A web-based care assistant for caregivers of the elderly: Development and pilot study.

Background: The aging population in Korea has driven a surge in demand for elderly care services, leading to significant growth in elderly welfare facilities, particularly Adult Daycare Centers (ADCs). However, despite advancements in care facilities, caregivers continue to face challenges in providing suitable elderly care due to difficulties arising from gaps in the latest information on the elderly and their coping abilities. Objective: The objective of this study is to develop and evaluate the effectiveness of the elderly care assistant system, which facilitates the sharing of information and knowledge necessary for elderly care among caregivers. Methods: The ECA system was designed to support knowledge sharing through a knowledge management system based on an ontological knowledge model, with a web-based user interface for improved accessibility. A field trial was conducted at ADC in Seoul from August 17 to September 21, with eight caregivers participating. A mixed-methods approach, involving both surveys and interviews, was employed to gauge the ECA system's effectiveness. Results: The study found that the use of the ECA was beneficial in promoting knowledge sharing among caregivers. Additionally, caregivers noted the potential benefits of using the ECA in conjunction with family caregivers, who can offer additional information and perspectives on elderly care. Conclusions: This study presents preliminary evidence of the potential benefits of a care knowledge sharing system among various caregivers in elderly care. Although the elderly care assistant effectively promotes knowledge sharing, more research is needed to fully understand its impact on elderly care outcomes.

Mom Didn't Go to School, Dad Is Out of Work: Associations between Maternal Educational Attainment, Family Socioeconomic Status, and Infant Development.

The purpose of this research is to assess the neuropsychomotor development (NPMD) of 6- to 18-month-old infants and identify factors that may pose a risk to their development. They underwent NPMD assessments, while the parents/guardians were interviewed through the other instruments. Altogether, 64 infants participated in this research. The results revealed infants with questionable NPMD: 29.7% verified with AIMS and 32.8%, with Denver II. There were significant associations between NPMD and maternal low educational attainment (P = .032); family low socioeconomic status and NPMD (P = .026), verified with AIMS and Denver II (P = .037); stimulation opportunities at home and maternal low educational attainment (P = .00026), socioeconomic status (P = .035), and NPMD, verified with AIMS (P = .02) and Denver II (P = .009). The following were identified as risk factors for NPMD: maternal low educational attainment (the lower her attainment, the more likely for the NPMD to be questionable) and family socioeconomic status (infants from disadvantaged homes tend to have questionable NPMD). Stimulation opportunities at home were also significantly associated with NPMD-that is, insufficient stimulations at home may lead to questionable NPMD.

SARS-CoV-2 viral clearance and viral load kinetics in young children (1-6 years) compared to adults: Results of a longitudinal study in Germany.

Objective: To investigate SARS-COV-2 viral clearance and viral load kinetics in the course of infection in children aged 1-6 years in comparison with adults. Methods: Prospective cohort study of infected daycare children and staff and their close contacts in households from 11/2020 to 06/2021. Adult participants took upper respiratory tract specimen from themselves and/or their children, for PCR tests on SARS-CoV-2. Data on symptoms and exposure were used to determine the date of probable infection for each participant. We determined (a) viral clearance, and (b) viral load dynamics over time. Samples were taken from day 4-6 to day 16-18 after diagnosis of the index case in the respective daycare group (5 samples per participant). Results: We included 40 children (1-6 years) and 67 adults (18-77 years) with SARS-CoV-2 infection. Samples were available at a mean of 4.3 points of time per participant. Among the participants, the 12-day study period fell in different periods within the individual course of infection, ranging from day 5-17 to day 15-26 after assumed infection.Children reached viral clearance at a median of 20 days after assumed infection (95% CI 17-21 days, Kaplan-Meier Analysis), adults at 23 days (95% CI 20-25 days, difference not significant). In both children and adults, viral load decreased over time with trajectories of the mean viral load not being statistically different between groups. Kaplan-Meier calculations show that from day 15 (95% CI 13-15), 50% of all participants had a viral load <1 million copies/ml, i.e. were no longer infectious or negative. Conclusion: Children aged 1-6 and adults infected with SARS-CoV-2 (wild type and Alpha variant) did not differ significantly in terms of viral load kinetics and time needed to clear the virus. Therefore, containment measures are important also in the daycare settings as long as the pandemic continues.

Impact of ventilation methods on indoor particle concentrations in a daycare center.

The objective of this study was to quantify the influence of ventilation methods on children's exposure to indoor particles in a daycare center located in an urban area. The ventilation methods applied to the center were monitored for 1 year. It appears that indoor PM10 and PM2.5 concentrations of the center were basically determined by outdoor conditions. The fluctuations in outdoor particle concentration also affected the ventilation behavior during class. The windows and doors of the classroom were frequently closed during both class hours and nights when the outdoor particle concentrations were at high levels. Statistically significant differences in the I/O ratios were found among the ventilation methods. The PM10 I/O ratio with the closed windows was significantly higher (p < 0.01) than that with the open windows, and when the mechanical fans were operated, the I/O ratio dramatically decreased (p < 0.01). The I/O ratio of PM2.5 showed a similar trend to that of PM10 except for the mechanical fan operation. The filters rated lower than MERV 11 appear to be insufficient to remove submicron particles from the mechanically supplied outdoor air when the PM2.5 concentrations are high, such as during the heating period.

Investigation of Concurrent Pneumococcal Meningitis in Two Children Attending the Same Day-Care Center.

Only a few clusters of invasive pneumococcal disease have been described globally in children, and most of these cases occurred before pneumococcal vaccination implementation. Two unusual cases of pneumococcal meningitis, occurring in the same daycare center over a 3-day period, were reported. Both cerebrospinal fluid (CSF) were sent to the National reference center for pneumococci. In addition, we decided to perform a pneumococcal carriage study on all children and staff of the daycare center to analyze the pneumococcal serotypes circulating in this DCC and to discuss an antibiotic chemoprophylaxis. CSF culture was positive for pneumococcus, and serotype 25A was identified by latex agglutination. The second case had negative CSF culture, but CSF antigen test and gene amplification results were positive for Streptococcus pneumoniae. Serotype 12F was identified by using molecular biology. The absence of correlation between these strains was confirmed by multi-locus sequence typing. In the carriage study, we included 29 children (median age 1.9 years, interquartile range 1.4-2.5) and 10 adults. Among the children, 24 carried Streptococcus pneumoniae (83%). The main serotypes isolated were 23A for 6 children and 25A for 5 children; serotypes were non-typeable for 3 children. Only 1 of 10 adults tested carried Streptococcus pneumoniae (serotype 12F). Despite this temporo-spatial pattern, the cases were unrelated and not due to carriage of a particular serotype. No specific action has been taken for the other children attending this DCC, and no other case of bacterial meningitis occurred.

Laboratory evaluation of low-cost air quality monitors and single sensors for monitoring typical indoor emission events in Dutch daycare centers.

Daycare centers (DCCs) are where infants and toddlers (0-4 years old) spend the most time besides their homes. Given their higher susceptibility to the effects of air pollutants, as compared to older children and adults, indoor air quality (IAQ) is regarded as an essential parameter to monitor in DCCs. Recent advances in IAQ monitoring technologies have enabled the deployment of low-cost air quality monitors (LCMs) and single sensors (LCSs) to continuously monitor various indoor environments, and their performance testing should also be performed in the intended indoor applications. To our knowledge, there is no study evaluating the application of LCMs/LCSs in DCCs scenarios yet. Therefore, this study is aimed to assess the response of five types of LCMs (previously not tested) and five LCSs to typical DCCs emission activities in detecting multiple IAQ parameters, i.e., particulate matter, carbon dioxide, total volatile organic compounds, temperature, and relative humidity. These LCMs/LCSs were compared to outcomes from research-grade instruments (RGIs). All the experiments were performed in a climate chamber, where three kinds of typical activities (background; arts-and-crafts; cleaning; [in a total of 32 events]) were simulated by recruited subjects at two typical indoor climatic conditions (cool and dry [20 ± 1 °C & 40 ± 10%], warm and humid [26 ± 1 °C & 70 ± 5%]). Results showed that tested LCMs had the ability to capture DCCs activities by simultaneously monitoring multiple IAQ parameters, and LCMs/LCSs revealed a strong correlation with RGIs in most events (R2 values from 0.7 to 1), but, for some events, the magnitude of responses varied widely. Sensirion SCD41, an emerging CO2 sensor built on the photoacoustic sensing principle, had a more accurate performance than all tested NDIR-based CO2 sensors/monitors. In general, the study implies that the selection of LCMs/LCSs for a specific application of interest should be based on emission characteristics and space conditions.

Differences in Health-Related Quality of Life in Older People with and without Sarcopenia Covered by Long-Term Care Insurance.

Background: As a result of the increase in older people covered by long-term care insurance (LTCI), prevention of sarcopenia and maintenance and improvement of health-related quality of life (HRQOL) have become important themes. This study aimed to clarify both the differences in HRQOL in older people with and without sarcopenia covered by LTCI and the correlation between HRQOL and physical function. Methods: Participants were 101 older people with LTCI at a daycare center in Japan. We investigated clinical factors using the EuroQol five-dimension three-level questionnaire (EQ-5D-3L). Analysis was by unpaired t-test, Mann−Whitney U test, chi-square test, analysis of covariance, Pearson's correlation coefficient, and Spearman's rank correlation coefficient. Results: Compared to the no sarcopenia group (n = 40), the sarcopenia group (n = 24) had significantly lower body mass index, skeletal muscle mass index, gait speed, EQ-5D-3L, and adjusted EQ-5D-3L (p < 0.05). The EQ-5D-3L showed a significant correlation with handgrip strength in the sarcopenia group (p = 0.02) and significant correlations with gait speed and one-leg standing time (both, p = 0.01) in the no sarcopenia group. Conclusion: We clarified differences in HRQOL in older people with and without sarcopenia covered by LTCI. This information on the interrelationship between HRQOL and physical function may help maintain and improve HRQOL in these people.

Identifying behavior of long-distance virus transmission and mitigation performance from a COVID-19 outbreak of a daycare center.

During the last two years, hundreds of millions of people in the world have been infected with SARS-CoV-2 due to recurrent waves and closed spaces. Daycare centers are critical infrastructures that cannot be replaced, even during the COVID-19 period. However, the existing settings in daycare centers may pose risks of inevitable close contact between teachers and children, as well as fomite and airborne transmission during care hours. Therefore, reinforced mitigation strategies have been applied in daycare centers to reduce potential indoor virus transfer in many countries. However, numerous outbreaks of COVID-19 have been reported in daycare centers. Therefore, in this study, researchers focused on the risk and behavior of long-distance virus transmission based on the detected viruses on air purifier filter sampling in a daycare center outbreak in Korea. Various experiments of possible situations were conducted in nursing rooms based on field interviews. The experiments monitored the long-distance transmission behavior of aerosol-sized particles and visualized particle behavior at the daycare center. The results of this study revealed that long-distance virus transmission is possible under the current settings in the daycare center, and flush-out can be an important countermeasure with reinforced ventilation methods to prevent potential airborne spread in the daycare center. The results of air purifiers represented that air purifiers should be properly installed and operated in the daycare center to prevent airborne virus spread by airflow during occupied hours. The findings of this study will contribute to the understanding of airborne virus risk and the development of customized virus measures for daycare centers.

Dialogue Based Early Detection-Development of a Novel Approach for Detection of Mental Health Problems Among Children in Daycare Centers.

BACKGROUND: Among 1-7 years old children the worldwide prevalence of mental disorders is ~20%. Without treatment, the prognosis of such disorders in children is poor. Early intervention is estimated to result in a positive return. However, traditional screening to detect children at need is particularly challenging due to the concerns by false positives. The aim of the current study was to develop a more acceptable though effective method using the existing annual evaluation meetings between parents and teachers in a more systematic and goal directed way. The method should build on the teacher's and parents' complementary knowledge and perception of the child, and fit into the everyday routines in daycare centers. METHOD: During a period of 6 years, a developmental process aiming for a novel screening method was carried out in cooperation with eight Norwegian daycare centers. After conception of the idea, the framework of the Dialogue Based Early Detection including the first version of the Early Worry Questionnaire (EWQ) was constructed. An iterative process involving parents and teachers completing workshops and subsequent testing facilitated a re-modeling of the method. RESULTS: In the resulting Dialogue Based Early Detection a 36-item version of EWQ was completed by both parents and teachers ahead of the annual parent-teacher meeting. During that meeting the participants should try to reach a consensus whether there was a concern, some uncertainty, or no worry for the child, and which appropriate actions should be taken for a possible follow up. Both parents and teachers reported that the EWQ supported them in verbalizing already existing worries for the child. Teachers reported that parents were better prepared and participated more actively in the evaluation meetings. However, some parents complained that there was too much focus on possible worries. During the testing, challenges of language development, conduct, emotional reactions, toileting, attention, and eating were detected among the children. CONCLUSION: The Dialogue Based Early Detection method was endorsed by both teachers and parents and holds promise as a tool for improving early awareness and identification of developmental and mental health problems of preschool children in daycare centers.

Aspectos esenciales para realizar los cuidados en guarderías privadas desde la perspectiva de las cuidadoras / Essential Aspects, from the Perspective of Childcare Workers, for Providing Care in Private Daycare Centers

Introducción: El nuevo modelo económico cubano ha posibilitado la aparición de guarderías privadas, pero se desconocen qué aspectos deben ser considerados como esenciales para ejercer los cuidados desde la perspectiva de las cuidadoras Objetivo: Explorar aspectos esenciales para realizar los cuidados en guarderías privadas desde la perspectiva de las cuidadoras. Métodos: Estudio cualitativo de tipo exploratorio, realizado entre junio y septiembre de 2021 con 12 cuidadoras que laboran en guarderías privadas del municipio Santa Clara, provincia Villa Clara, Cuba. Los datos se obtuvieron mediante dos rondas de entrevistas; las narrativas fueron procesadas mediante análisis de contenido. Resultados: De la primera entrevista se manifestaron las siguientes categorías: higiene y protección para el cuidado, alimentación del niño, rutinas (sueño), problemas relacionados con el cuidado y rutinas (juego). De la segunda entrevista emergieron tres categorías: necesidad de un manual para la preparación, necesidad de un sitio digital para consulta y necesidad de curso de formación. Conclusiones: Se destaca la necesidad de garantizar en la guardería la higiene adecuada y disminuir el riesgo de accidentes; la preparación de alimentos y dietas; las rabietas, caídas y la fiebre como problemas más comunes; las rutinas de descanso y la rutina de juego y su influencia para el desarrollo armónico de los niños, además que las cuidadoras deberían recibir formación a través de un manual específico para guarderías privadas; algún sitio de consulta en internet y un curso preparatorio(AU)

Introduction: The new Cuban economic model has made possible the appearance of private daycare centers, but there is lack of knowledge concerning what aspects, from the perspective of childcare workers, should be considered as essential to perform caregiving. Objective: To explore, from the perspective of childcare workers, essential aspects of care in private daycare centers. Methods: Qualitative and exploratory study carried out between June and September 2021 with twelve childcare workers from private daycare centers in Santa Clara Municipality, Villa Clara Province, Cuba. The data were obtained through two rounds of interviews; the answers were processed through content analysis. Results: The following categories emerged from the first interview: hygiene and protection for care, child feeding, routines (sleep), problems related to care and routines (playing). Three categories emerged from the second interview: the need for a training manual, the need for a virtual consultation site, and the need for a training course. Conclusions: The need is highlighted to guarantee adequate hygiene in the daycare center and reduce the risk of accidents; diet and food preparation; tantrums, falls and fever as the most common problems; rest and playing routines, as well as their influence on harmonious child development; together with the fact that childcare workers should receive training through a specific manual designed for private daycare centers, any type of virtual consultation site and training course(AU)

Occupant behavior and indoor particulate concentrations in daycare centers.

'Occupant behavior' is the primary mechanism determining indoor particulate concentrations. Various indoor human activities generate particulate matter. Human-building interactions, such as window opening behavior, change the number of outdoor particulate matter introduces to the building. 'Daycare center' where young children spend considerable time has an occupant schedule distinguished from other types of buildings. In the study, we analyzed the effects of occupant behavior on indoor particle concentrations in daycare centers by on-site monitoring. The measurements were performed in four daycare centers located in Gyeonggi-do, South Korea. Optical particle counters(OPS, model 3330, TSI Inc., Shoreview, MN, USA) were used for particulate concentration monitoring. The source strengths of particles resuspended by each human activity were calculated, and their contributions to indoor particle concentrations were evaluated. Further, characteristics of human-building interactions and their corresponding impacts on indoor air quality were also analyzed. Results showed that particle resuspension was greater when occupants were awake (mean, 41.0 particles·min-1) than when they were asleep (mean, 9.2 particles·min-1), and the contribution of occupant status was also higher when awake (37-70% vs. 8-18%) for particles sized (0.3-10.0 µm). Analyzing five detailed human activities, vacuuming (9.8·107 particles·min-1) emitted the highest amount of particulate matter per person, followed by physical activity (4.8·107 particles·min-1), sedentary activity (1.9·107 particles· min-1), meals (1.9·107 particles·min-1), and nap time (8.1·106 particles·min-1). The study suggests that vacuuming should be avoided while children are occupied. This research also shows that children could be exposed to high daily average indoor particulate concentration (up to 1217 particles·cm-3) when windows were opened for an extended period of time while poor outdoor air quality. These results indicate that indoor air quality can be severely degraded by opening windows without considering the level of outdoor particle concentration.

The Indoor Mycobiomes of Daycare Centers Are Affected by Occupancy and Climate.

Many children spend considerable time in daycare centers and may be influenced by the indoor microorganisms there, including fungi. In this study, we investigate the indoor mycobiomes of 125 daycare centers distributed along strong environmental gradients throughout Norway. Dust samples were collected from doorframes outside and inside buildings using a community science sampling approach. Fungal communities in the dust samples were analyzed using DNA metabarcoding of the internal transcribed spacer 2 (ITS2) region. We observed a marked difference between the outdoor and indoor mycobiomes. The indoor mycobiomes included considerably more yeasts and molds than the outdoor samples, with Saccharomyces, Mucor, Malassezia, and Penicillium being among the most dominant fungal genera. Changes in the indoor fungal richness and composition correlated with numerous variables related to both outdoor and indoor conditions; there was a clear geographic structure in the indoor mycobiome composition that mirrored the outdoor climate, ranging from humid areas in western Norway to drier and colder areas in eastern Norway. Moreover, the number of children in the daycare centers, as well as various building features, influenced the indoor mycobiome composition. We conclude that the indoor mycobiomes in Norwegian daycare centers are structured by multiple factors and are dominated by yeasts and molds. This study exemplifies how community science sampling enables DNA-based analyses of a high number of samples covering wide geographic areas. IMPORTANCE With an alarming increase in chronic diseases like childhood asthma and allergies, there is an increased focus on the exposure of young children to indoor biological and chemical air pollutants. Our study of 125 daycares throughout Norway demonstrates that the indoor mycobiome not only reflects cooccurring outdoor fungi but also includes a high abundance of yeast and mold fungi with an affinity for indoor environments. A multitude of factors influence the indoor mycobiomes in daycares, including the building type, inhabitants, as well as the outdoor environment. Many of the detected yeasts and molds are likely associated with the human body, where some have been coupled with allergies and respiratory problems. Our results call for further studies investigating the potential impact of the identified daycare-associated mycobiomes on children's health.

Comparison of growth and psychomotor development in daycare centers attended by professionals.

BACKGROUND: Growth and development reflect the child's health condition. Currently, child care is supported in daycare centers. In this context, this article aimed to identify the differences in growth and psychomotor development in children according to their attendance at daycare centers. METHODS: We conducted an analytical cross-sectional study in children aged 25 to 48 months. Two groups were identified: 68 children attended daycare, and 68 children did not attend daycare. Growth was assessed with weight-for-height curves, and psychomotor development was evaluated with the child developmental assessment instrument (psychosocial, language, psychomotor, and cognitive area). The X2 test was used for statistical analysis. RESULTS: The percentage of daycare children with ideal weight was higher than those not attending in daycare (p = 0.035). Psychomotor development was significantly higher in daycare children: in the psychosocial (p = 0.000), language (p = 0.000), motor (p = 0.000), and cognitive development (p = 0.000) areas. CONCLUSIONS: The psychomotor development of children attending daycare centers is superior to that of children not in daycare centers.

INTRODUCCIÓN: La salud del niño se puede evaluar a partir de su crecimiento y desarrollo. En la sociedad actual, el cuidado de los hijos se comparte con las guarderías infantiles. En este contexto, el objetivo del artículo fue identificar las diferencias de crecimiento y desarrollo psicomotor en niños de acuerdo con su asistencia a las guarderías. MÉTODOS: Se llevó a cabo un estudio transversal analítico en niños de 25 a 48 meses de edad. Se identificaron dos grupos: 68 niños atendidos en guarderías y 68 niños no atendidos en guarderías. El crecimiento se evaluó con las curvas de peso para la talla y el desarrollo psicomotor, con el instrumento de evaluación del desarrollo del niño (área psicosocial, lenguaje, psicomotriz, y cognitiva). Se utilizó la prueba de X2 para el análisis estadístico. RESULTADOS: El porcentaje de niños de guardería con peso ideal es superior al de los no atendidos en guardería (p = 0.035). El desarrollo psicomotor es significativamente mayor en los niños de guardería: en el área psicosocial (p = 0.000), en lenguaje (p = 0.000), en el área motriz (p = 0.000) y en desarrollo cognitivo (p = 0.000). CONCLUSIONES: El desarrollo psicomotor de los niños atendidos en guardería es superior al de los niños no atendidos en guardería.

[SARS-CoV-2 incidence, transmission, and containment measures in daycare centers during the COVID-19 pandemic-findings from the Corona Daycare Study]. / Infektionsgeschehen und Eindämmungsmaßnahmen in Kitas während der COVID-19-Pandemie ­ Erkenntnisse aus der Corona-KiTa-Studie.

BACKGROUND: Daycare centers are of substantial sociopolitical and pedagogical relevance; at the same time, the close contact of children in daycare groups among each other and with employees favors the transmission of infections. In the COVID-19 pandemic, questions arose about how infection events occur in daycare centers, what role daycare children play in the pandemic, and what protective and hygienic measures are implemented in daycare centers. From 06/2020 to 12/2021, we conducted the "Corona Day Care Study," in which we address pedagogical and infection epidemiological topics in a joint approach. METHODS: In the study, data are collected from different sources. Official reporting data as well as weekly data from daycare centers in the so-called KiTa Register are continuously evaluated. In addition, SARS-CoV­2 outbreaks in daycare centers are investigated on site by repeated sample collection and interviews. RESULTS: SARS-CoV­2 infection incidence in daycare centers or in daycare-aged children was very dynamic from 03/2020 to 05/2021. In the second and third pandemic waves, the number of SARS-CoV­2 outbreaks in daycare centers rose sharply, accompanied by a substantial increase in daycare and group closures. Most recently, the proportion of affected children in outbreaks increased steadily. However, preliminary examinations of SARS-CoV­2 outbreaks (n = 28) revealed that, on average, only a fraction of daycare contact persons (6.8%) were infected by child index cases. Transmission frequencies differed markedly between the individual daycare centers. DISCUSSION: The combination of regularly collected reporting and survey data as well as outbreak investigations allows a multilayered monitoring and understanding of infection events in daycare centers; its findings could be incorporated into recommendations for public health measures.

Prevalence and Risk Factors of Sarcopenia among Older Adults Aged ≥65 Years Admitted to Daycare Centers of Taiwan: Using AWGS 2019 Guidelines.

Sarcopenia is a geriatric syndrome which is likely to cause disability, body unbalance, and mortality and thus can lead to heavy healthcare expenditure and caregiver burden. Although some studies have addressed the prevalence of sarcopenia for older adults, there are limited studies conducted in daycare centers. The present study aimed to (i) estimate the prevalence of sarcopenia and (ii) explore associated factors of sarcopenia and standing balance among older adults admitted to daycare centers in Taiwan. The cross-sectional study collected data on demographics, health status, handgrip strength, gait speed (GS), skeletal muscle mass, Taiwan-Mini Nutritional Assessment Short-Form (TW-MNA-SF), and Short Physical Performance Battery from daycare centers in northern Taiwan. The definition of sarcopenia followed the Asian Working Group for Sarcopenia 2019 guidelines. Among 173 participants ≥65 year-old, 50.9% had confirmed sarcopenia, 47.4% possible sarcopenia, and 1.7% normal. Results showed that calf circumference, TW-MNA-SF, dementia, and body mass index (BMI) were associated with sarcopenia. Moreover, BMI, GS, and sarcopenia were associated factors of standing balance. The study estimated a high prevalence of sarcopenia in daycare centers and identified some significant factors of sarcopenia and standing balance. Early nutritional and physiotherapy interventions could benefit older adults to prevent sarcopenia or unbalance.

Development and Validation of a Person-Centered Care Assessment Questionnaire for Daycare Centers for Older Adults.

Daycare services serve to prolong aging at home. This decreases both families' care burden and the government's financial burden. We identified key factors in the person-centered approach of South Korean daycare center workers to develop and validate a Korean person-centered care questionnaire. Twenty-one items were developed, and 10 expert interviews were conducted. The items were applied to 271 daycare center staff (19.2% male vs. 80.0% female, mean age = 50.68 ± 11.37 years) to evaluate their reliability and validity. Twenty items concerning intimate relationships and the environment, consumers' self-determination, and home-likeness domains were derived, explaining 40.28%, 10.44%, and 6.97% of the total variance, respectively. The overall tool's Cronbach's alpha was 0.905, demonstrating internal consistency. Inter-rater agreement ranged from 0.221 (fair) to 0.765 (good). This tool will be useful for individual staff members as well as for the National Health Insurance Service's evaluations of service quality at daycare centers.

Human Astrovirus Outbreak in a Daycare Center and Propagation among Household Contacts.

We investigated an outbreak of acute gastroenteritis due to human astrovirus in a daycare center, describing the transmission mechanism, the most affected age groups, conditioning factors and the extent of the outbreak among household contacts of the daycare center attenders. Data were collected from persons exposed at the daycare center and their home contacts. Fecal samples from affected and non-affected daycare center attenders were analyzed for viruses causing acute gastroenteritis by RT-PCR. The percentage of households affected and the attack rates (AR) were calculated. The attack rates were compared using the rate ratio (RR) with 95% confidence intervals. Information was obtained from 245 people (76 attenders and 169 contacts) of whom 49 were clinical cases. Five HAstV-4, two HAstV-8 and three non-typable HAstV cases were identified (six from clinical cases and four from asymptomatic infected people). The global AR was 20% (41.2% in children aged < 2 years). Data were obtained from 67 households: 20 households of affected attenders and 47 of non-affected attendees. Household contacts of affected attenders had a higher AR (74.3%) than that of non-affected attendees (2.4%). We found asymptomatic infections amongst daycare attendees. The transmission of HAstV during the outbreak was not limited to the daycare center but extended to household contacts of both affected and non-affected attenders.

EHEC O111:H8 strain and norovirus GII.4 Sydney [P16] causing an outbreak in a daycare center, Brazil, 2019.

BACKGROUND: This study describes the investigation of an outbreak of diarrhea, hemorrhagic colitis (HC), and hemolytic uremic syndrome (HUS) at a daycare center in southeastern Brazil, involving fourteen children, six staff members, six family members, and one nurse. All bacterial and viral pathogens detected were genetically characterized. RESULTS: Two isolates of a strain of enterohemorrhagic Escherichia coli (EHEC) serotype O111:H8 were recovered, one implicated in a case of HUS and the other in a case of uncomplicated diarrhea. These isolates had a clonal relationship of 94% and carried the stx2a and eae virulence genes and the OI-122 pathogenicity island. The EHEC strain was determined to be a single-locus variant of sequence type (ST) 327. EHEC isolates were resistant to ofloxacin, doxycycline, tetracycline, ampicillin, and trimethoprim-sulfamethoxazole and intermediately resistant to levofloxacin and ciprofloxacin. Rotavirus was not detected in any samples, and norovirus was detected in 46.7% (14/30) of the stool samples, three of which were from asymptomatic staff members. The noroviruses were classified as the recombinant GII.4 Sydney [P16] by gene sequencing. CONCLUSION: In this outbreak, it was possible to identify an uncommon stx2a + EHEC O111:H8 strain, and the most recent pandemic norovirus strain GII.4 Sydney [P16]. Our findings reinforce the need for surveillance and diagnosis of multiple enteric pathogens by public health authorities, especially during outbreaks.

Using Hybrid Telepractice for Supporting Parents of Children with ASD during the COVID-19 Lockdown: A Feasibility Study in Iran.

During the three-month closure of clinics and day centers in Iran due to the coronavirus disease 2019 (COVID-19) lockdown, parents of children with Autism Spectrum Disorder (ASD) became solely responsible for their care and education. Although centers maintained telephone contact, it quickly became evident that parents needed more detailed advice and guidance. Staff from 30 daycare centers volunteered to take part in a two-month online support and training course for 336 caregivers of children with ASD of different ages. In addition to the provision of visual and written information, synchronous video sessions were used to coach parents on the learning goals devised for the children. Both qualitative and quantitative data were collected to understand the acceptability of using telepractice and the outcomes achieved. A low dropout rate and positive feedback from parents indicated that they perceived telepractice sessions to be useful. The factors contributing to parents' satisfaction were identified. Although the use of telepractice would be a good alternative for caregivers in any future lockdowns, it could also be used in conjunction with daycare center services to encourage greater parental participation, or with families living in areas with no day centers. Further studies are needed to compare telepractice to usual daycare face-to-face interventions, and to document its impact and cost-effectiveness for parents and children.

Trends in Hospitalization of Patients with Potentially Serious Diseases Evaluated at a Quick Diagnosis Clinic.

Although quick diagnosis units (QDU) have become a cost-effective alternative to inpatient admission for diagnosis of potentially serious diseases, the rate of return hospitalizations among evaluated patients is unknown. This study examined the temporal trends in admissions of QDU patients through 15 years. Adult patients referred to QDU from 2004 to 2019 who were hospitalized between the first and last visit in the unit were eligible. Decisions about admissions were mainly based on the Appropriateness Evaluation Protocol and required independent validation by experienced clinicians using a customized tool. The final analysis included 825 patients. Patient characteristics and major reasons for admission were compared each year and linear trends were analyzed. Admission rates decreased from 7.2% in 2004-2005 to 4.3% in 2018-2019 (p < 0.0001). While a significant increasing trend was observed in the rate of admissions due to cancer-related complications (from 39.5% in 2004-2005 to 61.7% in 2018-2019; p < 0.0001), those due to anemia-related complications and scheduled invasive procedures experienced a significant downward trend. A likely explanation for these declining trends was the relocation of the unit to a new daycare center in 2013-2014 with recovery rooms and armchairs for IV treatments. The facts of this study could help in the provision of anticipatory guidance for the optimal management of patients at risk of clinical complications.