Assessing the impact of diabetes on the quality of life of older adults living in a care home : validation of the ADDQoL senior

Aims  Around a quarter of UK care-home residents have diabetes. Diabetes is known to impact quality of life but existing diabetes-specific quality of life measures are unsuitable for elderly care-home residents. We aimed to develop and evaluate a new measure for use with older adults, to be particularly suitable for use with care-home residents: the Audit of Diabetes-Dependent Quality of Life (ADDQoL) Senior†.

Methods  Content and format changes were made to the 19-domain ADDQoL, informed by related measures for people with visual impairments (12 domain-specific items were retained, four items were revised/added and three items were removed). This revision was modified further following cognitive debriefing interviews with three older adults living in a care home. Psychometric evaluation of the newly developed 17-domain ADDQoL Senior was conducted using data from 90 care-home residents with diabetes who took part in a broader intervention study.

Results  The life domains most impacted by diabetes were ‘independence’ and ‘freedom to eat as I wish’. The ADDQoL Senior demonstrated good factor structure and internal consistency (Cronbach’s alpha = 0.924). Domain scores were, as expected, significantly intercorrelated.

Conclusions  The ADDQoL Senior measures the perceived impact of diabetes on quality of life in older adults, and has been found to be suitable for those living in care homes if administered by interview. The scale has demonstrated acceptability and excellent psychometric properties. It is anticipated that the number of items may be reduced in the future if our current findings can be replicated.

Using social network analysis to identify key child care center staff for obesity prevention interventions: a pilot study

Introduction. Interest has grown in how systems thinking could be used in obesity prevention. Relationships between key actors, represented by social networks, are an important focus for considering intervention in systems. Method. Two long day care centers were selected in which previous obesity prevention programs had been implemented. Measures showed ways in which physical activity and dietary policy are conversations and actions transacted through social networks (interrelationships) within centers, via an eight item closed-ended social network questionnaire. Questionnaire data were collected from (17/20; response rate 85%) long day care center staff. Social network density and centrality statistics were calculated, using UCINET social network software, to examine the role of networks in obesity prevention. Results. “Degree” (influence) and “betweeness” (gatekeeper) centrality measures of staff inter-relationships about physical activity, dietary, and policy information identified key players in each center. Network density was similar and high on some relationship networks in both centers but markedly different in others, suggesting that the network tool identified unique center social dynamics. These differences could potentially be the focus of future team capacity building. Conclusion. Social network analysis is a feasible and useful method to identify existing obesity prevention networks and key personnel in long day care centers.

Physical environments, policies and practices for physical activity and screen-based sedentary behaviour among preschoolers within child care centres in Melbourne, Australia and Kingston, Canada

Characteristics of preschool and child care centres have previously been shown to be associated with children's health behaviours such as physical activity and screen-based sedentary behaviour. This paper investigates differences in physical environments, policies and practices between child care centres in Melbourne, Australia and Kingston, Canada which may be associated with such behaviours.

Modeling the cost effectiveness of child care policy changes in the U.S.

INTRODUCTION: Child care facilities influence diet and physical activity, making them ideal obesity prevention settings. The purpose of this study is to quantify the health and economic impacts of a multi-component regulatory obesity policy intervention in licensed U.S. child care facilities. METHODS: Two-year costs and BMI changes resulting from changes in beverage, physical activity, and screen time regulations affecting a cohort of up to 6.5 million preschool-aged children attending child care facilities were estimated in 2014 using published data. A Markov cohort model simulated the intervention's impact on changes in the U.S. population from 2015 to 2025, including short-term BMI effects and 10-year healthcare expenditures. Future outcomes were discounted at 3% annually. Probabilistic sensitivity analyses simulated 95% uncertainty intervals (UIs) around outcomes. RESULTS: Regulatory changes would lead children to watch less TV, get more minutes of moderate and vigorous physical activity, and consume fewer sugar-sweetened beverages. Within the 6.5 million eligible population, national implementation could reach 3.69 million children, cost $4.82 million in the first year, and result in 0.0186 fewer BMI units (95% UI=0.00592 kg/m(2), 0.0434 kg/m(2)) per eligible child at a cost of $57.80 per BMI unit avoided. Over 10 years, these effects would result in net healthcare cost savings of $51.6 (95% UI=$14.2, $134) million. The intervention is 94.7% likely to be cost saving by 2025. CONCLUSIONS: Changing child care regulations could have a small but meaningful impact on short-term BMI at low cost. If effects are maintained for 10 years, obesity-related healthcare cost savings are likely.

Position, professional expertise and functions of an educator of child care homes in Lithuania

Speaking about professionals, working with children at child care homes in Lithuania, first of all we encounter a problem of terminology. This problem rises, because in various countries and languages we call these professionals differently. In Lithuania we call them ”aukletojai”. We also use the word ”aukletojas” when speaking about both professionals, working directly with children at kindergartens, and parents, as all parents are educators of their children. We suppose, that the word ”aukletojas” corresponds to the German “erzieher”, and “aukleti” to “erziehen”. Every “aukletojas” in Lithuania clearly realizes, that he is a pedagogue, because in this country every professional, involved in educational work with children – an ”aukletojas”, a teacher, a social pedagogue and a special pedagogue – is called a pedagogue. In this context it is essential to conceive that in Lithuania an ”educator” and a ”social pedagogue” are different pedagogical professions and that none of the ”aukletojas” identify himself as a social pedagogue.

Significance of the Philosophy of Family-Centered Care in the

The philosophy of family-centered care is “an approach to the planning, delivery, and evaluation of healthcare that is grounded in mutually beneficial partnerships among patients, families and healthcare practitioners” (Children’s Hospital of Philadelphia, 1996-2008). The word “family” refers to “two or more persons who are related in any way-biologically, legally, or emotionally” (Institute for Family-Centered Care). It is patients and families, who define those included in their families, which usually in pediatrics includes parents or guardians.

A qualitative assessment of the impact of Texas policy changes on nutrition in child care centers in Travis County, Texas

Background. Over half of children in the United States under age five spend 32 hours a week in child care, facilities, where they consume approximately 33-50% of their food intake. ^ Objectives. The aim of this research was to identify the effects of state nutrition policies on provision of food in child care centers. ^ Subjects. Eleven directors or their designee from ten randomly selected licensed child care centers in Travis County, Texas were interviewed. Centers included both nonprofit and for-profit centers, with enrollments ranging from 19 to 82. ^ Methods. Centers were selected using a web-based list of licensed child care providers in the Austin area. One-on-one interviews were conducted in person with center directors using a standard set of questions developed from previous pilot work. Interview items included demographic data, questions about state policies regarding provision of foods in centers, effects of policies on child care center budgets and foods offered, and changes in the provision of food. All interviews were audiotaped and transcribed, and themes were identified using standard qualitative techniques. ^ Results. Four of the centers provided both meals and snacks, four provided snacks only, and two did not provide any food. Directors of centers that provided food were more likely to report adherence to the Minimum Standards than directors of centers that did not. In general, center directors reported that the regulations were loosely enforced. In contrast, center directors were more concerned about a local city-county regulation that required food permits and new standards for kitchens. Most of these local regulations were cost prohibitive and, as a result, centers had changed the types of foods provided, which included providing less fresh produce and more prepackaged items. Although implementation of local regulations had reduced provision of fruits and vegetables to children, no adjustments were reported for allocation of resources, tuition costs or care of the children. ^ Conclusions. Qualitative data from a small sample of child care directors indicate that the implementation and accountability of food- and nutrition-related guidelines for centers is sporadic, uncoordinated, and can have unforeseen effects on the provision of food. A quantitative survey and dietary assessment methods should be conducted to verify these findings in a larger and more representative sample.^

Strategies for obesity prevention in child care settings: A literature review

Background. Children in the age group of 2-5 years spend substantial amount of time during the day in some kind of childcare setting. These settings are an excellent environmental infrastructure to enhance their nutrition and physical activity behavior and to promote healthy eating and physical activity habits. Due to the steep rise in overweight and obesity among children in the past three decades, it becomes essential to intervene early. There exists a need for literature on a comprehensive and sustainable approach to obesity prevention for younger children in these settings. ^ Methods. Systematic literature search was undertaken using databases like Medline Ovid, Pubmed, Medline Ebsco, and Cochrane Library. Articles published in English as well as English language abstracts of foreign articles were included. The inclusion criteria were as follows: (1) Studies conducted in any part of the world exploring relevant themes and a child care or preschool setting would be included. (2) The interventions promoted physical activity, nutrition/healthy eating/improved diet, reduced television viewing, reduced BMI, changed knowledge and behavior of children and or staff or affected policy/standards/regulations. (3) The population was children in the age group of at least 2 years to 5 years. (4) Articles published in English and English language abstracts for foreign articles would be included. ^ Results. 16 articles were included in the review that consisted of primary interventions in the form of randomized control trials or pre-post interventions were conducted in a preschool or child care or day care setting only. The outcomes pertaining to healthy weight in children were increased vegetable intake, reduced BMI and increased knowledge among others. ^ Conclusion. There is a dearth of data on strong intervention trials in the child care setting. Preschool research studies in the young children that have been conducted are not strong enough. There is a need for more randomized control trials and a well planned evaluation in the preschool age children. There is a need to develop outcome measures that can accurately assess the changes in diet and physical activity in this age group. Child care nutrition and physical activity standards need to be made stringent. ^

Infectious diseases, immune status, and health insurance among child care providers in Houston, Texas

The objectives of this study were to compare female child-care providers with female university workers and with mothers of children in child-care centers for: (1) frequency of illness and work loss days due to infectious diseases, (2) prevalence of antibodies against measles, rubella, mumps, hepatitis B, hepatitis A, chickenpox and cytomegalovirus (CMV), and (3) status regarding health insurance and job benefits.^ Subjects from twenty child-care centers and twenty randomly selected departments of a university in Houston, Texas were studied in a cross-sectional fashion.^ A cluster sample of 281 female child-care providers from randomly selected child-care centers, a cluster sample of 286 university workers from randomly selected departments and a systematic sample of 198 mothers of children from randomly selected child-care centers.^ Main outcome measures were: (1) self-reported frequency of infectious diseases and number of work-days lost due to infectious diseases; (2) presence of antibodies in blood; and (3) self-reported health insurance and job benefits.^ In comparison to university workers, child-care providers reported a higher prevalence of infectious diseases in the past 30 days; lost three times more work-days due to infectious diseases; and were more likely to have anti-core antibodies against hepatitis B (odds ratio = 3.16 95% CI 1.27-7.85) and rubella (OR 1.88, 95% CI 1.02-3.45). Child-care providers had less health insurance and job-related benefits than mothers of children attending child-care centers.^ Regulations designed to reduce transmission of vaccine and non-vaccine preventable diseases in child-care centers should be strictly enforced. In addition policies to improve health insurance and job benefits of child-care providers are urgently needed. ^

Family to Family: Child Welfare for the 21st Century

Child welfare services have undergone many revisions and transformations since their initiation. Some scholars trace the beginning of child welfare in the United States to events such as a 1655 Massachusetts conviction for maltreatment leading to the death of a 12-year-old boy (Watkins, 1990). The predominant philosophy of child welfare has shifted over time from an early emphasis on child saving, to child protection, to family preservation. Building on family preservation, one of the current transformations in child welfare that is taking place in isolated pockets to whole states, is family-centered, neighborhood-based services. One force behind implementation of this transformation is the Family to Family Initiative of the Annie E. Casey Foundation. This paper places family-centered, neighborhood-based child welfare services within the historical context of development of child welfare and within the recent move to reinvent human services (Adams & Nelson, 1995). Against this backdrop, a locality-based implementation of the Family to Family Initiative is described.

Recent Changes in European Welfare State Services: A Comparison of Child Care Politics in the U.K., Sweden, Germany, and the Netherlands. CES Germany & Europe Working Papers, No. 07.6, 1997

This paper examines recent policies and politics of services, in particular child care services in European welfare states. It is argued that social (care) services are becoming an increasingly political issue in postindustrial societies and are at the very center of welfare-state restructuring. Some countries have recently developed new policy pro­ grams for child care-but there are important differences among these programs. To understand these differences as well as some common features, the paper argues that it is necessary to examine the institutional organization of child care and short-term political factors as well as the rationales articulated in political debates to support or im­ pede various policies. The paper concludes that a comprehensive system of child care provisions is still far off in most countries, despite a rhetoric of choice and postindustrial care and labor-market patterns.