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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.

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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.

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Purpose: 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. Methods: 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. Results: 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. Conclusion: 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.

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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.

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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.

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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).

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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. DISCUSSION: 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. TRIAL REGISTRATION: ClinicalTrials.gov NCT05224700. Registered on February 2022.

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Introduction: Recent research investigating the benefits of being outdoors and contact with nature in children showed strong associations with children's health and development. More teachers are choosing to integrate outdoor learning (OL) into their practice in Quebec, but few studies have focused on OL in the school environment, particularly in Canada and more specifically in Quebec, despite the fact that the school context lends itself favorably to this practice. Objective: The purpose of this study was to portray OL in preschool and primary schools in Québec by identifying three key elements: (1) teachers' perception of the outdoors, (2) the uses of OL in schools, and (3) teaching strategies and factors that influence teachers' integration of OL. Methodology: Semi-structured group interviews (n = 4) conducted with 14 teachers and participant observations (n = 4) were used for data collection. Inclusion criteria were to be a preschool or primary school teacher, to have taught at least eight sessions of OL in the past year, and to have no connection or contact with the research team prior to the start of the study. Results: First, the results showed that teachers commonly understood the outdoors as being in the open air, practicing a physical activity, having the presence of nature, providing physical freedom and targeting a pedagogical intention. Second, teachers appeared to incorporate a variety of pedagogical intentions in OL (e.g., environmental awareness, interdisciplinary learning), in a variety of settings (e.g., city parks, woodlands), and with a variety of academic subjects (e.g., French, mathematics) and learning tasks (e.g., walking, nature shelter building). Third, teachers used a wide range of teaching strategies in OL (e.g., flexible planning, well-established routines). Participants also identified multiple factors specific to their setting that appeared to facilitate (e.g., parental support) or limit (e.g., storage of materials) their integration of OL into the school environment. Conclusion: This study provided a better understanding of the current use of the OL in the Quebec school environment by identifying the common characteristics, limitations and winning strategies of its use in schools. Teachers and schools interested in OL could benefit from the results of this study, particularly those interested in adopting a Forest School or Udeskole approach.

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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.

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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.

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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.

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Children with hearing loss often attend inclusive preschool classrooms aimed at improving their spoken language skills. Although preschool classrooms are fertile environments for vocal interaction with peers, little is known about the dyadic processes that influence children's speech to one another and foster their language abilities and how these processes may vary in children with hearing loss. We used new objective measurement approaches to identify and quantify children's vocalizations during social contact, as determined by children's proximity and mutual orientation. The contributions of peer vocalizations to children's future vocalizations and language abilities were examined in oral language inclusion classrooms containing children with hearing loss who use hearing aids or cochlear implants and their typically hearing peers. Across over 600 hours of recorded vocal interactions of twenty-nine 2.5-3.5 year olds (16 girls) in three cohorts of children in a classroom, we found that vocalizations from each peer on a given observation predicted a child's vocalizations to that same peer on the subsequent observation. Children who produced more vocalizations to their peers had higher receptive and expressive language abilities, as measured by a standardized end-of-year language assessment. In fact, vocalizations from peers had an indirect association with end-of-year language abilities as mediated by children's vocalizations to peers. These findings did not vary as a function of hearing status. Overall, then, the results demonstrate the importance of dyadic peer vocal interactions for children's language use and abilities.

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This study examined the effect of nature preschools on the development of key protective factors associated with psychological resilience. The Deveraux Early Childhood Assessment for Preschoolers, Second Edition (DECA-P2), was used to assess the growth in the protective factors of initiative, self-regulation, and attachment in 87 children who attended nature, blended, and traditional preschool classes within the same school district. Study results suggest that nature preschool participation was important in the context of initiative. Blended classes, where some nature-based practices were incorporated into traditional preschool classes, were sufficient in the sense of being more impactful than traditional classes on self-regulation, attachment, and the total protective factors overall. Implications are discussed within the context of the limitations of the study.

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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.

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BACKGROUND: Children from under-served communities are at risk for delayed spoken language and literacy development. Under-served preschools frequently contend with lack of resources, especially with regard to access to age-appropriate storybooks and/or print resources. Environmental print is a cost-effective material that can be used to stimulate emergent literacy skills. In the context of under-served communities, a collaborative approach and mentorship between preschool teachers and Speech-Language Therapists (SLTs) promote language and literacy development. OBJECTIVES: This article's purpose is two-fold; firstly, to discuss the use of environmental print as a stimulus material to promote emergent literacy in preschoolers in under-served preschools. Secondly, to promote the SLT's involvement in such education initiatives. METHOD: A mixed-method, comparative intervention research design, was reported in this article. A pre- and post-test design was employed, with data collected before and after a teacher-based intervention. RESULTS: Participants in the intervention group displayed increased scores on the Concepts About Print (CAP) assessment, participants in the comparison group showed no change in scores using the same assessment over the same time period. CONCLUSION: A short-term, teacher-based intervention using environmental print with SLT mentoring and collaboration promoted preschool children's emergent literacy skills. Implications include the value of using environmental print as a teaching material and the positive impact of collaboration between SLTs and teachers to promote emergent literacy in preschool children.

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Introduction: With the increased emergence of SARS-CoV-2 variants, the impact on schools and preschools remains a matter of debate. To ensure that schools and preschools are kept open safely, the identification of factors influencing the extent of outbreaks is of importance. Aim: To monitor dynamics of COVID-19 infections in schools and preschools and identify factors influencing the extent of outbreaks. Methods: In this prospective observational study we analyzed routine surveillance data of Mecklenburg-Western Pomerania, Germany, from calendar week (CW) 32, 2020 to CW19, 2021 regarding SARS-CoV-2 infection events in schools and preschools considering changes in infection control measures over time. A multivariate linear regression model was fitted to evaluate factors influencing the number of students, teachers and staff tested positive following index cases in schools and preschools. Due to an existing multicollinearity in the common multivariate regression model between the variables "face mask obligation for children" and "face mask obligation for adults", two further separate regression models were set up (Multivariate Model Adults and Multivariate Model Children). Results: We observed a significant increase in secondary cases in preschools in the first quarter of 2021 (CW8 to CW15, 2021), and simultaneously a decrease in secondary cases in schools. In multivariate regression analysis, the strongest predictor of the extent of the outbreaks was the teacher/ caregiver mask obligation (B = -1.9; 95% CI: -2.9 to -1.0; p < 0.001). Furthermore, adult index cases (adult only or child+adult combinations) increased the likelihood of secondary cases (B = 1.3; 95% CI: 0.9 to 1.8; p < 0.001). The face mask obligation for children also showed a significant reduction in the number of secondary cases (B = -0.6; 95% CI: -0.9 to -0.2; p = 0.004. Conclusion: The present study indicates that outbreak events at schools and preschools are effectively contained by an obligation for adults and children to wear face masks.

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Health risks caused by exposure to black carbon (BC) and nanoparticles (NP) are well studied, although no standard currently exists for them worldwide. Exposure to children may lead to serious health effects due to their increased vulnerability and longer time spend inside the classrooms, making it important to assess the factors that affect air quality in preschools. Thus, this work aims to evaluate indoor-outdoor (I/O) relationships of NPs in the 10-420 nm range, BC and volatile organic compounds (VOCs) at rural and urban preschools (aged 3-5 years) between May 2016 and July 2017. Factorial analysis was applied to identify the possible emission sources. Prior communalities were estimated by the squared multiple correlations with all other variables. We used the varimax rotation method and the criterion for factor selection was the number of eigenvalues greater than one. Results indicate that BC and NP were 4- and 3.2-times higher in urban outdoor caused by traffic emissions, respectively. Highest concentrations occurred during rush hours and during the pickup time of children. In urban school, BC was directly related to accumulation mode (N49-205), while in the rural area, BC was related to local traffic and particles from pulp industries in the regional background. Nucleation mode (N11-36) was related to traffic emissions in urban school, while in the rural school was related with secondary formation of particles. Mean I/O ratios of BC and NP in the urban (0.54; 0.51) and rural (0.71; 0.91) schools, respectively, suggested that their higher concentrations occurred in outdoors. VOCs were higher indoor in urban (I/O = 1.97) and rural (I/O = 2.22) sites, indicating these pollutants are generated inside, regardless of urban or rural sites. These findings suggest the necessity of improving ventilation and commuting styles to lower the exposure of children to air pollutants in and around school environments.

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In 2016, a group of 55 Syrian quota refugees arrived in Iceland from Lebanon and settled in three municipalities. There were 11 families comprising 20 adults and 35 children. This study1 aimed to critically explore the experiences, opportunities and challenges of these children, their parents, their teachers and principals in the municipalities of their resettlement since their arrival in Iceland. The theoretical framework of the study includes critical approaches to education, and multilingual education for social justice. Methods of data collection included semi-structured interviews with the refugee parents, the head teachers and teachers in all the schools in the study. While the findings indicate that most of the children were doing well both academically and socially in their first months in the schools, they also show that the children and parents have experienced a number of challenges. These included illiteracy, interrupted schooling of the children and hidden trauma before arriving in Iceland. After arrival, the parents have experienced lack of communication between schools and homes, as well as differences in norms, values, languages, and expectations between the schools and homes.

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BACKGROUND: Social skills are valid predictors for school readiness and subsequent school success. The federal state law for child day-care and preschools in Mecklenburg-Western Pomerania, a federal state in Germany, provides additional funds for the targeted and individualized promotion of social developmental delays for children in preschools in social hotspots. The law grants additional funds to eligible preschools, provided that each child's development is documented with a standardized, objective and valid screening instrument. METHODS: To monitor the development and to detect social developmental delays, the preschools involved use the "Dortmund Developmental Screening for Preschools" (DESK 3-6). For the prevalence and risk factors, data of 5595 children aged 3 to 6 years from these preschools were analyzed. RESULTS: 9.6% of the children show reasonable findings in their social development; for a further 6.1% the results were inconclusive. Sex, presence of chronic diseases or disabilities and reasonable findings in the domains motor development and language and cognition were risk factors in terms of social development across all age groups. CONCLUSIONS: The federal state law is a good example for the implementation of a standardized monitoring of the development of children. With the help of this screening instrument, prevention activities to reduce the prevalence of developmental delays can be conducted in early childhood. Early preventive activities should take into account the reported risk factors for the social development. TRIAL REGISTRATION: German Clinical Trials Register, ID: DRKS00015134, Registered on 29 October 2018, retrospectively registered.

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Environmental education focused on the early-childhood years is experiencing dynamic growth in research and practice due to persistent environmental challenges coupled with burgeoning interest in the documented benefits of nature-rich experiences for infants and children. To better understand the landscape of early childhood environmental education (ECEE) pedagogical practices and expected outcomes, we undertook a systematic review of empirical studies of ECEE programs. Focusing on a 25-year span, we surfaced 66 studies that met our inclusion criteria. We found that participants in such programs spanned the early-childhood age range (birth through age eight) with the majority involving three- to six-year-olds in teacher-led, formal (school-like) programs. The primary outcomes documented in our sample studies included environmental literacy development, cognitive development, and social and emotional development. To a lesser extent, the studies addressed physical development and language and literacy development. On balance, our sample of ECEE studies reported strongly positive findings associated with the aforementioned outcomes. The majority emphasized the effectiveness of play-based, nature-rich pedagogical approaches that incorporated movement and social interaction. We include a visualization that synthesizes cross-sample findings with the intention of assisting ECEE practitioners in developing, implementing, and evaluating programs as well as encouraging researchers to further study elements, processes, and theoretical assumptions inherent in them.