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Background: The primary objective of this study was to investigate the relative contributions of factors from multiple social-ecological levels in explaining outdoor play changes in childcare centers during the COVID-19 pandemic. Methods: In Alberta, Canada, licensed childcare center directors (n = 160) completed an online questionnaire. For outcomes, changes in the frequency and duration of outdoor play in childcare centers during COVID-19 compared to before COVID-19 were measured. For exposures, center demographic, director, parental, social, environmental, and policy-level factors were measured. Hierarchical regression analyses were conducted separately for winter (December–March) and nonwinter months (April–November). Results: In most instances, factors at each social-ecological level explained a statistically significant amount of unique variance in changes in outdoor play in childcare centers during COVID-19. Full models accounted for more than 26% of the variance in the outcomes. Changes in parental interest in outdoor play was the most consistent correlate of changes in the frequency and duration of outdoor play in both winter and nonwinter months during COVID-19. In terms of changes in the duration of outdoor play, social support from the provincial government, health authority, and licensing, and changes in the number of play areas in licensed outdoor play spaces were also consistent correlates in both winter and nonwinter months during COVID-19. Conclusions: Factors from multiple social-ecological levels uniquely contributed to changes in outdoor play in childcare centers during the COVID-19 pandemic. Findings can help inform interventions and public health initiatives related to outdoor play in childcare centers during and after the ongoing pandemic. [ABSTRACT FROM AUTHOR]

Decades have passed since the controversy regarding the putative risks of childcare for mother–child attachment broke out. Yet, some uncertainty remains, as relevant studies have produced inconsistent evidence. Some have proposed that those conflicting findings may be due to the fact that the effects of childcare are conditioned on parenting. Accordingly, this study examined whether relations between childcare participation and mother–child attachment vary according to maternal sensitivity and autonomy support. In this sample of 236 mother–child dyads, there was no indication of main effects of childcare participation on attachment. There were, however, some interactive effects, such that the children who showed the least secure attachment behaviors were those who did not attend childcare and had either less sensitive or less autonomy-supportive mothers. The findings suggest that the effects of childcare on mother–child attachment are best understood in light of the parenting children receive at home. [ABSTRACT FROM AUTHOR]

Background and purpose: PECs blocks are usually combined for breast surgery under general anesthesia (GA) to provide postoperative analgesia rather than primary anesthesia technique. Material and methods: A prospective, interventional, single-center, double-blind, randomized, parallel-group, active-controlled, Helsinki protocol-compliant clinical study was conducted in a tertiary care teaching center after obtaining the Ethics Committee's approval and patients' written informed consent. Forty-eight American Society of Anesthesiologists physical status I/II patients aged 18-60 years, undergoing elective unilateral breast surgery were enrolled. Patients were block-randomized (computer-generated) to two equal groups (24 patients each), with one of them receiving Dexmedetomidine and the other one Ketamine. For concealment, sequentially numbered, sealed, opaque envelopes were used. The study was double-blinded for both the anesthesiologist and outcome assessor anesthesiologist. Obese patients (body mass index > 30), those with infection at block site, coagulopathy and known hypersensitivity to local anesthetics or study medications as well as individuals who refused participation in research were all excluded. The Dexmedetomidine group received a bolus of 0.5 mcg/kg over ten minutes, followed by an infusion of 0.3 mcg/kg/hour, while the Ketamine group received a bolus of 0.5 mg/kg over ten minutes, followed by an infusion of 0.3 mg/kg/hour. Postoperative analgesia was compared using a visual analogue scale (VAS) at regular intervals. When VAS exceeded four, 1 mg/kg intravenous Pethidine was administered as a rescue analgesic. Results: Sub-anesthetic low-dose Ketamine was more effective than low-dose Dexmedetomidine in prolonging PECs block analgesia, which was statistically significant (p value < 0.001). The Ketamine group had lower rescue analgesic Pethidine consumption and longer first-rescue analgesia demand time. There was no significant hemodynamic difference between the study groups. Conclusion: Ketamine was more efficient than Dexmedetomidine for postoperative analgesia. [ABSTRACT FROM AUTHOR]

Copyright of Barn: Forskning om Barn og Barndom i Norden is the property of Cappelen Damm Akademisk and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

SARS-CoV-2 serology may be helpful to retrospectively understand infection dynamics in specific settings including kindergartens. We assessed SARS-CoV-2 seroprevalence in individuals connected to kindergartens in Berlin, Germany in September 2021. Children, staff, and household members from 12 randomly selected kindergartens were interviewed on COVID-19 history and sociodemographic parameters. Blood samples were collected on filter paper. SARS-CoV-2 anti-S and anti-N antibodies were assessed using Roche Elecsys. We assessed seroprevalence and the proportion of so far unrecognized SARS-CoV-2 infections. We included 277 participants, comprising 48 (17.3%) kindergarten children, 37 (13.4%) staff, and 192 (69.3%) household members. SARS-CoV-2 antibodies were present in 65.0%, and 52.7% of all participants were vaccinated. Evidence of previous infection was observed in 16.7% of kindergarten children, 16.2% of staff, and 10.4% of household members. Undiagnosed infections were observed in 12.5%, 5.4%, and 3.6%, respectively. Preceding infections were associated with facemask neglect. In conclusion, two-thirds of our cohort were SARS-CoV-2 seroreactive in September 2021, largely as a result of vaccination in adults. Kindergarten children showed the highest proportion of non-vaccine-induced seropositivity and an increased proportion of previously unrecognized SARS-CoV-2 infection. Silent infections in pre-school children need to be considered when interpreting SARS-CoV-2 infections in the kindergarten context. [ABSTRACT FROM AUTHOR]

Within the field of early childhood education, the Nordic model is characterised as being child-centred and holistic, based on children's participation, democracy, autonomy, and freedom. Despite a strong tradition of incorporating children's perspectives, research has identified it as a democratic problem that children continue to occupy a non-privileged position in which their voices are often unheard or disregarded in many contexts. Similarly, there is a tendency to apply adult-led methods, such as interviews, which can hinder the openness to children's diverse ways of communicating, which is not just through verbal expressions. In this article, we position ourselves within what we perceive as the second wave of research on child perspectives in which the research interest converges on exploring how children's perspectives are connected with the contexts in which children participate. Drawing on agential realism and an empirical example from a daycare centre, we demonstrate how children's perspectives emerge from and become entangled with pedagogues, ethics, spaces, materials and discourse. Thus, the question is not about gaining access to children's perspectives, but rather to be concerned with the interactions wherein children's perspectives can emerge. This involves a critical view of the structures and basic assumptions that manifest themselves in the daily life of daycare centres and which underlie, and can result in, a subordination of children and children's perspectives. [ABSTRACT FROM AUTHOR]

We study the effect of a 12-week maternity leave extension in Chile on the health of infants between 6 and 12 months old. Using unique administrative sick leave data for working women enrolled in the private health insurance system who gave birth between 2011 and 2013, we estimate the effect of this extension on the number of paid sick days taken by the mother due to her child being ill. We find that extending maternity leave improved infant health and decreased the number of sick days by 6.43 (0.18 SD) days on average. Additionally, we show that mothers with extended maternity leave take their infant to the pediatrician less often than mothers without the extended leave. Our results are consistent with a decrease in daycare attendance, which decreases exposure to communicable diseases. [ABSTRACT FROM AUTHOR]

Interventions are strongly recommended for preschoolers experiencing participation difficulties in their daily life, regardless of whether or not they have a diagnosis. Best practices recommend that interventions should include the child's significant adults and be delivered in the child's environments. Occupational Performance Coaching (OPC) has shown promising results in improving children's participation by supporting significant adults of school-aged children either with cerebral palsy or without a definite diagnosis, and of preschoolers with developmental coordination disorder. However, this approach has not yet been studied for preschoolers without a definite diagnosis. A multiple case study design was used to explore the interventions's feasibility for this population. Eight parents and three early childhood educators received OPC to help seven children (cases). Intra- and inter-case analyses were conducted to document the effects of the intervention on the children's participation and the caregivers' goals. All children had difficulties in their daily life, and most presented motor, sensory, behavioral and/or adaptive difficulties. Improvements in children's participation and significant adults' satisfaction as well as goal attainment were observed in most cases. Improvements were generally maintained at a three-month follow-up. These findings support the feasibility of OPC for significant adults of preschoolers with participation difficulties in daily life but no definite diagnosis. [ABSTRACT FROM AUTHOR]

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Daycare maltreatment refers to abusive and/or neglectful acts perpetrated by teachers, directors, non-professionals or volunteers, family members of staff, and peers in a daycare setting. Despite growing evidence of its occurrence, the prevalence and consequences of daycare maltreatment for the child, the parent(s), and their dyad are largely unknown. This qualitative systematic literature review was conducted to synthesize the existing literature referring to daycare maltreatment, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In order to be included in the analysis, the manuscripts needed to report empirical findings regarding maltreatment in daycare settings, be written in English, be published in a peer-reviewed journal or a dissertation, and be accessible by our research team. In all, 25 manuscripts met the above criteria and were included in the review. Our results indicate that reports of daycare maltreatment are characterized by early age of abused children, inferring mainly to sexual, physical, and emotional abuse. The majority of these manuscripts reported caregivers' and teachers' abuse, while peer victimization was reported much less. In addition, the findings demonstrated a higher representation of female perpetrators compared to abuse in other scenarios. Although some indications of long-term implications are reported in the manuscripts, a well-validated measure for assessment of daycare maltreatment seems to be lacking. These findings contribute to a more nuanced understanding of the complex experience and ramifications of daycare maltreatment, providing insight into its multi-faceted implications. [ABSTRACT FROM AUTHOR]

Copyright of Pedagogía y Saberes is the property of Universidad Pedaggica Nacional and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The problem currently faced is the lack of trust from some parents towards daycare due to the lack of detailed information about daycare and the lack of attractive promotional media for working parents to entrust their children. Therefore, a decision support system is needed that uses the fuzzy logic method and haversine formula to assist in decision making when choosing the best alternative in daycare selection. The criteria used in this study were price, distance, quantity of caregivers, quality of caregivers, and facilities and infrastructure. The results of this study indicate that the system calculations are in accordance with manual calculations and the results of system testing prove that this system percieved of usefulness it has an actual score of 93.69% (0.9369), in terms of percieved ease of use it has an actual score of 93.21% (0, 9321), in terms of attitude toward using it has an actual score of 92.68% (0.9368) and in terms of behavior in use it has an actual score of 91.19% (0.9119). This was obtained by distributing questionnaires to 28 users (parents) during system testing. [ABSTRACT FROM AUTHOR]

Introduction: Total Intravenous Anaesthesia (TIVA) with propofol is gaining acceptance for day care surgeries due to its advantages over inhalational agents. Opioids administered as premedication are known to enhance the hypnotic effect of propofol and provide intraoperative and postoperative analgesia. Aim: To compare the effectiveness of Nalbuphine and Fentanyl for postoperative analgesia in short surgical procedures. Materials and Methods: In present double-blinded randomised controlled trail conducted in the Department of Anaesthesia at the Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India, 60 patients aged 18 to 60 years, classified as American Soceity of Anaesthesiologists (ASA) Grade-I or II, and scheduled for elective short surgical procedures under TIVA were randomly assigned to two groups. Group N received Nalbuphine 0.05 mg/kg, and control Group F received 0.001 mg/ kg Fentanyl intravenously before induction. Parameters studied included pain scores, first rescue analgesia, haemodynamics, and side effects. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA, version 19.0 for Windows). Parametric data were analysed using paired and unpaired t-tests. Results: Data from a total of 60 patients (Group N mean age: 46.9±9.96 years and Group F mean age: 46.6±10.44 years) were collected and analysed. Both groups were comparable in terms of age, Body Mass Index (BMI), mean duration of surgery, and type of surgery (p > 0.05). Pain scores on the Visual Analogue Scale (VAS) were not significant upto 15 minutes after surgery, but thereafter, the VAS score was significantly lower in the Nalbuphine group (p-value < 0.05). Intraoperative episodes of significant hypotension were observed only in the Fentanyl group (p-value < 0.05). The total dose of propofol required was significantly lower in the Fentanyl group (p-value < 0.001). The time to the first rescue analgesia requirement (in minutes) was significantly shorter in the Fentanyl group (32.83±28.43) compared to the Nalbuphine group (56.37±25.31). Side effects such as postoperative sedation, nausea, and vomiting were observed in the Fentanyl group (p-value >0.05). Conclusion: Nalbuphine provided superior postoperative analgesic effects compared to Fentanyl when used as an analgesic component in TIVA. Postoperatively, pain scores were lower, and the time to the first rescue analgesia was longer in the Nalbuphine group.

BACKGROUND: Childcare center providers in Miami-Dade County, Florida a COVID-19 hotspot, are made up almost entirely of ethnic minority women. This is a critical frontline staff that is now encountering the triple threat of respiratory illnesses from respiratory syncytial virus (RSV), influenza viruses (or the seasonal flu), and COVID-19. OBJECTIVE: To examine sociodemographic characteristics, anthropometrics, and health behaviors that were collected from a sample of CCC teachers in Miami Dade County, a COVID-19 hotspot. METHODS: Cross-sectional data were used from Healthy Caregivers, Healthy Children (HC2), a randomized controlled intervention trial (#NCT02697565) for healthy weight maintenance among children 2-to-5 years old, conducted in 24 subsidized childcare centers in MDC in 2015–2018. Prevalence was determined by frequency or mean/standard deviation of each variable. Chi-squared analyses were performed to test for differences in BMI categories. RESULTS: In this sample of childcare center providers (n = 255), the majority (61%) had an elevated body mass index. Positive health behaviors such as regular exercise and eating fruits and vegetables were only reported in about a third of the sample. CONCLUSION: It is vital that we encourage the uptake of regular vaccination schedules as a means to protect our community, especially the critical frontline workers that have been caring for our young children. [ABSTRACT FROM AUTHOR]

This exploratory study aims to explore and analyse the process of parental decision-making for baby rooms in daycare centres, within the Portuguese context of early childhood education and care. The theoretical framework is based on the accommodation model. Methodologically, the research is based on a qualitative and interpretative approach involving data collection through a focus group discussion, with seven parents who decided to enrol their babies, in baby rooms of seven non-profit daycare settings. The findings and discussion show that parental decision-making for a baby room in daycare is a complex and multidimensional process that involves opportunities, constraints, and preferences concerning pragmatic, personal, family, contextual and baby-centred factors. The need to provide parents with better information on what matters in daycare contexts is also a significant finding. The article ends by presenting some conclusions and recommendations addressed to all stakeholders, especially educators, to support the parental decision-making process for baby rooms in daycare. [ABSTRACT FROM AUTHOR]

Introduction: Total Intravenous Anaesthesia (TIVA) with propofol is gaining acceptance for day care surgeries due to its advantages over inhalational agents. Opioids administered as premedication are known to enhance the hypnotic effect of propofol and provide intraoperative and postoperative analgesia. Aim: To compare the effectiveness of Nalbuphine and Fentanyl for postoperative analgesia in short surgical procedures. Materials and Methods: In present double-blinded randomised controlled trail conducted in the Department of Anaesthesia at the Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India, 60 patients aged 18 to 60 years, classified as American Soceity of Anaesthesiologists (ASA) Grade-I or II, and scheduled for elective short surgical procedures under TIVA were randomly assigned to two groups. Group N received Nalbuphine 0.05 mg/kg, and control Group F received 0.001 mg/ kg Fentanyl intravenously before induction. Parameters studied included pain scores, first rescue analgesia, haemodynamics, and side effects. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA, version 19.0 for Windows). Parametric data were analysed using paired and unpaired t-tests. Results: Data from a total of 60 patients (Group N mean age: 46.9±9.96 years and Group F mean age: 46.6±10.44 years) were collected and analysed. Both groups were comparable in terms of age, Body Mass Index (BMI), mean duration of surgery, and type of surgery (p > 0.05). Pain scores on the Visual Analogue Scale (VAS) were not significant upto 15 minutes after surgery, but thereafter, the VAS score was significantly lower in the Nalbuphine group (p-value < 0.05). Intraoperative episodes of significant hypotension were observed only in the Fentanyl group (p-value < 0.05). The total dose of propofol required was significantly lower in the Fentanyl group (p-value < 0.001). The time to the first rescue analgesia requirement (in minutes) was significantly shorter in the Fentanyl group (32.83±28.43) compared to the Nalbuphine group (56.37±25.31). Side effects such as postoperative sedation, nausea, and vomiting were observed in the Fentanyl group (p-value >0.05). Conclusion: Nalbuphine provided superior postoperative analgesic effects compared to Fentanyl when used as an analgesic component in TIVA. Postoperatively, pain scores were lower, and the time to the first rescue analgesia was longer in the Nalbuphine group. [ABSTRACT FROM AUTHOR]

Background: Moderate-to-vigorous physical activity (MVPA) offers many health benefits for preschoolers (2.5–5 y). In childcare, MVPA is predominantly accumulated outdoors, with higher rates purported among children within the first few minutes outside. The Supporting Physical Activity in the Childcare Environment intervention included shorter, more frequent outdoor play sessions; this study sought to explore children's activity levels during various outdoor play schedules. Methods: During the final week of the Supporting Physical Activity in the Childcare Environment intervention, preschoolers wore an Actical™ accelerometer for 5 days during childcare and staff logged outdoor times. Separate linear mixed effects models were run to explore the effect of the intervention on preschoolers' physical activity (total and MVPA) and sedentary time during outdoor play. Sex was entered as an interaction effect. Results: Preschoolers (n = 292) were significantly more active in the first 10 minutes outdoors compared with remaining time (P <.0083). For total outdoor time, children in the experimental group engaged in significantly less sedentary time than those in the control group (P <.017), and experimental group boys and girls engaged in higher MVPA than boys and girls in the control group (P <.017). Conclusions: Findings support scheduling more frequent outdoor play sessions in childcare to increase physical activity participation among young children. [ABSTRACT FROM AUTHOR]

Abstract The Italian welfare state is characterised by a preference for income transfers over transfers in kind and the marginal role of policies aimed directly at supporting the family. Despite the growing participation of women in the labour market, the Italian welfare system still assumes the family, with its unbalanced gender division of housework and its intergenerational solidarity, to be the primary provider of protection and support. As a result, in Italy in 2019 only 26.9% of children under 3 years of age were enrolled in formal childcare, which is below the European average. In this context, births from at least one foreign parent had increased over time, and foreign national children accounted for 14.0% of all children aged 0–3 in 2019. Despite this, migrants are still seen as ‘suppliers’ rather than citizens who, as parents, are potential consumers of childcare services. Aspects related to the use of childcare by migrants and differences compared to natives in Italy are currently understudied. We use the 2012 Birth Sample Survey by the Italian National Institute of Statistics to fill this gap. Mothers were interviewed about 18–21 months after having given birth: information on sociodemographic characteristics of both parents was collected, including their use of childcare services, their reasons for not using them, their unmet need for childcare services, and the lack of access to the job market due to care work. Our study aims to understand childcare patterns among migrants and the differences between them and those of the native-born population. We found that Italian mothers use informal care more than migrants. Unlike the evidence from other international studies, our results show that migrant mothers use daycare for children aged 0–3 more than native-born mothers. However, we found that the migrants who had arrived as children show patterns more similar to natives. This finding might be associated with a better knowledge of the system and a more extensive network (including grandparents) in Italy. Similarly, we found that migrant mothers who co-parent with an Italian father use more informal care and experience lower logistical barriers to accessing daycare. In addition, we observed that obstacles to children’s enrolment resulting in an unmet need for daycare are also related to migrant background.

Abstract Policy attempts in Italy to raise fertility place considerable importance on subsidizing daycare. The aim of this paper is to determine whether receiving a daycare subsidy for one child increases the probability of having a subsequent child in the Friuli Venezia Giulia (FVG) region in Italy. A novel approach is used combining administrative data on the means test certification (Indicatore della Situazione Economica Equivalente or ISEE) needed to access various benefits, matched with the actual subsidy requests. Propensity score matching is applied to the resulting longitudinal data set and the matched data are analyzed with an event history analysis model. Results suggest that besides a positive impact of daycare subsidies and family wealth, non-monetary factors have a larger effect, with female employment having a possible postponement effect on subsequent births.

This study conducted an empirical study in a town of Dongguan by adopting a convenience sampling method from September to November 2022. The research team conducted one ⁃ to ⁃ one questionnaire surveys on the basic information，purchase intention and payment intention of home ⁃ based elderly and their adult children for daycare services to understand the effective demand of residents for day care services and the development potential of daycare in Dongguan. The chi⁃square test and logistic regression analysis were used to analyze the influencing factors of purchase intention. U/H test and multiple stepwise regression analysis were used to analyze the influencing factors of payment intention. The results showed that 251 of the 392 respondents were willing to purchase daycare services，accounting for 64.03% . The average monthly payment value of daycare services was 2 127.2 yuan. The purchase intention of residents is affected by education level，income and expenditure and the number of children. Residents’willingness to pay for daycare was influenced by education level，health status of the elderly，income and expenditure of the respondents and whether they had children to provide care. The study found that daycare service has a particular development potential in Dongguan. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 serology may be helpful to retrospectively understand infection dynamics in specific settings including kindergartens. We assessed SARS-CoV-2 seroprevalence in individuals connected to kindergartens in Berlin, Germany in September 2021. Children, staff, and household members from 12 randomly selected kindergartens were interviewed on COVID-19 history and sociodemographic parameters. Blood samples were collected on filter paper. SARS-CoV-2 anti-S and anti-N antibodies were assessed using Roche Elecsys. We assessed seroprevalence and the proportion of so far unrecognized SARS-CoV-2 infections. We included 277 participants, comprising 48 (17.3%) kindergarten children, 37 (13.4%) staff, and 192 (69.3%) household members. SARS-CoV-2 antibodies were present in 65.0%, and 52.7% of all participants were vaccinated. Evidence of previous infection was observed in 16.7% of kindergarten children, 16.2% of staff, and 10.4% of household members. Undiagnosed infections were observed in 12.5%, 5.4%, and 3.6%, respectively. Preceding infections were associated with facemask neglect. In conclusion, two-thirds of our cohort were SARS-CoV-2 seroreactive in September 2021, largely as a result of vaccination in adults. Kindergarten children showed the highest proportion of non-vaccine-induced seropositivity and an increased proportion of previously unrecognized SARS-CoV-2 infection. Silent infections in pre-school children need to be considered when interpreting SARS-CoV-2 infections in the kindergarten context.

Within the field of early childhood education, the Nordic model is characterised as being child-centred and holistic, based on children’s participation, democracy, autonomy, and freedom. Despite a strong tradition of incorporating children’s perspectives, research has identified it as a democratic problem that children continue to occupy a non-privileged position in which their voices are often unheard or disregarded in many contexts. Similarly, there is a tendency to apply adult-led methods, such as interviews, which can hinder the openness to children’s diverse ways of communicating, which is not just through verbal expressions. In this article, we position ourselves within what we perceive as the second wave of research on child perspectives in which the research interest converges on exploring how children’s perspectives are connected with the contexts in which children participate. Drawing on agential realism and an empirical example from a daycare centre, we demonstrate how children’s perspectives emerge from and become entangled with pedagogues, ethics, spaces, materials and discourse. Thus, the question is not about gaining access to children’s perspectives, but rather to be concerned with the interactions wherein children’s perspectives can emerge. This involves a critical view of the structures and basic assumptions that manifest themselves in the daily life of daycare centres and which underlie, and can result in, a subordination of children and children’s perspectives.

The Italian welfare state is characterised by a preference for income transfers over transfers in kind and the marginal role of policies aimed directly at supporting the family. Despite the growing participation of women in the labour market, the Italian welfare system still assumes the family, with its unbalanced gender division of housework and its intergenerational solidarity, to be the primary provider of protection and support. As a result, in Italy in 2019 only 26.9% of children under 3 years of age were enrolled in formal childcare, which is below the European average. In this context, births from at least one foreign parent had increased over time, and foreign national children accounted for 14.0% of all children aged 0–3 in 2019. Despite this, migrants are still seen as 'suppliers' rather than citizens who, as parents, are potential consumers of childcare services. Aspects related to the use of childcare by migrants and differences compared to natives in Italy are currently understudied. We use the 2012 Birth Sample Survey by the Italian National Institute of Statistics to fill this gap. Mothers were interviewed about 18–21 months after having given birth: information on sociodemographic characteristics of both parents was collected, including their use of childcare services, their reasons for not using them, their unmet need for childcare services, and the lack of access to the job market due to care work. Our study aims to understand childcare patterns among migrants and the differences between them and those of the native-born population. We found that Italian mothers use informal care more than migrants. Unlike the evidence from other international studies, our results show that migrant mothers use daycare for children aged 0–3 more than native-born mothers. However, we found that the migrants who had arrived as children show patterns more similar to natives. This finding might be associated with a better knowledge of the system and a more extensive network (including grandparents) in Italy. Similarly, we found that migrant mothers who co-parent with an Italian father use more informal care and experience lower logistical barriers to accessing daycare. In addition, we observed that obstacles to children's enrolment resulting in an unmet need for daycare are also related to migrant background. [ABSTRACT FROM AUTHOR]

Although the transition into kindergarten of children at the age of three is regarded as a meaningful event in the lives of children and their families, little is known about the role of peer relationships during this transition phase. Based on a Viennese research project, in this article observational material is presented and analysed to describe how three-year-old Patrick experiences peer relationships during his transition into kindergarten. The authors describe Patrick's meaningful, recurring and characteristic interactions with his kindergarten peers; they also formulate patterns of experience. In addition, the analysis of the observation material is linked to publications on the topic of peer relationships, in order to show to what extent the presented form of research can enrich the current scientific discourse. [ABSTRACT FROM AUTHOR]

Policy attempts in Italy to raise fertility place considerable importance on subsidizing daycare. The aim of this paper is to determine whether receiving a daycare subsidy for one child increases the probability of having a subsequent child in the Friuli Venezia Giulia (FVG) region in Italy. A novel approach is used combining administrative data on the means test certification (Indicatore della Situazione Economica Equivalente or ISEE) needed to access various benefits, matched with the actual subsidy requests. Propensity score matching is applied to the resulting longitudinal data set and the matched data are analyzed with an event history analysis model. Results suggest that besides a positive impact of daycare subsidies and family wealth, non-monetary factors have a larger effect, with female employment having a possible postponement effect on subsequent births. [ABSTRACT FROM AUTHOR]

Copyright of Estilos da Clínica is the property of FEUSP - Faculdade de Educacao da USP - Universidade de Sao Paulo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Tonsillectomy is one of the most common surgical procedure in the world performed by Ear, Nose and Throat surgeon. Over the past decade, there has been progress in surgical techniques for tonsillectomy, yet pain and bleeding after tonsillectomy remain important surgical complications. With the increasing need to reduce healthcare costs in developing countries, there is currently a trend towards performing tonsillectomy on a daycare basis and this study aims at evaluating how efficacious it may be in our setting. Methods: A retrospective review of all the daycare tonsillectomy surgeries performed at the Pokhara ENT Center, Pokhara, Nepal from February 2018 to January 2019. Patients aged 15 years and up of either sex who met the paradise criteria were included while patients who met the same but had a contraindication for tonsillectomy surgery were excluded. Demographic information as well as complications within six hours of surgery before discharge and on follow-up on the seventh post-operative day were evaluated, as were any emergency room visits in the first 24 hours and any complications requiring a visit to a healthcare facility. Results: On day of surgery 17% had worst pain and on seventh post-operative day 75% had no pain, only 2% presented with primary hemorrhage and 3% presented with secondary hemorrhage. None of them required revision surgery. Conclusions: Daycare tonsillectomy is being done in only some of the centers owing to the risk of postoperative complications in our country. In our study, the number of complications was lower and not life-threatening. It can be considered a safe and cost-effective method, though patient selection is crucial.

Daycare is an alternative care service for working parents. The occurrence of a paradigm shift where currently many mothers work has implications for the role of care that is taken over by social institutions. So this study aims to explore what factors influence mothers' decision-making in leaving their children at Balita Ceria Daycare. This research uses a qualitative method with a phenomenological approach. The subjects in this study used a purposive sampling technique with the criteria of working mothers, choosing the Fullday program, and having children aged 0 - 5 years or not yet attending kindergarten. The results of the research on factors influencing decision-making in leaving children there are five factors originating from parents, namely work opportunities, professionalism, time management, lower stress and fatigue levels due to work, and independence in households. Other factors related to daycare are curriculum and learning, legality, distance, communication, and safety and comfort of TPA for child development.

This study presents the insights gained from interviewing 12 parentally bereaved children aged 5–8. All were below six years of age when bereft. Participants were interviewed through Sandtray interviews. The study finds that children are developing an understanding of what it means to live with loss, but want truthful information about the illness of their parent, and to understand the loss. They value help from the remaining parent, but also appreciate the support from daycare staff and friends. Findings further highlight that under the right circumstances, children have much to contribute when it comes to understanding their support needs. [ABSTRACT FROM AUTHOR]

The article presents the results of a research that aimed to understand how young children, from their photographic production, read and communicate the world. This is qualitative research that had as methodological procedures analysis of photographs produced by 3-year-old children in a municipal day care center in the Greater ABC/SP Region and interviews with educators. As a theoretical reference, it dialogued with childhood studies. Data analysis shows that children engage in the act of photographing with joy and empowerment and produce images that denote curiosity, creativity, imagination, sensitivity and investigation. His photographs present a reading of the world open to novelty, in which they create new and different meanings. However, it appears that photography is still little used in the educational routine as an expressive form of children, which reveals the need for formative processes on its importance. [ABSTRACT FROM AUTHOR]

The work described illustrates the importance of active playing in childhood as a subjective activity from age two-and-one-half years up to at least five years old, as a means of communicating nonverbally, especially when words are not yet readily available. It is a young child's way of exploring the world and his own interests, while also communicating what matters to him emotionally. It requires adults to translate and understand what playing communicates and actually means, and why it matters emotionally. Playing enhances relationships and is useful in conveying and furthering interpersonal understanding, gradually becoming ever more verbal. [ABSTRACT FROM AUTHOR]

When one thinks about the constitution of daycare centers and preschools in Brasília, from the moment the capital was inaugurated, on April 21, 1960, there is still a gap in history that allows us to grasp a historical interpretation of the education and care given to these children, at least in the first two decades. To understand this constitution and the practices/conceptions present there, this study locates, through an inventory of sources, the documents that make it possible to go through the traces of the first daycare centers and kindergartens in Brasília, in the 1960s and 1970s. Having defined the intention, the files consulted were: the National Institute of Educational Studies and Research Anísio Teixeira (INEP); the Public Archive of the Federal District; the Public Archive of the Senate, the Digital Newspaper Library of the National Library, and the Museum of Education of the Federal District. As first interpretations, it was possible to show that, in Brasília, the creation of the daycare center and preschool follows what happened in other parts of the Brazilian territory, with distinction where the first was a guard space and the second of pedagogical practices with children, made by trained teachers. However, there is already a demand for daycare that ends up echoing in the pages of the Correio Braziliense newspaper, albeit as a right of the mother and not of the children. In the kindergartens, the organization of routines is located, where the languages appeared, linked to playing, although not centered on the children, but on the proposers of the activities: the teachers. [ABSTRACT FROM AUTHOR]

Introduction: Therapeutic phlebotomy procedure, being very similar to blood donation, is currently done in various hospitals in the world in the ward or a daycare procedure room or a blood bank or an apheresis center as these facilities know the mechanics of it as well as are well equipped and trained for blood collection. Our institute started doing it in the blood center in the past couple of years. This study was performed to understand the patients' perspectives on getting this procedure done in the blood bank compared to them getting these services in the ward side as was happening previously. Methodology: This was a qualitative-exploratory study done at the blood center and included adult patients who have undergone therapeutic phlebotomy in the blood center at least twice in the last 3 months. An in-depth interview in private on one to one basis was performed using a topic guide and necessary probes to get the information. Manual descriptive content was used to analyze the transcripts. Thematic analyses were performed. Results: Majority of the patients felt that they were comfortable getting the procedure done in a blood center compared to wards as it takes lesser time here (64%), better personal care and attention by the staff (52%), conducive attitude and friendliness of the healthcare staff (76%), better ambience (24%) and overall satisfaction (24%). Conclusion: The study has encouraging results with respect to patients; hence, more and more blood centers should explore this and convince the hospital administration to set the therapeutic phlebotomy facilities in the blood services. [ABSTRACT FROM AUTHOR]

Summary: Background: We aimed to define clinical and cost-effectiveness of a Day Care Approach (DCA) alternative to Usual Care (UC, comparison group) within the Bangladesh health system to manage severe childhood pneumonia. Methods: This was a cluster randomised controlled trial in urban Dhaka and rural Bangladesh between November 1, 2015 and March 23, 2019. Children aged 2–59 months with severe pneumonia with or without malnutrition received DCA or UC. The DCA treatment settings comprised of urban primary health care clinics run by NGO under Dhaka South City Corporation and in rural Union health and family welfare centres under the Ministry of Health and Family welfare Services. The UC treatment settings were hospitals in these respective areas. Primary outcome was treatment failure (persistence of pneumonia symptoms, referral or death). We performed both intention-to-treat and per-protocol analysis for treatment failure. Registered at www.ClinicalTrials.gov, NCT02669654. Findings: In total 3211 children were enrolled, 1739 in DCA and 1472 in UC; primary outcome data were available in 1682 and 1357 in DCA and UC, respectively. Treatment failure rate was 9.6% among children in DCA (167 of 1739) and 13.5% in the UC (198 of 1472) (group difference, −3.9 percentage point; 95% confidence interval (CI), −4.8 to −1.5, p = 0.165). Treatment success within the health care systems [DCA plus referral vs. UC plus referral, 1587/1739 (91.3%) vs. 1283/1472 (87.2%), group difference 4.1 percentage point, 95% CI, 3.7 to 4.1, p = 0.160)] was better in DCA. One child each in UC of both urban and rural sites died within day 6 after admission. Average cost of treatment per child was US$94.2 (95% CI, 92.2 to 96.3) and US$184.8 (95% CI, 178.6 to 190.9) for DCA and UC, respectively. Interpretation: In our population of children with severe pneumonia with or without malnutrition, >90% were successfully treated at Day care Clinics at 50% lower cost. A modest investment to upgrade Day care facilities may provide a cost-effective, accessible alternative to hospital management. Funding: UNICEF, Botnar Foundation, UBS Optimus Foundation, and EAGLE Foundation, Switzerland.

Abstract Background Untreated dental caries negatively impacts a child's quality of life including overall health and wellbeing, growth and development, social interaction ability, and school attendance. School-based toothbrushing programs have been recognised as an effective intervention to reduce the burden of dental caries. However, limited information is available to understand the real-world enablers and challenges in the implementation and sustainability of toothbrushing programs. This review aims to understand the barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings and primary schools. Methods Five electronic databases [i.e., CINAHL (EBSCO), Medline (EBSCO), EMBASE (Ovid), Web of Science, and PsycINFO] and backward citation chasing were performed. The last updated databases searches were conducted in May 2022. Studies reporting on barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings or primary schools were included in the review. The methodological quality of included studies was assessed by using Joanna Briggs Institute [JBI] and mixed methods appraisal tool [MMAT] critical appraisal tools and results were reported in accordance with PRISMA guidelines. Results A total of six studies met the eligibility criteria and were included in the review. Toothbrushing programs in early childhood settings and primary schools were mostly implemented under the supervision of staff and teachers. A positive attitude of the staff, the flexibility of toothbrushing sessions, involvement of community volunteers and parents were a few of the identified enablers. However, the timing of the communication of the program, inadequate transfer of information among staff, frequent staffing turnover, lack of parental support, and staff feeling overburdened while acting as pseudo parents were frequently reported as barriers. Conclusion The results of this systematic review identify key enablers and barriers for toothbrushing programs in early childhood settings and primary schools which need to be considered for developing oral health promotion initiatives.

Infant attachment theory is now nearly seventy-years old. Despite debates that developed around the original theory relating to the role of the mother and the potential for emotional flexibility in the infant, its core thesis of the role of the 'Internal Working Model' in human mental health endures. Recent neurophysiological research reveals complex relationships between stress biology and infant attachment. In this article, attachment theory is summarised from its origins to its currently emerging relationship with neurophysiology, and implications for policy are discussed. Emergent concepts include the indication that insecure relationships in infancy have the potential to impact upon lifelong mental health, and that contemporary UK policy does not give enough weight to this finding when planning care and social strategies for infants and their families. This article attempts to bring together a cohesive picture of research across neurophysiology, psychology and practice to inform future policy development. [ABSTRACT FROM AUTHOR]

In the modern era, endoscopic retrograde cholangiopancreatography (ERCP) and therapeutic endoscopic ultrasound (EUS) are increasingly being performed in day-care settings. The safety of these procedures in elderly admitted patients has been established in previous studies, but evidence for the safety of day-care ERCP/therapeutic EUS is limited. We retrospectively analyzed the outcomes of day-care ERCP/EUS in patients more than 80 years of age. All procedures were done under total intravenous anesthesia (ketamine- and propofol-based) and the intra-procedural and immediate postprocedural complications (within 6 hours) were noted. Thirty patients (24 male and 6 female) were enrolled. The most common indication for the procedure was choledocholithiasis (46.6%), followed by malignant stenosis (30.0%) and benign strictures (20.0%). One patient had transient desaturation during the procedure and two patients had hypotension. The dreaded complications of bleeding, perforation, or pancreatitis did not occur in any patients, and none required admission. In conclusion, day-care therapeutic ERCP/EUS is safe and cost-effective in the oldest old patients.

This study examines the implementation and use of bereavement response plans (bereavement plans) in Danish and Norwegian daycare institutions. Two large-scale surveys were conducted to explore the implementation rates, satisfaction levels, and source of the plans. The data collected was analyzed using frequency analyses and Chi-square tests of independence. The findings suggest that 87% of Danish institutions have bereavement plans compared to 98% in Norway. Furthermore, the study highlights the differences in the development of bereavement plans between the two countries, as Danish institutions trust their individually tailored plans more than their Norwegian counterparts, while the Norwegian plans seem to be of higher quality. Despite these differences, bereavement plans provide a sense of safety for staff when supporting bereaved children in both countries. This study contributes to the ongoing efforts to improve bereavement support in daycare institutions and emphasizes the importance of continued research and development in this area. [ABSTRACT FROM AUTHOR]

Despite the recognized effectiveness of naturalistic intervention practices, including activity-based intervention (ABI), challenges remain regarding their implementation. Assessing implementation fidelity can help understand factors that may influence their implementation. This study aims to document the evolution of ABI implementation fidelity (Adherence, Dosage, Quality and Participant responsiveness) in daycare settings following professional development. The participants are four educators. The current study uses an embedded design. The predominant aspect is quantitative, that is, single-case research design with three measurement phases of 12 observation moments. In terms of Dosage, an increase in the frequency of learning opportunities offered by educators is observed as the experiment progresses. For three educators, results show moderate and significant effects of professional development between Phases 1 and 3. A slight decrease in Quality can be observed when learning opportunities are adapted to children's developmental levels. This article highlights the importance of documenting several components of implementation fidelity. [ABSTRACT FROM AUTHOR]

Background Nephrology services encompass a wide range of day-care procedures. Securing beds for day admissions can be challenging and may lead to significant delays in patient management. Objective This study aims to describe the impact of establishing a dedicated nephrology daycare unit at a tertiary care center. Methods Since January 2021, a dedicated nephrology daycare unit has been operational at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. This observational study retrospectively reviewed the admission records to the KAUH nephrology daycare unit from January 2021 to December 2023. Admissions with missing data were excluded from the analysis. The study outcomes included: 1. the number of patients served in the unit, 2. the scope of services provided, 3. the "time to completion" of immunosuppressive therapy administered in the unit, and 4. the rate of complications related to admission to the unit. Results There were 233 admissions for 157 patients. The scope of procedures included: 1. administration of immunosuppressive therapy (42 doses of cyclophosphamide, 70 doses of rituximab, three doses of methylprednisolone), 2. renal biopsies (25 procedures), 3. tunneled dialysis catheter procedures (40 procedures, both insertion and removal), 4. dialysis access angioplasty (three procedures), 5. IV iron therapy (45 admissions), and 6. other miscellaneous causes (five admissions). Ideal time to completion of cyclophosphamide therapy was achieved in 86% of patients, with the remaining 14% experiencing delays due to reasons other than bed availability. Time to completion of rituximab therapy was achieved without delay in 85% of patients, with a time interval of less than 21 days. There were no reported complications associated with admission to the unit. Conclusions Establishing a dedicated nephrology daycare unit facilitates the delivery of nephrology day-procedures and reduces delays in therapy., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Research Ethics Committee (REC) at King Abdulaziz University issued approval Reference No 8-24. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ankawi et al.)

Sebagai upaya meningkatkan kualitas layanan pendidikan dan pembelajaran, kurikulum perguruan tinggi terus diinovasikan untuk mencapai tujuan SDGs. Outcome-based Education (OBE) dan model Project-Based Learning (PjBL) merupakan strategi pembelajaran inovatif untuk meningkatkan pendidikan dan pembelajaran di perguruan tinggi. Artikel ini mendeskripsikan tentang desain pengembangan mata kuliah Pengelolaan Taman Penitipan Anak (TPA) yang berbasis pada OBE dengan PjBL pada Program Studi S1 PG-PAUD. Rancangan pengembangan mata kuliah yang dijabarkan melalui Rencana Pembelajaran Semester (RPS) dapat ditetapkan dan dikembangkan oleh dosen secara mandiri atau bersama dalam kelompok keahlian suatu bidang ilmu pengetahuan dan/atau teknologi dalam PS. Rancangan ini merumuskan capaian pembelajaran lulusan (CPL), capaian pembelajaran mata kuliah (CPMK), sub-CPMK, dan analisis mata kuliah. Metode pembelajaran menggunakan model PjBL yang dirumuskan dalam enam tahapan, yaitu: (1) pendahuluan, (2) pertanyaan pendorong, (3) penyelidikan berkelanjutan, (4) refleksi pengalaman, (5) analisis dan revisi proyek, dan (6) penyajian proyek. Model tersebut menjadi sebuah inovasi kurikulum yang dapat meningkatkan profesionalisme lulusan S1-PGPAUD dalam mengelola TPA. Kata Kunci: Outcome-based Education; Project-Based Learning; Taman Penitipan Anak; S1 PG-PAUD Abstract To improve the quality of education and learning services in universities, improvement of the curriculum is done continuously to achieve the goals of the SDGs. Outcome-Based Education (OBE) and project-based learning (PjBL) models are innovative instructional strategies to advance education and learning in higher education. This article describes the development design of Daycare Management courses based on OBE and PjBL Models in a bachelor's degree of Early Childhood Education Department. The course development plan can be determined and developed by the lecturers independently or together in a team of experts in the same fields of science and technology in the study program. The model includes determining graduate learning outcome (GLO), course learning outcome (CLO), subject learning outcome (sub-CLO), and course analysis. The learning method uses the PjBL model is formulated in six stages, namely: (1) introduction, (2) prompting questions, (3) ongoing investigation, (4) reflection on experience, (5) project analysis and revision, and (6) project presentation. This model becomes a curriculum innovation that can improve the professionalism of undergraduate students in managing daycare.

Background: Untreated dental caries negatively impacts a child's quality of life including overall health and wellbeing, growth and development, social interaction ability, and school attendance. School-based toothbrushing programs have been recognised as an effective intervention to reduce the burden of dental caries. However, limited information is available to understand the real-world enablers and challenges in the implementation and sustainability of toothbrushing programs. This review aims to understand the barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings and primary schools. Methods: Five electronic databases [i.e., CINAHL (EBSCO), Medline (EBSCO), EMBASE (Ovid), Web of Science, and PsycINFO] and backward citation chasing were performed. The last updated databases searches were conducted in May 2022. Studies reporting on barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings or primary schools were included in the review. The methodological quality of included studies was assessed by using Joanna Briggs Institute [JBI] and mixed methods appraisal tool [MMAT] critical appraisal tools and results were reported in accordance with PRISMA guidelines. Results: A total of six studies met the eligibility criteria and were included in the review. Toothbrushing programs in early childhood settings and primary schools were mostly implemented under the supervision of staff and teachers. A positive attitude of the staff, the flexibility of toothbrushing sessions, involvement of community volunteers and parents were a few of the identified enablers. However, the timing of the communication of the program, inadequate transfer of information among staff, frequent staffing turnover, lack of parental support, and staff feeling overburdened while acting as pseudo parents were frequently reported as barriers. Conclusion: The results of this systematic review identify key enablers and barriers for toothbrushing programs in early childhood settings and primary schools which need to be considered for developing oral health promotion initiatives. [ABSTRACT FROM AUTHOR]

The environmental influences on early childhood development are understudied. The association between vegetation cover (i.e., trees, shrubs, grassed areas) in four key behaviour settings and socioemotional functioning was investigated in 1196 young children (2–5 years). Emotional difficulties were inversely associated with vegetation cover in the home yard (OR: 0.81 [0.69—0.96]) and neighbourhood (OR: 0.79 [0.67–0.94]), but not in early childhood education and care (ECEC) centre outdoor areas or the ECEC neighbourhood. The higher odds of emotional difficulties associated with lower levels of maternal education was reduced with higher percentages of home yard vegetation cover. There was no evidence of mediation of the relationship between emotional difficulties and vegetation cover by time spent playing outside the home, day or nighttime sleep duration, or physical activity. We found no associations between vegetation cover and conduct, hyperactivity and inattention, peer difficulties, or prosocial behaviours. A video abstract of this article can be viewed at https://www.youtube.com/watch?v=J3HeEiIjVZc [ABSTRACT FROM AUTHOR]

Infants and toddlers spend a substantial amount of their time in out-of-home care, and are thus being tended to not only by their mothers but also by their caregivers. It is therefore of considerable importance to study the effects of caregiver-infant compared to mother-infant interactions. To address this issue, first, various variables of caregiver-infant and mother-infant interaction were assessed in a group of participants at approximately 2 years of age. Then, 9 years later, their cognitive, social and emotional functions were evaluated. A substantially larger range of child outcome measures was found to be associated with the quality of caregiver-infant interactions compared to the quality of mother-infant interactions. Concomitantly, the level of parental education was found to be a prominent cofactor in exhibiting strong correlations with child outcome measures. These findings suggest that interaction with a caregiver may have more predictive value for developmental outcomes than previously appreciated. [ABSTRACT FROM AUTHOR]

Background: Levels of physical activity (PA) affect health already at 4 years of age. The aims of this study were to describe levels and patterns of PA and sedentary time (ST) in a sample of 4-year-old Swedish children and to assess the number of children achieving PA guidelines throughout the week. Methods: Data from 540 4-year-old children enrolled in the population-based PRIMROSE trial was used. PA was measured for a period of 1 week by the Actigraph GT3X+ accelerometer. Average PA, time spent in light PA, moderate-to-vigorous PA (MVPA) and ST were assessed. Results: On average children spent 6.7% of the day in MVPA and 45% of the day being sedentary and 33% (n = 178) of the children met the PA guidelines of 60 minutes of MVPA per day. Boys spent 56.8 (SD 21.8) minutes/day in MVPA, while girls spent 43.0 (SD 18.1) minutes/day in MVPA (P < .001). Conclusions: Four-year-old children spent almost half of the day being sedentary and only one-third meet the recommended PA guidelines. This finding is alarming as higher levels of PA, already at 4 years of age, seem to reduce the risk of childhood obesity and provides long-term health benefits. [ABSTRACT FROM AUTHOR]