Day Care Settings Research Articles

Fluoroscopy-Guided Implantation of Subacromial “Biodegradable Spacer” Using Local Anesthesia in Patients With Irreparable Rotator Cuff Tear

Treatment of massive rotator cuff tears can be challenging, especially when tears are considered irreparable or, when repaired, at significant risk of retear. A surgical technique is described using a biodegradable subacromial balloon-shaped spacer (InSpace; Ortho-Space, Caesarea, Israel) that, when implanted between the humeral head and acromion, permits smooth, frictionless gliding, supporting shoulder biomechanics. The specific insertion technique described herein is a simple procedure that can be performed in a day-care or outpatient setting with patients under local anesthesia, thus providing a treatment option for patients with multiple comorbidities complicating or contraindicating surgery, such as reverse arthroplasty under general anesthesia.

Observation-projet: a professional tool for caregivers. Two experiences in Italian day-care settings

ABSTRACTAbility to reflect on practice is a key element of early childhood professionalism and is positively associated with the quality of educational services. Observation-Projet (Fontaine 2008, 2011b) is a method designed to support practitioners’ reflection through the observational process. The method adapts the required scientific procedures to the concrete demands faced by practitioners in their everyday activities. The article presents the results of two projects developed to teach the practitioners the use of Observation-Projet. The principal aim of Study 1 was to explore how the space was currently used by the children and to intervene on adults’ position to enhance children's use of space. In Study 2, the caregivers chose to focus on the organisation of afternoon activities, a time of the day identified as difficult to manage, reducing the number of children per play group and better organising the type of activities offered to children. The results confirm both the intervention efficacy and the Observation-Projet effectiveness as an instrument for reflecting and intervening on educational contexts.

The colic experience

With more and more babies entering the care of childminders and daycare settings, practitioners need to be able to provide support and advice for parents on a range of different conditions, such as colic.

Influenza vaccination and treatment in children with neurologic disorders.

Influenza viruses cause substantial morbidity in children each year, especially among children with specific chronic conditions. In particular, neurologic disorders have emerged as a strong risk factor for influenza-related complications. Children with these disorders may be vulnerable due to diminished respiratory muscle strength, decreased muscle tone or impaired mobility, which can compromise pulmonary function and the ability to handle secretions. Although they represent a small fraction of the general pediatric population, children with neurologic disorders make up a disproportionately high number of those children who are hospitalized and die as a result of influenza-associated complications. Annual vaccination is the most effective way to prevent influenza and its complications, and is recommended for all children 6 months through 18 years of age, including children with neurologic disorders. Family members and those who work with these children in institutional, educational and daycare settings should also be vaccinated against influenza annually. However, there have been few studies of influenza vaccination specifically in this population. In addition, vaccine effectiveness may vary from year to year and vaccination will not prevent all infections. Early empiric antiviral treatment should be started promptly in these children if they present to healthcare providers with symptoms suspicious for influenza. This article reviews influenza epidemiology in children with neurologic disorders and what is known about vaccines and other methods of protecting this vulnerable population from influenza-related complications.

Food Allergy In Daycare Centers: Prevalence, Management, and Knowledge Of Directors

RationaleFood allergy (FA) affects 6-8% of children, with young children affected the most. FA reactions may commonly occur at daycares; however, little is known about FA knowledge and preparation in daycare settings.MethodsIRB approval was obtained to distribute a 43 item web-based questionnaire to daycare directors around Cleveland, OH. Fisher exact tests calculated associations between daycare characteristics and responses.Results29/81 (36%) questionnaires were completed. 41.3% from national chains, 48.2% single sites, 10.3% local chains. Of 3,155 children, 6.8% had reported FA. Peanut was most common (3.1%), then milk (2.7%), tree nut (1.6%), egg (1.2%). All centers accepted children with FAs. 69% restricted peanuts. All centers had training on epinephrine administration; most had formal training on FAs (82.8%). 93.1% had FA Action Plans. Only 51.7% had epinephrine for each child. One center reported a generic epinephrine available for a first reaction; 24% would administer another child’s epinephrine to a child having a severe reaction. The majority answered general knowledge questions correctly. National chains vs. single sites (p=0.047) and peanut-free centers (p=0.05) were more likely to have epinephrine available.ConclusionsThis web-based questionnaire on FAs in daycares found that all centers had at least one child with FA. The directors’ knowledge about FAs was high. Only half of centers had epinephrine available for each child with FA. The availability of a generic epinephrine was rare and most would not administer another child’s epinephrine in an emergency. National chains and peanut-free centers were more likely to have epinephrine available, which may be helpful for patient counseling. RationaleFood allergy (FA) affects 6-8% of children, with young children affected the most. FA reactions may commonly occur at daycares; however, little is known about FA knowledge and preparation in daycare settings. Food allergy (FA) affects 6-8% of children, with young children affected the most. FA reactions may commonly occur at daycares; however, little is known about FA knowledge and preparation in daycare settings. MethodsIRB approval was obtained to distribute a 43 item web-based questionnaire to daycare directors around Cleveland, OH. Fisher exact tests calculated associations between daycare characteristics and responses. IRB approval was obtained to distribute a 43 item web-based questionnaire to daycare directors around Cleveland, OH. Fisher exact tests calculated associations between daycare characteristics and responses. Results29/81 (36%) questionnaires were completed. 41.3% from national chains, 48.2% single sites, 10.3% local chains. Of 3,155 children, 6.8% had reported FA. Peanut was most common (3.1%), then milk (2.7%), tree nut (1.6%), egg (1.2%). All centers accepted children with FAs. 69% restricted peanuts. All centers had training on epinephrine administration; most had formal training on FAs (82.8%). 93.1% had FA Action Plans. Only 51.7% had epinephrine for each child. One center reported a generic epinephrine available for a first reaction; 24% would administer another child’s epinephrine to a child having a severe reaction. The majority answered general knowledge questions correctly. National chains vs. single sites (p=0.047) and peanut-free centers (p=0.05) were more likely to have epinephrine available. 29/81 (36%) questionnaires were completed. 41.3% from national chains, 48.2% single sites, 10.3% local chains. Of 3,155 children, 6.8% had reported FA. Peanut was most common (3.1%), then milk (2.7%), tree nut (1.6%), egg (1.2%). All centers accepted children with FAs. 69% restricted peanuts. All centers had training on epinephrine administration; most had formal training on FAs (82.8%). 93.1% had FA Action Plans. Only 51.7% had epinephrine for each child. One center reported a generic epinephrine available for a first reaction; 24% would administer another child’s epinephrine to a child having a severe reaction. The majority answered general knowledge questions correctly. National chains vs. single sites (p=0.047) and peanut-free centers (p=0.05) were more likely to have epinephrine available. ConclusionsThis web-based questionnaire on FAs in daycares found that all centers had at least one child with FA. The directors’ knowledge about FAs was high. Only half of centers had epinephrine available for each child with FA. The availability of a generic epinephrine was rare and most would not administer another child’s epinephrine in an emergency. National chains and peanut-free centers were more likely to have epinephrine available, which may be helpful for patient counseling. This web-based questionnaire on FAs in daycares found that all centers had at least one child with FA. The directors’ knowledge about FAs was high. Only half of centers had epinephrine available for each child with FA. The availability of a generic epinephrine was rare and most would not administer another child’s epinephrine in an emergency. National chains and peanut-free centers were more likely to have epinephrine available, which may be helpful for patient counseling.

Development and change in disabled children’s social participation assessed by parents in Norwegian daycare centres: 1999–2009

The aim of this paper is to explore if there is any alteration in social participation with peers assessed by parents amongst children with disabilities from 1999 to 2009 and discuss the results in light of the developments in disability policies during the last decades, and internal developments in education/welfare policies regarding children under compulsory school age. We address changes in levels of social participation of children with disabilities in daycare centres and examine changes in mechanisms leading to social participation with peers from 1999 to 2009. The analysis is based on cross-sectional data of two representative samples of disabled children 10 years apart. The main finding of this study is that disabled children have increased their social participation with peers in the period from 1999 to 2009. Gender, age and being in a segregated daycare setting, all had a significant impact on social participation with peers in 1999, but had lost their significance in 2009. The current study found that Norwegian daycare centres still have to be considered as social integrating institutions, even though in the period from 1999 to 2009, they have changed from being a care- and family-supportive service to become a pedagogical service preparing children for school.

What is important in rehabilitation for persons with epilepsy? Experiences from focus group interviews with patients and staff

This study aimed to identify the issues experienced as essential in rehabilitation for persons with epilepsy. Six focus group interviews were conducted, five groups with patients that had completed comprehensive rehabilitation for persons with epilepsy, in a day-care setting, at the Neurological Rehabilitation Clinic at Stora Sköndal Hospital, between 2006 and 2009 (total n=17) and one group with staff members (n=5). Using content analysis, two themes emerged: life with epilepsy and rehabilitation experiences. The result emphasizes that rehabilitation for persons with epilepsy should be designed individually, in structure and in content. Encounters between patients were important, as well as the team's attitude in meeting with the patients. Therapeutic working alliance is essential between patients and staff for creating an individual rehabilitation.

Observational study to assess pregnant women’s knowledge and behaviour to prevent toxoplasmosis, listeriosis and cytomegalovirus

BackgroundToxoplasmosis, listeriosis and cytomegalovirus (CMV) can negatively affect pregnancy outcomes, but can be prevented by simple precautions of pregnant women. Literature suggests that pregnant women are not always adequately informed by their care provider about preventable infectious diseases and most pregnant women have a low level of knowledge regarding these topics. There is not much information about the actual risk behaviour of pregnant women. The purpose of this study was to assess knowledge and risk behaviour related to toxoplasmosis, listeriosis and CMV infection prevention in pregnant women.MethodsA cross-sectional survey among pregnant women from twenty midwifery practices across the Netherlands that participated in the DELIVER study, between October 2010 and December 2010. The questionnaire items covered respondents’ knowledge of preventive practices in general, risk behaviour, and sources of received information.ResultsOf the 1,097 respondents (response 66.0%), 75.3% had heard, read or seen information about toxoplasmosis, 61.7% about listeriosis and 12.5% about CMV. The majority reported having heard about these infections from their care providers or read about these in printed media or on the Internet. Respondents showed limited knowledge about preventive practices for toxoplasmosis, listeriosis or CMV infection. Regarding toxoplasmosis, risk behaviour was more prevalent among respondents who had a high level of education, had the Dutch nationality, did not take folic acid during their first trimester, and had ever worked in a children day-care setting. Regarding listeriosis, risk behaviour was more prevalent among respondents who where in their third trimester. Regarding CMV infections, risk behaviour was less prevalent among respondents who were in their third trimester of pregnancy.ConclusionOf the respondents, a substantial part did not have knowledge about preventive practices to avoid listeriosis, toxoplasmosis and CMV infections during pregnancy. Many pregnant women are appropriately avoiding risk behaviour, without knowing what they are avoiding. Advising pregnant women about behaviours and life-style habits to prevent infectious diseases remains important and information about preventive practices need to be complete and adequate. However, it may be less important to give pregnant women specific infectious diseases information. More attention towards CMV is necessary.

The behavioral outcomes of a technology-supported leisure activity in people with dementia

This paper presents the results of an evaluation of a technology-supported leisure game for people with dementia in relation to the stimulation of social behavior.Technology, reminiscence, nursing home, behavioral outcomes, Alzheimer

Simple Suppers: A family nutrition education and cooking program delivered in the daycare setting designed to improve diet quality in preschool aged children

In order to reverse current trends in childhood obesity, early intervention and engagement of parents are essential. The aim of this study was to test feasibility and potential efficacy of a nutrition education and cooking program aimed at teaching parents and their preschool children positive eating behaviors. Our hypothesis was that children of participating families would develop and maintain food choices that include nutrient‐rich foods while limiting energy‐dense foods and beverages. Our curriculum is based on the 2010 Dietary Guidelines and consists of 10X90 min programs delivered monthly in a daycare located in a low‐income urban neighborhood. Session components include: nutrition education, family meal prep, group meal, take‐home educational materials. The evaluation plan included a pre‐, mid‐, and post‐assessment of child food prep skills (5‐point Likert scale) and dietary intake (Harvard FFQ). Ten families enrolled in the study. Adjusted for baseline child age, BMI, and economic status, 1) ability of child to rinse fruits and vegetables (p=0.04) and mean daily servings of fruit (p=0.04) increased and 2) mean daily servings of sugar sweetened beverages (p=0.04) and added fat (p=0.059) decreased. An innovative nutrition education and cooking class engaged the target audience of parents and preschool‐aged children and improved certain child food choices and eating behaviors.Grant Funding Source: The Ohio State University Food Innovation Center

Is there still a role for pre-operative liver biopsy for the potential live related liver donor?

Background: Assessment of donors for living donor liver transplant (LDLT) should include a detailed evaluation of the quality of donor liver. The precise role of pre-operative donor liver biopsy in this setting is unclear. Improved ability to predict steatosis on CT and concern regarding risk of liver biopsy has limited the use of this investigation. In our centre, biopsy is used selectively based on a combination of clinical, biochemical & radiological variables. Aim: This study evaluated the indications for donor liver biopsy in our LDLT practice, the spectrum of biopsy findings and the factors predicting significant pathology that can preclude donation. Methods: Data of all potential donors evaluated for living donor liver transplant at our unit was analyzed. Potential donors who underwent liver biopsy were identified and analyzed in detail. Results: Between Jan 2010 and December 2012, 183 donors underwent evaluation for LDLT. Of these 27 underwent liver biopsy as part of assessment. The indications for liver biopsy were either one or a combination of the following factors: increased BMI (13, 50%), mild alteration of liver function tests (10, 37%), abnormal lipid profile (10, 37%), liver attenuation index suggestive of fatty change (17,63%) or positive autoimmune workup(3,11%). Six patients (22%) had one risk factor, 15 (56%) had two risk factors and 6 (22%) had more than 2 risk factors. Biopsy was done percutaneously under USG guidance in a daycare setting. One patient had biopsy site haematoma needing in-patient observation.Histology revealed significant fatty change (more than 10% macrovesicularsteatosis) in 11 (41%) biopsies, moderate to severe inflammation in 10 (37%), fibrosis in 2 (7.5%) and significant vascular changes in 3 (11%) biopsies. Based on these biopsy findings, eight proceeded to donation and went through the procedure with no major morbidity or mortality. None of the above noted factors independently or in combination could predict the presence of significant steatosis or inflammation in biopsy. Conclusion: Selective use of pre-operative liver biopsy in potential donors is still a necessary aid in identification of donors with significant liver pathology precluding liver donation.

Active SupportActive Support

THIS BOOK will be of great interest to learning disability nurses and other healthcare workers who support people with intellectual disabilities in residential or day-care settings.

Orchestrating professional development for baby room practitioners: Raising the stakes in new dialogic encounters

This article has emerged from a research and development project, The Baby Room, which was designed to examine how babies are cared for in daycare settings. Within the project, a form of professional development was created which designated a central space for dialogic encounter, primarily to enable the baby room practitioners who participated in the project to begin to theorize their practice. Findings indicate that those working with babies frequently feel isolated and neglected in relation to support for their practice, that the practitioners had a very low sense of self-worth in relation to their work, low self-confidence and an inability or a reluctance to articulate their own understandings of their practice. Significantly we also found that many of the practitioners were not routinely, incidentally or intuitively talking to the babies in their care, nor were they aware of the importance of doing so. While it is difficult to provide robust research evidence to demonstrate any close causal connections between the lack of professional talk, the evident low self-worth of the practitioners and talk experiences with babies, the study does indicate that there may be distinct connections between practitioners’ professional knowledge and understanding, their confidence, opportunities for professional talk experience and their perceptions of the need to develop talk encounters with babies. This article describes the background and rationale for the project work, ranges over some key issues in relation to talk, and the importance of professional dialogic encounters for those working with babies, and it indicates the rich potential this may have for positive talk outcomes in baby room practice.

Evidence for Interventions to Prevent and Control Obesity Among Children and Adolescents: Its Applicability to India

Childhood obesity is on the rise worldwide and its increasing prevalence in low and middle income countries is well-known. Obesity interventions have the potential to prevent adverse health outcomes; however, large gaps in research and knowledge about the efficacy and sustainability of such interventions remain. The objectives of this article were to review the evidence for interventions to prevent and control obesity among children and adolescents, evaluate their applicability in India, and discuss the challenges to sustain such interventions. The authors reviewed published research focusing on childhood obesity interventions, especially in India and other lower-resource countries. Nine observational and 10 interventional studies were reviewed. Most studies identified were from developed countries and took place at day-care settings, schools, and after school programs. Nineteen reported studies were grouped into categories: diet (2), physical activity (4), childcare programs (2), media-based programs (2), parental involvement (2), multi-component studies (1), and screen time (6). Most interventions were effective in reducing BMI, decreasing sedentary behaviors, and increasing physical activity. Sustainability of these interventions was not evaluated. While there is no one method or simple intervention to address obesity, multi-component approaches involving home and school environments are promising and warrant evaluation in India. Literature on obesity prevention and control in India and in lower-resource countries, however, is sparse. Existing gaps in knowledge about obesity should be addressed by conducting research in India and carrying out interventions to determine what strategies will be successful and sustainable locally.

Parental Stress and Daycare Attendance. Does Daycare Quality and Parental Satisfaction with Daycare Moderate the Relation Between Family Income and Stress Level among Parents of Four Years Old Children?

This study examine whether quality of daycare and parental satisfaction with daycare moderate the relationship between family income and parental stress. The sample consisted of 163 families of four year old children (Montreal), who have attended regulated daycare full time since 12 months old. Results indicate that parental satisfaction with daycare is a significant predictor of parental stress and that low quality of care moderates the relation between low family income and high parental stress. The results underline the importance of interventions to enhance quality in daycare settings, particularly in a childcare network largely funded by the government.

Transmission of Varicella Zoster Virus From Individuals With Herpes Zoster or Varicella in School and Day-care Settings

Transmission of Varicella Zoster Virus From Individuals With Herpes Zoster or Varicella in School and Day-care Settings

Whose hand rocks the cradle? Parallel discourses in the baby room

This article explores the practice narratives of a group of 25 caregivers who work with babies in daycare settings in England and seeks to illustrate awareness of, resistance to and compliance with powerful discourses. It is argued that multiple voices exert an influence over baby room practice, disempowering the caregivers and reducing their capacity to practise in ways that meet the ‘babies’ best interests’. Yet there may also be ways in which they collude in their own oppression. Opportunities to engage in professional dialogue, reflection and critique as a means of conscientizaçāo (conscientization or ‘dialogic cultural action’ as described by Freire in Pedagogy of the Oppressed [London: Penguin, 1970], 141) are rare. When offered, these may simultaneously increase participants’ awareness of discourses of performativity and inadequacy and heighten feelings of powerlessness, but may also offer a space in which to nourish professional knowledge and understanding and the self-confidence to challenge and resist privileged voices that sustain a hegemony.

A Comparison of Recordings of Sentences and Spontaneous Speech: Perceptual and Acoustic Measures in Preschool Children’s Voices

A well-controlled recording in a studio is fundamental in most voice rehabilitation. However, this laboratory like recording method has been questioned because voice use in a natural environment may be quite different. In children's natural environment, high background noise levels are common and are an important factor contributing to voice problems. The primary noise source in day-care centers is the children themselves. The aim of the present study was to compare perceptual evaluations of voice quality and acoustic measures from a controlled recording with recordings of spontaneous speech in children's natural environment in a day-care setting. Eleven 5-year-old children were recorded three times during a day at the day care. The controlled speech material consisted of repeated sentences. Matching sentences were selected from the spontaneous speech. All sentences were repeated three times. Recordings were randomized and analyzed acoustically and perceptually. Statistic analyses showed that fundamental frequency was significantly higher in spontaneous speech (P<0.01) as was hyperfunction (P<0.001). The only characteristic the controlled sentences shared with spontaneous speech was degree of hoarseness (Spearman's rho=0.564). When data for boys and girls were analyzed separately, a correlation was found for the parameter breathiness (rho=0.551) for boys, and for girls the correlation for hoarseness remained (rho=0.752). Regarding acoustic data, none of the measures correlated across recording conditions for the whole group.

Intravenous diuretic day-care treatment for patients with heart failure

Fluid overload is a common manifestation of decompensated chronic heart failure. This paper reports on a pilot study that investigated whether intravenous (i.v.) furosemide administered on a cardiology day ward for three successive days was effective in improving the symptoms of patients with fluid overload and chronic heart failure. The results showed that 94.1% of patients reported an improvement in their breathlessness, with a marked weight loss in 88.2% of patients. There were no marked changes in blood pressure or renal function. Hospital admission was avoided in 94.1% of cases. The study concluded that i.v. diuretic treatment given in a hospital day-care setting is safe and effective, and that it reduces the need for hospital admissions. As a consequence, this reduces the associated financial costs of hospitalisation.

Partnerships in Early Childhood Education and Care: Empowering Parents or Empowering Practitioners

Research acknowledges that outcomes for young children are enhanced when effective partnerships are developed between educators and families. The Australian Early Years Learning Framework provides direction for the professional practice of early childhood educators by acknowledging the importance of educators working in partnership with families. In the Victorian state-based early years framework, family-centred practice has been included as the practice model. Family-centred practice has as its core a philosophy of professionals supporting the empowerment of parents as active decision makers for their child. The early childhood education and care sector in Australia, however, is made up of a workforce which is largely perceived as being undervalued as a profession. This raises questions as to the capacity of these educators to support the empowerment of parents when they themselves are coming from a position of disempowerment due to their professional status. This article reports on findings from a small-scale study of childhood educators working in a long day-care setting which aimed to identify perceptions of the partnerships that exist between themselves and parents. In the course of the investigation, it became evident that some of educators felt disempowered in the relationships that exist with some families.