Preschool Facility Research Articles

An Analysis of the Level of Parental Demand for a Preschool Facility with a Special Focus on the Inclusion of Artistically Gifted Children and the Adequacy of its Marketability

The aim of this paper is to analyse the level of awareness and interest of parents and other relevant subjects in a new form of educational preparation for the inclusion of specially talented children, and the adequacy of its introduction to the market, through the analysis of demographic development at selected locations. The research in this area is very underdeveloped, because the focus is shifted towards the other end of the spectrum, and that is why we would like to draw attention to this problem via our article. In the introduction, the paper deals with the theoretical definition of social inclusion of gifted children and social entrepreneurship and its conditions in the Slovak Republic. In a separate chapter, the paper describes the methodology, data collection procedure, and sources and methods used, such as abstraction, comparison, and basic statistical and mathematical methods. Then exponential smoothing was used for prediction. We analysed through a survey the interest of parents and other relevant subjects, and the data collected was then synthesised. The last chapter presents the results of our work together with its limitations, and recommendations for future research. The whole idea of our preschool facility could be summarised in four words based on our results, namely, adequate, necessary, desirable and original. The paper serves to clarify and support the solution of our chosen research problem: education and the inclusion of above-average gifted children through social entrepreneurship.

Functional Design of Lekotek Centers

This study aims to investigate the current trends in inclusive preschool educational facility design and planning. It highlights the most common types of special needs preschool establishments, which was made possible through the historical analysis of regulatory guidelines and studying the most common disabilities in children. The facilities under analysis provide advisory support and educational services for children with special needs and their families. The paper also gives a definition of a lekotek as a new generation preschool facility designed to solve problems of socialization and education for disabled children and their parents. The research draws on statistical information confirming the relevance of this study. It systematizes the historical evidence of the development of inclusive preschool facilities, which reflects how this type of buildings and its functional design evolved in different countries. The study proposes a methodology for developing a functional design of a lekotek so that it creates a better classroom environment for children with special needs that allows them to thrive and rehabilitate in an educational setting.

Children’s Drawings of Themselves after Exercising Drawn in a Five-year-old Class of a Preschool Facility

Children’s Drawings of Themselves after Exercising Drawn in a Five-year-old Class of a Preschool Facility

Do it yourself: The role of early self-care ability in social skills in Japanese preschool settings

Self-care ability and social skills are potential areas of difficulty for preschool children. However, values about young children's self-care ability are different worldwide. This longitudinal study examined the influence of early self-care ability on social skills at the end of the preschool years. Participants were 509 children recruited from kindergartens and child care centers across Japan, whose self-care ability and social skills were assessed at baseline year and three years later (Age of children in 2015 at baseline: M = 35 months, SD = 6.1 months). The study found that gender was significantly associated with social skills, while preschool facility entrance age was only associated with assertion skills. After controlling gender and entrance age, early self-care ability was still positively related to later assertion and cooperation (Assertion: OR = 2.55, 95% CI = 1.00–6.51; Cooperation: OR = 3.15, 95% CI = 1.23–8.07). Implications of the findings are discussed in the context of cultural diversity, highlighting the importance of cultivating children's age-appropriate self-care ability based on daily observations and evaluations.

Parental Views on the Lives of Preschool Children in the Covid-19 Pandemic Process

This study aims to investigate the parental views of pre-school children during the Covid 19 pandemic and is conducted using a basic qualitative research design from qualitative research methods. In the study, parents of children attending pre-school institution were identified through criterion sampling techniques from non-selective sampling methods. The study prepared a semi-structured interview form for parents with children attending pre-school institution as an instrument for data collection. The data from the semi-structured interview form was collected through online interviews with parents whose children attend the pre-school facility. As a result of the study, parents indicated that during the pre-school children's pandemic process, there were more activities with family members at home, the children spent more time with technological devices, terms such as pandemic, diseases, and viruses were frequently used in their daily conversations, and their negative, boring, and aggressive behaviors increased. It was also noted that children were sleeping and waking up later during this time, thus changing their sleep patterns. Another finding observed by the parents was that irregular eating habits increased in the children's eating behavior. It was observed by the parents that children were washing their hands more frequently than before the pandemic. Another finding of the study was that children spoke with longing about their school life due to the disruption of personal instruction in schools.

ОЦЕНКА МЕР СОЦИАЛЬНОЙ ПОДДЕРЖКИ МЕДИЦИНСКИХ РАБОТНИКОВ ИРКУТСКОЙ ОБЛАСТИ, ЗАЯВЛЕННЫХ В ОФИЦИАЛЬНЫХ ПРЕДЛОЖЕНИЯХ ОБ ИХ ТРУДОУСТРОЙСТВЕ

Significance. Social support measures for healthcare workers are one of the key mechanisms for retaining specialists. Meanwhile, according to the Ministry of Health of the Russian Federation, the current indicators of their implementation remain unsatisfactory. The purpose of the study was to assess frequency and structure of social support measures for medical workers based on the data of the official employment proposals posted by state medical organizations on the website of the Ministry of Health of the Irkutsk Region. Material and methods. Statistical charts have been developed, they included information from the employment proposals posted on the official website of the Ministry of Health of the Irkutsk Region, the total number of proposals added up to 429. Statistical methods to process the material included calculation of the extensive and intensive indexes without determining confidence intervals because the general aggregate was used in all cases. Results. The most wanted out of all doctors are district therapists (7.0% in the structure of doctors’ vacancies), followed by obstetricians-gynecologists (6.7%) and infectious disease specialists (6.1%). As for nursing staff, the highest number of employment proposals were looking for feldshers (22.4%), ward nurses (12.9%) and district nurses (11.2%). Of the total number of job proposals, social support measures were stated in 76.2 proposals out of 100, while the frequency of these measures added up to 77.4 out of 100 for doctors and 63.8 for nurses. The stated social support measures for doctors in the ascending order include as follows: issues related to housing (79.2 per 100 employment proposals); direct financial support (72.2 per 100); provision of a place in a preschool facility without waiting (35.1); additional vacation and travel expense reimbursement (27.2); reimbursement of expenses related to relocation and travel to the place of employment (14.4); payment for postgraduate and additional professional education (9.3). The rank structure of social support measures for nursing staff differs in the order, starting from the third. Conclusion. In both absolute and relative terms, the measures of social support stated by the employment proposals for doctors prevail. While primary health care workers are in highest demand, the need for such specialists is not directly reflected by the corresponding frequency of the stated social support measures. The results obtained are relevant to the development and implementation of the evidence-based personnel policy in healthcare at the level of an individual region of the Russian Federation.

Markers showing allergic reactions in children caused by aerogenic exposure to manganese and nickel compounds

High prevalence of allergic diseases among children and their close relation with quality of the environment require new approaches to organizing diagnostic and prevention activities. Our research objects were 247 children attending pre-school children facilities (PSCF). It was detected that children who permanently lived and/or attended a pre-school facility for not less than three years under long-term chemical aerogenic exposure to manganese and nickel compounds in low doses (0.17–0.23 MPC average daily) had contents of these metals in their blood that were 1.9–2.0 times higher than the same parameter in children from the reference group and 1.7–2.1 times higher than background level in the region. Pre-school children with their biological media being contaminated with nickel and manganese compounds suffered from atopic dermatitis, allergic rhinitis, and bronchial asthma 1.3–4.5 times more frequently (0.23R20.73; 59.2F388.1; р≤0.001). Allergic diseases associated with aerogenic exposure to chemicals with sensitizing power have certain pathogenetic peculiarities such as active overall inflammatory reaction; sensitization in 54–86% children (the parameter is 1.5–4.3 times higher than in the reference group); cellular metabolism disorder; depletion of antioxidant protection resources in 72% children; deficient activity of phagocytic and humoral section in immunity (1.2 times lower than in the reference group); cytokine regulation disorders (2.4–2.5 time difference); reduced expression of a receptor that induces activation apoptosis; stronger sympathetic influence on heart rate modulation in 26.0% children. Basing on statistical analysis and model making, we determined markers that showed occurring allergic reactions caused by aerogenic exposure to manganese and nickel compounds. These markers are targets for prevention activities; they include growth in allergic pathologies prevalence; these pathologies occurring together with chronic inflammatory-proliferative diseases and disorders in the vegetative nervous system; increased contents of leukocytes, eosinophils, and immunoglobulin E specific to nickel in blood; a decrease in phagocyte number and contents of IgM, IgА in blood serum (0.07≤R2≤0.74; 19.3≤F≤713.2; р≤0.0001).

Маркерные показатели реализации у детского населения аллергических реакций, ассоциированных с аэрогенным воздействием соединений марганца и никеля

High prevalence of allergic diseases among children and their close relation with quality of the environment require new approaches to organizing diagnostic and prevention activities. Our research objects were 247 children attending pre-school children facilities (PSCF). It was detected that children who permanently lived and/or attended a pre-school facility for not less than three years under long-term chemical aerogenic exposure to manganese and nickel compounds in low doses (0.17–0.23 MPC average daily) had contents of these metals in their blood that were 1.9–2.0 times higher than the same parameter in children from the reference group and 1.7–2.1 times higher than background level in the region. Pre-school children with their biological media being contaminated with nickel and manganese compounds suffered from atopic dermatitis, allergic rhinitis, and bronchial asthma 1.3–4.5 times more frequently (0.23R20.73; 59.2F388.1; р≤0.001). Allergic diseases associated with aerogenic exposure to chemicals with sensitizing power have certain pathogenetic peculiarities such as active overall inflammatory reaction; sensitization in 54–86% children (the parameter is 1.5–4.3 times higher than in the reference group); cellular metabolism disorder; depletion of antioxidant protection resources in 72% children; deficient activity of phagocytic and humoral section in immunity (1.2 times lower than in the reference group); cytokine regulation disorders (2.4–2.5 time difference); reduced expression of a receptor that induces activation apoptosis; stronger sympathetic influence on heart rate modulation in 26.0% children. Basing on statistical analysis and model making, we determined markers that showed occurring allergic reactions caused by aerogenic exposure to manganese and nickel compounds. These markers are targets for prevention activities; they include growth in allergic pathologies prevalence; these pathologies occurring together with chronic inflammatory-proliferative diseases and disorders in the vegetative nervous system; increased contents of leukocytes, eosinophils, and immunoglobulin E specific to nickel in blood; a decrease in phagocyte number and contents of IgM, IgА in blood serum (0.07≤R2≤0.74; 19.3≤F≤713.2; р≤0.0001).

The benefits and challenges of a rural community-based work-ready placement program for allied health students.

Rural and remote Australia has a shortage of allied health clinicians. The provision of quality rural placement experiences for allied health students has been a significant strategy to address these health workforce shortages. Service learning rural placements are providing allied health services in small rural towns where previously allied health services were limited or did not exist. Published literature has little detailed description of the origin or nature of particular placement programs. An increase in Commonwealth funding for rural allied health clinical placements led to the development of an innovative service learning placement model in northern New South Wales, the Rural Community-Based Work-Ready Placement Program. During this placement, students were paired for 4-10 full-time weeks in a preschool, school or aged care facility. The program's fundamental properties included cultural and social equity education, providing continuous service throughout the year, and quality improvement initiatives in placement sites. The program was underpinned by an interdisciplinary approach that included interdisciplinary placements, interdisciplinary supervision and a structured interdisciplinary education program. The program required investment in stakeholder engagement and in the alignment of universities' requirements for student learning outcomes and the sites' specific needs. Clinical supervisors had to adapt to supervising students from various disciplines and universities across several sites, towns and services. The program provided students with opportunities to work autonomously, problem-solve and to initiate and implement quality improvement projects at each site. Careful selection of students, adequate preparation and management of students' expectations were important contributors to the success of the program. Providing a continuous service is an ongoing logistical challenge.

Behavioral mapping of children\u2019s physical activities and social behaviors in an indoor preschool facility: methodological challenges in revealing the influence of space in play

BackgroundGIS (Geographic Information Systems) based behavior maps are useful for visualizing and analyzing how children utilize their play spaces. However, a GIS needs accurate locational information to ensure that observations are correctly represented on the layout maps of play spaces. The most commonly used tools for observing and coding free play among children in indoor play spaces require that locational data be collected alongside other play variables. There is a need for a practical, cost-effective approach for extending most tools for analyzing free play by adding geospatial locational information to children’s behavior data collected in indoor play environments.ResultsWe provide a non-intrusive approach to adding locational information to behavior data acquired from video recordings of preschool children in their indoor play spaces. The gridding technique showed to be a cost-effective method of gathering locational information about children from video recordings of their indoor physical activities and social behaviors. Visualizing the proportions of categories and observed intervals was done using bubble pie charts which allowed for the merging of multiple categorical information on one map. The addition of locational information to other play activity and social behavior data presented the opportunity to assess what types of equipment or play areas may encourage different physical activities and social behaviors among preschool children.ConclusionsGridding is an effective method for providing locational data when analyzing physical activities and social behaviors of preschool children in indoor spaces. It is also reproducible for most GIS behavior mapping focusing on indoor environments. This bypasses the need to have positioning devices attached to children during observations, which can raise ethical considerations regarding children’s privacy and methodological implications with children playing less naturally. It also supports visualizations on behavior maps making them easier to interpret.

An outbreak of Salmonella Saintpaul in a Scottish childcare facility: the influence of parental under-reporting

BackgroundSalmonella outbreaks in childcare facilities are relatively rare, most often occurring secondary to contaminated food products or poor infection control practices. We report an outbreak of Salmonella Saintpaul at a pre-school facility in Ayrshire, Scotland with atypical clinical and epidemiological features.MethodsFollowing notification of the initial two cases, the multi-disciplinary Incident Management Team initiated enhanced active case finding and two environmental inspections of the site, including food preparation areas. Parent and staff interviews were conducted by the Public Health department covering attendance, symptomatology and risk factors for all probable and confirmed cases. Microbiological testing of stool samples and the facility water tank was conducted. Whole Genome Sequencing (WGS) was performed for positive stool samples at the national reference laboratory. Infection control measures were introduced iteratively due to the atypical progression of the outbreak.ResultsThere were 15 confirmed cases and 3 children admitted to hospital during the outbreak. However, 35.7% of cases reported extremely mild symptoms. The attack rate was 15.2%, and age of affected children ranged from 18 to 58 months (mean 35 months). All cases were the same Multilocus Sequence Type (MLST50). Epidemiological investigation strongly suggested person-to-person spread within the facility. Existing infection control practices were found to be of a high standard, but introduction of additional evidence-based control measures was inadequate in halting transmission. Facility staff reported concerns about lack of parental disclosure of gastrointestinal symptoms, particularly where these were mild, with 50.0% of cases having attended while symptomatic against public health advice. Voluntary two-week closure of the facility was implemented to halt transmission, following which there were no new cases. WGS results were unavailable until after the decision was taken to close the facility.ConclusionsThis is the first reported instance of a Salmonella Saintpaul outbreak at a childcare facility, or where person-to-person transmission is indicated. Clinicians should consider the influence of parental under-reporting on gastrointestinal outbreaks in childcare settings, particularly where perceived severity is low and financial or social pressures to attend work may reduce compliance. WGS cannot yet replace conventional microbiological techniques during short, localised outbreaks due to delays receiving results.

176 The Impact of Inter-generational Care on the Emotional Well-Being of Older Persons with Dementia Living in Long Term Care Settings

Abstract Background A significant number of older persons living with dementia highlight feelings of low mood following admission to care settings. There needs to be ongoing development in addressing the emotional well-being of this group as highlighted by 2013 NICE quality standard: Mental well-being of older persons in care homes. This exploratory study evaluates the impact of an inter-generational care group with emphasis on the emotional well-being of the older persons. A structured programme of shared experiences between the older persons group and pre-school age children was introduced. Methods Approval was sought from the safeguarding committee and insurance board of the care facility. Consent was obtained from residents to participate. Risk assessments were completed for the activities and the participants. Cognitive screen score and communication ability of each resident was noted in selecting the focus group (n=10). Outcome measures included qualitative interviews completed after each session. A qualitative mood wheel was completed with residents before and after the session had taken place. Results Focus group data supported the programme’s impact on emotional well-being. Eighty percent of participants reported mood elevation. Other benefits identified included excitement for the next session and bringing back memories of raising their own children and grandchildren. A singular negative aspect identified was that on occasion over stimulation impacted mood and participation level of one resident. Ninety percent of participants were female. The costs incurred were minimal to the organisation. Provision of resources were shared between the care facility and preschool facility. Conclusion The findings of this study support the use of inter-generational care groups in long term care facilities for residents with dementia. It confirms the benefits of improving emotional well-being of this cohort. Adequate supervision measures must be in place to regulate the stimulation level of the environment and facilitate individuals to exit the session.

Interventions Aimed at Increasing Dairy and/or Calcium Consumption of Preschool-Aged Children: A Systematic Literature Review.

Dairy product consumption is important during childhood, as dairy products provide nutrients to support growth and development. However, a high proportion of children globally are not meeting recommended daily intakes, which may have long-term health implications. Accumulating evidence suggests that interventions aimed at instilling healthy lifestyle habits are most effective when initiated during the preschool years. Therefore, the purpose of the review was to identify the characteristics of effective dairy and/or calcium interventions targeting preschool-aged children. A systematic literature review identified 14 intervention studies published between 1998–2018 addressing dairy/calcium intakes in the preschool population (1.5 to 5 years). Intervention reporting was assessed using intervention intensity, behavior change techniques and Workgroup for Intervention Development and Evaluation Research (WIDER), with the quality of studies evaluated using risk of bias and Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Five of the 14 studies included in the review reported significant improvements in children’s dairy (4/5) or calcium (1/5) intake. Characteristics that may enable intervention effectiveness include the delivery of interventions in one setting (preschool facility), using specific behavior change techniques (environmental restructuring and teach to use prompts/cues), and targeting both parent and child. Overall, the interventions assessed demonstrated variable success and highlighted the need for developing effective interventions designed to increase dairy and/or calcium intakes in preschool-aged children.

Perspectives on Inclusive Education of Preschool Children with Autism Spectrum Disorders and Other Developmental Disabilities in Iran.

Background: Iranian children with disabilities invariably attend special schools and many may be excluded from education entirely. Information on preschool education is limited but probably mirrors the situation in schools. There is a lack of information in terms of parental preferences for schooling and teachers’ experiences of inclusion in Iran. Method: Two feasibility studies were undertaken; one with 89 parents of children with autism or intellectual disabilities, and another with the head teachers of two private kindergartens. Results: Two-thirds of parents favored inclusive schools; most parents whose children had autism or were verbally proficient were in favor of their child attending ordinary schools, even if their child had been placed in a specialist preschool facility. The head teachers justified inclusion in terms of children’s rights but identified three main challenges: coping with the diverse level of functioning, the need for special devices and training of teachers, and challenging the negative reactions of parents of non-disabled children. Conclusions: Further exploration of the views of those who have experienced inclusion would further challenge existing practices. Moreover, the training and preparation of teachers is key to reforming schools. However, wider social values and beliefs towards disabilities also need to change.

Measuring Potential of Preschool Facility Staff to Prevent Early Childhood Caries

AbstractThe aim of this study was to investigate the possible potential of preschool staff through a newly designed questionnaire and evaluate their role in the prevention of early childhood caries (EEC) in Serbia where extremely high prevalence of this preventable disease was recorded.We preformed a cross-sectional study of 268 preschool staff using specially prepared semi-structured questionnaire for measuring potential of secondary children’s caregivers to prevent EEC. The questionnaire was tested on a pilot sample and after that all collected data were analyzed trough construction of correlation matrix with the evaluation of the value of each question, reliability testing, factorial analysis and estimating of its validity using SPSS software.The tested questionnaire had good internal consistency based on the Cronbach’s alpha coefficient value of 0.873 calculated directly and similar value (0.899) after applied Spearman-Brown “prediction” formula. Using exploratory factorial analysis and orthogonal rotation, we identified two domains that emerged with similar loadings (4.043 and 3.183). The first factor (domain) reflected attitudes of the study participants towards prevention of EEC, and the second factor (domain) showed behaviour of the study participants, which includes preventive actions against EEC.The total score of the questionnaire was correlated positively with oral health knowledge (Spearman’s correlation coefficient 0.331, p=000) and inversely with the length of employment, where each additional year of employment decreased the total score of the questionnaire by 1.20.These findings could partially explain an extremely high prevalence of EEC in young children and indicate that preschool teachers should be more engaged in health education activities and motivation programs.

Does Preschool Boost the Development of Minority Children?: The Case of Roma Children

Summary Does universal preschool constitute an effective policy tool to promote the development and integration of children from minority groups? We address this question for the children of the Roma—the largest and most disadvantaged minority group in Europe. To tackle the issue of non-random selection into preschool, we exploit variation in the individual distance to the nearest preschool facility. Non-parametric instrumental variable estimations reveal significant short-term gains in terms of children's literacy. Preschool attendance also increases the prevalence of vaccinations but has no effect on other observed health outcomes. Overall, preschool also does not seem to enhance integration measured by children's language proficiency or social–emotional development, at least not in the short term.

Analysis of Macronutrients Intake and Body Mass Index in Preschool Children in the Western Region of the Republic of Srpska.

Childhood obesity is currently considered to be one of the most prevailing and challenging public health issues in industrialized countries and some developing countries, including the Republic of Srpska. Our objective was to determine macronutrients intake in collective diet of preschool children and to estimate the rate of obesity in this population. Samples of food intended for preschool children diet were collected in a preschool facility in the western region of the Republic of Srpska. In daily portions, the content of proteins, fats, carbohydrates, water and mineral matter were determined using standard methods. The body mass index was determined on the basis of anthropometric measurements. RESULTS An average daily meal contained 17.5 g of fats, 19.1 g of proteins and 101.5 g of carbohydrates. The energy value was 676 Kcal. The analysis of the data from the menu showed that the number of consumed servings of fruits, vegetables, legumes, milk and dairy products was less than one portion per day. However, the amount of consumed meat and meat products exceeded one portion per day. Out of the total number of children, 10.0% were undernourished, 16.7% were overweight and 13.3% were obese. Daily portions in the preschool facility are not in accordance with the recommended dietary allowance for energy and carbohydrates intake, and the composition of meals is inadequate. Parents and caregivers should be encouraged to expose young children to a wide variety of fruit and vegetables, whole grains, low-fat dairy products, and to balance food intake with the requirements.

Preschool Power Play: Resource Control Strategies Associated with Health

Background. This exploratory study uses a multimethod approach to examine the relationship between social strategy usage and overall health in preschool children. Methods. Children's temperament, social strategies, and health assessments were obtained via reported behavior from parents and teachers. In addition, children's use of prosocial and coercive strategies was observed and recorded via one-way windows in the preschool facility. Results. Results revealed that the temperament characteristic of effortful control was related to the observed use of coercive strategies and that coercive strategies were not observed by teachers, who viewed these children as primarily prosocial. The reported use of both coercive and prosocial strategies was also related to decrease in illness. Conclusion. These findings in relation to previous work suggest that using both prosocial and coercive strategies can elevate status as well as maintain health even in young children.

Revitalization process of preschool buildings

This paper represents the research associated with establishment of the methodological approach to reviving architecture designed for children?s upbringing and education, and consider new possible strategies for implementing eco-principles in the existing construction fund of preschool facilities in Serbia. Basic research problem is global state of resources, energy consumption and disrupted children comfort in preschool facilities. Research gives concrete proposals for future architectural praxis in Serbia in terms of eliminating the aforementioned problems. The aim of the research is to record and valorize practical measures for environmental, energy-efficient and economic reshaping in accordance with pre-set criteria, which will provide healthy, safe, comfortable, functional and progressive eco inner and outer environment of a child in preschool facility.

Cluster of three cases of invasive meningococcal disease in a preschool facility in West Bohemia, the Czech Republic

From 1993 to 2009, there was only one cluster of invasive meningococcal disease (IMD) reported in a community of children in the Czech Republic. This exceptional cluster that occurred in a preschool facility is the focus of this report. In response to the announcement of the disease, anti-epidemic precautions were put in place. Neisseria meningitidis isolates were delivered from local laboratories to the National Reference Laboratory for Meningococcal Infections in Prague. Phenotyping was performed there along with multilocus sequence typing. Related factors and microbiological results were analyzed retrospectively. In October 2009, three girls contracted IMD within a period of 1week in a 42-member group in a preschool facility attached to the elementary school in Starý Plzenec-Sedlec. In relation to three cases of the disease, another 66 people were registered of which 58 underwent a microbiological examination. N. meningitidis was detected in a total of five (8.6%) people. The National Reference Laboratory for Meningococcal Infections defined the type of the strain to be C: P1.18-1,34-2,38: F1-7: ST-467 (cc269) and penA27. Tests showed the precise identity of all strains obtained from the three sick children and of two strains contracted through contact with the preschool facility. Despite the complete recovery of all patients with no permanent damage, the need for rapid cooperation between clinical sites, diagnostic laboratories, and epidemiologists was confirmed.