Increasing capacity in acute day care settings: patients' experiences of a pop-up day care unit.

The COVID-19 pandemic had considerable impact on paediatric ambulatory care. A pop-up paediatric day care unit for children with allergic and inflammatory bowel diseases was delivered from Nightingale Hospital Bristol (NHB) which was set up to treat patients during the pandemic. METHODOLOGY: The unit operated fortnightly between December 2020 and March 2021. Family feedback on the service was collated via an online survey. RESULTS: 72 respondents found NHB acceptable; 70 (97%) would be happy to return; 63 (90.3%) preferred the NHB to attending Bristol Royal Hospital for Children or had no preference for their appointments. Positive comments focused on service organisation and clinical environment. Families valued the availability of the close, free parking. The minimal negative comments related to travel directions, lack of catering facilities and the small number of toilets. CONCLUSION: The pop-up service model was highly acceptable to families. This highlights the need for appropriate hospital services to explore similar initiatives beyond traditional healthcare settings in order to ensure that the provision of equitable health care is in line with the NHS Long Term Plan.

Italian guidance on Dementia Day Care Centres: A position paper.

Dementia Day Care Centres (DDCCs) are defined as services providing care and rehabilitation to people with dementia associated with behavioural and psychological symptoms (BPSD) in a semi-residential setting. According to available evidence, DDCCs may decrease BPSD, depressive symptoms and caregiver burden. The present position paper reports a consensus of Italian experts of different disciplines regarding DDCCs and includes recommendations about architectural features, requirements of personnel, psychosocial interventions, management of psychoactive drug treatment, prevention and care of geriatric syndromes, and support to family caregivers. DDCCs architectural features should follow specific criteria and address specific needs of people with dementia, supporting independence, safety, and comfort. Staffing should be adequate in size and competence and should be able to implement psychosocial interventions, especially focused on BPSD. Individualized care plan should include prevention and treatment of geriatric syndromes, a targeted vaccination plan for infectious diseases including COVID-19, and adjustment of psychotropic drug treatment, all in cooperation with the general practitioner. Informal caregivers should be involved in the focus of intervention, with the aim of reducing assistance burden and promoting the adaptation to the ever-changing relationship with the patient.

Positive Outcomes in a Virtual Partial Hospitalization Program.

BACKGROUND: Partial hospitalization programs (PHPs) are intensive outpatient mental health programs. During the COVID-19 pandemic, our PHP was converted from an in-person service to a completely virtual telehealth service. This study compared the outcomes of care between these two versions of our PHP. METHODS: In the live version of the program, care was provided to patients aged 18 to 65 years in person, five days a week, with five groups per day and additional services, such as family work. In the telehealth version, we attempted to provide the same services by HIPAA-secure videoconferencing and telephone, after educating staff and patients. The attendance at clinic, the hospitalization rate, and patient satisfaction with care were compared between the two program versions in the 12 months prior to and after the transition to virtual care. RESULTS: There were 4,821 patient visits in the in-person program, and 4,371 in the telehealth program. Compared to the in-person program, the telehealth program was associated with a higher attendance (84.5% vs. 89.5%, p = 0.0168), a lower hospitalization rate (16.5% vs. 8.9%, p = 0.02), without a difference in the patient satisfaction rate, and with 74.3% of patients reporting improvement in their condition. CONCLUSIONS: A PHP completely delivered via telehealth was feasible to implement, and some outcomes with such a program were superior to those of a live PHP. Because this was a nonexperimental study, factors other than the method of service provision may have been responsible for the observed results.

Delta and Omicron: protective measures and SARS-CoV-2 infections in day care centres in Germany in the 4th and 5th wave of the pandemic 2021/2022.

BACKGROUND: During the five waves of the SARS-CoV-2 pandemic so far, German early childhood education and care (ECEC) centres implemented various protective measures, such as wearing a face mask, fixed children-staff groups or regular ventilation. In addition, parents and ECEC staff were increasingly vaccinated throughout 2021. During the 4th wave, variant of concern (VOC) Delta-driven transmission indicators reached record values at the end of 2021. Those values were even exceeded in the 5th wave at the beginning of 2022 when Omicron dominated. We examine which factors facilitated or prevented infection with SARS-CoV-2 in ECEC centres, and if these differed between different phases within wave 4 (Delta) and 5 (Omicron). METHODS: Since August 2020, a weekly online survey among approximately 8000 ECEC managers has been conducted, monitoring both incident SARS-CoV-2 infections and protective measures taken. We included data from calendar week 26/2021 to 05/2022. We estimate the probability of any infections and the number of SARS-CoV-2 infections in children, parents and staff using random-effect-within-between (REWB) panel models for binomial and count data. RESULTS: While children, parents and staff of ECEC centres with a high proportion of children from families with low socioeconomic status (SES) have a higher risk of infections in the beginning of wave 4 (OR up to 1.99 [1.56; 2.56]), this effect diminishes for children and parents with rising incidences. Protective measures, such as wearing face masks, tend to have more extensive effects with rising incidences in wave 5 (IRR up to 0.87 [0.8; 0.93]). Further, the protective effect of vaccination against infection among staff is decreasing from wave 4 to wave 5 (OR 0.3 [0.16; 0.55] to OR 0.95, [0.84; 1.07, n.s.]). The degree of transmission from staff to child and from staff to parent is decreasing from wave 4 to wave 5, while transmission from child to staff seems to increase. CONCLUSION: While Omicron seems to affect children and parents from ECEC centres with families with all SES levels more equally than Delta, the protective effect of vaccination against infection is decreasing and the effect of protective measures like face masks becomes increasingly important. In order to prevent massive closures of ECEC centres due to infection of staff, protective measures should be strictly adhered to, especially to protect staff in centres with a high proportion of children from families with low socioeconomic status.

Acceptance of Different Self-sampling Methods for Semiweekly SARS-CoV-2 Testing in Asymptomatic Children and Childcare Workers at German Day Care Centers: A Nonrandomized Controlled Trial.

Importance: Closure of day care centers (DCCs) to contain the COVID-19 pandemic has been associated with negative effects on children's health and well-being. Objective: To investigate the acceptance of self-sampling methods for continuous SARS-CoV-2 surveillance among asymptomatic children and childcare workers (CCWs) in DCCs. Design, Setting, and Participants: This nonrandomized pilot study included children and CCWs at 9 DCCs in Wuerzburg, Germany, from May to July 2021. Interventions: Twice weekly testing for SARS-CoV-2 was conducted by self-sampled mouth-rinsing fluid (saliva sampling [SAL], with subsequent pooled polymerase chain reaction test) plus nasal rapid antigen self-test (RAgT) (group 1), SAL only (group 2), or RAgT only (group 3) in children and CCWs. Main Outcomes and Measures: Main outcomes were rates for initial acceptance and successful (≥60% of scheduled samples) long-term participation. The probability of SARS-CoV-2 introduction into DCCs was modeled as a function of age-adjusted background incidence and DCC size. Results: Of 836 eligible children, 452 (54.1%; 95% CI, 50.7%-57.4%) participated (median [IQR] age: 4 [3-5] years; 213 [47.1%] girls), including 215 (47.6%) in group 1, 172 (38.1%) in group 2, and 65 (14.4%) in group 3. Of 190 CCWs, 139 (73.2%; 95% CI, 66.4%-79.0%) participated (median [IQR] age: 30 [25-46] years; 128 [92.1%] women), including 96 (69.1%) in group 1, 29 (20.9%) in group 2, and 14 (10.1%) in group 3. Overall, SARS-CoV-2 PCR tests on 5306 SAL samples and 2896 RAgTs were performed in children, with 1 asymptomatic child detected by PCR from SAL. Successful long-term participation was highest in group 2 (SAL only; children: 111 of 172 [64.5%]; CCWs: 18 of 29 [62.1%]). Weekly participation rates in children ranged from 54.0% to 83.8% for SAL and from 44.6% to 61.4% for RAgT. Participation rates decreased during the study course (P < .001). The probability of SARS-CoV-2 introduction into a DCC with 50 children was estimated to reach at most 5% for an age-adjusted SARS-CoV-2 incidence below 143. Conclusions and Relevance: Self-sampling for continuous SARS-CoV-2 testing was well accepted, with SAL being the preferred method. Given the high number of negative tests, thresholds for initiating continuous testing should be established based on age-adjusted SARS-CoV-2 incidence rates. Trial Registration: German Registry for Clinical Trials Identifier: DRKS00025546.

Physical Competence, Physical Well-Being, and Perceived Physical Literacy among Older Adults in Day Care Centers of Hong Kong.

In Hong Kong, where the aging problem is inevitable, it is increasingly common for older adults to be admitted to day care centers. However, there has been limited research exploring conceivable indicators of healthy aging among older adults in such settings. The present study investigated the associations among the three indicators (physical competence, physical well-being, and perceived physical literacy) among older adults in day care centers of Hong Kong. A total of 97 participants (aged 60 years old or above) participated in the study from April to July 2021 amid the COVID-19 pandemic. Data on participants' sociodemographic information, physical competence (PC), physical well-being (PWB), and perceived physical literacy (PPL) were collected. Our results showed that the level of PC reached a high level among the participants. Positive correlations were found between PC and PWB and between PPL and PWB (r = 0.22-0.23, p < 0.05). However, PC was not associated with PPL (r = 0.11, p > 0.05). In addition, as a component within PPL, "knowledge and understanding" (KU) was found to be correlated with PC (r = 0.21, p < 0.05) and had a positive and moderate correlation with PWB (r = 0.35, p < 0.01). The results suggest that older adults admitted to day care centers maintain and enhance their physical competence to improve their physical well-being. Greater knowledge and understanding of physical literacy and physical health should be delivered among day care centers considering future development.

SARS-CoV-2 Transmissibility Within Day Care Centers-Study Protocol of a Prospective Analysis of Outbreaks in Germany.

Introduction: Until today, the role of children in the transmission dynamics of SARS-CoV-2 and the development of the COVID-19 pandemic seems to be dynamic and is not finally resolved. The primary aim of this study is to investigate the transmission dynamics of SARS-CoV-2 in child day care centers and connected households as well as transmission-related indicators and clinical symptoms among children and adults. Methods and Analysis: COALA ("Corona outbreak-related examinations in day care centers") is a day care center- and household-based study with a case-ascertained study design. Based on day care centers with at least one reported case of SARS-CoV-2, we include one- to six-year-old children and staff of the affected group in the day care center as well as their respective households. We visit each child's and adult's household. During the home visit we take from each household member a combined mouth and nose swab as well as a saliva sample for analysis of SARS-CoV-2-RNA by real-time reverse transcription polymerase chain reaction (real-time RT-PCR) and a capillary blood sample for a retrospective assessment of an earlier SARS-CoV-2 infection. Furthermore, information on health status, socio-demographics and COVID-19 protective measures are collected via a short telephone interview in the subsequent days. In the following 12 days, household members (or parents for their children) self-collect the same respiratory samples as described above every 3 days and a stool sample for children once. COVID-19 symptoms are documented daily in a symptom diary. Approximately 35 days after testing the index case, every participant who tested positive for SARS-CoV-2 during the study is re-visited at home for another capillary blood sample and a standardized interview. The analysis includes secondary attack rates, by age of primary case, both in the day care center and in households, as well as viral shedding dynamics, including the beginning of shedding relative to symptom onset and viral clearance. Discussion: The results contribute to a better understanding of the epidemiological and virological transmission-related indicators of SARS-CoV-2 among young children, as compared to adults and the interplay between day care and households.

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

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

Longitudinal Testing for Respiratory and Gastrointestinal Shedding of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Day Care Centers in Hesse, Germany.

BACKGROUND: With the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ongoing in Europe in June 2020, day care centers were reopened in the state of Hesse, Germany, after the lockdown. The role young children play in the dynamics of the transmission was unknown. METHODS: We conducted a longitudinal study over 12 weeks and 2 days (18 June 2020-10 September 2020) to screen attendees and staff from day care centers in the state of Hesse, Germany, for both respiratory and gastrointestinal shedding of SARS-CoV-2. A total of 859 children (age range, 3 months-8 years) and 376 staff members from 50 day care centers, which were chosen representatively from throughout the state, participated in the study. Parents were asked to collect both a buccal mucosa and an anal swab from their children once a week. Staff were asked to self-administer the swabs. Reverse transcriptas polymerase chain reaction for SARS-CoV-2 was performed in a multiple-swab pooling protocol. RESULTS: A total of 7366 buccal mucosa swabs and 5907 anal swabs were analyzed. No respiratory or gastrointestinal shedding of SARS-CoV-2 was detected in any of the children. Shedding of SARS-CoV-2 was detected in 2 staff members from distinct day care centers. One was asymptomatic at the time of testing, and one was symptomatic and did not attend the facility on that day. CONCLUSION: Detection of either respiratory or gastrointestinal shedding of SARS-CoV-2 RNA in children and staff members attending day care centers was rare in the context of limited community activity and with infection prevention measures in the facilities in place.

Post-traumatic stress symptomatology and adjustment of medical oncology practice during the COVID-19 pandemic among adult patients with cancer in a day care hospital.

BACKGROUND: The COVID-19 pandemic may induce post-traumatic stress disorder (PTSD) symptoms among patients with cancer, who also face adaptations to their treatment. The authors assessed the occurrence of PTSD symptoms, investigated pandemic-induced adjustments in medical oncology practice in patients with cancer, and explored risk factors for PTSD and the association between PTSD symptoms, insomnia, and quality of life (QoL). METHODS: This prospective French study was conducted in patients with solid/hematologic tumors who were receiving medical treatment in the day care departments of 2 cancer centers during the lockdown. Adjustments to medical oncology practice were collected from medical records. PTSD (measured using the Impact of Event Scale-Revised), insomnia (measured using the Insomnia Severity Index), QoL (measured using the Functional Assessment of Cancer Therapy-General instrument), and cognitive complaints (measured using the Functional Assessment of Cancer Therapy-Cognitive Function instrument) were collected through validated questionnaires. RESULTS: Clinical data and questionnaires were available for 734 and 576 patients, respectively. The median patient age was 64 years, and 69% of patients were women. Twenty-one percent of patients had PTSD. Twenty-seven percent (95% CI, 23%-30%) had an adjustment in their medical oncology program, including adjournments (29%), treatment interruptions (16%), modified treatment plans (27%), or adapted monitoring (27%). Women and patients experiencing an adjustment in oncology practice had a higher odds of PTSD (odds ratio= 2.10 [95% CI, 1.07-4.14] and 1.65 [95% CI, 1.03-2.63]; P < .05). PTSD symptoms were correlated with worse scores for QoL, cognition, and insomnia. CONCLUSIONS: Twenty-one percent of patients with cancer experienced PTSD symptoms associated with poor QoL during the first COVID-19-induced lockdown. Medical oncology practice was adjusted in approximately one-quarter of patients and was associated with the occurrence of PTSD symptoms. Psychosocial support should be offered in cancer centers to promote emotional resilience and avoid PTSD symptoms in patients.

Crisis Preparedness in Acute and Intensive Treatment Settings: Lessons Learned From a Year of COVID-19.

The impact of COVID-19 changed the use and delivery of health care services, requiring an abrupt shift in treatment and staffing models 1,2. This is particularly salient in youth acute and intensive treatment services (AITS), including inpatient psychiatric hospitals (IPH), intensive outpatient programs (IOP), and partial hospitalization programs (PHP), because of challenging issues of maintaining high-quality care and a safe therapeutic milieu during increased demand for acute services,3 all while limiting transmission of COVID-19 on locked units, in close quarters, and for youths traveling back and forth to day-programs. Over the past year, AITS adapted and evolved without the ability to pause services and plan, increase staffing, or allocate additional resources. This article discusses themes of changes made based on more than 20 facilities across the United States through the American Psychological Association Child and Adolescent Psychology Division's Acute, Intensive, and Residential Service Special Interest Group.4 These facilities include psychiatric inpatient units and day-treatment programs. We discuss lessons learned from these changes, the need for evaluating these changes, and application of these lessons in future crises.

Development of a Child and Adolescent Tele-Partial Hospitalization Program (tele-PHP) in Response to the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic prevented a group-based partial hospitalization program (PHP) from running in-person care due to social distancing guidelines. However, the crisis also simultaneously increased stress on families while decreasing their desire to hospitalize youth for a nonmedical issue. Hence, the need for a PHP remained high. Health care organizations worked diligently to create a secure telehealth platform (tele-PHP) to be delivered to patients in their home environments. This article describes the development and implementation of child and adolescent tele-PHPs in response to the COVID-19 pandemic. These new programs were started in mid-March 2020, and changes were implemented over the next 3 to 4 weeks. Overall, patients and families have been receptive to behavioral health services delivered through telemedicine. While tele-PHPs are the most plausible solution to continue behavioral health care for these patients, some challenges were observed during this process. Besides procedural and technological challenges associated with creating a virtual setup, other difficulties include variable patient engagement, specific treatment-related challenges, and system-related changes. These challenges are addressed through psychoeducation, provision of online measures to assess treatment outcomes, and efforts to optimize parent engagement prior to treatment initiation for better treatment adherence. Initial experiences during a time of crisis suggest that tele-PHP services can be a viable long-term treatment option in the future during both a disaster and routine times to improve access for those who otherwise cannot take advantage of such services. Long-term effectiveness of these interventions still needs to be explored.

Children and adolescents with eating disorders during COVID-19 confinement: Difficulties and future challenges.

OBJECTIVE: To present the adaptations to treatment protocols made in a child and adolescent eating disorders (ED) unit during the eight-week confinement period mandated in response to the COVID-19 pandemic and examine clinical and treatment variables in the outpatient, day hospital, and inpatient care programs. METHOD: Description of the implementation of a combined teletherapy program for outpatient and day-hospital patients and the adaptations made to the inpatient protocol. Retrospective review of medical records and analysis of general and specific variables related to the pandemic and confinement. RESULTS: We held 1,329 (73.10%) telehealth consultations and 489 (26.9%) face-to-face outpatient visits with 365 patients undergoing treatment in the outpatient clinic or day hospital. Twenty-eight (7.67%) were initial evaluations. Twenty-two patients were newly admitted and 68 ED-related emergencies were attended. Almost half of the children and adolescents studied experienced reactivation of ED symptoms despite treatment, and severe patients (25%) presented self-harm and suicide risk. CONCLUSIONS: The implementation of a combined teletherapy program has enabled continuity of care during confinement for children and adolescents with ED. Delivery of treatment to adolescents in the day hospital program posed the biggest challenge due to their greater degrees of severity and higher hospitalization rates. An adapted inpatient program should be maintained throughout confinement, as the need for hospitalization of children and adolescents with ED does not decrease with lockdown.