches: era pré- e pós-vacinação contra o rotavírus Characterization of rotavirus strains from day care centers: pre- and post-rotavirus vaccine era

    Directory of Open Access Journals (Sweden)

    Simone G. Morillo


    Full Text Available OBJETIVOS: Em 2006, a vacina contra rotavírus foi incluída no Programa Nacional de Imunização. Este estudo teve como objetivo analisar os resultados da vigilância de genótipos de rotavírus em crianças OBJECTIVES: In 2006 the rotavirus vaccine was included in the Brazilian Immunization Program. The aim of this study was to report the results of a 5-year surveillance study of rotavirus strains in children < 5 years with acute gastroenteritis from day care centers in the state of São Paulo, Brazil. METHODS: This retrospective study was conducted with 30 day care centers from 2004 to 2008 with convenient surveillance fecal specimens, investigated by ELISA, SDS-PAGE, RT-PCR and gene sequencing to genotype characterization. RESULTS: Rotavirus infection was detected in 28.3% of samples (38/134. The most frequent genotypes detected were G9P[8] and G1P[8] in 2004; G1P[8] in 2005; GNTP[NT] in 2006; G2P[4] in 2007; and there were no cases in 2008. Mixed infections were not observed. Detection rate declined from 65.7% (23/35 in 2004 to 50% (9/18 in 2007. CONCLUSIONS: Genotype distribution varied according to collection year, accompanied by a reduction in detection rate. Use of rotavirus vaccine requires implementation of post-marketing surveillance to monitor rotavirus strain diversity and its efficacy against possible new emerging genotypes.

  11. Microepidemia de tinha do couro cabeludo por Microsporum canis em creche de Vitória - Espírito Santo (Brasil Tinea capitis micro-epidemic by Microsporum canis in a day care center of Vitória - Espírito Santo (Brazil

    Directory of Open Access Journals (Sweden)

    Thaiz Gava Rigoni Gürtler


    Full Text Available Tinha do couro cabeludo é infecção da pele e cabelos dessa área, causada pelos dermatófitos do gênero Microsporum e Trichophyton. Acomete preferencialmente crianças pré-escolares e escolares, devido ao maior contato com fontes de infecção. Os autores relatam uma microepidemia de tinha do couro cabeludo em 11 crianças de uma creche pública de Vitória (ES, entre dois e seis anos de idade, 61% do sexo masculino. Apresentavam lesões arredondadas, escamosas, tonsurantes, grandes e únicas, nas regiões frontal, occipital, parietal, e, em dois casos, o couro cabeludo estava difusamente acometido. Os micológicos diretos mostravam parasitismo tipo ectotrix, e 45,5% das culturas foram positivas para Microsporum canis, justificadas pela história de contato entre algumas crianças da creche e cães errantes pelo bairro.Tinea capitis of the scalp is an infection of the skin and hair of this area caused by the dermatophytes of the Microsporum and Trichophyton genus. It preferentially attacks pre-school and school children due to their greater contact with infection sources. The authors report a micro-epidemic of Tinea capitis of the scalp in 11 children of a day care center of Vitória (ES, between two and six years of age, 61% of masculine sex. They presented rounded, scaly lesions with tonsured hair, large and unique in the frontal, occipital and parietal regions. In two cases the scalp was diffusely attacked. The direct mycology showed parasitism of the ectothrix type, and 45.5% of the cultures were positive for Microsporum canis, justified by the history of contact between some children of the day care center and stray dogs of the district.

  12. Improving personal health records for patient-centered care (United States)

    Feldman, Henry J; Ross, Stephen E; Safran, Charles


    Objective To assess the patient-centeredness of personal health records (PHR) and offer recommendations for best practice guidelines. Design Semi-structured interviews were conducted in seven large early PHR adopter organizations in 2007. Organizations were purposively selected to represent a variety of US settings, including medium and large hospitals, ambulatory care facilities, insurers and health plans, government departments, and commercial sectors. Measurements Patient-centeredness was assessed against a framework of care that includes: (1) respect for patient values, preferences, and expressed needs; (2) information and education; (3) access to care; (4) emotional support to relieve fear and anxiety; (5) involvement of family and friends; (6) continuity and secure transition between healthcare providers; (7) physical comfort; (8) coordination of care. Within this framework we used evidence for patient preferences (where it exists) to compare existing PHR policies, and propose a best practice model. Results Most organizations enable many patient-centered functions such as data access for proxies and minors. No organization allows patient views of clinical progress notes, and turnaround times for PHR reporting of normal laboratory results can be up to 7 days. Conclusion Findings suggest patient-centeredness for personal health records can be improved, and recommendations are made for best practice guidelines. PMID:20190063

  13. The ten successful elements of an ambulatory care center. (United States)

    Watkins, G


    Experts in healthcare predict that in the future, over 80% of all care will be provided either in the home or ambulatory care centers. How radiology facilities position themselves for this shifting market is critical to their long-term success, even though it appears there are endless opportunities for providing care in this atmosphere. The ten most critical elements that healthcare providers must address to ensure their preparedness are discussed. Location is critical, particularly since patients no longer want to travel to regional medical centers. The most aggressive providers are building local care centers to serve specific populations. Ambulatory care centers should project a high tech, high touch atmosphere. Patient comfort and the appeal of the overall environment must be considered. Centers need to focus on their customers' needs in multiple areas of care. A quick and easy registration process, providing dressing gowns in patient areas, clear billing functions--these are all important areas that centers should develop. Physicians practicing in the ambulatory care center are key to its overall success and can set the tone for all staff members. Staff members must be friendly and professional in their work with patients. The hours offered by the center must meet the needs of its client base, perhaps by offering evening and weekend appointments. Keeping appointments on schedule is critical if a center wants satisfied customers. It's important to identify the target before developing your marketing plan. Where do your referrals come from? Look to such sources as referring physicians, managed care plans and patients themselves. Careful billing is critical for survival in the ambulatory care world. Costs are important and systems that can track cost per exam are useful. Know your bottom line. Service remains the central focus of all successful ambulatory care center functions.

  14. Effects of Quality Improvement System for Child Care Centers (United States)

    Ma, Xin; Shen, Jianping; Kavanaugh, Amy; Lu, Xuejin; Brandi, Karen; Goodman, Jeff; Till, Lance; Watson, Grace


    Using multiple years of data collected from about 100 child care centers in Palm Beach County, Florida, the authors studied whether the Quality Improvement System (QIS) made a significant impact on quality of child care centers. Based on a pre- and postresearch design spanning a period of 13 months, QIS appeared to be effective in improving…

  15. Pediculose nos centros de educação infantil: conhecimentos e práticas dos trabalhadores Infestión de piojos en los centros de educación infantil: conocimientos y prácticas de los trabajadores Pediculosis in children attending day care centers: knowledge and practice of workers

    Directory of Open Access Journals (Sweden)

    Flávia Lopes Gabani


    ún son limitadas. Persisten muchos mitos y tabúes (que los piojos saltan, el uso de la sal, del vinagre y de la parafina, etc. Las principales dudas se relacionan con el tratamiento y la mayor dificultad que se presenta es la falta de cooperación de los padres. Por último, cabe señalar la necesidad y la importancia de que se implementen acciones intersectoriales, preventivas y sistemáticas en el ambiente escolar.This study aimed to identify and analyze knowledge and practices, about pediculosis, from employees at Child Day Care Centers at two areas of coverage of the Family Health Units, Londrina, Paraná. It's descriptive transversal study. Form was applied with questions about myths, taboos, practices, doubts and difficulties in stopping the infestation of pediculosis in eight Child Day Care Centers. Subsequently, workshop was held with educational materials. 60.4% of employees participated, those who were present on the day determined by the institution. Almost all indicated the ectoparasitic infestation, as well as their families. The problem is faced daily in Child Day Care Centers (72.1%. Practice appropriate care is still limited. Many myths and taboos persist (lice jump, use salt, vinegar and kerosene, etc. The main questions are related to treatment and the greatest difficulty is the lack of cooperation from parents. It emphasizes, finally, the need and the importance of internal actions, preventive and systematic in the school environment.

  16. Sleep characteristics of Veterans Affairs Adult Day Health Care participants. (United States)

    Hughes, Jaime M; Martin, Jennifer L


    Addressing sleep disturbance can help to slow functional decline, delay nursing home admission, and improve overall health among older adults; however, sleep is not widely studied in high-risk older adults such as Adult Day Health Care (ADHC) participants. Sixty-eight ADHC participants were interviewed for sleep disturbance using a 28-item screening questionnaire. More than two thirds (n = 48, 70.6%) reported one or more characteristics of poor sleep, and 38% of participants met basic criteria for insomnia. Individuals with insomnia attended ADHC less frequently, reported worse sleep quality and shorter sleep duration, and were more likely to endorse trouble falling asleep, staying asleep, and waking up too early (ps sleep disturbance within ADHC participants.

  17. Efficacy of primary care in a nursing center. (United States)

    Helvie, C O


    Nursing opportunities have expanded beyond the traditional bedside role. Nurses serve in a variety of roles such as administrators, teachers, or primary care givers in a variety of settings. The role of primary care giver is a more recent role; it involves relatively independent nursing practice with clients who have acute or chronic illnesses. Client groups may include the elderly in high rise buildings, mothers and children at schools, or homeless and low-income populations at homeless shelters. This care is often provided in a nursing center. Nursing centers are nurse-managed centers in which nurses are accountable and responsible for care of clients; they are the primary provider of care and the one most seen by clients. Case managers may be in a position to refer patients to nursing centers or to work directly with nurse practitioners in nursing centers. However, questions about the primary care provided in nursing centers must be addressed for healthcare providers, insurance companies, and patients to be confident in the efficacy of this delivery system. Is the primary care comprehensive? Is it of high quality? Is it cost effective? Is it satisfactory to clients? These and other questions about the primary care provided in nursing centers must be answered to effect political and other changes needed to fulfill the role of nursing centers envisioned by early leaders of the movement. This article addresses questions related to the efficacy of primary care provided in nursing centers by family nurse practitioners. After defining efficacy, the discussion focuses on the components identified and studied in one nursing center and includes information on opportunities for case managers to utilize nursing centers for referral and appropriate follow-up of their patients.

  18. A day in the life: a case series of acute care palliative medicine--the Cleveland model. (United States)

    Lagman, Ruth; Walsh, Declan; Heintz, Jessica; Legrand, Susan B; Davis, Mellar P


    Palliative care in advanced disease is complex. Knowledge and experience of symptom control and management of multiple complications are essential. An interdisciplinary team is also required to meet the medical and psychosocial needs in life-limiting illness. Acute care palliative medicine is a new concept in the spectrum of palliative care services. Acute care palliative medicine, integrated into a tertiary academic medical center, provides expert medical management and specialized care as part of the spectrum of acute medical care services to this challenging patient population. The authors describe a case series to provide a snapshot of a typical day in an acute care inpatient palliative medicine unit. The cases illustrate the sophisticated medical care involved for each individual and the important skill sets of the palliative medicine specialist required to provide high-quality acute medical care for the very ill.

  19. Reported Drug Allergy among Children Attending Day Care Centers


    Carreiro-Martins, P.; Belo, J; Marques, J.; Papoila, AL; Caires, I; Araújo-Martins, J; Pedro, C; Rosado-Pinto, J.; Virella, D; Leiria-Pinto, P; Neuparth, N.


    Introdução: A prevalência de alergia a fármacos na população geral não se encontra devidamente caraterizada, existindo poucos estudos publicados que tenham abordado esta situação em crianças com idades inferior a seis anos de idade. Este estudo tem como objetivo principal estimar a prevalência de alergia a medicamentos reportada pelos pais de crianças de infantários de Lisboa e do Porto. Material e Métodos: No âmbito da Fase II do projeto “ENVIRH – Ambiente e Saúde em Creches e Infantários...

  20. [Reported drug allergy among children attending day care centers]. (United States)

    Martins, Pedro; Belo, Joana; Marques, João; Papoila, Ana Luísa; Caires, Iolanda; Araújo-Martins, José; Pedro, Catarina; Rosado-Pinto, José; Virella, Daniel; Leiria-Pinto, Paula; Neuparth, Nuno


    Introdução: A prevalência de alergia a fármacos na população geral não se encontra devidamente caraterizada, existindo poucos estudos publicados que tenham abordado esta situação em crianças com idades inferior a seis anos de idade. Este estudo tem como objetivo principal estimar a prevalência de alergia a medicamentos reportada pelos pais de crianças de infantários de Lisboa e do Porto. Material e Métodos: No âmbito da Fase II do projeto “ENVIRH – Ambiente e Saúde em Creches e Infantários” foi aplicado um questionário sobre alergia a medicamentos aos pais das crianças, recrutadas por amostragem aleatória estratificada dos infantários. Resultados: Foram analisados 1 169 questionários, 52,5% de rapazes. A idade média foi de 3,5 ± 1,5 anos. A prevalência de alergia a medicamentos reportada foi de 4,1% (IC 95%: 3,0 - 5,2%). Os fármacos mais referidos foram os antibióticos (em 27 reações) e os AINEs (em seis reações). Na análise multivariável, a alergia a medicamentos reportada associou-se diretamente com a idade da criança (OR 1,19; IC 95% 1,01 - 1,41) e com a referência a alergia alimentar (OR 3,19; IC95% 1,41 - 7,19) e inversamente com o nível de escolaridade dos pais (OR 0,25; IC95% 0,10 - 0,59). Discussão: Apesar das limitações do estudo, os resultados encontram-se de acordo com o reportado por outros autores e sugerem que a prevalência reportada de alergia a medicamentos seja elevada no grupo etário estudado. Conclusão: Torna-se necessário que situações de alergia a medicamentos reportadas pelos pais sejam devidamente estudadas, no sentido de evitar evicções desnecessárias que possam condicionar opções terapêuticas em futuras situações de doença.

  1. Patient- and family-centered care and the pediatrician's role. (United States)


    Drawing on several decades of work with families, pediatricians, other health care professionals, and policy makers, the American Academy of Pediatrics provides a definition of patient- and family-centered care. In pediatrics, patient- and family-centered care is based on the understanding that the family is the child's primary source of strength and support. Further, this approach to care recognizes that the perspectives and information provided by families, children, and young adults are essential components of high-quality clinical decision-making, and that patients and family are integral partners with the health care team. This policy statement outlines the core principles of patient- and family-centered care, summarizes some of the recent literature linking patient- and family-centered care to improved health outcomes, and lists various other benefits to be expected when engaging in patient- and family-centered pediatric practice. The statement concludes with specific recommendations for how pediatricians can integrate patient- and family-centered care in hospitals, clinics, and community settings, and in broader systems of care, as well.

  2. Center to Advance Palliative Care palliative care clinical care and customer satisfaction metrics consensus recommendations. (United States)

    Weissman, David E; Morrison, R Sean; Meier, Diane E


    Data collection and analysis are vital for strategic planning, quality improvement, and demonstration of palliative care program impact to hospital administrators, private funders and policymakers. Since 2000, the Center to Advance Palliative Care (CAPC) has provided technical assistance to hospitals, health systems and hospices working to start, sustain, and grow nonhospice palliative care programs. CAPC convened a consensus panel in 2008 to develop recommendations for specific clinical and customer metrics that programs should track. The panel agreed on four key domains of clinical metrics and two domains of customer metrics. Clinical metrics include: daily assessment of physical/psychological/spiritual symptoms by a symptom assessment tool; establishment of patient-centered goals of care; support to patient/family caregivers; and management of transitions across care sites. For customer metrics, consensus was reached on two domains that should be tracked to assess satisfaction: patient/family satisfaction, and referring clinician satisfaction. In an effort to ensure access to reliably high-quality palliative care data throughout the nation, hospital palliative care programs are encouraged to collect and report outcomes for each of the metric domains described here.

  3. The Rise in Cortisol in Family Day Care: Associations with Aspects of Care Quality, Child Behavior, and Child Sex (United States)

    Gunnar, Megan R.; Kryzer, Erin; Van Ryzin, Mark J.; Phillips, Deborah A.


    This study examined the increase in salivary cortisol from midmorning to midafternoon in 151 children (3.0-4.5 years) in full-time home-based day care. Compared to cortisol levels at home, increases were noted in the majority of children (63%) at day care, with 40% classified as a stress response. Observations at day care revealed that intrusive,…

  4. A patient-centered care ethics analysis model for rehabilitation. (United States)

    Hunt, Matthew R; Ells, Carolyn


    There exists a paucity of ethics resources tailored to rehabilitation. To help fill this ethics resource gap, the authors developed an ethics analysis model specifically for use in rehabilitation care. The Patient-Centered Care Ethics Analysis Model for Rehabilitation is a process model to guide careful moral reasoning for particularly complex or challenging matters in rehabilitation. The Patient-Centered Care Ethics Analysis Model for Rehabilitation was developed over several iterations, with feedback at different stages from rehabilitation professionals and bioethics experts. Development of the model was explicitly informed by the theoretical grounding of patient-centered care and the context of rehabilitation, including the International Classification of Functioning, Disability and Health. Being patient centered, the model encourages (1) shared control of consultations, decisions about interventions, and management of the health problems with the patient and (2) understanding the patient as a whole person who has individual preferences situated within social contexts. Although the major process headings of the Patient-Centered Care Ethics Analysis Model for Rehabilitation resemble typical ethical decision-making and problem-solving models, the probes under those headings direct attention to considerations relevant to rehabilitation care. The Patient-Centered Care Ethics Analysis Model for Rehabilitation is a suitable tool for rehabilitation professionals to use (in real time, for retrospective review, and for training purposes) to help arrive at ethical outcomes.

  5. [Teaching patient-centered holistic care]. (United States)

    Wung, Hwang-Ling; Chen, Huei-Ling; Hwu, Yueh-Juen


    Nursing education aims to help students understand concepts and gain competencies in holistic care. The purpose of this paper was to present a nursing curriculum that adapted and introduced holistic care into an adult nursing curriculum taught at a university of science and technology. The course framework included both holistic and nursing domains. The holistic aspect addressed client physical psychological-spiritual needs and related factors, health related factors, and the status of Maslow's hierarchy of needs and related factors. The nursing aspect addressed the way in which nursing was applied to identify client problems and provide individualized, integrated and continuous care in hospital, family or community based settings employing primary, secondary, or tertiary prevention. Scenario with problem based learning and concept mapping were used in class to guide students to consider in depth the concepts that underpin holistic care.

  6. Translating person-centered care into practice

    DEFF Research Database (Denmark)

    Zoffmann, Vibeke; Hörnsten, Åsa; Storbækken, Solveig


    OBJECTIVE: Person-centred care [PCC] can engage people in living well with a chronic condition. However, translating PCC into practice is challenging. We aimed to compare the translational potentials of three approaches: motivational interviewing [MI], illness integration support [IIS] and guided......) health care professionals' background and training; (7) fidelity assessment; (8) reported effects. RESULTS: Although all approaches promoted autonomous motivation, they differed in other ways. Their original settings explain why IIS and GSD strive for life-illness integration, whereas MI focuses...

  7. Estado nutricional e carência de ferro em crianças freqüentadoras de creche antes e 15 meses após intervenção nutricional Nutritional status and iron deficiency among children enrolled in a day care center before and after 15 months of nutritional management

    Directory of Open Access Journals (Sweden)

    Terezinha Soares Biscegli


    Full Text Available OBJETIVO: Comparar o estado nutricional e a prevalência de carência de ferro em crianças freqüentadoras de creche antes e 15 meses após orientação nutricional e intervenção terapêutica. MÉTODOS: Estudo coorte com 52 crianças de 32 a 78 meses de idade, freqüentadoras de uma creche em Catanduva, São Paulo, avaliadas em dois períodos: antes e 15 meses após receberem tratamento para anemia e correção das alterações no estado nutricional. O estado nutricional das crianças foi avaliado por meio da curva da Organização Mundial de Saúde (2006. O diagnóstico de carência de ferro foi realizado por dosagem de hemoglobina e nível de ferritina sérica. Dados adicionais das crianças não eutróficas foram obtidos por meio de entrevistas com suas mães. RESULTADOS: Observou-se 2% de desnutrição aguda e 8% de obesidade, não havendo diferença significante entre os dois períodos. 12% das crianças apresentaram anemia, havendo diminuição do número de crianças com anemia após o tratamento. Dois novos casos de obesidade e cinco de carência de ferro surgiram durante o período de intervenção nutricional. Das oito crianças com alterações nutricionais no período inicial, 63% das mães procuraram atendimento médico para tratamento. CONCLUSÕES: O tratamento dos distúrbios nutricionais e da carência de ferro diminuiu o número de crianças afetadas. O aparecimento de novos casos de obesidade e anemia serve de alerta para a necessidade de outras medidas preventivas tanto na creche como no âmbito familiar.OBJECTIVE: To compare the nutritional status and the prevalence of iron deficiency among children enrolled in a day care center before and after 15 months of nutritional management. METHODS: Cohort study of 52 children, aged 32 to 78 months, evaluated before and after treatment of anemia and nutritional disturbs in a no-profit day care center in Catanduva, São Paulo, Brazil. The nutritional status was classified according

  8. The Politics of Family Day Care: Legislatively What Can Be Done. (United States)

    Anderson, Elaine A.

    A questionnaire designed to measure a number of topical issues regarding child care providers and child care provision was sent to all licensed family day care home providers in the state of Connecticut. The questionnaire focused on six major areas of investigation: the service provider's history in the area of day care, issues surrounding…

  9. Day-care hypospadias surgery: Single surgeon experience

    Directory of Open Access Journals (Sweden)

    Chandrasekharam V.V.S.S


    Full Text Available Aim: To report the results of the early discharge of children after hypospadias repair with an indwelling catheter. Materials and Methods: To facilitate early the discharge of children after hypospadias repair, the author adopted the technique of draining the indwelling urinary catheter into diapers in children undergoing this operation. Home catheter care was taught to the mother; the dressings and catheters were subsequently managed in the outpatient clinic. Results: Over a 2-year period, 43 children were managed by this technique and were sent home within 24-48 h after the operation with an indwelling catheter. Minor problems requiring outpatient visits to the surgeon occurred in nine (20% children after discharge from the hospital. All the nine children were successfully managed as outpatients and no child required rehospitalisation. The catheter remained in position for 5 days in all the children. The overall results were satisfactory with an acceptable (7% fistula rate. Conclusions: It is possible to reduce the duration of the hospital stay of children after hypospadias repair without compromising on the final results.

  10. Factors associated with acute respiratory illness in day care children. (United States)

    Hatakka, Katja; Piirainen, Laura; Pohjavuori, Sara; Poussa, Tuija; Savilahti, Erkki; Korpela, Riitta


    The aim of this study was to investigate the relationship between child characteristics, parental and environmental factors and the occurrence of acute respiratory illness (ARI) and acute otitis media (AOM) among Finnish children attending day care centres (DCCs). The study was a cross-sectional questionnaire of 594 children aged 1-6 y from 18 DCCs in Helsinki, Finland. Recurrent (> or =4 diseases/y) ARI was present in 44% of the 1-3-y-olds and 23% of the 4-6-y-olds, and recurrent AOM in 15% and 2.5%, respectively. Parent atopic disease (odds ratio (OR) 1.53, p = 0.033), mother's academic education (OR 1.77, p = 0.008) and a medium length of DCC attendance compared to a short period (OR 1.67, p = 0.049) increased, while furry pets (OR 0.44, p = 0.003) and older child age (OR 0.38, p or =6 months (OR 0.20, p = 0.002) and older child age (OR 0.05, p < 0.001) reduced the risk of recurrent AOM. Parental and environmental factors had a significant impact on recurrent ARI and AOM episodes in children attending DCCs. These risk factors should be considered in future studies intending to reduce DCC infections.

  11. Freqüência e atividade enzimática de Candida albicans isoladas da mucosa bucal de crianças de uma creche da prefeitura de Fortaleza Frequency and enzymatic activity of Candida albicans isolated from the buccal mucosa of children of a day-care center of the city hall of Fortaleza, Ceará, Brazil

    Directory of Open Access Journals (Sweden)

    Everardo Albuquerque Menezes


    Full Text Available As candidíases bucais (também chamadas sapinhos que ocorrem em crianças são causadas por uma deficiência imunológica, bem como por outros fatores tais como má higiene bucal e esterilização inadequada dos utensílios utilizados pelas mesmas, que potencializam a ocorrência dessa infecção fúngica. Considerando esse fato, foram avaliadas a freqüência e a atividade enzimática de Candida sp. isoladas em crianças de uma creche pública (Aprisco na cidade de Fortaleza, Ceará. Foram coletadas amostras da mucosa bucal de 364 alunos de 1 a 5 anos de idade. Elas foram semeadas em ágar Sabouraud dextrose com cloranfenicol, incubadas por 72 horas a 37ºC e identificadas por testes micológicos. Verificou-se que 67 (18% apresentaram leveduras do gênero Candida. A Candida albicans foi a mais freqüente, com 30 isolados (45%, seguida pelas C. tropicalis (31%, C. guilliermondii (17%, C. glabrata (4,5% e C. stellatoidea (1,5%. Com relação às atividades enzimáticas das cepas de Candida albicans, 20% produziram a enzima proteinase e 33%, a fosfolipase. As Candida albicans isoladas da mucosa bucal de crianças dessa creche da prefeitura apresentaram uma fraca atividade enzimática. Assim, conclui-se que essas cepas parecem ter uma baixa virulência.Immunedefficiency is one of the main causes of buccal candidiasis, also called thrush, in children. Other factors like inadequate mouth hygiene and inappropriate sterilization utensils potentialize this fungal infection. Considering these facts, Candida sp. frequency and enzymatic activity were evaluated in 364 stocks from mouth mucous of one to five year-old children from a public day care center in Fortaleza, Ceará (Brazil. The samples were cultured in dextrose Sabouraud with chloranfenicol agar and incubated for 72 hours at 37°C. They were identified by mycological tests. It was verified that 67 samples (18% presented Candida sp. and the most frequent genus was Candida albicans (30

  12. FastStats: Home Health Care (United States)

    ... Day Services Centers Home Health Care Hospice Care Nursing Home Care Residential Care Communities Screenings Mammography Pap Tests Disability ... Care National Study of Long-Term Care Providers Nursing Home Care Residential Care Communities Centers for Medicare and Medicaid ...


    Directory of Open Access Journals (Sweden)

    Mariet Caroline, MPT,


    Full Text Available Child care workers are those who take care of children in the absence of their parents. Child care workers are exposed to various kinds of occupational injuries which include infections, sprains and strains, trauma like bites from children, trip falls and noise exposure. The risks of injury among these workers are due to their nature of the job. One of the common occupational risks found in these workers is musculoskeletal injury, it occurs as a result of working in awkward postures such as bending, twisting, lifting and carrying in incorrect positions, which may result in various injuries like strain, sprain and soft tissue ruptures. Workers with poor physical conditioning may tend to undergo these changes very rapidly. The purpose of this study was to find out the prevalence of various musculoskeletal disorders in child care workers who are taking care of the babies. The study was conducted around various day care centres, among 160 women from who were chosen for the study and were given musculoskeletal analysis questionnaires (Nordic musculoskeletal questionnaire , The Questionnaires were evaluated using descriptive statistics, analysed using SPSS and the results were computed in percentage. Following the analysis, it was concluded that low back injury was predominant among 44% of workers followed by 18% with neck pain, 11% of shoulder pain, 9% of knee pain, 7% of elbow, 6% of wrist, 4% of others and surprisingly 1 % had no musculoskeletal complaints.

  14. Being an Active Subject as an Element of Quality in Day Care Centres. Reprints and Miniprints No. 844. (United States)

    Brostrom, Stig; And Others

    This project dealt with the quality of the child's life in day care centers and aimed at a better understanding of the concept of quality. The project was based on a synthesis of knowledge from various research traditions, as well as theories of education and developmental psychology (such as Bruner, Davydov, Leontiev, Piaget, and Vygotsky). The…

  15. Occurence of Giardia lamblia in children of municipal day-care centers from Botucatu, São Paulo State, Brazil Ocorrência de Giardia lamblia em crianças atendidas em creches municipais de Botucatu, Estado de São Paulo, Brasil

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    Semíramis Guimarães


    Full Text Available Considering that the number of day-care centers for pre-school-age children has expanded rapidly in developing countries, and that these institutions presenting conditions that facilitate the transmission of many enteric agents, a parasitological survey was carried out in three municipal day-cares from Botucatu: two in the urban area (one in downtown area and the other one in the city periphery area and the third in the rural area. Three separate stool specimens were collected from 147 children ranging from 0 to 72 months old and 20 staff members. Each stool specimen was processed by Lutz and zinc sulfate flotation methods. The frequency of giardiasis observed among children of downtown, periphery and rural day-cares was 69.6%, 52.7% and 69.6%, respectively. Only one employee was positive for G. lamblia. The examination of three stool specimens increased the positivity for G. lamblia: from the ninety three final positive examinations, 24 (25.5% and 8 (8.5% were positives only after examination of the second and third samples, respectively. Others intestinal organisms like Ascaris lumbricoides (20.4%, Trichuris trichiura (19.0%. Hymenolepis nana (8.8%, Entamoeba coli (22.4% and Blastocystis hominis (32.0% were frequently found in the children. There was no significant association among localization of the day-cares, sex of the children and the levels of G. lamblia infection. According to the age, G. lamblia was found mainly in children between 12 to 47 months old.Foi realizado um levantamento parasitológico em três creches da rede municipal: duas na área urbana, uma no centro da cidade e a outra na periferia, e a terceira na zona rural. Três amostras de fezes, coletadas com intervalo de 7 dias, foram obtidas de 147 crianças com idade variando de 0 a 6 anos e de 20 funcionários. Cada amostra foi processada pelos métodos de sedimentação espontânea e centrífugo - flutuação com sulfato de zinco. Os resultados demonstraram que das 147

  16. Healthcare professionals' views on patient-centered care in hospitals

    NARCIS (Netherlands)

    M. Berghout (Mathilde); N.J.A. van Exel (Job); L. Leensvaart (Laszlo); J.M. Cramm (Jane)


    textabstractBackground: Patient-centered care (PCC) is a main determinant of care quality. Research has shown that PCC is a multi-dimensional concept, and organizations that provide PCC well report better patient and organizational outcomes. However, little is known about the relative importance of

  17. Designing Robots for Care: Care Centered Value-Sensitive Design



    The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship—what I refer to as care robots—require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a vulnerable and sensitive time in their lives. The ethical evaluation of care robots requires insight into the values at stake in the healthcare tradition. What’s more, given the stage of their develo...

  18. Osteomyelitis/septic arthritis caused by Kingella kingae among day care attendees--Minnesota, 2003. (United States)


    Kingella kingae is a fastidious gram-negative coccobacillus that colonizes the respiratory and oropharyngeal tract in children. K. kingae occasionally causes invasive disease, primarily osteomyelitis/septic arthritis in young children, bacteremia in infants, and endocarditis in school-aged children and adults. Although diagnosis of this organism frequently is missed, invasive disease is uncommon. Only sporadic, non-epidemiologically linked cases have been reported previously. In October 2003, the Minnesota Department of Health (MDH) investigated a cluster of two confirmed cases and one probable case of osteomyelitis/septic arthritis caused by K. kingae among children aged 17-21 months attending the same toddler classroom in a day care center. All reported within the same week with onset of fever, preceding or concurrent upper respiratory illness (URI), and refusal to bear weight on the affected limb. This report summarizes these cases and describes the epidemiologic investigation of the day care center. The findings underscore the need for clinicians and laboratorians to consider K. kingae infection in young children with Gram stain--negative or culture-negative skeletal infections.

  19. Designing Robots for Care: Care Centered Value-Sensitive Design

    NARCIS (Netherlands)

    Wynsberghe, van A.


    The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship—what I refer to as care robots—require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a vu

  20. Pioneers in trauma care at Harborview Medical Center. (United States)

    Whalen, Eileen; Hecker, Cynthia J; Butler, Steven


    Harborview Medical Center in Seattle has been home to the pioneering work of University of Washington (UW) Medicine physicians and staff who have led innovations to improve trauma care for more than 40 years. As the only level I adult and pediatric trauma center and regional burn center for Washington, Alaska, Montana, and Idaho, Harborview provides cares for more than 6500 critically injured trauma and burn patients per year. Our physicians, researchers and staff are recognized as national experts and as collaborative partners with nursing in the delivery of outstanding clinical care, research, and education. Beginning with the establishment of Seattle Medic One in the late 1960s, a groundbreaking program to train firefighters as paramedics, Harborview and the work of UW Medicine has been recognized locally and globally as a leader in every component of the ideal trauma system, as defined by the American College of Surgeons: prevention, access, acute hospital care, rehabilitation, education, and research activities.

  1. Family-Centered Care in Neonatal Intensive Care Unit: A Concept Analysis (United States)

    Ramezani, Tahereh; Hadian Shirazi, Zahra; Sabet Sarvestani, Raheleh; Moattari, Marzieh


    Background: The concept of family- centered care in neonatal intensive care unit has changed drastically in protracted years and has been used in various contexts differently. Since we require clarity in our understanding, we aimed to analyze this concept. Methods: This study was done on the basis of developmental approach of Rodgers’s concept analysis. We reviewed the existing literature in Science direct, PubMed, Google Scholar, Scopus, and Iran Medex databases from 1980 to 2012. The keywords were family-centered care, family-oriented care, and neonatal intensive care unit. After all, 59 out of 244 English and Persian articles and books (more than 20%) were selected. Results: The attributes of family-centered care in neonatal intensive care unit were recognized as care taking of family (assessment of family and its needs, providing family needs), equal family participation (participation in care planning, decision making, and providing care from routine to special ones), collaboration (inter-professional collaboration with family, family involvement in regulating and implementing care plans), regarding family’s respect and dignity (importance of families’ differences, recognizing families’ tendencies), and knowledge transformation (information sharing between healthcare workers and family, complete information sharing according to family learning style). Besides, the recognized antecedents were professional and management-organizational factors. Finally, the consequences included benefits related to neonate, family, and organization. Conclusion: The findings revealed that family centered-care was a comprehensive and holistic caring approach in neonatal intensive care. Therefore, it is highly recommended to change the current care approach and philosophy and provide facilities for conducting family-centered care in neonatal intensive care unit.  PMID:25349870

  2. Setting up a health care quality management system in a multidisciplinary clinical research center

    Directory of Open Access Journals (Sweden)

    L. V. Laktionova


    Full Text Available The paper discusses the issues of setting up a quality management system in a multidisciplinary specialized clinical research center. It describes the experience with information technologies used in a prophylactic facility to set up effective out- and inpatient health care control. Measures to optimize work under present-day conditions to upgrade the quality of health care are given using the federal health facility as an example.

  3. [Family-centered care and post-traumatic stress disorder]. (United States)

    Lin, Chia-Huei; Sun, Yin-Jhen; Tzeng, Wen-Chii; Chiang, Li-Chi


    A year has passed since a major earthquake and tsunami hit northeastern Honshu, Japan in March 2011. Amidst mourning for the tens of thousands of victims, survivors have just begun the difficult and urgent tasks of rebuilding. Many survivors suffer from post-traumatic stress disorder (PTSD). PTSD causes chronic, long-term suffering for patients and their families and inevitably burdens social and medical care systems. This article tries to integrate PTSD evidence-based treatment experiences into a practical and detailed nursing intervention protocol for PTSD. We also elicit the function and effect of "family-centered care." We hope that nursing professionals apply family-centered care principles to PTSD treatment and care approaches in order to promote PTSD patient resilience. Nurses can thus enhance PTSD care efficacy and improve the opportunity for PTSD patients to overcome their symptoms and recover their life.

  4. Day Care Work as the Creation of Coherence in Everyday Life

    DEFF Research Database (Denmark)

    Ahrenkiel, Annegrethe


    Day care institutions serve a central function in modern society; not least because taking care of children is a prerequisite for parent’s participation in the labour market. This is certainly the case in Denmark, where 90 % of children attend day care institutions. In this sense, day care...... institutions are a prerequisite for a sus-tainable everyday life in modern society. Without day care for children it is not possible for families to create a coherent everyday life. At the same time, life in day care institutions shares a lot of similarities with everyday life. It is extremely important...... of kindergarten teachers: confronting neoliberal regulation”, is that a great deal of the work of kindergarten teachers is oriented towards creating coherence in the every life of children and their families. But this central function is threatened by neoliberal forms to the regulation of work in day care...

  5. Day Care Doesn't Encourage Weight Gain in Kids (United States)

    ... Services, or federal policy. More Health News on: Obesity in Children Recent Health News Related MedlinePlus Health Topics Child Care Obesity in Children About MedlinePlus Site Map FAQs Contact Us Get ...

  6. The Day Nursery Association of Cleveland, Cleveland, Ohio: A Long History of Care for Children, Involvement of Parents, and Service to the Community. Model Programs--Childhood Education. (United States)

    American Institutes for Research in the Behavioral Sciences, Palo Alto, CA.

    The multi-faceted program of the Day Nursery Association of Cleveland is described in this booklet. Specific topics included are: a therapeutic nursery school, day nurseries for low-income neighborhoods, neighborhood day care homes and group centers, summer camp, and consultation services. Sources of more detailed information are provided for this…

  7. Consumerism: forcing medical practices toward patient-centered care. (United States)

    Ozmon, Jeff


    Consumerism has been apart of many industries over the years; now consumerism may change the way many medical practices deliver healthcare. With the advent of consumer-driven healthcare, employers are shifting the decision-making power to their employees. Benefits strategies like health savings accounts and high-deductible insurance plans now allow the patients to control how and where they spend their money on medical care. Practices that seek to attract the more affluent and informed consumers are beginning to institute patient-centered systems designs that invite patients to actively participate in their healthcare. This article will outline the changes in the healthcare delivery system facing medical practices, the importance of patient-centered care, and six strategies to implement to change toward more patient-centered care.

  8. Primary care nursing role and care coordination: an observational study of nursing work in a community health center. (United States)

    Anderson, Daren R; St Hilaire, Daniel; Flinter, Margaret


    Care coordination is a core element of the Patient-Centered Medical Home and requires an effective, well educated nursing staff. A greater understanding of roles and tasks currently being carried out by nurses in primary care is needed to help practices determine how best to implement care coordination and transform into PCMHs. We conducted an observational study of primary care nursing in a Community Health Center by creating a classification schema for nursing responsibilities, directly observing and tracking nurses' work, and categorizing their activities. Ten nurses in eight different practice sites were observed for a total of 61 hours. The vast majority of nursing time was spent in vaccine and medication administration; telephone work; and charting and paper work, while only 15% of their time was spent in activity that was classified broadly as care coordination. Care coordination work appeared to be subsumed by other daily tasks, many of which could have been accomplished by other, lesser trained members of the health care team. Practices looking to implement care coordination need a detailed look at work flow, task assignments, and a critical assessment of staffing, adhering to the principal of each team member working to the highest level of his or her education and license. Care coordination represents a distinct responsibility that requires dedicated nursing time, separate from the day to day tasks in a busy practice. To fully support these new functions, reimbursement models are needed that support such non visit-based work and provide incentives to coordinate and manage complex cases, achieve improved clinical outcomes and enhance efficiency of the health system. This article describes our study methods, data collection, and analysis, results, and discussion about reorganizing nursing roles to promote care coordination.

  9. [Surgical Center environment and its elements: implications for nursing care]. (United States)

    Silva, Denise Conceição; Alvim, Neide Aparecida Titonelli


    The purpose of this qualitative research was to characterize the elements that constitute the environment of the Surgical Center and to analyze its implications for dynamic of care and nursing care. Based on the Environmental Theory's principals. Participated twelve nurses from the Surgical Center of a College Hospital in Rio de Janeiro. Data were gathered through the creativity and sensitivity technique "Map-Speaker", semi-structered interviews and participant observation, and were analyzed by thematic categories. The results showed that care can happen directly and indirectly in favor of full client recovery, counting the environment that the integrate in purpose to maintain harmonic and balanced. The nurse interventions aim to maintain the environment in favorable conditions so that a higher standard of care can be promoted.

  10. Fatores associados ao desenvolvimento mental e motor de crianças de quatro creches públicas de Recife, Brasil Factors associated with mental and psychomotor development of infants in four public day care centers in the municipality of Recife, Brazil

    Directory of Open Access Journals (Sweden)

    Sophie Helena Eickmann


    Full Text Available OBJETIVO: Identificar os fatores associados aos índices de desenvolvimento mental e motor em lactentes que frequentam creches da rede municipal em Recife. MÉTODOS: Estudo de corte transversal realizado entre fevereiro e abril de 2005 em uma amostra de 108 crianças com idade entre quatro e 24 meses, pertencentes a quatro creches municipais do Recife. O desenvolvimento mental e motor foi avaliado pela Escala de Desenvolvimento Infantil de Bayley II. Por meio de entrevistas às mães, foram obtidas informações sobre as condições socioeconômicas e demográficas das famílias e as características biológicas das crianças ao nascer (peso, sexo e idade gestacional. O estado nutricional foi avaliado através dos índices peso/idade, comprimento/idade, peso/comprimento e da concentração de hemoglobina. RESULTADOS: As médias dos índices de desenvolvimento mental e motor foram 88±11 e 95±12 pontos, respectivamente. A idade gestacional apresentou associação significativa com o desenvolvimento mental e motor e o peso ao nascer e o estado nutricional atual, avaliado pelo índice peso/comprimento, se associaram ao desenvolvimento motor. CONCLUSÕES: As crianças analisadas apresentaram desenvolvimento neuropsicomotor ainda na faixa de normalidade, mas aquém do esperado para a idade, comparado a populações de referência em países desenvolvidos. Os fatores associados ao baixo desempenho do desenvolvimento nessa população estão relacionados aos fatores biológicos, destacando-se os déficits nutricionais, cuja redução deve ser uma prioridade para gestores em saúde e educação.OBJECTIVE: To identify factors associated with mental and psychomotor development of infants enrolled at public day care centers of Recife, Pernambuco, Brazil. METHODS: This is a cross-sectional study conducted with 108 infants aged four to 24 months attending four public day care centers of the Municipality of Recife from February to April 2005. Mental and

  11. Preschool Education and Day Care for Swedish Children. (United States)

    Mueller, Jeanne

    A comprehensive study of the types of care provided for Swedish children is presented. The point is made that the three major frameworks which support the Swedish philosophy of early childhood education are those of Arnold Gesell, Jean Piaget, and Erik H. Erikson. From all three sources, preschool teachers learn the concept of epigenesis, the…

  12. 'Have a nice day': consumerism, compassion and health care. (United States)

    Sturgeon, David

    Plans to implement a quality measurement framework that will rate nurses according to the level of care and compassion they demonstrate have been proposed and discussed in a number of Department of Health documents. From September 2010 degree-level nursing students in Wales will receive regular feedback on their communication skills and whether they are exhibiting sufficient levels of compassion. This article examines the reasons why there have been such moves by both politicians and health professionals to demonstrate, in quantifiable terms, that they are able to measure something that is frequently contextual and subject to individual interpretation. It explores how these moves have been influenced by the disclosure of unacceptable standards of care by the Patients Association report and the enquiry into Mid-Staffordshire NHS Foundation Trust. It also discusses how the adoption of targets to evaluate care and compassion seems to reflect a market-driven and bureaucratic approach to health care that has resulted in a system in which measurability and outcome are considered the most important indicator of quality.

  13. [Trials for early intervention in Mie Prefectural Mental Care Center]. (United States)

    Harada, Masanori; Adachi, Takako; Iwasa, Takashi; Kurita, Kouji; Nakamura, Tomoki; Hama, Yukinobu; Yamamoto, Ayako; Maegawa, Sanae


    Mie Prefectural Mental Care Center is a public psychiatric hospital that has 400 beds and 250 outpatients a day. The main catchment area is Tsu City (population: 290,000). Our hospital started early intervention in Aug 2008, and opened the Youth Mental Support Center MIE (YMSC MIE) in Oct 2008. This article reports an early intervention trial in a regional area of Japan. The mission of YMSC MIE is the education, consultation, staff training, and intervention for mental health problems and early psychosis of youths. In Jul 2009, we set up the Youth Assist Clinic (YAC) to support youths with mental health problems and early psychoses. Our activities consist of school-based, community-based, and hospital-based approaches. Specific programs are as follows: 1) School-based approaches: Outreach consultation to school. Mental health lessens. Creating mental health textbooks. Education for parents and teachers. 2) Community-based approaches: To enlighten primary physicians and mental clinic psychiatrists about the importance of early psychosis. To survey their concerns regarding early psychosis. Promoting awareness of community staff and the general public. 3) Hospital-based approaches: YAC. Case manager system. Family meetings for the family including the young with mental disorders. Peer group. Looking back over our 3-year trials, especially in school and the community, we find several problems, as follows: 1) Lack of consultation skills of medical staff outside the hospital. 2) Limiting number of schools which have mental support system. 3) Support for school attendance and learning. 4) Lack of concern about early psychosis of primary physicians and mental clinic psychiatrists. 5) Staff training for early intervention. We are now getting close to improving these issues.

  14. A violência familiar no mundo da criança de creche e pré-escola La violencia familiar bajo la visión del niño que va a los jardines infantiles y pre-escuela Family violence in the perspective of the child who goes to day care center and pre-school

    Directory of Open Access Journals (Sweden)

    Lana Ermelina da Silva dos Santos


    Full Text Available A presente pesquisa utiliza o estudo descritivo e transversal e também a análise de conteúdo para conhecer a violência familiar em crianças de creches e pré-escolas. A população e os sujeitos são constituídos de educadores infantis, professores e monitores. Verificam-se nos resultados a presença da violência doméstica, praticada principalmente pela mãe, a criança agressiva está presente no ambiente das escolas como uma forma de reprodução de comportamento e também da negligência com relação aos cuidados e a atenção à criança no cotidiano. Esses comportamentos podem gerar outras formas de violência, mantendo a criança sempre em ambientes de risco durante várias fases da vida.La presente investigación utiliza el estudio descriptivo y también la análisis del contenido para conocer la violencia familiar en niños de jardines infantiles y Pre-escuela. La población y los sujetos son constituidos de educadores infantiles, profesores y monitores. Verificase en los resultados la presencia de la violencia doméstica, practicada principalmente por la madre, el niño agresivo está presente en el ambiente de las escuelas como una forma de reproducción de comportamiento y también, la negligencia con relación a los cuidados y la atención al niño en el cotidiano. Estos comportamientos pueden generar otras formas de violencia, manteniendo el niño siempre en ambientes de riesgo durante varias fases de la vida.The present research uses the descriptive and traversal study and also the content analysis to know the family violence in children of day care center and pre-schools. The population and the subjects are constituted of infantile educators, teachers and monitors. It is verified in the results the presence of the domestic violence, practiced mainly by the mother, the aggressive child is present in the atmosphere of the schools as a form of reproduction of behavior and also, the negligence regarding the cares and the

  15. Weather daily variation in winter and its effect on behavior and affective states in day-care children (United States)

    Ciucci, Enrica; Calussi, Pamela; Menesini, Ersilia; Mattei, Alessandra; Petralli, Martina; Orlandini, Simone


    This study aimed to analyze the impact of winter weather conditions on young children's behavior and affective states by examining a group of 61 children attending day-care centers in Florence (Italy). Participants were 33 males, 28 females and their 11 teachers. The mean age of the children at the beginning of the observation period was 24.1 months. The day-care teachers observed the children's behavioral and emotional states during the morning before their sleeping time and filled in a questionnaire for each baby five times over a winter period of 3 weeks. Air temperature, relative humidity, air pressure and solar radiation data were collected every 15 min from a weather station located in the city center of Florence. At the same time, air temperature and relative humidity data were collected in the classroom and in the garden of each day-care center. We used multilevel linear models to evaluate the extent to which children's emotional and behavioral states could be predicted by weather conditions, controlling for child characteristics (gender and age). The data showed that relative humidity and solar radiation were the main predictors of the children's emotional and behavioral states. The outdoor humidity had a significant positive effect on frustration, sadness and aggression; solar radiation had a significant negative effect only on sadness, suggesting that a sunny winter day makes children more cheerful. The results are discussed in term of implications for parents and teachers to improve children's ecological environment.

  16. College and University Summer Camps: Creative Alternatives to Day Care. (United States)

    Wever, Matthew F.


    The successful summer day camp program of Saint Louis University (Missouri) is described. Program rationale, philosophy, objectives, structure, staffing, activities, and benefits to the university community are discussed. A majority of the children served by the camp are the children, ages 6 to 12, of university employees. (MSE)

  17. Cost-income analysis of oral health units of health care centers in Yazd city

    Directory of Open Access Journals (Sweden)

    Hosein Fallahzadeh


    Full Text Available Background and Aims: Increasing demands for health care's services on one hand and limited resources on the other hand brings about pressure over governments to find out a mechanism for fair and appropriate distribution of resources. Economic analysis is one of the appropriate tools for policy making on this priority. The aim of this study was to assess capital and consumption of oral health units of health care centers in Yazd city and comparing it with revenue of these centers and determining of cost effectiveness.Materials and Methods: In this descriptive cross sectional study, all health care centers of Yazd city with active dentistry department were evaluated. The data has been extracted from current documents in health care center of county based issued receipts and daily information registers.Results: Expended cost for providing of oral hygiene services in second half of 2008 in 13 medical health centers of Yazd included active dentistry section was 557.887.500 Rials and revenue to cost ratio was about 34%. The most provided service was related to tooth extraction and the average of tooth restoration in each working day was 0.48.Conclusion: With attention to low tariffs of dentistry services in medical health centers and paying subsidy to target groups, expenses of oral hygiene are always more than its revenue.

  18. The integration of oral health care into day-to-day care in nursing homes: a qualitative study.

    NARCIS (Netherlands)

    Visschere, L. De; Baat, C. de; Meyer, L.; Putten, G.J. van der; Peeters, B.; Soderfelt, B.; Vanobbergen, J.


    OBJECTIVE: This qualitative study explored barriers and enabling factors to the implementation of an oral hygiene protocol in nursing homes. BACKGROUND: Oral health care in nursing homes in Flanders (Belgium) is inadequate. MATERIALS AND METHODS: Qualitative data were obtained from nurses employed i

  19. The web site of the center to advance palliative care. (United States)

    Gavrin, Jonathan R


    The web site of the Center to Advance Palliative Care is reviewed. This is an excellent resource containing resources that address financial tutorials and customizable Excel worksheets, development and marketing tools, particularly the decision checklists, satisfaction tools, the information on tracking and reporting outcomes, bereavement tools and a press kit.

  20. Moving family-centered care forward: Bereaved fathers' perspectives. (United States)

    Davies, Betty; Baird, Jennifer; Gudmundsdottir, Maria


    This paper describes the key behaviors of "excellent" pediatric healthcare providers - a term used by fathers of children with complex, life-threatening illness to describe providers who consistently and effectively engage in family-centered care for children and their families. Using interview data from a multi-site grounded theory study of 60 fathers with a deceased child, five behaviors were identified: getting to know the family as individuals, talking about non-healthcare related topics, connecting in a human-human relationship, including parents as team members, and applying specialized knowledge to help the family. These behaviors are consistent with the goals of family-centered care, but they are inconsistently practiced, resulting in less-than-optimal care for children and their families during periods of crisis and vulnerability. A renewed focus on relationship building and interactions with families is needed, as well as a re-evaluation of the training of pediatric healthcare providers.

  1. Recursos/Resources: A Bibliography of Spanish-Language Family Day Care Training Materials. (United States)

    California Child Care Resource and Referral Network, San Francisco.

    This bibliography provides descriptions and contact information regarding resources produced by American and Canadian family day care training projects and other educational organizations for agencies working with Spanish-speaking family day care providers. Included are resources in the following areas: (1) "Recruitment Resources"; (2) "Family Day…

  2. Professionalism--A Breeding Ground for Struggle. The Example of the Finnish Day-Care Centre (United States)

    Kinos, Jarmo


    This article examines the Finnish day-care centre out of a neo-Weberian-Bourdieuan frame of reference. The leading idea is that the day-care centre field is continuously shaping as a result of both inner struggles and struggles with other fields. The state, the education system, and trade unions act as the dealers of professional playing cards.…

  3. High Detection Rates of Enteropathogens in Asymptomatic Children Attending Day Care

    NARCIS (Netherlands)

    Enserink, Remko; Scholts, Rianne; Bruijning-Verhagen, Patricia; Duizer, Erwin; Vennema, Harry; de Boer, Richard; Kortbeek, Titia; Roelfsema, Jeroen; Smit, Henriette; Kooistra-Smid, Mirjam; van Pelt, Wilfrid


    Background: Gastroenteritis morbidity is high among children under the age of four, especially amongst those who attend day care. Objective: To determine the prevalence of a range of enteropathogens in the intestinal flora of children attending day care and to relate their occurrence with characteri

  4. When Risk Becomes Invisible in the Everyday Life of Day Care (United States)

    Villumsen, Anne Marie; Kristensen, Ole Steen


    Both the identification of children at risk in day care and multidisciplinary collaboration with other professions have a political focus. This study was designed as an organizational field study and attempts to establish a coherent practice of multidisciplinary collaboration between day care and social services. This article focuses on the…

  5. Recursos/Resources: A Bibliography of Spanish-Language Family Day Care Training Materials. (United States)

    California Child Care Resource and Referral Network, San Francisco.

    This bibliography provides descriptions and contact information regarding resources produced by American and Canadian family day care training projects and other educational organizations for agencies working with Spanish-speaking family day care providers. Included are resources in the following areas: (1) "Recruitment Resources"; (2)…

  6. Unnoticed professional competence and knowledge in day care work

    DEFF Research Database (Denmark)

    Warring, Niels; Ahrenkiel, Annegrethe; Nielsen, Birger Steen

    be argued that there is a pressure on these aspects of professional competence and knowledge ultimately resulting in poorer quality of work for both employees and citizens – the exact opposite of what presumably has been the goal with the steering systems. In this paper we will discuss the case of social......), communities of practice (Wenger) have been influencing the discussion on professional development. Across the different notions there is a shared view that important parts of professional competence is part of daily practices and embedded in routines, experiences, shared repertoire, etc. NPM and neoliberalism...... has had an important impact on care and health work imposing demands for documentation, standardization and evaluation. These increasing demands seem to be in contrast with the tacit and embodied parts of professional competence that not easily can be documented, standardized and evaluated. It can...

  7. When risk becomes invisible in the everyday life of day care

    DEFF Research Database (Denmark)

    Villumsen, Anne Marie; Kristensen, Ole Steen


    Both the identification of children at risk in day care and multidisciplinary collaboration with other professions have a political focus. This study was designed as an organizational field study and attempts to establish a coherent practice of multidisciplinary collaboration between day care...... and their life circumstances become invisible in the everyday life of day care. Due to defensive routines as well as an organizational culture that frames and creates a non-explicitly structured practice using intuitive processes, the problems of children at risk become invisible in the everyday life of day care...... and social services. This article focuses on the mono-professional pedagogical identification of children at risk as well as on the underlying process of professional reasoning. Interviews with day care staff are analysed and the findings give reason to assume that central aspects of the children at risk...

  8. Accountable care organization readiness and academic medical centers. (United States)

    Berkowitz, Scott A; Pahira, Jennifer J


    As academic medical centers (AMCs) consider becoming accountable care organizations (ACOs) under Medicare, they must assess their readiness for this transition. Of the 253 Medicare ACOs prior to 2014, 51 (20%) are AMCs. Three critical components of ACO readiness are institutional and ACO structure, leadership, and governance; robust information technology and analytic systems; and care coordination and management to improve care delivery and health at the population level. All of these must be viewed through the lens of unique AMC mission-driven goals.There is clear benefit to developing and maintaining a centralized internal leadership when it comes to driving change within an ACO, yet there is also the need for broad stakeholder involvement. Other important structural features are an extensive primary care foundation; concomitant operation of a managed care plan or risk-bearing entity; or maintaining a close relationship with post-acute-care or skilled nursing facilities, which provide valuable expertise in coordinating care across the continuum. ACOs also require comprehensive and integrated data and analytic systems that provide meaningful population data to inform care teams in real time, promote quality improvement, and monitor spending trends. AMCs will require proven care coordination and management strategies within a population health framework and deployment of an innovative workforce.AMC core functions of providing high-quality subspecialty and primary care, generating new knowledge, and training future health care leaders can be well aligned with a transition to an ACO model. Further study of results from Medicare-related ACO programs and commercial ACOs will help define best practices.

  9. Clustering of serotypes in a longitudinal study of Streptococcus pneumoniae carriage in three day care centres

    Directory of Open Access Journals (Sweden)

    Tanskanen Antti


    Full Text Available Abstract Background Streptococcus pneumoniae (pneumococcus causes a wide range of clinical manifestations that together constitute a major burden of disease worldwide. The main route of pneumococcal transmission is through asymptomatic colonisation of the nasopharynx. Studies of transmission are currently of general interest because of the impact of the new conjugate-polysaccharide vaccines on nasopharyngeal colonisation (carriage. Here we report the first longitudinal study of pneumococcal carriage that records serotype specific exposure to pneumococci simultaneously within the two most important mixing groups, families and day care facilities. Methods We followed attendees (N = 59 with their family members (N = 117 and the employees (N = 37 in three Finnish day care centres for 9 months with monthly sampling of nasopharyngeal carriage. Pneumococci were cultured, identified and serotyped by standard methods. Results Children in day care constitute a core group of pneumococcal carriage: of the 36 acquisitions of carriage with documented exposure to homologous pneumococci, the attendee had been exposed in her/his day care centre in 35 cases and in the family in 9 cases. Day care children introduce pneumococci to the family: 66% of acquisitions of a new serotype in a family were associated with simultaneous or previous carriage of the same type in the child attending day care. Consequently, pneumococcal transmission was found to take place as micro-epidemics driven by the day care centres. Each of the three day care centres was dominated by a serotype of its own, accounting for 100% of the isolates of that serotype among all samples from the day care attendees. Conclusion The transmission of pneumococci is more intense within than across clusters defined by day care facilities. The ensuing micro-epidemic behaviour enhances pneumococcal transmission.

  10. Khoa Trinh Huan Luyen Giu Tre Ban Ngay Tai Gia (Family Day Care Training Curriculum--Vietnamese). (United States)

    Nakatsu, Gail

    California's Family Day Care Training Program was designed to recruit and train, in 7 weeks, Lao, Vietnamese, and Chinese refugees to establish their own state-licensed, family day care homes. Topics in the program's curriculum include an introduction to family day care, state licenses and licensing requirements for family day care, licensing…

  11. Detection of Cryptosporidium sp. in non diarrheal faeces from children, in a day care center in the city of São Paulo, Brazil Detecção de Cryptosporidium sp. em fezes não diarréicas de crianças, em uma escola de educação infantil de São Paulo, Brasil

    Directory of Open Access Journals (Sweden)

    Therezinha T. Carvalho-Almeida


    Full Text Available The protozoan Cryptosporidium sp. has been frequently detected in faeces from children with persistent diarrhoea. This work achieved to investigate an outbreak of cryptosporidiosis, in a day care center, attending children of high socio-economic level, between 0 and six years old. The outbreak was detected through the network of public health, when stool samples, not diarrhoeic, were examined at the Parasitology Service of the Adolfo Lutz Institute. Among the 64 examined children, 13 (20.3% showed oocysts of Cryptosporidium sp. in the faeces examined by Kinyoun technique: seven children one year old, three, two years old and three, three years old. Among the 23 examined adults, only a 22 years old woman, possibly having an immunocomprometiment, was positive. Clinical and epidemiological aspects were investigated by questionnaires, highlighting the occurrence of the outbreak in a very dry period.O protozoário Cryptosporidium sp. tem sido detectado com freqüência em fezes de crianças com diarréia persistente. Este trabalho teve como objetivo investigar um surto de criptosporidiose, em uma escola de educação infantil, que atende crianças de classe média alta, de 0 a seis anos de idade. O surto foi detectado a partir de amostras fecais não diarréicas encaminhadas ao Instituto Adolfo Lutz através da rede de saúde pública. Das 64 crianças 13 (20,3% apresentaram oocistos de Cryptosporidium nas fezes, examinadas pelo método de Kinyoun, sendo sete crianças com um ano de idade, três com dois anos de idade e três, com três anos de idade. Dos 23 adultos examinados, apenas uma mulher de 22 anos, com possível imunocomprometimento, foi positiva. Aspectos epidemiológicos e clínicos foram investigados por meio de questionários, ressaltando-se que o surto ocorreu em período muito seco.

  12. Do environmental influences alter motor abilities acquisition? A comparison among children from day-care centers and private schools Influências do ambiente podem alterar a aquisição de habilidades motoras? Uma comparação entre pré-escolares de creches públicas e escolas privadas

    Directory of Open Access Journals (Sweden)

    Karla Mônica F. T. de Barros


    Full Text Available Development occurs in a proper rhythm as result of genetic inheritance and environment factors. This study had the aim to identify some environmental risk factors for the motor development in two groups of healthy children. 100 pre-school aged (five years children from two day-care centers and a private school were evaluated, in Recife-PE. All the children underwent to a motor skills assessment and their parents answered a questionnaire. The children from the public nursery remained behind in fine motor skills. The results showed that the biologically healthy children development can suffer negative influence of the environmental risk factors. In this research these factors were: the father absence, improper toys use to the correct age, the place were the child was kept in the early childhood, the lack of pedagogical guidance and extra-parental socialization and low familiar socioeconomic status.O desenvolvimento ocorre num ritmo resultante da interação entre herança genética e fatores ambientais. Este estudo teve por objetivo identificar alguns fatores de risco ambientais para o desenvolvimento motor, em dois grupos de crianças saudáveis. Foram avaliadas 100 crianças (idade:5 anos provenientes de duas creches públicas e uma escola particular, em Recife-PE. Todas as crianças foram submetidas a uma avaliação das habilidades motoras e seus pais responderam a um questionário. As crianças da creche pública mostraram atraso no campo das habilidades motoras finas. Os resultados indicaram que o desenvolvimento das crianças biologicamente saudáveis pode sofrer influência negativa dos fatores de risco ambientais. Os fatores encontrados foram: a ausência do pai; a utilização de brinquedos inadequados para faixa etária; o local onde a criança era mantida em idades precoces da infância; a falta de orientação pedagógica e de socialização extra-familiar precoce, e a baixa condição socioeconômica familiar.

  13. Application of theory to family-centered care: a role for social workers. (United States)

    Miller, Gary


    Family-centered care is an emerging trend in health care settings today. An explanation, principles, and a definition of family-centered care are offered and discussed. A theoretical framework, Balance Theory of Coordination, which can be utilized by social workers to develop and enhance family-centered care practices, is explained and discussed. Various family-centered care practices are examined within the context of Balance Theory of Coordination as examples.

  14. Model Child Care Standards Act--Guidance to States to Prevent Child Abuse in Day Care Facilities. (United States)

    Department of Health and Human Services, Washington, DC.

    The document offers guidelines to states regarding review and revision of child care statutes, standards, and policies to address the prevention of child sexual abuse in day care facilities. General information is also provided on changes in state standards in recent years. Each of six sections examines findings of the 1981 Comparative Licensing…

  15. 76 FR 44573 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service... (United States)


    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF AGRICULTURE Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations...

  16. 76 FR 43254 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service... (United States)


    ..., 2010, at 75 FR 41793. Child and Adult Care Food Program (CACFP) [Per meal rates in whole or fractions... 48 FR 29114, June 24, 1983.) This notice has been determined to be not significant and was reviewed... Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day...

  17. Conhecimentos e práticas de trabalhadoras de creches universitárias relativos às infecções respiratórias agudas na infância Conocimientos y prácticas de trabajadoras de guarderías universitarias relativos a las infecciones respiratorias agudas en la infancia Knowledge and practices of university day care center workers relative to acute respiratory infections in childhood

    Directory of Open Access Journals (Sweden)

    Roberta Cristiane P. Alves


    Full Text Available Dada a elevada freqüência de infecções respiratórias agudas em creches, o objetivo deste trabalho foi identificar conhecimentos e práticas de trabalhadoras de creches relativos à prevenção, detecção precoce e manejo desses agravos. Mediante quatorze entrevistas estruturadas em duas creches universitárias da cidade de São Paulo, verificou-se que as trabalhadoras: demonstram familiaridade com diversos agravos; apontam febre e respiração ruidosa como sinais de gravidade; consideram poluição e transmissão como principais causas; referem o cuidado com o ambiente como melhor forma de controle; cuidam mantendo observação contínua da criança e intervenções de higiene e conforto e maior cuidado emocional; consideram educação e cuidado interligados no atendimento infantil, manifestando necessidade de maior preparo para cuidar; têm na prática diária a fonte de seus conhecimentos.Dada la elevada frecuencia de infecciones respiratorias agudas en guarderías, el objetivo en este trabajo fue identificar conocimientos y prácticas de trabajadoras de guarderías relativos a la prevención, detección precoz y manejo de esas afecciones. Mediante catorce entrevistas estructuradas en dos guarderías universitarias de la ciudad de São Paulo, se verificó que las trabajadoras: demuestran familiaridad con las diversas afecciones; señalan fiebre y respiración ruidosa como signos de gravedad; consideran a la polución y transmisión como sus principales causas; refieren al cuidado del ambiente como la mejor forma de control; se preocupan con la observación continua del niño y con acciones de higiene, confort y cuidado emocional; consideran que la educación y el cuidado son necesarios para atender a los niños y desean mayor preparación para cuidar; tienen en la práctica diaria la fuente de sus conocimientos.Given the increasing frequency of acute respiratory infections in day care centers, the objective of this work was to identify

  18. Children with Special Needs in Family Day Care Homes: A Handbook of Approaches and Activities for Family Day Care Home Providers. (United States)

    de la Brosse, Beatrice

    Practical information and sample teaching activities for child caregivers who work with young developmentally disabled children in family day care settings are provided in this manual. Each chapter shares a typical experience a caregiver may have with a particular child. Chapter 1 focuses on getting to know a new child, initial expectations, and…

  19. The effectiveness and safety of short-contact dithranol therapy in paediatric psoriasis: a prospective comparison of regular day care and day care with telemedicine

    NARCIS (Netherlands)

    Oostveen, A.M.; Beulens, C.A.; Kerkhof, P.C.M. van de; Jong, E.M.G.J. de; Seyger, M.M.B.


    BACKGROUND: Evidence on the effectiveness and safety of short-contact dithranol therapy in paediatric psoriasis is sparse and based only on retrospective data. The best results are achieved in a time-consuming day-care setting. OBJECTIVES: To study prospectively the effectiveness and safety of short

  20. Oncology nurse communication barriers to patient-centered care. (United States)

    Wittenberg-Lyles, Elaine; Goldsmith, Joy; Ferrell, Betty


    Although quality communication has been identified as a necessary component to cancer care, communication skills training programs have yet to focus on the unique role of nurses. This study explored communication barriers as reported by seven nurse managers to better identify communication skills needed for oncology nurses to practice patient-centered care. Thematic analysis of transcripts was used to identify barriers to patient and family communication and desirable patient-centered nursing communication skills. Overall, the nurse managers reported that nurses experience patient and family communication difficulties as a result of inconsistent messages to patients and family from other healthcare staff. Physician assumptions about nursing left nurses feeling uncomfortable asking for clarification, creating a barrier to team communication processes. Patient-centered communication and care cannot be actualized for nurses unless team roles are clarified and nurses receive training in how to communicate with physicians, patients, and family. Therefore, the authors of this article created the COMFORT communication training protocol, and key concepts and resources for nurse communication training through COMFORT are detailed in this article.

  1. Improving the financial viability of primary care health centers. (United States)

    Finkler, S A; Knickman, J R; Hanson, K L


    This article presents findings from a national demonstration program to improve the long-term financial viability of small not-for-profit primary care health centers. The program initiatives and their implementation are described in some detail. A standard pre/post study design was used to measure the impact of the initiatives on general outcome measures, financial ratios, and the utilization of management techniques. Overall, demonstration centers showed improvement over the study period. Notable short-term improvements included significant growth in the volume of patient visits and increased profit. Observed changes also revealed an increased use of sophisticated management techniques, expected to positively affect longer-term financial health. The findings suggest that improving the financial viability of health centers need not be expensive.

  2. Dental Care Every Day: A Caregiver's Guide. Practical Oral Care for People with Developmental Disabilities (United States)

    National Institute of Dental and Craniofacial Research (NIDCR), 2009


    Taking care of someone with a developmental disability requires patience and skill. As a caregiver, you know this as well as anyone does. You also know how challenging it is to help that person with dental care. It takes planning, time, and the ability to manage physical, mental, and behavioral problems. Dental care isn't always easy, but you can…

  3. VERIFICATION OF THE PRESENCE OF CAPSULE GENE SEQUENCES IN NASOPHARYNGEAL ISOLATES OF NONTYPEABLE HAEMOPHILUS INFLUENZAE FROM HEALTHY CHILDREN AT A BRAZILIAN DAY CARE CENTER Verificação da presença de seqüências do gene da cápsula em cepas não tipáveis de Haemophilus influenzae isoladas da nasofaringe de crianças saudáveis em uma creche brasileira

    Directory of Open Access Journals (Sweden)

    Maria Emilia Bonifácio da Silva


    Full Text Available Fifty-eight nasopharyngeal isolates of Haemophilus influenzae were collected from healthy children at a day care center, and nontypeable isolates were examined by Southern blot for the presence of capsule gene sequences. Seven isolates (12% demonstrated homology with capsule-specific sequences. One isolate was characterized as an H. influenzae type b capsule-deficient strain.Cinqüenta e oito cepas de Haemophilus influenzae foram isoladas da nasofaringe de crianças saudáveis que freqüentam uma creche, e através da técnica de Southern blot foi pesquisada nas cepas acapsuladas a presença de seqüências do gene capsular. Sete cepas (12% caracterizadas sorologicamente como acapsuladas mostraram homologia com seqüências específicas da cápsula. Uma cepa foi caracterizada com uma linhagem H. influenzae tipo b cápsula deficiente.

  4. Utilização de assentos de segurança por crianças matriculadas em creches Utilización de asientos de seguridad por niños matriculados en guarderías Child safety restraint use among children attending day care centers

    Directory of Open Access Journals (Sweden)

    Sergio Ricardo Lopes de Oliveira


    -sectional study using a stratified sampling conducted in the city of Maringá, Southern Brazil, between March and May 2007. Each day care center was visited at one day only. The outcome was use of child safety restraints by children under four. Vehicles (N=301 driving children under four were approached and information was collected using semi-structured questionnaires. Variables regarding child and adult seat distribution, use of safety restraints by occupants and driver's gender were analyzed. Data analyses included Fisher's exact test, Mantel-Haenszel chi-square test, and logistic regression. RESULTS: Of the drivers approached, 51.8% were using seat belts (60.4% among women, 44.9% among men. Among children, 36.1% were using child safety seats, 45.4% were unrestrained during traveling, 16.0% were seated on an adult lap, and 2.7% were using seat belts. The logistic regression showed the following factors affecting child safety restraint use: child age under 15 months (OR = 3.76; seat belt use by the driver (OR = 2.45; and children from socio-occupational condition with higher income and education (OR = 1.37. CONCLUSIONS: Child safety restraint use was associated to child age, seat belt use by the driver, and socio-occupational condition of day care centers. The finding of low rates of child safety restraint use poses a challenge to preventive medicine in Brazil, requiring attention and action to promote its widespread use.

  5. Measuring Therapeutic Alliance with Children in Residential Treatment and Therapeutic Day Care (United States)

    Roest, Jesse; van der Helm, Peer; Strijbosch, Eefje; van Brandenburg, Mariëtte; Stams, Geert Jan


    Purpose: This study examined the construct validity and reliability of a therapeutic alliance measure (Children's Alliance Questionnaire [CAQ]) for children with psychosocial and/or behavioral problems, receiving therapeutic residential care or day care in the Netherlands. Methods: Confirmatory factor analysis of a one-factor model ''therapeutic…

  6. Child-to-Teacher Ratio and Day Care Teacher Sickeness Absenteeism

    DEFF Research Database (Denmark)

    Gørtz, Mette; Andersson, Elvira


    The literature on occupational health points to work pressure as a trigger of sickness absence. However, reliable, objective measures of work pressure are in short supply. This paper uses Danish day care teachers as an ideal case for analysing whether work pressure measured by the child-to-teache...... for nursery care teachers, but not for preschool teacher...

  7. Thriving Children, Striving Families: A Blueprint for Streamlined Delivery of Child Day Care Collaboration Plan. (United States)

    Bassler, Elissa J.; And Others

    Upcoming federal and state changes in welfare and social services will have a profound effect on the delivery of early childhood care and education in Illinois. In October, 1995, the Day Care Action Council of Illinois convened a meeting of early childhood experts and advocates. From this retreat, a vision for a new system of the delivery of child…

  8. Fatores interferentes na alimentação de crianças de 17 a 25 meses de uma creche municipal Aspects interfering in the feeding of children from 17 to 25 months of a municipal day-care center

    Directory of Open Access Journals (Sweden)

    Ana Paola Nicolielo


    Full Text Available OBJETIVO: verificar fatores interferentes no padrão de alimentação de crianças de 17 a 25 meses. MÉTODOS: dados de avaliações fonoaudiológicas de todas as crianças do berçário (n=14 de uma creche no município de Bauru/SP. Aplicação de questionário aos pais a respeito das condições de saúde geral e desenvolvimento neuromotor, aleitamento natural ou artificial, hábitos orais e problemas respiratórios. Analisou-se a morfofuncionalidade dos constituintes do sistema estomatognático e características clínico-fisiológicas da mastiga��ão e deglutição. A análise estatística foi descritiva. RESULTADOS: constatou-se alteração em diversos aspectos da saúde nas crianças (92,8%; presença de má oclusão (28,6%; alterações morfológicas para lábio (21,4% e língua (21,4%; alterações de tonicidade de bochechas (57,1%, mento (21,4% e lábios (42,8%; respiração oral ou oronasal (42,8%; alterações na mastigação (35,7% e na deglutição de sólido (50% e líquido (42,8%. CONCLUSÃO: para esse grupo, a presença de hábitos orais, assim como as alterações morfológicas e de tonicidade influenciam o padrão de alimentação das crianças analisadas, evidenciando a necessidade de prevenir e detectar precocemente tais fatores para que a alimentação nas crianças ocorra de forma adequada, promovendo assim condições de saúde para um desenvolvimento hígido.PURPOSE: to check interfering aspects in the feeding standard of children from 17 to 25 months. METHODS: data of speech language pathology evaluation related to 14 children that attended a day-care center in the city of Bauru/SP. A questionnaire was applied in order to get information about general health conditions and neuromotor development, natural or artificial feeding, oral habits and breathing problems. The analysis was made under the following aspects: morpho-functionality of the physician-physiological characteristic constituting the stomatognathic system

  9. Estado nutricional de crianças assistidas em creches e situação de (insegurança alimentar de suas famílias Nutritional status of children attended in day-care-centers and food (insecurity of their families

    Directory of Open Access Journals (Sweden)

    Maercio Mota de Souza


    Full Text Available Examinar fatores associados a excesso de peso, déficit de estatura e déficit de peso em crianças assistidas em creches estaduais de João Pessoa e descrever a situação de (insegurança alimentar das suas famílias. Trata-se de um estudo transversal com amostra de 250 crianças. Foram estudadas variáveis socioeconômicas, maternas e das crianças. O estado nutricional das crianças foi avaliado considerando os índices estatura-para-idade e peso-para-estatura. A segurança alimentar familiar foi avaliada com a utilização da Escala Brasileira de Insegurança Alimentar. As proporções de déficit de estatura, déficit de peso e excesso de peso foram 7,6%, 1,6% e 6,4%, respectivamente. Os fatores associados à baixa estatura foram baixa estatura materna e esquema vacinal incompleto. Com relação ao baixo peso, o fator associado foi idade materna inferior a 20 anos. O excesso de peso infantil apresentou associação com o excesso de peso materno e baixa estatura materna. Em 59,6% das famílias, observou-se situação de insegurança alimentar e nutricional, sendo mais frequente a forma leve (32,4%. Excesso de peso e déficit de estatura foram os distúrbios nutricionais mais frequentes neste estudo, constituindo prioridades que devem ser consideradas nas políticas públicas atuais.The scope of this study was to examine associated factors with overweight, stunting and underweight in children attending state day care centers of João Pessoa, as well as to describe the situation of food (insecurity of their families. A cross-sectional study was conducted with a sample of 250 children. Socioeconomic, maternal and child variables were studied. The nutritional status of children was evaluated considering the height-for-age and weight-for-height indices. Household food security was assessed using the Brazilian Scale of Food Insecurity. The proportions of stunting, underweight and overweight were 7.6%, 1.6% and 6.4% respectively. The associated

  10. Day Care for Working Families Act of 1987. Hearing on S. 1271 To Provide Comprehensive Federal Assistance for Day Care, before the Subcommittee on Labor of the Committee on Labor and Human Resources. United States Senate, One Hundredth Congress, First Session. (United States)

    Congress of the U.S., Washington, DC. Senate Committee on Labor and Human Resources.

    Recognizing the importance of the need for quality day care for children of working mothers, handicapped children, and children of low income families, the U.S. Senate Subcommittee on Labor and Human Resources met to address this issue in the Child Care Center of Owens Technical College, in Toledo, Ohio. The Subcommittee interviewed or heard…

  11. Cancer patient-centered home care: a new model for health care in oncology

    Directory of Open Access Journals (Sweden)

    Tralongo P


    Full Text Available Paolo Tralongo1, Francesco Ferraù2, Nicolò Borsellino3, Francesco Verderame4, Michele Caruso5, Dario Giuffrida6, Alfredo Butera7, Vittorio Gebbia81Medical Oncology Unit, Azienda Sanitaria Provinciale, Siracusa; 2Medical Oncology Unit, Ospedale San Vincenzo, Taormina; 3Medical Oncology Unit, Ospedale Buccheri La Ferla, Palermo; 4Medical Oncology Unit, Ospedale Giovanni Paolo II, Sciacca; 5Medical Oncology Unit, Istituto Humanitas, Catania; 6Medical Oncology Unit, Istituto Oncologico del Mediterraneo, Catania; 7Medical Oncology Unit, Ospedale San Giovanni di Dio, Agrigento; 8Medical Oncology Unit, Dipartimento Oncologico, La Maddalena, Università degli Studi, Palermo, ItalyAbstract: Patient-centered home care is a new model of assistance, which may be integrated with more traditional hospital-centered care especially in selected groups of informed and trained patients. Patient-centered care is based on patients' needs rather than on prognosis, and takes into account the emotional and psychosocial aspects of the disease. This model may be applied to elderly patients, who present comorbid diseases, but it also fits with the needs of younger fit patients. A specialized multidisciplinary team coordinated by experienced medical oncologists and including pharmacists, psychologists, nurses, and social assistance providers should carry out home care. Other professional figures may be required depending on patients' needs. Every effort should be made to achieve optimal coordination between the health professionals and the reference hospital and to employ shared evidence-based guidelines, which in turn guarantee safety and efficacy. Comprehensive care has to be easily accessible and requires a high level of education and knowledge of the disease for both the patients and their caregivers. Patient-centered home care represents an important tool to improve quality of life and help cancer patients while also being cost effective.Keywords: cancer, home care

  12. Patient-centered care or cultural competence: negotiating palliative care at home for Chinese Canadian immigrants. (United States)

    Nielsen, Lisa Seto; Angus, Jan E; Howell, Doris; Husain, Amna; Gastaldo, Denise


    The literature about Chinese attitudes toward death and dying contains frequent references to strong taboos against open discussion about death; consequently, there is an assumption that dying at home is not the preferred option. This focused ethnographic study examined the palliative home care experiences of 4 Chinese immigrants with terminal cancer, their family caregivers, and home care nurses and key informant interviews with 11 health care providers. Three main themes emerged: (1) the many facets of taboo; (2) discursive tensions between patient-centered care and cultural competence; and (3) rethinking language barriers. Thus, training on cultural competence needs to move away from models that portray cultural beliefs as shared, fixed patterns, and take into account the complicated reality of everyday care provision at end of life in the home.

  13. Child voice and noise: a pilot study of noise in day cares and the effects on 10 children's voice quality according to perceptual evaluation. (United States)

    McAllister, Anita M; Granqvist, Svante; Sjölander, Peta; Sundberg, Johan


    The purpose of this investigation was to study children's exposure to background noise at the ears during a normal day at the day care center and also to relate this to a perceptual evaluation of voice quality. Ten children, from three day care centers, with no history of hearing and speech problems or frequent infections were selected as subjects. A binaural recording technique was used with two microphones placed on both sides of the subject's head, at equal distance from the mouth. A portable digital audio tape (DAT) recorder (Sony TCD-D 100, Stockholm, Sweden) was attached to the subject's waist. Three recordings were made for each child during the day. Each recording was calibrated and started with three repetitions of three sentences containing only sonorants. The recording technique allowed separate analyses of the background noise level and of the sound pressure level (SPL) of each subjects' own voice. Results showed a mean background noise level for the three day care centers at 82.6dBA Leq, ranging from 81.5 to 83.6dBA Leq. Day care center no. 2 had the highest mean value and also the highest value at any separate recording session with a mean background noise level of 85.4dBA Leq during the noontime recordings. Perceptual evaluation showed that the children attending this day care center also received higher values on the following voice characteristics: hoarseness, breathiness, and hyperfunction. Girls increased their loudness level during the day, whereas for boys no such change could be observed.

  14. The National Palliative Care Research Center and the Center to Advance Palliative Care: a partnership to improve care for persons with serious illness and their families. (United States)

    Morrison, R Sean; Meier, Diane E


    families must know to request palliative care, medical professionals must have the knowledge and skills to provide palliative care, and hospitals and other healthcare institutions must be equipped to deliver and support palliative care services. The Center to Advance Palliative Care (CAPC) and the National Palliative Care Research Center (NPCRC) are accomplishing this three-part mission by working in partnership to: 1) Develop research to serve as the knowledge base for quality clinical care and the foundation on which to build palliative care programs and systems; 2) Disseminate this knowledge to patients, families, professionals, and institutions throughout the United States and ensure that it is integrated within mainstream healthcare; and 3) Influence and collaborate with policy makers , regulatory bodies, and federal funding agencies to ensure that the healthcare infrastructure supports the continued growth and development of palliative care.


    NARCIS (Netherlands)



    The feasibility of day treatment with community care for schizophrenic patients was tested by means of a longitudinal randomized experiment with 34 experimentals and 16 controls: 38 percent could be treated satisfactorily in a day program that included a very active ambulatory service. The new appro

  16. Day Hospital and Residential Addiction Treatment: Randomized and Nonrandomized Managed Care Clients (United States)

    Witbrodt, Jane; Bond, Jason; Kaskutas, Lee Ann; Weisner, Constance; Jaeger, Gary; Pating, David; Moore, Charles


    Male and female managed care clients randomized to day hospital (n=154) or community residential treatment (n=139) were compared on substance use outcomes at 6 and 12 months. To address possible bias in naturalistic studies, outcomes were also examined for clients who self-selected day hospital (n=321) and for clients excluded from randomization…

  17. Cortisol Response to Physical Activity in African American Toddlers Attending Full-Time Day Care (United States)

    Wall, Sarah J.; Rudisill, Mary E.; Gladden, L. Bruce


    The purpose of this study was to examine African American toddlers' cortisol response to acute physical play activity within a full-time subsidized day care environment. Saliva samples were taken from participants (N = 22, ages 26-45.5 months) before and after physical play and control play conditions at the same time of day. Actiheart[TM]monitors…

  18. Learning dementia care in three contexts: practical training in day-care, group dwelling and nursing home. (United States)

    Skog, M; Negussie, B; Grafström, M


    During the period 1996-1999, 18 licensed practical nurses (LPNs) received specialized training to become caregivers and mentors in the field of dementia care at the Silvia Home Foundation in Stockholm, Sweden. The aim of the study was to illuminate how the trainees utilized their practical training to learn about dementia care. The trainees gained practical training within three care models for elderly persons with dementia. The three forms of care and the context for practical training included the school's integrated day-care, a group dwelling and a nursing home. The findings show that the trainees made use of each training context in a similar fashion but there were differences between the contexts. A perspective of human dignity characterized the day-care. This was an opportunity for the nursing philosophy taught by the programme to be put to practical use, and for reflection and experiences pertaining to the individual patient to be developed. In the group dwelling, the trainees encountered patients with different forms of dementia and studied how the care-giving could be adapted to the individual patient's symptoms - the disease perspective. In the nursing home, the trainees chose a staff perspective in which they focused on organization, management and working conditions as well as staff attitudes and the effects of these factors on patient care.

  19. Climate Prediction Center (CPC) 8 to 14 Day Probabilistic Temperature Outlook for the Contiguous United States and Alaska (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Climate Prediction Center (CPC) issues 8 to 14 day probabilistic temperature outlooks for the United States. The 8-14 day Outlook gives the confidence that a...

  20. Climate Prediction Center (CPC) 8 to 14 Day Probabilistic Precipitation Outlook for the Contiguous United States and Alaska (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Climate Prediction Center (CPC) issues 8 to 14 day probabilistic precipitation outlooks for the United States. The 8-14 day Outlook gives the confidence that a...

  1. Climate Prediction Center (CPC) 6 to 10 Day Probabilistic Precipitation Outlook for the Contiguous United States and Alaska (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Climate Prediction Center (CPC) issues 6 to 10 day probabilistic precipitation outlooks for the United States. The 6-10 day Outlook gives the confidence that a...

  2. Climate Prediction Center (CPC) 6 to 10 Day Probabilistic Temperature Outlook for the Contiguous United States and Alaska (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Climate Prediction Center (CPC) issues 6 to 10 day probabilistic temperature outlooks for the United States. The 6-10 day Outlook gives the confidence that a...

  3. [Feasibility Study of a One-Day Educational Program to Train Advance Care Planning Facilitators(ACPFs)in Regional Areas]. (United States)

    Nishikawa, Mitsunori; Miura, Hisayuki; Oya, Sanae; Kato, Tomonari; Nagae, Hiroyuki; Osada, Yoshiyuki; Watanabe, Tetsuya; Matsuoka, Sachiko; Otsuka, Yasuro; Yamaguchi, Mie; Watanabe, Kazuko; Kito, Katsutoshi; Ooi, Hatsue; Suzuki, Naoko


    Promoting advance care planning in regional areas is important. Education For Implementing End-of-Life Discussion(EFIELD) is a two-day educational program for Advance Care Planning Facilitators(ACPFs)developed by the National Center for Geriatrics and Gerontology. Unfortunately, some trainers experience difficulties implementing the content of the program, and some trainees feel the program is too long for implementation in many regional areas. The purpose of the research is to clarify the feasibility of ACPFs education using a one-day program in regional areas. The methods involved documenting the process of a one-day program from implementation to evaluation from May of 2015 to March of 2016 and then evaluating the effectiveness of the program 3 months after the implementation using meeting minutes from 7 local hospitals. The results indicated a need for 5 steps from program implementation to evaluation as well as 5 categories for final evaluation. The most important finding is that E-FIELD challenged trainers to shorten and simplify their expressions in order to teach the content more efficiently. The second finding is that Group for Promoting Advance Care Planning & End Of Life Discussion in Chita(GACPEL) activities encouraged ACPimplementation within each hospital. The limitations of this research are related to small regional areas. In conclusion, a one-day regional ACPFs educational program is feasible.

  4. [Systematization of nursing care in the obstetrical center]. (United States)

    dos Santos, Raquel Bezerra; Ramos, Karla da Silva


    This is a descriptive and exploratory study with a quantitative approach, aiming to propose a protocol for the systematization of nursing care to women in the process of giving birth in the Obstetrical Center of a public hospital in Recife, Pernambuco, Brazil. A semi-structured instrument was applied to forty women in the process of giving birth, in order to obtaining the nursing history; from which the nursing diagnoses were identified, having as a basis the International Classification for Nursing Practice (ICNP®), version 1, and their respective results and nursing interventions were established. The protocol consists in two stages: the first one is the nursing consultation, which involves the anamnesis and physical examination; and the second, involves the judicious identification of the nursing diagnoses, which will guide the planning of the nursing care to provide the individualized attention to women in the process of giving birth, using a universal terminology.

  5. [Fusing empowerment concept into patient-centered collaborative care model]. (United States)

    Wu, Chia-Chen; Lin, Chiu-Chu


    Chronic diseases are incurable, long-term illnesses. To improve quality of life, patients with chronic diseases must adjust their own personal lifestyle to cope with their diseases and eventually learn to achieve a balance between disease control and daily life. Therefore, self-management necessarily plays a key role in chronic disease management. Different from physician-centered healthcare, the self-management practiced by chronic disease patients is more patient-centered with a greater emphasis on active patient participation. The main goal of this article is to elucidate the essence of the empowerment concept. An example of diabetes care, this article introduces a detailed five-step application as a basic model for incorporating the empowerment concept into the healthcare of patients with chronic disease. The author suggests that healthcare providers apply the empowerment model in clinical practice to assist patients to maintain an optimal balance between their health status and personal lives.

  6. Why Patient Centered Care Coordination Is Important in Developing Countries? (United States)

    Luna, D.; Marcelo, A.; Househ, M.; Mandirola, H.; Curioso, W.; Pazos, P.; Villalba, C.


    Summary Patient Centered Care Coordination (PCCC) focuses on the patient health care needs. PCCC involves the organization, the patients and their families, that must coordinate resources in order to accomplish the goals of PCCC. In developing countries, where disparities are frequent, PCCC could improve clinical outcomes, costs and patients satisfaction. Objective the IMIA working group Health Informatics for Development analyzes the benefits, identifies the barriers and proposes strategies to reach PCCC. Methods Discussions about PCCC emerged from a brief guide that posed questions about what is PCCC, why consider PCCC important, barriers to grow in this direction and ask about resources considered relevant in the topic. Results PCCC encompasses a broad definition, includes physical, mental, socio-environmental and self care. Even benefits are proved, in developing countries the lack of a comprehensive and integrated healthcare network is one of the main barriers to reach this objective. Working hard to reach strong health policies, focus on patients, and optimizing the use of resources could improve the performance in the devolvement of PCCC programs. International collaboration could bring benefits. We believe information IT, and education in this field will play an important role in PCCC. Conclusion PCCC in developing countries has the potential to improve quality of care. Education, IT, policies and cultural issues must be addressed in an international collaborative context in order to reach this goal. PMID:26123907

  7. The effect of exercise intervention on frail elderly in need of care: half-day program in a senior day-care service facility specializing in functional training (United States)

    Sakamoto, Ryota; Miura, Yasushi


    [Purpose] This study investigated the long-term effect of a half-day exercise intervention program on health-related quality of life, life function, and physical function in frail elderly in need of care. The program was conducted at a senior day-care facility specializing in functional training. [Subjects and Methods] Subjects included 41 elderly in need of care who had visited the service facility for at least 1 year. Physical function and life function were evaluated at baseline, 6 months, and 12 months. Quality of life was evaluated with the Short Form-36 at baseline and 12 months. [Results] Improvements in balance, walking speed and endurance, complex performance abilities, self-efficacy during the activities, and the level and sphere of activity were observed at 6 months and maintained up to 12 months. Moreover, improvements in agility, activities of daily living, life function, and quality of life were also observed at 12 months. Improvements in muscle strength, walking ability, self-efficacy over an action, and activities of daily living were related to the improvement in quality of life. [Conclusion] The use of individualized exercise programs developed by physiotherapists led to improvements in activities of daily living and quality of life among elderly in need of care. PMID:27512243

  8. Status of Day Care in Canada: A Review of the Major Findings of the National Day Care Study, 1974. (Situation De La Garde De Jour Au Canada: Une Revue des Principales Constatations Sur La Garde De Jour, 1974). (United States)

    Department of National Health and Welfare, Ottawa (Ontario).

    This booklet presents (in both French and English) the results of a 1974 survey which assessed the growth of day care services in Canada. Similar national surveys had been conducted in 1971 and 1973. Results indicated that the number of day care spaces and the number of children of working mothers in day care increased substantially from 1973 to…

  9. Seasonal variation, weather and behavior in day-care children: a multilevel approach (United States)

    Ciucci, Enrica; Calussi, Pamela; Menesini, Ersilia; Mattei, Alessandra; Petralli, Martina; Orlandini, Simone


    This study analyzes the effect of weather variables, such as solar radiation, indoor and outdoor air temperature, relative humidity and time spent outdoor, on the behavior of 2-year-old children and their affects across different seasons: winter, spring and summer. Participants were a group of 61 children (33 males and 28 females) attending four day-care centers in Florence (Central Italy). Mean age of children at the beginning of the study was 24.1 months ( SD = 3.6). We used multilevel linear analyses to account for the hierarchical structure of our data. The study analyzed the following behavioral variables: Activity Level, Attentional Focusing, Frustration, and Aggression. Results showed a different impact of some weather variables on children’s behavior across seasons, indicating that the weather variable that affects children’s behavior is usually the one that shows extreme values during the studied seasons, such as air temperature and relative humidity in winter and summer. Studying children and their reactions to weather conditions could have potentially wide-reaching implications for parenting and teaching practices, as well as for researchers studying social relationships development.

  10. Quality of Prenatal Care Services in Karabuk Community Health Center

    Directory of Open Access Journals (Sweden)

    Binali Catak


    Full Text Available The aim of the study was to evaluate the quality and quantity of prenatal care services according to gestastional week in Karabuk Community Health Center (CHC. Methods: In this descriptive study 365 pregnant women was selected as sample among 753 pregnant women registered at Karabuk CHC in 18/01/2011. 93.0% of women in the selected sample has been visited in their homes and the face to face interviews were done. The questionnaire was prepared according to Prenatal Care Management Guidelines (PCMG of Ministry of Health. Findings The number of follow-ups was not complete in 23.7% of 15-24 month, 34.4% of 25-32 month, 52,1% of 33-42 month pregnant women. At least four follow-up visits were completed only in 66,7% of postpartum women. Timing of first visit was after 15th week in 15,6% of women. In follow up visits 62.5% of of women’s height were never measured, in 13,0% the women hearth sound of infants didn’t monitored at least once. Laboratory test numbers were under the level required by PCMG. The delivery conditions weren’t planned in 41,8% of last trimester and postpartum women and training about breastfeeding wasn’t given to 15,5 of the same group. Result In family medicine model in Karabuk CHC developments in number of prenatal follow-up visits were observed, but no substantial improvements were found in quality of prenatal visits. Regular in service trainings shoud be given to family doctors and midwives. The use of prenatal care guideline published by MoH should be increased. Keywords: Prenatal care, pregnancy, timing of first visit, qality of prenatal care [TAF Prev Med Bull 2012; 11(2.000: 153-162

  11. Tracking non-burn center care: what you don't know may surprise you. (United States)

    Davis, James S; Dearwater, Stephen; Rosales, Oscar; Varas, Robin; Quintana, Olga D; Pizano, Louis; Namias, Nicholas; Schulman, Carl I


    The American Burn Association publishes a list of defined criteria for patients who require admission or transfer to a burn center. This study examines the extent to which those criteria are observed within a regional burn network. Hospital discharge data for 2008 were obtained for all hospitals within the South Florida regional burn network. Patients with International Classification of Diseases, 9th revision discharge diagnoses for burns were reviewed, and their triage destination was compared with the burn triage referral criteria to determine whether patients were inappropriately triaged. Descriptive statistics were used to analyze the data. Four hundred ninety-eight burn admissions were documented to non-burn center center hospitals, 269 (54%) of which were deemed inappropriate by burn triage referral criteria. Burn center patients had greater length of stay when compared with non-burn center patients (14 vs 7 days), but a greater percentage were discharged home for self-care (88 vs 57%). Thirty-three percent of the inappropriate admissions were in a neighboring county, whereas 27% were in the same county where the burn center is located. Inappropriate burn patient triage may be occurring to more than half of the burn patients within our regional burn network despite better functional outcomes at the burn center. This may be because of a lack of knowledge regarding triage criteria, patient insurance status, or other factors. Further studies are necessary to fully characterize the problem and implement education or incentives to encourage appropriate burn patient triage.

  12. Effect of a Comprehensive Health Care Program by Korean Medicine Doctors on Medical Care Utilization for Common Infectious Diseases in Child-Care Centers

    Directory of Open Access Journals (Sweden)

    Minjung Park


    Full Text Available As the role of traditional medicine in community health improvement increases, a comprehensive health care program for infectious diseases management in child-care centers by Korean medicine doctors was developed. The purpose of this study is to evaluate the effects of the program intervention on infection-related medical care utilization among children. The study used a quasi-experimental design with nonequivalent control group, comparing pre- and post-intervention data of the same children. The program implemented interventions in terms of management, education, and medical examination for the teachers, parents, and children in 12-week period. The frequency of utilization, cost, and prescription days of drugs and antibiotics due to infectious diseases prior to the intervention were compared with those during the 3-month intervention, using health insurance claim data. A panel analysis was also conducted to support the findings. A significant reduction (12% in infection-related visit days of hospitals was observed with the intervention (incident rate ratio = 0.88, P=0.01. And medical cost, drug prescription days, and antibiotics prescription days were decreased, although not statistically significant. A further cost-effectiveness analysis in terms of social perspectives, considering the opportunity costs for guardians to take children to medical institutions, would be needed.

  13. Influence of the day care, home and neighbourhood environment on young children's physical activity and health

    DEFF Research Database (Denmark)

    Christian, Hayley; Maitland, Clover; Enkel, Stephanie


    will be collected by geographic information systems measures, parent and day care educator surveys. ETHICS AND DISSEMINATION: Ethical approval has been granted by The University of Western Australia Human Ethics Research Committee, approval number RA/4/1/7417. Findings will be published in international peer......-sectional observational study (April 2015 to April 2018) of 2400 children aged 2-5 years attending long day care in metropolitan Perth, Western Australia. Accelerometers will measure physical activity with indoor physical activity measured using radio frequency identification. Global positioning systems will be used...... to determine outdoor location of physical activity around the home and neighbourhood for a subsample (n=310). The day care environment will be objectively measured using a validated audit tool. Other potential individual, social and physical environmental influences on preschoolers' physical activity...

  14. 78 FR 45176 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service... (United States)


    ... June 30, 2013, on July 24, 2012, in the Federal Register at 77 FR 43229. Adjusted Payments The... related notice published at 48 FR 29114, June 24, 1983.) This notice has been determined to be not... Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day...

  15. Improving pain care through implementation of the Stepped Care Model at a multisite community health center (United States)

    Anderson, Daren R; Zlateva, Ianita; Coman, Emil N; Khatri, Khushbu; Tian, Terrence; Kerns, Robert D


    Purpose Treating pain in primary care is challenging. Primary care providers (PCPs) receive limited training in pain care and express low confidence in their knowledge and ability to manage pain effectively. Models to improve pain outcomes have been developed, but not formally implemented in safety net practices where pain is particularly common. This study evaluated the impact of implementing the Stepped Care Model for Pain Management (SCM-PM) at a large, multisite Federally Qualified Health Center. Methods The Promoting Action on Research Implementation in Health Services framework guided the implementation of the SCM-PM. The multicomponent intervention included: education on pain care, new protocols for pain assessment and management, implementation of an opioid management dashboard, telehealth consultations, and enhanced onsite specialty resources. Participants included 25 PCPs and their patients with chronic pain (3,357 preintervention and 4,385 postintervention) cared for at Community Health Center, Inc. Data were collected from the electronic health record and supplemented by chart reviews. Surveys were administered to PCPs to assess knowledge, attitudes, and confidence. Results Providers’ pain knowledge scores increased to an average of 11% from baseline; self-rated confidence in ability to manage pain also increased. Use of opioid treatment agreements and urine drug screens increased significantly by 27.3% and 22.6%, respectively. Significant improvements were also noted in documentation of pain, pain treatment, and pain follow-up. Referrals to behavioral health providers for patients with pain increased by 5.96% (P=0.009). There was no significant change in opioid prescribing. Conclusion Implementation of the SCM-PM resulted in clinically significant improvements in several quality of pain care outcomes. These findings, if sustained, may translate into improved patient outcomes. PMID:27881926

  16. Impact of a 2-Day Critical Care Ultrasound Course during Fellowship Training: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Vi Am Dinh


    Full Text Available Objectives. Despite the increasing utilization of point-of-care critical care ultrasonography (CCUS, standards establishing competency for its use are lacking. The purpose of this study was to evaluate the effectiveness of a 2-day CCUS course implementation on ultrasound-naïve critical care medicine (CCM fellows. Methods. Prospective evaluation of the impact of a two-day CCUS course on eight CCM fellows’ attitudes, proficiency, and use of CCUS. Ultrasound competency on multiple organ systems was assessed including abdominal, pulmonary, vascular, and cardiac systems. Subjects served as self-controls and were assessed just prior to, within 1 week after, and 3 months after the course. Results. There was a significant improvement in CCM fellows’ written test scores, image acquisition ability, and pathologic image interpretation 1 week after the course and it was retained 3 months after the course. Fellows also had self-reported increased confidence and usage of CCUS applications after the course. Conclusions. Implementation of a 2-day critical care ultrasound course covering general CCUS and basic critical care echocardiography using a combination of didactics, live models, and ultrasound simulators is effective in improving critical care fellows’ proficiency and confidence with ultrasound use in both the short- and long-term settings.

  17. Decentralisation of long-term care in the Netherlands: the case of day care at green care farms for people with dementia

    NARCIS (Netherlands)

    Nowak, S.J.M.; Molema, C.M.; Baan, C.A.; Oosting, S.J.; Vaandrager, L.; Hop, P.; Bruin, de R.


    Responsibility for health and social care services is being delegated from central to local authorities in an increasing number of countries. In the Netherlands, the planned transfer of responsibility for day care for people with dementia from the central government to municipalities is a case in po

  18. "We prefer greeting rather than eating:" life in an elder care center in Ethiopia. (United States)

    Teka, Alemnesh; Adamek, Margaret E


    In Ethiopia where family care is a centuries-long tradition, living in an elder care institution invariably brings social devaluation. Accordingly, this study explored the psychosocial needs of older adults in a residential elder care center in Ethiopia from the perspective of both staff and residents. Three focus group discussions of 24 residents and interviews with 5 staff persons revealed that elders were living a subsistence lifestyle, eating the same meal every day, mostly cutoff from the surrounding community, and lacking basic amenities. Despite the absence of basic amenities, residents yearned even more so for meaningful social interaction. Psychosocial support was both undervalued and underutilized by staff members, and thus, residents' psychosocial well-being appeared to be at risk. The addition of social workers in institutional care in Ethiopia may help to promote improved living standards. Advocacy is needed on behalf of residents to establish and implement guidelines on care and support of residents in old age homes. As elders in developing countries are living longer--a growing number with disabilities--at the same time that informal supports are waning, the need for developing long term care policies is becoming critical.

  19. The adult day care workforce in England at a time of policy change: implications for learning disability support services. (United States)

    Hussein, Shereen; Manthorpe, Jill


    More people will receive personal budgets to pay for social care services in England. Such people may or may not continue using services such as adult day care centres. Many day centres are under threat of closure. These trends will affect those working in adult day care. This article examines the profile of this workforce, using recent NMDS-SC data and applying multinomial statistical modelling. We identified nearly 6000 adult day care workers, over half supporting adults with learning disability. The results of the analysis show significant variations between the adult day care, residential care and domiciliary workforces. At the personal level, day care workers are significantly older and less ethnically diverse than other workers. They tend to have been working in the sector for longer, and their work patterns are more stable. The findings are discussed within the context of policy changes affecting learning disabilities and social care workforce strategies.

  20. My personal experiences at the BEST Medical Center: A day in the clinic-the afternoon. (United States)

    Cohen, Philip R; Kurzrock, Razelle


    Dr. Ida Lystic is a gastroenterologist who recently began her new faculty position at the BEST (Byron Edwards and Samuel Thompson) Medical Center. After completing her MD degree at the prestigious Harvey Medical School (recently renamed the Harvey Provider School), she did her internal medicine residency and fellowship training at the OTHER (Owen T. Henry and Eugene Rutherford) Medical Center. Her morning in gastroenterology clinic was highlighted by: (1) being reprimanded by the clinic nurse manager for a patient who not only arrived early, before clinic had opened, but also neglected to schedule the anesthesiologist for his colonoscopy; (2) the continued challenges of LEGEND (also known as Lengthy and Excessively Graded Evaluation and Nomenclature for Diagnosis by her colleagues), the new electronic medical record system after the BEST discarded the SIMPLE (Succinct Input Making Patient's Lives Electronic) system; (3) a nurse's interruption of an office visit-once the egg timer on the examination room door ran out-because she had exceeded the allocated time for the appointment; and (4) her chairman's unanticipated arrival in the clinic to visit with the clinic nurse manager. In addition to seeing her patients, Dr. Lystic's afternoon is occupied by attending a LOST (Laboratory OverSight and Testing) Committee meeting and a visit from a wayfinding and signage specialist to depersonalize the doorpost plaques of the examination rooms. Her day ends with a demeaning email from her chairman regarding the poor results of the most recent patient satisfaction survey and being personally held accountable to develop solutions to improve not only her performance but also that of the clinic. Although Dr. Ida Lystic and the gastroenterology clinic at "the BEST Medical Center" are creations of the authors' imagination, the majority of the anecdotes mentioned in this essay are based on individual patients and their physicians, clinics in medical centers and their administration

  1. VHA Support Service Center Primary Care Management Module (PCMM) (United States)

    Department of Veterans Affairs — The Primary Care Management Module (PCMM) was developed to assist VA facilities in implementing Primary Care. PCMM supports both Primary Care and non-Primary Care...

  2. Integrating Mental Health In Care For Noncommunicable Diseases: An Imperative For Person-Centered Care. (United States)

    Patel, Vikram; Chatterji, Somnath


    Mental disorders such as depression and alcohol use disorders often co-occur with other common noncommunicable diseases such as diabetes and heart disease. Furthermore, noncommunicable diseases are frequently encountered in patients with severe mental disorders such as schizophrenia. The pathways underlying the comorbidity of mental disorders and noncommunicable diseases are complex. For example, mental and physical noncommunicable diseases may have common environmental risk factors such as unhealthy lifestyles, and treatments for one condition may have side effects that increase the risk of another condition. Building on the robust evidence base for effective treatments for a range of mental disorders, there is now a growing evidence base for how such treatments can be integrated into the care of people with noncommunicable diseases. The best-established delivery model is a team approach that features a nonspecialist case manager who coordinates care with primary care physicians and specialists. This approach maximizes efficiencies in person-centered care, which are essential for achieving universal health coverage for both noncommunicable diseases and mental disorders. A number of research gaps remain, but there is sufficient evidence for policy makers to immediately implement measures to integrate mental health and noncommunicable disease care in primary care platforms.

  3. Improving pain care through implementation of the Stepped Care Model at a multisite community health center

    Directory of Open Access Journals (Sweden)

    Anderson DR


    Full Text Available Daren R Anderson,1 Ianita Zlateva,1 Emil N Coman,2 Khushbu Khatri,1 Terrence Tian,1 Robert D Kerns3 1Weitzman Institute, Community Health Center, Inc., Middletown, 2UCONN Health Disparities Institute, University of Connecticut, Farmington, 3VA Connecticut Healthcare System, West Haven, CT, USA Purpose: Treating pain in primary care is challenging. Primary care providers (PCPs receive limited training in pain care and express low confidence in their knowledge and ability to manage pain effectively. Models to improve pain outcomes have been developed, but not formally implemented in safety net practices where pain is particularly common. This study evaluated the impact of implementing the Stepped Care Model for Pain Management (SCM-PM at a large, multisite Federally Qualified Health Center. Methods: The Promoting Action on Research Implementation in Health Services framework guided the implementation of the SCM-PM. The multicomponent intervention included: education on pain care, new protocols for pain assessment and management, implementation of an opioid management dashboard, telehealth consultations, and enhanced onsite specialty resources. Participants included 25 PCPs and their patients with chronic pain (3,357 preintervention and 4,385 postintervention cared for at Community Health Center, Inc. Data were collected from the electronic health record and supplemented by chart reviews. Surveys were administered to PCPs to assess knowledge, attitudes, and confidence. Results: Providers’ pain knowledge scores increased to an average of 11% from baseline; self-rated confidence in ability to manage pain also increased. Use of opioid treatment agreements and urine drug screens increased significantly by 27.3% and 22.6%, respectively. Significant improvements were also noted in documentation of pain, pain treatment, and pain follow-up. Referrals to behavioral health providers for patients with pain increased by 5.96% (P=0.009. There was no

  4. Patient-centered care: the key to cultural competence. (United States)

    Epner, D E; Baile, W F


    Much of the early literature on 'cultural competence' focuses on the 'categorical' or 'multicultural' approach, in which providers learn relevant attitudes, values, beliefs, and behaviors of certain cultural groups. In essence, this involves learning key 'dos and don'ts' for each group. Literature and educational materials of this kind focus on broad ethnic, racial, religious, or national groups, such as 'African American', 'Hispanic', or 'Asian'. The problem with this categorical or 'list of traits' approach to clinical cultural competence is that culture is multidimensional and dynamic. Culture comprises multiple variables, affecting all aspects of experience. Cultural processes frequently differ within the same ethnic or social group because of differences in age cohort, gender, political association, class, religion, ethnicity, and even personality. Culture is therefore a very elusive and nebulous concept, like art. The multicultural approach to cultural competence results in stereotypical thinking rather than clinical competence. A newer, cross cultural approach to culturally competent clinical practice focuses on foundational communication skills, awareness of cross-cutting cultural and social issues, and health beliefs that are present in all cultures. We can think of these as universal human beliefs, needs, and traits. This patient centered approach relies on identifying and negotiating different styles of communication, decision-making preferences, roles of family, sexual and gender issues, and issues of mistrust, prejudice, and racism, among other factors. In the current paper, we describe 'cultural' challenges that arise in the care of four patients from disparate cultures, each of whom has advanced colon cancer that is no longer responding to chemotherapy. We then illustrate how to apply principles of patient centered care to these challenges.

  5. Occurrence of enteroparasites in day care centers in Botucatu (São Paulo State, Brazil with emphasis on Cryptosporidium sp., Giardia duodenalis and Enterobius vermicularis Ocorrência de enteroparasitas em creches de Botucatu (Estado de São Paulo, Brasil com ênfase em Cryptosporidium sp., Giardia duodenalis e Enterobius vermicularis

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    Thaís Batista de Carvalho


    Full Text Available The occurrence of the enteroparasites was verified in 279 children (0 to 6 years of four municipal day cares of Botucatu/SP. Three samples of each child's feces were collected and processed by the methods of Hoffman-Pons-Janner, Faust and Ritchie and subsequent coloration of the fecal smear by the methods of Auramina-O and Ziehl-Neelsen modified for diagnosis of Cryptosporidium sp. and Graham method for diagnosis of Enterobius vermicularis. Of the analyzed children we verified a prevalence of intestinal parasitism in 53.40%, and the most frequent parasite was Giardia duodenalis (26.88%. Significant association was verified among enteroparasitosis, family income, maternal education and age; the lowest enteroparasite frequency occurred in children of families with larger income and higher education. It was observed that G. duodenalis is more prevalent in children from 0 to 4 years and E. vermicularis is more frequent in children between three and four years old. The high enteroparasite prevalence in day cares suggests complex structure in its epidemiology, where factors beyond sanitation should be considered.Verificou-se a prevalência dos enteroparasitas em 279 crianças (0 a 6 anos de quatro creches municipais de Botucatu/SP. Foram coletadas três amostras de fezes de cada criança e processadas pelos métodos Hoffman, Faust e Ritchie e posterior coloração do esfregaço fecal pelos métodos de Auramina-O e Ziehl-Neelsen modificado para diagnóstico de Cryptosporidium sp. e método da fita gomada para diagnóstico de Enterobius vermicularis. Das crianças analisadas apresentaram-se parasitadas 53.40%, sendo que o parasita mais freqüente foi Giardia duodenalis (26.88%. Verificou-se associação significativa entre enteroparasitose, renda familiar, escolaridade materna e idade; quanto maior a renda e o grau escolar, menor a freqüência de enteroparasitas. Observou-se que G. duodenalis é mais prevalente em crianças de 0 a 4 anos e E

  6. Assessment of food, nutrition, and physical activity practices in Oklahoma child-care centers. (United States)

    Sisson, Susan B; Campbell, Janis E; May, Kellie B; Brittain, Danielle R; Monroe, Lisa A; Guss, Shannon H; Ladner, Jennifer L


    The purpose of the current study was to determine the obesogenic practices in all-day child-care centers caring for preschool-aged children. This study used a cross-sectional, self-reported survey mailed to centers across Oklahoma (n=314). Frequency of responses and χ(2) were calculated comparing region and star rating. Items where the majority of centers frequently report best practices include: daily fruits served (76%), daily nonfried vegetables served (71%), rarely/never served sugary drinks (92%), rarely/never used food to encourage good behaviors (88%), staff join children at table most of the time (81%), staff rarely eat different foods in view of children (69%), visible self-serve or request availability of water (93%), regular informal communication about healthy eating (86%), opportunities for outdoor play (95%), not withholding activity for punishment (91%), accessible play equipment (59% to 80% for different types of equipment), and minimization of extended sitting time (78%). Practices where centers can improve include increasing variety of vegetables (18%), reducing frequency of high-fat meats served (74% serve more than once per week), increasing high-fiber and whole-grain foods (35% offer daily), serving style of "seconds" (28% help kids determine whether they are still hungry), nonfood holiday celebrations (44% use nonfood treats), having toys and books that encourage healthy eating (27%) and physical activity (25%) in all rooms in the center, a standard nutrition (21%) and physical education (50%) curriculum, and following a written physical activity policy (43%). Practitioners can use these data to develop benchmarks and interventions, as this was the first study to assess statewide obesogenic practices in child care.

  7. Incidence of occupational exposures in a tertiary health care center

    Directory of Open Access Journals (Sweden)

    Amrita Shriyan


    Full Text Available Introduction: Occupational exposure to Hepatitis B virus (HBV, human immunodeficiency virus (HIV and Hepatitis C virus (HCV infection is a cause of concern to all health care workers (HCWs, especially those, in hospitals. Among the HCWs, nurses, interns, technicians, resident doctors and housekeeping staff have the highest incidence of occupational exposure. Aims: To analyze the cases of needle stick injuries and other exposures to patient′s blood or body fluids among health care workers. Materials and Methods: A detailed account of the exposure is documented which includes incidence of needle stick injuries (NSI and implementation of post-exposure prophylaxis (PEP as per the hospital guidelines. We report a two-year continuing surveillance study where 255 health care workers (HCWs were included. PEP was given to HCWs sustaining NSI or exposures to blood and body fluids when the source is known sero-positive or even unknown where the risk of transmission is high. Follow-up of these HCW′s was done after three and six months of exposure. Results: Of the 255 HCWs, 59 sustained needle stick injuries and two were exposed to splashes. 31 of the NSI were from known sources and 28 from unknown sources. From known sources, thirteen were seropositive; seven for HIV, three for HCV and three for HBV. Nineteen of them sustained needle stick during needle re-capping, six of them during clean up, six of them while discarding into the container, 17 during administration of injection, eight of them during suturing, two occurred in restless patient, 17 during needle disposal. Conclusion: So far, no case of sero-conversion as a result of needle stick injuries was reported at our center.

  8. Fostering innovation in medicine and health care: what must academic health centers do? (United States)

    Dzau, Victor J; Yoediono, Ziggy; Ellaissi, William F; Cho, Alex H


    There is a real need for innovation in health care delivery, as well as in medicine, to address related challenges of access, quality, and affordability through new and creative approaches. Health care environments must foster innovation, not just allowing it but actively encouraging it to happen anywhere and at every level in health care and medicine-from the laboratory, to the operating room, bedside, and clinics. This paper reviews the essential elements and environmental factors important for health-related innovation to flourish in academic health systems.The authors maintain that innovation must be actively cultivated by teaching it, creating "space" for and supporting it, and providing opportunities for its implementation. The authors seek to show the importance of these three fundamental principles and how they can be implemented, highlighting examples from across the country and their own institution.Health innovation cannot be relegated to a second-class status by the urgency of day-to-day operations, patient care, and the requirements of traditional research. Innovation needs to be elevated to a committed endeavor and become a part of an organization's culture, particularly in academic health centers.

  9. One- to Three-Year-Old Children's Experience of Subjective Wellbeing in Day Care (United States)

    Seland, Monica; Sandseter, Ellen Beate Hansen; Bratterud, Åse


    The aim of the study on which this paper is based was to explore in which situations and contexts Norwegian 1-3-year-olds experience subjective wellbeing in day care. The data in this study was collected through qualitative phenomenological observations of 18 children, and an inductive process of analysis was conducted. The results show that…


    NARCIS (Netherlands)



    Background. A randomised controlled trial of day treatment with community care for patients with schizophrenic and affective disorders, referred for in-patient psychiatric treatment, was conducted to evaluate patterns of treatment and the course of illness with its psychosocial consequences over a p

  11. Disadvantaged Single Teenage Mothers and Their Children: Consequences of Free Educational Day Care. (United States)

    Campbell, Frances A.; And Others


    Examined the benefits of providing free educational day care to children of single teen-age mothers. Results indicated that the children benefitted intellectually from the program, scoring significantly higher than controls on a general cognitive index. Mothers had an increased likelihood of completing high school, obtaining postsecondary…

  12. Summaries of the State-of-the-Art Position Papers on Day Care. (United States)

    Texas State Dept. of Public Welfare, Austin.

    This review consists of summaries of 20 position papers presenting varying viewpoints on aspects of the Federal Interagency Day Care Requirements (FIDCR). Among the authors represented are Gwen Morgan, Edward Zigler, Greta Fein, Henry Ricciuti, Urie Bronfenbrenner, Jerome Kagan and Elizabeth Prescott. Seven of the position papers deal with legal…

  13. Does Santa Exist? Children's Everyday Narratives as Dynamic Meeting Places in a Day Care Centre Context (United States)

    Puroila, Anna-Maija; Estola, Eila; Syrjala, Leena


    The article attempts to answer the question: What is the nature of children's everyday narratives in a day care centre context? The theoretical framework of this study is based on a narrative approach. The research material was gathered through applying the methodology of narrative ethnography. The article is based on observational material…

  14. Public School Aggression among Children with Varying Day-Care Experience. (United States)

    Haskins, Ron


    Fifty-nine children with varying amounts and types of day-care experience were followed over their first 2 or 3 years of public schooling. Schoolteachers rated aggressiveness of several types and in several situations and supplied information about managing the children, their use of conflict-avoiding strategies, and other associated skills and…

  15. Availability and Price of High Quality Day Care and Female Employment

    DEFF Research Database (Denmark)

    Simonsen, Marianne

    In this paper I analyse to what degree availability and price of high quality publicly subsidised childcare affects female employment for women living in couples following maternity leave. The results show that unrestricted access to day care has a significantly positive effct on female employmen.......The price effect is significantly negative: An increase in the price of child care of C=1 will decrease the female employment with 0.08% corresponding to a price elasticity of −0.17. This effect prevails during the first 12 months after childbirth.......In this paper I analyse to what degree availability and price of high quality publicly subsidised childcare affects female employment for women living in couples following maternity leave. The results show that unrestricted access to day care has a significantly positive effct on female employment...

  16. [Relationship between child day-care attendance and acute infectious disease. A systematic review]. (United States)

    Ochoa Sangrador, Carlos; Barajas Sánchez, M Verisima; Muñoz Martín, Beatriz


    Child day-care attendance is considered to be an acute early childhood disease risk factor, the studies available however not affording the possibility of fully quantifying this risk. A systematic review of clinical trials and cohort studies was conducted, in which the effects child day-care attendance had on the health of young children based on the Cochrane Collaboration, PubMed and Spanish Medical Index databases, without any time or language-related limits, were analyzed and rounded out with analyses of referenced works and an additional EMBASE search. The methodological quality was evaluated by means of personalized criteria. Pooling measures (relative risks, incidence density ratios and weighted mean differences) were calculated with their confidence intervals, assuming random effects models. A significant increase was found to exist of a risk consistent over time and among different social and geographical environments. Considering the most methodologically-stringent studies with adjusted effect estimates, child day-care attendance was related to an increased risk of upper respiratory tract infection (RR=1,88), acute otitis media (RR=1,58), otitis media with fluid draining (RR=2,43), lower respiratory tract infections (overall RR=210; acute pneumonia RR=1.70; broncholitis RR=1,80; bronchitis RR=2,10) and gastroenteritis (RR=1,40). Child day-care attendance could be responsible for 33%-50% of the episodes of respiratory infection and gastroenteritis among the exposed population. In conclusion, it can be said that the risk for childhood health attributable to the child day-care attendance is discreet but of high-impact. This information has some major implications for research, clinical practice, healthcare authorities and society as a whole.

  17. Creating New Child Care Slots in Mini Child Care Centers: Big Bang for the Buck in New Jersey. (United States)

    Frankel, Arthur J.; And Others


    Small grants of $7,500 with technical assistance were offered to the child care community of New Jersey to either start or increase licensed capacity in mini-child care centers. Results of a subsequent analysis showed that 26 grantees created 481 new child care slots at an average cost of $561 per slot. (Author/SM)

  18. Thirty-day outcome of carotid artery stenting in Chinese patients: a single-center experience

    Institute of Scientific and Technical Information of China (English)

    JIAO Li-qun; SONG Gang; LI Shen-mao; MIAO Zhong-rong; ZHU Feng-shui; JI Xun-ming; YIN Guo-yang


    Background Carotid artery stenting (CAS) as a competing treatment modality has had to adhere to limits to gain widespread acceptance in some studies.This study analyzed the clinical data of 1700 consecutive patients after CAS to retrospectively evaluate the 30-day outcome of CAS for internal carotid artery stenosis in a Chinese population.Methods Medical records of 1700 patients who underwent CAS at Xuanwu Hospital affiliated to Capital Medical University between January 2001 and August 2012 were reviewed.Postoperative 30-day complication rates were analyzed and compared with those of other studies.Univariate and multivariate Logistic regression analyses were used to identify factors associated with perioperation myocardial infarction (MI),stroke,and death.Results The overall 30-day rate of MI,stroke,and death after CAS was 2.53%.In univariate analysis,patients who were symptomatic,had a neurological deficit (modified Rankin score (mRS) ≥3; P=0.001),and who were not taking statins experienced a significantly increased rate of MI,stroke,and death (P=-0.017).In multivariate Logistic regression analysis,the presence of symptoms (odds ratio (OR)=2.485; 95% confidence interval (CI)=1.267-4.876; P=0.008) and a neurological deficit (mRS ≥3) (OR=3.025; 95% CI=1.353-6.763; P=0.007) were independent risk factors for perioperative MI,stroke,and death.Conclusions According to this single-center experience,CAS may effectively prevent and treat carotid artery stenosis that would otherwise lead to stroke.Being symptomatic and having a neurological deficit (mRS ≥3) increased the risk of perioperative MI,stroke,and death.

  19. Identifying reasons for delays in acute hospitals using the Day-of-Care Survey method. (United States)

    Reid, Erica; King, Andrew; Mathieson, Alex; Woodcock, Thomas; Watkin, Simon W


    This paper describes a new tool called 'Day-of-Care Survey', developed to assess inpatient delays in acute hospitals. Using literature review, iterative testing and feedback from professional groups, a national multidisciplinary team developed the survey criteria and methodology. Review teams working in pairs visited wards and used case records and bedside charts to assess the patient's status against severity of illness and service intensity criteria. Patients who did not meet the survey criteria for acute care were identified and delays were categorised. From March 2012 to December 2013, nine acute hospitals across Scotland, Australia and England were surveyed. A total of 3,846 adult general inpatient beds (excluding intensive care and maternity) were reviewed. There were 145 empty beds at the time of surveys across the nine sites, with 270 definite discharges planned on the day of the survey. The total number of patients not meeting criteria for acute care was 798/3,431 (23%, range 18-28%). Six factors accounted for 61% (490/798) of the reasons why patients not meeting acute care criteria remained in hospital. This survey gives important insights into the challenges of managing inpatient flow using system level information as a method to target interventions designed to address delay.

  20. Diabetes in a primary care center among Spaniards and immigrants

    Directory of Open Access Journals (Sweden)

    Roca Vilalta M


    Full Text Available Diabetes is a disease with different prevalence in different populations. Objectives: The aim of the present study is to describe diabetic patients in a primary care center with regard to their geographic origin, and to determine the status of their disease. Methods: A cross-sectional descriptive study, with data available from clinical records in South Tarrasa primary care center (Barcelona, Spain in 2004. Results: A total of 1215 diabetic patients with an average age of 65 years, 51% female, were included in the study. Regarding their origin, 97% were from Spain, 2% from Morocco, 0.8% from Latin America, and 0.2% from the rest of Europe. The average Hb1AC was 6.9%. In type 2 diabetic patients, treatment consisted of oral hypoglycemic agents (OHA for 46.6%, only dietetic restrictions for 36.5%, OHA + insulin for 7.9%, and only insulin for 9%. In the age group 30-39 years, 0.7% of Moroccans suffer from diabetes versus 0.5% of Spaniards. The values in the 40-49 year group are 3.9% of Moroccans, 3% of Spaniards, and 2.1% of Latin Americans. The values in the 50-59 year group are 13.5% of Moroccans, 10.6% of Spaniards, and 7.7% of Latin Americans. The values in the 60-69 year group are 40% of Moroccans, 18.8% of Spaniards, and 44.5% of Latin Americans. The values in the 70-79 year group are 67% of Moroccans, 26% of Spaniards, and 50% of Latin Americans. The average Hb1AC was 6.3% in Latin Americans, 6.9% in Spaniards, and 8.1% in Moroccans. In type 1 diabetic patients, the average Hb1AC was 10.2% in Moroccans and 8% in Spaniards; while in type 2 diabetes, the average Hb1AC was 7.8% in Moroccans and 6.9% in Spaniards. Gestational diabetes was observed in 6.1% of the Spanish, 10.9% of the Moroccan and 4.2% of the Latin American women. Conclusions: A higher prevalence of diabetes was detected in Moroccans than in patients from other countries. These patients present poor control of the disease.


    Directory of Open Access Journals (Sweden)



    Full Text Available BACKGROUND The current study was undertaken at a tertiary care center, Bhopal, MP, India, with the objective of establishing frequency of occurrence of congenital heart diseases by echocardiography. MATERIALS AND METHOD 10,000 consecutive cases undergoing Echo Color Doppler in the Cardiology Department Hamidia Hospital, Bhopal, between 1st Jan 2009 and July 2011 were analysed. Echo CD was performed by consultant cardiologist using Acuson Aspen Color Doppler machine following the ASE guidelines. RESULTS AND CONCLUSIONS In the present study out of 10,000consecutive cases undergoing echo 648 were identified to having congenital heart diseases. Isolated VSD (30.5%, isolated ASD (23.6% PDA (9% and TOF (8.3% were commonest defect observed. Most common congenital heart disease found in the present study is VSD and is most prevalent in males and is highest among 0-5 yrs.

  2. Evaluation of an Intervention to Reduce Playground Hazards in Atlanta Child-Care Centers. (United States)

    Sacks, Jeffrey J.; And Others


    Revisits 58 child care centers in Atlanta (Georgia) that had received interventions alerting directors to playground safety hazards. Comparison with 71 control centers randomly selected found averages of 9.4 hazards at intervention center playgrounds and 8.0 hazards at control centers. These results indicate the ineffectiveness of the…

  3. DayAND#8211;Care Surgery for Pilonidal Sinus Using Sinotomy Technique and Fibrin Glue Injection

    Directory of Open Access Journals (Sweden)

    Selim Sozen


    Conclusion: An ideal surgical procedure for a pilonidal sinus should be one aiming at reducing hospital stay, minimizing tissue assault, promoting early work resumption, and preventing recurrence. The method described in this paper was found to be simple, safe, and feasible as day-care surgery. The technique of sinotomy with a good wound and surrounding skin care is an ideal approach with a high chance of cure. The patients returned to their routine within a short duration of time. [Arch Clin Exp Surg 2012; 1(3.000: 138-141

  4. Implementing Patient Family-Centered Care Grand Rounds Using Patient/Family Advisor Narratives


    Maureen B Fagan DNP, MHA, FNP-BC; Celene Wong MHA; Martha B Carnie AS; Stanley W Ashley MD; Jacqueline G Somerville RN, PhD


    With the emerging trend of patient family–centered care in health care, it is essential that physicians be exposed to patient and family perspectives of care during medical education and training. Grand Rounds provides an ideal format for physicians to learn about patient family–centered care. At Brigham and Women’s Hospital, we sought to bring the voice of the patient to Patient Family–Centered Grand Rounds in order to expose clinicians to rich narratives describing the medical care received...

  5. Percepções de educadores de creches acerca de práticas cotidianas na alimentação de lactentes: impacto de um treinamento Perceptions of day care center teachers about daily practices of infant feeding: the impact of training

    Directory of Open Access Journals (Sweden)

    Giovana Longo-Silva


    Full Text Available O artigo apresenta a importância da capacitação dos profissionais envolvidos com alimentação das crianças em creches, para que estes ofereçam alimentos adequados e promovam ações para que os lactentes incorporem práticas alimentares saudáveis desde o nascimento. Desta forma, o objetivo do presente trabalho foi avaliar o impacto de um treinamento de educadores de creches nas percepções e práticas acerca da alimentação infantil. Para avaliação do impacto do treinamento foi utilizada abordagem qualitativa, com aplicação da técnica do grupo focal. Foram realizados 16 grupos, sendo oito com as creches expostas ao treinamento e oito com as não-expostas, tendo em média de seis a 11 participantes por instituição, os quais apresentavam idades entre 19 e 66 anos. O discurso das educadoras que participaram do treinamento está pontuado de indícios de pequenas mudanças, ou pelo menos, de reconhecimento de que é preciso e possível mudar. Destaca-se a relevância de elaborar e executar programas de treinamento e educação nutricional para educadores de creches com supervisão contínua dos efeitos da capacitação como estratégia de saúde infantil.This article stresses the importance of the qualification of professionals involved in thefeeding of children in daycare centers, such that they offeradequate food and programs are developed in order to fosterhealthy food habits in infantsfrom birth. Thus, the scope of this paper was to evaluate the impact of a training program for these daycare teachers in their perceptions and practicesin infant feeding. A qualitative approach was used to evaluate the impact of training, with the application of the focus grouptechnique. Sixteen groups were created, eight of whichwere daycare centerswith training and eight without training, the average number of participants being 6 to 11 per institution agedbetween 19 and 66. The discourse of the teachers who took part in the training program is

  6. Pediatric Mortality in a Rural Tertiary Care Center in Liberia (United States)

    Tsai, Carmelle; Walters, Camila B.; Sampson, John; Kateh, Francis; Chang, Mary P.


    Liberia is a low-income country in West Africa that has faced significant challenges, including a civil war and the recent Ebola epidemic. Little data exists on the more current post-war and pre-Ebola trends of child health in Liberia in the rural setting. This study is a retrospective chart review of pediatric mortality in 2013 at a rural tertiary care center in Liberia, 10 years post-war. From January 2013 to December 2013, there were 50 pediatric deaths, or 5.4% of the 920 total pediatric admissions. The most common cause of neonatal death was sepsis, and the most common cause of death under five years of age was malaria. The majority (82.0%) of the deaths were in children under five. Pediatric mortality at this hospital was similar to other reported mortality six years post-war, and lower than that reported immediately post-war. Neonatal sepsis and malaria are two significant causes of pediatric mortality in this community and, therefore, further efforts to decrease childhood mortality should focus on these causes. PMID:28146099

  7. Patient- and family-centered care coordination: a framework for integrating care for children and youth across multiple systems. (United States)


    Understanding a care coordination framework, its functions, and its effects on children and families is critical for patients and families themselves, as well as for pediatricians, pediatric medical subspecialists/surgical specialists, and anyone providing services to children and families. Care coordination is an essential element of a transformed American health care delivery system that emphasizes optimal quality and cost outcomes, addresses family-centered care, and calls for partnership across various settings and communities. High-quality, cost-effective health care requires that the delivery system include elements for the provision of services supporting the coordination of care across settings and professionals. This requirement of supporting coordination of care is generally true for health systems providing care for all children and youth but especially for those with special health care needs. At the foundation of an efficient and effective system of care delivery is the patient-/family-centered medical home. From its inception, the medical home has had care coordination as a core element. In general, optimal outcomes for children and youth, especially those with special health care needs, require interfacing among multiple care systems and individuals, including the following: medical, social, and behavioral professionals; the educational system; payers; medical equipment providers; home care agencies; advocacy groups; needed supportive therapies/services; and families. Coordination of care across settings permits an integration of services that is centered on the comprehensive needs of the patient and family, leading to decreased health care costs, reduction in fragmented care, and improvement in the patient/family experience of care.

  8. Innovation in patient-centered care: lessons from a qualitative study of innovative health care organizations in Washington State

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    Reed Peter


    Full Text Available Abstract Background Growing interest in the promise of patient-centered care has led to numerous health care innovations, including the patient-centered medical home, shared decision-making, and payment reforms. How best to vet and adopt innovations is an open question. Washington State has been a leader in health care reform and is a rich laboratory for patient-centered innovations. We sought to understand the process of patient-centered care innovation undertaken by innovative health care organizations – from strategic planning to goal selection to implementation to maintenance. Methods We conducted key-informant interviews with executives at five health plans, five provider organizations, and ten primary care clinics in Washington State. At least two readers of each interview transcript identified themes inductively; final themes were determined by consensus. Results Innovation in patient-centered care was a strategic objective chosen by nearly every organization in this study. However, other goals were paramount: cost containment, quality improvement, and organization survival. Organizations commonly perceived effective chronic disease management and integrated health information technology as key elements for successful patient-centered care innovation. Inertia, resource deficits, fee-for-service payment, and regulatory limits on scope of practice were cited as barriers to innovation, while organization leadership, human capital, and adaptive culture facilitated innovation. Conclusions Patient-centered care innovations reflected organizational perspectives: health plans emphasized cost-effectiveness while providers emphasized health care delivery processes. Health plans and providers shared many objectives, yet the two rarely collaborated to achieve them. The process of innovation is heavily dependent on organizational culture and leadership. Policymakers can improve the pace and quality of patient-centered innovation by setting targets

  9. Implementing Patient Family-Centered Care Grand Rounds Using Patient/Family Advisor Narratives

    Directory of Open Access Journals (Sweden)

    Maureen B Fagan DNP, MHA, FNP-BC


    Full Text Available With the emerging trend of patient family–centered care in health care, it is essential that physicians be exposed to patient and family perspectives of care during medical education and training. Grand Rounds provides an ideal format for physicians to learn about patient family–centered care. At Brigham and Women’s Hospital, we sought to bring the voice of the patient to Patient Family–Centered Grand Rounds in order to expose clinicians to rich narratives describing the medical care received by patients/families and to ultimately change physician practice to reflect patient family–centered principles. We conducted a clinician survey and found promising results indicating that patient/family narratives can be effective at educating physicians about patient family–centered care.

  10. Researching family through the everyday lives of children across home and day care in Denmark

    DEFF Research Database (Denmark)

    Kousholt, Dorte


    The article investigates family as a conflictual community with a specific starting point in exploring children's lives across day-care institution and home. Children's development is theorised in relation to taking part in different communities across different contexts. The article draws...... on an ethnographically inspired research project with 6 families living in a small town in Denmark. The analysis points to how the children's possibilities of participation are created across their different life contexts and that the social interplay and conflicts between the children in the day-care institution have...... impacts on the relation and interaction between parents and children. Parenting in that way reaches far beyond the family and includes taking into account various issues in the other places where the children spend their time. The children's developmental possibilities are shaped by the relations...

  11. Important themes in research on and education of young children in day care centres: Finnish viewpoints

    Directory of Open Access Journals (Sweden)

    Maritta Hännikäinen


    Full Text Available The aim of this article is to outline important themes, according to Finnish early childhood education researchers, that need to be addressed in researching and educating children under three years of age in Finland. To achieve this aim, the article divides into two parts. First, we present and discuss the results of a small-scale survey, conducted in Finland, on the views of key informants in the early childhood education units of Finnish universities. Second, the views presented in the survey are used as a starting point to introduce two ongoing qualitative case studies on the everyday life of toddlers in Finnish day care centres. In line with the survey findings, these case studies emphasize in particular the importance of the relational, social nature of children, the educational community, and the sensitivity of the adult for children’s wellbeing in day care groups.

  12. Gestalt therapy approaches with aggressive children in a day care setting


    Maxey, Win


    This research study was designed to evaluate whether or not Gestalt therapy approaches could be used effectively when intervening with aggressive acts in a day care setting. Five focus children were observed at timed intervals as to whether or not they were aggressive, how the caretaker intervened, and how the children responded to the caretaker intervention. After a baseline of aggressive acts was established, caretakers were trained to use Gestalt therapy interventio...

  13. Educators' working conditions in a day care centre on ownership of a non-profit organization

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    Kusma Bianca


    Full Text Available Abstract Background Working conditions of nursery school teachers have not been scrutinized thoroughly in scientific research. Only a few studies have so far examined work-load and strain in this profession. Preferably, subjective perceptions should be corroborated by data that can be quantified more objectively and accurately. The aim of the present observational field study was to evaluate pedagogical staffs' workflow. Methods In 2009 eleven educators in a day care centre were observed throughout three complete workdays. A total of 250 working hours were recorded. Results An educators' workday lasted on average 07:46:59 h (SD = 01:01:10 h. Within this time span, an average of 02:20:46 h (30.14%, SD = 00:28:07 h were spent on caring, 01:44:18 h on playing (22.33%, SD = 00:54:12 h, 00:49:37 h on educational work (10.62%, SD = 00:40:09, and only 00:05:38 h on individual child contact (1.21%, SD = 00:04:58 h. Conclusion For the first time, educators' workflow in day care centres was studied in real time. Some of the educators' self-reported problems were corroborated. The results of this study form a basis upon which further investigations can be built and measures can be developed for an overall improvement of child care.

  14. Healthy incentive scheme in the Irish full-day-care pre-school setting.

    LENUS (Irish Health Repository)

    Molloy, C Johnston


    A pre-school offering a full-day-care service provides for children aged 0-5 years for more than 4 h\\/d. Researchers have called for studies that will provide an understanding of nutrition and physical activity practices in this setting. Obesity prevention in pre-schools, through the development of healthy associations with food and health-related practices, has been advocated. While guidelines for the promotion of best nutrition and health-related practice in the early years\\' setting exist in a number of jurisdictions, associated regulations have been noted to be poor, with the environment of the child-care facility mainly evaluated for safety. Much cross-sectional research outlines poor nutrition and physical activity practice in this setting. However, there are few published environmental and policy-level interventions targeting the child-care provider with, to our knowledge, no evidence of such interventions in Ireland. The aim of the present paper is to review international guidelines and recommendations relating to health promotion best practice in the pre-school setting: service and resource provision; food service and food availability; and the role and involvement of parents in pre-schools. Intervention programmes and assessment tools available to measure such practice are outlined; and insight is provided into an intervention scheme, formulated from available best practice, that was introduced into the Irish full-day-care pre-school setting.

  15. Treatment Attrition of Probationers With Mental Illness From an Enhanced Day Reporting Center. (United States)

    Carr, W Amory; Cassidy, James J


    Treatment completion is an important outcome for both mental health and criminal justice agencies tasked with managing offenders with mental illness in the community. Previous research has shown that greater degrees of criminogenic risk factors (e.g., specific criminal history variables) predict treatment non-completion among legally mandated populations. However, most studies were conducted with offenders without mental illness. In this study, demographic (e.g., age, gender), clinical (e.g., psychiatric diagnosis), and criminogenic risk factors (measured using the Level of Service Inventory-Revised [LSI-R]) were compared by treatment completion status using 167 probationers with mental illness treated at an enhanced day reporting center. Bivariate and multivariate (i.e., forward entry logistic regression) analyses revealed that while the LSI-R total score was unrelated to treatment completion, higher scores on the LSI-R Alcohol and Drug use subscale (odds ratio [OR] = 1.25, 95% confidence interval [CI] = [1.01, 1.54]) and older age (OR = 1.04, 95% CI = [1.00, 1.09]) were significantly predictive of non-completion.

  16. The Evaluation of Nursing Care Satisfaction and Patient Learning Needs in day Case Surgery. (United States)

    Goktas, Sonay B; Yildiz, Tülin; Nargiz, Sibel Kosucu


    Patients in surgical service units have higher expectations for treatment and care. The aims of this study were to determine nursing care satisfaction and information requirements at the time of discharge of patients from a day surgery unit and to assess the effects of demographics. The study was conducted on 291 patients undergoing day case surgery. Patient perception scale for nursing care (PPSN) and the patient learning needs scale (PLNS) were used and total and sub-dimension points averages were calculated and then compared with demographic data using the Kruskal-Wallis test. The results were evaluated at the p patients, 58.8 % (n = 171) were females and the average age was 49.5 ± 15.3 years. PPSN and PLNS total point averages were 68.16 ± 10.17 and 178.53 ± 27.59, respectively. A significant difference was determined in PPSN total point average with regard to previous hospitalisations; the PPSN total point average was higher for patients with prior hospitalisations (p patient satisfaction and patient information requirements could change according to demographic features of the patients at a day case surgery unit. In this respect, healthcare providers should offer healthcare services by evaluating the personal characteristics of patients because this is important for their satisfaction.

  17. Transurethral Cystolithotripsy of Large Bladder Stones by Holmium Laser as a Day Care Procedure (United States)

    Naorem, Salinita; Faridi, M.S.; Akoijam, Kaku Singh; Sinam, Rajendra Singh


    Introduction Bladder stones constitute around 5% of bladder stones in the developed countries. Holmium laser lithotripsy has revolutionised the treatment of urinary lithiasis. Aim The aim of this study was to report the outcome of transurethral cystolithotripsy with Holmium Laser under Local Anaesthesia (LA) as a day care procedure in patients with bladder stones. Materials and Methods Patients with bladder stone greater than 1.5cm attending urology Outpatient Department underwent transurethral cystolithotripsy with Holmium Laser under LA as day care procedure. The results were analysed on aspects of peri-operative pain, completion of procedure, stone clearance, hospital stay, complications and patient compliance. Results A total of 85 patients with bladder stone ≥1.5cm underwent transurethral cystolithotripsy LA. The mean age of the patient was 52±7 years. There were 80 males. The mean size of stone was 3±1.2cm. Mean operation time was 40±10 minutes. Complete stone clearance was achieved in all the patients. None of the patients required hospital stay following the procedure. Conclusion Transurethral holmium laser lithotripsy is an effective and safe procedure for large bladder stones. This procedure can be easily performed as a day care procedure. PMID:28208921

  18. Smoking-attributable morbidity: acute care hospital diagnoses and days of treatment in Canada, 2002

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    Rehm Jürgen


    Full Text Available Abstract Background Smoking is one of the most important risk factors for burden of disease. Our objective was to estimate the number of hospital diagnoses and days of treatment attributable to smoking for Canada, 2002. Methods Distribution of exposure was taken from a major national survey of Canada, the Canadian Community Health Survey. For chronic diseases, risk relations were taken from the published literature and combined with exposure to calculate age- and sex-specific smoking-attributable fractions (SAFs. For fire deaths, SAFs were taken directly from available statistics. Information on morbidity, with cause of illness coded according to the International Classification of Diseases version 10, was obtained from the Canadian Institute for Health Information. Results For Canada in 2002, 339,179 of all hospital diagnoses were estimated to be attributable to smoking and 2,210,155 acute care hospital days. Ischaemic heart disease was the largest single category in terms of hospital days accounting for 21 percent, followed by lung cancer at 9 percent. Smoking-attributable acute care hospital days cost over $2.5 billion in Canada in 2002. Conclusion Since the last major project produced estimates of this type, the rate of hospital days per 100,000 population has decreased by 33.8 percent. Several possible factors may have contributed to the decline in the rate of smoking-attributable hospital days: a drop in smoking prevalence, a decline in overall hospital days, and a shift in distribution of disease categories. Smoking remains a significant health, social, and economic burden in Canada.

  19. Clinical Outcomes of Colonic Stent in a Tertiary Care Center

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    Mahesh Gajendran


    Full Text Available Introduction. Colonic obstruction is one of the manifestations of colon cancer for which self-expanding metal stents (SEMS have been effectively used, to restore the luminal patency either for palliative care or as a bridge to resective surgery. The aim of our study is to evaluate the efficacy and safety of large diameter SEMS in patients with malignant colorectal obstruction. Methods and Results. A four-year retrospective review of the Medical Archival System was performed and identified 16 patients. The average age was 70.8 years, of which 56% were females. The most common cause of obstruction was colon cancer (9/16, 56%. Rectosigmoid was the main site of obstruction (9/16 and complete obstruction occurred in 31% of cases. The overall technical and clinical success rates were 100% and 87%, respectively. There were no immediate complications (<24 hours, but stent stenosis due to kinking occurred within one week of stent placement in 2 patients. Stent migration occurred in 2 patients at 34 and 91 days, respectively. There were no perforations or bleeding complications. Conclusion. Large diameter SEMS provide a safe method for palliation or as a bridge to therapy in patients with malignant colonic obstruction with high technical success and very low complication rates.

  20. Advancing patient-centered care through transformative educational leadership: a critical review of health care professional preparation for patient-centered care

    Directory of Open Access Journals (Sweden)

    Lévesque MC


    Full Text Available Martine C Lévesque,1,2 Richard Bruce Hovey,2,3 Christophe Bedos2,4 1Faculté de médecine, Université de Montréal, Montréal, QC, Canada; 2Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, QC, Canada; 3Faculty of Medicine, University of Calgary, Calgary, AB, Canada; 4Département de médecine sociale et préventive, Faculté de médicine, Université de Montréal, Montréal, QC, Canada Abstract: Following a historical brief on the development of patient-centered care (PCC, we discuss PCC's value and role in counterbalancing the evidence-based movement in health care. We in turn make a case for a philosophical shift in thinking about the PCC concept, one based on a consideration for how knowledge is produced, used, and valued within care provision processes. A “shared epistemology” foundation is presented, defined, and promoted as essential to the authentic and ethical realization of “shared decision making” between patient and health care provider, and, more generally, of PCC. In accordance with these views, this article critically reviews the literature on health care professional education for the development of PCC. We uncover the disturbing ways in which education frequently undermines the development of patient centeredness, despite curricular emphasis on professionalism and ethical PCC. We also establish the need to raise awareness of how dominant approaches to evaluating student or practitioner performance often fail to reinforce or promote patient centeredness. Finally, we identify successful and inspiring cases of teaching and learning experiences that have achieved perspective transformation on PCC and on new ways of providing care. The pertinence of adopting the theoretical foundations of adult transformative learning is argued, and a call to action is proposed to the leadership of health professional educators across all disciplines. Keywords: patient-centered care, health professional

  1. Learning the 'SMART' way... results from a pilot study evaluating an interprofessional acute care study day. (United States)

    Lewis, Robin


    A significant number of patients requiring critical care are now being managed outside of critical care facilities. There is evidence that staff looking after these patients lack the necessary knowledge and skills to care for them safely, and that effective pre-registration education can play a significant role in addressing these shortfalls in nurses' knowledge and skills. A team from Sheffield Hallam University, in collaboration with the University of Sheffield, developed a pilot one day interprofessional acute illness programme which was called SMART® (Student Management of Acute illness - Recognition and Treatment). To evaluate the pilot programme, 16 student doctors and 72 student nurses were recruited. A pre- and post-course questionnaire based on the Featherstone et al. (2005) evaluation of ALERT was used to ascertain the students' general level of knowledge of the deteriorating patient, their experiences of and confidence in caring for an acutely unwell patient, and their level of comfort with interprofessional working. The results from the pilot study indicate that the students' levels of knowledge, their levels of confidence and their comfort with interprofessional working all rose after undertaking the programme. The pilot study has a number of implications for the future teaching and learning of acute care clinical skills, within a theoretically based curriculum.

  2. Neonatal family care for 24 hours per day: effects on maternal confidence and breast-feeding. (United States)

    Wataker, Heidi; Meberg, Alf; Nestaas, Eirik


    In family care (FC) program for neonatal intensive care units (NICUs), parents are encouraged to reside together with their infant for 24 hours a day to actively be involved in the care. The aim of this study was to assess the impact of FC on maternal confidence and breast-feeding. Maternal confidence and rate of breast-feeding were assessed in 31 mothers offered FC that included special family rooms in the NICU, and in 30 mothers from a comparable NICU providing traditional care without such facilities. One week prior to hospital discharge, mothers in the FC group felt better informed regarding nursing issues and had more confidence in interpretation of the infants regarding feeding issues and in caregiving without staff attendance (P skill level for interpretation of the infant's signals and knowledge about breast-feeding (P < .05). Despite similar rate of breast-feeding at discharge, more infants in the FC group were breastfed 3 months after discharge (P < .05). An FC program in the NICU promoted better maternal confidence during the hospital stay and 3 months after discharge compared with traditional care.

  3. Developmental stimulation in child care centers contributes to young infants’ cognitive development

    NARCIS (Netherlands)

    Albers, E.M.; Riksen-Walraven, J.M.A.; Weerth, C. de


    This study examined whether the quality of caregiver behavior in child care centers contributes to infant cognitive development at 9 months of age. Sixty-four infants (34 boys) were observed with their primary caregivers in child care centers at 3, 6, and 9 months of age. Caregiver behavior was rate

  4. Diabetes Stories: Use of Patient Narratives of Diabetes to Teach Patient-Centered Care (United States)

    Kumagai, Arno K.; Murphy, Elizabeth A.; Ross, Paula T.


    A critical component to instituting compassionate, patient-centered diabetes care is the training of health care providers. Our institution developed the Family Centered Experience (FCE), a comprehensive 2-year preclinical program based on longitudinal conversations with patients about living with chronic illness. The goal of the FCE is to explore…

  5. Lead, Allergen, and Pesticide Levels in Licensed Child Care Centers in the United States (United States)

    The First National Environmental Health Survey of Child Care Centers was conducted to provide information about lead, allergens, and pesticide levels in licensed U.S. child care centers. Lead levels were measured in settled dust, paint, and play area soil; indoor allergen levels ...

  6. Biological air contamination in elderly care centers: geria project. (United States)

    Aguiar, Lívia; Mendes, Ana; Pereira, Cristiana; Neves, Paula; Mendes, Diana; Teixeira, João Paulo


    Indoor air quality (IAQ) affects health particularly in susceptible individuals such as the elderly. It has been estimated that the older population spends approximately 19-20 h/d indoors, and the majority of the elderly spend all of their time indoors in elderly care centers (ECC). Older individuals may be particularly at risk of exposure to detrimental effects from pollutants, even at low concentrations, due to common and multiple underlying chronic diseases that increase susceptibility. This study, aimed to assess the impact of indoor biological agents in 22 ECC located in Porto, was conducted during summer and winter from November 2011 to August 2013 at a total of 141 areas within dining rooms, drawing rooms, medical offices, and bedrooms (including the bedridden). Air sampling was carried out with a microbiological air sampler (Merck MAS-100) and using tryptic soy agar for bacteria and malt extract agar for fungi. The results obtained were compared with the recently revised Portuguese standards. In winter, mean fungi concentration exceeded reference values, while bacteria concentrations were within the new standards in both seasons. The main fungi species found indoors were Cladosporium (73%) in summer and Penicillium (67%) in winter. Aspergillus fumigatus, Aspergillus niger, and Aspergillus flavus, known potential pathogenic/toxigenic species, were also identified. Although the overall rate and mean values of bacteria and fungi found in ECC indoor air met Portuguese legislation, some concern is raised by the presence of pathogenic microorganisms. Simple measures, like opening windows and doors to promote air exchange and renewal, may improve effectiveness in enhancing IAQ.

  7. Optimizing Patient-centered Communication and Multidisciplinary Care Coordination in Emergency Diagnostic Imaging: A Research Agenda. (United States)

    Sabbatini, Amber K; Merck, Lisa H; Froemming, Adam T; Vaughan, William; Brown, Michael D; Hess, Erik P; Applegate, Kimberly E; Comfere, Nneka I


    Patient-centered emergency diagnostic imaging relies on efficient communication and multispecialty care coordination to ensure optimal imaging utilization. The construct of the emergency diagnostic imaging care coordination cycle with three main phases (pretest, test, and posttest) provides a useful framework to evaluate care coordination in patient-centered emergency diagnostic imaging. This article summarizes findings reached during the patient-centered outcomes session of the 2015 Academic Emergency Medicine consensus conference "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization." The primary objective was to develop a research agenda focused on 1) defining component parts of the emergency diagnostic imaging care coordination process, 2) identifying gaps in communication that affect emergency diagnostic imaging, and 3) defining optimal methods of communication and multidisciplinary care coordination that ensure patient-centered emergency diagnostic imaging. Prioritized research questions provided the framework to define a research agenda for multidisciplinary care coordination in emergency diagnostic imaging.

  8. Implications of the 90-day episode definition used for the Comprehensive Care for Joint Replacement model (United States)

    Ellimoottil, Chad; Ryan, Andrew M.; Hou, Hechuan; Dupree, James M.; Hallstrom, Brian; Miller, David C.


    Importance Under the Comprehensive Care for Joint Replacement (CJR) model, hospitals are held accountable for nearly all Medicare payments that occur during the initial hospitalization through 90-days post-discharge (i.e., episode of care). It is unknown whether unrelated expenditures resulting from this “broad” episode definition will impact participating hospital’s average 90-day episode payments. Objective To compare the CJR program’s broad episode definition to a clinically-narrow episode definition Design We identified Medicare claims for patients in Michigan who underwent joint replacement from 2011 through 2013. Using specifications from the CJR model and the clinically-narrow Hospital Compare payment measure, we constructed episodes of care and calculated 90-day episode payments. We then compared hospitals’ average 90-day episode payments using the two episode definitions and fit linear regression models to understand whether payment differences were associated with specific hospital characteristics (average CMS-HCC risk score, rural hospital status, joint replacement volume, percentage of Medicaid discharges, teaching hospital status, number of beds, percentage of joint replacements performed on African American patients and median income of the hospital’s county). Setting All Michigan hospitals located in metropolitan statistical areas Participants Medicare beneficiaries Main Outcome and Measure(s) The correlation and difference between average 90-day episode payments using the broad CJR model episode definition and the clinically-narrow Hospital Compare episode definition. Results We identified 23,251 joint replacement episodes. 90-day episode payments using the broad CJR episode definition ranged from $17,349 to $29,465 (mean: $22,122, standard deviation: $2,600). Episode payments were slightly lower (mean: $21,670) when the Hospital Compare episode definition was used. Both methods were strongly correlated (r=0.99, p<0.001). The average

  9. Patient-centered care in lung cancer: exploring the next milestones



    In this editorial, the authors comment on a recently published review paper by Molassiotis et al. on the developments made over the past 40 years in supportive care for patients with lung cancer. During this period, a paradigm shift promoting patient-centered care (PCC) has led to an important change in the approach of supportive cancer care, from a purely disease-centered approach, measuring survival-related outcomes, to recognizing the importance of quality of life outcomes as well. This ch...

  10. Gastroenteritis Attributable to 16 Enteropathogens in Children Attending Day Care Significant Effects of Rotavirus, Norovirus, Astrovirus, Cryptosporidium and Giardia

    NARCIS (Netherlands)

    Enserink, Remko; van den Wijngaard, Cees; Bruijning-Verhagen, Patricia; van Asten, Liselotte; Mughini-Gras, Lapo; Duizer, Erwin; Kortbeek, Titia; Scholts, Rianne; Nagelkerke, Nico; Smit, Henriette A.; Kooistra-Smid, Mirjam; van Pelt, Wilfrid


    Background: Children attending day care experience substantial gastrointestinal morbidity due to circulating seasonal enteropathogens in the day-care environment. The lack of a distinct clinical presentation of gastroenteritis (GE) in these children, in combination with the high diversity of enterop

  11. Day care attendance in early life, maternal history of asthma, and asthma at the age of 6 years

    NARCIS (Netherlands)

    Celedon, JC; Wright, RJ; Litonjua, AA; Sredl, D; Ryan, L; Weiss, ST; Gold, DR


    Among children not selected on the basis of a parental history of atopy, day care attendance in early life is inversely associated with asthma at school age. We examined the relation between day care in the first year of life and asthma, recurrent wheezing, and eczema at the age of 6 years and wheez

  12. Improving coordination of care centers for the elderly through IT support

    DEFF Research Database (Denmark)

    Johansen, Andreas Kaas; Lauridsen, Frederik Vahr Bjarnø; Manea, Vlad;


    In Denmark, care of elderly people involves numerous and relatively autonomous care providers, including care centers, activity centers, physiotherapists, doctors, and other specialists. However, due to a poor coordination of activities, many elderly experience a lack of continuity of care, missed...... appointments, and general discomfort. In this poster we report on preliminary findings from a project aimed at creating improved IT support for coordination of care for the elderly in a Danish municipality. We propose that in order to successfully support heterogeneous collaboration, our system must address...... the disruptions in the existing routines, minimize the inherent articulation work, and coherently unify their coordination mechanisms....

  13. Commitment, Community, and Passion: Dimensions of a Care-Centered Approach to Teacher Education. (United States)

    Goldstein, Lisa S.


    Builds on Nel Noddings' work on caring encounters to develop a care-centered approach to teacher education. This model emphasizes the important contributions to the process of preparing caring teachers made by enhanced interpersonal commitment, membership in a community of learners, and passion for the creative, intellectual aspects of teaching.…

  14. What is Patient-Centered Care? A Typology of Models and Missions. (United States)

    Tanenbaum, Sandra J


    Recently adopted health care practices and policies describe themselves as "patient-centered care." The meaning of the term, however, remains contested and obscure. This paper offers a typology of "patient-centered care" models that aims to contribute to greater clarity about, continuing discussion of, and further advances in patient-centered care. The paper imposes an original analytic framework on extensive material covering mostly US health care and health policy topics over several decades. It finds that four models of patient-centered care emphasize: patients versus their parts; patients versus providers; patients/providers/states versus "the system"; and patients and providers as persons. Each type is distinguishable along three dimensions: epistemological orientations, practical accommodations, and policy tools. Based on this analysis, the paper recommends that four questions be asked of any proposal that claims to provide patient-centered care: Is this care a means to an end or an end in itself? Are patients here subjects or objects? Are patients here individuals or aggregates? How do we know what patients want and need? The typology reveals that models are neither entirely compatible nor entirely incompatible and may be usefully combined in certain practices and policies. In other instances, internal contradictions may jeopardize the realization of coherent patient-centered care.

  15. Extending residential care through telephone counseling: Initial results from the Betty Ford Center Focused Continuing Care protocol



    There is increasing evidence that a chronic care model may be effective when treating substance use disorders. In 1996, the Betty Ford Center (BFC) began implementing a telephone-based continuing care intervention now called Focused Continuing Care (FCC) to assist and support patients in their transition from residential treatment to longer-term recovery in the “real world”. This article reports on patient utilization and outcomes of FCC. FCC staff placed clinically directed telephone calls t...


    Directory of Open Access Journals (Sweden)



    Full Text Available BACKGROUND The growing demand for early discharge from hospital, consequent early return to work has resulted in the evolution of concept of “day care surgery.” This has led to development of precise safe anaesthetic techniques and agents as well as a battery of tests of recovery. Day care surgery presents unique challenges for the anaesthetists to produce a ‘street fit’ patient as soon as possible after the surgery with least complications, which can be achieved by both intravenous and inhalational techniques. Thus, an endeavour was made to carry out the present study with the aims and objectives to assess the progress of recovery in patients undergoing day care surgery with two groups of intravenous anaesthetic agents and also to determine the optimum time taken to achieve “home readiness.” METHODS The study included patients of average intelligence of both sexes aged between 15 and 45 yrs. belonging to physical status ASA I and II, undergoing operative procedures less than 30 minutes in our institute over a period of two years. A randomized double blind study was done amongst 80 patients scheduled for day care surgery, where two techniques were compared. Amongst 2 groups [Group I: Propofol (1% and Group II: Thiopentone (2.5% as the intravenous anaesthetic agent]. Recovery was assessed using standard scoring systems. The different variables were evaluated by mean and standard deviation. For comparing two groups, paired ‘t’ test was applied and a p value of ˂0.05 was considered significant. RESULTS The mean total dose requirement in Group-II patients were more than that in Group-I patients (p0.05, but the quality of anaesthesia was excellent in 57.5% in Group-I as compared to 45% in Group-II. After 5 minutes of cessation of anaesthesia, patients in Group-I attained much higher score as compared to Group-II (p<0.001 as assessed by the “Steward scoring system.” More number of patients were “Home ready” in Group-I than in

  17. Psychometric evaluation of the Swedish version of the Person-Centered Care Assessment Tool (P-CAT)


    Sjögren, Karin; Lindkvist, Marie; Sandman, Per-Olof; Zingmark, Karin; Edvardsson, David


    Background: Person-centered care is a multidimensional concept describing good care, especially within aged care and care for people with dementia. Research studies evaluating person-centered care interventions seldom use direct measurement of levels of person-centeredness. Existing scales that measure person-centeredness need further testing. This study evaluated the psychometric properties of the Swedish version of the Person-Centered Care Assessment Tool (P-CAT). Methods: A cross-sectional...

  18. Avaliação do consumo alimentar em creches públicas em São Paulo, Brasil Evaluación del consumo alimentar en guarderías públicas en São Paulo, Brasil Evaluation of food consumption at public day care centers in São Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    Giovana Longo-Silva


    edades entre 12 y 29 meses. La recolección de los datos se realizó por el método de pesaje directo durante tres días no consecutivos. Para el cálculo nutricional, se utilizó el software DietWin Profissional 2.0®, siendo posteriormente calculada la adecuación del consumo de energía, proteína, hierro, vitamina A y vitamina C. Para el cálculo de proteína, hierro, vitaminas A y C, se utilizó como referencia la necesidad mediana estimada (Estimated Average Requirement del National Research Council (2002. El calcio se evaluó por la ingestión adecuada (Adequate Intake, 1999. La evaluación de la ingestión de energía se realizó con base en la necesidad energética estimada (Estimated Energy Requirement, 2002. Los datos fueron analizados en el programa Epi-Info 2000, versión 3.4.3. RESULTADOS: Se identificaron déficits medianos para energía (49,78%, hierro (81,67%, calcio (57,44%, excesos de proteína (183,27% y vitaminas A (126,86% y C (57,44%. La distribución de los porcentuales de adecuación de los macronutrientes se mostró inadecuada para lípidos. CONCLUSIONES: Aunque los menús servidos en guarderías sean planeados por nutricionistas, los resultados apuntan a posibles fallas en el proceso de la alimentación infantil relacionadas a la preparación, proporcionamiento y/o prácticas de oferta de los alimentos. Tales hallazgos refuerzan la necesidad de acciones de educación y supervisión en salud para garantizar el suministro de alimentación adecuada a este grupo poblacional.OBJECTIVE: To evaluate the energy intake and dietary adequacy of children attending nurseries of public and not-for-profit daycare centers in the city of São Paulo, Brazil. METHODS: Cross-sectional study conducted at 16 nurseries, attended by 236 children between the ages of 12 and 29 months. Data collection was carried out by the direct weighing method over three nonconsecutive days. The DietWin® 2.0 Professional software was used for nutritional calculations. The adequacy of

  19. [Intersubjectivity in Mental Health care: narratives of nursing technicians at a Psychosocial Care Center]. (United States)

    Campos, Rosana Onocko; Baccari, Ivana Preto


    Psychosocial Care Centers (Caps) were established as a result of the demand for Mental Health care and were an attempt to update psychiatric treatment for those afflicted with severe mental disorders. This article seeks to analyze subjective repercussions of work conducted in Caps on mid-level professionals and to contribute to healthcare planning. Two focal groups were conducted with workers of a Caps III. The methodology applied to the analysis was based on the critical hermeneutical approach proposed by Ricoeur and espoused by Gadamerian philosophy. Lack of appreciation in the workplace was revealed as being the main cause of suffering. Several themes stood out including the difficulty of obtaining the cooperation of users'; relatives, the tenuous interconnection between Caps and the health network, the attribution of responsibility for the night shift, controversies regarding overnight-stay patients and an excessive workload. Adequate structural planning and institutional organization is proposed when opening new Caps in order to reduce the workload of technicians and improve the clinical performance of the team.

  20. Conformity of pediatric/adolescent HIV clinics to the patient-centered medical home care model. (United States)

    Yehia, Baligh R; Agwu, Allison L; Schranz, Asher; Korthuis, P Todd; Gaur, Aditya H; Rutstein, Richard; Sharp, Victoria; Spector, Stephen A; Berry, Stephen A; Gebo, Kelly A


    The patient-centered medical home (PCMH) has been introduced as a model for providing high-quality, comprehensive, patient-centered care that is both accessible and coordinated, and may provide a framework for optimizing the care of youth living with HIV (YLH). We surveyed six pediatric/adolescent HIV clinics caring for 578 patients (median age 19 years, 51% male, and 82% black) in July 2011 to assess conformity to the PCMH. Clinics completed a 50-item survey covering the six domains of the PCMH: (1) comprehensive care, (2) patient-centered care, (3) coordinated care, (4) accessible services, (5) quality and safety, and (6) health information technology. To determine conformity to the PCMH, a novel point-based scoring system was devised. Points were tabulated across clinics by domain to obtain an aggregate assessment of PCMH conformity. All six clinics responded. Overall, clinics attained a mean 75.8% [95% CI, 63.3-88.3%] on PCMH measures-scoring highest on patient-centered care (94.7%), coordinated care (83.3%), and quality and safety measures (76.7%), and lowest on health information technology (70.0%), accessible services (69.1%), and comprehensive care (61.1%). Clinics moderately conformed to the PCMH model. Areas for improvement include access to care, comprehensive care, and health information technology. Future studies are warranted to determine whether greater clinic PCMH conformity improves clinical outcomes and cost savings for YLH.

  1. Student-Centered Deliberations of Ethical Care & Use of Animals (United States)

    Pecore, John; Demetrikopoulos, Melissa; Frantz, Kyle


    Most biology teachers implement animal dissection (real or virtual) and often lead discussions on research involving animal subjects. Such activities provide excellent opportunities to explore ideas about ethical conduct in the care and use of animals. The challenge for teachers is to present information about animal care and use that enables…

  2. Social influence in child care centers: a test of the theory of normative social behavior. (United States)

    Lapinski, Maria Knight; Anderson, Jenn; Shugart, Alicia; Todd, Ewen


    Child care centers are a unique context for studying communication about the social and personal expectations about health behaviors. The theory of normative social behavior (TNSB; Rimal & Real, 2005 ) provides a framework for testing the role of social and psychological influences on handwashing behaviors among child care workers. A cross-sectional survey of child care workers in 21 centers indicates that outcome expectations and group identity increase the strength of the relationship between descriptive norms and handwashing behavior. Injunctive norms also moderate the effect of descriptive norms on handwashing behavior such that when strong injunctive norms are reported, descriptive norms are positively related to handwashing, but when weak injunctive norms are reported, descriptive norms are negatively related to handwashing. The findings suggest that communication interventions in child care centers can focus on strengthening injunctive norms in order to increase handwashing behaviors in child care centers. The findings also suggest that the theory of normative social behavior can be useful in organizational contexts.

  3. Employer-Supported Child Care in Ontario. (United States)

    Ontario Ministry of Community and Social Services, Toronto.

    Six case studies describing current employer-supported child care services in Ontario are presented. The studies describe the PLADEC Day Care Center of the Kingston Psychiatric Hospital, the day care center at the Chedoke-McMaster Hospitals in Hamilton, the Early Learning Centre at Durham College in Oshawa, the Hydrokids day care center at the…

  4. Entre o fortalecimento e o declínio do vínculo voluntário-idoso dependente em um centro-dia Entre el fortalecimiento y la decadencia del vínculo voluntario-anciano dependiente en un centro-día Between the strengthening and the decline of the bond volunteer-disabled elderly person in a day-care center

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    Silvia Cristina Mangini Bocchi


    Interactionism as a theoretical framework and the Grounded Theory as a methodological background. It aimed at understanding the volunteer-disabled elderly person interaction at a Day-Care Center and at designing a representative theoretical model for such experience. Data were collected by non-directive interviews. Two phenomena emerged from data analysis: becoming responsible for the continuity of volunteer work with disabled elderly persons supported by the healing expectation of former family caregivers in a society with a declining solidary conscience and assuming the volunteer role. Understanding the experience enbaled us to expand the knowledge concerning the movement undertaken in the experience denominated: between strengthening and the decline of the bond volunteerdisabled elderly person in a day-care hospital, mediated by (de motivation.

  5. Consequences of alcohol consumption among women cared for in a Psychosocial Care Center

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    Sandra Cristina Pillon


    Full Text Available The aim of this study was to identify the consumption of alcohol and its impact on the physical, interpersonal, and intrapersonal realms, as well on the impulse control and social responsibility of a group of women receiving specialized treatment. It is a descriptive qualitative study. The sample comprised 61 women, predominately adults, single, with low education levels and who were domestic workers. On average they consumed high quantities of distilled alcohol per day. The women were diagnosed with alcohol dependence syndrome and presented significant damages to their intrapersonal and impulse control areas. A minority sought treatment to stop drinking, and 59% had initiated a prior treatment for mental and psychiatric disorders. The results provided use with information on alcohol consumption, as well as on the consequences of drinking among women. Such data is essential for rethinking how to plan health care proposals for this population. doi: 10.5216/ree.v16i2.22712.

  6. Clinical and epidemiological characteristics of patients with uveitis in an emergency eye care center in Brazil

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    Eduardo Nery Rossi Camilo


    Full Text Available Purpose: To analyze the clinical and epidemiological characteristics of patients with uveitis in an emergency eye care center. Methods: We conducted a prospective, observational study of patients with active uveitis admitted between May 2012 and July 2012 to an emergency eye care center. Results: The majority of patients were male (63.2%, with a mean age of 43.2 years; 66.2% patients were of mixed ethnicity, 22.5% were Caucasian, and 11.3% were black. Anterior uveitis was observed in 70.1% patients, posterior uveitis in 26.5%, and panuveitis in 3.4%; no patient was diagnosed with intermediate uveitis. All patients had a sudden and acute presentation. The most frequent symptoms were ocular pain (76.9%, redness (59.8%, and visual blurring (46.2%. The majority of patients had unilateral disease (94.9% with a mean symptom duration of 6.2 days. Diffuse and anterior uveitis were associated with ocular pain (p<0.001. Scotomata and floaters were more frequent in patients with posterior uveitis (p=0.003 and p=0.016, respectively. Patients with anterior uveitis presented with better visual acuity (p=0.025. Granulomatous keratotic precipitates were more frequent in patients with posterior uveitis (p=0.038. An etiological diagnosis based on the evaluation at the emergency center was made in 45 patients (38.5%. Conclusions: Acute anterior uveitis was the most frequent form of uveitis. Initial patient evaluation provided sufficient information for deciding primary therapy and aided in arriving at an etiological diagnosis in a considerable number of patients.

  7. [At the Savar center, primary health care (PHC) evolves with the health conditions]. (United States)

    Chirac, P


    A war hospital installed close to the front by a group of young Bangladeshi doctors during the 1971 war of liberation from Pakistan was the origin of the new "Gonoshasthaya Kendra" (GK), or people's health center, 40 km north of Dhaka in Savar. At the new center, as in the hospital, trained paramedics furnish basic health care for the population. The center at Savar was applying the principles of primary health care 6 years before they were recognized at the Alma Ata conference. Today, GK has integrated programs to fight poverty into its health activities, with educational, nutrition, and employment programs. The paramedics have a long training course, working under the supervision of a senior paramedic for a year and receiving theoretical training in the evenings. They do not become senior paramedics for several years. The work of the paramedics is oriented toward health education, prevention, and demoepidemiologic surveillance and registration. Each paramedic is responsible for 2 or 3 villages with about 3 thousand inhabitants. The paramedics visit and motivate the population, register births and deaths, identify and care for pregnant women, and vaccinate children and pregnant women. They provide health and nutrition education, treat diarrhea and instruct mothers in use of oral rehydration therapy, and provide family planning information and supplies. Persons in need are referred to "clinic days" held regularly in the larger villages. The paramedics maintain records for each family which allow calculation of vital rates and epidemiologic data. In the region of Savar served by the paramedics, the rates of general mortality and infant mortality are 12/1000 and 85/1000 respectively, vs. 17 and 124/1000 in Bangladesh as a whole. The GK has a new goal of reducing infant mortality to 60/1000. The paramedics have been taught to recognize 2 new symptoms, convulsions and respiratory distress, and to refer infants showing these symptoms to doctors. The GK doctors believe

  8. Intestinal parasites in children from a day care centre in Matanzas City, Cuba.

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    Roberto Cañete

    Full Text Available BACKGROUND: Intestinal parasitic infections are widely distributed throughout the world and children are the most affected population. Day care centres are environments where children have proven to be more susceptible to acquiring IP. METHODS AND PRINCIPAL FINDINGS: A cross-sectional study was carried to determine the prevalence of intestinal parasites in stool samples among children who attend to a day care centre in an urban area of Matanzas city, Cuba, from March to June 2012. 104 children under five years old were included on the study after informed consent form was signed by parents or legal guardians. Three fresh faecal samples were collected from each child in different days and were examined by direct wet mount, formalin-ether, and Kato- Katz techniques. Data relating to demography, socioeconomic status, source of drinking water, and personal hygiene habits were also collected using a standardized questionnaire. In total, 71.1% of children harbored at least one type of intestinal parasite and 47 (45.2% were infected by more than one species. Giardia duodenalis and Blastocystis sp. were the most common parasites found, with prevalence rates of 54.8% and 38.5% respectively. CONCLUSIONS: Despite public health campaigns, improvement in the level of education, and the availability of and access to medical services in Cuba infections by intestinal protozoan is high in this centre. Almost nothing is published regarding intestinal parasites in Matanzas province during the last 40 years so this work could also be the initial point to carry out other studies to clarify the IP status in this region.

  9. Impact of Inpatient Versus Outpatient Total Joint Arthroplasty on 30-Day Hospital Readmission Rates and Unplanned Episodes of Care. (United States)

    Springer, Bryan D; Odum, Susan M; Vegari, David N; Mokris, Jeffrey G; Beaver, Walter B


    This article describes a study comparing 30-day readmission rates between patients undergoing outpatient versus inpatient total hip (THA) and knee (TKA) arthroplasty. A retrospective review of 137 patients undergoing outpatient total joint arthroplasty (TJA) and 106 patients undergoing inpatient (minimum 2-day hospital stay) TJA was conducted. Unplanned hospital readmissions and unplanned episodes of care were recorded. All patients completed a telephone survey. Seven inpatients and 16 outpatients required hospital readmission or an unplanned episode of care following hospital discharge. Readmission rates were higher for TKA than THA. The authors found no statistical differences in 30-day readmission or unplanned care episodes.

  10. Quality of care and temperament determine changes in cortisol concentrations over the day for young children in childcare. (United States)

    Dettling, A C; Parker, S W; Lane, S; Sebanc, A; Gunnar, M R


    The current study investigated whether patterns of cortisol production in preschool-aged children in group care were influenced by characteristics such as group size, adult:child ratio, separation from family/parents, and quality of attention and stimulation from the childcare provider. Data were obtained from preschoolers attending home-based childcare. Cortisol levels were sampled at home and at childcare. Parents and teachers assessed the child's temperament (CBQ, TBQ). At childcare, the children were observed using the Observational Ratings of the Caregiving Environment (ORCE). Childcare characteristics were independent of family or child characteristics. In home-based childcare, children's cortisol patterns over the day correlated significantly with the amount of attention and stimulation provided by the childcare provider. Using a median split on the quality index measure of focused attention/stimulation, children in settings that were above the median exhibited no change in cortisol from home to childcare, while those in settings below the median exhibited a reversal of the typical pattern of cortisol production from morning to afternoon. At home these children exhibited the expected decrease in cortisol from morning to afternoon. Patterns of cortisol production at childcare were also correlated with child temperament with larger increases from morning to afternoon for more emotionally negative children and those with less self-control. Finally, cortisol production in home-based childcare was compared to data from children in center-based childcare and children not enrolled in full-day childcare.

  11. Peripherally inserted central venous catheter safety in burn care: a single-center retrospective cohort review. (United States)

    Austin, Ryan E; Shahrokhi, Shahriar; Bolourani, Siavash; Jeschke, Marc G


    The use of peripherally inserted central catheter (PICC) line for central venous access in thermally injured patients has increased in recent years despite a lack of evidence regarding safety in this patient population. A recent survey of invasive catheter practices among 44 burn centers in the United States found that 37% of burn units use PICC lines as part of their treatment protocol. The goal of this study was to compare PICC-associated complication rates with the existing literature in both the critical care and burn settings. The methodology involved is a single institution retrospective cohort review of patients who received a PICC line during admission to a regional burn unit between 2008 and 2013. Fifty-three patients were identified with a total of seventy-three PICC lines. The primary outcome measurement for this study was indication for PICC line discontinuation. The most common reason for PICC line discontinuation was that the line was no longer indicated (45.2%). Four cases of symptomatic upper extremity deep vein thrombosis (5.5%) and three cases of central line-associated bloodstream infection (4.3%, 2.72 infections per 1000 line days) were identified. PICC lines were in situ an average of 15 days (range 1 to 49 days). We suggest that PICC line-associated complication rates are similar to those published in the critical care literature. Though these rates are higher than those published in the burn literature, they are similar to central venous catheter-associated complication rates. While PICC lines can be a useful resource in the treatment of the thermally injured patient, they are associated with significant and potentially fatal risks.

  12. Cancer Care Initiative: Creation of a Comprehensive Cancer Center at Naval Medical Center Dan Diego (United States)


    clinic had Cancer Care Initiative 6 a dedicated satellite pharmacy staffed by a part-time pharmacist who prepared chemotherapy solutions...patient education information; 80% want clinical research trials; and 79% want end-of-life palliative care to be included as part of a CCC. Physicians...prevention, early detection, staging evaluation, initial and subsequent treatment, long-term follow-up, palliative and hospice care , and supportive

  13. Developmental stimulation in child care centers contributes to young infants' cognitive development. (United States)

    Albers, Esther M; Riksen-Walraven, J Marianne; de Weerth, Carolina


    This study examined whether the quality of caregiver behavior in child care centers contributes to infant cognitive development at 9 months of age. Sixty-four infants (34 boys) were observed with their primary caregivers in child care centers at 3, 6, and 9 months of age. Caregiver behavior was rated for sensitivity and for stimulation of infant development during one-to-one caregiving interactions. Infant cognitive development was assessed using the Bayley Scales of Infant Development-II (Mental Development Index). Higher levels of developmental stimulation in the centers predicted higher levels of infant cognitive development at 9 months, beyond infant cognitive development at 3 months (just before entering child care), parental education, and maternal sensitivity. The results suggest that even small increases in developmental stimulation provided in child care centers in the first year of life may foster infants' cognitive development.

  14. Use of narrative as an awareness strategy for a Family-Centered Care model

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    Daniela Doulavince Amador

    Full Text Available The aim of this study was to comprehend the meaning of using illness narratives to raise awareness among nursing students and healthcare professionals toward the family-centred care model. The adopted methodological framework was Qualitative Content Analysis based on the philosophy of Family-Centered Care. Data were collected by means of assessments provided by 29 participants at an event in 2013, in São Paulo. The resulting analytical category was "transformed by the family narrative", which consisted of three sub-categories: Favours a better understanding of the family's experience; facilitates learning of family issues; and triggers thought on family-centered care. Results showed that hearing the family narrative on experiences with illness and hospitalization raises awareness among nursing students and healthcare professionals toward the family-centered care model, and facilitates learning of this model of care.

  15. Communication About Sexuality in Advanced Illness Aligns With a Palliative Care Approach to Patient-Centered Care. (United States)

    Leung, Margaret W; Goldfarb, Shari; Dizon, Don S


    Treatment-related sexual complications are common in cancer patients although rarely discussed in the palliative care setting. Sexuality is an important survivorship issue and remains relevant even in the terminal setting. There are multiple barriers in dialoguing about intimacy and sexual functioning from the patient and provider perspectives. Palliative care providers, while not expected to be sexual health experts, can provide comprehensive patient-centered care by including sexual health as part of their evaluation. They can explore how sexual dysfunction can impair functioning and utilize an interdisciplinary approach to manage symptoms. Palliative care providers can help patients identify their goals of care and explore what anticipated sexual changes and treat-related side effects are tolerable and intolerable to the patient's quality of life. Principles on addressing sexuality in the palliative setting and practical ways of incorporating sexual history into the palliative care assessment are provided.


    Davidson, Ehud; Sheiner, Eyal


    Soroka University Medical Center is a tertiary hospital, and the sole medical center in the Negev, the southern part of Israel. Soroka has invested in quality, service and research. The region has developed joint programs in order to advance the quality of medical care whilst optimizing the utilization of available resources. In this editorial we describe the path to leadership in quality of medical care, service and research.


    Directory of Open Access Journals (Sweden)



    Full Text Available The main purpose of this study is to capture the practical point of view, the main issues in examples of best practices in the application for funding for the project "Christian Day Center- Support for young people and adults with disabilities" project benefited the City Council Târgu Jiu, is a project which was realized in the Regional Operational Programme, Priority Axis 3 DMI 3.2 - "Rehabilitation / modernization / development and equipping of social services", the total value of the project was 3,373,722.72 lei, of which non-repayable funding over was worth 2,592,251.08 lei. Through its general objective, the project "Day Center Christian - Support for young people and adults with disabilities" aims to contribute to improving the quality of infrastructure for social services by ensuring equal access of citizens of Tg-Jiu such services. Christian Day Center- support for young people and adults with physical disabilities, musculoskeletal, neuro, somatic and visual has already proposed to the idea of the project, to be a center which will ensure the social inclusion of these vulnerable and contribute to increasing the quality of life, improve communication and information on the rights and benefits of social services to improve the management and organization of the system of providing social services and facilitating the participation of all stakeholders in the development of social services.

  18. The Hospice Concept of Care: A Family Centered Approach. (United States)

    Story, Marilyn

    This description of the Cedar Valley Hospice program emphasizes palliative and supportive care for terminally ill patients and their families. The history of the hospice movement is outlined along with a description of the Cedar Valley program and the results of a 1980 program evaluation. The appendices contain a statement of the hospice goals and…

  19. Supporting Children's Participation in Finnish Child Care Centers (United States)

    Venninen, Tuulikki; Leinonen, Jonna; Lipponen, Lasse; Ojala, Mikko


    Children's participation in the early childhood education context is a multidimensional issue and educators have a significant role in enhancing participation. In this paper, we focus on the existing challenges to children's participation and the ways that child care educators can work as teams to meet those challenges. The data were collected…

  20. Human-centered environment design in intensive care unit

    NARCIS (Netherlands)

    Li, Y.; Albayrak, A.; Goossens, R.H.M.; Xiao, D.; Jakimowicz, J.J.


    Because of high risk and instability of the patients in Intensive care unit(ICU), the design of ICU is very difficult. ICU design, auxiliary building design, lighting design, noise control and other aspects can also enhance its management. In this paper, we compare ICU design in China and Holland ba

  1. Emergency care center turnaround time--an improvement story. (United States)

    Gelrud, Joan; Burroughs, Helen; Koterwas, Joanne


    Emergency department overcrowding is a nationally recognized barrier to patient safety. Other obstacles to efficiency and adequate care in emergency rooms include lengthy patient waits and side-tracked ambulances. This article explores one community hospital's approach to significantly decreasing emergency visit turnaround times while increasing patient satisfaction.

  2. Patient centered primary care is associated with patient hypertension medication adherence. (United States)

    Roumie, Christianne L; Greevy, Robert; Wallston, Kenneth A; Elasy, Tom A; Kaltenbach, Lisa; Kotter, Kristen; Dittus, Robert S; Speroff, Theodore


    There is increasing evidence that patient centered care, including communication skills, is an essential component to chronic illness care. Our aim was to evaluate patient centered primary care as a determinant of medication adherence. We mailed 1,341 veterans with hypertension the Short Form Primary Care Assessment Survey (PCAS) which measures elements of patient centered primary care. We prospectively collected each patient's antihypertensive medication adherence for 6 months. Patients were characterized as adherent if they had medication for >80%. 654 surveys were returned (50.7%); and 499 patients with complete data were analyzed. Antihypertensive adherence increased as scores in patient centered care increased [RR 3.18 (95% CI 1.44, 16.23) bootstrap 5000 resamples] for PCAS score of 4.5 (highest quartile) versus 1.5 (lowest quartile). Future research is needed to determine if improving patient centered care, particularly communication skills, could lead to improvements in health related behaviors such as medication adherence and health outcomes.

  3. Outbreaks of Streptococcus pneumoniae carriage in day care cohorts in Finland – implications for elimination of transmission

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    Auranen Kari


    Full Text Available Abstract Background Day care centre (DCC attendees play a central role in maintaining the circulation of Streptococcus pneumoniae (pneumococcus in the population. Exposure within families and within DCCs are the main risk factors for colonisation with pneumococcal serotypes in DCC attendees. Methods Transmission of serotype specific carriage was analysed with a continuous time event history model, based on longitudinal data from day care attendees and their family members. Rates of acquisition, conditional on exposure, were estimated in a Bayesian framework utilising latent processes of carriage. To ensure a correct level of exposure, non-participating day care attendees and their family members were included in the analysis. Posterior predictive simulations were used to quantify transmission patterns within day care cohorts, to estimate the basic reproduction number for pneumococcal carriage in a population of day care cohorts, and to assess the critical vaccine efficacy against carriage to eliminate pneumococcal transmission. Results The model, validated by posterior predictive sampling, was successful in capturing the strong temporal clustering of pneumococcal serotypes in the day care cohorts. In average 2.7 new outbreaks of pneumococcal carriage initiate in a day care cohort each month. While 39% of outbreaks were of size one, the mean outbreak size was 7.6 individuals and the mean length of an outbreak was 2.8 months. The role of families in creating and maintaining transmission was minimal, as only 10% of acquisitions in day care attendees were from family members. Considering a population of day care cohorts, a child-to-child basic reproduction number was estimated as 1.4 and the critical vaccine efficacy against acquisition of carriage as 0.3. Conclusion Pneumococcal transmission occurs in serotype specific outbreaks of carriage, driven by within-day-care transmission and between-serotype competition. An amplifying effect of the day

  4. Visiting nursery, kindergarten and after-school day care as astronomy for development (United States)

    Tomita, Akihiko


    One of the frontiers of astronomy for development is astronomy education for young children. Note that it is not too-much-going-ahead education nor education for so-called gifted children. It is for all children in various situations. As an example, I present "Uchu no O-hanashi," a visiting activity which includeds slide show, story telling, and enjoying pictures on large sheets for children. Not only just for young children, but this activity also aims at intercultural understanding. Sometimes guest educator from abroad join the activity. Video letter exchange was successful even though there is a language barrier. For assessment of the activity, I have recorded the voice of children. I will present various examples of written records and their analysis of activites, at nursery, kindergarten, preschool, after-school day care for primary school children, and other sites. I hope exchanging the record will make a worldwide connection among educators for very young children.

  5. [Mental health care: listening to patients discharged from a day hospital]. (United States)

    Ferreira, Maria Solange de Castro; Pereira, Maria Alice Ornellas


    This is a qualitative study aiming at understanding how patients discharged from a Mental Health Day Hospital view the service, at learning whether such service contributed to changes in their lives and at whether those individuals continued treatment. Semi-structured interviews and documental research were used for nine patients who had completed treatment at the service in 2008. Thematic analysis was adopted for organization of the data obtained, which were analyzed according to the Psychosocial Rehabilitation framework. It emphasizes the importance of looking for the various subjective aspects of human existence, requiring from services and professionals the establishment of a caring relationship that enables the reconstruction of trajectories interrupted by the onset of the disease, through actions that consider the integrality and intersectionality.

  6. Early Full-Time Day Care, Mother-Child Attachment, and Quality of the Home Environment in Chile: Preliminary Findings (United States)

    Cárcamo, Rodrigo A.; Vermeer, Harriet J.; van der Veer, René; van IJzendoorn, Marinus H.


    Research Findings: Two longitudinal studies are reported examining the effects of full-time day care in Mapuche and non-Mapuche families in Chile. First, the Magellan-Leiden Childcare Study (MLCS) used a sample of 95 mothers with children younger than 1 year old (n = 36 in day care). Second, we partially cross-validated our results in a large and…

  7. Music benefits on postoperative distress and pain in pediatric day care surgery. (United States)

    Calcaterra, Valeria; Ostuni, Selene; Bonomelli, Irene; Mencherini, Simonetta; Brunero, Marco; Zambaiti, Elisa; Mannarino, Savina; Larizza, Daniela; Albertini, Riccardo; Tinelli, Carmine; Pelizzo, Gloria


    Postoperative effect of music listening has not been established in pediatric age. Response on postoperative distress and pain in pediatric day care surgery has been evaluated. Forty-two children were enrolled. Patients were randomly assigned to the music-group (music intervention during awakening period) or the non-music group (standard postoperative care). Slow and fast classical music and pauses were recorded and played via ambient speakers. Heart rate, blood pressure, oxygen saturation, glucose and cortisol levels, faces pain scale and Face, Legs, Activity, Cry, Consolability (FLACC) Pain Scale were considered as indicators of response to stress and pain experience. Music during awakening induced lower increase of systolic and diastolic blood pressure levels. The non-music group showed progressive increasing values of glycemia; in music-group the curve of glycemia presented a plateau pattern (PMusic improves cardiovascular parameters, stress-induced hyperglycemia. Amelioration on pain perception is more evident in older children. Positive effects seems to be achieved by the alternation of fast, slow rhythms and pauses even in pediatric age.

  8. Music benefits on postoperative distress and pain in pediatric day care surgery

    Directory of Open Access Journals (Sweden)

    Valeria Calcaterra


    Full Text Available Postoperative effect of music listening has not been established in pediatric age. Response on postoperative distress and pain in pediatric day care surgery has been evaluated. Forty-two children were enrolled. Patients were randomly assigned to the music-group (music intervention during awakening period or the non-music group (standard postoperative care. Slow and fast classical music and pauses were recorded and played via ambient speakers. Heart rate, blood pressure, oxygen saturation, glucose and cortisol levels, faces pain scale and Face, Legs, Activity, Cry, Consolability (FLACC Pain Scale were considered as indicators of response to stress and pain experience. Music during awakening induced lower increase of systolic and diastolic blood pressure levels. The non-music group showed progressive increasing values of glycemia; in music-group the curve of glycemia presented a plateau pattern (P<0.001. Positive impact on reactions to pain was noted using the FLACC scale. Music improves cardiovascular parameters, stress-induced hyperglycemia. Amelioration on pain perception is more evident in older children. Positive effects seems to be achieved by the alternation of fast, slow rhythms and pauses even in pediatric age.

  9. Using a patient-centered approach for health and social care integration. (United States)

    Poulymenopoulou, Mikaela; Papakonstantinou, Despoina; Malamateniou, Flora; Vassilacopoulos, George


    The drive in using health and social care resources more effectively has resulted in undertaking various efforts towards better coordination in order to improve patient-centered and personalized care for the individuals. This requires horizontal integration in terms of processes among health and social care organizations existing information systems (ISs) and personal health records (PHRs) in order to enable integrated patient information sharing among all the health and social care staff and individuals involved. Service-oriented and business process management (BPM) technologies are considered most appropriate for achieving such integration especially when is required to change existing processes and to integrate diverse information systems. On these grounds, a patient-centered approach is proposed for redesigning health and social care processes and for integrating diverse ISs and PHRs with the objective to meet holistic care goals.

  10. 7 CFR 226.19 - Outside-school-hours care center provisions. (United States)


    ... Section 226.19 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Operational... precondition for any outside-school-hours care center's eligibility for CACFP nutrition benefits. In...

  11. Comparing the implementation of team approaches for improving diabetes care in community health centers

    NARCIS (Netherlands)

    Wees, P.J. van der; Friedberg, M.W.; Guzman, E.; Ayanian, J.Z.; Rodriguez, H.P.


    BackgroundPatient panel management and community-based care management may be viable strategies for community health centers to improve the quality of diabetes care for vulnerable patient populations. The objective of our study was to clarify implementation processes and experiences of integrating o

  12. Partnership and empowerment program: a model for patient-centered, comprehensive, and cost-effective care. (United States)

    Brown, Corinne; Bornstein, Elizabeth; Wilcox, Catina


    The Partnership and Empowerment Program model offers a comprehensive, patient-centered, and cost-effective template for coordinating care for underinsured and uninsured patients with cancer. Attention to effective coordination, including use of internal and external resources, may result in decreased costs of care and improved patient compliance and health outcomes.

  13. Eleven Years of Primary Health Care Delivery in an Academic Nursing Center. (United States)

    Hildebrandt, Eugenie; Baisch, Mary Jo; Lundeen, Sally P.; Bell-Calvin, Jean; Kelber, Sheryl


    Client visits to an academic community nursing center (n=25,495) were coded and analyzed. Results show expansion of nursing practice and services, strong case management, and management of illness care. The usefulness of computerized clinical documentation system and of the Lundeen conceptional model of community nursing care was demonstrated.…

  14. Primary Care Screening of Depression and Treatment Engagement in a University Health Center: A Retrospective Analysis (United States)

    Klein, Michael C.; Ciotoli, Carlo; Chung, Henry


    Objectives: This retrospective study analyzed a primary care depression screening initiative in a large urban university health center. Depression detection, treatment status, and engagement data are presented. Participants: Participants were 3,713 graduate and undergraduate students who presented consecutively for primary care services between…

  15. Profit centers in clinical care departments: an idea whose time has gone. (United States)

    Young, David W


    If a hospital is to use profit centers successfully, it should resolve several philosophical, organizational, and accounting matters, including: How much decisionmaking latitude clinical care chiefs should have. Whether to take a cross-subsidization approach. What role clinical care departments should take in a service line strategy.


    Grishina, N K; Solovieva, N B; Abdulsalamova, Z A


    The article considers issues concerning increasing of quality and accessibility of medical care in Moscow neurological profile included at the expense of wide-spread implementation of specialized day-time hospitals in health care practice. The analysis applied was based on average Moscow indicators of functioning of public health institutions and characteristics of clinical course of diseases of the mentioned profile.

  17. Comparing the implementation of team approaches for improving diabetes care in community health centers


    Wees, P.J. van der; Friedberg, M.W.; Guzman, E.; Ayanian, J.Z.; Rodriguez, H.P.


    Background Patient panel management and community-based care management may be viable strategies for community health centers to improve the quality of diabetes care for vulnerable patient populations. The objective of our study was to clarify implementation processes and experiences of integrating office-based medical assistant (MA) panel management and community health worker (CHW) community-based management into routine care for diabetic patients. Methods Mixed m...

  18. Fatores de risco para perda ponderal de crianças frequentadoras de berçários em creches do município de São Paulo Risk factors for ponderal loss of children attending the nurseries of day care centers in São Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    Maysa Helena A. Toloni


    Full Text Available OBJETIVO: Identificar e quantificar os fatores de risco relacionados ao agravamento da condição nutricional entre o nascimento e a realização deste estudo. MÉTODOS: Estudo transversal com 270 crianças frequentadoras dos berçários de oito creches públicas e filantrópicas do município de São Paulo. Considerou-se com perda ponderal as crianças que apresentaram diferença negativa do escore Z para a relação peso para idade entre o nascimento e a ocasião da realização desse inquérito. No estudo das associações, utilizou-se o teste do qui-quadrado e consideraram-se as variáveis com nível de significância pOBJECTIVE: To identify and quantify risk factors related to the aggravation of nutritional condition from birth until the date of the study. METHODS: Cross-sectional study with 270 children attending nurseries of eight public and non-for-profit daycare centers in the city of São Paulo, Brazil. Ponderal loss was considered when children presented negative difference of Z score for weight-for-age (W/A from birth until the date of the present inquiry. Chi-square was used to test associations and considered significant if p<0.05. Multivariate logistic regression model adjusted Odds Ratio estimates for confounding variables and/or covariables. RESULTS: Anthropometric analysis showed 7.1% prevalence of malnutrition (W/A<-2 Z score at birth and 4.4% by the time of measurement. Ponderal evolution with unfavorable Z score was present in 50.7% of studied children (n=137. In the bivariate analyses, the variables: birth weight (OR=5.35; p<0.001, anemia (OR=1.81; p=0.019 and age less than 19 months (OR=1.67; p=0.036 were statistically significant. CONCLUSIONS: Ponderal loss in Z score during the first months of life has not been often used in epidemiological studies. However, future researches might identify weight loss as an indicator of risk for sociobiological vulnerability. Development of health programs in order to reduce the

  19. Reality TV positions heart center as cardiac care leader. (United States)

    Rees, T


    Saint Thomas Heart Institute, Nashville, Tenn., has a long history of successful cardiac care. More than 200,000 patients have been treated at Saint Thomas. Earlier this year the hospital launched a new branding campaign that features former patients who have bonded with the institution. These former patients were provided MiniDV video cameras to record their stories. The campaign has attracted considerable attention, including newspaper and TV news coverage.

  20. Market-Based Health Care in Specialty Surgery: Finding Patient-Centered Shared Value. (United States)

    Smith, Timothy R; Rambachan, Aksharananda; Cote, David; Cybulski, George; Laws, Edward R


    : The US health care system is struggling with rising costs, poor outcomes, waste, and inefficiency. The Patient Protection and Affordable Care Act represents a substantial effort to improve access and emphasizes value-based care. Value in health care has been defined as health outcomes for the patient per dollar spent. However, given the opacity of health outcomes and cost, the identification and quantification of patient-centered value is problematic. These problems are magnified by highly technical, specialized care (eg, neurosurgery). This is further complicated by potentially competing interests of the 5 major stakeholders in health care: patients, doctors, payers, hospitals, and manufacturers. These stakeholders are watching with great interest as health care in the United States moves toward a value-based system. Market principles can be harnessed to drive costs down, improve outcomes, and improve overall value to patients. However, there are many caveats to a market-based, value-driven system that must be identified and addressed. Many excellent neurosurgical efforts are already underway to nudge health care toward increased efficiency, decreased costs, and improved quality. Patient-centered shared value can provide a philosophical mooring for the development of health care policies that utilize market principles without losing sight of the ultimate goals of health care, to care for patients.

  1. CenteringParenting: an innovative dyad model for group mother-infant care. (United States)

    Bloomfield, Joanna; Rising, Sharon Schindler


    CenteringParenting is a group model that brings a cohort of 6 to 7 mothers and infants together for care during the first year of life. During 9 group sessions the clinician provides well-baby care and also attends to the health, development, and safety issues of the mother. Ideally, CenteringParenting provides continuity of care for a cohort of women who have received care in CenteringPregnancy, group prenatal care that is 10 sessions throughout the entire pregnancy and that leads to community building, better health outcomes, and increased satisfaction with prenatal care. The postpartum year affects the entire family, but especially the mother, who is redefining herself and her own personal goals. Issues of weight/body image, breastfeeding, depression, contraception, and relationship issues all may surface. In traditional care, health resources for support and intervention are frequently lacking or unavailable. Women's health clinicians also note the loss of contact with women they have followed during the prenatal period, often not seeing a woman again until she returns for another pregnancy. CenteringParenting recognizes that the health of the mother is tied to the health of the infant and that assessment and interventions are more appropriate and efficient when done in a dyad context. Facilitative leadership, rather than didactic education, encourages women to fully engage in their care, to raise issues of importance to them, and to discuss concerns within an atmosphere that allows for the surfacing of culturally appropriate values and beliefs. Implementing the model calls for system changes that are often significant. It also requires the building of a substantial team relationship among care providers. This overview describes the CenteringParenting mother-infant dyad care model with special focus on the mother and reviews the perspectives and experiences of staff from several practice sites.

  2. Connecting teens to caring adults in a school-based health center: a case study. (United States)

    Blacksin, Beth A; Kelly, Patricia J


    The traditional medical care system is generally unable to provide the broad health and wellness services needed by many adolescents, especially those from low-income and racial/ethnic minority communities. Using a theoretical framework adapted from Bronfenbrenner's ecological model of multiple influencers, this case study examined how a school-based health center was able to provide a network of connections for adolescents to caring adults within the school and the local community. Contributors to this network were the creation of a student-centered community with access to adolescent-friendly services, providers acting as connectors, and care of the whole adolescent.

  3. "Stay, give me your paw." The benefits of family-centered care. (United States)

    Ambardekar, Aditee P; Litman, Ronald S; Schwartz, Alan Jay


    The value of family-centered care in general and subspecialty pediatrics has been well documented in the literature. Translation of these principles into perioperative medicine has its logistical challenges; however, there are theoretical benefits. Specifically, pediatric patients with psychiatric diagnoses or special needs related to autism benefit from the incorporation of service animals into their daily routines. We describe the presence of one such service dog, at the request of our patient, during induction of general anesthesia. Consideration of the service dog as part of our family-centered care model improved the quality of care we provided this anxious teenager and her mother.

  4. "Gender aware therapy" for professional men in a day treatment center. (United States)

    Robertson, John M; Williams, Betsy White


    High accountability men in the medical, legal, corporate, and mental health professions sometimes engage in behavior that violates their fiduciary responsibilities. These highly skilled men may engage in disruptive or explosive behavior, cross sexual boundaries with clients or patients, abuse substances, or have other psychiatric problems that compromise their workplace performance. When this occurs, licensing boards, professional societies, or supervising executives often require the dysregulated man to seek assistance. This article reports on ways the Professional Renewal Center incorporates recommendations from "Gender Aware Therapy" in developing a male-friendly approach to conducting comprehensive multidisciplinary psychological assessments, and to providing intensive, multimodal, weeks-long treatment services.

  5. Does occupational lifting and carrying among female health care workers contribute to an escalation of pain-day frequency?

    DEFF Research Database (Denmark)

    Holtermann, A; Clausen, T; Aust, B;


    The aim of the study was to investigate if different frequencies, loads and trunk postures of occupational lifting and carrying increases the risk of sub-chronic (1-30 days last 12 months) low back pain (LBP) to become persistent (>30 days last 12 months) among female health care workers....

  6. A nurse practitioner-led urgent care center: meeting the needs of the patient with cancer. (United States)

    Ruegg, Tracy A


    Providing comprehensive care for patients with cancer is complex with regard to severe treatment-related side effects. Hundreds of thousands of patients with cancer visit the emergency department (ED) each year, and more than half report multiple visits. In the United States, few of the National Cancer Institute-designated cancer centers have an ED specifically for patients with cancer. EDs often are an overcrowded and expensive way in which to care for the urgent needs of patients with cancer. In addition, a looming shortage exists for both primary care providers and oncologists who can address symptom issues. As the Affordable Care Act is implemented, more patients will enter the healthcare system, placing a demand on providers that the current supply cannot meet. A report from the Institute of Medicine advocates that nurse practitioners (NPs) are more than competent to provide for the unique urgent care needs of patients with cancer. The aim of this article is to describe an NP-led urgent care center for patients with cancer and how that care center provides access to vital, expeditious, and cost-effective care.

  7. [Evaluation of animal-assisted therapy for the elderly with senile dementia in a day care program]. (United States)

    Kanamori, M; Suzuki, M; Yamamoto, K; Kanda, M; Matsui, Y; Kozima, E; Takeuchi, S; Oshiro, H


    We conducted animal-assisted therapy (AAT) for the elderly with senile dementia in a day care center. AAT was performed between July 27 and October 12, 1999 for a total of six biweekly sessions. The AAT group consisted of 7 subjects; 5 with senile dementia of Alzheimer's type (SDAT) and 2 with vascular dementia (VD). The control group was 20 elderly subjects (7 SDAT, 13 VD). The results were as follows: Comparing between MMS scores at the baseline and those three months later, the average score on MMS before AAT (baseline) was 11.43 (+/- 9.00), and that three months later was 12.29 (+/- 9.69). In the AAT group, the average baseline N-ADL score was 28.43 (+/- 14.00) and that after ATT was 29.57 (+/- 14.47). In the AAT group, the average baseline score on Behave-AD was 11.14 (+/- 4.85), and that three months after AAT was 7.29 (+/- 7.11) (p AAT group. Our findings suggested we should use several evaluation methods for evaluation of the changes of patients receiving AAT.

  8. [Certified prostate cancer centers and second opinion centers for testicular cancer: successful models of uro-oncology cancer care]. (United States)

    Gschwend, J E; Albers, P; Schrader, M


    Establishment of organ site-specific cancer centers by the German Cancer Society (GCS) is part of the basic politically driven reform of oncology care in Germany. Since 2007 an increasing number of prostate cancer centers have been guided toward certification by the OnkoZert GmbH of the GCS. Currently 68 centers are certified and together with ongoing certification proceedings will amount to 81 prostate cancer centers, which cover about one fourth of cases of primary prostate cancer. Urology is of particular importance in the management of these centers. For the most part, urologists belonging to a clinical unit are the initiators of the certification process, thus ensuring that uro-oncology is firmly entrenched in the specialty with involvement of outpatient service providers. Fears that authority will be lost are unfounded as long as responsibility for this task is taken seriously and active use is made of the possibilities for creativity. A similarly important function is fulfilled by the testicular cancer centers that offer second opinion services, which were initiated by urology conjointly with German Cancer Aid to pursue the goal of quality assurance for this tumor entity and therefore likewise secure the position of this tumor in the realm of urologists. By applying such strategic approaches, urologists will succeed in sustainably safeguarding their future importance in a very competitive environment and in counteracting the encroachments of other specialties by exhibiting clear orientation.

  9. Customer centered health care: why managed care organizations must capitalize on new technology to build brands and customer loyalty. (United States)

    Fell, D


    Now, more than ever, health care organizations are desperately trying to reach out to customers and establish stronger relationships that will generate increased loyalty and repeat business. As technology, like the Internet and related mediums, allow us to do a better job of managing information and communication, health care executives must invest the time and resources necessary to bring these new advances into the day-to-day operations of their businesses. Those that do will have a head start in building their brand and their customer loyalty.

  10. Transforming care teams to provide the best possible patient-centered, collaborative care. (United States)

    Sevin, Cory; Moore, Gordon; Shepherd, John; Jacobs, Tracy; Hupke, Cindy


    Patient experience of care is now a crucial parameter in assessing the quality of healthcare delivered in the United States. Continuity, patient-driven access to care, and being "known" by a provider or practice, particularly for patients with chronic diseases, have been shown to enhance patient satisfaction with care and health outcomes. Healthcare systems are challenged to effectively meet the wants and needs of patients by tailoring interventions based on each person's unique set factors-his or her strengths, preferences, and personal and social context. Creating care teams, a coordinated multidisciplinary group of healthcare professionals, enables a practice to take advantage of the skill sets represented and redesign care delivery with the patient and community as the focal point. This article describes the attributes of highly functioning care teams, how to measure them, and guidance on creating them. A case example illustrates how these ideas work in practice.

  11. Partnering Urban Academic Medical Centers And Rural Primary Care Clinicians To Provide Complex Chronic Disease Care



    Many of the estimated thirty-two million Americans expected to gain coverage under the Affordable Care Act are likely to have high levels of unmet need for various chronic illnesses and to live in areas that are already underserved. In New Mexico an innovative new model of health care education and delivery known as Project ECHO (Extension for Community Healthcare Outcomes) provides high-quality primary and specialty care to a comparable population. Using state-of-the-art telehealth technolog...

  12. Measurement of Family-centered care perception and parental stress in a neonatal unit

    Directory of Open Access Journals (Sweden)

    Flávia Simphronio Balbino

    Full Text Available ABSTRACT Objective: to evaluate the effects of the implementation of the Patient and Family-Centered Care Model on parents and healthcare perceptions and parental stress. Method: a quasi-experimental study developed in a neonatal unit of a university hospital in the municipality of São Paulo, Brazil, with the implementation of this model of care. Data collection were performed by two sample groups, one using non-equivalent groups of parents, and another using equivalent groups of healthcare professionals. The instruments Perceptions of Family-Centered Care-Parent Brazilian Version, Perceptions of Family-Centered Care-Staff Brazilian Version and Parental Stress Scale: Neonatal Intensive Care Unit, were applied to 132 parents of newborns hospitalized and to 57 professionals. Results: there was a statistically significant improvement in the perceptions of the parents in most items assessed (p ≤0,05 and for the staff in relation to the family welcome in the neonatal unit (p = 0.041 and to the comprehension of the family's experience with the infant´s hospitalization (p = 0,050. There was a reduction in the average scores of parental stress, with a greater decrease in the Alteration in Parental Role from 4,2 to 3,8 (p = 0,048. Conclusion: the interventions improved the perceptions of parents and healthcare team related to patient and family-centered care and contributed to reducing parental stress.

  13. An epidemiological perspective on gastroenteritis in child day care centers : Assessment of impact and risk

    NARCIS (Netherlands)

    Enserink, R.


    The impact of gastroenteritis related to Dutch DCCs is substantial, particularly among the very young attendees. Attending a DCC roughly doubles a child’s probability of experiencing an episode of gastroenteritis that requires a visit to a general practitioner or hospital. A child might experience a

  14. Reducing Food Waste at a Migrant Day Care Center through the Rearrangement of Existing Activities. (United States)

    Montesinos, Luis; And Others


    An intervention in which second food helpings were made contingent upon consumption of at least half of all food groups and, children who ate half of each food category were the first to be allowed to brush their teeth resulted in a reduction of waste for all three categories (vegetables, meat, milk) in which waste was high. (Author/CL)

  15. Using the "customer service framework" to successfully implement patient- and family-centered care. (United States)

    Rangachari, Pavani; Bhat, Anita; Seol, Yoon-Ho


    Despite the growing momentum toward patient- and family-centered care at the federal policy level, the organizational literature remains divided on its effectiveness, especially in regard to its key dimension of involving patients and families in treatment decisions and safety practices. Although some have argued for the universal adoption of patient involvement, others have questioned both the effectiveness and feasibility of patient involvement. In this article, we apply a well-established theoretical perspective, that is, the Service Quality Model (SQM) (also known as the "customer service framework") to the health care context, to reconcile the debate related to patient involvement. The application helps support the case for universal adoption of patient involvement and also question the arguments against it. A key contribution of the SQM lies in highlighting a set of fundamental service quality determinants emanating from basic consumer service needs. It also provides a simple framework for understanding how gaps between consumer expectations and management perceptions of those expectations can affect the gap between "expected" and "perceived" service quality from a consumer's perspective. Simultaneously, the SQM also outlines "management requirements" for the successful implementation of a customer service strategy. Applying the SQM to the health care context therefore, in addition to reconciling the debate on patient involvement, helps identify specific steps health care managers could take to successfully implement patient- and family-centered care. Correspondingly, the application also provides insights into strategies for the successful implementation of policy recommendations related to patient- and family-centered care in health care organizations.

  16. 78 FR 22911 - Delta Air Lines, Inc., Reservation Sales and Customer Care Call Center, Seatac, WA; Delta Air... (United States)


    ... Employment and Training Administration Delta Air Lines, Inc., Reservation Sales and Customer Care Call Center, Seatac, WA; Delta Air Lines, Inc., Reservation Sales and Customer Care Call Center, Sioux City, IA... workers and former workers of Delta Air Lines, Inc., Reservation Sales and Customer Care Call...

  17. The Centers for Disease Control and Prevention's Healthy Days Measures – Population tracking of perceived physical and mental health over time

    Directory of Open Access Journals (Sweden)

    Kobau Rosemarie


    Full Text Available Abstract To promote the health and quality of life of United States residents, the U.S. Department of Health and Human Services' Centers for Disease Control and Prevention (CDC – with 54 state and territorial health agencies – has supported population surveillance of health-related quality of life (HRQOL. HRQOL was defined as "perceived physical and mental health over time." Commonly-used measures of health status and activity limitation were identified and a set of "Healthy Days" HRQOL measures was developed and validated. A core set of these measures (the CDC HRQOL-4 asks about self-rated general health and the number of recent days when a person was physically unhealthy, mentally unhealthy, or limited in usual activities. A summary measure combines physically and mentally unhealthy days. From 1993 to 2001, more than 1.2 million adults responded to the CDC HRQOL-4 in each state-based Behavioral Risk Factor Surveillance System (BRFSS telephone interview. More than one fifth of all BRFSS respondents also responded to a set of related questions – including five items that assess the presence, main cause and duration of a current activity limitation, and the need for activity-related personal and routine care; as well as five items that ask about recent days of pain, depression, anxiety, sleeplessness, and vitality. The Healthy Days surveillance data are particularly useful for finding unmet health needs, identifying disparities among demographic and socioeconomic subpopulations, characterizing the symptom burden of disabilities and chronic diseases, and tracking population patterns and trends. The full set of 14 Healthy Days Measures (the CDC HRQOL-14 has shown good measurement properties in several populations, languages, and settings. The brief standard CDC HRQOL-4 is now often used in surveys, surveillance systems, prevention research, and population health report cards.

  18. The Social Work Role in Reducing 30-Day Readmissions: The Effectiveness of the Bridge Model of Transitional Care. (United States)

    Alvarez, Renae; Ginsburg, Jacob; Grabowski, Jessica; Post, Sharon; Rosenberg, Walter


    The hospital experience is taxing and confusing for patients and their families, particularly those with limited economic and social resources. This complexity often leads to disengagement, poor adherence to the plan of care, and high readmission rates. Novel approaches to addressing the complexities of transitional care are emerging as possible solutions. The Bridge Model is a person-centered, social work-led, interdisciplinary transitional care intervention that helps older adults safely transition from the hospital back to their homes and communities. The Bridge Model combines 3 key components-care coordination, case management, and patient engagement-which provide a seamless transition during this stressful time and improve the overall quality of transitional care for older adults, including reducing hospital readmissions. The post Affordable Care Act (ACA) and managed care environment's emphasis on value and quality support further development and expansion of transitional care strategies, such as the Bridge Model, which offer promising avenues to fulfil the triple aim by improving the quality of individual patient care while also impacting population health and controlling per capita costs.

  19. Patient-Centered Care and Patient-Reported Measures: Let's Look Before We Leap. (United States)

    Miller, Daniel; Steele Gray, Carolyn; Kuluski, Kerry; Cott, Cheryl


    This commentary focuses on patient-reported measures as tools to support patient-centered care for patients with multiple chronic conditions (MCCs). We argue that those using patient-reported measures in care management or evaluation of services for MCC patients should do so in recognition of the challenges involved in treating them. MCC patient care is challenging because (1) it is difficult to specify the causes of particular symptoms; (2) assessment of many important symptoms relies on subjective report; and (3) patients require care from a variety of providers. Due to the multiple domains of health affected in single individuals, and the large variation in needs, care that is holistic and individualized (i.e. patient-centered) is appropriate for MCC patients. However, due to the afore-mentioned challenges, it is important to carefully consider what this care entails and how practical contexts shape it. Patient-centered care for MCC patients implies continuous, dialogic patient-provider relationships, and the formulation of coherent and adaptive multi-disciplinary care protocols. We identify two broadly defined contextual influences on the nature and quality of these processes and their outputs: (1) busy practice settings and (2) fragmented information technology. We then identify several consequences that may result from inattention to these contextual influences upon introduction of patient-reported measure applications. To maximize the benefits, and minimize the harms of patient-reported measure use, we encourage policy makers and providers to attend carefully to these and other important contextual factors before, during and after the introduction of patient-reported measure initiatives.

  20. Childhood diarrhoea in Danish day care centres could be associated with infant colic, low birthweight and antibiotics

    DEFF Research Database (Denmark)

    Jensen, Betina Hebbelstrup; Röser, Dennis; Andreassen, Bente Utoft


    AIM: Diarrhoea is very common in children attending day care centres. The aim of this study was to examine certain predisposing risk factors for an association with diarrhoea, including foreign travel, treatment with antibiotics, having household pets, infant colic, bottle feeding, using a pacifier...... and low birth weight. METHODS: A dynamic one-year follow-up cohort study comprising 179 children from 36 day care centres was conducted from September 2009 to July 2013 in Copenhagen, Denmark. Questionnaires were sent to the children's parents or legal guardians every two months for a year, requesting...... the risk of diarrhoea in Danish children in day care centres This article is protected by copyright. All rights reserved....

  1. Health Care Preferences Among Nursing Home Residents: Perceived Barriers and Situational Dependencies to Person-Centered Care. (United States)

    Bangerter, Lauren R; Abbott, Katherine; Heid, Allison R; Klumpp, Rachel E; Van Haitsma, Kimberly


    Although much research has examined end-of-life care preferences of nursing home (NH) residents, little work has examined resident preferences for everyday health care. The current study conducted interviews with 255 residents recruited from 35 NHs. Content analysis identified barriers (i.e., hindrances to the fulfillment of resident preferences) and situational dependencies (i.e., what would make residents change their mind about the importance of these preferences) associated with preferences for using mental health services, choosing a medical care provider, and choosing individuals involved in care discussions. Barriers and situational dependencies were embedded within the individual, facility environment, and social environment. Approximately one half of residents identified barriers to their preferences of choosing others involved in care and choosing a medical care provider. In contrast, the importance of mental health services was situationally dependent on needs of residents. Results highlight opportunities for improvement in practice and facility policies that promote person-centered care. [Journal of Gerontological Nursing, 42(2), 11-16.].

  2. Organizational culture and the implementation of person centered care: results from a change process in Swedish hospital care. (United States)

    Alharbi, Tariq Saleem J; Ekman, Inger; Olsson, Lars-Eric; Dudas, Kerstin; Carlström, Eric


    Sweden has one of the oldest, most coherent and stable healthcare systems in the world. The culture has been described as conservative, mechanistic and increasingly standardized. In order to provide a care adjusted to the patient, person centered care (PCC) has been developed and implemented into some parts of the health care industry. The model has proven to decrease patient uncertainty. However, the impact of PCC has been limited in some clinics and hospital wards. An assumption is that organizational culture has an impact on desired outcomes of PCC, such as patient uncertainty. Therefore, in this study we identify the impact of organizational culture on patient uncertainty in five hospital wards during the implementation of PCC. Data from 220 hospitalized patients who completed the uncertainty cardiovascular population scale (UCPS) and 117 nurses who completed the organizational values questionnaire (OVQ) were investigated with regression analysis. The results seemed to indicate that in hospitals where the culture promotes stability, control and goal setting, patient uncertainty is reduced. In contrast to previous studies suggesting that a culture of flexibility, cohesion and trust is positive, a culture of stability can better sustain a desired outcome of reform or implementation of new care models such as person centered care. It is essential for health managers to be aware of what characterizes their organizational culture before attempting to implement any sort of new healthcare model. The organizational values questionnaire has the potential to be used as a tool to aid health managers in reaching that understanding.

  3. Caring for people with dementia in residential aged care: successes with a composite person-centered care model featuring Montessori-based activities. (United States)

    Roberts, Gail; Morley, Catherine; Walters, Wendy; Malta, Sue; Doyle, Colleen


    Person-centered models of dementia care commonly merge aspects of existing models with additional influences from published and unpublished evidence and existing government policy. This study reports on the development and evaluation of one such composite model of person-centered dementia care, the ABLE model. The model was based on building the capacity and ability of residents living with dementia, using environmental changes, staff education and organizational and community engagement. Montessori principles were also used. The evaluation of the model employed mixed methods. Significant behavior changes were evident among residents of the dementia care Unit after the model was introduced, as were reductions in anti-psychotic and sedative medication. Staff reported increased knowledge about meeting the needs of people with dementia, and experienced organizational culture change that supported the ABLE model of care. Families were very satisfied with the changes.

  4. An integrated model for inner-city health-care delivery: the Deaconess Center. (United States)

    James, D M


    Under the auspices of the Buffalo General Hospital and the faculty of medicine of the State University of New York at Buffalo, a comprehensive delivery system for primary care has been established in a local inner-city neighborhood. At the Deaconess Family Medicine Center, located within an inner-city location of Buffalo, New York, several divisions have been integrated to provide comprehensive patient-oriented primary care. These divisions include a primary care clinic, an urgent care clinic, a substance abuse clinic, and a community pediatrics clinic. Professional services are provided by attending physicians and residents. The horizontal integration of these four divisions is in turn vertically integrated with the tertiary care teaching hospital inpatient and obstetrical services, providing a continuum of patient care. The horizontal integration serves as an entry point for patients to enter the hospital's health-care system, while the vertical integration capability serves to capture any specialized referrals or inpatient needs. This article discusses the structure of the center, with special reference to service integration, service delivery, and patient capture; medical education; and the place of integrated units in the strategic plan of a tertiary care hospital.

  5. Patient-centered care in lung cancer: exploring the next milestones. (United States)

    Ben-Arye, Eran; Samuels, Noah


    In this editorial, the authors comment on a recently published review paper by Molassiotis et al. on the developments made over the past 40 years in supportive care for patients with lung cancer. During this period, a paradigm shift promoting patient-centered care (PCC) has led to an important change in the approach of supportive cancer care, from a purely disease-centered approach, measuring survival-related outcomes, to recognizing the importance of quality of life outcomes as well. This change of understanding in supportive and palliative care for patients with lung cancer can be further advanced through the understanding that there is a need to address bio-psycho-spiritual concerns and health belief models, within the context of the family socio-cultural environment, for both patients and their caregivers. There is also a need to address the psycho-spiritual effects of cancer on those health care professionals treating patients with lung cancer, in order to reduce compassion fatigue and increase resilience. Future directions for supportive care for patients with lung cancer may include the development of a patient-tailored treatment approach, assisted by the integration of a multidisciplinary team of health care providers and evidence-based complementary medicine practices, within conventional supportive care practice.

  6. [Management of type 2 diabetes patients in community health care centers in Grenoble]. (United States)

    François, Patrice; Pichon, Philippe; Poulizac, Morgan; Cruaud, Anna; Bal, Gaelle; Hirsch, Martin


    Community health care centers in Grenoble aim to provide quality primary health care, including prevention, to populations living in disadvantaged urban areas. The objective of the study was to assess the quality of follow-up provided by physicians in health care centers in Grenoble to patients with diabetes mellitus. A cross-sectional study was conducted for an observation period of one week in june 2007. All type 2 diabetes patients seen in community health care centers during this given week were included in the study's sample (n=121). During the consultation, the physician collected the data on diabetes follow-up recorded in the patient's medical record over the last year. The data were compared with the recommendations and guidance published by the French National Authority for Health in 2006. The result of a hemoglobin A1c test dated less that three months-old was present in 80% of patients' medical records. Serum creatinine concentration, blood lipids, and microalbuminuria levels were obtained and confirmed with annual tests, and were present and recorded in the last year in 95%, 91%, and 77% of cases, respectively. The patient's weight, recorded within the last year, was noted in all cases. An ophthalmology consultation had been provided within the year for 57% of patients and 55% had received an electrocardiogram. Compliance with French National Authority for Health recommendations for the follow-up of diabetics in the community health care centers was satisfactory. Thus, it seems relevant to analyze their organizational methods.

  7. The impact of managed care on graduate medical education and academic medical centers. (United States)

    Bolognia, J L; Wintroub, B U


    The goal of this article is to examine the present and future impact of managed care on graduate medical education (GME) and academic medical centers. Obviously, the later 2 entities are closely intertwined and will share in the consequences of changes in our medical care systems. However, there are differences in the funding of medical schools as compared with GME provided by teaching hospitals, and an appreciation of the vital issues and concerns requires that each be discussed separately.

  8. Family-Centered Care in Juvenile Justice Institutions: A Mixed Methods Study Protocol (United States)

    Mulder, Eva; Rigter, Henk; Breuk, René; van der Vaart, Wander; Vermeiren, Robert


    Background Treatment and rehabilitation interventions in juvenile justice institutions aim to prevent criminal reoffending by adolescents and to enhance their prospects of successful social reintegration. There is evidence that these goals are best achieved when the institution adopts a family-centered approach, involving the parents of the adolescents. The Academic Workplace Forensic Care for Youth has developed two programs for family-centered care for youth detained in groups for short-term and long-term stay, respectively. Objective The overall aim of our study is to evaluate the family-centered care program in the first two years after the first steps of its implementation in short-term stay groups of two juvenile justice institutions in the Netherlands. The current paper discusses our study design. Methods Based on a quantitative pilot study, we opted for a study with an explanatory sequential mixed methods design. This pilot is considered the first stage of our study. The second stage of our study includes concurrent quantitative and qualitative approaches. The quantitative part of our study is a pre-post quasi-experimental comparison of family-centered care with usual care in short-term stay groups. The qualitative part of our study involves in-depth interviews with adolescents, parents, and group workers to elaborate on the preceding quantitative pilot study and to help interpret the outcomes of the quasi-experimental quantitative part of the study. Results We believe that our study will result in the following findings. In the quantitative comparison of usual care with family-centered care, we assume that in the latter group, parents will be more involved with their child and with the institution, and that parents and adolescents will be more motivated to take part in therapy. In addition, we expect family-centered care to improve family interactions, to decrease parenting stress, and to reduce problem behavior among the adolescents. Finally, we assume


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    Full Text Available The Day Care Institutions for children are forms of organized protection for improvement of the psycho-physical, emotional and social development of children. In this period, the growth and development are in their most intensive phase when the outside influence plays an extraordinary role both in a positive and in negative a direction. Directed and well-organized protection is of a great importance. By inclusion of children with developmental disorders in the group and with special, individual treatment of each child by adequate specialized staff, their socialization and stimulus for developmental acceleration is achieved.Many years ago, by recommendation of the Advisory Institution for Development, the doctors from the Advisory Institution for small children, the public-health nurses or by the parents initiative, the kindergartens accept children with Down syndrome, children with limited and lower level backwardness, with disharmonious development, with lower level forms of cerebral paralysis and with speech disorders.Children at the earliest age of one month are resided at the Advisory Institu­­tion for Development and receive treatment until they are categorized and are ready to start school, but certain children are sent to the kindergartens at the age of 3.In the previous years, out of five children with Down syndrome treated in the Advisory Institution for Development, four were sent to the kindergarten. Now, one of these children attends the fifth grade and two attend the first grade in a regular elementary school and one attends the special school. Three children with Spastic dyplegia, four children with lower level of retardation, two with surdomutitas and four with disharmonious development are still in the kindergarten.


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    Full Text Available To find the ideal drug combinations which can be used during day care surgeries and procedures. AIMS: This study was conducted. To evaluate and compare the efficacy, and haemodynamic stability of ketamine and fentanyl combination with propofol. To compare the incidence of side effects. To compare the time of awakening and recovery time. To compare the discharge criteria in both groups. METHODS: The study was conducted in 50 patients of age group 18-50 years of either gender belonging to ASA grade I and II, were divided into two groups of 25 each. They underwent elective surgery of approximately 1 hour duration. Group I received Propofol-ketamine while group II received Propofol-fentanyl for induction and maintenance of anaesthesia. Postoperatively, time for awakening, recovery time ‘(by modified Aldrete scoring system and discharge status (by modified post anaesthetic discharge scoring system were recorded and compared in two groups. RESULTS: Profol-fentanyl combination produced a significantly greater fall in pulse rate and in both systolic and diastolic blood pressure as compared to Propofol-ketamine during induction and maintenance of anaesthesia. Fall in respiratory rate was greater in Propofol-fentanyl group as compared to Propofol-ketamine group. The recovery time in group I was longer than group II. Discharge criteria is significantly earlier in group II. CONCLUSION: Both Profol-ketamine and Propofol-fentanyl combination reduce rapid, pleasant and safe anesthesia with only a few untoward side effects and propofol-ketamine produces better haemodynamic statistic, during anaesthesia.

  11. Pharmaceutical care as narrative practice? Rethinking patient-centered care through a pharmacist's perspective. (United States)

    Naß, Janine; Banerjee, Mita; Efferth, Thomas; Wohlmann, Anita


    Illness is a disruptive experience that requires high-quality care. The best evidence-based medical treatment risks losing some of its efficacy, however, when patients feel misunderstood when faced with the complexity of their experiences. They might stop treatment, refuse to disclose relevant information or seek unsound alternatives. A narrative-based approach to health care understands the patient's case history as a narrative that can be read or analyzed like a story. In other words, this approach honors individual illness experiences through the stories that patients tell. While programs that train 'narrative competence' have been successfully implemented in medical education, an application to pharmaceutical training is missing so far. We argue for the necessity to complement evidence-based pharmaceutical practice with narrative-based approaches to ensure high-quality care. Using the perspective of a pharmacist in a case scenario, we exemplify the centrality of "narrative pharmacy" for improving the quality and safety of pharmaceutical health care.

  12. Identity of care in a Psychosocial Care Center for Children and Adolescents who uses drugs

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    Isabella Teixeira Bastos


    Full Text Available Objective To associate the territory of identity with the production of care within a PCC focusing on children and adolescents with drug abuse and their institutional identity. Method We used the “ process tracing methodology” in four research categories: focus groups, characterization of professionals, observing the everyday and interviewing two members of emblematic cases of the service. Results territory of identity of the institution, which operates the production of care is crossed by the difficulty of dealing with the complexity brought by the users and the performance of the PCC network. This paper is also permeated by different conceptions of care and small problematization of these issues in collective spaces of service. Conclusion The discussion in focus groups and other devices can be powerful resources to reframe the meaning of care and identity of collective service.

  13. Integrating patient-centered care and clinical ethics into nutrition practice. (United States)

    Schwartz, Denise Baird


    The purpose of this article is to present the application of patient-centered care and clinical ethics into nutrition practice, illustrate the process in a case study, and promote change in the current healthcare clinical ethics model. Nutrition support clinicians have an opportunity to add another dimension to their practice with the incorporation of patient-centered care and clinical ethics. This represents a culture change for healthcare professionals, including nutrition support clinicians, patients and their family. All of these individuals are stakeholders in the process and have the ability to modify the current healthcare system to improve communication and facilitate a change by humanizing nutrition support practice. Nutrition support is a medical, life-sustaining treatment, and the use of this therapy requires knowledge by the nutrition support clinician of patient-centered care concepts, preventive clinical ethics, religion/spirituality and cultural diversity, palliative care team role, and advance care planning. Integrating these into the practice of nutrition support is an innovative approach and results in new knowledge that requires a change in the culture of care and engagement and empowerment of the patient and their family in the process. This is more than a healthcare issue; it involves a social/family conversation movement that will be enhanced by the nutrition support clinician's participation.

  14. The Department of Defense and Veteran Affairs Health Care Joint Venture at Tripler Army Medical Center Needs More Management Oversight (United States)


    E M B E R 1 8 , 2 0 1 3 The Department of Defense and Veteran Affairs Health Care Joint Venture at Tripler Army Medical Center Needs More...Department of Defense and Veteran Affairs Health Care Joint Venture at Tripler Army Medical Center Needs More Management Oversight 5a. CONTRACT NUMBER...Health Care Joint Venture at Tripler Army Medical Center Needs More Management Oversight Objective Our audit objective was to determine whether the

  15. Does the Culture of Modern Day Palliative Care Social Work Leave Room for Leadership?


    Davidson, Jason


    This paper describes research undertaken as part of an MA study in leadership. It draws on interviews with six high profile leaders at the fore front of end of life care sector in the UK. Its findings and emerging themes offer insights about the opportunities for social work leaders in palliative care in the future and how the profession and palliative care sector address current barriers to taking advantage of such opportunity. The main focus of this paper is leadership related to palliative...

  16. A Forgotten Issue: Distributional Effects of Day Care Subsidies in Germany


    Kreyenfeld, Michaela; Spieß, Christa Katharina; Wagner, Gert G.


    In general child care subsidies are widely accepted as a means to create equal chances for mothers in the labour market as well as for children. Although there is a general consensus that the use of child care should be publicly supported, there is no consensus on how this should be done. Moreover, there is little knowledge on the distributional effects of child care subsidies. In order to assess whether public expenditures are targeted efficiently, it is, however, vital to know which social ...

  17. Person-Centered Care in the Home Setting for Parkinson's Disease: Operation House Call Quality of Care Pilot Study. (United States)

    Hack, Nawaz; Akbar, Umer; Monari, Erin H; Eilers, Amanda; Thompson-Avila, Amanda; Hwynn, Nelson H; Sriram, Ashok; Haq, Ihtsham; Hardwick, Angela; Malaty, Irene A; Okun, Michael S


    Objective. (1) To evaluate the feasibility of implementing and evaluating a home visit program for persons with Parkinson's disease (PD) in a rural setting. (2) To have movement disorders fellows coordinate and manage health care delivery. Background. The University of Florida, Center for Movement Disorders and Neurorestoration established Operation House Call to serve patients with PD who could not otherwise afford to travel to an expert center or to pay for medical care. PD is known to lead to significant disability, frequent hospitalization, early nursing home placement, and morbidity. Methods. This was designed as a quality improvement project. Movement disorders fellows travelled to the home(s) of underserved PD patients and coordinated their clinical care. The diagnosis of Parkinson's disease was confirmed using standardized criteria, and the Unified Parkinson's Disease Rating Scale was performed and best treatment practices were delivered. Results. All seven patients have been followed up longitudinally every 3 to 6 months in the home setting, and they remain functional and independent. None of the patients have been hospitalized for PD related complications. Each patient has a new updatable electronic medical record. All Operation House Call cases are presented during video rounds for the interdisciplinary PD team to make recommendations for care (neurology, neurosurgery, neuropsychology, psychiatry, physical therapy, occupational therapy, speech therapy, and social work). One Operation House Call patient has successfully received deep brain stimulation (DBS). Conclusion. This program is a pilot program that has demonstrated that it is possible to provide person-centered care in the home setting for PD patients. This program could provide a proof of concept for the construction of a larger visiting physician or nurse program.

  18. Pathways to Care of Alcohol -Dependent Patients: An Exploratory Study From a Tertiary Care Substance Use Disorder Treatment Center

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    Pal Singh Balhara


    Full Text Available Background No study from India has examined pathways to care in alcohol using population systematically. Objectives The present study aimed to understand the pathways to care among alcohol-dependent individuals seeking help at a tertiary care center. Patients and Methods It was a cross-sectional, observational study. A total of 58 subjects diagnosed with alcohol- dependence syndrome as per DSM-IV-TR were included in the study. Pathways to care were assessed using the world health organization encounter form. Results For 56.9% of the subjects, first point of contact was with a tertiary care addiction psychiatrist. Traditional healers were consulted by about 5.2% of the patients seeking help for the first time. The mean duration of main problems due to alcohol use was 5.82 ± 4.95 years. The first contact tended to be at place nearer to the patient’s residence while further contacts tended to be farther away. Family, friends and neighbours together constituted the single largest group suggesting patients to seek care. Conclusions There is a long time lag between the onset of alcohol use related problems and the first help seeking attempt. Of those who do decide to seek help, the proportion of those obtaining specialist help is higher than commonly believed.

  19. Caregiver Objective Burden and Assessments of Patient-Centered, Family-Focused Care for Frail Elderly Veterans (United States)

    Rose, Julia Hannum; Bowman, Karen F.; O'Toole, Elizabeth E.; Abbott, Katherine; Love, Thomas E.; Thomas, Charles; Dawson, Neal V.


    Purpose: There is a growing consensus that quality of care for frail elders should include family and be evaluated in terms of patient-centered, family-focused care (PCFFC). Family caregivers are in a unique and sometimes sole position to evaluate such care. In the context of caring for physically frail elders, this study examined the extent to…

  20. A comprehensive palliative care center implementation in S.B. Ulus State Hospital

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    Ayla Kabalak


    Every people wants to best care and to die painless in their end-stage of life. This is a human right. Therefore, end-of-life care is considered an indicator of health quality all over the world. The ultimate goal of palliative care is to relieve the suffering of patients and their families by the comprehensive assessment and treatment of physical, psychosocial, and spiritual symptoms experienced by patients. After the patient\\s death, palliative care focuses primarily on bereavement of the family. T.C. Ministry of Health to find a solution of this important issue as a first step, the preparations for the establishment of palliative care centers and units, training of health personnel started. S.B. Ulus State Hospital as a team we have set out to open a comprehensive palliative care center. Our goal is to contribute on take place of palliative care organization in health system and to the spread across the country. [J Contemp Med 2012; 2(2.000: 122-126

  1. Societal Values and Policies May Curtail Preschool Children’s Physical Activity in Child Care Centers (United States)

    Sherman, Susan N.; Kendeigh, Cassandra A.; Kalkwarf, Heidi J.; Saelens, Brian E.


    BACKGROUND AND OBJECTIVES: Three-fourths of US preschool-age children are in child care centers. Children are primarily sedentary in these settings, and are not meeting recommended levels of physical activity. Our objective was to identify potential barriers to children’s physical activity in child care centers. METHODS: Nine focus groups with 49 child care providers (55% African American) were assembled from 34 centers (inner-city, suburban, Head Start, and Montessori) in Cincinnati, Ohio. Three coders independently analyzed verbatim transcripts for themes. Data analysis and interpretation of findings were verified through triangulation of methods. RESULTS: We identified 3 main barriers to children’s physical activity in child care: (1) injury concerns, (2) financial, and (3) a focus on “academics.” Stricter licensing codes intended to reduce children's injuries on playgrounds rendered playgrounds less physically challenging and interesting. In addition, some parents concerned about potential injury, requested staff to restrict playground participation for their children. Small operating margins of most child care centers limited their ability to install abundant playground equipment. Child care providers felt pressure from state mandates and parents to focus on academics at the expense of gross motor play. Because children spend long hours in care and many lack a safe place to play near their home, these barriers may limit children's only opportunity to engage in physical activity. CONCLUSIONS: Societal priorities for young children—safety and school readiness—may be hindering children’s physical development. In designing environments that optimally promote children’s health and development, child advocates should think holistically about potential unintended consequences of policies. PMID:22218842


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    Fatma ILHAN


    Full Text Available The aim of this study was to determine the status of satisfaction from health insurance institutions among people at age 18 and over , attending the primary health care centers in Ankara city center. This study was conducted by applying a questionnaire to the persons attending to four primary health care center and two Mather-Child Health Care and Family Planning Centers in Ankara City Center between May 20-July 20, 2003. 3184 persons applied to six primary health care centers in Ankara city center were interviewed. The median age of the subjects was 38; 66.4 % were women; 30.9 % were primary school graduate and 48.8% were housewife. 100% of the subjects who own private health insurance were satisfied with their insurance status. This rate was 92.0% for the subjects who were under coverage of Emekli Sandigi, and 79% for those who were under coverage of Bag-Kur. The most common health insurance institution the subjects were not satisfied with, was SSK with 48.4 % unsatisfaction rate. “The capability of being physically emamined and treated in any health facility he/she want” was in the first rank among the satisfaction reasons (54.2%. “The absence of this capability” was the most common reason for unsatisfaction (44.0%. 51.6 of the subjects were satisfied with their own health insurance institution, Emekli Sandigi was the most preffered institution with a percentage of 22.3. [TAF Prev Med Bull 2006; 5(4.000: 244-253

  3. Language Discordance and Patient- Centered Care in Occupational Therapy: A Case Study. (United States)

    Martinez, Jenny; Leland, Natalie


    The accumulative burden of a growing non-English speaking minority population and health disparities in the United States demonstrate the urgency of examining occupational therapy practices and defining care that is timely, effective, safe, and patient-centered. In this context, we investigate an occupational therapy episode of care from the perspectives of patient, caregiver, and primary occupational therapy care provider. Treatment sessions were observed and one-on-one semistructured interviews were conducted with the participants. Several themes describing areas of concern in communication and care delivery emerged, including expectations for care, the therapy relationship, professional identity, and pragmatic constraints. The use of untrained interpreters compromised treatment effectiveness and safety. This case highlights potential areas of concern in therapy when working with a diverse patient population. Abundant opportunities exist for occupational therapy to situate itself as an equitable, responsive, valuable, and essential service.

  4. Increasing access--a qualitative study of homelessness and palliative care in a major urban center. (United States)

    Krakowsky, Yonah; Gofine, Mirriam; Brown, Pnina; Danziger, Jana; Knowles, Holly


    Rates of morbidity and mortality are significantly higher in homeless populations. Homeless people experience many barriers to receive adequate palliative care. This qualitative study examines how a major urban city's palliative care resources can be improved to increase access and better serve the homeless. Audiotaped interviews were preformed with 7 homeless care providers in Toronto, Canada, and their transcripts were analyzed using thematic analysis. The findings of the study suggest that in order to increase access and to serve the city's terminally ill homeless better, the following 4 areas must be addressed: (1) increasing positive interaction between the health care system and the homeless, (2) training staff to deal with the unique issues confronting the homeless, (3) providing patient-centered care, and (4) diversifying the methods of delivery.

  5. Application of a marketing concept to patient-centered care: co-producing health with heart failure patients. (United States)

    Leone, Robert P; Walker, Charles A; Curry, Linda Cox; Agee, Elizabeth J


    Increasing numbers of patients are being treated for heart failure each year. One out of four of the heart failure patients who receives care in a hospital is readmitted to the hospital within 30 days of discharge. Effective discharge instruction is critical to prevent these patient readmissions. Co-production is a marketing concept whereby the customer is a partner in the delivery of a good or service. For example, a patient and nurse may partner to co-produce a patient-centered health regimen to improve patient outcomes. In this article we review the cost of treating heart failure patients and current strategies to decrease hospital readmissions for these patients along with the role of the nurse and the concept of co-producing health as related to heart failure patients. Next we describe our study assessing the degree to which discharge processes were co-produced on two hospital units having a preponderance of heart failure patients, and present our findings indicating minimal evidence of co-production. A discussion of our findings, along with clinical implications of these findings, recommendations for change, and suggestions for future research are offered. We conclude that standardized discharge plans lead to a mindset of 'one size fits all,' a mindset inconsistent with the recent call for patient-centered care. We offer co-production as a patient-centered strategy for customizing discharge teaching and improving health outcomes for heart failure patients.

  6. 7 CFR 226.17a - At-risk afterschool care center provisions. (United States)


    ... Section 226.17a Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Operational... standards will remain a precondition for any afterschool center's eligibility for CACFP nutrition...

  7. The Role of Attending Center-Based Care for Kindergarten-Aged Children with Disabilities (United States)

    Gottfried, Michael A.


    Background/Context: Families have been increasingly utilizing center-based care both during prekindergarten as well as before/after school during kindergarten (CBC-K), and the literature has addressed the relative effectiveness of attending the former on early schooling outcomes. However, missing in the field is an analysis of the efficacy of…

  8. Role for a Labor-Management Partnership in Nursing Home Person-Centered Care (United States)

    Leutz, Walter; Bishop, Christine E.; Dodson, Lisa


    Purpose: To investigate how a partnership between labor and management works to change the organization and focus of nursing home frontline work, supporting a transition toward person-centered care (PCC) in participating nursing homes. Design and Methods: Using a participatory research approach, we conducted case studies of 2 nursing homes…

  9. Care in a birth center according to the recommendations of the World Health Organization

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    Flora Maria Barbosa da Silva


    Full Text Available Birth centers are maternal care models that use appropriate technology when providing care to birthing women. This descriptive study aimed to characterize intrapartum care in a freestanding birth center, in light of the practices recommended by the World Health Organization (WHO, with 1,079 assisted births from 2006 to 2009 in the Sapopemba Birth Center, São Paulo, Brazil. Results included the use of intermittent auscultation (mean=7 controls; maternal positions during delivery: semi-sitting (82.3%, side-lying (16.0%, other positions (1.7%, oral intake (95.6%; companionship (93.3%; exposure to up to three vaginal examinations (85.4%, shower bathing (84.0%, walking (68.0%, massage (60.1%, exercising with a Swiss ball (51.7%; amniotomy (53.4%, oxytocin use during the first (31.0% and second stages of labor (25.8%, bath immersion (29.3% and episiotomy (14.1%. In this birth center, care providers used practices recommended by the WHO, although some practices might have been applied less frequently.

  10. Reenacted Case Scenarios for Undergraduate Healthcare Students to Illustrate Person-Centered Care in Dementia (United States)

    Bradley, Sandra L.; De Bellis, Anita; Guerin, Pauline; Walters, Bonnie; Wotherspoon, Alison; Cecchin, Maggie; Paterson, Jan


    Healthcare practitioners have suggested that interpreting person-centered care for people who have dementia to undergraduate students requires guidance in practical application. This article describes the production of a written and digital interdisciplinary educational resource for tertiary students. It uses real-life case scenarios provided by…

  11. How To Start a Family Day Care = Como Iniciar una Guarderia en El Hogar. [Videotape and Viewer's Guide]. (United States)

    Raphael, Doris; Weisman, Douglas

    Being a family day care provider is work that requires professional responsibilities and attention to the physical, emotional, and educational well-being of children; listening and responding to parents; and running a business. This videotape, in English- and Spanish-language versions, explores the elements involved in starting up a family day…

  12. Prognostic Patterns in Self-Report, Relative Report, and Professional Evaluation Measures for Hospitalized and Day-Care Patients (United States)

    Sappington, A. A.; Michaux, Mary H.


    This study attempted to determine differences between patients who relapse and those who do not in both hospital and day-care settings. Subjects were 142 adult psychiatric patients. Three groups of measures were used: one based on professional evaluation, one based on self-report, and one based on relative report. (Author)

  13. Adaptive practices in heart failure care teams: implications for patient-centered care in the context of complexity

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    Tait GR


    Full Text Available Glendon R Tait,1 Joanna Bates,2 Kori A LaDonna,3 Valerie N Schulz,4 Patricia H Strachan,5 Allan McDougall,3 Lorelei Lingard3 1Department of Psychiatry and Division of Medical Education, Dalhousie University, Halifax, NS, 2Centre for Health Education Scholarship, Vancouver General Hospital, Vancouver, BC, 3Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, 4Palliative Care, London Health Sciences Centre, University Hospital, London; 5School of Nursing, McMaster University, Hamilton, ON, Canada Background: Heart failure (HF, one of the three leading causes of death, is a chronic, progressive, incurable disease. There is growing support for integration of palliative care’s holistic approach to suffering, but insufficient understanding of how this would happen in the complex team context of HF care. This study examined how HF care teams, as defined by patients, work together to provide care to patients with advanced disease. Methods: Team members were identified by each participating patient, generating team sampling units (TSUs for each patient. Drawn from five study sites in three Canadian provinces, our dataset consists of 209 interviews from 50 TSUs. Drawing on a theoretical framing of HF teams as complex adaptive systems (CAS, interviews were analyzed using the constant comparative method associated with constructivist grounded theory. Results: This paper centers on the dominant theme of system practices, how HF care delivery is reported to work organizationally, socially, and practically, and describes two subthemes: “the way things work around here”, which were commonplace, routine ways of doing things, and “the way we make things work around here”, which were more conscious, effortful adaptations to usual practice in response to emergent needs. An adaptive practice, often a small alteration to routine, could have amplified effects beyond those intended by the innovating team

  14. Food Consumption and Nutrient Intake by Children Aged 10 to 48 Months Attending Day Care in The Netherlands

    NARCIS (Netherlands)

    Goldbohm, R.A.; Rubingh, C.M.; Lanting, C.L.; Joosten, K.F.M.


    The diet of young children is an important determinant of long-term health effects, such as overweight and obesity. We analyzed two-day food consumption records from 1526 young children (10–48 months old) attending 199 daycare centers across The Netherlands. Data were observed and recorded in diarie

  15. Food consumption and nutrient intake by children aged 10 to 48 months attending day care in the Netherlands

    NARCIS (Netherlands)

    R.A. Goldbohm; Rubingh, C.M. (Carina M.); C.I. Lanting (Caren); K.F.M. Joosten (Koen)


    textabstractThe diet of young children is an important determinant of long-term health effects, such as overweight and obesity. We analyzed two-day food consumption records from 1526 young children (10–48 months old) attending 199 daycare centers across The Netherlands. Data were observed and record

  16. Free-standing cancer centers: rationale for improving cancer care delivery. (United States)

    Lokich, J J; Silvers, S; Brereton, H; Byfield, J; Bick, R


    Free-standing cancer centers (FSCC) represent a growing trend in cancer care delivery within community practice. The critical components to FSCC are multidisciplinary cancer care, a complete menu of direct care and support services, a commitment to clinical trials and clinical investigation, and a comprehensive program for quality assurance. The advantages of FSCC to the community, to hospital programs, to the practicing surgical, medical, and radiation oncologists, and to the third-party carriers, including health maintenance organizations, are detailed. The development of an FSCC depends on the resolution of issues of (a) competition (between hospitals, hospitals and physicians, therapeutic disciplines, regional comprehensive cancer centers and FSCCs) and (b) concerns about conflict of interest. The ideal model of FSCC may well be represented by the joint venture of community hospital(s) and the community oncologists.

  17. Significant Improvements in the Practice Patterns of Adult Related Donor Care in US Transplantation Centers. (United States)

    Anthias, Chloe; Shaw, Bronwen E; Kiefer, Deidre M; Liesveld, Jane L; Yared, Jean; Kamble, Rammurti T; D'Souza, Anita; Hematti, Peiman; Seftel, Matthew D; Norkin, Maxim; DeFilipp, Zachariah; Kasow, Kimberly A; Abidi, Muneer H; Savani, Bipin N; Shah, Nirali N; Anderlini, Paolo; Diaz, Miguel A; Malone, Adriana K; Halter, Joerg P; Lazarus, Hillard M; Logan, Brent R; Switzer, Galen E; Pulsipher, Michael A; Confer, Dennis L; O'Donnell, Paul V


    Recent investigations have found a higher incidence of adverse events associated with hematopoietic cell donation in related donors (RDs) who have morbidities that if present in an unrelated donor (UD) would preclude donation. In the UD setting, regulatory standards ensure independent assessment of donors, one of several crucial measures to safeguard donor health and safety. A survey conducted by the Center for International Blood and Marrow Transplant Research (CIBMTR) Donor Health and Safety Working Committee in 2007 reported a potential conflict of interest in >70% of US centers, where physicians had simultaneous responsibility for RDs and their recipients. Consequently, several international organizations have endeavored to improve practice through regulations and consensus recommendations. We hypothesized that the changes in the 2012 Foundation for the Accreditation of Cellular Therapy and the Joint Accreditation Committee-International Society for Cellular Therapy and European Society for Blood and Marrow Transplantation standards resulting from the CIBMTR study would have significantly impacted practice. Accordingly, we conducted a follow-up survey of US transplantation centers to assess practice changes since 2007, and to investigate additional areas where RD care was predicted to differ from UD care. A total of 73 centers (53%), performing 79% of RD transplantations in the United States, responded. Significant improvements were observed since the earlier survey; 62% centers now ensure separation of RD and recipient care (P < .0001). This study identifies several areas where RD management does not meet international donor care standards, however. Particular concerns include counseling and assessment of donors before HLA typing, with 61% centers first disclosing donor HLA results to an individual other than the donor, the use of unlicensed mobilization agents, and the absence of long-term donor follow-up. Recommendations for improvement are made.

  18. Patient-centered care and its effect on outcomes in the treatment of asthma

    Directory of Open Access Journals (Sweden)

    Qamar N


    Full Text Available Nashmia Qamar1,*, Andrea A Pappalardo2,*, Vineet M Arora3, Valerie G Press41Pediatric Residency Program, University of Chicago Medical Center, Chicago, IL, USA; 2Internal Medicine-Pediatric Residency Program, University of Chicago Medical Center, Chicago, IL, USA; 3Section of General Internal Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA; 4Section of Hospital Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA *Drs Qamar and Pappalardo contributed equally to this paperAbstract: Patient-centered care may be pivotal in improving health outcomes for patients with asthma. In addition to increased attention in both research and clinical forums, recent legislation also highlights the importance of patient-centered outcomes research in the Patient Protection and Affordable Care Act. However, whether patient-centered care has been shown to improve outcomes for this population is unclear. To answer this question, we performed a systematic review of the literature that aimed to define current patient-focused management issues, characterize important patient-defined outcomes in asthma control, and identify current and emerging treatments related to patient outcomes and perspectives. We used a parallel search strategy via Medline®, Cochrane Central Register of Controlled Trials, CINAHL® (Cumulative Index to Nursing and Allied Health Literature, and PsycINFO®, complemented with a reference review of key articles that resulted in a total of 133 articles; 58 were interventions that evaluated the effect on patient-centered outcomes, and 75 were descriptive studies. The majority of intervention studies demonstrated improved patient outcomes (44; “positive” results; none showed true harm (0; “negative”; and the remainder were equivocal (14; “neutral”. Key themes emerged relating to patients’ desires for asthma knowledge, preferences for tailored management plans, and

  19. Factors Affecting the Involvement of Day Centre Care Staff in the Delivery of Physiotherapy to Adults with Intellectual Disabilities: An Exploratory Study in One London Borough (United States)

    Middleton, M. -J.; Kitchen, S. S.


    Background: Physiotherapists for adults with intellectual disabilities often work in day centres, relying on care staff to support programmes. This study investigates factors affecting physiotherapy delivery in 4 day centres in one London borough. Materials and Method: Semi-structured interviews were carried out with day centre care staff,…

  20. Cortisol levels of infants in center care across the first year of life: links with quality of care and infant temperament. (United States)

    Albers, Esther M; Beijers, Roseriet; Riksen-Walraven, J Marianne; Sweep, Fred C G J; de Weerth, Carolina


    Cortisol concentrations of older children in childcare centers have been found to be higher than at home. This study focuses on infant cortisol in childcare centers throughout the first year of life, and aims to investigate whether inter-individual differences can be explained by temperament, the quality of maternal behavior, and the quality of center care. Sixty-four infants were followed for 9 months after entering care at 3 months of age. Salivary samples were taken at 10.00 h and 16.00 h in center care (in post-entry weeks 1, 2, 3, 4, 8, 12, 16, 24, and 36) and at home (in post-entry weeks 1, 24, and 36). Prior to entry, mothers completed a temperament questionnaire and the quality of maternal behavior (sensitivity and cooperation) was observed during routine bathing sessions. Subsequently, the infants were visited three times at center care to observe the quality of infant's interactive experiences with their professional caregiver. Longitudinal regression models showed that both morning and afternoon cortisol were higher in center care compared to home. Longitudinal regression models showed that infants receiving higher quality of maternal behavior displayed higher morning cortisol in center care, compared to infants receiving lower quality of maternal behavior. Higher quality of maternal behavior was also related to higher afternoon cortisol in center care, but only in infants high in negative emotionality. Center care quality was not related to cortisol. In sum, young infants show higher cortisol concentrations in center care that are related to infant temperament and quality of maternal behavior at home.

  1. Health professionals’ experiences of person-centered collaboration in mental health care

    Directory of Open Access Journals (Sweden)

    Rita Sommerseth


    Full Text Available Rita Sommerseth, Elin DysvikUniversity of Stavanger, Faculty of Social Sciences, Department of Health Studies, Stavanger, NorwayObjective: The basic aim in this paper is to discuss health care professionals’ experiences of person-centered collaboration and involvement in mental health rehabilitation and suggest ways of improving this perspective. Furthermore, the paper explains the supportive systems that are at work throughout the process of rehabilitation.Method: The study design is a qualitative approach using three focus group interviews with a total of 17 informants with different professional backgrounds such as nurses, social workers, and social pedagogies. In addition, one nurse and one social worker participated in a semistructured in-depth interview to judge validity.Results: Our results may demonstrate deficits concerning mental health care on several levels. This understanding suggests firstly, that a person-centered perspective and involvement still are uncommon. Secondly, multidisciplinary work seems uncommon and only sporadically follows recommendations. Thirdly, family support is seldom involved. Lastly, firm leadership and knowledge about laws and regulations seems not to be systematically integrated in daily care.Conclusion: Taking these matters together, the improvement of a person-centered perspective implies cooperation between different services and levels in mental health care. In order to bring about improvement the health care workers must critically consider their own culture, coordination of competence must be increased, and leadership at an institutional and organizational level must be improved so that scarce rehabilitation resources are used to the optimal benefit of people with a mental illness.Keywords: multidisciplinary teams, person-centered collaboration, supportive systems, rehabilitation

  2. Make Time to Talk: Language Building Tips for Center-Based Child Care Providers (United States)

    National Institute for Literacy, 2010


    Everyone knows that it's important to talk every day with each child, using the kind of talk that builds language and thinking skills. The phrase MAKE TIME TO TALK is to help child care providers remember things they can do when talking to children to help them learn new vocabulary and how to use language to express their ideas and needs, and that…

  3. A patient-centered research agenda for the care of the acutely ill older patient. (United States)

    Wald, Heidi L; Leykum, Luci K; Mattison, Melissa L P; Vasilevskis, Eduard E; Meltzer, David O


    Hospitalists and others acute-care providers are limited by gaps in evidence addressing the needs of the acutely ill older adult population. The Society of Hospital Medicine sponsored the Acute Care of Older Patients Priority Setting Partnership to develop a research agenda focused on bridging this gap. Informed by the Patient-Centered Outcomes Research Institute framework for identification and prioritization of research areas, we adapted a methodology developed by the James Lind Alliance to engage diverse stakeholders in the research agenda setting process. The work of the Partnership proceeded through 4 steps: convening, consulting, collating, and prioritizing. First, the steering committee convened a partnership of 18 stakeholder organizations in May 2013. Next, stakeholder organizations surveyed members to identify important unanswered questions in the acute care of older persons, receiving 1299 responses from 580 individuals. Finally, an extensive and structured process of collation and prioritization resulted in a final list of 10 research questions in the following areas: advanced-care planning, care transitions, delirium, dementia, depression, medications, models of care, physical function, surgery, and training. With the changing demographics of the hospitalized population, a workforce with limited geriatrics training, and gaps in evidence to inform clinical decision making for acutely ill older patients, the identified research questions deserve the highest priority in directing future research efforts to improve care for the older hospitalized patient and enrich training.

  4. Survey of care and evaluation of East African burn unit feasibility: an academic burn center exchange. (United States)

    Mitchell, Katrina B; Giiti, Geofrey; Gallagher, James J


    Weill Cornell Medical College in New York, partnered with Weill Bugando Medical College and Sekou Toure Regional Referral Hospital, in Mwanza, Tanzania, to consider the development of a burn unit there. This institutional partnership provided a unique opportunity to promote sustainable academic exchange and build burn care capacity in the East African region. A Weill Cornell burn surgeon and burn fellow collaborated with the Sekou Toure department of surgery to assess its current burn care capabilities and potential for burn unit development. All aspects of interdisciplinary burn care were reviewed and institutional infrastructure evaluated. Sekou Toure is a 375-bed regional referral center and teaching hospital of Weill Bugando Medical College. In 2010-2011, it admitted 5244 pediatric patients in total; 100 of these patients were burn-injured children (2% of admissions). There was no specific data kept on percentage of body surface burned, degree of burn, length of stay, or complications. No adult, operative, or outpatient burn data were available. There are two operating theaters. Patient's families perform wound care with nursing supervision. Rehabilitation therapists consult as needed. Meals are provided three times daily by a central kitchen. Public health outreach is possible through village-based communication networks. Infrastructure to support the development of a burn care unit exists at Sekou Toure, but needs increased clinical focus, human resource capacity building, and record-keeping to track accurate patient numbers. A multidisciplinary center could improve record-keeping and outcomes, encourage referrals, and facilitate outreach through villages.

  5. Integrating Adolescents and Young Adults into Adult-Centered Care for IBD. (United States)

    Trivedi, Itishree; Holl, Jane L; Hanauer, Stephen; Keefer, Laurie


    Planned healthcare transition, initiated in pediatric care, is a gradual process aimed at fostering the adolescent patient's disease knowledge and skills with the ultimate objective of preparing patients and families for adult-centered care. The process is critical in inflammatory bowel diseases (IBD) where there is an increased risk of non-adherence, hospitalizations, and emergency department use as young adult patients graduate from pediatric to adult-centered care. While evidence for healthcare transition in IBD is mounting, important gaps remain in the understanding of this process from the perspective of the adult gastroenterologist. This paper summarizes what is known about healthcare transition in IBD and explores the unanswered questions-a conceptual and methodological framework for transition interventions, relevant outcomes that define successful transition, and key stakeholder perspectives. For the adult gastroenterologist managing the young adult patient population, this paper presents the paradigm of "care integration"-a process of ongoing, multi-modality support for the patient, initiated in the adult care setting, with the goal of improving self-management skills and active participation in medical decision-making.

  6. Disruptive innovation in academic medical centers: balancing accountable and academic care. (United States)

    Stein, Daniel; Chen, Christopher; Ackerly, D Clay


    Numerous academic medicine leaders have argued that academic referral centers must prepare for the growing importance of accountability-driven payment models by adopting population health initiatives. Although this shift has merit, execution of this strategy will prove significantly more problematic than most observers have appreciated. The authors describe how successful implementation of an accountable care health strategy within a referral academic medical center (AMC) requires navigating a critical tension: The academic referral business model, driven by tertiary-level care, is fundamentally in conflict with population health. Referral AMCs that create successful value-driven population health systems within their organizations will in effect disrupt their own existing tertiary care businesses. The theory of disruptive innovation suggests that balancing the push and pull of academic and accountable care within a single organization is achievable. However, it will require significant shifts in resource allocation and changes in management structure to enable AMCs to make the inherent difficult choices and trade-offs that will ensue. On the basis of the theories of disruptive innovation, the authors present recommendations for how academic health systems can successfully navigate these issues as they transition toward accountability-driven care.

  7. Building social participation with a support group users: challenges of care qualification in a Psychosocial Care Center (CAPS

    Directory of Open Access Journals (Sweden)

    Vitor Corrêa Detomini


    Full Text Available The literature points out a lack of studies describing practical experiences approaching the role of social participation, even though, the subject Brazilian Health System (SUS as a principle is valued by theoretical-conceptual works. The lack of studies is especially observed in mental health care services, where the existing studies focus on the users’ management engagement as part of psychosocial rehabilitation. Thus, this article introduces an experience developed in a Center for Psycho-Social Attention (CAPS, in the state of Mato Grosso do Sul, aiming to address the issue of social participation in care qualification, in accordance to legislation and technical standards. Thisstudy focused on two types of sources. 1 Internship Final Report of a Psycology Student including 54 sessions of a support group, 2 technical and legal documents concerning the SUS and the National Mental Health Policy and Humanization. The service aspects were analyzed through technical and legislative foundations - focusing the needs and claims on group discussions, classified as structure and process, used to assess the health care quality. Most concerns were listed on normative Ordinances and Regulations. Achieving social participation was not an institutional premise and, among the main difficulties was the medical/outpatient centered model and the representation of “crazy”/”CAPS users” as incapable. It requires: i integration of “clinic” and “politics”; ii intensification of interdisciplinary and psychological care; iii respect the citizenship of mental health users, and, finally, iv that the collective participation spaces do not exhaust themselves. Therefore, the collective participation spaces need practical recommendations in order to improve the structures and work processes and meet the users’ needs.

  8. Unmet Needs of Children with Special Health Care Needs in a Specialized Day School Setting (United States)

    Aruda, Mary M.; Kelly, Mary; Newinsky, Karina


    Children with Special Health Care Needs (CSHCN) represent a significant component of the pediatric population. They often present to schools with multiple and increasingly complex health issues, including medical technology dependency. Their daily variation in health status requires close monitoring and communication among caregivers. Limited…

  9. What is patient-centered care really? Voices of Hispanic prenatal patients. (United States)

    Bergman, Alicia A; Connaughton, Stacey L


    Variations in patient-centered care (PCC) models and approaches contribute to ambiguity in how PCC is understood and defined, especially with regard to meeting the needs of diverse patient populations. One of the biggest challenges of putting PCC into practice is knowing what elements are the most important to patients. This qualitative study privileges patients' voices and adds a cultural dimension to existing health communication research on PCC through an empirical investigation of 48 Hispanic prenatal care patients' understandings and expectations of PCC. Semistructured interviews with 48 patients revealed five key themes in order of frequency: (a) una relación amable (a friendly relationship), (b) la atencion médica efectiva (effective medical care), (c) Español hablado (the Spanish language spoken), (d) comprensión de la información (understanding of information), and (e) eliminación del racismo (elimination of racism). The themes reflected several different assumptions and expectations with regard to PCC as compared to those espoused in many of the existing models and frameworks, such as the extent to which friendly interpersonal behaviors (e.g., smiling, making eye contact, displaying patience, and engaging in formal greetings, introductions, and farewells) were critical to patient satisfaction with the health care experience. Not only did patients feel better understood, but accompanied by friendly behaviors, information was viewed as more believable and accurate, and thus more patient-centered. The findings suggest that implementing culturally sensitive PCC approaches to caring for Hispanic prenatal care patients can include training health care staff on the importance of displaying friendly communicative behaviors such as smiling.

  10. Same-Day CD4 Testing to Improve Uptake of HIV Care and Treatment in South Africa: Point-of-Care Is Not Enough

    Directory of Open Access Journals (Sweden)

    Bruce A. Larson


    Full Text Available Background. We evaluated whether a pilot program providing point-of-care (POC, but not rapid, CD4 testing (BD FACSCount immediately after testing HIV-positive improved retention in care. Methods. We conducted a retrospective record review at the Themba Lethu Clinic in Johannesburg, South Africa. We compared all walk-in patients testing HIV-positive during February, July 2010 (pilot POC period to patients testing positive during January 2008–February 2009 (baseline period. The outcome for those with a ≤250 cells/mm3 when testing HIV-positive was initiating ART <16 weeks after HIV testing. Results. 771 patients had CD4 results from the day of HIV testing (421 pilots, 350 baselines. ART initiation within 16 weeks was 49% in the pilot period and 46% in the baseline period. While all 421 patients during the pilot period should have been offered the POC test, patient records indicate that only 73% of them were actually offered it, and among these patients only 63% accepted the offer. Conclusions. Offering CD4 testing using a point-of-care, but not rapid, technology and without other health system changes had minor impacts on the uptake of HIV care and treatment. Point-of-care technologies alone may not be enough to improve linkage to care and treatment after HIV testing.

  11. Family centered maternity care: its relationship to perinatal regionalization and neonatal intensive care. (United States)

    Swartz, W H; Swartz, J V


    For several months prior to birth a major portion of a family's attention, conversation, thought, and often worry, is directed toward the idea of a new child. This prolonged attention and anticipation contribute to making childbirth an emotionally charged experience. In psychological terms, it is therefore a critical period of peak motivation for learning, and a time to peak susceptibility to reinforcement. Theory, reason, and scientific evidence indicate thng with childbirth and early postpartum experiences, can significantly affect subsequent parental behaviors, the child's central environment influence. Evidence strongly suggests that these parental attitudes and behaviors so crucial to the child's ultimate well-being are learned rather than derived instinctually, and therefore they are malleable and can be taught, directed, and corrected. Through education and reinforcement it is possible to encourage parental behaviors and child interactions which are products of feelings of control, competence, accomplishment, understanding, and caring. Similarly we can recognize and work toward replacing attitudes, feelings, and behaviors that express fear, worry, and insecurity about the child. Over the past 50 years major changes have occurred in the practice of obstetrics and newborn pediatrics. Other major changes will necessarily occur as we move toward perinatal regionalization. Changes instigated solely on physiologic data can have unrecognized collateral effects on the psychological component of the childbirth experience. All concerned health care personnel, especially obstetricians and pediatricians, can insist that the importance of desirable mother-father-child interactions be recognized and that practices fostering them be afforded a high priority. I would like to endorse a comment from a recent article by Richmond concerning the advent of behavioral pediatrics by adding that behavioral obstetrics is also "an idea whose time has arrived".

  12. Effectiveness of person-centered care on people with dementia: a systematic review and meta-analysis (United States)

    Kim, Sun Kyung; Park, Myonghwa


    Background Person-centered care is a holistic and integrative approach designed to maintain well-being and quality of life for people with dementia, and it includes the elements of care, the individual, the carers, and the family. Aim A systematic literature review and meta-analysis were undertaken to investigate the effectiveness of person-centered care for people with dementia. Methods Literature searches were undertaken using six databases including Medline, EMBASE, CINAHL, PsycINFO, Cochrane Database, and KoreaMed using the following keywords: cognition disorder, dementia, person-centered care, patient-centered care, client-centered care, relationship-centered care, and dementia care. The searches were limited to interventional studies written in English and Korean and included randomized controlled studies and noncontrolled studies for people with dementia living in any setting. Results Nineteen interventional studies, including 3,985 participants, were identified. Of these, 17 studies were from long-term care facilities and two studies were from homecare settings. The pooled data from randomized controlled studies favored person-centered care in reducing agitation, neuropsychiatric symptoms, and depression and improving the quality of life. Subgroup analysis identified greater effectiveness of person-centered care when implemented for people with less severe dementia. For agitation, short-term interventions had a greater effect (standardized mean difference [SMD]: −0.434; 95% conference interval [CI]: −0.701 to −0.166) than long-term interventions (SMD: −0.098; 95% CI: −0.190 to 0.007). Individualized activities resulted in a significantly greater beneficial effect than standard care (SMD: 0.513; 95% CI: −0.994 to −0.032). However, long-term, staff education, and cultural change interventions had a greater effect on improving the quality of life for people with dementia (SMD: 0.191; 95% CI: 0.079 to 0.302). Conclusion This systematic review and

  13. How the center for Medicare and Medicaid innovation should test accountable care organizations. (United States)

    Shortell, Stephen M; Casalino, Lawrence P; Fisher, Elliott S


    The Patient Protection and Affordable Care Act establishes a national voluntary program for accountable care organizations (ACOs) by January 2012 under the auspices of the Centers for Medicare and Medicaid Services (CMS). The act also creates a Center for Medicare and Medicaid Innovation in the CMS. We propose that the CMS allow flexibility and tiers in ACOs based on their specific circumstances, such as the degree to which they are or are not fully integrated systems. Further, we propose that the CMS assume responsibility for ACO provisions and develop an ordered system for learning how to create and sustain ACOs. Key steps would include setting specific performance goals, developing skills and tools that facilitate change, establishing measurement and accountability mechanisms, and supporting leadership development.

  14. Effect of horticultural therapy on wellbeing among dementia day care programme participants: A mixed-methods study (Innovative Practice). (United States)

    Hall, Jodi; Mitchell, Gary; Webber, Catherine; Johnson, Karen


    Fourteen people attending an adult day programme were recruited to a structured horticultural therapy programme which took place over 10 weeks. The effects were assessed using Dementia Care Mapping and questionnaires completed by family carers. High levels of wellbeing were observed while the participants were engaged in horticultural therapy, and these were sustained once the programme was completed. This study adds to the growing evidence on the benefits of horticultural therapy for people with dementia who have enjoyed gardening in the past.

  15. The role of probiotics and prebiotics in the prevention of infections in child day-care centres. (United States)

    Weizman, Z


    Infants and children attending day-care centres demonstrate a notably higher risk of gastrointestinal as well as of respiratory tract infections. The present short review evaluates various well-controlled clinical trials analysing the effect of probiotics and prebiotics in the prevention of such infections. In most of the 12 studies identified, probiotic supplementation was found to be a safe and effective therapeutic tool in preventing gastrointestinal and respiratory infection in this population.

  16. Assessment of chronic diarrhea in early infancy in Tehran Tertiary Care Center; Tehran-Iran


    Farzaneh Motamed; Naheid Kazemi; Raheleh Nabavizadeh


    Introduction Chronic diarrhea of infancy is a heterogeneous syndrome that includes several diseases with different etiologies. The aim of this study was investigating chronic diarrhea, its etiologies, clinical features and outcomes in infancy.Materials and Methods Retrospective study investigating infants hospitalized in the gastroenterology department of Tehran tertiary care center.The main demographic data, etiology, characteristics of diarrhea, and outcome were evaluated. Data were analyze...

  17. Body, stress and nursing: ethnography of an Intensive Care and Surgical Center


    Martins, Maria das Graças Teles [UNIFESP; Castro, Odilon; Pereira,Pedro Paulo Gomes


    This text seeks to reflect on the concepts of stress among nurses that work in the Surgical and Intensive Care Centers of a teaching hospital in the State of Paraíba. Qualitative ethnographic research allowed us to perceive that when talking about stress, these professionals mentioned their bodies and bodily manifestations. The research undertaken allowed us to understand the intimate relationships between the body, stress and nursing.

  18. Hypertensive Crisis, Burden, Management, and Outcome at a Tertiary Care Center in Karachi


    Aysha Almas; Ayaz Ghouse; Ahmed Raza Iftikhar; Munawwar Khursheed


    Objectives. Hypertension, if uncontrolled, can lead to hypertensive crisis. We aim to determine the prevalence of hypertensive crisis, its management, and outcome in patients presenting to a tertiary care center in Karachi. Methods. This was a cross-sectional study conducted at the Aga Khan University, Karachi, Pakistan. Adult inpatients (>18 yrs) presenting to the ER who were known hypertensive and had uncontrolled hypertension were included. Results. Out of 1336 patients, 28.6% (387) had un...

  19. Feminist health care in a hostile environment: a case study of the Womancare Health Center. (United States)

    Hyde, Cheryl A


    This article presents a case study of the Womancare Health Center in order to illustrate the development of and challenges to the feminist health movement in the United States. Specific attention is placed on the legislative, fiscal, and direct actions by the New Right against this organization. Analysis focuses on the means through which Womancare survived. The repercussions of constant intimidation and harassment for women's health programs and for health care policy overall are discussed.



    Mithun N; Pattanashetty; Reshmina; Sharath Babu; Harikrishna; Sreedhar Reddy; Ramakrishna J


    INTRODUCTION : India is considered as the diabetic capital of the world. Diabetic foot osteomyelitis is considered as one of the severe complications of diabetes mellitus. Diabetic foot osteomyelitis tends to complicate around one third of diabetic foot infections. In v iew of this we conducted a prospective study on the bacteriological analysis of diabetic foot osteomyelitis at a tertiary care center. MATERIALS AND METHODS : A prospective study was perform...

  1. Patient-centered collaborative care: employer-led business coalition vision for action. (United States)

    Webber, Andrew; Mercure, Suzanne


    Employers influence healthcare delivery. Two spheres of influence include (i) what is done at each worksite and by each employer (plan design and communications as well as health plan contracting) and (ii) what is done collectively in both private and public sectors to address performance and to encourage the physicians to adopt practice changes. The need for change toward patient-centered care is the subject of this article.

  2. Relationship between organizational culture and commitment of employees in health care centers in west of Iran (United States)

    Hamidi, Yadollah; Mohammadibakhsh, Roghayeh; Soltanian, Alireza; Behzadifar, Masoud


    Introduction Presence of committed personnel in each organization not only reduces their absenteeism, delays, and displacements but also leads to a dramatic increase in performance and efficiency of an organization, mental freshness of employees, better manifestation of noble objectives, and organizational mission as well as fulfillment of personal goals. Therefore, the purpose of this study was to determine the relationship between organizational culture and organizational commitment of employees in administrative units of health care centers in the cities of Hamedan Province based on the Denison model in 2015. Methods In this cross-sectional study, 177 employees in administrative units of health care centers in the cities of Hamedan Province were selected by a multistage stratified sampling method. The data collection instruments included the standardized Denison organizational culture survey and organizational commitment questionnaire by Meyer and Allen. Data were analyzed by IBM-SPSS version 21 using descriptive statistics and Pearson product-moment coefficient. Results Among the 12 indicators of organizational culture, the highest mean scores were assigned to empowerment (16.74), organizational learning (16.41), vision (16.4), and strategic direction (16.35); respectively. Furthermore, the indicators of capability development (14.2), core values (15.31), team orientation (15.45), and goals (15.46) received the lowest mean scores in this respect. Among the four dimensions of organizational culture, the highest mean score was related to “mission” in organizational culture and the lowest score was associated with “involvement.” Meyer and Allen’s organizational commitment model also had three components in which affective commitment in this study obtained the highest score (26.63) and continuance commitment received the lowest score (24.73). In this study, there was a significant correlation between all the components of organizational culture and

  3. 7 CFR 226.11 - Program payments for centers. (United States)


    ... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Payment Provisions § 226.11 Program... approved child care centers, at-risk afterschool care centers, adult day care centers, emergency...

  4. Prenatal care in a primary healthcare center for imprisoned pregnant women

    Directory of Open Access Journals (Sweden)

    Maria do Carmo Silva Fochi


    Full Text Available This experience report aimed to describe the prenatal care undertaken in a primary care center in the non-metropolitan area of the State of São Paulo, offered to the female prison population. The data and related information refer to the period June 2010 – June 2012. The article describes the construction of the work process by the local team, the dynamics of providing the attendance, the human resources involved and the consultations undertaken. The prenatal care provided to the pregnant women made it possible to investigate the pluralized universe of imprisoned women and their needs resulting from the condition of being pregnant in the prison environment. Thus, decent attendance to the prison population’s health - a human and constitutional right - is considered important, so as to avoid physical, emotional and social problems, which in the pregnant woman may be passed on to her child.

  5. Characterization of the clientele attended in a Psychosocial Care Center - alcohol and drugs

    Directory of Open Access Journals (Sweden)

    Eliany Nazaré Oliveira


    Full Text Available This documentary and retrospective study aimed to analyze the profile of the clientele attended in the Psychosocial Care Center Alcohol and Other Drugs from Sobral, Ceará, Brazil in 2010, based on 300 records. Males predominated with 75% (n=225, with age ranging from 11 to 29 years old with 44.3% (n=133, single with 49% (n=147, and with elementary school 45.7% (n=137. The most commonly used drug among men was crack, 31.3% (n=94, and among women, tobacco, 12% (n=36. The losses associated with dependence, are mostly related to the family, with 31.3% (n=94. The highlight to crack requires changes in the care process implemented in institutions. One should remain alert to these new profiles related to chemical dependency, so that quality and integral care can be offered to this clientele.

  6. Identifying Elements of Patient-Centered Care in Underserved Populations: A Qualitative Study of Patient Perspectives (United States)

    Raja, Sheela; Hasnain, Memoona; Vadakumchery, Tracy; Hamad, Judy; Shah, Raveena; Hoersch, Michelle


    Patient-centered care is an important goal in the delivery of healthcare. However, many patients do not engage in preventive medical care. In this pilot study, we conducted twenty in depth, semi-structured qualitative interviews at the University of Illinois at Chicago Health Sciences campus in a four month time frame. Many patients were underserved and underinsured, and we wanted to understand their experiences in the healthcare system. Using content analysis, several themes emerged from the interview data. Participants discussed the need for empathy and rapport with their providers. They identified provider behaviors that fostered a positive clinical relationship, including step-by step explanations of procedures, attention to body language and clinic atmosphere, and appropriate time management. Participants identified cost as the most common barrier to engaging in preventive care and discussed children and social support as motivating factors. A long-term relationship with a provider was an important motivator for preventive care, suggesting that the therapeutic alliance was essential to many patients. Conversely, many participants discussed a sense of dehumanization in the healthcare system, reporting that their life circumstances were overlooked, or that they were judged based on insurance status or ethnicity. We discuss implications for provider training and healthcare delivery, including the importance of patient-centered medical homes. PMID:25993110

  7. Identifying elements of patient-centered care in underserved populations: a qualitative study of patient perspectives.

    Directory of Open Access Journals (Sweden)

    Sheela Raja

    Full Text Available Patient-centered care is an important goal in the delivery of healthcare. However, many patients do not engage in preventive medical care. In this pilot study, we conducted twenty in depth, semi-structured qualitative interviews at the University of Illinois at Chicago Health Sciences campus in a four month time frame. Many patients were underserved and underinsured, and we wanted to understand their experiences in the healthcare system. Using content analysis, several themes emerged from the interview data. Participants discussed the need for empathy and rapport with their providers. They identified provider behaviors that fostered a positive clinical relationship, including step-by step explanations of procedures, attention to body language and clinic atmosphere, and appropriate time management. Participants identified cost as the most common barrier to engaging in preventive care and discussed children and social support as motivating factors. A long-term relationship with a provider was an important motivator for preventive care, suggesting that the therapeutic alliance was essential to many patients. Conversely, many participants discussed a sense of dehumanization in the healthcare system, reporting that their life circumstances were overlooked, or that they were judged based on insurance status or ethnicity. We discuss implications for provider training and healthcare delivery, including the importance of patient-centered medical homes.

  8. Determinants of quality of life in elderly patients of a psychosocial care center in Brazil. (United States)

    Bottan, Gabriela; Morais, Eliane Pinheiro de; Schneider, Jacó Fernando; Trentini, Clarissa; Heldt, Elizeth


    The purpose of the present study was to identify the sociodemographic, clinical, and functional determinants of quality of life in elderly (older than 60 years) patients from a Psychosocial Care Center. The sample was randomly selected patients undergoing treatment at the center during the study period. Quality of life was assessed using the brief version of the World Health Organization Quality of Life Assessment (WHOQOL-BREF) and the World Health Organization Quality of Life Assessment for older adults (WHOQOL-OLD). A total of 50 elderly individuals with a mean age of 67.5 (SD = 5.72) years were included in the study. A hierarchical linear regression showed that clinical characteristics, such as severe symptoms of depression and a higher number of comorbidities, were related to lower quality of life. Better functional capacity and more frequent visits to the center were determinants of higher quality of life. These findings underscore the importance of assessing quality of life and of taking this variable into account when planning health interventions for elderly patients at a Psychosocial Care Center.

  9. Use of mortality within 30 days of a COPD hospitalisation as a measure of COPD care in UK hospitals. (United States)

    Walker, P P; Thompson, E; Crone, H; Flatt, G; Holton, K; Hill, S L; Pearson, M G


    Mortality rate has been proposed as a metric of hospital chronic obstructive pulmonary disease (COPD) care in light of variation seen in national COPD audits. Using Hospital Episode Statistics (hospital 'coding') we examined 30-day mortality after COPD hospitalisation in 150 UK hospitals during 2006-2007 and 2007-2008. Mean and median 30-day mortalities were similar each year but the coefficient of variation was >20% and hospitals could change from a low or high quartile to the median by chance. We could not detect any reasons for hospitals being at the extremes. 30-day mortality after COPD hospitalisation is a complex variable and unlikely to be useful as a primary annual COPD metric.

  10. The ethical leadership challenge: creating a culture of patient- and family-centered care in the hospital setting. (United States)

    Piper, Llewellyn E


    The growing number of medical errors and resulting preventable deaths in hospitals presents an ethical dilemma that must be addressed by health care leaders and managers. These medical errors and deaths raise questions about safety and quality issues resulting in rising public mistrust and patient dissatisfaction. Many of these medical errors and deaths could have been avoided by including the patient and family in the care. The ethical challenge for leadership is creating a culture of patient- and family-centered care as a means to improve quality, safety, patient satisfaction, and public trust. This article addresses ways to improve safety, quality, patient satisfaction, and cost and thereby reduce medical errors and deaths by implementing a patient- and family-centered care culture. The first critical step for improvement is for hospital leaders and managers to answer the ethical call to create a culture centered on patient- and family-centered care in the hospital setting.

  11. Urgent Need to Antibiotic Pharmacokinetic Services for Iranian Health Care Centers

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    Alireza Hayatshahi


    amikacin for both empiric and culture based therapy. In some cases, it is necessary for patient to be on these antibacterial agents for weeks (endocarditis, osteomyelitis, pneumonia, etc..  Fever, white blood cells (WBC besides other clinical measurements are often used to assess the clinical response to antimicrobial agents. On the other hand microbiological tests including cultures and sensitivity results are routinely utilized to guide the therapy. At our medical centers as the clinicians do not see any of the expected responses based on the above measurements, they change the agent or add another antibacterial to the regimen with no consideration of performing appropriate TDM. Based on the most updated guidelines, a vancomycin trough level at the steady state and peak and trough levels for aminoglycosides make it possible for clinicians to optimize the antibacterial doses without necessarily changing the whole regimen and significantly reduce the rate of treatment failures. If an aminoglycoside is dosed as extended interval, then a random level can help to adjust the frequency of the doses. This valuable pharmacokinetic service by clinical pharmacists would be a great asset to healthcare and medical team which significantly reduces the morbidity and mortality due to both underdosing or high dose induced toxicities in both hospitalized and outpatients. Pharmacokinetic services must be a 24 hour seven day task of the pharmaceutical care division of each medical center. It will be necessary for each hospital to have a permanent team of clinical pharmacists to maintain this TDM service. This is not possible unless there would be a close cooperation between pharmacy and medical laboratory of each hospital or an outsource laboratory with drug serum level measuring services. As a result, it seems to be an absolute need to perform pharmacokinetic services with the cooperation of medical, clinical pharmacy and laboratory teams under the support of insurance companies since

  12. Supply-side barriers to maternal health care utilization at health sub-centers in India

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    Aditya Singh


    Full Text Available Introduction There exist several barriers to maternal health service utilization in developing countries. Most of the previous studies conducted in India have focused on demand-side barriers, while only a few have touched upon supply-side barriers. None of the previous studies in India have investigated the factors that affect maternal health care utilization at health sub-centers (HSCs in India, despite the fact that these institutions, which are the geographically closest available public health care facilities in rural areas, play a significant role in providing affordable maternal health care. Therefore, this study aims to examine the supply-side determinants of maternal service utilization at HSCs in rural India. Data and Methods This study uses health facility data from the nationally representative District-Level Household Survey, which was administered in 2007–2008 to examine the effect of supply-side variables on the utilization of maternal health care services across HSCs in rural India. Since the dependent variables (the number of antenatal registrations, in-facility deliveries, and postnatal care services are count variables and exhibit considerable variability, the data were analyzed using negative binomial regression instead of Poisson regression. Results The results show that those HSCs run by a contractual auxiliary nurse midwife (ANM are likely to offer a lower volume of services when compared to those run by a permanent ANM. The availability of obstetric drugs, weighing scales, and blood pressure equipment is associated with the increased utilization of antenatal and postnatal services. The unavailability of a labor/examination table and bed screen is associated with a reduction in the number of deliveries and postnatal services. The utilization of services is expected to increase if essential facilities, such as water, telephones, toilets, and electricity, are available at the HSCs. Monitoring of ANM’s work by Village

  13. Impact of Information Technology, Clinical Resource Constraints, and Patient-Centered Practice Characteristics on Quality of Care

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    JongDeuk Baek


    Full Text Available Objective: Factors in the practice environment, such as health information technology (IT infrastructure, availability of other clinical resources, and financial incentives, may influence whether practices are able to successfully implement the patient-centered medical home (PCMH model and realize its benefits. This study investigates the impacts of those PCMH-related elements on primary care physicians’ perception of quality of care. Methods: A multiple logistic regression model was estimated using the 2004 to 2005 CTS Physician Survey, a national sample of salaried primary care physicians (n = 1733. Results: The patient-centered practice environment and availability of clinical resources increased physicians’ perceived quality of care. Although IT use for clinical information access did enhance physicians’ ability to provide high quality of care, a similar positive impact of IT use was not found for e-prescribing or the exchange of clinical patient information. Lack of resources was negatively associated with physician perception of quality of care. Conclusion: Since health IT is an important foundation of PCMH, patient-centered practices are more likely to have health IT in place to support care delivery. However, despite its potential to enhance delivery of primary care, simply making health IT available does not necessarily translate into physicians’ perceptions that it enhances the quality of care they provide. It is critical for health-care managers and policy makers to ensure that primary care physicians fully recognize and embrace the use of new technology to improve both the quality of care provided and the patient outcomes.

  14. 30-day hospital readmission of older adults using care transitions after hospitalization: a pilot prospective cohort study

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    Takahashi PY


    Full Text Available Paul Y Takahashi,1 Lindsey R Haas,2 Stephanie M Quigg,1 Ivana T Croghan,1 James M Naessens,2 Nilay D Shah,2 Gregory J Hanson11Division of Primary Care Internal Medicine, Department of Medicine, 2Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USAPurpose: Patients leaving the hospital are at increased risk of functional decline and hospital readmission. The Employee and Community Health service at Mayo Clinic in Rochester developed a care transition program (CTP to provide home-based care services for medically complex patients. The study objective was to determine the relationship between CTP use, 30-day hospital readmission, and Emergency Room (ER visits for adults over 60 years with high Elder Risk Assessment scores.Patients and methods: This was a pilot prospective cohort study that included 20 patients that used the CTP and 20 patients discharged from the hospital without using the CTP. The medically complex study patients were drawn from the department of Employee and Community Health population between October 14, 2011 and September 27, 2012. The primary outcomes were 30-day hospital readmission or ER visit after discharge from the hospital. The secondary outcomes were within-group changes in grip strength, gait speed, and quality of life (QOL. Patients underwent two study visits, one at baseline and one at 30 days postbaseline. The primary analysis included time-to-event from baseline to rehospitalization or ER visit. Paired t-tests were used for secondary outcomes, with continuous scores.Results: Of the 40 patients enrolled, 36 completed all study visits. The 30-day hospital readmission rates for usual care patients were 10.5% compared with no readmissions for CTP patients. There were 31.6% ER visits in the UC group and 11.8% in the CTP group (P = 0.37. The secondary analysis showed some improvement in physical QOL scores (pre: 32.7; post: 39.4 for the CTP participants (P < 0.01 and no differences in gait speed or

  15. Primary Care Research in the Patient-Centered Outcomes Research Institute's Portfolio. (United States)

    Selby, Joe V; Slutsky, Jean R


    In their article in this issue, Mazur and colleagues analyze the characteristics of early recipients of funding from the Patient-Centered Outcomes Research Institute (PCORI). Mazur and colleagues note correctly that PCORI has a unique purpose and mission and suggest that it should therefore have a distinct portfolio of researchers and departments when compared with other funders such as the National Institutes of Health (NIH). Responding on behalf of PCORI, the authors of this Commentary agree with the characterization of PCORI's mission as distinct from that of NIH and others. They agree too that data found on PCORI's Web site demonstrate that PCORI's portfolio of researchers and departments is more diverse and more heavily populated with clinician researchers, as would be expected. The authors take issue with Mazur and colleagues' suggestion that because half of clinical visits occur within primary care settings, half of PCORI's funded research should be based in primary care departments. PCORI's portfolio reflects what patients and others tell PCORI are the critical questions. Many of these do, in fact, occur with more complex conditions in specialty care. The authors question whether the research of primary care departments is too narrowly focused and whether it sufficiently considers study of these complex conditions. Research on more complex conditions including heart failure, coronary artery disease, and multiple comorbid conditions could be highly valuable when approached from the primary care perspective, where many of the comparative effectiveness questions first arise.

  16. Emergency care and the national quality strategy: highlights from the Centers for Medicare & Medicaid Services. (United States)

    Venkatesh, Arjun K; Goodrich, Kate


    The Centers for Medicare & Medicaid Services (CMS) of the US Department of Health and Human Services seeks to optimize health outcomes by leading clinical quality improvement and health system transformation through a variety of activities, including quality measure alignment, prioritization, and implementation. CMS manages more than 20 federal quality measurement and public reporting programs that cover the gamut of health care providers and facilities, including both hospital-based emergency departments (EDs) and individual emergency physicians. With more than 130 million annual visits, and as the primary portal of hospital admission, US hospital-based EDs deliver a substantial portion of acute care to Medicare beneficiaries. Given the position of emergency care across clinical conditions and between multiple settings of care, the ED plays a critical role in fulfilling all 6 priorities of the National Quality Strategy. We outline current CMS initiatives and future opportunities for emergency physicians and EDs to effect each of these priorities and help CMS achieve the triple aim of better health, better health care, and lower costs.

  17. Food insecure families: description of access and barriers to food from one pediatric primary care center. (United States)

    DeMartini, Tori L; Beck, Andrew F; Kahn, Robert S; Klein, Melissa D


    Despite evidence that food insecurity negatively impacts child health, health care providers play little role in addressing the issue. To inform potential primary care interventions, we sought to assess a range of challenges faced by food insecure (FI) families coming to an urban, pediatric primary care setting. A cross-sectional study was performed at a hospital-based, urban, academic pediatric primary care clinic that serves as a medical home for approximately 15,000 patients with 35,000 annual visits. Subjects included a convenience sample of caregivers of children presenting for either well child or ill care over a 4 months period in 2012. A self-administered survey assessed household food security status, shopping habits, transportation access, budgeting priorities, and perceptions about nutrition access in one's community. Bivariate analyses between food security status and these characteristics were performed using Chi square statistics or Fisher's exact test. The survey was completed by 199 caregivers. Approximately 33% of families were FI; 93% received food-related governmental assistance. FI families were more likely to obtain food from a corner/convenience store, utilize food banks, require transportation other than a household car, and prioritize paying bills before purchasing food. FI families perceived less access to healthy, affordable foods within their community. Thus, FI families may face unique barriers to accessing food. Knowledge of these barriers could allow clinicians to tailor in-clinic screening and create family-centered interventions.

  18. Toward Culturally Centered Integrative Care for Addressing Mental Health Disparities among Ethnic Minorities (United States)

    Holden, Kisha; McGregor, Brian; Thandi, Poonam; Fresh, Edith; Sheats, Kameron; Belton, Allyson; Mattox, Gail; Satcher, David


    Despite decades of research, recognition and treatment of mental illness and its co-morbidities still remain a significant public health problem in the United States. Ethnic minorities are identified as a population that is vulnerable to mental health disparities and face unique challenges pertaining to mental health care. Psychiatric illness is associated with great physical, emotional, functional, and societal burden. The primary health care setting may be a promising venue for screening, assessment, and treatment of mental illnesses for ethnic minority populations. We propose a comprehensive, innovative, culturally centered integrated care model to address the complexities within the health care system, from the individual level, that includes provider and patient factors, to the system level, which include practice culture and system functionality issues. Our multi-disciplinary investigative team acknowledges the importance of providing culturally tailored integrative healthcare to holistically concentrate on physical, mental, emotional, and behavioral problems among ethnic minorities in a primary care setting. It is our intention that the proposed model will be useful for health practitioners, contribute to the reduction of mental health disparities, and promote better mental health and well-being for ethnic minority individuals, families, and communities. PMID:25383991

  19. Improving the quality of discharge care for the homeless: a patient-centered approach. (United States)

    Greysen, S Ryan; Allen, Rebecca; Rosenthal, Marjorie S; Lucas, Georgina I; Wang, Emily A


    Homeless patients are at risk for low-quality discharge care, yet there are limited patient-centered data to guide improvement. We explored relationships between assessment of housing status by hospital staff and quality of discharge care using quantitative and qualitative data from interviews and chart reviews with 98 homeless patients: 80% male, mean homelessness 2.8 years, mean age 44. Patient-reported performance of discharge care varied substantially across seven domains from 16-75% and chart review documented lower performance than patient report. Over half (56%) were not asked about their housing status and multivariable logistic regression showed assessment of housing status was independently associated with higher performance in five domains: discussions about cost of medications, physical activity levels, diet, transportation, and mental health follow-up. Qualitative data revealed patient concerns about stigmatization from disclosure of housing status. Our findings suggest that addressing housing status in acute care settings while avoiding stigmatization may improve discharge care for homeless patients.

  20. From foundling homes to day care: a historical review of childcare in Chile

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    A Rodrigo


    Full Text Available This article discusses significant changes in childcare policy and practice in Chile. We distinguish four specific periods of childcare history: child abandonment and the creation of foundling homes in the 19th century; efforts to reduce infant mortality and the creation of the health care system in the first half of the 20th century; an increasing focus on inequality and poverty and the consequences for child development in the second half of the 20th century; and, finally, the current focus on children’s social and emotional development. It is concluded that, although Chile has achieved infant mortality and malnutrition rates comparable to those of developed countries, the country bears the mark of a history of inequality and is still unable to fully guarantee the health of children from the poorest sectors of society. Recent initiatives seek to improve this situation and put a strong emphasis on the psychosocial condition of children and their families.

  1. Integrating Palliative Care into the Care of Neurocritically Ill Patients: A Report from The IPAL-ICU (Improving Palliative Care in the Intensive Care Unit) Project Advisory Board and the Center to Advance Palliative Care (United States)

    Frontera, Jennifer A.; Curtis, J. Randall; Nelson, Judith E.; Campbell, Margaret; Gabriel, Michelle; Hays, Ross M.; Mosenthal, Anne C.; Mulkerin, Colleen; Puntillo, Kathleen A.; Ray, Daniel E.; Bassett, Rick; Boss, Renee D.; Lustbader, Dana R.; Brasel, Karen J.; Weiss, Stefanie P.; Weissman, David E.


    Objectives To describe unique features of neurocritical illness that are relevant to provision of high-quality palliative care; To discuss key prognostic aids and their limitations for neurocritical illnesses; To review challenges and strategies for establishing realistic goals of care for patients in the neuro-ICU; To describe elements of best practice concerning symptom management, limitation of life support, and organ donation for the neurocritically ill. Data Sources A search of Pubmed and MEDLINE was conducted from inception through January 2015 for all English-language articles using the term “palliative care,” “supportive care,” “end-of-life care,” “withdrawal of life-sustaining therapy,” “limitation of life support,” “prognosis,” or “goals of care” together with “neurocritical care,” “neurointensive care,” “neurological,” “stroke,” “subarachnoid hemorrhage,” “intracerebral hemorrhage,” or “brain injury.” Data Extraction and Synthesis We reviewed the existing literature on delivery of palliative care in the neurointensive care unit setting, focusing on challenges and strategies for establishing realistic and appropriate goals of care, symptom management, organ donation, and other considerations related to use and limitation of life-sustaining therapies for neurocritically ill patients. Based on review of these articles and the experiences of our interdisciplinary/interprofessional expert Advisory Board, this report was prepared to guide critical care staff, palliative care specialists, and others who practice in this setting. Conclusions Most neurocritically ill patients and their families face the sudden onset of devastating cognitive and functional changes that challenge clinicians to provide patient-centered palliative care within a complex and often uncertain prognostic environment. Application of palliative care principles concerning symptom relief, goal setting, and family emotional support, will

  2. [Initiation and consumption of psychoactive substances among adolescents and young adults in an Anti-Drug Psychosocial Care Center]. (United States)

    Silva, Carolina Carvalho; Costa, Maria Conceição Oliveira; de Carvalho, Rosely Cabral; Amaral, Magali Teresópolis Reis; Cruz, Nilma Lázara de Almeida; da Silva, Mariana Rocha


    The study seeks to characterize the initiation and consumption pattern of psychoactive substances among adolescents and young adults enrolled in an Alcohol and Drug Psychosocial Care Center (CAPS-AD). This study was conducted with records of attendance and the consumption pattern was classified in accordance with WHO: infrequent use (lifetime use, per year or up to five days per month); frequent use (6 to 19 times in the past 30 days); heavy use (≥ 20 times in the last 30 days). In the age group comparison, the test for proportion and association analysis was used and the prevalence and prevalence ratio was calculated with a significance level of 5% and 95% confidence interval. Of the total of adolescents and young adults treated between 2003 and 2008 (475), most were male, single, poorly educated, live with relations and have psychic symptoms. Statistical significance was found for age at initiation of use: adolescents compared to young adults started earlier (≤ 14 years): tobacco, marijuana, cocaine, crack and other SPA consumption. Among adolescents, significant results were found for the less frequent consumption of tobacco, more frequent use of alcohol, and heavy consumption of marijuana. These findings may contribute to the preventive and therapeutic CAPS-AD programs.

  3. [The Day Service as a tool to reduce inappropriateness of care: the experience of a research hospital in Rome (Italy)]. (United States)

    Cadeddu, Chiara; Specchia, Maria Lucia; Principi, Francesca; Marchini, Raffaele; Cerimele, Marina; Ricciardi, Walter; Cavuto, Costanza


    The Day Service was established in Italy to promote appropriateness of care and consists in the delivery of packages of complex outpatient services. A Working Group for the continuous improvement of pre-hospitalization activities of the Regina Elena Scientific Institute in Rome, Italy, established that the outpatient management of surgical patients in the hospital would occur in a Day Service, through a package of services identified at the regional level or appropriate diagnostic and therapeutic pathways. This article describes the experience of the hospital's Day Service and compares results from the last four months of 2013 with those of the first four months of 2014. The introduction of a Day Service has led to a reduction in the number of inappropriate pre-admission tests (mainly computerized tomography, magnetic resonance and Positron emission scans and scintigraphy) and this has had a positive impact not only in terms of organization, reduction of hospital stay and overall hospitalization-related activities, but also from an economic standpoint. The implementation of a Day Service has also improved the overall patient experience, from an organizational point of view, and this is an important aspect, considering that patients at the Regina Elena Scientific Institute are oncological patients, they are often elderly and most reside in other Italian regions.

  4. Creating and sustainable development of specialized centers as a way to improve quality of medical care

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    V. I. Guzeva


    Full Text Available Quality of care is evaluated on the completeness of the survey, the correct diagnosis, treatment efficacy, and its duration. Improving the quality and efficiency of medical care for children with paroxysmal disorders of consciousness is one of topical problems of neurology.Aim. The aim of the work is to justify the relationship between improving the quality of health care and sustainable development in the modern conditions of specialized medical centers on the example of the work on the identification and treatment of children with paroxysmal disorders of consciousness of the Center for diagnosis and treatment of epilepsy, and sleep disorders in children and adolescents at the department neurology, neurosurgery and medical genetics SPbGPMU.Materials and methods. For more accurate diagnosis and treatment at the Center conducted a comprehensive examination, including video-EEG оf 527 children aged 1 month to 18 years. A clinical trial study included medical cases, assessment of neurological and somatic status, the study of seizure types and forms of the disease. Instrumental methods of examination were determined by EEG and MRI studies of the brain.Main results. Comprehensive survey of sick children with monitoring video-EEG revealed that 317 children (60,1% had epileptic paroxysms and 210 children (39,8% – non-epileptic paroxysms. Correction treatment was performed in 284 (89,5% children with epileptic paroxysms and altered the treatment in 190 (90,4% children with epileptic paroxysms.Conclusion. The presented clinical data show the high effectiveness of the Centre in the diagnosis and treatment of children with paroxysmal disorders of consciousness. The accumulated experience in the Center confirms the relevance of the creation of the structure of scientific and educational institutions specialized centers in which patients will be given to high-quality medical care.

  5. A designated centre for people with disabilities operated by St Aidan's Day Care Centre Ltd., Wexford

    LENUS (Irish Health Repository)

    Gibbons, C


    Ireland has seen a steady increase in paediatric sickle cell disease (SCD). In 2005, only 25% of children with SCD were referred to the haemoglobinopathy service in their first year. A non-funded screening programme was implemented. This review aimed to assess the impact screening has had. All children referred to the haemoglobinopathy service born in Ireland after 2005 were identified. Data was collected from the medical chart and laboratory system. Information was analysed using Microsoft Excel. 77 children with SCD were identified. The median age at antibiotic commencement in the screened group was 56 days compared with 447 days in the unscreened group, p = < 0.0003. 22 (28%) of infants were born in centre\\'s that do not screen and 17 (81%) were over 6 months old at referral, compared with 14 (21%) in the screened group. 6 (27%) of those in the unscreened group presented in acute crisis compared with 2 (3%) in the screened population. The point prevalence of SCD in Ireland is 0.2% in children under 15 yr of African and Asian descent. We identified delays in referral and treatment, which reflect the lack of government funded support and policy. We suggest all maternity units commence screening for newborns at risk of SCD. It is a cost effective intervention with a number needed to screen of just 4 to prevent a potentially fatal crisis.

  6. Diagnosis and treatment outcome of mycotic keratitis at a tertiary eye care center in eastern india

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    Rautaraya Bibhudutta


    Full Text Available Abstract Background Mycotic keratitis is an important cause of corneal blindness world over including India. Geographical location and climate are known to influence the profile of fungal diseases. While there are several reports on mycotic keratitis from southern India, comprehensive clinico-microbiological reports from eastern India are few. The reported prevalence of mycotic keratitis are 36.7%,36.3%,25.6%,7.3% in southern, western, north- eastern and northern India respectively. This study reports the epidemiological characteristics, microbiological diagnosis and treatment outcome of mycotic keratitis at a tertiary eye care center in eastern India. Methods A retrospective review of medical and microbiology records was done for all patients with laboratory proven fungal keratitis. Results Between July 2006 and December 2009, 997 patients were clinically diagnosed as microbial keratitis. While no organisms were found in 25.4% (253/997 corneal samples, 23.4% (233/997 were bacterial, 26.4% (264/997 were fungal (45 cases mixed with bacteria, 1.4% (14/997 were Acanthamoeba with or without bacteria and 23.4% (233/997 were microsporidial with or without bacteria. Two hundred fifteen of 264 (81.4%, 215/264 samples grew fungus in culture while 49 corneal scrapings were positive for fungal elements only in direct microscopy. Clinical diagnosis of fungal keratitis was made in 186 of 264 (70.5% cases. The microscopic detection of fungal elements was achieved by 10% potassium hydroxide with 0.1% calcoflour white stain in 94.8%(238/251 cases. Aspergillus species (27.9%, 60/215 and Fusarium species (23.2%, 50/215 were the major fungal isolates. Concomitant bacterial infection was seen in 45 (17.1%, 45/264 cases of mycotic keratitis. Clinical outcome of healed scar was achieved in 94 (35.6%, 94/264 cases. Fifty two patients (19.7%, 52/264 required therapeutic PK, 9 (3.4%, 9/264 went for evisceration, 18.9% (50/264 received glue application with bandage

  7. Food Consumption and Nutrient Intake by Children Aged 10 to 48 Months Attending Day Care in The Netherlands

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    R. Alexandra Goldbohm


    Full Text Available The diet of young children is an important determinant of long-term health effects, such as overweight and obesity. We analyzed two-day food consumption records from 1526 young children (10–48 months old attending 199 daycare centers across The Netherlands. Data were observed and recorded in diaries by caregivers at the day nursery and by parents at home on days that the children attended the daycare center. According to national and European reference values, the children had an adequate nutrient intake with exception of low intakes of total fat, n-3 fatty acids from fish and possibly iron. Intakes of energy and protein were substantially higher than recommended and part of the population exceeded the tolerable upper intake levels for sodium, zinc and retinol. Consumption of fruit, fats, fish, and fluids was substantially less than recommended. The children used mostly (semi-skimmed milk products and non-refined bread and cereals, as recommended. Two thirds of the consumed beverages, however, contained sugar and contributed substantially to energy intake. In young children, low intakes of n-3 fatty acids and iron are a potential matter of concern, as are the high intakes of energy, protein, sugared beverages, and milk, since these may increase the risk of becoming overweight.

  8. [Work as a source of pleasure: evaluating a Psychosocial Care Center team]. (United States)

    Glanzner, Cecília Helena; Olschowsky, Agnes; Kantorski, Luciane Prado


    The objective of this study was to evaluate the pleasure at work felt by the members of a Psychosocial Care Center team. This qualitative case study used Forth Generation Evaluation. This study was performed in Foz do Iguaçu, Parana, Brazil, in November and December 2006. Participants were 10 tem members. Data collection was performed through observation and individual interviews. The analysis was initiated at the same time as the data collection, and the final analysis was performed as per the following steps: data ordering, classification and final analysis. The following analysis themes were developed: work characteristics at the psychological care center, suffering and coping with suffering at work. During the evaluation, the participants showed pleasure and fulfillment with their work by expressing pride, fulfillment and appreciation of what they deliver. Pleasure occurs during the development of psychosocial care, because they always have the freedom to rearrange their manner of working, making possible to develop activities and attitudes capable of giving them pleasure.

  9. Physical activity in child-care centers: do teachers hold the key to the playground? (United States)

    Copeland, Kristen A; Kendeigh, Cassandra A; Saelens, Brian E; Kalkwarf, Heidi J; Sherman, Susan N


    Many (56%) US children aged 3-5 years are in center-based childcare and are not obtaining recommended levels of physical activity. In order to determine what child-care teachers/providers perceived as benefits and barriers to children's physical activity in child-care centers, we conducted nine focus groups and 13 one-on-one interviews with 49 child-care teachers/providers in Cincinnati, OH. Participants noted physical and socio-emotional benefits of physical activity particular to preschoolers (e.g. gross motor skill development, self-confidence after mastery of new skills and improved mood, attention and napping after exercise) but also noted several barriers including their own personal attitudes (e.g. low self-efficacy) and preferences to avoid the outdoors (e.g. don't like hot/cold weather, getting dirty, chaos of playground). Because individual teachers determine daily schedules and ultimately make the decision whether to take the children outdoors, they serve as gatekeepers to the playground. Participants discussed a spectrum of roles on the playground, from facilitator to chaperone to physical activity inhibitor. These findings suggest that children could have very different gross motor experiences even within the same facility (with presumably the same environment and policies), based on the beliefs, creativity and level of engagement of their teacher.

  10. Incidence of diabetes mellitus type 2 complications among Saudi adult patients at primary health care center. (United States)

    Alsenany, Samira; Al Saif, Amer


    [Purpose] This study analyzed type 2 diabetes and its role in complications among adult Saudi patients. [Subjects] Patients attending four primary health care centers in Jeddah were enrolled. [Methods] A cross-sectional design study among Saudi patients attending Ministry of Health primary health care centers in Jeddah was selected for use by the Primary Health Care administration. Patients were interviewed with structured questionnaires to determine the presence of diabetes and risk factors using questions about the history of any disease. [Results] Diabetes mellitus was present in 234 subjects during the data collection period (March-June 2014). Mean patient age was 58 years; diabetes prevalence was 42% in males and 58% in females. The mean age for diabetes onset in males and females was 34 and 39 years, respectively. There was a higher incidence of obesity (75%) associated with a sedentary lifestyle (body mass index ≥25) in females (N= 96; 40%) compared with males (N= 87; 36%). In this study, >44% of individuals aged 55 or older had severe to uncontrolled diabetes with long-term complications. The age-adjusted incidence of hypertension and coronary heart disease was 38% and 24%, respectively, showing a clear incidence of diabetes associated with cardiovascular disease in Saudi Arabia. [Conclusion] This study found that a multifactorial approach to managing diabetes complication risks is needed.

  11. Survey of Wound-Healing Centers and Wound Care Units in China. (United States)

    Jiang, Yufeng; Xia, Lei; Jia, Lijing; Fu, Xiaobing


    The purpose of this study is to report the Chinese experience of establishing hospital-based wound care centers over 15 years. A total of 69 wound-healing centers (WHCs) and wound care units (WCUs) were involved. Questionnaires were diverged to the principal directors of these sites; data extracted for this study included origin, year of establishment, medical staff, degree of hospitals, wound etiology, wound-healing rate, hospital stay, and outcomes data. The period of data extraction was defined as before and after 1 year of the establishment of WHCs and WCUs. The earliest WHC was established in 1999, and from 2010 the speeds of establishing WHCs and WCUs rapidly increased. The majority of WHCs were divisions of burn departments, and all WHCs came from departments of outpatient dressing rooms. Full-time multidisciplinary employees of WHCs differed greatly to WCUs. Types of wound and outcomes vary with those of centers reported from Western countries and the United States. Improvement in wound healing caused by the establishment of WHCs and WCUs in China occurred without doubt. Some advices include the following: rearrange and reorganize the distribution of WHCs and WCUs; enact and generalize Chinese guidelines for chronic wounds; utilize medical resources reasonably; improve multidisciplinary medical staff team; draw up and change some medical and public policies and regulations.

  12. Stress ulcer prophylaxis guidelines:Are they being implemented in Lebanese health care centers?

    Institute of Scientific and Technical Information of China (English)

    Abeer; Zeitoun; Maya; Zeineddine; Hani; Dimassi


    AIM:To evaluate the current practice of stress ulcer prophylaxis (SUP) in Lebanese Health care centers.METHODS:A multi-center prospective chart review study was conducted over 8 mo.A questionnaire was distributed to pharmacy students who collected data on demographics,SUP medications,dose,route,duration and associated risk factors.The appropriateness of SUP use was determined as per American Society of Health-System Pharmacists guidelines.Institutional review board approval was obtained from each hospital center.RESULTS:A total of 1004 patients were included.67% of the patients who received prophylaxis did not have an indication for SUP.The majority (71.6%) of the patients who were administered parenteral drugs can tolerate oral medications.Overall,the regimen of acid-suppressant drugs was suboptimal in 87.6% of the sample.This misuse was mainly observed in non-teaching hospitals.CONCLUSION:This study highlighted the need,in Lebanese hospitals,to establish clinical practice guidelines for the use of SUP;mainly in non-critical care settings.

  13. Maternal and Neonatal Outcomes of Women with Preeclampsia and Eclampsia at a Tertiary Care Center

    Directory of Open Access Journals (Sweden)

    Hediye Dağdeviren


    Full Text Available Aim: Preeclampsia is a multisystem disorder of unknown etiology and one of the leading causes of maternal, fetal and neonatal mortality and morbidity. Adverse outcomes can be improved by early identification of the disease and timely referral to a tertiary center. The aims of this study were to evaluate the outcomes of preeclampsia-eclampsia cases and share our experiences in a tertiary center. Methods: The study conducted by retrospectively analyzing the data of 350 women who gave birth between 2008 and 2013 at a tertiary care center. Results: The mean age of the enrolled women was 35 years, the mean gestational age at delivery-36 weeks, the mean birth weight-2.73 kg, and the mean platelet count was 204.000/ mm3. The incidence of preterm deliveries was 66.6%. Severe preeclampsia was noted in 29.4% of cases. Neonatal intensive care unit admissions were seen in 10.6% of cases. A total of 22.9% of these women had vaginal deliveries, while the other 77.1% underwent cesarean section. High systolic blood pressure and elevated serum alanine and aspartate aminotransferase values had significant independent effects of differentiating between mild and severe preeclampsia. Conclusion: Fetomaternal morbidity and mortality rates associated with hypertensive disorders are alarming, especially in developing countries. As such, the high-risk obstetric population should be screened earlier in pregnancy. A system allowing early referral in these cases should be created. (The Medical Bulletin of Haseki 2015; 53:143-6

  14. Designing a patient-centered personal health record to promote preventive care

    Directory of Open Access Journals (Sweden)

    Krist Alex H


    Full Text Available Abstract Background Evidence-based preventive services offer profound health benefits, yet Americans receive only half of indicated care. A variety of government and specialty society policy initiatives are promoting the adoption of information technologies to engage patients in their care, such as personal health records, but current systems may not utilize the technology's full potential. Methods Using a previously described model to make information technology more patient-centered, we developed an interactive preventive health record (IPHR designed to more deeply engage patients in preventive care and health promotion. We recruited 14 primary care practices to promote the IPHR to all adult patients and sought practice and patient input in designing the IPHR to ensure its usability, salience, and generalizability. The input involved patient usability tests, practice workflow observations, learning collaboratives, and patient feedback. Use of the IPHR was measured using practice appointment and IPHR databases. Results The IPHR that emerged from this process generates tailored patient recommendations based on guidelines from the U.S. Preventive Services Task Force and other organizations. It extracts clinical data from the practices' electronic medical record and obtains health risk assessment information from patients. Clinical content is translated and explained in lay language. Recommendations review the benefits and uncertainties of services and possible actions for patients and clinicians. Embedded in recommendations are self management tools, risk calculators, decision aids, and community resources - selected to match patient's clinical circumstances. Within six months, practices had encouraged 14.4% of patients to use the IPHR (ranging from 1.5% to 28.3% across the 14 practices. Practices successfully incorporated the IPHR into workflow, using it to prepare patients for visits, augment health behavior counseling, explain test results

  15. Day care PNL using ‘Santosh-PGI hemostatic seal’ versus standard PNL: A randomized controlled study (United States)

    Singh, Shivanshu; Singh, Prashant; Singh, Shrawan Kumar


    Introduction To compare the outcomes of tubeless day care PNL using hemostatic seal in the access tract versus standard PNL. Material and methods It was a prospective randomized controlled study. Cases were randomized to either the day care group with hemostatic seal (DCS) or the control group where patients were admitted and a nephrostomy tube was placed at the conclusion of surgery. Results A total of 180 cases were screened and out of these, 113 were included in the final analysis. The stone clearance rates were comparable in both the groups. The mean drop in hemoglobin was significantly lower in DCS group than the control group (1.05 ±0.68 vs. 1.30 ±0.58 gm/dl, p = 0.038).Mean postoperative pain score, analgesic requirement (paracetamol) and duration of hospital stay were also significantly lower in the DCS group (3.79 ±1.23 vs. 6.12 ±0.96, 1.48 ±0.50 vs. 4.09 ±1.11 grams and 0.48 ±0.26 vs. 4.74 ±1.53 days respectively; p PNL with composite hemostatic tract seal is considered safe. It resulted in a significant reduction of blood loss and analgesic requirement with significantly reduced hospital stay, nephrostomy tube site morbidity and time required to resume normal activity when compared to the standard PNL. However, patients must be compliant with the given instructions and should have access to a health care facility, as few of them may need re-admission. PMID:27551557

  16. An Integrated Model of Care: A Visit to The SPARK Center, a Program of Boston Medical Center (United States)

    Griest, Christa


    This article features The SPARK Center, a program of Boston Medical Center, located in Mattapan, Massachusetts. The Center has pioneered a whole-child approach to address the multi-dimensional needs of Boston's most at-risk children, recognizing that vulnerable children need more than educational supports to flourish. The Center's integrated model…

  17. "WhatsApp"ening in orthopedic care: a concise report from a 300-bedded tertiary care teaching center. (United States)

    Khanna, Vishesh; Sambandam, Senthil N; Gul, Arif; Mounasamy, Varatharaj


    Smartphones have emerged as essential tools providing assistance in patient care, monitoring, rehabilitation, communication, diagnosis, teaching, research and reference. Among innumerable communication apps, WhatsApp has been widely popular and cost effective. The aim of our study was to report the impact of introduction of a smartphone app "WhatsApp" as an intradepartmental communication tool on (1) awareness of patient-related information, (2) efficiency of the handover process and (3) duration of traditional morning handovers among orthopedic residents in a 300-bedded tertiary care teaching center. Written handovers and paging used for communication at our center led to occasional inefficiencies among residents. Widespread use, low cost, availability and double password protection (phone lock and WhatsApp lock) made WhatsApp's group conversation feature an ideal tool for intradepartmental patient-related communication. Twenty-five consecutive admissions before and after WhatsApp (BW, AW) were included in the study. Eight orthopedic residents attempted fifty randomly arranged questions based on the twenty-five patients in each study period. A null hypothesis that introduction of WhatsApp group would neither increase the awareness of patient-related information nor improve the efficiency of the handovers among residents was assumed. A significant improvement observed in scores obtained by residents in the AW group led to rejection of the null hypothesis. The residents also reported swifter and efficient handovers after the introduction of WhatsApp. Our results indicate that the introduction of a smartphone app "WhatsApp" as an intradepartmental communication tool can bring about an improvement in patient-related awareness, communication and handovers among orthopedic residents.

  18. Doors are opening at children’s day-care centre at Champs-Fréchets

    CERN Multimedia

    HR Department


    Opened in August 2008, this new centre offers day-care for children between the ages of 4 months and 4 years. Following an agreement with CERN, up to 20 places are reserved for members of the CERN personnel. The commune of Meyrin invites interested parents to come and visit the centre on Saturday 11 October 2008 from 10 a.m. to 4 p.m. Address : 69, rue des Lattes -1217 Meyrin Further information on the agreement with CERN:

  19. Effectiveness of person-centered care on people with dementia: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Kim SK


    Full Text Available Sun Kyung Kim, Myonghwa Park Education and Research Center for Evidence Based Nursing Knowledge, College of Nursing, Chungnam National University, Daejeon, Republic of Korea Background: Person-centered care is a holistic and integrative approach designed to maintain well-being and quality of life for people with dementia, and it includes the elements of care, the individual, the carers, and the family.Aim: A systematic literature review and meta-analysis were undertaken to investigate the effectiveness of person-centered care for people with dementia.Methods: Literature searches were undertaken using six databases including Medline, EMBASE, CINAHL, PsycINFO, Cochrane Database, and KoreaMed using the following keywords: cognition disorder, dementia, person-centered care, patient-centered care, client-centered care, relationship-centered care, and dementia care. The searches were limited to interventional studies written in English and Korean and included randomized controlled studies and noncontrolled studies for people with dementia living in any setting.Results: Nineteen interventional studies, including 3,985 participants, were identified. Of these, 17 studies were from long-term care facilities and two studies were from homecare settings. The pooled data from randomized controlled studies favored person-centered care in reducing agitation, neuropsychiatric symptoms, and depression and improving the quality of life. Subgroup analysis identified greater effectiveness of person-centered care when implemented for people with less severe dementia. For agitation, short-term interventions had a greater effect (standardized mean difference [SMD]: -0.434; 95% conference interval [CI]: -0.701 to -0.166 than long-term interventions (SMD: -0.098; 95% CI: -0.190 to 0.007. Individualized activities resulted in a significantly greater beneficial effect than standard care (SMD: 0.513; 95% CI: -0.994 to -0.032. However, long-term, staff education, and

  20. Consumer-Centered, Collaborative, and Comprehensive Care: The Core Essentials of Recovery-Oriented System of Care. (United States)

    DiClemente, Carlo C; Norwood, Amber E Q; Gregory, W Henry; Travaglini, Letitia; Graydon, Meagan M; Corno, Catherine M


    Recovery from substance abuse and mental health disorders represents a journey through which individuals move beyond treatment of provider-identified problems toward a path of achieving wellness and productive lives. Overcoming obstacles and barriers encountered along the recovery process, individuals reveal their own strengths and resilience necessary to cope, survive, and thrive in the face of adversity. Recovery-oriented system of care (ROSC) is a framework designed to address the multidimensional nature of recovery by creating a system for coordinating multiple systems, services, and supports that are person centered and build on the strengths and resiliencies of individuals, families, and communities. As is common knowledge among substance abuse and mental health providers, consumers often present with high rates of comorbidity, which complicates care. In addition, behavioral health consumers engage in risky health behaviors (e.g., smoking) at a disproportionate rate, which places them at increased risk for developing noncommunicable diseases. ROSCs are ideal for addressing the complicated and varied needs of consumers as they progress toward wellness. The challenges of creating an ROSC framework that is effective, efficient, and acceptable to consumers is formidable. It requires change on the part of agencies, organizations, providers, and consumers. The importance of comprehensive, integrated screening is highlighted as a critical component of ROSC. Key suggestions for initiating ROSC are offered.