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"DAY CARE"
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Childcare markets : can they deliver an equitable service?
This text brings together recent policy relevant research from seven nations operating childcare markets, allowing comparisons between privatisation and marketisation processes of early childcare education and care services.
Book
Day-patient treatment after short inpatient care versus continued inpatient treatment in adolescents with anorexia nervosa (ANDI): a multicentre, randomised, open-label, non-inferiority trial
In-patient treatment (IP) is the treatment setting of choice for moderately-to-severely ill adolescents with anorexia nervosa, but it is costly, and the risks of relapse and readmissions are high. Day patient treatment (DP) is less expensive and might avoid problems of relapse and readmission by easing the transition from hospital to home. We investigated the safety and efficacy of DP after short inpatient care compared with continued IP.
For this multicentre, randomised, open-label, non-inferiority trial, we enrolled female patients (aged 11–18 years) with anorexia nervosa from six centres in Germany. Patients were eligible if they had a body-mass index (BMI) below the tenth percentile and it was their first admission to hospital for anorexia nervosa. We used a computer-generated randomisation sequence to randomly assign patients to continued IP or DP after 3 weeks of inpatient care (1:1; stratified for age and BMI at admission). The treatment programme and treatment intensity in both study groups were identical. The primary outcome was the increase in BMI between the time of admission and a 12-month follow-up adjusted for age and duration of illness (non-inferiority margin of 0·75 kg/m2). Analysis was done by modified intention to treat. This trial is registered with the International Standard Randomised Controlled Trial Number Register, number ISRCTN67783402, and the Deutsches Register Klinischer Studien, number DRKS00000101.
Between Feb 2, 2007, to April 27, 2010, we screened 660 patients for eligibility, 172 of whom we randomly allocated to treatment: 85 to IP and 87 to DP. DP was non-inferior to IP with respect to the primary outcome, BMI at the 12-month follow-up (mean difference 0·46 kg/m2 in favour of DP (95% CI, −0·11 to 1·02; pnon-inferiority<0·0001). The number of treatment-related serious adverse events was similar in both study groups (eight in the IP group, seven in the DP group). Three serious adverse events in the IP group and two in the DP group were related to suicidal ideation; one patient in the DP attempted suicide 3 months after she was discharged.
DP after short inpatient care in adolescent patients with non-chronic anorexia nervosa seems no less effective than IP for weight restoration and maintenance during the first year after admission. Thus, DP might be a safe and less costly alternative to IP. Our results justify the broad implementation of this approach.
German Ministry for Education and Research.
Journal Article
A bone to pick
\"In this sixth book, the Dog Club is busier than ever---and headed right for its first big fight! Sasha doesn't think it's fair that she's stuck answering calls and emails while Kim, Taylor, and Bri don't have to worry about the business side of the Club. But when she tries to speak up, the other girls don't get it. Now they're mad at Sasha...and it feels like the Dog Club is about to fall apart!\"--Provided by Google.
Book
Understanding the implementation process of the Adult Day Services Plus program
Background
Among the available evidence-based interventions targeting dementia family caregivers, there is limited evidence on implementation processes that produce desired outcomes (i.e., reductions in depression and burden) for caregivers, people living with dementia (PLWD), and community-based programs themselves. In a national multi-site hybrid effectiveness trial, we investigated the implementation success and challenges of embedding an evidence-based intervention (ADS Plus) targeting dementia family caregivers whose PLWD was enrolled in an adult day service (ADS).
Methods
Informed by the Consolidated Framework for Implementation Research, we conducted a directed qualitative content analysis to understand caregiver (
n
= 15) and staff (
n
= 14) perceptions of facilitators of and potential barriers to implementation of ADS Plus in nine ADS programs to guide future dissemination efforts.
Results
Results demonstrated that successful delivery of ADS Plus was achieved through intervention adaptability, personalization, and structure (innovation); responsiveness of ADS Plus to external changes and intervention marketability (outer domain); presence of aligned goals and familiarity (inner setting); involvement of research staff, connections among practitioners, and meeting caregiver needs (individual domain); and understanding caregivers’ needs and addressing staff capacity to take action (implementation process). This adaptability reassures us of the potential to implement ADS Plus in heterogeneous programmatic settings.
Conclusion
Globally, our results demonstrate that ADS Plus offers a viable community-based solution for supporting dementia family caregivers with high implementation potential for diverse ADS settings.
Trial registration
ClinicalTrials.gov ID: NCT02927821 (Registration Date 10/7/2016).
Journal Article
The impact of attending day care designed for home-dwelling people with dementia on nursing home admission: a 24-month controlled study
Background
Day care services offer meaningful activities, a safe environment for attendees and respite for family caregivers while being expected to delay the need for nursing home (NH) admission. However, previous research has shown inconsistent results regarding postponement of NH admission. The objective of the study was to explore the influence of a day care programme designed for home-dwelling people with dementia on NH admission.
Method
A quasi-experimental trial explored the proportion of patients permanently admitted to nursing homes after 24 months as the main outcome by comparing a group of day care attendees (DG) and a group of participants without day care (CG). In all, 257 participants were included (181 in DG and 76 in CG). A logistic regression model was developed with NH admission as the outcome. Participant group (DG or CG) was the main predictor, baseline patient and family caregiver characteristics and interactions were used as covariates.
Results
The mean age of participants was 81.5 (SD 6.4), 65% were women and 53% lived alone. The mean MMSE score was 20.4 (SD 3.5). In all, 128 (50%) of the participants were admitted to a nursing home by the 24-month follow-up, 63 participants (25%) completed the follow-up assessment and 66 (26%) dropped out due to death (8%) and other reasons (18%). In the logistic unadjusted regression model for NH admission after 24 months, participant group (DG or CG) was not found to be a significant predictor of NH admission. The results from the adjusted model revealed that the participant group was associated with NH admission through the interactions with age, living conditions, affective symptoms, sleep symptoms and practical functioning, showing a higher probability for NH admission in DG compared to CG.
Conclusion
The study reveals no evidence to confirm that day care services designed for people with dementia postpone the need for NH admission. Admission to nursing homes seems to be based on a complex mix of personal and functional characteristics both in the person with dementia and the family caregivers. The findings should be considered in accordance with the limitation of inadequate power and the high drop-out rate.
Trial registration
The study is registered in Clinical Trials (
NCT01943071
).
Journal Article
A band of babies
When Benny arrives at day care, where the babies are bored, he finds the instruments and soon they are off on a musical journey to the store for a snack.
Book
Managing Infectious Diseases in Child Care and Schools
This guide provides child care directors, teachers, and caregivers with essential information on infectious diseases in group care settings. It includes a robust section of more than 55 quick reference fact sheets on common infectious diseases and symptoms. Additionally, it includes forms that can be photocopied and used with families. As always, the reference is easy to use, providing clear, authoritative information on infectious diseases.
eBook
ECERS-E : the four curricular subscales extension to the early childhood environment rating scale (ECERS-R)
Using the ECERS-E along with the ECERS-R gives users a more complete picture of what a high quality early childhood education program can look like.
Book
Status of Beverages Served to Young Children in Child Care After Implementation of California Policy, 2012–2016
Since 2012, licensed California child care centers and homes, per state policy, are required to serve only unflavored low-fat or nonfat milk to children aged 2 years or older, no more than one serving of 100% juice daily, and no beverages with added sweeteners, and they are required to ensure that drinking water is readily accessible throughout the day. We evaluated adherence to the policy after 4 years in comparison to the adherence evaluation conducted shortly after the policy went into effect.
Licensed California child care sites were randomly selected in 2012 and 2016 and surveyed about beverage practices and provisions to children aged 1-5 years. We used logistic regression to analyze between-year differences for all sites combined and within-year differences by site type and participation in the federal Child and Adult Care Food Program (CACFP) in self-reported policy adherence and beverage provisions.
Respondents in 2016 (n = 680), compared with those in 2012 (n = 435), were more adherent to California's 2010 Healthy Beverages in Child Care Act overall (45.1% vs 27.2%, P < .001) and with individual provisions for milk (65.0% vs 41.4%, P < .001), 100% juice (91.2% vs 81.5%, P < .001), and sugar-sweetened beverages (97.4% vs 93.4%, P = .006). In 2016, centers compared with homes (48.5% vs 28.0%, P = .001) and CACFP sites compared with non-CACFP sites (51.6% vs 27.9%, P < .001) were more adherent to AB2084 overall.
Beverage policy adherence in California child care has improved since 2012 and is higher in CACFP sites and centers. Additional policy promotion and implementation support is encouraged for non-CACFP sites and homes. Other states should consider adopting such policies.
Journal Article