Effects Of Day Care Research Articles

Peran Day Care Dalam Stimulasi Perkembangan Fisik Motorik Anak Usia Dini Di Buncha Daycare Jakarta Pusat

Nurpadilah, The Role of Day Care in Stimulating Early Childhood Physical Motor Development at Buncha Daycare, Central Jakarta (2024). Thesis. Jakarta: College of Teacher Training and Education Panca Sakti Bekasi. 2024. This study aims to examine the role of day care in stimulating the physical motor development of early childhood in buncha day care central Jakarta, using physical motor development instruments with the role of day care in child growth and development and the effectiveness of day care in stimulating children's physical motor development using the Likert model attitude scale form. The research method used is descriptive research method with qualitative approach. The subjects of this study were elements of the day care institution which included the principal, educators/caregivers, and parents at Buncha Day care. Data collection techniques using interviews, observation and documentation with a qualitative data analysis process through several activities, namely data reduction, data display and conclusion drawing/verification. The results showed that the growth and development of children (aged 2-3 years) there are still those who are not actively participating in activities (rare entry / new to daycare) and must be considered again by employees or parents and more routine child stimulation is needed because seeing growth and development is not in accordance with the age stage. Through analysis of the results of observations, what should be considered

Teilstationäre Versorgung im Fokus – Entwicklung wissenschaftsgestützter Impulse zur Gestaltung von Tagespflegen für ältere Menschen

BackgroundDespite its important role in the elderly care system, day care in Germany has so far rather little attention paid to it. Keeping their patients’ health and self-reliance and facilitating relief and support for family caregivers are central tasks of day care, regulated by law. Nevertheless, there is not only a lack of findings about the working methods and effects of day care, but also of orientation in terms of how to configure high-quality care on a structural, process-related and conceptual level. The aim of the TpQ project (“Weiterentwicklung und Qualitätsverbesserung von Tagespflege in Nordrhein-Westfalen”, “further development of and quality improvement in day care facilities in Northrhine-Westphalia”) was to close this gap and to offer the institutions a catalogue of impulses that contains current national and international research findings as well as the perspectives of every stakeholder associated with day care. MethodIn an explorative sequential mixed-method design, we conducted a search for and a synthesis of the literature in the form of a scoping review, qualitative interviews with guests, relatives, non-users, employees and managers of day care, association representatives, nursing scientists and business consultants, a quantitative paper-based survey among guests, relatives, employees and managers of day care and an expert conference for result validation. The sample received study information either directly by mail or through the staff of the recruited adult day care facilities. The survey-area is the federal state of North Rhine-Westphalia. The analysis of the qualitative data was conducted according to the qualitative content analysis and was used for the development of the quantitative surveys. The quantitative data analysis was descriptive. Based on the comparison with literature analysis and qualitative findings, the impulses for the design of day care were finally formulated and validated during an expert workshop. ResultsFrom the literature (N=49) and the interviews (N=85), different expectations and wishes with regard to day care were generated. These included staff and structural requirements as well as concrete ideas of the conceptual orientation of day care. The quantitative survey (N=392) showed considerable agreement with the content-related and organizational requirements of the qualitative survey and allowed us to identify the relevant quality aspects from the point of view of guests, relatives and staff of day care facilities. In summary, 15 dimensions for the design of day care (conception/basic principles, quality management, nursing care, transport/driving service, opening hours, equipment, networking, staff, introduction of new guests, activity offers, health promotion and prevention, promotion of social participation, support of relatives, public work, counseling) were defined as relevant quality areas and explained with 81 impulses. Discussion and conclusionAddressing the perspective of users, family caregivers and other persons involved in adult day care reveals complex requirements and opportunities for the design of adult day care. In contrast to existing quality inspection guidelines, the impulses can be used to independently assess adult day care with the goal of contributing to the further development and sharpening of the profile of adult day care.

Gut microbiome development in early childhood is affected by day care attendance

The human gut microbiome develops during the first years of life, followed by a relatively stable adult microbiome. Day care attendance is a drastic change that exposes children to a large group of peers in a diverse environment for prolonged periods, at this critical time of microbial development, and therefore has the potential to affect microbial composition. We characterize the effect of day care on the gut microbial development throughout a single school year in 61 children from 4 different day care facilities, and in additional 24 age-matched home care children (n = 268 samples, median age of entering the study was 12 months). We show that day care attendance is a significant and impactful factor in shaping the microbial composition of the growing child, the specific daycare facility and class influence the gut microbiome, and each child becomes more similar to others in their day care. Furthermore, in comparison to home care children, day care children have a different gut microbial composition, with enrichment of taxa more frequently observed in older populations. Our results provide evidence that daycare may be an external factor that contributes to gut microbiome maturation and make-up in early childhood.

Is the Association of Early Day Care Attendance with Childhood Asthma Explained by Underlying Susceptibility?

Previous studies of early day care attendance and asthma development are inconsistent, which may be explained by inadequate control of confounding and effect modification. We examined the effect of early day care on the risk of asthma taking into account the underlying susceptibility to asthma. The study included 55,404 children participating in the Norwegian Mother, Father and Child Cohort Study. Asthma at age 7 was defined by dispensed asthma medications in the Norwegian Prescription Database. We defined a disease risk score (DRS) to account for an underlying susceptibility to asthma including a range of hereditary and nonhereditary predictors of asthma. We assessed confounding and modifying effects of DRS on the association between day care and asthma. Day care before 18 months was associated with a lower risk of asthma by age 7 (adjusted risk ratio [RR] = 0.85; 95% confidence interval [CI] = 0.78, 0.92) when compared with home care. DRS modified the estimated effect of day care on asthma risk. Among the 80% of children with DRS between 0.03 and 0.16, day care was associated with a reduced asthma risk (RRs between 0.79 and 0.87), whereas among 0.5% of children with a high DRS (above 0.28), estimated effect of day care on asthma increased gradually (RR for the highest DRS 2.2; 1.0-4.9). In our study, among most children, early day care was associated with reduced asthma risk at 7 years, and increased risk in a small group of children with very high underlying susceptibility to asthma.

Cost analysis of day care centres in Norway.

BackgroundDay care services aim to offer meaningful activities and a safe environment for the attendees and a respite for family caregivers while being cost effective. This study compares the use of formal and informal care in users and non-users of day care centres designed for persons with dementia.MethodUsers of day care designed for dementia (DC group) and non-users (NDC group) were followed over a period of 24 months or until nursing home admission (NHA) respectively death. Demographic and clinical characteristics were collected at baseline and after 12 and 24 months. The use of care was recorded by Resource Utilization in Dementia (RUD).ResultsA total of 257 persons with dementia participated in the study, 181 in the DC group and 76 in the NDC group. Users of day care centres cause higher costs due to the expenses for day care, while neither the use of home nursing, secondary care, informal care nor the time until NHA did show any differences between users and non-users. The overall costs were higher in the DC group at baseline and after 12 months, but this difference was no longer present at the end of the two-year study period.ConclusionOur results indicate no potential cost-saving effect of day care designed for people with dementia, as the use of day care did neither result in a reduced use of care nor in a delay of NHA. Future research should balance the non-monetary benefits of day care against its costs for a full cost-effectiveness analysis, most favourable in a RCT-design.

Effectiveness of day care in supporting family caregivers of people with dementia: A systematic review.

ABSTRACTDay care (DC) provides a break in daily care as a support strategy for family caregivers (FC) of people with dementia (PwD).Objective:to analyze the support strategies used by the DC for FC, their methodological and theoretical models, as well as the respective benefits for FC burden, coping strategies and quality of life.Methods:a systematic review following the Prisma methodology was performed on PubMed, PsycInfo, Scopus and SciELO electronic databases in August, 2018. The search keywords were “day care”, “dementia” or Alzheimer disease, “caregiver”, “quality of life” and “psychological adaptation”.Results:twenty-one studies were included. No randomized controlled trials were found. The provision of education, counseling and support, access to information, the professionals' expertise and the quality of their relationship with DC users were highlighted by caregivers. Compared to standard programs centering on PwD, the integrated program focused on PwD and FC activities showed increased feelings of competence and self-confidence of FC to postpone institutionalization. Heterogeneity in the structure and organization of the DC programs, intervention strategies and theoretical basis was observed.Conclusion:Integrated programs are a promising approach that addresses the needs and demands of PwD and their FC in a multidimensional manner.

The Effects of Day Care on Health During Childhood: Evidence by Age

This paper studies the effects of day care exposure on behavioral problems and mental health as well as on various aspects of physical health, at various ages during childhood. We draw on a unique set of comprehensive individual-level out-patient and inpatient health care register data from Sweden over the period 1999-2008 merged with other population register data. By exploiting variation in day care exposure by age generated by a major day care policy reform, we estimate cumulative and instantaneous effects on child health at different ages. We find beneficial cumulative impacts on behavioral and mental health at primary school ages, and substitution of the incidence of infections from primary school ages to low ages. The evidence suggests that the behavioral effects are mostly driven by children from low socio-economic households. Day care usage affects health care utilization and leads to a moderate reduction in health care costs.

Day Care for People with Dementia: A Qualitative Study Comparing Experiences from Norway and Scotland.

Potential benefits from day care attendance are reported in the literature for both people with dementia and caregivers, although the evidence-base is limited. The study aimed to explore and compare experiences of day care services for people with dementia as described by day care attendees and their caregivers in Norway and Scotland. Whereas day care receives prominence in Norway's national dementia plan, Scotland does not highlight day care in its national dementia strategy. A qualitative cross-national comparative study was undertaken. Semi-structured interviews were conducted with 17 people with dementia and 17 caregivers in Norway, and 19 people with dementia and 15 caregivers in Scotland. Data were analyzed thematically and comparatively to explore the experiences and outcomes of the participants. Findings indicate positive outcomes from day care for both people with dementia and caregivers. Satisfaction with services related to meaningful activities, getting out of the home, strengthening social connections and careful staff facilitation to create a positive and welcoming atmosphere. There were strong similarities in the content of services and experiences reported in the two countries. Some minor differences were noted, with caregiver support being an area of notable divergence in experiences. Specialist day care for people with dementia seems to provide important support and positive outcomes for people with dementia, and respite and reassurance for their caregivers. More research is needed to further explore the effect of day care designed for people with dementia both on the attendees and their caregivers.

Acute Otitis Media During Infancy: Parent-reported Incidence and Modifiable Risk Factors.

Age at exposure to acute otitis media (AOM) risk factors such as day care attendance, lack of breastfeeding and tobacco smoke is little studied but important for targeting AOM prevention strategies. Moreover, studies are typically restricted to clinically diagnosed AOM, while a significant subset can occur outside the health care system, depending on the country setting. This study aims to determine risk factor exposure and effect of its timing within the first year of life on parent-reported AOM symptom episodes. In the WHeezing and Illnesses STudy LEidsche Rijn birth-cohort study, 1056 children were prospectively followed during their first year of life. Group day care attendance, breastfeeding and tobacco smoke exposure were recorded monthly and parent-reported AOM symptoms daily. Generalized estimating equations were used to estimate the association between the time-varying risk factors and AOM symptom episodes, while correcting for confounding by indication. The first-year incidence rate of parent-reported AOM was 569/1000 child-years [95% confidence interval (CI): 523-618]. Children who attended day care had higher odds of developing AOM symptom episodes compared with those not attending (odds ratio: 5.0; 95% CI: 2.6-9.6). Tobacco smoke exposure and (a history of) breastfeeding were not associated with AOM. Test for interaction revealed that the effect of day care increased with each month younger in age. First-year day care attendance is a major risk factor for AOM symptom episodes among infants in the community. This adjusted effect estimate is higher than previously reported and is age-dependent. AOM prevention strategies in day care facilities should therefore focus in particular on the youngest age groups.

Day care versus inpatient management of nausea and vomiting of pregnancy: cost utility analysis of a randomised controlled trial

ObjectiveTo assess the comparative cost effectiveness of day care over inpatient management of nausea and vomiting of pregnancy (NVP). Study designA cost utility analysis was performed using a decision analytical model in which a Markov model was constructed. The Markov model was primarily populated with data from a recently published randomised controlled trial. Which included pregnant women presenting to Cork University Maternity Hospital, a tertiary referral maternity hospital, seeking treatment for NVP. Costs and outcomes were estimated from the perspective of the Irish health service (HSE) and patients. A probabilistic sensitivity analysis, using a Monte Carlo simulation, was also performed. A Bayesian Value of Information analysis was used to estimate the value of collecting additional information. ResultsWhen both the healthcare provider and patient's perspective was considered, day care management of NVP remained less costly (mean €985; 95% C.I. 705–1456 vs. €3837 (2124–8466)) and more effective (9.42; 4.19–12.25 vs. 9.49; 4.32–12.39 quality adjusted life years) compared with inpatient management. The Cost Effectiveness Acceptability Curve indicates the probability that day care management is 70% more cost effective compared to inpatient management at a ceiling ratio of €45,000 per QALY, indicating little decision uncertainty. The Bayesian Value of Information analysis indicates there is value in collecting further information; the Expected Value of Perfect Information (EVPI) is estimated to be €5.4 million. ConclusionDay care management of NVP is cost effective compared to inpatient management.

Centre-based day care for children younger than five years of age in high-income countries.

A large proportion of children younger than five years of age in high-income countries experience significant non-parental care. Centre-based day care services may influence the development of children and the economic situation of parents. To assess the effects of centre-based day care without additional interventions (e.g. psychological or medical services, parent training) on the development and well-being of children and families in high-income countries (as defined by the World Bank 2011). In April 2014, we searched CENTRAL, Ovid MEDLINE, EMBASE, PsycINFO, the Education Resources Information Center (ERIC) and eight other databases. We also searched two trials registers and the reference lists of relevant studies. We included randomised and quasi-randomised controlled trials of centre-based day care for children younger than five years of age. We excluded studies that involved co-interventions not directed toward children (e.g. parent programmes, home visits, teacher training). We included the following outcomes: child cognitive development (primary outcome), child psychosocial development, maternal and family outcomes and child long-term outcomes. Two review authors independently assessed the risk of bias and extracted data from the single included study. We contacted investigators to obtain missing information. We included in the review one trial, involving 120 families and 143 children. Risk of bias was high because of contamination between groups, as 63% of control group participants accessed day care services separate from those offered within the intervention. No evidence suggested that centre-based day care, rather than no treatment (care at home), improved or worsened children's cognitive ability (Griffiths Mental Development Scale, standardised mean difference (SMD) 0.34, 95% confidence interval (CI) -0.01 to 0.69, 127 participants, 1 study, very low-quality evidence) or psychosocial development (parental report of abnormal development, risk ratio (RR) 1.21, 95% CI 0.25 to 5.78, 137 participants, 1 study, very low-quality evidence). No other measures of child intellectual or psychosocial development were reported in the included study. Moreover, no evidence indicated that centre-based day care, rather than no treatment (care at home), improved or worsened employment of parents, as measured by the number of mothers in full-time or part-time employment (RR 1.12, 95% CI 0.85 to 1.48, 114 participants, 1 study, very low-quality evidence) and maternal hours per week in paid employment (SMD 0.20, 95% -0.15 to 0.55, 127 participants, 1 study, very low-quality evidence) or household income above £200 per week (RR 0.86, 95% CI 0.57 to 1.29, 113 participants, 1 study, very low-quality evidence). This study did not report on long-term outcomes for children (high-school completion or income). This review includes one trial that provides inconclusive evidence as regards the effects of centre-based day care for children younger than five years of age and their families in high-income countries. Robust guidance for parents, policymakers and other stakeholders on the effects of day care cannot currently be offered on the basis of evidence from randomised controlled trials. Some trials included co-interventions that are unlikely to be found in normal day care centres. Effectiveness studies of centre-based day care without these co-interventions are few, and the need for such studies is significant. Comparisons might include home visits or alternative day care arrangements that provide special attention to children from low-income families while exploring possible mechanisms of effect.

Effect of day care attendance on sensitization and atopic wheezing differs by Toll-like receptor 2 genotype in 2 population-based birth cohort studies

Variation in the Toll-like receptor 2 gene (TLR2/-16934) is associated with allergic diseases among farmers' children but not among children not living on farms. To test the hypothesis that the same genetic variant conferring protection in the farming environment is associated with reduced risk of developing allergic phenotypes among urban children attending day care in early life. In 2 population-based birth cohorts (Manchester, United Kingdom, Manchester Asthma and Allergy Study [MAAS]; Tucson, Ariz, Tucson Infant Immune Study [IIS]), participants were recruited prenatally and followed prospectively (MAAS: 3, 5, 8 and 11 years; IIS: 1, 2, 3 and 5 years). We assessed allergic sensitization and atopic wheezing at each follow-up. A total of 727 children participated in Manchester and 263 in Tucson. We found no significant associations between TLR2/-16934 and sensitization and atopic wheeze in either cohort. However, a different pattern emerged when we explored the interaction between TLR2/-16934 and day care attendance on these outcomes. We found a significant interaction between day care and TLR2/-16934 on the development of sensitization in the longitudinal model in MAAS in that children carrying the T allele who attended day care were less likely to be sensitized than those who did not attend day care, whereas among AA homozygotes, the association tended to be in the opposite direction. In a longitudinal model in IIS, we found a significant interaction between day care attendance and TLR2/-16934 on the development atopic wheezing. Significant interactions between TLR2/-16934 and day care were maintained when adjusting for socioeconomic status. The effect of day care on sensitization and atopic wheezing may differ among children with different variants of the TLR2 gene.

Day Care for older dementia patients: favorable effects on behavioral and psychological symptoms and caregiver stress

To assess the effects of Day Care (DC) on older subjects with dementia and their caregivers. Thirty patients with dementia, consecutively admitted to a DC, were compared with 30 patients, matched for age and cognitive function, who received usual home care (HC). Primary caregivers were compared as well. At baseline and after 2 months, patients were assessed for cognitive and functional status, behavioral and psychological symptoms [Neuropsychiatric Inventory (NPI)] and psychotropic drugs use, and caregivers were evaluated for care burden [Caregiver Burden Inventory (CBI)] and depressive symptoms. After adjusting for potential confounders, NPI score significantly decreased in DC group, with a reduction of psychotropic drugs prescription, whereas it increased in HC. No significant between-group difference was observed for cognitive and functional change. CBI significantly decreased in DC, but not HC, caregivers, with no significant between-group difference in depressive symptoms change. A 2-month period of DC assistance is effective in reducing behavioral and psychological symptoms of dementia patients and in alleviating caregivers' burden.

Day Care for Demented Elderly in a Dairy Farm Setting: Positive First Impressions

Long-term care for demented patients in the Netherlands is changing. The focus is now more on quality of life and delaying institutionalization by offering substitutes to the traditional nursing home. In this article, we present a new type of day care, offered on a small dairy farm setting. A small observational study was performed to get a first impression of the effects of care farm day care on demented patients. Also, global comparisons were made between patients attending day care in the farm setting and patients attending regular day care in a nursing home. Demented patients attending day care on the farm showed fewer behavioral problems, used, on average, fewer drugs, including psychotropic drugs, and were more actively involved in normal daily activities. Moreover, family caregivers were more satisfied with this new type of day care. Currently, there is only a scant amount of information to support the therapeutic effects of day care in farm settings. This experience indicates a positive trend of this new form of day care. Well-designed longitudinal follow-up studies are needed to provide more substantial evidence of positive patient outcomes in this new care setting.

The many faces of the hygiene hypothesis

About 15 years have gone by since Strachan first proposed the idea that infections and unhygienic contact might confer protection against the development of allergic illnesses. The so-called hygiene hypothesis has ever since undergone numerous more or less subtle modifications by various researchers in the fields of epidemiology, clinical science, and immunology. Three major tracts have developed exploring the role of overt viral and bacterial infections, the significance of environmental exposure to microbial compounds, and the effect of both on underlying responses of the innate and adaptive immunity. To date, a truly unifying concept has not yet emerged, but various pieces of a complex interplay between immune responses of the host, characteristics of the invading microorganism, the level and variety of the environmental exposure, and the interactions between a genetic background and a range of exposures becomes apparent. These influences are discussed as determinants for a number of complex allergic illnesses in this review, while we attempt to pay attention to the importance of different phenotypes, namely of the asthma syndrome. Even if today practical implications cannot directly be deduced from these findings, there is great potential for the development of novel preventive and therapeutic strategies in the future.

Early child care and early child development: Major findings of the NICHD study of early child care

The changing landscape of maternal employment in the USA has led to more and more children at younger and younger ages experiencing routine, non-maternal care. Great debate about the effects of day care beginning very early in life led to the launch of a major study in the USA, following more than 1000 children from birth. Study findings through the start of school are summarized. These highlight the fact that good quality child care and exposure to centre-based care predict somewhat advanced cognitive-linguistic functioning, but that lots of time spent in any kind of care (irrespective of its quality) and greater exposure to centre-based care are related to elevated—but not clinical—levels of externalizing problem behaviour. Clearly, risks and benefits are associated with early child care, at least as routinely experienced in the USA. It is critically important to distinguish distinctive aspects of the child-care experience (i.e., quality, quantity, type) in order to understand its complex effect on child development.

Comparison of Large Versus Smaller Randomized Trials for Mental Health-Related Interventions

The extent of disagreement between large and smaller randomized, controlled trials on mental health issues is unknown. The authors aimed to compare the results of large versus smaller trials on mental health-related interventions. The authors screened 161 Cochrane and 254 Database of Abstracts of Reviews of Effectiveness systematic reviews on mental health-related interventions. They identified 16 meta-analyses with at least one "large" randomized trial with sample size >800 and at least one "smaller" trial. Effect sizes were calculated separately for large and smaller trials. Heterogeneity was assessed between all studies, within each group (large and smaller studies), and between large and smaller studies. Significant between-study heterogeneity was seen in five meta-analyses. By random-effects calculations, the results of large and smaller trials differed beyond chance in four meta-analyses (25%). In three of these disagreements (effect of day care on IQ, discontinuation of antidepressants, risperidone versus typical antipsychotics for schizophrenia), the smaller trials showed greater effect sizes than the large trials. The inverse was seen in one case (olanzapine versus typical antipsychotics for schizophrenia). With fixed-effects models, disagreements beyond chance occurred in five cases (31%). In four meta-analyses, the effect size differed over twofold between large and smaller trials. Various quality and design parameters were identified as potential explanations for some disagreements. Large trials are uncommon in mental health. Their results are usually comparable with the results of smaller studies, but major disagreements do occur. Both large and smaller trials should be scrutinized as they offer a continuum of randomized evidence.

Clinical, psychosocial, and economic effects of antenatal day care for three medical complications of pregnancy: a randomised controlled trial of 395 women

Day care is increasingly being used for complications of pregnancy, but there is little published evidence on its efficacy. We assessed the clinical, psychosocial, and economic effects of day care for three pregnancy complications in a randomised trial of day care versus standard care on an antenatal ward. 395 women were randomly assigned day (263) or ward (132) care in a ratio of two to one, stratified for major diagnostic categories (non-proteinuric hypertension, proteinuric hypertension, and preterm premature rupture of membranes). The research hypothesis was that for these disorders, as an alternative to admission, antenatal day care will reduce specified interventions and investigations, result in no differences in clinical outcome, lead to greater satisfaction and psychological wellbeing, and be more cost-effective. Data were collected through case-note review, self-report questionnaires (response rates 81.0% or higher) and via the hospital's financial system. Analysis was by intention to treat. All participants were included in the analyses. There were no differences between the groups in antenatal tests or investigations or intrapartum interventions. The total duration of antenatal care episodes was shorter in the day-care group than in the ward group (median 17 [IQR 5-9] vs 57 [35-123] h; p=0.001). Overall stay was also significantly shorter in the day-care group (mean 7.22 [SE 0.31] vs 8.53 [0.44]; p=0.014). The median number of care episodes was three (range one to 14) in the day-care group and two (one to nine) in the ward group (p=0.01). There were no statistically or clinically significant differences in maternal or perinatal outcomes. The day-care group reported greater satisfaction, with no evidence of unintended psychosocial sequelae. There was no significant difference in either average cost per patient or average cost per day of care. Since clinical outcomes and costs are similar, adoption by maternity services of a policy providing specified women with the choice between admission and day-unit care seems appropriate.

Science Is A Matter of Cumulative Learning: Authors' Reply to the Commentary

F OR three reasons, we would like to thank Zarit, Stephens, Townsend, Greene, and Femia (2003) for opening the discussion about the effectiveness of day care for caregivers in their response to our article ‘‘Evaluation of Geriatric Day Care Units: Effects on Patients and Caregivers’’ (Zank & Schacke, 2002). First, we discussed our results cautiously and did not conclude that day care is ineffective for caregivers. Yet, we do agree that there is a possibility of political misuse of our data. We certainly did not intend to support political decisions against day care. Second, the commentary gives us a chance to report our complex multimethodological approach and results that were beyond the scope of the original article (Zank & Schacke, 2002). Third, some of the issues raised could be due to differences between the American and the German health and care systems, which will be described later. When we started our study in 1994, we were very much aware of the risk that standardized measures might not grasp certain effects that day care might have on caregivers. We, therefore, applied a multimethod approach. First, we chose the most prominent standardized measures at that time, namely, the Burden Interview (BI) and the Memory and Behavior Checklist (Zarit & Zarit, 1983/1990), and the Family-Caregiving Conflict and Job-Caregiving Conflict scales (Pearlin, Mullan, Semple, & Skaff, 1990). These quantitative data failed to show positive effects of day care on caregivers. We will give detailed reasons for our choice of instruments later (see Criterion 4). Second, to examine the caregiver’s stress, we developed a semistructured qualitative interview based on stress theory. This interview took approximately an additional 1–1.5 hr to administer. We conducted these qualitative interviews twice with caregivers of dementia patients only (N 1⁄4 37, T1, and, after 9 months, T2 1⁄4 74 interviews). As the first step, we analyzed these qualitative interviews by using content-analytical techniques (Mayring, 1988). Then, to allow further statistical analyses, we developed response scales to measure the intensity of caregiving stress. Results from the analyses of variances of these data show that day care significantly reduced conflict between caregiving and job requirements, caregiving and family needs, and recreational constrictions. Initial results from these qualitative data were published in German (Schacke, 2001; 2002, Zank & Schacke, 2001, Zank, 2000), and an English article has been submitted (Schacke & Zank, 2002). These results convinced us that day care is effective, not only for patients but also for caregivers; nevertheless, we have to accept that the results based on the standardized measures did not reflect this conclusion. Zarit and colleagues (2003) suspected several methodological flaws in our quantitative data that could explain our results. In the following, we will explain why we think that these methodologicial flaws did not exist. Finally, we will explain our interpretation of the results and consequences we drew.

‘They Have Started to Call It Their Club’

The design of residential care facilities for people with dementia has become an area of increasing clinical, architectural and research interest (Kitwood, 1997; Judd et al., 1998; Lawton, 2001). Less is known about day care design and about staff views of the adequacy of the social and built environment in which day care takes place. This article reports survey data on a study of 18 day centres providing dementia-specific care across the Republic of Ireland. Quantitative and qualitative data were collected from 77 practitioners (nurses in charge, care staff and branch managers). The focus of the research was on examining staff views of the physical characteristics of day care settings, the effectiveness of day care and staff views on the major benefits derived from day care attendance. The research also explored the perceptions of staff on how design features could be improved and their views on challenging behaviours, the suitability of certain clients for day care, staff training needs and the cost of care. Policy, practice and research implications emerging from the study are discussed. The article argues for the need for guidelines in best practice in dementia day care to be established in Ireland.