Artículos de revistas sobre el tema "Neighborhood Centers Day Care Association"
Siga este enlace para ver otros tipos de publicaciones sobre el tema: Neighborhood Centers Day Care Association.
Crea una cita precisa en los estilos APA, MLA, Chicago, Harvard y otros
Consulte los 50 mejores artículos de revistas para su investigación sobre el tema "Neighborhood Centers Day Care Association".
Junto a cada fuente en la lista de referencias hay un botón "Agregar a la bibliografía". Pulsa este botón, y generaremos automáticamente la referencia bibliográfica para la obra elegida en el estilo de cita que necesites: APA, MLA, Harvard, Vancouver, Chicago, etc.
También puede descargar el texto completo de la publicación académica en formato pdf y leer en línea su resumen siempre que esté disponible en los metadatos.
Explore artículos de revistas sobre una amplia variedad de disciplinas y organice su bibliografía correctamente.
1
Diaz, Adrian, Stacy Tessler Lindau, Samilia Obeng-Gyasi, Justin B. Dimick, John W. Scott y Andrew M. Ibrahim. "Association of Hospital Quality and Neighborhood Deprivation With Mortality After Inpatient Surgery Among Medicare Beneficiaries". JAMA Network Open 6, n.º 1 (30 de enero de 2023): e2253620. http://dx.doi.org/10.1001/jamanetworkopen.2022.53620.
Texto completoResumen
ImportanceAlthough the hospital at which a patient is treated is a known source of variation in mortality after inpatient surgery, far less is known about how the neighborhoods from which patients come may also contribute.ObjectiveTo compare postoperative mortality among Medicare beneficiaries based on the level of neighborhood deprivation where they live and hospital quality where they received care.Design, Setting, and ParticipantsThis cross-sectional study examined outcomes among Medicare beneficiaries undergoing 1 of 5 common surgical procedures (colon resection, coronary artery bypass, cholecystectomy, appendectomy, or incisional hernia repair) between 2014 and 2018. Hospital quality was assigned using the Centers for Medicare & Medicaid Services Star Rating. Each beneficiary’s neighborhood was identified at the census tract level and sorted in quintiles based on its Area Deprivation Index score, a composite measure of neighborhood quality, including education, employment, and housing quality. A risk matrix across hospital quality and neighborhood deprivation was created to determine the relative contribution of each to mortality after surgery. Data were analyzed from June 1 to December 31, 2021.ExposuresHospital quality and neighborhood deprivation.Main Outcomes and MeasuresThe main outcome was risk-adjusted 30-day mortality after surgery using a multivariable logistic regression model taking into account patient factors and procedure type.ResultsA total of 1 898 829 Medicare beneficiaries (mean [SD] age, 74.8 [7.0] years; 961 216 [50.6%] male beneficiaries; 28 432 [1.5%] Asian, 145 160 [77%] Black, and 1 622 304 [86.5%] White beneficiaries) were included in analyses. Patients from all neighborhood deprivation group quintiles sought care at hospitals across hospital quality levels. For example, 9.1% of patients from the highest deprivation neighborhoods went to a hospital in the highest star rating of quality and 4.2% of patients from the lowest deprivation neighborhoods went to a hospital in the lowest star rating of quality. Thirty-day risk-adjusted mortality varied across high- and low-quality hospitals (4.3% vs 7.2%; adjusted odds ratio [aOR], 1.78; 95% CI, 1.66-1.92) and across the least and most deprived neighborhoods (4.5% vs 6.8%; aOR, 1.58; 95% CI, 1.53-1.64). When combined, comparing patients from the least deprived neighborhoods going to high-quality hospitals vs patients from the most deprived neighborhoods going to low-quality hospitals, the variation increased further (3.8% vs 8.1%; aOR, 2.20; 95% CI, 1.96-2.46).Conclusions and RelevanceThese findings suggest that characteristics of a patient’s neighborhood and the hospital where they received treatment were both associated with risk of death after commonly performed inpatient surgical procedures. The associations of these factors on mortality may be additive. Efforts and investments to address variation in postoperative mortality should include both hospital quality improvement as well as addressing drivers of neighborhood deprivation.
2
Cornell, Portia, Christopher Halladay, Gina Chmelka, Caitlin Celardo, Robert Burke, Jennifer Silva, James Rudolph y Kali Thomas. "SOCIAL DETERMINANTS OF HOSPITAL READMISSION FOR OLDER VETERANS". Innovation in Aging 6, Supplement_1 (1 de noviembre de 2022): 181. http://dx.doi.org/10.1093/geroni/igac059.723.
Texto completoResumen
Abstract The objective of this study was to estimate the effect of social risk on the likelihood of hospital readmission. Our study sample included 156,690 hospitalizations from 2016 - 2019 at one of 36 VA medical centers that participated in a national social-work staffing program. Using information from outpatient screenings, social workers’ assessments, and diagnosis codes, We identified Veterans’ social risks categorized into nine specific categories: intimate partner violence, financial need, housing instability, legal problems, social isolation, mental health, transportation, food insecurity, and functional need; and two general categories: nonspecific psychosocial and neighborhood deprivation. We estimated linear probability models of unplanned hospital readmission to a VA or a community hospital within 30 days of discharge, adjusted for demographics, clinical characteristics known to predict readmission (length of stay, primary diagnosis, admission from emergency department, chronic comorbidities, previous hospitalizations), and year and hospital fixed effects. 15.3 percent of hospital stays were followed by an unplanned readmission within 30 days. The prevalence of specific social risks ranged from 1.2% (food insecurity) to 13.9% (financial need). Social risk factors are important predictors of unplanned hospital readmission among Veterans after adjusting for medical risk. The risk categories with the strongest adjusted association with 30-day readmission were legal need, risk difference .033 (p=.015); interpersonal violence (r.d.=.022, p<.001); mental health (r.d.=.022, p=.002); social isolation (r.d.=.010, p<.001); and nonspecific psychosocial (r.d.=.017, p<.001). These social risk indicators could be used to target care-transition intervention and follow-up by a social worker to address social needs and avert unplanned hospital readmission.
3
Amano, Takashi, Yung Chun, Sojung Park y Yi Wang. "Geographic distribution of availability of adult day services in Missouri". Innovation in Aging 5, Supplement_1 (1 de diciembre de 2021): 620. http://dx.doi.org/10.1093/geroni/igab046.2367.
Texto completoResumen
Abstract Adult day service (ADS) is an important component of long-term supportive services. Geographic availability of ADS is an essential factor for aging in place especially for people with assistance needs. This study aims to examine the geographic distribution of availability of ADS and its relationship with the disadvantaged characteristics of neighborhoods. Data from the Missouri Department of Health and Senior Services and the American Community Survey were utilized. Geographic availability of ADS was measured as capacity (number of clients served) of ADS centers per week divided by the number of people who were 65 or older and under poverty at the census tract level. To examine neighborhood disadvantaged characteristics, principal component analysis was applied to construct a socioeconomic deprivation index (SDI). Using geographic information systems, we mapped ADS centers, geographic availability of ADS, and SDI scores. Pearson correlation coefficient was calculated between geographic availability of ADS and SDI scores. In 92.3% of the census tracts in Missouri, ADS centers are not available. Further, ADS centers are less likely to locate in rural areas or census tracts with higher numbers of residents 65 or older and poor. Also, lower availability of ADS was associated with higher levels of neighborhood disadvantage at a marginal level (r = - 0.163). Our findings suggested that strategies should be identified to provide ADS in rural areas, especially in the areas with higher levels of neighborhood disadvantage. Further investigation on the geographic distribution of ADS accessibility and its association with neighborhood characteristics is warranted.
4
Iecovich, Esther y Aya Biderman. "Attendance in adult day care centers and its relation to loneliness among frail older adults". International Psychogeriatrics 24, n.º 3 (14 de octubre de 2011): 439–48. http://dx.doi.org/10.1017/s1041610211001840.
Texto completoResumen
ABSTRACTBackground: Loneliness is widespread among older adults, in particular among those who are chronically ill and functionally limited. The aims of the paper are: (i) to examine the extent to which users of day care centers experience loneliness compared to their peers who are non-users; and (ii) to explore the relationships between length of use and frequency of weekly attendance at day care centers and loneliness among users of day care centers.Methods: A case-control study was used with a sample of 817 respondents of whom 417 were users of 13 day care centers and 400 were non-users, matched by age, gender, and family physician in the southern region of Israel. Data collection included face-to-face interviews using a structured questionnaire.Results: The vast majority in both groups (79.3% and 76.3%, respectively) reported moderate to severe levels of loneliness. Perceived economic status and self-rated health were the most significant variables in explaining loneliness. No significant differences were found between users and non-users of day care centers in the level of loneliness. Attendance at day care centers, as well as length and frequency of use, had no significant association with loneliness.Conclusion: More research, which will include quasi-experimental and longitudinal research designs, is necessary to examine the causal relationships between attendance at day care centers and loneliness. This can provide information on the effectiveness of day care centers in reducing loneliness among frail older adults.
5
Hurwitz, Eugene S., Carmen C. Deseda, Craig N. Shapiro, David R. Nalin, M. Jayne Freitg-Koontz y Jun Hayashi. "Hepatitis Infections in the Day-Care Setting". Pediatrics 94, n.º 6 (1 de diciembre de 1994): 1023–24. http://dx.doi.org/10.1542/peds.94.6.1023.
Texto completoResumen
The hepatitis session reviewed current knowledge of the epidemiology and public health importance of hepatitis A (HAV) and hepatitis B virus (HBV) in day care centers (DCCs), current recommendations and prevention measures, areas that need additional research, and the potential for new preventive measures. HEPATITIS A The clinical characteristics, modes of transmission, risk factors for day-care-related outbreaks, and characteristics of hepatitis A virus outbreaks have been well described previously.1 Within the day-care setting, HAV is transmitted via the fecal-oral route, either person to person (between children and staff); via contaminated food (often in association with individuals who prepare food and care for diapered children); or possibly via fomites on contaminated surfaces or toys. In young children, in contrast to adults, hepatitis A may be difficult to recognize, as clinical illness is frequently nonspecific and mild, consisting primarily of malaise, nausea, fever, and diarrhea. Fewer than 5% of children under 3 years of age and only about 10% of those 4 to 6 years of age develop jaundice and are thus easily recognized as having hepatitis. Consequently, recognition of hepatitis A outbreaks in the day-care setting is often dependent upon recognizing hepatitis A in adults (parents or staff) who have had contact with day-care centers (DCCs). The initial recognition of DCCs as important sources of hepatitis A virus transmission both within the centers and in the communities they serve occurred in the mid-1970s.2,3 Early studies focused on describing the characteristics of DCCs in which hepatitis A outbreaks occurred, including DCCs with large numbers (≥50) of children in diapers and centers that are open more than 15 hours per day.2
6
Rokstad, Anne Marie Mork, Knut Engedal, Øyvind Kirkevold, Jūratė Šaltytė Benth, Maria Lage Barca y Geir Selbæk. "The association between attending specialized day care centers and the quality of life of people with dementia". International Psychogeriatrics 29, n.º 4 (17 de noviembre de 2016): 627–36. http://dx.doi.org/10.1017/s1041610216002015.
Texto completoResumen
ABSTRACTBackground:Day care that is designed for people with dementia aims to increase the users’ quality of life (QoL). The objective of the study was to compare the QoL of people with dementia attending day care with those not attending day care.Methods:The study is based on baseline data from a project using a quasi-experimental design, including a group of day care users (n = 183) and a comparison group not receiving day care (n = 78). Quality of Life-Alzheimer's Disease (QoL-AD) was used as the primary outcome, to collect both self-reported and proxy-based information from family carers on the users’ QoL. A linear mixed model was used to examine the differences between groups.Results:Attending day care was significantly associated with higher mean scores of self-reported QoL. There was no difference between the groups in proxy-reported QoL. Analyses of the interaction between group belonging and awareness of memory loss revealed that the participants with shallow or no awareness who attended day care had significant higher mean scores of QoL-AD compared to those not attending day care.Conclusions:Higher self-reported QoL was found among people attending day care designed for people with dementia compared to the comparison group. The difference in QoL ratings was found in the group of day care users with shallow or no awareness of their memory loss. Hence, day care designed for people with dementia might have the potential to increase QoL as it is experienced by the users.
7
Victora, Cesar G., Sandra C. Fuchs, José Antonio C. Flores, Walter Fonseca y Betty Kirkwood. "Risk Factors for Pneumonia Among Children in a Brazilian Metropolitan Area". Pediatrics 93, n.º 6 (1 de junio de 1994): 977–85. http://dx.doi.org/10.1542/peds.93.6.977.
Texto completoResumen
Objective. To investigate risk factors for pneumonia for infants <2 years of age. Design. Hospital-based, case-control study with neighborhood control subjects. Setting. Urban area in southern Brazil. Subjects. Five hundred ten infants with radiologically confirmed pneumonia who were admitted to a pediatric hospital. One age-matched neighborhood control subject was selected for each case. Results. Multiple conditional regression modeling was used to control for confounding, taking into account the hierarchical relationships between risk factors. The incidence of radiologically confirmed pneumonia was associated with low paternal education, the number of persons in the household, young maternal age, attendance at day-care centers, low birth weight and weight-for-age, lack of breast-feeding and of non-milk supplements, and a history of previous pneumonia or wheezing. Day-care center attendance showed the highest risk, with an adjusted odds ratio of 11.75. Conclusions. In addition to continued efforts toward appropriate case management, actions directed against the above risk factors may help prevent the major cause of deaths of children younger than 5 years.
8
Hamadi, Hanadi, Darren Brownlee, Graham Howard, Jarrell Mahusay y Aaron Spaulding. "COPD Readmissions and Hospital Primary Care Physicians". Physician Leadership Journal 9, n.º 1 (8 de enero de 2022): 30–36. http://dx.doi.org/10.55834/plj.2161231247.
Texto completoResumen
The Centers for Medicare & Medicaid Services (CMS) collects data on hospital 30-day Chronic Obstructive Pulmonary Disease (COPD) readmission rates to reduce preventable readmissions and prevent wasteful use of Medicare dollars. Hospitals have begun exploring different strategies to reduce their COPD-related 30-day readmissions. One key strategy has been the use of primary care providers (PCPs). This study examined the association between the percentage of PCPs at the hospital and Medicare COPD 30-day readmissions from 2014 to 2019. Results demonstrate a slight positive association between PCP percentage and COPD 30-day readmission. Further, hospitals in rural areas and those in less competitive environments are also associated with increased COPD readmission rates; yet, hospitals that are part of a system, provide medical education, or are larger, tend to have lower readmission rates.
9
Herr, Raphael M., Katharina Diehl, Sven Schneider, Nina Osenbruegge, Nicole Memmer, Steffi Sachse, Stephanie Hoffmann et al. "Which Meso-Level Characteristics of Early Childhood Education and Care Centers Are Associated with Health, Health Behavior, and Well-Being of Young Children? Findings of a Scoping Review". International Journal of Environmental Research and Public Health 18, n.º 9 (7 de mayo de 2021): 4973. http://dx.doi.org/10.3390/ijerph18094973.
Texto completoResumen
Characteristics of early childhood education and care (ECEC) centers might be relevant for children’s health. This scoping review aims to provide an overview of the association between meso-level characteristics (MLCs) of ECEC centers with children’s health, health behavior, and wellbeing. Five databases were searched for quantitative and qualitative research articles published in English or German since 1 January 2000 on health, health behavior, and wellbeing of children aged 0 to 6 years considering MLCs of ECEC centers. Two authors screened 10,396 potentially eligible manuscripts and identified 117 papers, including 3077 examinations of the association between MLCs and children’s health indicators (Kappas > 0.91). Five categories of MLCs were identified: (1) structural characteristics, (2) equipment/furnishings, (3) location, (4) facilities/environment, (5) culture/activities/policies/practices, and 6) staff. Only very few studies found an association of MLCs with body weight/obesity, and general health and wellbeing. Especially physical activity and mental health were related to MLCs. In general, the location (rural vs. urban, neighborhood status) seemed to be a relevant health aspect. MLCs of ECEC centers appeared relevant for child health indicators to different degrees. Future research should focus on these associations, in detail, to identify concrete ECEC indicators that can support health promotion in early childhood.
10
Loberiza, Fausto R., Mei-Jie Zhang, Stephanie J. Lee, John P. Klein, Charles F. LeMaistre, Derek S. Serna, Mary Eapen, Christopher N. Bredeson, Mary M. Horowitz y J. Douglas Rizzo. "Association of transplant center and physician factors on mortality after hematopoietic stem cell transplantation in the United States". Blood 105, n.º 7 (1 de abril de 2005): 2979–87. http://dx.doi.org/10.1182/blood-2004-10-3863.
Texto completoResumen
AbstractThe effect of the organization and delivery of health care at medical centers, referred to as “center effects,” with clinical outcomes after hematopoietic stem cell transplantation (HSCT) is not clear. We examined the association between center and treatment provider factors and mortality after HSCT. We surveyed 163 (87% response rate) United States transplantation centers that performed HLA-identical sibling HSCT for leukemia or autologous HSCT for lymphoma between 1998 and 2000 among patients at least 18 years old. One hundred thirteen (69%) centers performed HLA-identical sibling transplantations, whereas 162 (99%) performed autologous transplantations. Factors associated with decreased 100-day mortality in the allogeneic setting include a higher patient-per-physician ratio (P = .003) and centers where physicians answer calls after office hours (P = .03). Medical school affiliation was not associated with increased 100-day mortality except in centers where students/residents are present without fellows (P = .02). Center effects were weaker in autologous HSCT at 1 year. Differences in 100-day mortality in patients receiving transplants in centers with favorable versus unfavorable factors were greater in allogeneic than autologous HSCT. Greater physician involvement in patient care is important in producing favorable outcomes after HSCT. To more clearly establish the role of the factors we identified, further studies are recommended.
11
Choi, Yeon Jin, Gillian Fennell y Jennifer Ailshire. "ACCESS TO NEIGHBORHOOD AMENITIES AND RISK OF INSTITUTIONALIZATION AMONG PERSONS WITH DEMENTIA". Innovation in Aging 7, Supplement_1 (1 de diciembre de 2023): 50–51. http://dx.doi.org/10.1093/geroni/igad104.0165.
Texto completoResumen
Abstract Compared to only 2% of the total population between ages 65 and 84, 15% of persons with dementia (PWD) transition to nursing homes. This may be due to caregiving challenges associated with the behavioral symptoms PWD exhibit and their reduced capacities to perform daily tasks. Access to neighborhood amenities (e.g., parks, food access, libraries, service providers) may reduce the risk of institutionalization by helping PWD maintain their health and independence through the provision of opportunities for physical exercise, nutritious diets, social interaction, and cognitive stimulation while providing their caregivers with supportive services. Using data from the2006-2016 waves of the Health and Retirement Study (HRS), the HRS Contextual Data Resource, and the National Neighborhood Data Archive, this study aimed to identify neighborhood factors that are associated with transition into a nursing home among PWD who lived in the community (N=3,366). A series of logistic regression models were estimated adjusting for sociodemographic characteristics, health status, and neighborhood characteristics. Findings suggest that access to more park areas, healthy food outlets (i.e., grocery stores, supermarkets, supercenters), social amenities (e.g., museums, libraries), and social services for older adults and those with disabilities (e.g., senior centers, adult day care centers, disability support groups) were significantly associated with a lower risk of 2-year institutionalization. Retail stores and home health services were not significantly associated with the risk of institutionalization. These findings emphasize the importance of neighborhood amenities, such as parks and healthy food outlets, in enabling PWD to age in place.
12
Boutsioli, Zoe. "A Promising Health Care Reform in Greece". International Journal of Healthcare Delivery Reform Initiatives 3, n.º 2 (abril de 2011): 23–27. http://dx.doi.org/10.4018/jhdri.2011040102.
Texto completoResumen
The Greek Ministry of Health has decided to reform hospital services, due to high cost and low services offered and a part of health care expenditures is wasted. The Minister of Health, Mr. Andreas Loverdos has enacted a law for the Greek health care system which include 3 major health reforms: the co-management of hospital units, taking either the type of ‘shared Manager’ or ‘shared Board of Directors,’ the transformation of some general hospitals/health centers or specialized hospitals that present low effective/efficiency rates into either primary health care units or day clinics for specific health care problems, and the merging of similar departments/clinics and/or laboratories either in a hospital or among two or more hospitals that are in the neighborhood. From these reforms, it is estimated that more than 150 million Euro will be saved from these reforms during the 4-year period 2012-2015.
13
Bredekamp, Sue. "Day-Care Standards: Need and Impact". Pediatrics 91, n.º 1 (1 de enero de 1993): 234–36. http://dx.doi.org/10.1542/peds.91.1.234.
Texto completoResumen
Any discussion of standards, no matter how brief, must first acknowledge that there are different types of standards established for different purposes. As the director of the national voluntary accreditation system for child care centers and schools established by the National Association for the Education of Young Children (NAEYC), I am most familiar with the need and impact of accreditation standards, which are, by definition, standards for distinguishing high-quality programs established by a professional organization. In any case the implementation of a national accreditation system is heavily influenced by local and state licensing standards, which are mandatory government regulations that establish a baseline of protection. Accreditation and licensing standards are both influenced by model standards such as the health and safety standards of the American Academy of Pediatrics and the American Public Health Association.1 These standards establish a model, based on the best professional evidence, that serves as a reference for the other two systems but does not carry an enforcement system of its own. This paper will discuss the need for and impact of all three types of standards from the point of view of my experience in operating NAEYC's accreditation system.2 Because our accreditation process is nationally administered, we have the opportunity to observe the impact of diverse licensing standards on quality. In order to maintain accessibility we have relatively few eligibility requirements, and because we do not require 100% compliance with our criteria, we also have the opportunity to observe the interrelationships among standards and other effects. One caveat must be offered at the outset.
14
Gaffney, Lukas K. y Kenneth A. Michelson. "Analysis of Hospital Operating Margins and Provision of Safety Net Services". JAMA Network Open 6, n.º 4 (18 de abril de 2023): e238785. http://dx.doi.org/10.1001/jamanetworkopen.2023.8785.
Texto completoResumen
ImportanceSafety net hospitals (SNH) provide many community services. The cost of providing these services is unknown.ObjectiveTo determine what safety net criteria are associated with differences in hospital operating margin.Design, Setting, and ParticipantsThis cross-sectional study of US acute care hospitals from 2017 to 2019 included eligible hospitals identified from US Centers for Medicare &amp; Medicaid Services Cost Reports.ExposuresFive domains of SNH: undercompensated care measured using the Disproportionate Share Hospital index, uncompensated care, essential community services, neighborhood disadvantage, and sole community hospital and critical access hospital status. Each was categorized as a quintile or binary response. Covariates included hospital ownership, size, teaching status, census region, urbanicity, and wage index.Main Outcomes and MeasuresOperating margin and its association with each safety net criterion was determined using linear regression adjusting for all safety net criteria and covariates.ResultsA total of 4219 hospitals were analyzed, of which 3329 hospitals (78.9%) satisfied at least 1 safety net criterion; 23 hospitals (0.5%) met 4 or all 5 criteria. Among safety net criteria, the highest quintile of undercompensated care (−6.2 percentage point difference compared with lowest quintile; 95% CI, −8.2 to −4.2 percentage points), uncompensated care (−3.4 percentage points; 95% CI, −5.1 to −1.6 percentage points), and neighborhood disadvantage (−3.9 percentage points; 95% CI, −5.7 to −2.1 percentage points) were each associated with a lower operating margin. No association with operating margin was found between critical access or sole community hospital status (0.9 percentage points; 95% CI, −0.8 to 2.7 percentage points) or the highest vs lowest quintile of essential services (0.8 percentage points; 95% CI, −1.2 to 2.7 percentage points). Among essential services, burn, inpatient psychiatry, and primary care services were associated with lower operating margin, while others were either not associated or showed positive association. Fall-off in operating margin by level of uncompensated care was most severe in the highest percentiles of uncompensated care, with the most marked declines among those with the lowest operating margin.Conclusions and RelevanceIn this cross-sectional study of SNH, hospitals in the highest quintiles of undercompensated care, uncompensated care, and neighborhood disadvantage were more financially vulnerable than those not in the top quintile, especially when they met numerous of these criteria. Ensuring targeting of financial support to these hospitals could improve their financial stability.
15
Barros, Henrique y Nuno Lunet. "Association between child-care and acute diarrhea: a study in Portuguese children". Revista de Saúde Pública 37, n.º 5 (octubre de 2003): 603–8. http://dx.doi.org/10.1590/s0034-89102003000500009.
Texto completoResumen
OBJECTIVE: To quantify the influence of the type of child-care on the occurrence of acute diarrhea with special emphasis on the effect of children grouping during care. METHODS: From October 1998 to January 1999 292 children, aged 24 to 36 months, recruited using a previously assembled cohort of newborns, were evaluated. Information on the type of care and occurrence of diarrhea in the previous year was obtained from parents by telephone interview. The X² and Kruskal-Wallis tests were used to compare proportions and quantitative variables, respectively. The risk of diarrhea was estimated through the calculation of incident odds ratios (OR) and their respective 95% confidence intervals (95% CI), crude and adjusted by unconditional logistic regression. RESULTS: Using as reference category children cared individually at home, the adjusted ORs for diarrhea occurrence were 3.18, 95% CI [1.49, 6.77] for children cared in group at home, 2.28, 95% CI [0.92, 5.67] for children cared in group in day-care homes and 2.54, 95% CI [1.21, 5.33] for children cared in day-care centers. Children that changed from any other type of child-care setting to child-care centers in the year preceding the study showed a risk even higher (OR 7.65, 95% CI [3.25, 18.02]). CONCLUSIONS: Group care increases the risk of acute diarrhea whatsoever the specific setting.
16
Marquet, Oriol, Myron F. Floyd, Peter James, Karen Glanz, Viniece Jennings, Marta M. Jankowska, Jacqueline Kerr y J. Aaron Hipp. "Associations Between Worksite Walkability, Greenness, and Physical Activity Around Work". Environment and Behavior 52, n.º 2 (5 de septiembre de 2018): 139–63. http://dx.doi.org/10.1177/0013916518797165.
Texto completoResumen
This article explores the role of the work environment in determining physical activity gained within and around the workplace. With most adults spending more than half of their waking day at work, the workplace is a promising venue for promoting physical activity. We used a sample of 147 employed women—median age = 53 years old; 42% meeting Centers for Disease Control and Prevention (CDC) physical activity recommendations—wearing a GPS device and accelerometer on the hip for 7 days to assess location and physical activity at minute-level epochs. We analyzed the association between geographic information systems (GIS) measures of walkability and greenness around the workplace and the amount of physical activity gained while in the work neighborhood. Our results showed that working in high walkable environments was associated with higher levels of moderate to vigorous physical activity while at work, and with higher moderate to vigorous physical activity gained within the work neighborhood. Increasing walkability levels around workplaces can contribute to increasing physical activity of employees.
17
Cabin, William D. y Marianne C. Fahs. "Eyes Wide Open or Not". Home Health Care Management & Practice 23, n.º 5 (21 de octubre de 2010): 342–55. http://dx.doi.org/10.1177/1084822310384924.
Texto completoResumen
Depression is significant among older Americans in the United States. A literature review found only five studies on the interrelationship between individual and neighborhood effects in predicting depression among older Americans. This article presents the results of exploring this interrelationship using data from the Brookdale Demonstration Project Initiative on Healthy Urban Aging (BDI). The BDI database is from a sample of 1,870 enrollees in New York City senior centers in 2008. The BDI analysis finds the association with depression is highest with visual impairment ( p = .000); frequent falling ( p = .000); lower income ( p = .000); little leisure-time physical activity ( p = .000); low neighborhood satisfaction ( p = .000); trouble hearing ( p = .000); arthritis/rheumatoid arthritis ( p = .001); and being disabled ( p = .005). Implications for senior center and home care provider collaboration on early preventive interventions relating to sensory impairment, depression, and conditions related to falls and the built environment are discussed.
18
Jutkowitz, Eric, John Mulcahy, Peter Huckfeldt, Christopher Frenier y Tetyana Shippee. "ASSOCIATION OF MANAGED CARE ORGANIZATION HCBS QUALITY AND HEALTH CARE UTILIZATION". Innovation in Aging 7, Supplement_1 (1 de diciembre de 2023): 245–46. http://dx.doi.org/10.1093/geroni/igad104.0809.
Texto completoResumen
Abstract Providing high quality home and community-based services (HCBS) to older adults is a priority, but surprisingly little is known about the association between HCBS quality and client health care utilization. We linked data from the 2018 wave of the National Core Indicators-Aging and Disabilities (NCI-AD) Adult Consumer Survey for participants in the State of Minnesota enrolled in the Elderly Waiver (n=1,449) to their Centers for Medicare and Medicaid Services (i.e., claims data). We attributed respondents in our sample to 1 of 8 managed care organizations (MCOs) responsible for managing the health and HCBS of beneficiaries. For each MCO, we calculated overall plan level HCBS quality using a validated approach based on items in NCI-AD with subdomains of care experience, security and inclusion. Plan quality was the independent variable in a series of multivariate regressions that controlled for county and beneficiary characteristics. Outcomes (yes/no for any utilization in year) included: 1) hospitalizations, 2) emergency department, 3) home health, 4) durable medical equipment, 5) personal care assistance, 6) transportation, 7) case management, 8) home services, and 9) adult day. Quality was positively associated with case management utilization, but no other measure. As the market share of the highest quality plan in a county increased, all beneficiaries (regardless of MCO) in the county used more durable medical equipment, case management services, and adult day care. In conclusion, MCO quality may be driven by client encounters with plans via case managers. A next step is to determine the causal relationship between quality and outcomes.
19
Jokelainen, Pikka, Betina Hebbelstrup Jensen, Bente Utoft Andreassen, Andreas Munk Petersen, Dennis Röser, Karen A. Krogfelt, Henrik V. Nielsen y Christen R. Stensvold. "Dientamoeba fragilis, a Commensal in Children in Danish Day Care Centers". Journal of Clinical Microbiology 55, n.º 6 (22 de marzo de 2017): 1707–13. http://dx.doi.org/10.1128/jcm.00037-17.
Texto completoResumen
ABSTRACT Dientamoeba fragilis is an intestinal protozoan of debated clinical significance. Here, we present cross-sectional and longitudinal observations on D. fragilis in children aged 0 to 6 years from a 1-year multi-day-care-center cohort study set in Copenhagen, Denmark. The inclusion period for the cohort was 2009 through 2012. Stool samples collected from the children were accompanied by questionnaires completed by the parents or guardians of the children. Using real-time PCR, D. fragilis was detected in the first stool sample from 97 of 142 (68.3%) children. We evaluated the associations between seven plausible risk factors (age, sex, having siblings, having domestic animals at home, having had infant colic, recent history of intake of antibiotics, and recent history of travel abroad) as well as six reported symptoms (lack of appetite, nausea, vomiting, abdominal pain, weight loss, and diarrhea) and testing positive for D. fragilis . The final multivariable model identified being >3 years old and having a history of recent travel abroad as risk factors for testing positive for D. fragilis . Moreover, univariable analyses indicated that having siblings was a risk factor. There was no statistical association between a recent history of gastrointestinal symptoms and testing positive for D. fragilis . Among the 108 children who were represented by ≥2 samples and thus included in the longitudinal analysis, 32 tested negative on the first sample and positive later, and the last sample from each of the 108 children was positive. The results are in support of D. fragilis being a common enteric commensal in this population.
20
Osterholm, Michael T. "Infectious Disease in Child Day Care: An Overview". Pediatrics 94, n.º 6 (1 de diciembre de 1994): 987–90. http://dx.doi.org/10.1542/peds.94.6.987a.
Texto completoResumen
In the early 1980s, the Minnesota Department of Health began to address the growing concern of the risk of infectious diseases in child day care by initiating a planning process that resulted in the first national symposium on infectious diseases in child day care. That symposium, which was held in June 1984 in Minneapolis, highlighted the fact that different vocabularies and points of reference would need to be bridged if day-care providers and regulators, clinicians, and public health practitioners are to work side-by-side in defining the risk of infectious diseases in day care and in developing appropriate prevention strategies.1 As a result of this meeting, the Minnesota Public Health Association submitted a resolution to the American Public Health Association (APHA) in the fall of 1984, stating that child-care standards, especially in the area of prevention of infectious diseases, were needed. This resolution, together with a simultaneous recommendation from the APHA's Maternal and Child Health Section for the development of health and safety standards for out-of-home child-care facilities, began a process which eventually led to the monumental effort now known as the American Public Health Association/American Academy of Pediatrics, National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs.2 In June, 1992, the Centers for Disease Control and Prevention sponsored the "International Conference on Child Day Care Health: Science, Prevention and Practice," a historic meeting bringing together concerned individuals from many disciplines to further define and set the future agenda for the science, prevention and practice of child day-care health.
21
Corseuil Giehl, Maruí W., Pedro C. Hallal, Ross C. Brownson y Eleonora d’Orsi. "Exploring Associations Between Perceived Measures of the Environment and Walking Among Brazilian Older Adults". Journal of Aging and Health 29, n.º 1 (9 de julio de 2016): 45–67. http://dx.doi.org/10.1177/0898264315624904.
Texto completoResumen
Objective: To investigate the associations between perceived environment features and walking in older adults. Method: A cross-sectional population-based study was performed in Florianopolis, Brazil, including 1,705 older adults (60+ years). Walking was measured by the International Physical Activity Questionnaire (IPAQ), and perceived environment was assessed through the Neighborhood Environment Walkability Scale. We conducted a multinomial logistic regression to examine the association between perceived environment and walking. Results: The presence of sidewalks was related to both walking for transportation and for leisure. Existence of crosswalks in the neighborhood, safety during the day, presence of street lighting, recreational facilities, and having dog were significant predictors of walking for transportation. Safety during the day and social support were significantly associated with walking for leisure. Discussion: The perceived environment may affect walking for specific purposes among older adults. Investments in the environment may increase physical activity levels of older adults in Brazil.
22
Rolf, Katarzyna, Aurelia Santoro, Morena Martucci y Barbara Pietruszka. "The Association of Nutrition Quality with Frailty Syndrome among the Elderly". International Journal of Environmental Research and Public Health 19, n.º 6 (13 de marzo de 2022): 3379. http://dx.doi.org/10.3390/ijerph19063379.
Texto completoResumen
Low diet quality among the elderly may be correlated with some diseases, including Frailty Syndrome (FS). This decline in function restricts the activity of older people, resulting in higher assistance costs. The aim of this study was to increase knowledge of diet quality predictors. Dietary intake was assessed among 196 individuals aged 60+ years using the three-day record method and FS by Fried’s criteria. Based on the compliance with the intake recommendation (% of EAR/AI), we distinguished three clusters that were homogeneous in terms of the nutritional quality of the diet, using Kohonen’s neural networks. The prevalence of frailty in the entire group was 3.1%, pre-frailty 38.8%, and non-frailty 58.1%. Cluster 1 (91 people with the lowest diet quality) was composed of a statistically significant higher number of the elderly attending day care centers (20.7%), frail (6.9%), pre-frail (51.7%), very low vitamin D intake (23.8% of AI), using sun cream during the summer months (always 19.8% or often 39.6%), having diabetes (20.7%), having leg pain when walking (43.1%), and deteriorating health during the last year (53.5%). The study suggests the need to take initiatives leading to the improvement of the diet of the elderly, especially in day care senior centers, where there are more frail individuals, including nutritional education for the elderly and their caregivers.
23
Spetz, Joanne y Jason Flatt. "Alzheimer’s Staffing, Services, and Outcomes in Adult Day Health Centers". Innovation in Aging 4, Supplement_1 (1 de diciembre de 2020): 82. http://dx.doi.org/10.1093/geroni/igaa057.270.
Texto completoResumen
Abstract Growing demand for care for Alzheimer’s Disease and related Dementia (ADRD) has resulted in rising use of adult day health centers (ADHCs), which employ teams of professionals including licensed nurses, nursing aides, social workers, and activity directors. This study evaluates the scope of services and staffing models of ADHCs that provide care to persons with ADRD compared to ADHCs that do not, and examines whether there is an association between staffing and client outcomes, measured as rates of hospitalizations, falls, and emergency department visits. We used facility-level data from the 2014 National Study of Long-Term Care Providers (NSLTCP) Adult Day Services Center module. We conducted bivariate comparisons and estimated multivariate regressions to identify ADHC characteristics associated with staffing and client outcomes. ADHCs that offered ADRD services had higher average daily attendance, greater shares of revenue from Medicaid and self-payment, and greater proportions of Blacks and females. They also had greater percentages of enrollees with depression, cardiovascular disease, diabetes, and needing assistance with activities of daily living. There were also greater numbers of registered nurse, licensed practical nurse, and social worker hours per enrollee day, but fewer activity staff hours per enrollee day. Multivariate regressions focused on ADHCs that offered skilled nursing services and revealed that total staff hours per enrollee day were not higher in ADHCs that provided ADRD services, controlling for other characteristics. However, staffing was greater in chain-affiliated ADHCs. Higher staffing levels were associated with lower rates of falls and emergency department visits.
24
Wesson, William, Aliya Rashid, Md Saiful Islam Saif, Emerson Logan, Carine Tabak, Mary McGann, James A. Davis et al. "Balancing Monitoring and Access: Optimal Duration of Monitoring for CD19 and BCMA CART Recipients for Lymphoma and Myeloma". Blood 142, Supplement 1 (28 de noviembre de 2023): 6914. http://dx.doi.org/10.1182/blood-2023-182872.
Texto completoResumen
Background: Due to the risks of cytokine release syndrome (CRS) and immune effector cell-associated neurologic syndromes (ICANS), a four-week monitoring period near the authorized treating center (ATC) is a requirement for all currently approved chimeric antigen receptor T cell (CART) therapies, as part of the required Risk Evaluation and Mitigation Strategy (REMS) programs. The purpose of the REMS program is to facilitate prompt administration of tocilizumab within 2 hours in the event of life-threatening adverse events . Most ATCs require patients to stay within a 30-60-minute radius of the ATC and require a dedicated caregiver. While monitoring is essential for safety, the optimal duration of monitoring post-CART has not been studied. It is an area of need as there is a known financial burden of relocation, which may increase gaps in access to care, especially for underserved populations. We evaluated real-world safety outcomes of patients receiving CD19 and BCMA CART for non-Hodgkin lymphoma (NHL) and relapsed refractory multiple myeloma (RRMM). Methods: Patients (pts) with NHL and RRMM who received commercial CD19-directed (axi-cel, tisa-cel, liso-cel, brexu-cel) and BCMA-directed CART (ide-cel, cilta-cel) respectively, from 1/2017 to 1/2023, at the University of Kansas Health System and Medical University of South Carolina were included. Based on each patient's 5-digit zip code, travel distance to the ATC, median household income, and rural or urban residence were estimated. Patients were divided into two groups: those who had either first or recurrent CRS or ICANS occurring at Day 7 or later (Events≥ D7) and the group with no CRS/ICANS ≥ Day 7 (No Events ≥ D7). Chi-square test and proportion tests were calculated. Results: 185 patients (pts) including 127 NHL pts (59% axi-cel, 19% tisa-cel, 13% liso-cel, 8% brexu-cel) and 58 RRMM pts (75% ide-cel and 25% cilta-cel) were included. Most patients (65%) lived beyond 30 minutes of the ATC, and only 23.2% were from rural neighborhoods. (Table 1) 150 pts were in the “No Events ≥ D7” while 35 pts were in the Events≥ D7 group. There were no differences in baseline characteristics of these groups (Table 1). 151 pts (81.6%) and 70 (39%) pts developed new-onset CRS and ICANS respectively on D0-28. Median time to onset for CRS vs ICANS: 2 (IQR 25-75%:1-4) vs 5 (IQR 25-75%:3-8). Median time to CRS vs ICANS resolution relative to infusion was 6 days (IQR 25-75%: 3-7) vs 11 days (IQR 25-75%: 8-15). 137 (91%) had onset of CRS D0-6, 12 (26% of at-risk at D7) developed CRS D7-14. There was no new onset CRS D15 onwards, although one pt (axi-cel recipient) developed CRS recurrence D15-28, and another axi-cel recipient developed CRS recurrence D43. Only these 2 pts had ongoing CRS beyond D14. 45 (64%) had onset of ICANS D0-6, 20 (14% of at-risk at D7) developed ICANS D7-14. Of the 119 at risk, 4 pts (1 axi-cel, 1 tisa-cel, 2 ide-cel) developed ICANS D15-28 and one pt (cilta-cel recipient) experienced new ICANS onset beyond D28. 30 pts had ongoing ICANS beyond D14 and 5 beyond D28. There was no significant association with disease, early vs no early event, product, co-stimulatory domain (CD28 vs 4-1BB), year of infusion (2021 onwards vs prior), or SDOH with CRS or ICANS on multivariate analysis. Resource Utilization: Tocilizumab (toci) was administered in 67% pts, median 2 doses (1-4). Median time to first dose toci was 3 days (0-11) and median time to last dose was 4 days (0-43). 44% pts received steroids, and all had first dose prior to D15. 14 pts had infections requiring admission D15-28. Other outcomes and resource utilization are shown in Table 2. Mortality:There were 15 deaths D0-90, mostly due to progression (9), 4 due to infection, and 1 “other” cause. No deaths were attributable to CRS or ICANS. Of these, one death occurred D0-28 (in an axi-cel recipient) due to progression. Conclusions: Despite differences in patterns of CRS and ICANS with CART products, there is a low incidence of CRS and ICANS onset beyond 2 weeks, but persistent risk of other fatal complications, mostly infectious, even beyond the mandated monitoring period. Our study suggests a flexible monitoring period proximal to the ATC for CRS/ICANS may be safe for select patients and will likely be more feasible especially for disadvantaged populations with limited support. Exploring hybrid models and earlier partnership of referring centers and ATCs for monitoring, may allow personalized continuum of care and improve outcomes.
25
Pinheiro, Igor de Matos y Crésio Alves. "Functionality and Risk of Falls in Elders Followed in a Day Care Center in Brazil". International Journal of Aging and Human Development 87, n.º 3 (27 de junio de 2018): 309–22. http://dx.doi.org/10.1177/0091415018785085.
Texto completoResumen
Adult day centers provide comprehensive care for older adults and may enhance autonomy, well-being, and socialization. This quasi-experimental study evaluated the impact of such multidisciplinary day care on functionality, fear of falling, and risk of falls in community elders. Fifty-two seniors who attended day services were followed for 1 year. During the year, the adults maintained functionality for activities of daily living, presented improvement in instrumental activities of daily living, and no longer presented high risk for falls. No association was found between the risk of falling and fear of falling, however. Results are discussed in terms of the positive outcomes of attending day services.
26
Paul, Jomon A., Benedikt Quosigk y Leo MacDonald. "Does Hospital Status Affect Performance?" Nonprofit and Voluntary Sector Quarterly 49, n.º 2 (27 de septiembre de 2019): 229–51. http://dx.doi.org/10.1177/0899764019877249.
Texto completoResumen
This article investigates the impact of hospital profit status on quality of care as measured by risk-adjusted, 30-day, inpatient readmission rates gathered by the Centers for Medicare and Medicaid Services. It also evaluates the association between inpatient readmission rates and market concentration, measured by the Herfindahl–Hirschman Index, and various hospital characteristics. It concludes that nonprofit (NP) hospitals have a statistically significant negative association with readmission rates because they can focus on their mission without intense pressure to make a profit. We find no significant association between quality of care and hospital market competitiveness nor any statistically significant evidence to reject the exogeneity assumption of NP status.
27
Kapral, Moira K., Hua Wang, Muhammad Mamdani y Jack V. Tu. "The effect of socioeconomic status on access to care and mortality following stroke". Stroke 32, suppl_1 (enero de 2001): 322. http://dx.doi.org/10.1161/str.32.suppl_1.322-c.
Texto completoResumen
36 Background: Socioeconomic status has been associated with increased mortality from ischemic heart disease as well as decreased access to interventions such as coronary angiography, even in countries with universal health care. We undertook a study to determine whether a similar association between socioeconomic status and mortality exists in the setting of stroke. Methods: We linked hospital discharge abstracts and vital-status data for all patients with acute stroke who were admitted to hospitals in Ontario between April 1994 and March 1997. Socioeconomic status for each patient was imputed based on their median neighborhood income as documented in Canada’s 1996 census. We determined the risk of death at thirty days and one year based on neighborhood income. Secondary analyses compared use of medications and carotid endarterectomy by income level. We used multivariate analyses to adjust for age, sex, stroke type, comorbid conditions and hospital and physician characteristics. Results: Overall, 39,545 patients were admitted with stroke during the study time frame. The crude 30-day and 1-year mortality rates were 19% and 33%, respectively. Thirty-day mortality was higher in those in the lowest income quintile than in the highest quintile (20% vs. 17%, P=0.002), with an adjusted hazard ratio of 1.1. One-year mortality was also higher in the lowest compared to the highest income quintile (34% vs. 31%, P=0.001), with an adjusted hazard ratio of 1.1. Each $10,000 increase in median neighborhood income was associated with a 9% reduction in the risk of death at 30 days (adjusted hazard ratio 0.91) and a 5% reduction in the risk of death at one year (adjusted hazard ratio 0.95). There were no differences in the use of medications (aspirin, ticlopidine, warfarin) or carotid endarterectomy based on socioeconomic status. However, waiting times for carotid surgery were significantly longer in the lowest income quintile compared to the highest (90 days vs. 60 days, P=0.001). Conclusion: Socioeconomic status affects mortality following stroke, even in a province with universal health care. The exact reasons for this effect on survival remain topics for future research.
28
Smith, Jamie M., Haiqun Lin, Charlotte Thomas-Hawkins, Jennifer Tsui y Olga F. Jarrín. "Timing of Home Health Care Initiation and 30-Day Rehospitalizations among Medicare Beneficiaries with Diabetes by Race and Ethnicity". International Journal of Environmental Research and Public Health 18, n.º 11 (25 de mayo de 2021): 5623. http://dx.doi.org/10.3390/ijerph18115623.
Texto completoResumen
Older adults with diabetes are at elevated risk of complications following hospitalization. Home health care services mitigate the risk of adverse events and facilitate a safe transition home. In the United States, when home health care services are prescribed, federal guidelines require they begin within two days of hospital discharge. This study examined the association between timing of home health care initiation and 30-day rehospitalization outcomes in a cohort of 786,734 Medicare beneficiaries following a diabetes-related index hospitalization admission during 2015. Of these patients, 26.6% were discharged to home health care. To evaluate the association between timing of home health care initiation and 30-day rehospitalizations, multivariate logistic regression models including patient demographics, clinical and geographic variables, and neighborhood socioeconomic variables were used. Inverse probability-weighted propensity scores were incorporated into the analysis to account for potential confounding between the timing of home health care initiation and the outcome in the cohort. Compared to the patients who received home health care within the recommended first two days, the patients who received delayed services (3–7 days after discharge) had higher odds of rehospitalization (OR, 1.28; 95% CI, 1.25–1.32). Among the patients who received late services (8–14 days after discharge), the odds of rehospitalization were four times greater than among the patients receiving services within two days (OR, 4.12; 95% CI, 3.97–4.28). Timely initiation of home health care following diabetes-related hospitalizations is one strategy to improve outcomes.
29
Mallikarjuna, Akshatha y Ashwani K. S. Sood. "Liver function tests as a prognostic indicator in Pediatric Intensive Care Unit (PICU)". International Journal of Contemporary Pediatrics 5, n.º 3 (20 de abril de 2018): 1031. http://dx.doi.org/10.18203/2349-3291.ijcp20181536.
Texto completoResumen
Background: Frank liver failure is incompatible with life. Severity of liver disease is reflected in clinical signs or biochemical alterations. Hepatic dysfunction indicates poor outcome in critically ill patients, but no large systematic investigation into its exact incidence and prognostic relevance has been performed in different population groups.Methods: All PICU admissions during the study period were included. Pattern of admission LFT (Liver Function Tests) was reported. Relationship between clinical events and patient outcome with the LFT panel on day 1 and day 3 were reported. Association between final outcome and day 7 LFT was explored.Results: Deranged AST (Aspartate Transaminase), ALT (Alanine Transaminase), Bilirubin, Albumin, PT (Prothrombin time) and INR (International Normalized Ratio) on Day1 and 3 had significant association with increased requirement of inotropic and ventilatory support as well with increased mortality. LFT parameters on day 7 showed significant correlation between normal AST, ALT, bilirubin, PT and INR with improved survival.Conclusions: LFT's should be essential part of biochemical profile and doctors caring for sick patients in peripheral hospitals should consider for early referral of patients to higher centers based on LFT parameters for the advanced care they deserve.
30
Reavis, Kevin M., Brian R. Smith, Marcelo W. Hinojosa y Ninh T. Nguyen. "Outcomes of Esophagectomy at Academic Centers: An Association between Volume and Outcome". American Surgeon 74, n.º 10 (octubre de 2008): 939–43. http://dx.doi.org/10.1177/000313480807401012.
Texto completoResumen
Studies have shown that esophagectomies performed at high-volume centers have lower in-hospital mortality. However, the volume-outcome relationship for esophagectomy performed at academic centers is unknown. Using the University HealthSystem Consortium national database, we examined the influence of the hospital's volume of esophagectomy on outcome at academic centers between January 2003 and October 2007. Outcomes including length of stay, 30-day re-admission, morbidity, and observed and expected mortality were compared between high (>12), medium (6–12), and low-volume centers’ (≤5) annual cases. There were 30 high (n = 3984), 23 medium (n = 822), and 54 low-volume (n = 430) hospitals. Compared with low-volume counterparts, high-volume hospitals had shorter lengths of stay (14.1 vs 17.2 days, P < 0.01), fewer overall complications (51.1% vs 56.5%, P = 0.03), fewer cardiac complications (1.1% vs 2.5%, P = 0.01), fewer pulmonary complications (18.5% vs 29.8%, P < 0.01), fewer hemorrhagic complications (3.2% vs 6.7%, P < 0.01), fewer patients requiring skilled nursing facility care (9.5% vs 19.7% P < 0.01), and lower in-hospital mortality (2.5% vs 5.6%, P < 0.01). The observed-to-expected mortality ratio was 0.6 for high-volume and 1.0 for low-volume centers. Within the context of academic centers, there is a threshold of >12 esophagectomies annually whereby there is a lower mortality and improved outcome.
31
Novaes, Taiane Gonçalves, Andressa Tavares Gomes, Karine Chagas Silveira, Cláudio Lima Souza, Joel Alves Lamounier, Michele Pereira Netto, Flávio Diniz Capanema y Daniela da Silva Rocha. "Prevalence and factors associated to vitamin A deficiency in children attending public day care centers in the Southwest of Bahia". Revista Brasileira de Saúde Materno Infantil 16, n.º 3 (septiembre de 2016): 337–44. http://dx.doi.org/10.1590/1806-93042016000300007.
Texto completoResumen
Abstract Objectives: to determine the prevalence of vitamin A deficiency and factors associated to children attending public day care centers in the Southwest of Bahia. Methods: a cross-sectional study involving 303 children aged 24 to 60 months attending public day care centers in the city of Vitória da Conquista, BA. A questionnaire was applied for the parents or legal guardians to answer and the children's height and weight were measured. Blood samples were collected to analyze serum retinol taking in consideration the values below 0.70 imol/L as inadequate. The vaccination card was verified in relation to the adequacy of vitamin A supplementation. Food weighting was done to evaluate the consuming of lipids and vitamin A. The association between the variables and vitamin A deficiency was verified by logistic regression. Results: the prevalence of inadequate serum retinol levels was 13.1% (1.99 ± 1.17 imol/L); 4.3% were low height and 1.2% of thinness. Most children (91.7%) had their vitamin A doses outdated on their vaccination cards. The variables associated to vitamin A deficiency were children aged less or equal to 34 months (OR: 2.66, 95% CI: 1.23 - 5.74) and maternal age was less than 26 years (OR: 2.39; 95% CI: 1.11 - 5.17). Conclusions: vitamin A deficiency configures as a moderate public health problem in children attending public day care centers in the Southwest of Bahia.
32
Sargent, Susie J. y Jena T. Martin. "Scabies Outbreak in a Day-Care Center". Pediatrics 94, n.º 6 (1 de diciembre de 1994): 1012–13. http://dx.doi.org/10.1542/peds.94.6.1012.
Texto completoResumen
Scabies is a highly contagious condition characterized by cutaneous infestation with the human itch mite, Sarcoptes scabiei var. hominis. Although not a reportable disease, its prevalence has increased in the US since the mid-1970s.1-3 Worldwide, outbreaks have generally occurred in association with conditions of crowding, poor hygiene, or malnutrition.4,5 However, the current nationwide resurgence has affected persons from all socioeconomic levels without regard to age, sex, or personal hygiene.4,6 While scabies is primarily spread by intimate personal contact, skin-to-skin transmission can also occur after prolonged casual contact such as occurs in institutional settings, nursing homes, and day-care centers. Mites can survive for 2 to 3 days on inanimate surfaces, which permits transmission via fomites such as clothes, furniture, floors, and bed linens. Persons with chronic skin disorders are more likely to transmit the mite to others because their infestations may be more difficult to diagnose and treat. Exfoliation of skin flakes may enhance transmission. To our knowledge, there is no published account of a scabies outbreak in a day-care center. We describe an outbreak of scabies infestation in a hospital-affiliated child-care facility that ultimately involved the treatment of more than 600 people at a cost of more than $16 000 and took at least 4 months to eradicate. All of the childrens' parents were health-care workers at the nearby 1000-bed hospital, so there was potential for spread to patients and thus, a need for rapid control. Elimination of scabies within a day-care center may be particularly problematic unless a coordinated effort among staff, parents, and physicians can be established.
33
Fuchs, Sandra Costa, Rita de Cássia Maynart, Lenara Ferreira da Costa, Adriana Cardozo y Rejane Schierholt. "Duration of day-care attendance and acute respiratory infection". Cadernos de Saúde Pública 12, n.º 3 (septiembre de 1996): 291–96. http://dx.doi.org/10.1590/s0102-311x1996000300002.
Texto completoResumen
Day-care attendance accounts for an increased frequency of acute respiratory infections (ARI), in numbers of both episodes and hospitalizations. In addition to day-care exposure, risk factors include age, siblings, and crowding. The purpose of this study was to investigate a possible association between duration of day-care exposure and ARI. A cross-sectional study was carried out to compared ARI rates for children exposed to day care and children cared for at home. Children with at least one parent working in a hospital were sampled from the hospital-run day-care center and those cared for at home. An acute respiratory infection was defined as the presence of two or more signs or symptoms in the previous two weeks. Children exposed to the day-care center for 12 to 50 hours a week had a three to five times greater risk of developing ARI than those staying at home. This risk was assessed independently, taking socioeconomic status, age, and number of siblings into account. Risk of respiratory illness and day-care attendance has been described elsewhere, but this study presents original findings related to duration of exposure. With a view towards reducing risk of ARI, improvements should be made in institutional day-care centers in Brazil, where family day care is still not available.
34
Takvorian, Samuel U., Laura Yasaitis, Manqing Liu, Daniel J. Lee, Rachel M. Werner y Justin E. Bekelman. "Association of hospital type with prices, spending, and acute care utilization among privately insured patients undergoing cancer surgery." Journal of Clinical Oncology 38, n.º 15_suppl (20 de mayo de 2020): e19376-e19376. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e19376.
Texto completoResumen
e19376 Background: With annual cancer spending estimated to surpass $170 billion in 2020, national attention has focused on the prices and utilization of cancer care. This is particularly important for privately insured patients, for whom healthcare prices are negotiated between insurers and providers and price transparency is lacking. Among privately insured patients undergoing common cancer surgery, we examined the relation between hospital type and prices, spending, and utilization. Methods: We conducted a retrospective study using Health Care Cost Institute’s multipayer national commercial claims data. The study population included patients with breast, colon or lung cancer undergoing cancer surgery from 2011-2014. The exposure was hospital type at which surgery was performed: National Cancer Institute (NCI), academic, or community. Spending outcomes were surgery-specific prices paid and 90-day total episode spending. Utilization outcomes were length of stay (LOS), emergency department (ED) use, and hospital readmission within 90 days. We estimated mean risk-adjusted spending and utilization outcomes for each hospital type using generalized linear mixed-effects models, adjusting for patient, hospital and region characteristics. Results: We identified 66,878 patients with incident breast (53.5%), colon (32.0%), or lung (14.5%) cancer undergoing cancer surgery at 2,995 hospitals (8.3% at NCI; 16.3% academic; 75.4% community). Treatment at NCI cancer centers was associated with higher surgical prices paid ($18,310 at NCI v $14,703 at community hospitals; diff +$3,607; p < 0.001) and 90-day total episode spending ($46,462 v $41,274; diff +$5,188; p = 0.008). There were no significant differences in LOS, ED use or hospital readmission within 90 days. Conclusions: Among privately insured patients undergoing cancer surgery, NCI cancer centers had higher surgical prices and episode spending without differences in utilization, compared to community hospitals. A better understanding of the drivers of prices and spending at NCI cancer centers is needed. [Table: see text]
35
Seethala, Raghu R., Kevin Blackney, Peter Hou, Haytham M. A. Kaafarani, Daniel Dante Yeh, Imoigele Aisiku, Christopher Tainter, Marc deMoya, David King y Jarone Lee. "The Association of Age With Short-Term and Long-Term Mortality in Adults Admitted to the Intensive Care Unit". Journal of Intensive Care Medicine 32, n.º 9 (11 de julio de 2016): 554–58. http://dx.doi.org/10.1177/0885066616658230.
Texto completoResumen
Background: Based on the current literature, it is unclear whether advanced age itself leads to higher mortality in critically ill patients or whether it is due to the greater number of comorbidities in the elderly patients. We hypothesized that increasing age would increase the odds of short-term and long-term mortality after adjusting for baseline comorbidities in intensive care unit (ICU) patients. Methods: We performed a retrospective cohort study of 57 160 adults admitted to any ICU over 5 years at 2 academic tertiary care centers. Patients were divided into age-groups, 18 to 39, 40 to 59, 60 to 79, and ≥80. The primary outcomes were 30-day and 365-day mortality. Results were analyzed with multivariate logistic regression adjusting for demographics and the Elixhauser-van Walraven Comorbidity Index. Results: The adjusted 30-day mortality odds ratios (ORs) were 1.39 (95% confidence interval [CI]: 1.21-1.60), 2.00 (95% CI: 1.75-2.28), and 3.33 (95% CI: 2.90-3.82) for age-groups 40 to 59, 60 to 79, and ≥80, respectively, using the age-group 18 to 39 as the reference. The adjusted 365-day mortality ORs were 1.46 (95% CI: 1.32-1.61), 2.10 (95% CI: 1.91-2.31), and 2.96 (95% CI: 2.67-3.27). Conclusion: In critically ill patients, increasing age is associated with higher odds of short-term and long-term death after correcting for existing comorbidities.
36
Smith, Chelsea L., Alexandria Benear, Michael P. Anderson, Jill Soto, Sandra Arnold y Susan B. Sisson. "Relationship between Outdoor and TV Viewing Time with Children's Movement in Early Care Settings". Translational Journal of the American College of Sports Medicine 3, n.º 5 (1 de marzo de 2018): 36–42. http://dx.doi.org/10.1249/tjx.0000000000000055.
Texto completoResumen
ABSTRACT Childhood obesity may be prevented by decreasing sedentary behavior (SB) and increasing moderate-to-vigorous physical activity (MVPA) in young children. Outdoor time and TV viewing time may contribute to SB and MVPA. Early childcare and education (ECE) settings are important environments for SB and MVPA. The purpose of this study is to determine the relationship between outdoor and TV viewing time with body mass index (BMI) percentile and movement in children attending ECE. An observational study at ECE centers and classrooms within those centers was conducted. Outdoor and TV viewing times were collected for 2 d using trained research assistants. Height and weight of children were objectively measured. Movement was measured for the entire school day using accelerometry. Dependent variables included BMI percentile, minutes of SB, light physical activity (LPA), MVPA, and steps. Hierarchical models adjusted for confounders and clustering of children in classrooms. In 34 classrooms (202 children), outdoor time was associated with BMI percentile (P < 0.03), SB (P < 0.01), LPA (P < 0.01), MVPA (P < 0.01), and steps (P < 0.01). On the classroom level, more outdoor time was associated with lower BMI percentile and higher MVPA, but outdoor time had different directions of association for SB and LPA on the classroom level. TV viewing time was associated with MVPA (P < 0.01). In TV viewing time, there were differing directions of association at the classroom level. Differing directions indicate that there was no consistent direction of association between classrooms. In conclusion, individual classrooms within centers had different relationships to outdoor time and TV viewing time to movement. Investigating the differences between classrooms may improve movement.
37
Mukamel, Dana B., Debra Saliba, Heather Ladd y R. Tamara Konetzka. "Association of Staffing Instability With Quality of Nursing Home Care". JAMA Network Open 6, n.º 1 (10 de enero de 2023): e2250389. http://dx.doi.org/10.1001/jamanetworkopen.2022.50389.
Texto completoResumen
ImportanceRecent work suggests that instability in nursing home staffing levels may be an important marker of nursing home quality. Whether that association holds when controlling for average staffing levels is unknown.ObjectiveTo examine whether staffing instability, defined as the percentage of days below average staffing levels, is associated with nursing home quality when controlling for average staffing levels.Design, Setting, and ParticipantsThis quality improvement study of 14 717 nursing homes used the merged Centers for Medicare &amp; Medicaid Services Payroll Based Journal, Minimum Data Set, Nursing Home Care Compare, and Long-Term-Care Focus data for fiscal years 2017 to 2019. Statistical analysis was performed from February 8 to November 14, 2022.Main Outcomes and MeasuresLinear, random-effect models with state fixed effects and robust SEs were estimated for 12 quality indicators as dependent variables, percentage of below-average staffing days as independent variables, controlling for average staffing hours per resident-day for registered nurses, licensed practical nurses, and certified nurse aides. Below-average staffing days were defined as those 20% below the facility average, by staffing type. Quality indicators included deficiency citations; long-stay residents receiving an antipsychotic; percentage of high-risk long-stay residents with pressure ulcers (2 different measures for pressure ulcers were used); and percentage of long-stay residents with activities of daily living decline, mobility decline, emergency department visits, and hospitalizations; and short-stay residents with new antipsychotic medication, mobility decline, emergency department visits, and rehospitalizations.ResultsFor the 14 717 nursing homes in this study, the mean (SD) percentage of days with below-average staffing was 30.2% (12.0%) for registered nurses, 16.4% (11.3%) for licensed practical nurses, and 5.1% (5.3%) for certified nurse aides. Mean (SD) staffing hours per resident-day were 0.44 (0.40) for registered nurses, 0.80 (0.32) for licensed practical nurses, and 2.20 (0.50) for certified nurse aides. In regression models that included average staffing, a higher percentage of below-average staffing days was significantly associated with worse quality for licensed practical nurses in 10 of 12 models, with the largest association for decline of activities of daily living among long-stay residents (regression coefficient, 0.020; P &lt; .001). A higher percentage of below-average staffing days was significantly associated with worse quality for certified nurse aides in 9 of 12 models, with the largest association for short-stay functioning (regression coefficient, 0.030; P = .01).Conclusions and RelevanceThis study suggests that holding average staffing levels constant, day-to-day staffing stability, especially avoiding days with low staffing of licensed practical nurses and certified nurse aides, is a marker of better quality of nursing homes. Future research should investigate the causes and potential solutions for instability in staffing in all facilities, including those that may appear well-staffed on average.
38
Dhakal, Binod, Smith Giri, Adam Levin, Rein Lisa, Timothy S. Fenske, Saurabh Chhabra, Nirav N. Shah et al. "Association between Transplant Volumes and 30-Day Readmissions Following Allogeneic Hematopoietic Cell Transplantation (allo-HCT) in the US". Blood 132, Supplement 1 (29 de noviembre de 2018): 617. http://dx.doi.org/10.1182/blood-2018-99-116196.
Texto completoResumen
Abstract Background: Readmissions within 30 days after index hospitalization is a quality and cost-containment metric. Financial penalties to hospitals with high rates of risk-adjusted readmissions have been expanded beyond medical conditions like heart failure and pneumonia. Published data show significant heterogeneity in readmission rates and recent data from elderly Medicare beneficiaries reported a 17.8% readmission rate for targeted conditions. Allo-HCT is a widely used therapeutic strategy in the management of various hematologic disorders like acute myelogenous (AML) and lymphoblastic leukemia (ALL). However, allo-HCT readmission rates are poorly described, and limited to single center studies only. The association between institution HCT volume and 30-day readmission metric has not been examined. Methods: In this observational study, we used the 2012-2014 Nationwide Readmission Database (NRD) to identify hospitals with established allo-HCT programs. Patients ≥18 years of age, discharged from hospital following an allo-HCT (identified using ICD-9 procedure code of 41.02, 41.03, 41.05, 41.06, or 41.08) were included. Annual hospital case volume was calculated as the sum of all discharges with allo-HCT within the calendar year; low, medium, and high annual case volume groups were created based on (survey weighted) tertiles of patients (pts.) in the analytic data domain (Figure 1). Rates, causes, and costs of 30-day readmissions were compared between low-, medium-, and high-volume hospitals. The analysis was limited to urban teaching hospitals and pts. admitted during month of December were excluded. The primary outcome, was the unplanned 30-day re-admission following allo-HCT. Multiple logistic regression was used to model each 30-day readmission outcome including hospital case volume with other predictors (age, sex, disease type, stem cell source, co-morbidity index, primary insurance, length of stay, infection and acute graft-versus-host-disease (aGVHD) at index admission, discharge disposition and median income quartile). Results: A total of 17,214 (weighted) allo-HCTs were performed during the time period. Baseline characteristics of pts. in low (<58 allo-HCTs/yr.)-, medium (58-158 allo-HCTs/yr.)- and high-volume (>158 allo-HCTs/yr.) hospitals were comparable as shown in Table 1. The overall rates of readmissions were significantly higher in low volume centers (24.7.4%; SE, 1.5) compared to medium (21.4% (1.7) and high volume (9.5% (1.8), centers (p=0.03). The mean time to readmission in low vs. medium vs. high volume centers was, 11.6 [0.39] days vs. 12 [0.26] days vs. 11.5 [0.57] days respectively, (p <0.001). The length of readmission stay was significantly longer in low volume centers (mean [SD], 12.8 [0.64] days vs. 12.3 [0.91] days vs. 10.6 [0.80] days; p=<0.001) respectively. Consequently, cost per readmission was significantly higher in low volume centers (mean [SD], $164,349 [12,328] vs. $140,327 [15,297] vs. $107,362 [11,665]; p<0.001). Readmission rates in low volume and medium volume centers compared to high volume centers were: adjusted odds ratio (aOR) 1.39, 95% CI 1.08-1.77; p =0.01 and 1.18, 95% CI, 0.89-1.55; p=0.23, respectively. Other significant predictors of readmission included disease type (ALL vs. AML): aOR 1.32, 95% CI 1.07-1.63; p= 0.009), type of primary insurance (Medicare vs. private): aOR 1.17, 95% CI 1.01-1.35; p=0.02; Elixhauser co-morbidity index (≥1 vs. 0): aOR 1.4, 95% CI 1.2-1.7; p= 0.001 and stem cell source (cord blood vs. peripheral blood; aOR 2.4, 95%CI 1.85-3.2, p<0.001). Patients with any infection and the presence of aGVHD at index admission did not have an effect on readmission rates. Neutropenia, fever, viral infection, sepsis, acute renal failure, and pneumonia were the most common reasons for readmission. Conclusions: The likelihood of readmission after allo-HCT is elevated in centers performing <58 allo-HCTs/year, in those pts. with ≥1 co-morbidities, cord blood transplants, in ALL pts. and in Medicare beneficiaries. Lower readmission at higher-volume centers was associated with significantly lower cost to the health care system. There are important limitations with the use of data from NRD particularly the lack of information on donor status and conditioning regimen. Despite these shortcomings, the information may aid health care when developing quality-of-care metric for allo-HCT. Disclosures Dhakal: Amgen: Honoraria; Takeda: Honoraria; Celgene: Consultancy, Honoraria. Shah:Geron: Equity Ownership; Lentigen Technology: Research Funding; Juno Pharmaceuticals: Honoraria; Oncosec: Equity Ownership; Miltenyi: Other: Travel funding, Research Funding; Exelexis: Equity Ownership. D'Souza:Prothena: Consultancy, Research Funding; Takeda: Research Funding; Celgene: Research Funding; Merck: Research Funding; Amgen: Research Funding. Hari:Celgene: Consultancy, Honoraria, Research Funding; Janssen: Honoraria; Bristol-Myers Squibb: Consultancy, Research Funding; Kite Pharma: Consultancy, Honoraria; Sanofi: Honoraria, Research Funding; Amgen Inc.: Research Funding; Takeda: Consultancy, Honoraria, Research Funding; Spectrum: Consultancy, Research Funding. Hamadani:Sanofi Genzyme: Research Funding, Speakers Bureau; MedImmune: Consultancy, Research Funding; Celgene Corporation: Consultancy; Takeda: Research Funding; Cellerant: Consultancy; ADC Therapeutics: Research Funding; Ostuka: Research Funding; Janssen: Consultancy; Merck: Research Funding.
39
Brown, Lana, C. Heath Gauss, Pamela Billings, Jade Moore, Linda Sawyer, Diane Sparks y Sheila Cox Sullivan. "NURSE STAFFING AND VETERAN OUTCOMES IN THE VETERANS HEALTH ADMINISTRATION’S COMMUNITY LIVING CENTERS". Innovation in Aging 7, Supplement_1 (1 de diciembre de 2023): 707. http://dx.doi.org/10.1093/geroni/igad104.2293.
Texto completoResumen
Abstract Higher nurse staffing levels have been associated with better outcomes for patients in the acute care setting and for residents in the long-term care setting. There are several publications available linking nurse staffing to improved quality measures. Conversely, minimal research has occurred examining associations between nurse staffing and Veteran outcomes. The purpose of this research study was to assess for associations between nursing hours per patient day (NHPPD) and Veteran outcome measures in the Veterans Health Administration Community Living Centers. A retrospective data review was completed for NHPPD and quality measures for 134 Community Living Centers. Descriptive statistics were used to analyze the average total NHPPD for each of six Minimum Data Set, version 3.0, quality measures. Linear regression was utilized to assess for a linear association between average total NHPPD and the defined quality measures. This study found no linear association between average total NHPPD and the following Veteran outcome measures: improvement in function (p=0.15), ability to move independently worsened (p=0.13), catheter in bladder (p=0.48), and UTI (p=0.48). However, a statistically significant linear association was found between average total NHPPD and the following Veteran outcome measures: falls with major injury (p=0.02) and help with ADLs (p=0.01). As the average total NHPPD increased, the mean for falls with major injury and the mean for help with ADLs decreased. This study adds to the body of literature regarding the impact of nurse staffing on quality measures in the long-term care setting.
40
Rodewald, Lance E., Peter G. Szilagyi, Sharon G. Humiston, Richard F. Raubertas, Klaus J. Roghmann, Cynthia B. Doane, Lisa A. Cove y Caroline B. Hall. "Is an Emergency Department Visit a Marker for Undervaccination and Missed Vaccination Opportunities Among Children Who Have Access to Primary Care?" Pediatrics 91, n.º 3 (1 de marzo de 1993): 605–11. http://dx.doi.org/10.1542/peds.91.3.605.
Texto completoResumen
The purpose of this study was to determine (1) whether preschool-age patients who utilize the emergency department (ED) are undervaccinated compared with patients having the same primary care provider and (2) whether reducing missed vaccination opportunities in the primary care office can potentially reduce the differences in undervaccination between the groups. This retrospective cohort study involved two groups: 583 ED patients, aged 4 to 48 months, who had primary care providers; and 583 control subjects randomly selected from primary care sites and matched according to date of birth and primary care site. The major outcome variable was the point prevalence of undervaccination, defined as more than 60 days past due for a vaccine at the time of the ED visit, and for control subjects, at the time of their matched patient's ED visit. Demographic variables, vaccination history, presence of chronic illness, and office utilization history were abstracted from office charts. The mean age of all patients was 20.0 months. Emergency department patients were more likely to be boys (61% vs 50%) and had more chronic illness, but did not differ racially from those in the control group. Primary care sites included a hospital-based clinic (n = 137), neighborhood health centers (n = 172), and private practices (n = 274). The undervaccination rates by primary provider type were for (1) hospital clinic ED patients 21.1%, control subjects 19.7%; (2) neighborhood health center ED patients 29.1%, control subjects 22.7%; and (3) private practice ED patients 26.6%, control subjects 14.9%. Overall, the odds ratio of ED patients' being undervaccinated compared with control subjects was 1.8 (95% confidence interval 1.3 to 2.5). This association was strongest for private practice patients (odds ratio 2.45, 95% confidence interval 1.5 to 4.2), but not significant for hospital clinic or neighborhood health center patients. Emergency department patients had previously missed more vaccination opportunities in the office than had control subjects (25% vs 16% of office visits). Taking advantage of missed vaccination opportunities would have greatly reduced undervaccination differences between ED patients and their controls. An ED visit is a marker for undervaccination, even for children who have primary care providers. These data support efforts to reach out to ED patients with interventions designed to increase their vaccination rates. Interventions in primary care offices, however, are likely to be the most effective.
41
Guimarães, Semíramis y Maria Inês L. Sogayar. "Occurence of Giardia lamblia in children of municipal day-care centers from Botucatu, São Paulo State, Brazil". Revista do Instituto de Medicina Tropical de São Paulo 37, n.º 6 (diciembre de 1995): 501–6. http://dx.doi.org/10.1590/s0036-46651995000600005.
Texto completoResumen
Considering that the number of day-care centers for pre-school-age children has expanded rapidly in developing countries, and that these institutions presenting conditions that facilitate the transmission of many enteric agents, a parasitological survey was carried out in three municipal day-cares from Botucatu: two in the urban area (one in downtown area and the other one in the city periphery area) and the third in the rural area. Three separate stool specimens were collected from 147 children ranging from 0 to 72 months old and 20 staff members. Each stool specimen was processed by Lutz and zinc sulfate flotation methods. The frequency of giardiasis observed among children of downtown, periphery and rural day-cares was 69.6%, 52.7% and 69.6%, respectively. Only one employee was positive for G. lamblia. The examination of three stool specimens increased the positivity for G. lamblia: from the ninety three final positive examinations, 24 (25.5%) and 8 (8.5%) were positives only after examination of the second and third samples, respectively. Others intestinal organisms like Ascaris lumbricoides (20.4%), Trichuris trichiura (19.0%). Hymenolepis nana (8.8%), Entamoeba coli (22.4%) and Blastocystis hominis (32.0%) were frequently found in the children. There was no significant association among localization of the day-cares, sex of the children and the levels of G. lamblia infection. According to the age, G. lamblia was found mainly in children between 12 to 47 months old.
42
Kumari, Meena. "A Pre-Experimental Study to Assess the Effectiveness of Basic Training Programme in Terms of Knowledge and Practice regarding Care of Young Children among Day Care Workers Working in Selected Day Care Centers of New Delhi". International Journal of Nursing & Midwifery Research 07, n.º 03 (16 de marzo de 2021): 24–30. http://dx.doi.org/10.24321/2455.9318.202022.
Texto completoResumen
A day care is a childcare center where care is provided by adults who are not their parents. Day care workers should have adequate knowledge regarding the care of young children. The study aimed to assess the knowledge and practice regarding care of young children in day care centers. Quantitative descriptive research approach was adopted for the study with one group pre-test post-test pre-experimental research design. The study included 30 day care workers working in a day care centre of New Delhi, using purposive sampling. Structured knowledge questionnaire and observation checklists were used for data collection and data was analysed using descriptive and inferential statistics. Results showed that before administration of basic training programmes, 18 (60%) of day care workers had average knowledge scores, 9 (30%) had good knowledge scores and 3 (10%) of day care workers had poor knowledge regarding care of young children. After the administration of the basic training programme, 30 (100%) were having good knowledge. It can be concluded that participants ranked highest (I) in knowledge score of Prevention of infections knowledge’ followed by rank II of ‘Growth and development of child’, rank III of ‘Nutrition for a child’, rank IV ‘Personal hygiene’, rank V of ‘Safety and security’ followed by rank VI - ‘Qualities of personnel in day care center’. In terms of practice before administration of basic training programme 23 (77%) of study subjects had average practice scores, 4 (13%) had good practice scores and 3 (10%) of day care workers had poor practice scores regarding care of young children. After the administration of the basic training programme, 27(90%) were having good practice and 3 (10%) were having average practice. There was no significant association found between the knowledge and practice score with demographic variables of day care workers.
43
Olariu, Tudor Rares, Octavian Mazilu, Rodica Mihaescu, Titus Ududec, Romulus Timar, Sorin Bolintineanu, Cristina Petrescu y Camelia Vidita Gurban. "Assessment of Giardia lamblia Infection Prevalence Using Lugol�s Iodine Staining Technique". Revista de Chimie 69, n.º 3 (15 de abril de 2018): 665–67. http://dx.doi.org/10.37358/rc.18.3.6171.
Texto completoResumen
Parasitic diseases have a worldwide distribution and represent an important public health problem. The aim of the present study was to evaluate the prevalence of intestinal parasitic infections in a Child Day Care Center from Western Romania using direct wet mount and concentration procedures of stool samples. One hundred sixty-four children aged 2-8 years were investigated. Stool examinations were performed using the iodine staining for the identification of protozoan cysts and the Willis-Hung concentration method for the identification of helminth eggs. Routine laboratory investigations were also conducted to evaluate the eosinophil count in the infected children. Intestinal parasitic infections were diagnosed in 47 cases (28.6%). Giardia lamblia (25%), Entamoeba coli (5.5%), Blastocystis hominis (1.2%), Ascaris lumbricoides (0.6%) and Trichuris trichiura (0.6%) were the only parasites identified. Among the children with parasitic infections we have determined association of two parasites in 7 (14.9%). We have found that in children with giardiasis the eosinophil values were increased (5.54�4.21%) compared to controls (3.69�1.48%) (p[0.01). Our findings suggest that giardiasis may be significantly prevalent in children attending day care centers in Western Romania. Efficient educational programs should be timely implemented in child care centers with the aim of providing appropriate infection control measures.
44
Sadarangani, Tina y Holly Dabelko-Schoeny. "Services That Matter for Aging in Place: Research on the Impact and Promise of Adult Day Centers". Innovation in Aging 4, Supplement_1 (1 de diciembre de 2020): 617–18. http://dx.doi.org/10.1093/geroni/igaa057.2098.
Texto completoResumen
Abstract Adult day service centers (ADCs) in the United States are increasingly recognized as an important source of community-based long-term care for older adults. However, awareness, widespread utilization, reimbursements, and access to ADCs have been limited by a lack of evidence on ADCs’ impact. In this interdisciplinary symposium, we explore current research taking place in the realm of adult day services to understand the reach and impact of ADCs. We begin by examining the most current center-level and user-level data from the National Center for Health Statistics, and demonstrate how these data can be used to inform research and policy. We subsequently evaluate survey data from the National Adult Day Services Association that captures clinical data being collected in ADCs (N=250) surrounding users’ clinical outcomes. We then explore the effectiveness of four interventions on ADC users’ health and functional status: board games, cognitive behavioral therapy, aromatherapy and dance. Finally, we examine the association between adult day services use by African American persons with dementia and depressive symptoms in their caregivers. Our findings suggest that ADCs serve a complex population with high rates of poverty and chronic conditions, but ADCs can have a meaningful impact on users’ health and well-being by leveraging innovative programming. We conclude by discussing how standardization of data collection efforts could enable researchers and policymakers to evaluate ADCs’ impact and target funding towards services that maximizes users’ health and well-being.
45
Sadarangani, Tina y Fei Sun. "THE ADULT DAY CENTER: UNTAPPED TERRITORY FOR AGING RESEARCH". Innovation in Aging 7, Supplement_1 (1 de diciembre de 2023): 30. http://dx.doi.org/10.1093/geroni/igad104.0099.
Texto completoResumen
Abstract Adult day service centers (ADCs) in the United States are a vital, but overlooked source of community-based long-term care for diverse older adults with multiple chronic conditions, including dementia. The National Institute on Aging has called for more research on ADCs. In this interdisciplinary symposium, we present challenges and opportunities in conducting research in these congregate settings. First, we look at the operating status of ADCs nationally in the aftermath of the COVID-19 pandemic and disparities in access to care using longitudinal data from the National Post-acute and Long-term Care Study. Then we examine the lack of electronic health record utilization and clinical data capture in 4,035 ADCs nationally and discuss strategies to modernize technology in these settings to facilitate data collection. We subsequently present a new database, developed vis a vis an academic/community partnership between the National Adult Day Services Association and researchers, that centralizes and makes data collection feasible in ADCs with limited resources. We will also explore factors supporting intervention research that are unique to ADCs. Finally, we present a protocol adapted for the ADC setting, to test a mobile application that facilitates data collection and enables communication between ADCs, caregivers, and healthcare providers. Our findings show that, while research in ADCs has been limited historically, academic, government, and community partners are working together to spur pragmatic innovations that modernize these settings and better resource them to elevate standards of care.
46
Vaughn, John L., Man-Yee Merl, Jensa C. Morris y Bonnie E. Gould Rothberg. "Association of Hospitalist Care and Outcomes on an Inpatient Elective Anticancer Therapy Service". Blood 142, Supplement 1 (28 de noviembre de 2023): 2335. http://dx.doi.org/10.1182/blood-2023-190824.
Texto completoResumen
Background: Hospitalist care is becoming increasingly common at cancer centers. Here, we assess the impact of oncology hospitalist care on quality outcomes on an inpatient elective anticancer therapy service for patients with leukemia and lymphoma. Methods: On July 26, 2021, the Smilow Cancer Hospital transitioned the elective anticancer therapy team from a hematologic oncologist-led traditional service (TS) to an oncology hospitalist-led service (HS). We compared quality outcomes for patients with leukemia and lymphoma requiring elective anticancer therapy who were admitted during two parallel 18-month periods (TS: July 1, 2018 to December 31, 2019; HS: July 26, 2021 to December 31, 2022). Longitudinal data analysis using mixed linear regression models with random effects for intercept (individual) and slope (time) were used to estimate the association between service and outcome, accounting for patients with multiple admissions reflecting sequential cycles of chemotherapy. The outcomes were length-of-stay (LOS), time from admission to first anticancer therapy administration, and discharge time of day. Models were adjusted for age, sex, race/ethnicity, diagnosis, anticancer therapy type, Severity of Illness index, and total elapsed time since cycle 1/day 1 of the index regimen. Results: The study included 161 patients, 59 from the TS and 102 from the HS. There were 65 patients with leukemia and 96 with lymphoma. No significant differences in median age, sex, race/ethnicity, or severity of illness index between services were observed (p>0.05). The most common anticancer regimen was etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone (EPOCH) for lymphoma (TS n=16 (27%); HS n=31 (30%)). For anticancer regimens with a fixed number of treatment days, after adjustment, we observed a significant reduction of length of stay that exceeded one full day (TS=6.09 days (95% CI: 6.09, 6.95 days); HS=3.82 days (95% CI:3.48, 4.16 days); p<0.001), the adjusted mean time from admission to first anticancer therapy administration decreased by 4.12 hours (95% CI: 0.66, 7.59 hours; p<0.001), and the adjusted mean discharge time decreased by 66 minutes (95% CI: 9, 211 minutes; p=0.01) ( Table 1). For those regimens that required variable monitoring for post-treatment methotrexate clearance or tumor lysis syndrome, no significant difference in outcomes was noted (p>0.05). Conclusions: Hospitalist care on an inpatient elective anticancer therapy service was associated with significant improvements in LOS, time from admission to anticancer therapy administration, and discharge time.
47
Deo, Salil V., Issam Motairek, Khurram Nasir, Amgad Mentias, Yakov Elgudin, Salim S. Virani, Sanjay Rajagopalan y Sadeer Al-Kindi. "Association Between Historical Neighborhood Redlining and Cardiovascular Outcomes Among US Veterans With Atherosclerotic Cardiovascular Diseases". JAMA Network Open 6, n.º 7 (11 de julio de 2023): e2322727. http://dx.doi.org/10.1001/jamanetworkopen.2023.22727.
Texto completoResumen
ImportanceIn the 1930s, the government-sponsored Home Owners’ Loan Corporation (HOLC) established maps of US neighborhoods that identified mortgage risk (grade A [green] characterizing lowest-risk neighborhoods in the US through mechanisms that transcend traditional risk factors to grade D [red] characterizing highest risk). This practice led to disinvestments and segregation in neighborhoods considered redlined. Very few studies have targeted whether there is an association between redlining and cardiovascular disease.ObjectiveTo evaluate whether redlining is associated with adverse cardiovascular outcomes in US veterans.Design, Setting, and ParticipantsIn this longitudinal cohort study, US veterans were followed up (January 1, 2016, to December 31, 2019) for a median of 4 years. Data, including self-reported race and ethnicity, were obtained from Veterans Affairs medical centers across the US on individuals receiving care for established atherosclerotic disease (coronary artery disease, peripheral vascular disease, or stroke). Data analysis was performed in June 2022.ExposureHome Owners’ Loan Corporation grade of the census tracts of residence.Main Outcomes and MeasuresThe first occurrence of major adverse cardiovascular events (MACE), comprising myocardial infarction, stroke, major adverse extremity events, and all-cause mortality. The adjusted association between HOLC grade and adverse outcomes was measured using Cox proportional hazards regression. Competing risks were used to model individual nonfatal components of MACE.ResultsOf 79 997 patients (mean [SD] age, 74.46 [10.16] years, female, 2.9%; White, 55.7%; Black, 37.3%; and Hispanic, 5.4%), a total of 7% of the individuals resided in HOLC grade A neighborhoods, 20% in B neighborhoods, 42% in C neighborhoods, and 31% in D neighborhoods. Compared with grade A neighborhoods, patients residing in HOLC grade D (redlined) neighborhoods were more likely to be Black or Hispanic with a higher prevalence of diabetes, heart failure, and chronic kidney disease. There were no associations between HOLC and MACE in unadjusted models. After adjustment for demographic factors, compared with grade A neighborhoods, those residing in redlined neighborhoods had an increased risk of MACE (hazard ratio [HR], 1.139; 95% CI, 1.083-1.198; P &lt; .001) and all-cause mortality (HR, 1.129; 95% CI, 1.072-1.190; P &lt; .001). Similarly, veterans residing in redlined neighborhoods had a higher risk of myocardial infarction (HR, 1.148; 95% CI, 1.011-1.303; P &lt; .001) but not stroke (HR, 0.889; 95% CI, 0.584-1.353; P = .58). Hazard ratios were smaller, but remained significant, after adjustment for risk factors and social vulnerability.Conclusions and RelevanceIn this cohort study of US veterans, the findings suggest that those with atherosclerotic cardiovascular disease who reside in historically redlined neighborhoods continue to have a higher prevalence of traditional cardiovascular risk factors and higher cardiovascular risk. Even close to a century after this practice was discontinued, redlining appears to still be adversely associated with adverse cardiovascular events.
48
Fajardo-Bullón, Fernando, Jesús Pérez-Mayo y Igor Esnaola. "The Association of Interpersonal Relationships and Social Services with the Self-Rated Health of Spanish Homelessness". International Journal of Environmental Research and Public Health 18, n.º 17 (6 de septiembre de 2021): 9392. http://dx.doi.org/10.3390/ijerph18179392.
Texto completoResumen
Understanding the specific factors associated with poor health is critical to improve the health of homeless people. This study aimed to analyze the influence of personal variables, interpersonal relationships, and the influence of social services on the health of homeless people. A secondary analysis was applied to cross-sectional data from a sample of 1382 homeless people living in the Basque Country (Spain) (75.69% male). Multinomial logistic regression modelling was used to analyze the relationship between health and personal variables, interpersonal variables, perceived help and use of the social services. Relationships with the family, using a day center, and a sufficient and high perceived help of the social services were significant factors associated with good health. On the other hand, spending the day alone or using mental and health care services are associated with poor health. In the same way, the longer a person has been homeless, the worse their expected state of health is. Addressing housing exclusion, promoting interpersonal relationships, using a day center, and developing the use and perceived helpfulness of social services stand out as key factors in improving health status. Social policies are usually focused on housing. However, this paper also highlights the relevance of developing interpersonal relationships and using day centers to improve homeless people’s health.
49
Ayalon, Liat. "Subjective Social Status as a Predictor of Loneliness: The Moderating Effect of the Type of Long-Term Care Setting". Research on Aging 41, n.º 10 (27 de agosto de 2019): 915–35. http://dx.doi.org/10.1177/0164027519871674.
Texto completoResumen
Much has been written about the important role that subjective social status plays in older adults’ well-being and subjective health. Less is known, however, about the potential role played by subjective social status in people’s sense of loneliness. In the present study, the author examined the role of subjective social status as a predictor of loneliness in adult day care centers (ADCCs) and continuing care retirement communities (CCRCs) over a 1-year period. The main analyses consist of data from 245 respondents (141 ADCC participants and 104 CCRC residents) who completed the interviews in Waves 1 and 2. A significant interaction between subjective social status and type of long-term care setting was found. Higher levels of subjective social status were associated with lower levels of loneliness in CCRCs, but no such association was evident in ADCCs. These findings are interpreted in view of the characteristics of the CCRC as a total institution versus the ADCC as a setting that provides support for only several hours per day, several days per week.
50
Lindgren, Antti, Sarah Burt, Ellie Bragan Turner, Atte Meretoja, Jin-Moo Lee, Thomas M. Hemmen, Mark Alberts, Robin Lemmens, Mervyn DI Vergouwen y Gabriel JE Rinkel. "Hospital case-volume is associated with case-fatality after aneurysmal subarachnoid hemorrhage". International Journal of Stroke 14, n.º 3 (18 de julio de 2018): 282–89. http://dx.doi.org/10.1177/1747493018790073.
Texto completoResumen
Background Inverse association between hospital case-volume and case-fatality has been observed for various nonsurgical interventions and surgical procedures. Aims To study the impact of hospital case-volume on outcome after aneurysmal subarachnoid hemorrhage (aSAH). Methods We included aSAH patients who underwent aneurysm coiling or clipping from tertiary care medical centers across three continents using the Dr Foster Stroke GOAL database 2007–2014. Hospitals were categorized by annual case-volume (low volume: <41/year; intermediate: 41–70/year; high: >70/year). Primary outcome was 14-day in-hospital case-fatality. We calculated proportions, and used multiple logistic regression to adjust for age, sex, differences in comorbidity or disease severity, aneurysm treatment modality, and hospital. Results We included 8525 patients (2363 treated in low volume hospitals, 3563 treated in intermediate volume hospitals, and 2599 in high-volume hospitals). Crude 14-day case-fatality for hospitals with low case-volume was 10.4% (95% confidence interval (CI) 9.2–11.7%), for intermediate volume 7.0% (95% CI 6.2–7.9%; adjusted odds ratio (OR) 0.63 (95%CI 0.47–0.85)) and for high volume 5.4% (95% CI 4.6–6.3%; adjusted OR 0.50 (95% CI 0.33–0.74)). In patients with clipped aneurysms, adjusted OR for 14-day case-fatality was 0.46 (95% CI 0.30–0.71) for hospitals with intermediate case-volume and 0.42 (95% CI 0.25–0.72) with high case-volume. In patients with coiled aneurysms, adjusted OR was 0.77 (95% CI 0.55–1.07) for hospitals with intermediate case-volume and 0.56 (95% CI 0.36–0.87) with high case-volume. Conclusions Even within a subset of large, tertiary care centers, intermediate and high hospital case-volume is associated with lower case-fatality after aSAH regardless of treatment modality, supporting centralization to higher volume centers.