Incidence of Postoperative Agitated Behavior in Nerve Block and Neuraxial Anesthesia: Retrospective Observational Study - Juniper Publishers

 Anesthesia & Intensive Care Medicine - Juniper Publishers

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Background: Postoperative delirium exacerbates the prognosis of elderly surgical patients. Postoperative agitation or confusion is one of the symptoms of hyperactive delirium. We retrospectively evaluated the incidence of postoperative abnormal psychomotor behavior in elderly surgical patients according to different anesthetic methods: nerve block vs. neuraxial anesthesia.

Methods: The medical records of 288 patients older than 64 years who underwent surgery with regional anesthesia between January 2015 and December 2017 were divided into two groups, the nerve block group (n=209) and the neuraxial anesthesia group (n=79). The primary outcome was postoperative agitated behaviors, and the secondary outcomes were patient and anesthesia related factors.

Results: In elderly patients, the incidence of agitated behavior was lower in the nerve block group compared with the neuraxial anesthesia group (4 {1.3%} vs. 8 {2.8%}, P=0.004). Neuraxial anesthesia, older age and male gender were found to be significant factors for the occurrence of agitation in elderly patients.

Conclusions: This study suggests that nerve block, as compared with neuraxial anesthesia, may have a greater beneficial effect in reducing postoperative agitated behavior in surgical elderly patients.

Keywords: Nerve block, Neuraxial anesthesia, Postoperative agitated behavior, Hyperactive delirium

Abbreviations: ANCOVA: Analysis of Covariance, CAM-ICU: Confusion Assessment Method in The Intensive Care Unit, OAA/S: Observer’s Assessment of Alertness/Sedation, RASS: Richmond Agitation-Sedation Scale

Introduction

Postoperative delirium can exacerbate the prognosis of surgical patients, result in increased postoperative morbidity and mortality, and generate higher hospital costs [1-3]. Postoperative delirium is a common complication, especially in elderly patients, occurring in up to 60% of patients after major surgery [4]. The risk factors for postoperative delirium such as old age, hip surgery, and propofol use are known [5-7]. In addition, postoperative pain is an important factor related to postoperative delirium [8]. However, the pathophysiology of postoperative delirium has not been elucidated yet. A previous study reported that peripheral nerve blocks reduce side effects such as postoperative delirium via an opioid-sparing effect [9].

There have been many studies on the incidence of delirium in different types of anesthesia. However, most studies compared general anesthesia with neuraxial (spinal, epidural, or combined spino-epidural) anesthesia [10,11]. There are few studies comparing neuraxial anesthesia with peripheral nerve block in regional anesthesia.

There are three types of delirium: hypoactive, hyperactive, and mixed [12]. Although the hypoactive type is more common than the hyperactive type [13], the abnormal behavioral patterns of the hyperactive type, such as agitation or confusion, are considered harmful to patients and medical providers and need to be quickly managed.

In this study, based on the hypothesis that nerve block may reduce the incidence of abnormal psychomotor behavior compared with neuraxial anesthesia, we retrospectively investigated the incidence of postoperative agitated or anxious behavior with other risk factors in elderly patients who underwent surgery with regional anesthesia.

Methods

Study population and data collection

After obtaining an approval from the Institutional Review Board at Hanyang University Hospital (HYUH 2018-07-006), this study was registered at the Clinical Research Information Service (KCT0003279). The requirement for informed consent was waived. Electronic medical records from January 2015 to December 2017 were reviewed. Adult patients aged 65 and over who underwent surgery with neuraxial anesthesia or nerve block were listed for this study.

Anesthesia techniques: neuraxial anesthesia and nerve block

Patients were injected intramuscularly with midazolam 1-2mg and atropine 0.5mg for anti-anxiety and reduction of salivation at the ward and were transferred to the operating room. The neuraxial anesthesia technique included either spinal or combined spinal-epidural anesthesia, which was chosen according to the duration of operation. In our hospital, an optimal dose of 0.5% hyperbaric bupivacaine is used intrathecally with or without fentanyl (10-20μg). In lengthy surgeries, 0.75% ropivacaine is injected additionally through the epidural catheter placed for combined spinal-epidural anesthesia at 2 hours after surgical incision. The nerve block technique includes brachial plexus block, sciatic nerve block or combined sciatic and femoral nerve block, which are chosen according to the patient’s lesion. In our hospital, an optimal dose of 0.75% ropivacaine is used with or without 2% lidocaine under ultrasound guidance.

Intraoperative sedation

Sedation was provided to patients after confirming the proper regional anesthesia level and obtaining hemodynamic stability. The sedative agent was selected among propofol, dexmedetomidine, remifentanil, midazolam, mixed, or no agents depending on the anesthesiologist’s preference. Sedation was usually maintained to achieve an observer’s assessment of alertness/sedation (OAA/S) score of 3 or 4. For sedation, propofol (Fresofol®, Fresenius Kabi, Graz, Austria) was administered continuously via a targetcontrolled infusion device (Orchestra®, Fresenius vial, Brézins, France), and the effect-site concentration was maintained within 0.5-2.0μg/mL. Dexmedetomidine (PrecedexfM, Hospira Inc., Lake Forest, IL, USA) was diluted with 0.9% normal saline to a concentration of 4μg/mL. Dexmedetomidine of 1μg/kg was administered over a 10-min period as a loading dose and was then infused continuously at 0.1-0.5 μg/kg/h. Remifentanil (UltiAN®, Hanlim Pharm.co., LTD., Republic of Korea) was diluted with 0.9% normal saline to a concentration of 50μg/mL and then infused continuously at 0.05-0.1μg/kg/h. Midazolam (MIDAZOLAM Bukwang, Bukwang Pharrm. Co., LTD., Republic of Korea) was administered 0.5-1mg as needed according to the OAA/S score. In the case of the mixed method, midazolam and propofol or dexmedetomidine, or propofol and remifentanil, were administered.

Assessment of postoperative abnormal behavior

The Richmond agitation-sedation scale (RASS) was used to evaluate the presence of patient abnormal behaviors after surgery [14]. The postoperative daily progress notes and nursing notes were recorded regularly by doctors and nurses in charge. By evaluating these notes, we were able to determine which patients were documented with abnormal behaviors, including agitated, uncooperative, aggressive, confused, combative, violent, hallucination, delusion, or removal of catheters, plasters, or bandages. In addition, the recording of consultation for delirium with the Psychiatry Department was determined to be abnormal behavior. These descriptions of abnormal behavior corresponded roughly to RASS scores of +2, +3, or +4.

Other outcome variables

The following variables were further evaluated:

a. preoperative factors (age, gender, weight, height, body mass index, and American Society of Anesthesiologist (ASA) physical status classification)

b. intraoperative factors (surgery and anesthesia time, use of midazolam for premedication, and use of sedative drugs); and

c. postoperative factors (total admission period).

Statistical analysis

Data are presented as the mean plus or minus the standard deviation or a number (proportion). All continuous data were assessed for normality using the Shapiro-Wilk test. Incidence was analyzed by the chi-square test. The numerical data were assessed using independent t-tests, as appropriate. A binary logistic regression model was used to evaluate the predisposing factors for abnormal postoperative behavior. The dependent variable was the occurrence of abnormal postoperative behavior; and the independent variables were anesthesia method, age, gender, preoperative stroke history, preoperative depressive disorder history, use of sedative agents, and admission period. Analysis of covariance (ANCOVA) was performed to reduce the risk of confounder effects between the nerve block group and the neuraxial anesthesia group. The covariates were age, gender, preoperative stroke history, preoperative depressive disorder history, use of sedative agents, surgery type, and admission period. The dependent variable was the anesthesia method: nerve block or neuraxial anesthesia. Also, the incidence of abnormal postoperative behaviors according to the types of sedatives in elderly patients was analyzed by the Kruskal-Wallis test. All analyses were carried out using IBM® SPSS® Statistics version 22.0 (IBM Corporation, NY, USA). P<0.05 was considered statistically significant.

Results

A total of 916 patients were screened and 622 patients under 65 years old were excluded. Four cases were changed from regional anesthesia to general anesthesia due to incomplete anesthesia. Two cases were excluded due to duplicated surgery of the same patient. Nerve block and neuraxial anesthesia were performed for surgery in 209 and 79 patients, respectively (Figure 1).

Patient characteristics and information regarding anesthesia are shown in Table 1. Demographic data were comparable between the two groups except age, gender, preoperative stroke, and depressive disorder histories, use of sedative agents, surgery type, and admission period. Preoperative stroke and depressive disorder histories were lower in the nerve block group than in the neuraxial anesthesia group (P<0.001 and P<0.001, respectively). The use of perioperative sedative agents was lower in the neuraxial anesthesia than in the nerve block group (P=0.034), and the effect of sedative agents was significantly different between the two groups (P<0.001). Surgery type was significantly different between two groups (P<0.001). Admission period was lower in the neuraxial anesthesia group than in the nerve block group (P=0.001). In order to reduce the risk of confounder effects between the two groups, ANCOVA was performed by setting age, gender, preoperative stroke history, preoperative depressive disorder history, use of sedative agents, surgery type, and admission period as covariance.

Data are expressed as the mean±SD or the number of the patients (proportion). BMI: body mass index; ASA: American Society of Anesthesiologist classification

We found that there were significantly less postoperative agitated behaviors in the nerve block group than in the neuraxial anesthesia group (1.3% vs. 2.8%, P=0.004), which was corrected with the ANCOVA method. In the nerve block group, one of the 168 patients receiving the brachial plexus block and three of the 40 patients receiving sciatic nerve block had abnormal postoperative agitated behaviors (Table 2).

Data are expressed as the mean±SD or the number of the patients (proportion).

The following parameters were confirmed as significant determinants for the occurrence of postoperative agitated behaviors by the binary logistic regression analysis (Table 3). Patients receiving neuraxial anesthesia were 65.26 (95% CI: 2.14- 1991.9, P=0.017) times more likely to experience postoperative agitated behaviors than patients receiving nerve block. Patients were 1.15 (95% CI: 1.03-1.29, P=0.016) times more likely to experience abnormal postoperative behaviors for each year increase in age. Men were 33.24 (95% CI: 4.24-260.7, P=0.001) times more likely to experience postoperative agitated behaviors than women.

The incidence of postoperative agitated behaviors according to the types of sedatives in elderly patients was not significantly different (p=0.217) (Table 4).

OR: odds ratio; CI: confidence interval.

Data are expressed as the mean±SD or the number of the patients (proportion).

Discussion

In this retrospective study, we found that surgical elderly patients under nerve block presented less postoperative agitation than those under neuraxial anesthesia. We believe that this is the first study to verify that type of regional anesthesia during surgery can affect postoperative behavioral pattern.

When assessing the data, our first consideration was whether postoperative agitated, anxious, or confused behavior was associated with postoperative delirium. Delirium can be divided into three types, hypoactive, hyperactive, or mixed type, according to the motor-activity profile [12]. Although the incidence of the hypoactive type of delirium is known to be more frequent, this study focused on symptoms of the hyperactive type. Agitation and confusion are major symptoms of hyperactive delirium. These symptoms can be a threat to patient prognosis and the safety of medical persons. Therefore, rapid diagnosis and multimodal approaches to actively prevent postoperative agitated behaviors are necessary.

Previous studies [10,11] compared general anesthesia with regional anesthesia and showed no difference in the incidence of postoperative delirium. However, the researchers did not investigate the types of regional anesthesia and the subtypes of delirium in detail. Our results specified that nerve block is associated with the reduction of agitated behavior presented in hyperactive delirium. The postoperative agitated state is related to patient safety. The type of anesthetic method is thought to be a modifiable factor, and according to our results, nerve block for surgery can be regarded as one of the preventive strategies for patients with a high possibility of postoperative hyperactive delirium.

To detect abnormal psychomotor behavior retrospectively, choosing the appropriate assessment tool is important. The confusion assessment method in the intensive care unit (CAMICU) is regarded as the standard tool for evaluating delirium [15]; however, in our study, checking CAM-ICU data retrospectively was challenging. Thus, we used RASS, which is a simpler scale than CAM-ICU, to detect any postoperative abnormal behavior. RASS was originally developed to assess the level of agitation and sedation [14]. RASS is composed of four levels of anxiety or agitation (+1 ~ +4) and 5 levels of sedation (-1 ~ -5) with a calm or alert state (0 point) as the center. Unfortunately, we were unable to prove whether the hypoactive subtype of delirium can be relieved by nerve block. Hypoactive delirium often cannot be recognized clinically, and there are limitations in evaluating the hypoactive state via a retrospective investigation [16,17]. Therefore, a precise and well-controlled prospective study may be required for this issue.

This study has a limitation to consider when interpreting its results. Because this study is retrospective in nature, the type of anesthetic method was not randomized. In addition, no specific sample size was determined. Based on a post-hoc power analysis, this study has 83.3% power with a type 1 error of 5% to detect the decreased incidence of postoperative agitated behavior in the nerve block group.

Conclusion

In conclusion, the nerve block method was associated with lowering the incidence of postoperative agitation in elderly patients undergoing surgery via regional anesthesia compared with neuraxial anesthesia. Thus, nerve block can be considered as one of the potential preventive strategies for postoperative hyperactive delirium.

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Assess the Impact of Targeting Subsidies on the Development of Rural Settlements - Juniper Publishers

 Archaeology & Anthropology - Juniper Publishers

Abstract

Since the of targeting subsidies has been at the head of the government’s economic development plans, this project the rural community in line with its policy has affected all classes of society. In this study, an attempt is made to assess the impact of implementation targeting subsidies law on the development of rural settlements in the central district of Borujerd county for “run-time assessment “ is checked. The statistical population of this research is rural settlements in the central part of Borujerd County. The sample size was 286 people and the subjects were studied by simple random sampling. Finally, spss software was used for data analysis. Kind of research is applied and research method is descriptive and analytical research and data collection, library documentation and field that for the analysis of data from the questionnaires, the two methods of descriptive and inferential statistics (Kendall’s tau-b, Spearman and multiple regression) using is. The results show that the correlation between the targeting subsidies and the Rural Development in this area is significant [1-4].

Keywords: Structural Adjustment Policies; Targeting Subsidies; Development; Rural Settlements

Introduction

With the evolution of economic theories, the role and position of the state has been transformed, so that the optimal allocation of resources, economic stability and distribution of income are among the main tasks of governments. In some cases, the optimal allocation of resources between sectors and economic activities is not naturally achieved and, with the imbalance in economics, Pareto efficiency access is not possible. As well, with the implementation of the historical evolution targeting subsidies law in 2010, surgery economic transition period of economic subsidies to be economically competitive and released after two decades of waiting, operational and research on the subject from the perspective of monitoring and impact assessment after the run, has entered a new realm [5-7]. Since the of targeting subsidies has been at the head of the government’s economic development plans, this project the rural community in line with its policy has affected all classes of society. In this study an attempt is made to assess the impact of implementation targeted subsidies law to the development of rural settlements the central district of Borujerd county for “run-time assessment” is checked [8]. In rural settlements around Boroujerd city, the purpose of subsidies is the emergence of social and spatial effects [9]. In order to compare the theoretical and objective issues, the purposeful targeted of subsidies with the realities of rural society in the central part of the city, from the perspective of its impact on rural development indicators In this research, an attempt is made to evaluate the effects of law enforcement on subsidies on the four dimensions of economic, socio-cultural, environmental and physical infrastructure of rural settlements under study [10].

The Study Area

Boroujerd County is one of the 429 County of Iran and located on the geographical coordinates of 33°36’12”N 48°35’26”E (Figure 1).

Methodology

Kind of research is applied and research method is descriptive and analytical research and data collection, library documentation and field that for the analysis of data from the questionnaires, the two methods of descriptive and inferential statistics (Kendall’s tau-b, Spearman and multiple regression) using is. Variables to measure the level of development of rural settlements of 56 items in the 4 criteria of environmental system, social system, economic system and physical system is measured. In relation to influence the process of targeted subsidies in the territorial space and rural settlements of 38 items within 7 standards of education and awareness, knowledge and skill, empowerment, service backup production and food security, access to financial resources, partnerships and policies is measured [11-13]. Thus, by analyzing the questionnaires of sampled households in rural areas of the central district of Boroujerd County, it was clarified that the targeting subsidies on the level of development and stability of rural settlements is effective [14,15].

Results and Discussion

Distribution of cash Transfer in many countries as one of the most important factors affecting the spatial system of the settlement, in addition to the development and structure and performance of the regions and districts, Cause improves the level of development of the indicators of the environmental, socio-economic, physical and infrastructural systems in Rural settlements [16,17]. Thus, the neglected sections of the spatial and interactive components (Targeting Subsidies) with the level of development of rural settlements in the central part of Borujerd County, are potentials that can be effective in improving the development indicators of Rural settlements. The results show that the correlation between the targeting subsidies and the Rural Development in this area is significant [18-21].

Conclusion

Considering the positive role played by targeting subsidies and the development of rural communities and settlements, as well as the numerous emphasis of many scholars as well as the experiences of other countries in this regard, the need for the government to promote these indicators and enhance the empowerment of local residents through the provision of credit services and Improving the rural business environment in this regard will improve the status of development indicators of rural settlements in the central part of Borujerd county [22-24]. The findings of this study indicate that lack of proper mechanism for law enforcement of subsidies in the agricultural sector and rural community has led to the instability of rural settlements in the central part of Borujerd city [25]. Therefore, local stakeholders, as they should have not been able to make the necessary investments in the process of improving the process Production and employment caused by the law enforcement purpose of subsidies [26].

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Occurrence of Antimicrobial Resistance in Foodborne Bacteria (Campylobacter and E. coli): A Food Safety Issue and Public Health Hazard - Juniper Publishers

 Nutrition and Food Science - Juniper Publishers

Abstract

Campylobacter and Escherichia coli (E. coli) are prominent bacterial causes of human gastroenteritis in the developing countries and the emergence of antibiotic resistance of these bacteria has been widely reported to be on the increase, particularly because of the increase in the number of resistant Campylobacter and E. coli isolated from human infections. The widespread use of antimicrobial drugs for therapeutic, prophylactic, and preventive purposes in modern food animal husbandry is a great concern in terms of the development of antibiotic resistance in many bacteria, and, therefore, a potential public health threat. This review simply describes the occurrence, spreading and public health significance of antimicrobial resistance in Campylobacter and E. coli.

Keywords: Antimicrobial resistance; Campylobacter; Escherichia coli; C. coli: Campylobacter coli

Abbreviations: AMR: Antimicrobial resistance; E. coli: Escherichia coli; C. jejuni: Campylobacter jejuni; ESBL: Extended-spectrum beta-lactamase.

Introduction

Antimicrobial resistance (AMR) is an emerging global threat. According to one estimate, unless appropriate action is taken, the annual number of deaths due to antimicrobial resistance may reach 10 million by 2050 [1]. This estimate, however, is considered high and has been questioned by others. Nevertheless, problems associated with antimicrobial resistance and the urgency to act are recognized by all. The presence of antimicrobial resistant bacteria and related resistant genes in the environment is well recognized for their role in the spread of antimicrobial resistance [2]. Numerous resistant genes associated with human diseases have an environmental origin [3]. Recent studies related to AMR have focused on the monitoring and treatment of resistant genes in different environmental matrices [4,5]. A focus on environmental occurrence is essential not only from the perspective of water and environmental safety but also to prevent the spread of AMR. Resistant genes in wastewater treatment plants, for example, are being studied from multiple perspectives due to the reuse of wastewater for agricultural purposes often without extensive treatment [6,7]. Globally, the increase and spread of antibiotic resistance, especially to foodborne zoonotic bacteria with their reservoirs in healthy food animals, such as poultry, pigs and cattle, have become a public health concern [8]. In developed countries, there is an increasing number of scientific reports regarding the widespread usage of antibiotics in food animal production, which leads to the development of resistant pathogenic organisms in the food chain [9,10].

The resistant elements reduce the efficiency of antibiotic therapy, which results in an increased morbidity and mortality associated with disease outbreaks [8]. It has been reported by Schwarz and Chaslus-Dancla [11] in 2001, that an antibiotic therapy with a specific agent has been either accompanied or followed shortly by the occurrence of resistant bacteria, and, for the past twenty years, the effect of antibiotics on the development of resistance has gained much attention. Poultry farms are regarded as the major source of resistant genetic elements for foodborn pathogens such as Campylobacter and E. coli [12-14], and poultry products are considered as vehicle of these pathogens to human. Once a broiler chicken becomes infected, Campylobacter spread rapidly to other broiler chickens in that flock, and up to slaughter age, or, at thinning, the chickens remain colonized. Almost all (100%) of the broiler chickens brought to the slaughterhouses were reported to be colonized with Campylobacter [15], and the contaminated chicken meat acts as a probable risk of human campylobacteriosis. The detection of C. jejuni, C. coli and E. coli on the carcasses is mainly due to contamination from the gastrointestinal contents of slaughtered healthy animals during processing as well as at retail [16].

Campylobacter and E. coli has been reported to develop resistance to a number of antibiotics including ciprofloxacin and other fluoroquinolones, macrolides and licosamides, chloramphenicols, aminoglycosides, tetracyclines, and ampicillins, as well as β-lactams, cotrimoxazole, and tylosin [17-19]. Wild birds are important with regard to antibiotic resistance in several different ways: 1) As sentinels, mirroring human activity and its impact on the environment because of the diverse ecological niches of birds, and as they easily pick up human and environmental bacteria. 2) As a reservoir and melting pot of antibiotic-resistant bacteria and resistant genes. 3) As potential spreaders of antibiotic resistance through the ability to migrate long distances in short periods of time. 4) As a possible source of antibiotic resistant bacteria colonizing and/or infecting human beings. The first antibiotic resistant bacteria noted in wildlife were in fact from wild bird strains of E. coli, which were resistant to multiple antibiotics; for example, chloramphenicol was isolated in pigeons around 1975 [20]. Many bird species have been found to carry antibiotic resistant bacteria. Resistant E. coli has been isolated from ducks and geese [21,22], cormorants [23], birds of prey [24], gulls [25], doves, and passerines [26].

The results from a study on Campylobacter by Chen et al. [27] showed that the vast majority of the isolates from birds appeared to be resistant to fluoroquinolones by more than 98%. In the same study, Campylobacter jejuni was resistant to gentamicin at 27.2%. Importantly, a previous study from the Netherlands revealed a substantial increase in fluoroquinolone resistance among human cases since the advent of enrofloxacin in veterinary medicine [28,29,30]. While, apart from poultry, other animals, such as pigs and cattle, also serve as reservoir hosts [31]. Resistant Campylobacter and E. coli are also found in various other domestic and wild animals, including goats, horses, cats, rodents, and dogs [32-34], and have been isolated from marine animals, such as shellfish and dolphins [35,36]. Campylobacter infection is normally self-limiting, but it may be associated with complications, such as Guillain-Barre Syndrome (neurological) and Reiter’s Syndrome (reactive arthritis) [37]. Escherichia coli is part of the normal enteric microbial flora in humans, poultry, and other animals, and the pathogenic E. coli causes disease in both [17]. The pathogenic E. coli causes a number of diseases in both poultry and humans, which include hemorrhagic colitis, hemolytic uremic syndrome, acute and chronic endemic and epidemic diarrhea.

Diarrheagenic strains of E. coli can be divided into six main categories on the basis of distinct epidemiological and clinical features, specific virulence determinants, and association with certain serotypes: enteroaggregative E. coli (EAEC), enterohemorrhagic E. coli (EHEC), enteroinvasive E. coli (EIEC), enteropathogenic E. coli (EPEC), enterotoxigenic E. coli (ETEC), and Diffuse- Adhering E. coli (DAEC). They are transmitted from person to person via direct contact with animal carriers, feces, contaminated soil and water or via ingestion undercooked meat and other animal products, as well as contaminated vegetables and fruits. As a result of contamination from feces, they are often found in soil, water and food. Commensal E. coli flora can be regarded as a rich source of emergence and spreading of antibiotic resistance [38]. Chickens may also be infected with antibiotic resistant E. coli or may develop resistance to one or more antibiotics in the gut. Even though antibiotic consumption is a major contributor of the antibiotic resistance phenomenon different factors have enhanced the development and dissemination of antibiotic resistance [39]. For instance, population densities among humans have been identified as risk factors for the development and spread of antibiotic resistance [40].

Several antibiotics have been shown to give rise to antibiotic resistant bacteria, which, when shed in the environment, comprise a reservoir of these bacteria [41-43]. These resistance elements decrease the effectiveness of antibiotic therapy, and, thus, result in increased morbidity and mortality associated with disease outbreaks, and, later, are transferred or spread to other animals or humans [39,44]. This shows that an antibiotic therapy with a particular agent has been either conveyed or followed shortly by the appearance of resistant bacteria [11]. Clinically, based on antibiotic susceptibility tests, a bacterium is classified as susceptible, intermediate, or resistant. A susceptible bacterium is inhibited in vitro by a concentration of an antibiotic agent that is associated with high therapeutic success. When the outcome of treatment is indefinite as a result of the in vitro inhibition effect of the concentration of the antibiotic, the sensitivity of a bacterial strain to that antibiotic is said to be intermediate, and when the likelihood of therapeutic failure is significant or high due to in vitro inhibition by the concentration of the drug, a bacterial strain is referred to as resistant to that antibiotic [45].

There are several mechanisms through which bacteria can become resistant. An antibiotic (bactericidal or bacteriostatic) has an effect on microorganisms when it restricts within their site of action. The mechanisms of action include inhibition of cell wall synthesis, such as glycopeptides, vancomycin, and β-lactams; disruption of cell membrane function, such as polymixins, surfactants, polyenes, and polypeptides; inhibition of protein synthesis, such as aminoglycosides, tetracyclines, phenicols, and macrolides; inhibition of nucleic acid synthesis, such as fluroquinolones and metronidazole; action as antimetabolites, such as diaminopyrimidines, flucytosine, and sulfanilamide [46,47]. The mechanism of resistance can be either an acquired trait or an intrinsic activity of bacterial specie. Acquired resistance occurs due to mutation of the chromosomes (point mutations, deletions, inversions, insertions, etc.) or by the acquiring of genetic elements. Several bacterial strains have a natural resistance towards some types of antimicrobial agent. Intrinsic resistance covers whole bacterial specie and requires resistance without any addition of genetic elements or mutations. Some bacteria lack a cell wall, e.g., mycoplasma; this will be the effect of intrinsic resistance to β-lactams [48,49].

Public Health significance of antibiotic resistance

In humans, most of the antibiotic resistance problems originate from the misuse of these agents in human medicine, and there is evidence that antimicrobial resistant enteric bacteria can transfer from animals to humans, and thus create a reservoir of resistant bacteria [50,51]. The transfer of resistant bacteria between animals and human via food products has been recognized and could pose a threat to public health [51,52]. The transfer pathway is diverse and complex, and bacteria can transfer from food animals to humans by direct contact through which farmers, abattoir workers and veterinarians are particularly at risk [53], and the bacteria can be carried between farms via the food chain through meat, eggs, and milk [54-56], as well as via the environment as animals produce a large amount of waste that can be used for manure and can contaminate water, soil, and crops [17,57]. Moreover, the situation is made more complex by the transfer of bacteria from humans to animals and the environment; from pets to humans and vice versa; from feed to production animals; and from the environment to wildlife to production animals. The main concern is over the risk and dissemination of resistant zoonotic bacteria, such as Salmonella spp or Campylobacter spp and resistant commensals bacteria, such as E. coli, which can spread their resistance gene on to the human gut flora and possible human pathogens. There is broad scientific agreement that the use of antibiotics in food animals has harmful effects on human health. According to [58], the use of the antibiotic avoparcin as a growth promoter in food animals in Europe resulted in the development and amplification of vancomycin-resistant enterococci (VRE) and the subsequent colonization of a significant percentage of these VRE in the human population via the food chain (between 2% and 17%).

When the use of avoparcin in food animals in the European Union was banned, there was a marked reduction in the percentage of the general population carrying VRE in their bowels. In Australia, vancomycin-resistance is a cause for concern because vancomycin is used as a last- line antibiotic for some hospital-acquired infections of enterococci and staphylococci that have become resistant to the more commonly used antibiotics. Collignon [59] also reported that the use of the antibiotic enrofloxacin has been approved for use in food production animals in many countries. The use of this antibiotic in food animals has led to the development of ciprofloxacin-resistant strains of Salmonella and Campylobacter. The use of antibiotic tylosin in the animal feed as a supplement has led to the development of erythromycin-resistant streptococci and staphylococci not only in the animals but also in their caretakers. It has been reported that there is a relationship between the approval of fluoroquinolones for therapeutic use in food producing animals and the development of fluoroquinolone resistance in Campylobacter in animals and humans after the approval of fluoroquinolones for use in food-producing animals [60]. The approval of these drugs in food- producing animals led to an increase in the resistance in the Campylobacter isolates from treated animals and ill humans in the Netherlands, Spain, and the United States.

Campylobacter

The aim of using antibiotics in both human and veterinary practice was to acquire health benefits for humans and animals, however, resistance to certain classes of antibiotics has been discovered that could have a public health impact [60]. Consequently, the imprudent use of antibiotics would facilitate the persistence of these emerging resistant bacteria, which could subsequently be transmitted to humans and cause untreatable illnesses [18]. Campylobacter is an important foodborne zoonotic disease. However, the highly resistant strains of this bacterium, which can acquire resistance in response to antibiotic selection pressures in animal food production, can cause severe economic losses for humans, especially when these antibiotics are used as the drugs of choice for treating infections in humans where the resistance is acquired [61]. Resistance to antibiotics has developed into a serious problem worldwide, and the rate of Campylobacter resistant to multiple antibiotics continues to rise. Campylobacter resistant strains can successively transpire because of the administration of antibiotics for the treatment of bacterial infections in animals, which may possibly contaminate human food [62].

The ability of Campylobacter resistance to antibiotics poses a major problem and highlights the need for further research, especially in livestock production [63,64]. Several studies implied that livestock-associated Campylobacter are gradually becoming resistant to numerous antibiotics that are of high importance for the treatment of human infection [64-67], and, consequently, poses a threat to public health. Furthermore, there is a clear link in the antibiotic resistance among the pathogens that are isolated from dairy cattle and the use of antibiotics in dairy cows and other livestock to significantly increased antibiotic resistance [68]. In a study by Sato et al. [69], there was no significant distinction in the occurrence of Campylobacter specie in organic and conventional farms. In the United States, resistance to Campylobacter isolates to fluoroquinolones (FQ) in humans is consistently growing with the widespread use of the same drug in animals and poultry [70,71]. Of specific interest is the increased resistance to fluoroquinolone and macrolides by the Campylobacter isolates from food animals, which has been significantly established, as these are the drugs of choice for the treatment of Campylobacter infection in humans, especially when clinical treatment is required [71,72].

E. coli

In studying the levels of resistance in bacteria, E. coli is considered to be the organism of choice; this is because the strains are capable of transmitting genetic material not only to each other but also other enteric pathogens (Lambrecht et al., 2019). A study in northern Georgia, USA 73. Zhao et al. [73] tested 95 APEC isolates and found that 92% of the isolates were resistant to three or more antibiotics. A study by Yuan et al. [74] in China reported that 80% of 71 E. coli isolates from the livers of chickens that died in 10 poultry farms were resistant to eight or more antibiotics. Similarly, between 2004 and 2005, Li et al. [75] found high levels of antibiotic resistant E. coli isolates from diseased chickens in China; the isolates showed 100% resistance to tetracycline and trimethoprim/sulfonamide, and 79–83% resistance to chloramphenicol, ampicillin, ciprofloxacin, and enrofloxacin. Antibiotic resistance in commensal strains of E. coli could play an essential role in the ecology of resistance and infectious diseases. European data in France, the UK, and the Netherlands show that there is a moderate resistance pattern to ampicillin, streptomycin, tetracycline, and trimethoprim/ sulfonamide; low resistance to gentamicin, chloramphenicol, and ciprofloxacin; and no resistance to cephalosporins [76]. There is 100% and 42% resistance of the isolates to nalidixic acid and ciprofloxacin, respectively, in 181 E. coli from broiler chickens based on the study by Moniri and Dastehgoli [77]. In addition to fluoroquinolone resistance, there is also a need to know the resistance to beta-lactams, especially extended spectrum beta-lactams. In Belgium, five-broiler chicken farms revealed 295 ceftiofur resistant E. coli from cloacal swabs [78].

In another study in the US, 194 E. coli recovered from egg shells showed that 73% of the isolates were susceptible to all seven antibiotics used [79]; the most resistance was to tetracycline at 17%. A study in Lithuania to evaluate the occurrence of the antibiotic resistance of E. coli isolated from the livers of chickens sold in the retail market showed that 42% of the isolates were resistant to the most frequently used tetracyclines, quinolones, and aminopenicillins. Chambers et al. [80] reported a resistance to 3^rd generation cephalosporins, which are important in human medicine. In Japan, in a study on retailed chicken meat, twenty-eight (28) out of 69 E. coli isolates showed a multidrug resistance profile [81], and the most frequently reported resistance pattern was against trimethoprim/sulfamethoxazole, streptomycin, ampicillin, ciprofloxacin, spectinomycin, kanamycin, nalidixic acid, and cephalosporins. In a study in Kenya on the antibiotic resistance in E. coli isolated from feces and the carcasses of pigs, chicken, and cattle, the highest was 74%, which was for the chicken isolates that also showed a significantly high multidrug resistance [82]. Extended spectrum beta lactamase producing E. coli have also been reported in chickens. In poultry practice, with the widely used beta lactam antibiotics, e.g., amoxicillin and cephalosporins (particularly extended spectrum cephalosporins), Extended-spectrum beta-lactamase (ESBL) induced resistance in gram-negative bacilli has become critical and the treatment options for such infections are becoming inadequate [83]. A study by Yuan et al. [74] indicated that 60.8% of the isolates tested were ESBL-producing E. coli. Another survey in China by Lee et al. [84] showed that the occurrence of ESBL producing animal-associated bacteria was 30%.

Conclusion

The use of antibiotics in human therapy, aquaculture, and food animal production contributes to the emergence and development of antibiotic resistant pathogens due to selective pressure. The surveillance of antibiotic resistance in commensal, zoonotic and pathogenic bacteria from humans, animals, and food is a basic source of information when planning actions to increase food safety and identify new problems and potential outbreaks. Surveillance data are also crucial to monitor policy decision-making and to evaluate and validate their results. A combined approach is essential in order to be able to use and interpret these data, and this type of approach involves numerous sectors: healthcare organizations and public health, animal food production, food processing, and distribution.

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Production of A New Materials from Moroccan Oil Shale - Juniper Publishers

 Civil Engineering Research Journal - Juniper Publishers

Introduction

Morocco, with estimated reserves of 93 billion tons [1], is increasingly looking at oil shales as an alternative energy source. Many studies have concentrated on oil shales located in Timahdit and Tarfaya, because of their high proportion of organic matter [2]. Most of the studies focused either on the yield and the quality of the oils obtained by conventional pyrolysis or on the characterization of these oils by different physical and chemical techniques [3-6]. In addition, oil shales have a certain potential for the production of several synthetic products such as cement, sulfur, ammonia, adsorbent carbons, carbon fibers and other chemicals [7-9]. In this work, we explore the possibility of transforming the oil shales to materials with high added value. More specifically, we aim at demonstrating that the organic fraction of the oil shales could be used as precursor of low-cost carbon fibers or graphitizable carbon, after appropriate chemical treatments resulting in a “maturation” of this organic phase.

Activated Carbon Fibers from Moroccan Oil Shales

Preparation of the precursor of carbon fibers (pitches)

The oil shale used in this work was from the Tarfaya deposit located in the South of Morocco. This deposit consists of several layers that are subdivided in sub-layers, each having a different amount of organic matter. The samples were obtained from the so-called R₃ sub-layer characterized by its high content of organic matter [10-12]. Its chemical composition is given in (Table 1).

Preparation of the raw material

The carbonate-free oil shale was obtained by dissolution of carbonates with HCl [13,14]. The powdered R3 shale (20 g, grain size 0.063-0.08 mm) and 80 mL of concentrated HCl (7 M) were introduced in an Erlenmeyer. The mixture was then subjected to magnetic stirring for 4 h. The formed CO₂ was trapped by bubbling in a solution of barium hydroxide. After filtration, the solid residue (referred to as RH) was washed carefully with distilled water, dried at 100 °C and stocked in a sealed plastic bag.

Procedures

Supercritical extraction of RH (10 g) with toluene was conducted in a 120 mL stainless steel autoclave equipped with a pressure gauge and heated in a tubular furnace whose temperature, as well as the heating rate, was controlled (Figure 1). The temperature of extraction was 390 °C with a heating rate of 16 °C·min^-1 [15]. The maximum pressure reached during this treatment of 120 min was 5.3 MPa and 7.5 MPa for a volume of toluene of 50 mL and 70 mL respectively, beyond the critical point of toluene (320 °C, 4.2 MPa), After being cooled to room temperature, the mixture was extracted in a Soxhlet apparatus with chloroform for 12 h. The solvent was removed under reduced pressure, and then the organic material was dried for 12 h at 40 °C and weighed. The recovered oil was treated with n-hexane in a 1/10 oil to solvent mass ratio [16]. After stirring for 12 h, the two fractions, soluble (maltenes) and insoluble (asphaltenes), were separated by filtration through Whatman paper, and then dried for 12 h at 40 °C and 80 °C respectively. The maltenes were fractionated in a silica gel column (70-230 mesh, 1 m long and 1.5 cm diameter). Elution of paraffinic, aromatic and polar compounds was performed with hexane, toluene and methanol, respectively [16]. The high-molecular fraction (asphaltenes) constitutes the pitch.

Preparation of carbon fibers

The black, solid precursor is soluble in toluene and its softening point is about 120 °C. It was melted at 150 °C in a laboratory-made spinning device with a single spinneret, equipped with a filter to remove solid particles from the melt. After extrusion and mechanical stretching, the fiber was thermoset by oxidation in dry air by being slowly heated at atmospheric pressure to the temperature in the range 60-280 °C. The thermoset fibers were pyrolyzed under nitrogen flow. The temperature was progressively raised up to 950 °C with a rate of 5 °C·min^-1.

Activation of the carbon fibers

The pyrolyzed carbon fibers were activated with phosphoric acid [17] at different temperatures. The samples were impregnated in H3PO4 (10 %) for 1 h and then dried in air at 120 °C for 2 h. The activation reactions were performed in a thermolyne silica electric oven with a temperature control device linked to a thermocouple. The steam generator was placed at the entrance of the reactor. The activation was carried out either under nitrogen or under steam flow. In both cases, the carbon fibers were placed in the reactor and the temperature was progressively raised at a rate of 5 °C·min^-1 up to 500 °C, 700 °C and 850 °C, under nitrogen flow, and then the system was set at the maximum temperature that was maintained for 1 h. The first series (FHN) was treated under nitrogen atmosphere and the second series (FHV) under water vapor (Table 2). At the end of the activation, the oven was cooled to ambient, and then the activated carbon fibers were retrieved and boiled for 2 h in distilled water, then washed, dried and retained for subsequent analyses.

Characterization of the activated carbon fibers

These activated carbon fibers are essentially microporous. The adsorption isotherm is of type I of the BDDT classification [18] and the t-plot [19], which compares the nitrogen adsorption isotherm obtained for the studied porous solid to a reference isotherm determined on a nonporous solid, presents a negative deviation from straight line, which is characteristic of micropores. This observation is confirmed by the B hysteresis characteristic of pores, according to the de Boer classification [20]. The surface area and the pore diameter calculated by the BET method [21] are given in (Table 3).

Scanning electron microscopy (SEM)

Samples FHN850 and FHV850 were analyzed by SEM. The micrographs in (Figure 2) show little pores at the outer surface of the two activated fibers, but micrographs of cross section surfaces present a great difference between the samples. They reveal that activation under steam flow produced fibers with a homogeneous repartition of porosity. In the case of activation under nitrogen, the experimental conditions used were insufficient to create a large porosity, which is observed only at the surface of the fiber.

New Graphitizable Carbon Obtained from Moroccan Oil Shales

Our objective was to study the possibility to produce new pitches by using the insoluble fraction resulting from the separation by hexane of the oils recovered from Moroccan oil shales. The evolution of the degree of graphitization of carbons resulting from the pyrolysis of oil shale pitches in the temperature range 1100-2800 °C was studied by Raman spectroscopy in order to determine the operating conditions that were likely to give a pitch leading to a graphitizable carbon [22,23]. The pitches obtained under different conditions of treatment by supercritical extraction were subjected to pyrolysis at 1100 °C and subsequent heat treatments between 1400 and 2800 °C, in order to obtained carbon materials with different degrees of graphitization. After each treatment, the residue was characterized by Raman spectroscopy (Figure 3). The results obtained shows that the degree of graphitization was strongly dependent on the composition of the pitch. Interestingly, it was found that the organization of carbon began at relatively low temperatures. Thus, beyond 1400 °C, a marked structural evolution occurred, leading to a more or less ordered material, according to the composition of the pitch and its preparation conditions. Moreover, phenol is a good extraction solvent under the operating conditions used, leading to carbon pitches with a high graphitization aptitude. The pitches treated at 2800 °C were also analyzed by SEM (Figure 4). These images largely confirm the results of analysis by Raman. Indeed, the pitches treated at 2800°C have a rather unique structure and surprising. This structure is similar to a laminated structure with the appearance of regular hexagons, which is characteristic of a good carbon structural organization.

Conclusion

The present work is part of a more general program for the exploitation of natural resources, and more particularly the Moroccan oil shale deposit of Tarfaya. We have presented a new process using supercritical extraction to produce activated carbon fibers or graphitizable carbon. The fibers exhibit low mechanical properties owing to the isotropic character of the precursor and the absence of mechanical stretching during pyrolysis. The activation of the fibers with phosphoric acid at 850 °C yields a carbon fiber with a specific area of 800 m²·g^-1. These fibers can be used as adsorbent or filter in environmental applications. We also prepared new pitches starting from the extraction of Moroccan oil shales. Aptitude for graphitization of carbon resulting from their pyrolysis at increasing temperatures was studied by Raman spectrometry. The degree of graphitization was strongly dependent on the composition of the pitch. Interestingly, it was found that the organization of carbon began at relatively low temperatures. Thus, beyond 1400 °C, a marked structural evolution occurred, leading to a more or less ordered material, according to the composition of the pitch and its preparation conditions.

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The Relationship Between Liking of Children and Job Satisfaction Among Preschool Teachers - Juniper Publishers

 Nursing & Health Care - Juniper Publishers

Abstract

This study was conducted to examine the relationship between liking of children and job satisfaction among preschool teachers. This cross-sectional analytical study included 140 teachers who volunteered to participate. Data were collected using a sociodemographic information form, the Barnett Liking of Children Scale (BLOCS), and the Minnesota Job Satisfaction Scale. Statistical Package for the Social Sciences (SPSS) 21 package program was used for statistical analysis and p values less than 0.05 were considered significant. There was a statistically significant difference in the preschool teachers’ job satisfaction scores according to age, marital status, and the facilities in their school (p<0.05). In addition, there was a statistically significant difference in liking of children scores based on the teachers’ education level (p<0.05). Correlation analysis revealed statistically significant and positive correlations between liking of children score and overall job satisfaction, intrinsic job satisfaction, and extrinsic job satisfaction (p<0.01). Regression analysis showed that liking of children affected overall, intrinsic, and extrinsic job satisfaction (F=13.175; R²=0.081; F=12.722, R²=0.078; F=10.739, R²=0.065, respectively). The results of this study demonstrate that preschool teachers’ job satisfaction and liking of children are affected by various factors, and that levels of job satisfaction and liking of children are positively correlated.

Keywords: Liking of children Job satisfaction Preschool teacher Child education

Abbrevations: SPSS: Statistical Package for the Social Sciences; BLOCS: Barnet Liking of Children Scale; SD: Standard Deviation

Introduction

Preschool education aims to support children in all areas of development in order to help them acquire new skills and behaviors and prepare them for primary education [1]. Currently, preschool teachers spend the longest time with children due to the prevalence of working mothers. After their primary caretakers (usually the parents), their preschool teachers is the most important person for a child [2]. Therefore, children’s basic need for love and attention must be met as well as their developmental and educational needs [3]. According to Downing, Ryndak & Clark [4], necessary qualities of a preschool teacher include being able to interact with children, being patient, attentive, gentle, and flexible, and liking children. Gelbal & Duyan [5] stated that liking children is the main characteristic of teachers. Brown, Morehead & Smith [6] also emphasized that liking children is a particularly important condition for people who choose teaching as a career. Teacher performance and job satisfaction are also important for effective preschool education [7]. Job satisfaction has been defined in many ways. Especially about teaching, job satisfaction is defined as a series of emotional responses toward their work and their role that explains how they generally feel at work [8,9]. Altaş & Kuzu [10] reported that the positive influence of job satisfaction on preschool teachers’ performance was stronger than that of organizational reassurance or emotional commitment. Massari [11] emphasized that job satisfaction affects not only work-related attitudes but also teaching quality. Job satisfaction is an important factor that can affect teachers’ productivity and their communication with children. Failure to find job satisfaction may have a detrimental impact on teacher-student rapport and quality of education [12]. It is especially important to investigate job satisfaction among preschool teachers, who interact extensively with their students. Therefore, the aim of this study was to investigate the relationship between liking of children and job satisfaction in preschool teachers. For this purpose, the following questions were explored in the study:

The purpose of this article is to identify and discuss literature identifying the use of a MDI-spacer as at least as effective as nebulizers in the delivery of short acting bronchodilators to manage children under 5 years of age with exacerbation of wheezing or asthma.

a.Do teachers’ scores on a liking of children scale differ from their descriptive characteristics?

b.Do teachers’ scores on a job satisfaction scale differ from their descriptive characteristics?

c.Is there a statistically significant relationship between teachers’ liking of children scores and job satisfaction scores?

d.Does teachers’ liking of children affect their job satisfaction and it sub-dimensions?

Methods

Study design

This cross-sectional, analytical study was conducted between April 1 and May 30, 2019 in 21 kindergartens (7 state, 17 private) associated with the Ministry of National Education in the city of Kutahya, Turkey.

Study population

The universe of the study comprised the 159 preschool teachers working in all of the kindergartens of Kutahya Provincial Directorate of National Education. No sample selection was made from the universe; all 140 teachers who were in school on the day of the survey and agreed to participate in the study were included in the study.

Ethical approval

The study was approved by the Kutahya Provincial Directorate of National Education and the Kutahya Health Sciences University Rectorate Non-Interventional Clinical Trials Ethics Committee (approval number 2019/04, dated 19.03.2019). The teachers provided verbal and written informed consent after being informed of the purpose of the study and assured that the study data would remain confidential.

Data collection

Questionnaires were used to collect data from the teachers who agreed to participate in the study. The teachers completed a sociodemographic information form, the Minnesota Job Satisfaction Scale and the Barnet Liking of Children Scale (BLOCS). It took approximately 20 minutes.

Instruments

Sociodemographic Information Form was developed by the researchers and consists of 7 questions that were answered by the teachers. Minnesota Job Satisfaction Scale was developed by Weiss, Davis, England, and the Turkish validity and reliability studieswere conducted by Baycan [13]. It has 20 items that are rated on a Likert-type scale of “very dissatisfied” (1 point), “dissatisfied” (2 points), “can’t decide” (3 points), “satisfied” (4 points), and “very satisfied” (5 points). Scores range from a minimum of 20 to a maximum of 100. The intrinsic satisfaction score includes factors such as achievement, recognition, responsibility, advancement, creativity, and working conditions, while extrinsic satisfaction score includes factors such as compensation, job security, and supervision. The original scale was calculated to have a reliability coefficient of 0.90 for overall job satisfaction, 0.86 for intrinsic satisfaction, and 0.80 for extrinsic satisfaction [13]. In this study, Cronbach’s alpha coefficient was calculated as 0.89 for intrinsic satisfaction, 0.79 for extrinsic satisfaction, and 0.92 for overall job satisfaction. Barnett Liking of Children Scale (BLOCS) was developed by Barnett & Sinisi and the Turkish validity and reliability study was conducted by Duyan & Gelbal [14]. It includes 14 items scored on a 7-point Likert scale from “strongly disagree” to “strongly agree”. The lowest possible score is 14 and the highest score is 98, with higher scores indicating more positive attitudes toward children. Results of the validity and reliability study indicated a test-retest reliability coefficient of 0.85 and internal consistency level of 0.92 [14]. In this study, the Cronbach’s alpha coefficient for total BLOCS score was 0.84.

Data analysis

The study data were analyzed using the SPSS package program. Using the Kolmogorov–Smirnov test, we determined that the data were normally distributed. Number, mean, and standard deviation were used in descriptive statistical analysis. For categorical variables, independent-samples t test was used for comparisons of two groups and one-way ANOVA was used for comparisons of three or more groups. Pearson correlation analysis was used to evaluate the relationships between the scales. Simple linear regression analysis was performed to examine the direction and effect of the relationship between liking of children score and job satisfaction overall and within its sub dimensions. P values <0.05 were considered statistically significant in all statistical tests.

Results

The teachers’ mean job satisfaction and liking of children scores according to descriptive characteristics are shown in Table 1. The study group included mostly women (95%, n=113), 45.7% (n=64) of the participants were in the 26-35 age group, 51.4% (n=72) were married, 53.6% (n=75) did not have children, and 70.8% (n=99) had undergraduate degrees. The preschool teachers’ job satisfaction scores showed significant differences according to age, school facilities, and marital status (p<0.05). Mean scores were significantly higher in single teachers (85.50) compared to married teachers (81.04), teachers who rated their school’s facilities as advanced (84.28), and teachers 25 years old or younger (85.38). There were no significant differences in the preschool teachers’ job satisfaction scores according to their gender, education level, years of professional experience, or parental status (p>0.05) (Table 1). BLOCS score differed significantly according to education level (p<0.05). Mean score was significantly higher among teachers with associate degrees (95.70) compared to those who graduated from high school (86.50) or had undergraduate (90.76) and master’s degrees (92.70). BLOCS score was not associated with gender, age, marital status, years of experience, school facilities, or parental status (p>0.05) (Table 1).

Pearson correlation analysis revealed statistically significant but weak positive correlations between job satisfaction and liking of children (r=0.30; p<0.01); intrinsic job satisfaction (r=0.29; p<0.01), and extrinsic job satisfaction (r=0.27; p<0.01). There were strong positive correlations between overall job satisfaction and both job satisfaction sub-dimensions (Table 2). The results of simple linear regression analysis to determine whether BLOCS score affects job satisfaction are shown in Table 3. The regression model generated from the analysis was found to be significant (F=13.175; p<0.01) and indicated that liking of children affects job satisfaction (B=0.330; p<0.01). According to the regression model, liking of children explains 8.1% of job satisfaction (Table 3). Simple linear regression analysis showed that the teachers’ liking of children had a significant effect on their intrinsic job satisfaction (F=12.722, p<0.01). According to the regression model, liking of children explains 7.8% of intrinsic job satisfaction (Table 4). Similarly, the linear regression model for liking of children and extrinsic satisfaction was significant (F=10.739; p<0.01) and revealed that liking of children significantly affects extrinsic job satisfaction (B=0.130; p<0.01). According to the regression model, 6.5% of extrinsic job satisfaction is explained by liking of children (Table 5).

Discussion

In this study, we detected a significant age-based difference in preschool teachers’ job satisfaction, with the highest job satisfaction in teachers aged 25 and under (p<0.05). Kılıç et al. [15] evaluated job satisfaction and social comparison levels in primary and secondary school teachers and determined that teachers in the 20-25 age group had the highest job satisfaction levels. In another study investigating job satisfaction in male and female early childhood educators, Şahin & Sak [16] also found that female teachers aged 21-25 years had higher job satisfaction levels. A possible explanation for these findings is that teachers starting their career at an early age are young and enthusiastic. Another finding of our study is that preschool teachers who considered their school facilities to be advanced also reported higher job satisfaction. Aldridge & Fraser [17] also emphasized the high level of job satisfaction among teachers working in schools with good facilities. Gupta & Gehlawat [18] analyzed secondary school teachers’ job satisfaction and motivation in term of certaindemographic variables and reported that teachers working in schools with good opportunities had higher job satisfaction. Treputtharat & Tayiam [19] conducted a study examining the effects of the school environment on job satisfaction in teachers working in primary education and determined that teachers working in schools with adequate physical facilities and advanced school facilities have higher job satisfaction. In a study by Jiang et al. [20] including 206 preschool teacher candidates in Shanghai, China, school facilities were found to have a positive effect on job satisfaction. These common findings can be attributed to the fact that quality education given under better physical conditions increases teachers’ productivity and job satisfaction.

In our study, preschool teachers’ job satisfaction differed significantly according to marital status, with single teachers’ showing higher job satisfaction levels than married teachers (p<0.05) Kılıç et al. [15] also reported that single teachers were more satisfied with their jobs than married teachers. Considering economic conditions, fewer individuals in the household increases the amount of income per capita. Therefore, single teachers have a higher welfare level and this may contribute to greater job satisfaction. In contrast, job satisfaction was not show significant differences in our study based on the teachers’ gender, education level, years of experience, or parental status (p>0.05). Karakaya et al. [21] also detected no difference in teachers’ job satisfaction according to gender. Koruklu et al. [22] emphasized that job satisfaction of secondary school teachers was not affected by gender or years of experience. Demirtaş & Alanoğlu [23] found that job satisfaction of administrators and teachers did not show significant differences associated with their gender, the school they worked in, their branch, or years of professional experience. However, other investigators have reported contradictory results. Büyükgöze & Özdemir [24] reported that male teachers had higher job satisfaction than female teachers, while a comparative analysis of job satisfaction among male and female early childhood teachers by Şahin & Sak [16] showed that female teachers had higher job satisfaction than male teachers. The preschool teachers participating in our study showed significant differences in liking of children according to their education level. Those with associate degrees had higher mean liking of children score compared to those graduated from high school and those with undergraduate and master’s degrees (p>0.05). In a study conducted by BayramSarıkaya & Özdemir [25] in teachers working with autistic children, a significant and positive relationship was observed between empathic tendency and liking of children, with associate degree holders having the greatest empathic tendencies. The teachers’ success in improving themselves in their schools and the fields in which they studied may be a factor in this difference.

Among the preschool teachers in our study, liking of children was not associated with gender, age, marital status, years of experience, school facilities, or parental status (p>0.05). Durualp & Kaytez [12] showed that there was no significant relationship between teachers’ gender and their liking of children. [26] also determined that preschool teachers’ age, professional experience, institution, and marital or parental status did not have a significant effect on their liking of children. Türk et al. [27] observed no statistically significant effect of gender on liking of children among female and male teachers. All of these findings indicate that teachers’ attitudes toward children are not affected by their gender, age, years of experience, school facilities, or whether they are married or have children of their own. However, some studies have demonstrated a relationship between these variables and teachers’ liking of children [2,28]. In a study conducted by Kaynak et al. [29], it was found that the gender of preschool teacher candidates was associated with their liking of children, with female preschool teachers expressing more positive attitudes toward children than male preschool teachers. Quaglia et al. [30] found that female teachers could establish closer relationships with children. These discrepancies may be due to the fact that the studies were conducted in different societies and cultures. Our evaluation of the relationship between liking of children and job satisfaction revealed positive correlations between liking of children and overall, intrinsic, and extrinsic satisfaction. Longobardi et al. [12] also found a positive, moderate relationship between teachers’ overall job satisfaction and their liking of children. These results are consistent with those of another study [31]. The fundamental building block of the teaching profession is liking children. We believe that teachers who enjoy their profession and like children also have greater job satisfaction.

Conclusion

At the end of the research, it was determined that the preschool teachers’ job satisfaction scores showed significant differences. Mean score was significantly higher among single teachers, teachers who rated their school’s facilities as advanced, and teachers 25 years old or younger (p<0.05). BLOCS score differed significantly according to education level. Mean score was significantly higher among teachers with associate degrees (p<0.05). BLOCS score was not associated with gender, age, marital status, years of experience, school facilities, or parental status (p>0.05) When the relationship between the job satisfaction and child liking levels of the teachers is analyzed, the positive and weak level relationship was found between the job satisfactionand child liking levels of the teachers. There were strong positive correlations between overall job satisfaction and job satisfaction sub-dimensions (p<0.01). Additionally, at this research, the regression model was found to be significant and determined that the liking of children affects job satisfaction and job satisfaction sub-dimensions (p<0.01). This research is limited to the answers provided by the preschool teachers working in one province of Turkey. Thus, the same study can be used with different sample groups. All the necessary works to better the factors (physical conditions, work environment, salary, motivation, etc.) that affect the job satisfaction of the teachers negatively can be conducted and the students can be directed towards choosing a profession consciously.

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