Explore the vast range of titles available.

The quality of staff/child interactions as measured by the Classroom Assessment Scoring System (CLASS) in Early Childhood Education and Care (ECEC) programs is thought to be important for children's outcomes. The CLASS is made of three domains that assess Emotional Support, Classroom Organization and Instructional Support. It is a relatively new measure that is being used increasingly for research, quality monitoring/accountability and other applied purposes. Our objective was to evaluate the association between the CLASS and child outcomes. Searches of Medline, PsycINFO, ERIC, websites of large datasets and reference sections of all retrieved articles were conducted up to July 3, 2015. Studies that measured association between the CLASS and child outcomes for preschool-aged children who attended ECEC programs were included after screening by two independent reviewers. Searches and data extraction were conducted by two independent reviewers. Thirty-five studies were systematically reviewed of which 19 provided data for meta-analyses. Most studies had moderate to high risk of bias. Of the 14 meta-analyses we conducted, associations between Classroom Organization and Pencil Tapping and between Instructional Support and SSRS Social Skills were significant with pooled correlations of .06 and .09 respectively. All associations were in the expected direction. In the systematic review, significant correlations were reported mainly from one large dataset. Substantial heterogeneity in use of the CLASS, its dimensions, child outcomes and statistical measures was identified. Greater consistency in study methodology is urgently needed. Given the multitude of factors that impact child development it is encouraging that our analyses revealed some, although small, associations between the CLASS and children's outcomes.

The Early Childhood Environment Rating Scale (ECERS) and its revised version (ECERS-R) were designed as global measures of quality that assess structural and process aspects of Early Childhood Education and Care (ECEC) programs. Despite frequent use of the ECERS/ECERS-R in research and applied settings, associations between it and child outcomes have not been systematically reviewed. The objective of this research was to evaluate the association between the ECERS/ECERS-R and children's wellbeing. Searches of Medline, PsycINFO, ERIC, websites of large datasets and reference sections of all retrieved articles were completed up to July 3, 2015. Eligible studies provided a statistical link between the ECERS/ECERS-R and child outcomes for preschool-aged children in ECEC programs. Of the 823 studies selected for full review, 73 were included in the systematic review and 16 were meta-analyzed. The combined sample across all eligible studies consisted of 33, 318 preschool-aged children. Qualitative systematic review results revealed that ECERS/ECERS-R total scores were more generally associated with positive outcomes than subscales or factors. Seventeen separate meta-analyses were conducted to assess the strength of association between the ECERS/ECERS-R and measures that assessed children's language, math and social-emotional outcomes. Meta-analyses revealed a small number of weak effects (in the expected direction) between the ECERS/ECERS-R total score and children's language and positive behavior outcomes. The Language-Reasoning subscale was weakly related to a language outcome. The enormous heterogeneity in how studies operationalized the ECERS/ECERS-R, the outcomes measured and statistics reported limited our ability to meta-analyze many studies. Greater consistency in study methodology is needed in this area of research. Despite these methodological challenges, the ECERS/ECERS-R does appear to capture aspects of quality that are important for children's wellbeing; however, the strength of association is weak.

Child-staff ratios are a key quality indicator in early childhood education and care (ECEC) programs. Better ratios are believed to improve child outcomes by increasing opportunities for individual interactions and educational instruction from staff. The purpose of this systematic review, and where possible, meta-analysis, was to evaluate the association between child-staff ratios in preschool ECEC programs and children's outcomes. Searches of Medline, PsycINFO, ERIC, websites of large datasets and reference sections of all retrieved articles were conducted up to July 3, 2015. Cross-sectional or longitudinal studies that evaluated the relationship between child-staff ratios in ECEC classrooms serving preschool aged children and child outcomes were independently identified by two reviewers. Data were independently extracted from included studies by two raters and differences between raters were resolved by consensus. Searches revealed 29 eligible studies (31 samples). Child-staff ratios ranged from 5 to 14.5 preschool-aged children per adult with a mean of 8.65. All 29 studies were included in the systematic review. However, the only meta-analysis that could be conducted was based on three studies that explored associations between ratios and children's receptive language. Results of this meta-analysis were not significant. Results of the qualitative systematic review revealed few significant relationships between child-staff ratios and child outcomes construed broadly. Thus, the available literature reveal few, if any, relationships between child-staff ratios in preschool ECEC programs and children's developmental outcomes. Substantial heterogeneity in the assessment of ratios, outcomes measured, and statistics used to capture associations limited quantitative synthesis. Other methodological limitations of the research integrated in this synthesis are discussed.

In the Early Childhood Education and Care (ECEC) sector there is a move to reduce oversight costs by reducing the frequency of quality assessments in providers who score highly consistently across time. However, virtually nothing is known about the stability of ECEC quality assessments over time. Using a validated measure of overall classroom quality, we examined stability of quality in a sample of over 1000 classrooms in licensed child care centres in Toronto, Canada over a 3-year period. Multilevel mixed-effects linear regression analyses revealed substantial instability across all types of ECEC centres, although publicly operated centres were somewhat more stable and tended to have higher quality scores. We also found substantial variance between classrooms within ECEC centres. None of the structural, child/family and neighbourhood characteristics we examined were significantly related to stability of quality ratings. The lack of stability found in our sample does not support the use of a risk-based approach to quality oversight in ECEC. Large within centre classroom quality variance suggest that all classrooms within a centre should be assessed individually. Furthermore, classroom level scores should be posted when scores are made public as part of accountability systems. Future research should, in addition to administrative data used in our study, explore how factors such as educator training, participation in program planning, reflective practices and ongoing learning might improve stability of quality over time.

Staff education is considered key to quality of early childhood education and care (ECEC) programs. However, findings about associations between staff education and children's outcomes have been inconsistent. We conducted a systematic review and meta-analysis of associations between ECEC staff education and child outcomes. Searches of Medline, PsycINFO, and ERIC, websites of large datasets and reference sections of all retrieved articles were conducted. Eligible studies provided a statistical link between staff education and child outcomes for preschool-aged children in ECEC programs. Titles, abstracts and paper reviews as well as all data extraction were conducted by two independent raters. Of the 823 studies reviewed for eligibility, 39 met our inclusion criteria. Research in this area is observational in nature and subject to the inherent biases of that research design. Results from our systematic review were hampered by heterogeneity in how staff education was defined, variability in whose education was measured and the child outcomes that were assessed. However, overall the qualitative summary indicates that associations between staff education and childhood outcomes are non-existent to very borderline positive. In our meta-analysis of more homogeneous studies we identified certain positive, albeit very weak, associations between staff education and children's language outcomes (specifically, vocabulary and letter word identification) and no significant association with a mathematics outcome (WJ Applied Problems). Thus, our findings suggest that within the range of education levels found in the existing literature, education is not a key driver of child outcomes. However, since we only explored levels of education that were reported in the literature, our findings cannot be used to argue for lowering education standards in ECEC settings.

Background Timely, appropriate, and equitable access to quality healthcare during pregnancy is proven to contribute to better health outcomes of birthing individuals and infants following birth. Equity is conceptualized as the absence of differences in healthcare access and quality among population groups. Healthcare policies are guides for front-line practices, and despite merits of contemporary policies striving to foster equitable healthcare, inequities persist. The purpose of this umbrella review is to identify prenatal healthcare practices, summarize how equities/inequities are reported in relation to patient experiences or health outcomes when accessing or using services, and collate equity reporting characteristics. Methods For this umbrella review, six electronic databases were searched (Medline, EMBASE, APA PsychInfo, CINAHL, International Bibliography of the Social Sciences, and Cochrane Library). Included studies were extracted for publication and study characteristics, equity reporting, primary outcomes (prenatal care influenced by equity/inequity) and secondary outcomes (infant health influenced by equity/inequity during pregnancy). Data was analyzed deductively using the PROGRESS-Plus equity framework and by summative content analysis for equity reporting characteristics. The included articles were assessed for quality using the Risk of Bias Assessment Tool for Systematic Reviews. Results The search identified 8065 articles and 236 underwent full-text screening. Of the 236, 68 systematic reviews were included with first authors representing 20 different countries. The population focus of included studies ranged across prenatal only ( n  = 14), perinatal ( n  = 25), maternal ( n  = 2), maternal and child ( n  = 19), and a general population ( n  = 8). Barriers to equity in prenatal care included travel and financial burden, culturally insensitive practices that deterred care engagement and continuity, and discriminatory behaviour that reduced care access and satisfaction. Facilitators to achieve equity included innovations such as community health workers, home visitation programs, conditional cash transfer programs, virtual care, and cross-cultural training, to enhance patient experiences and increase their access to, and use of health services. There was overlap across PROGRESS-Plus factors. Conclusions This umbrella review collated inequities present in prenatal healthcare services, globally. Further, this synthesis contributes to future solution and action-oriented research and practice by assembling evidence-informed opportunities, innovations, and approaches that may foster equitable prenatal health services to all members of diverse communities.

Instability in early childhood education and care (ECEC) arrangements may have detrimental consequences on children’s mental health. This study examined ECEC trajectories in the first 30 months of life for 373 children from low-income families in Toronto. We provide information about patterns of instability and reasons for instability. We also tested whether instability in ECEC was related to children’s mental health using the Strengths and Difficulties Questionnaire. Five main profiles of ECEC stability were identified: (1) 8% in Home-Only, (2) 56.3% in Home-Center, (3) 8.0% in Home-Center-Home, (4) 5.9% in In-and-Out, and (5) 20.9% in Home-Multiple-Centers. Frequently mentioned reasons for change were a new baby in the family, availability of grandparents, quality of ECEC and family relocation. Families in these different profiles had similar demographic characteristics. Of the five profiles, children in the Home-Center-Home profile had a significantly higher likelihood of experiencing mental health problems compared to the Home-Center and Home-Multiple-Centers groups. These findings have important implications for future research, policy and practice related to ECEC availability.

Responsive caregiving is the dimension of parenting most consistently related to later child functioning in both developing and developed countries. There is a growing need for efficient, psychometrically sound and culturally appropriate measurement of this construct. This study describes the cross-cultural validation in Brazil of the Responsive Interactions for Learning (RIFL-P) measure, requiring only eight minutes for assessment and coding. The cross-cultural adaptation used a recognized seven-step procedure. The adapted version was applied to a stratified sample of 153 Brazilian mother–child (18 months) dyads. Videos of mother–child interaction were coded using the RIFL-P and a longer gold standard parenting assessment. Mothers completed a survey on child stimulation (18 months) and child outcomes were measured at 24 months. Internal consistency (α = 0.94), inter-rater reliability (r = 0.83), and intra-rater reliability (r = 0.94) were all satisfactory to high. RIFL-P scores were significantly correlated with another measurement of parenting (r’s ranged from 0.32 to 0.47, p < 0.001), stimulation markers (r = 0.34, p < 0.01), and children’s cognition (r = 0.29, p < 0.001), language (r = 0.28, p < 0.001), and positive behavior (r = 0.17, p < 0.05). The Brazilian Portuguese version is a valid and reliable instrument for a brief assessment of responsive caregiving.

Abstract Natural environments in healthcare design are thought to promote health. However, its empirical research in long-term care (LTC) has been limited; the degree of rigor is mixed, focusing on older adults with little research on professional caregivers. This study examined the relationships between the natural environment and the mental health and well-being of older adults 65+ living with Alzheimer’s disease and related dementias (residents) and of their professional caregivers in LTC homes using a rigorously developed survey to standardize an approach to the evaluation of natural environments for these population groups. A cross-sectional, multiphase mixed method study was conducted that included a scoping review (n=137), a Delphi panel (n=24 experts), cognitive debriefing interviews (n=33), psychometric evaluations (n=83 LTC home areas), and multilevel modeling and regression analyses (n=1599 residents; n=563 professional caregivers). A conceptual framework on the natural environment in healthcare was developed, which informed the development of the Natural Environment Survey for Long-Term Care. This survey evaluates 1) the design of natural environments, 2) residents’ usage of and exposure to natural environments, and 3) professional caregivers’ usage of, exposure to, and perception of natural environments. Unlocked doors to outdoor spaces, outdoor activities, and indoor activities were significantly associated with residents’ responsive behavior in secure home areas (i.e., locked access and egress). Usage of and exposure to the natural environment during breaks and leisure were associated with their professional caregivers’ work-related stress, burnout, and turnover intention in secure and non-secure home areas. These findings have potential utility for decision-makers transforming LTC.

Background The publication of the International Subarachnoid Aneurysm Trial rapidly changed the management of patients with subarachnoid hemorrhage. The present and perceived future trends of aneurysm management have significant implications for patients and how we educate future cerebrovascular specialists. Objective To determine present perceived competencies of final-year neurosurgical residents who have just finished their residencies and to relate those to what practitioners from a variety of continents expect of these persons. The goal is to provide a basis for further discussion regarding the design of further educational programs in neurosurgery. Methods A 55-item questionnaire with 33 questions related to competencies and expectations of competency from final-year residents who have just finished residency was completed by 229 neurosurgeons and neuro-radiologists (81 % response rate) of mixed seniority from 45 countries. We used bivariate and descriptive analyses to determine future trends and geographic differences in cerebral aneurysm management as well as the educational implications on the future. Results More North Americans than those from the rest of the world are of the opinion that graduating residents are presently competent to perform basic cerebrovascular procedures like evacuation of a hematoma and clipping a simple 7-mm middle cerebral artery aneurysm. Extremely few graduating neurosurgical residents anywhere are presently capable of performing endovascular techniques for even the most basic of aneurysms. Most of those surveyed also believe that endovascular and open surgical management of aneurysms should be a part of residency training for all residents (70.4 and 88.7 %, respectively). Conclusions Our findings have implications for the design of neurosurgical curricula for residents as well as for certification examinations and procedures. Specialty and educational organizations and those responsible for the education of future clinicians who will care for patients with cerebrovascular problems should adjust educational objectives and implement curricula and learning experiences that will ensure that cerebrovascular specialists are capable of providing the best care possible to the patient with an aneurysm, whether that be open surgery or endovascular management. These findings mean that organizations around the world will need to make these adjustments to the education of future specialists.