Characteristics of Gastroenteritis Outbreaks Investigated in Singapore: 2018-2021

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.

Development and Validation of the Observation Checklist Assessing the Hygiene and Sanitation of the Food Preparation Areas in Kota Bharu Kelantan Preschool

INTRODUCTION

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.

METHODOLOGY

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.

CONCLUSION

The newly developed observation checklist is a valid and reliable tool for assessing the hygiene and sanitation of preschool food preparation areas.

Translation, Cross-Cultural Adaptation and Validation of Movement Behaviour Questionnaire into Malay Language (MBQ-M) for Measuring Movement Behaviors among Preschool Children in Kelantan, Malaysia

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.

An analysis of inclusive education practices in East Java Indonesian preschools

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.

Cluster Randomized Trial: Sun Protection Intervention 'Clever in Sun and Shade for Preschools'-Effectiveness and Dissemination

Skin cancer is one of the most common types of cancer and UV radiation is one of the main risk factors. Therefore, sun protection, especially in childhood, is strongly recommended. We examined the effectiveness of the ‘Clever in Sun and Shade for Preschools’ program (CLEVER) in promoting sun protection behavior among preschool staff (trial registration: DRKS00023468) and describe its dissemination. Within a cluster randomized trial with 24 preschools (n = 273 staff members) stating a high need for sun protection measures, an educational workshop for preschool staff and a project kit with materials applicable in preschool groups was provided. Staff members of preschools taking part in CLEVER report significantly stronger sun protection behavior to avoid the sun (effect size [ES] 0.70, 95% confidence interval [CI] 0.04 0.71, p < 0.05) and less perceived impediments to avoid the sun (ES −0.56, CI −0.82 −0.17, p < 0.01) after 12 months as well as higher self-efficacy to avoid the sun (ES 1.09, CI 0.39 1.07, p < 0.001) and to use sunscreen (ES 0.71, CI 0.03 0.88, p < 0.05) after 1 month. Compared to the control group, there was no significant effect on sunscreen use and further psychosocial outcomes. The effectiveness of CLEVER may be underrated due to a high drop-out rate. Within three years, an enhanced free-of-charge program kit, including a media-based workshop and materials, had reached over 4000 preschools, i.e., 7.1% of all daycare centers in Germany. The results show that CLEVER can strengthen sun protection, offer high-quality information at low cost, and is easily disseminable.

Effects of a low-intensity Early Start Denver Model-based intervention delivered in an inclusive preschool setting

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.

[Protocols Related to Food Allergies and Intolerances in Preschools in Reykjavik, Iceland]

INTRODUCTION

The aim of the study was to explore prevalence of food allergies and intolerances among children in preschools in Reykjavik, Iceland. Also, to investigate how well preschools maintain a safe environment for children with food allergies.

MATERIALS AND METHODS

In 2014, a questionnaire designed specifically for this study, was sent to 65 preschools. Forty-nine participated (75%) representing a total of 4225 children. Prevalence of food allergy and intolerance was determined based on medical certificates from physi-cians delivered to the preschools. Descriptive statistics were used to assess whether there were protocols related to food allergy, and if there was a difference between schools based on staff's education and number of children.

RESULTS

The prevalence of documented food allergies/intolerances in children aged 2-6 years was 5%, 1% had severe allergy and 1% had multiple food allergies. Lactose intolerance was most frequent (2%), then milk allergy (2%) and egg allergy (1%). Only 41% preschools had a protocol that was activated if food with an allergen was accidentally given. Moreover, only 55% of preschools with children with severe -allergy reported all of their staff to have knowledge of symptoms related to anaphylaxis and only 64% were trained to respond to an anaphylactic shock. The education of preschool principals, kitchen employees and number of children in preschool were not related to having an active protocol at site.

CONCLUSION

Prevalence of food allergy and intolerance was 5% in preschools in Reykjavik. Strategy for an active protocol related to food allergy was lacking in 59% of pre-schools.

Implementation of Dietary Reference Intake Standards in Preschool Menus in Poland

Although the nutritional value of preschool menus largely determines the proper nutrition of attending children, their nutrient composition often does not meet the standards. The purpose of the study was to assess the nutritional value of menus served in preschools throughout Poland. We analyzed a sample of 10 daily menus and inventory reports reflecting foods and beverages served in 270 full-board government-sponsored preschools. Nutrient content was calculated per child per day, and compared with 70% of dietary reference intake (DRI) for children aged 1–3 and 4–6. The content of energy, protein, fat, and carbohydrates generally exceeded 70% of DRI. The amount of vitamins was correct, with the exception of vitamin D (100% of daycare centers (DCCs) were below the recommendations); in ≤3% of preschools vitamin E, folate, and niacin were below DRI. Calcium was too low in 63% of preschools for children aged 1–3 years and in 99% for 4–6-year-olds. A shortage of iodine, iron, and potassium (especially for 4–6-year-olds) was observed in a small number of preschools. Our study highlights the need for uniform legal standards of nutrition in childcare centers, based on the current recommendations for the age group.

The iPad as a Research Tool for the Understanding of English Plurals by English, Chinese, and Other L1 Speaking 3- and 4-Year-Olds

Learning about what young children with limited spoken language know about the grammar of their language is extremely challenging. Researchers have traditionally used looking behavior as a measure of language processing and to infer what overt choices children might make. However, these methods are expensive to setup, require specialized training, are time intensive for data analysis and can have considerable dropout rates. For these reasons, we have developed a forced choice task delivered on an iPad based on our eye-tracking studies with English monolinguals (Davies et al., 2016, under review). Using the iPad we investigated 3- and 4-year-olds’ understanding of the English plural in preschool centers. The primary aim of the study was to provide evidence for the usefulness of the iPad as a language research tool. We evaluated the usefulness of the iPad with second language (L2) learning children who have limited L2 language skills. Studies with school aged Chinese-speaking children show below native performance on English inflectional morphology despite 5–6 years of immersion (Jia, 2003; Jia and Fuse, 2007; Paradis et al., 2016). However, it is unclear whether this is specific only to children who speak Chinese as their first language (L1) or if younger preschoolers will also show similar challenges. We tested three groups of preschoolers with different L1s (English, Chinese, and other languages). L1 Chinese children’s performance was below both English monolinguals and children speaking Other L1 languages, providing evidence that English inflections are specifically challenging for Chinese-speaking children. The results provide further evidence to support previous eye-tracking findings with monolinguals and studies with older bilinguals. The study provides evidence for the usefulness of iPads as research tool for studying language acquisition. Implications for future application of the iPad as a teaching and intervention tool, and limitations for the method, are discussed.

Assessment of ultrafine particles in Portuguese preschools: levels and exposure doses

The aim of this work was to assess ultrafine particles (UFP) number concentrations in different microenvironments of Portuguese preschools and to estimate the respective exposure doses of UFP for 3-5-year-old children (in comparison with adults). UFP were sampled both indoors and outdoors in two urban (US1, US2) and one rural (RS1) preschool located in north of Portugal for 31 days. Total levels of indoor UFP were significantly higher at the urban preschools (mean of 1.82 × 10(4) and 1.32 × 10(4) particles/cm(3) at US1 an US2, respectively) than at the rural one (1.15 × 10(4) particles/cm(3) ). Canteens were the indoor microenvironment with the highest UFP (mean of 5.17 × 10(4) , 3.28 × 10(4) , and 4.09 × 10(4) particles/cm(3) at US1, US2, and RS1), whereas the lowest concentrations were observed in classrooms (9.31 × 10(3) , 11.3 × 10(3) , and 7.14 × 10(3) particles/cm(3) at US1, US2, and RS1). Mean indoor/outdoor ratios (I/O) of UFP at three preschools were lower than 1 (0.54-0.93), indicating that outdoor emissions significantly contributed to UFP indoors. Significant correlations were obtained between temperature, wind speed, relative humidity, solar radiation, and ambient UFP number concentrations. The estimated exposure doses were higher in children attending urban preschools; 3-5-year-old children were exposed to 4-6 times higher UFP doses than adults with similar daily schedules.

PRACTICAL IMPLICATIONS

This study reports information on ultrafine particles (UFPs) in various indoor and outdoor microenvironments (canteens, classrooms, gymnasiums, and outdoor) of urban and rural preschools. It identifies the potential sources and origins, characterizes the influence of meteorological parameters on UFP levels, and performs a comparison with other existing international studies. To this date, relatively few studies have investigated UFP in preschools (none in Portugal) and none assessed exposure dose for different age-groups. The obtained findings showed that levels of UFP in various microenvironments of schools differed significantly. Therefore, to obtain an accurate representation of child’s overall preschool exposure profiles, the exposures occurring in these different microenvironments should be always accounted for.