There is a need to study the characteristics of outbreaks via Singapore\'s outbreak surveillance system to understand and identify the gaps in food safety for targeted policy interventions due to the increasing trend in gastroenteritis outbreaks and consequential increase in foodborne-related deaths and economic burden on public health systems worldwide. A total of 171 gastroenteritis outbreaks were investigated in Singapore from January 2018 to December 2021. This study analyzed the annual trend of investigated gastroenteritis outbreaks, the proportion of outbreaks by implicated sources of food, and the proportion of the type of pathogens identified from human cases, food samples, and environmental swabs collected from outbreak investigations. Among the foodborne gastroenteritis outbreaks (n = 121) investigated in Singapore, approximately 42.1% of the outbreaks had food prepared by caterers, 14.9% by restaurants, and 12.4% had food prepared by in-house kitchens. Clostridium perfringens and Salmonella were the most common causative pathogens in foodborne outbreaks throughout the analysis period. The food samples and environmental swabs collected were mostly detected for Bacillus cereus. Norovirus was the most common causative pathogen in non-foodborne outbreaks and was mainly attributable to preschools. This highlights the importance of monitoring and educating the catering industry and preschools to prevent future outbreaks.

UNASSIGNED: Noise exposure in preschools is cited as one of the main stresses by preschool teachers in surveys worldwide. Hearing-related symptoms as well as physiological stress reactions are often mentioned in this context. Therefore, the aim of the study was to investigate whether the noise has an impact on the cardiovascular activity of the preschool teachers.
UNASSIGNED: The study took place in nine private preschools in Vienna. In the classrooms of 23 preschool teachers stationary noise recordings were conducted and the participants were equipped with 24-hour electrocardiograms (ECGs). Questionnaires on noise-related stress, well-being, stress perception, burnout risk, noise annoyance, and noise sensitivity were provided. Data were described descriptively and correlations and one-way analyses of variance (ANOVAs) with repeated measures were performed.
UNASSIGNED: The average sound pressure level in the classrooms during the first four hours was LAeq 74.7 dB(A) (standard deviation [SD] = 1.74). A significant correlation between heart rate and sound pressure level (LAeq,4 h) was found, r = 0.40, P = 0.04 (one-tailed). Noise sensitivity and noise annoyance showed no effect. With increasing sound level classes [≤65 dB(A), 66-75 dB(A), 76-85 dB(A)], the heart rate increased significantly, and the heart rate variability decreased significantly. It was also found that tolerating noise becomes more difficult with increasing length of employment and increasing age.
UNASSIGNED: The noise level in classrooms showed an impact on the cardiovascular activity of preschool teachers, which can be considered as an indicator of stress. Measures to reduce noise in preschools are recommended.

BACKGROUND: The current inspection checklist for the assessment of food preparation areas in preschools in Malaysia has not been revised since 2012. The checklist\'s content needs to be improved to ensure relevant parameters are covered during preschool inspections.
OBJECTIVE: The objective of this study was to develop and validate an observation checklist for assessing the hygiene and sanitation of food preparation areas in preschools.
METHODS: The study was conducted in Kota Bharu Kelantan from March 2021 to February 2022. The development of the observation checklist was conducted in four stages: (1) the construction of domains and items from the existing literature, (2) content validation by six experts (using the item-level content validity index (I-CVI) and the scale-level content validity index (S-CVI), (3) face validation by 10 experts (using the item-level face validity index (I-FVI) and the scale-level face validity index (S-FVI)), and (4) reliability analysis (using the intercorrelation coefficient (ICC)). Four assessors performed the reliability analysis at two preschools.
RESULTS: The initial draft of the checklist contained three domains and 57 items: building and facility (10 subdomains and 38 items), process control (four subdomains and 12 items), and food handlers (one subdomain and seven items). The I-CVI scores for building and facility, process control, and food handlers were 0.97, 1.00, and 1.00, respectively, indicating good relevancy of items. The S-CVI value was 1.0 for all domains, showing good relevance of the items. The I-FVI above 0.8 and S-FVI values above 0.9 for all domains imply that the participants easily understood the checklist. The ICC for each domain was 0.847 (95% CI 0.716-0.902) for the building facility and 1.0 for process control and food handler, and the ICC for the three domains combined was 0.848 (95% CI 0.772-0.904). The final validated checklist consists of three domains with 57 items.
CONCLUSIONS: The newly developed observation checklist is a valid and reliable tool for assessing the hygiene and sanitation of preschool food preparation areas.

Measuring movement behaviours such as physical activity, sedentary behaviour, and sleep throughout 24 h is critical for assessing early childhood development. A valid tool based on cultural adaptation is required to achieve an appropriate result. Thus, this study aims to translate, culturally modify, and validate the movement behaviour questionnaire (MBQ) into Malay (MBQ-M) for preschool children in Kelantan, Malaysia. Permission to translate was obtained and the MBQ was translated using a ten-step process. Ten independent experts evaluated the content validity in terms of the content validity ratio (CVR), scale-level content validity index-average (SCVI-average), item-level content validity index (I-CVI), and the modified kappa statistic. The original questionnaire had modest adjustments: CVR 0.91, SCVI-average 0.93 for clarity, 0.95 for simplicity, and 0.93 for ambiguity. The SCVI-average relevance was 0.95, and the majority kappa value was excellent (>0.74). All the data imply that the overall content validity of the MBQ items is appropriate. Thirty parents assessed face validity, and the scale-level face validity index (S-FVI/Ave) for clarity (0.95) and comprehension (0.95) was satisfactory. In conclusion, the MBQ-M has satisfactory and acceptable content validity and face validity. Thus, it can be used as a valid tool to measure 24-h movement behaviours among preschool children in Malaysia.

Poor access to quality education among preschool students in Indonesia is a cause for concern. To address this issue, the first step is to identify the current level of inclusive education practises in these institutions. Thus, this study is aimed at identifying the level of inclusivity of Indonesian preschools, particularly in East Java, from the perspective of education practitioners. This study employed a sequential explanatory mix design. A survey questionnaire and semi-structured interviews were utilised in collecting the data. A total of 277 education practitioners, including principals and teachers at the preschool level, were randomly sampled to answer the questionnaire. As interview respondents, 12 teachers and principals were recruited via purposive sampling. Generally, the findings indicated that community building for inclusive education was found to be at an average level (M = 3.418, SD = 0.323), whereas building inclusive values in preschools was found to be at a high level (M = 4.020, SD = 0.414). In support of this, the findings of the semi-structured interviews suggested that the school community was aware of the differences among students and that respecting each other was generally practised among the school community. However, poor community involvement to support inclusive education was a challenge in most Indonesian preschools. These findings are crucial for stakeholders and policymakers to continue promoting community awareness and supporting inclusive education in these institutions.

This dynamic cohort was established to evaluate the targeted individual promotion of children affected by developmental risks as part of the German federal state law for child day-care and preschools in Mecklenburg-Western Pomerania. The project has been conducted in preschools in regions with a low socio-economic profile since 2011. Since 2017, the revision of the standardized Dortmund Developmental Screening for Preschools (DESK 3-6 R) has been applied. Developmental risks of 3 to 6-year-old children in the domains of motor, linguistic, cognitive and social competencies are monitored. The cohort is followed up annually. In 2020, n = 7,678 children from n = 152 preschools participated. At the baseline (2017), n = 8,439 children participated. Due to the defined age range of this screening, 3,000 to 4,000 5-6-year-old children leave the cohort annually. Simultaneously, an approximately equal number of 3-year-old children enters the cohort per survey wave. N = 702 children participated in all 4 survey waves. On the basis of DESK 3-6 R scores available from survey waves 2017 to 2019 it is possible to compute expected values for the survey wave 2020 and to compare those with the measured values to evaluate the effects of the COVID-19 pandemic (i.e. parental home care due to restrictions related to COVID-19).

BACKGROUND: Evidence suggests that children from low-income families begin the preschool stage with less academic and non-academic skills development compared to higher-income families. There are several successful experiences of early stimulation of cognitive and social-emotional skills; however, there is scarce evidence of the effectiveness of a video game that incorporates the stimulation of these skills simultaneously. This study aims to evaluate the effectiveness of a video game in stimulating cognitive, emotional, and social competence skills in developing academic skills in socioeconomically disadvantaged preschool children.
METHODS: A cluster-randomized controlled trial design will be used. A tablet-based video game that stimulates cognitive and socio-emotional skills to improve the development of academic skills is compared with a tablet-based game where students draw and paint with no explicit stimulation of cognitive and socio-emotional skills. Eighteen schools and 750 Chilean preschool students will be recruited. The effectiveness of the intervention will be assessed using a direct evaluation of children on literacy learning and pre-calculation skills at baseline, immediately after stimulation, and at 6, 12, 18, and 24 months post-intervention. The mediating effect of working memory, inhibitory control, emotion recognition, and prosocial behaviours will be assessed on the effectiveness of the intervention.
CONCLUSIONS: The proposed study will be the first to test the effectiveness of a tablet-based video game stimulating cognitive and social-emotional skills to improve academic skills in socioeconomically disadvantaged preschool children in Chile, controlling for gender, age (in months), mental health, and baseline conditions of stimulated skills.
BACKGROUND: ClinicalTrials.gov NCT05224700. Registered on February 2022.

With diet-related chronic diseases being the largest contributors to U.S. morbidity and mortality, identifying population-level strategies to promote healthier diets is essential. Intervention during early childhood may be particularly important. The Child and Adult Care Food Program (CACFP), a federal nutrition assistance program in the U.S. that supports serving meals and snacks in child care settings, reaches millions of U.S. children. Recent 2017 updates to CACFP\'s meal patterns were meant to improve the nutritional quality of food served through CACFP by providing more whole grains, fruit, and vegetables. In this study, we used a natural experimental, longitudinal study of child care centers participating in CACFP compared to nonparticipating centers to assess whether the quality of food and beverages served (per menu analysis) improved following the CACFP meal pattern changes. While we found that CACFP centers were more likely to meet several key nutrition standards in comparison to non-CACFP centers overall, there were no differences in menu quality from before to after the 2017 standards change between CACFP and non-CACFP centers. Nutrition standards for CACFP may need to be further strengthened with adequate financial and technical support given to child care programs for effective implementation.

BACKGROUND: Schools and preschools have largely remained open in Norway throughout the pandemic, with flexible mitigation measures in place. This contrasts with many other high-income countries that closed schools for long periods of time. Here we describe cases and outbreaks of COVID-19 in schools and preschools during the academic year 2020/2021, to evaluate the strategy of keeping these open with infection prevention control measures in place.
METHODS: In this descriptive study, the Norwegian Institute of Public Health initiated systematic surveillance for COVID-19 cases and outbreaks in schools and preschools in October 2020. Data was compiled from the national outbreak alert system VESUV, municipality websites, and media scanning combined with the national emergency preparedness register Beredt C-19. An outbreak was defined as ≥ 2 cases among pupils or staff within 14 days at the same educational setting. Settings were categorized as preschool (1-5-years), primary school (6-12-years), lower secondary school (13-15-years) and upper secondary school (16-18- years). We reported the incidence rate among preschool and school-aged pupils and gave a descriptive overview of outbreaks and included cases per educational setting.
RESULTS: During the whole academic year, a total of 1203 outbreaks in preschools and school settings were identified, out of a total of 8311 preschools and schools nationwide. The incidence of COVID-19 in preschool- and school-aged children and the rates of outbreaks in these settings largely followed the community trend. Most of the outbreaks occurred in primary schools (40%) and preschools (25%). Outbreaks across all settings were mostly small (median 3 cases, range 2 to 72), however, 40 outbreaks (3% of total) included 20 or more cases. The larger outbreaks were predominantly seen in primary schools (43%).
CONCLUSIONS: We observed few large outbreaks in open schools and preschools in Norway during the academic year of 2020/2021, also when the Alpha variant was predominant. This illustrates that it is possible to keep schools and preschools open even during periods of high community transmission of COVID-19. Adherence to targeted IPC measures adaptable to the local situation has been essential to keep educational settings open, and thus reduce the total burden on children and adolescents.

The Early Start Denver Model (ESDM) is a promising early intervention for promoting improved social, cognitive, and communication outcomes for young children with autism spectrum disorder (ASD). However, most studies evaluating group-based delivery of this program have used 15-25 h per week of intervention in specialized ESDM preschools with low child-teacher ratios. Thus, the positive results from such studies might not be obtained when this intervention model is evaluated in more typical inclusive preschool settings. In this study, a low-intensity version of the ESDM was delivered to three young children with ASD in their regular inclusive preschool by a certified therapist who did not typically work at any of the preschools. The intervention procedures were implemented for 3 h per week over an 8- to 10-week period. Data were gathered on children\'s levels of participation, imitation, and communication from weekly 10-min video recordings. The effects of the intervention were evaluated using a multiple probe across participants design with 3 weekly follow-up probes, 3 weeks after the intervention ended. All participants showed improvement in active participation, imitation and either intentional vocalizations or spontaneous functional utterances. These results were generally maintained at follow-up. This low-intensity version of the ESDM would seem effective for use in real-world preschool environments.