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  1. Short Reviews
  2. BioMed Research International
  3. Pediatric Tuberculosis in Young Children in India: A Prospective Study

Hestenes and Carroll observed an inclusive classroom with approximately equal numbers of typically developing children and children with disabilities and found that those without disabilities engaged in more cooperative and less solitary play than did those with disabilities. Although both groups of children chose similar activities, typically developing children interacted less often with children with disabilities than expected. They suggest that, while effects of inclusive settings on play patterns of children with disabilities are not yet clear, such settings do not appear to disrupt the play of typically developing children.

In sum, research has shown some clear links between social and linguistic competence and high-quality pretense; thus, engagement in such pretense with peers may assist children's development in these areas. Numerous studies of literacy skill development through play, which embed literacy materials within play settings in preschool, kindergarten, and multiage programs, have typically shown increases in children's use of literacy materials and engagement in literacy acts e.

Using such a literacy intervention, Vukelich found that kindergarten children's ability to read print embedded in the environment was increased. In a longitudinal study, Bergen and Mauer found that children who had high levels of play with literacy materials in preschool were likely to be spontaneous readers of place signs and have greater pretend verbalizations in a "town-building" activity at age 5.

Roskos and Neuman have pointed out that, although emerging literacy can be enhanced through play, further research comparing the efficacy of play-related literacy approaches to other methods of increasing literacy skills is still needed, as are longitudinal studies. Using a strategy similar to the literacy-embedding studies, Cook enriched preschoolers' pretend play settings with artifacts emphasizing number symbols and found that the children in the math-enriched setting engaged in more talk and activity related to mathematical concepts; however, the effects did not extend to more mature conceptual forms.

The researchers speculate that the reasons no relationships were found with third- and fifth-grade test scores may be because of the "minimum skill and memorization" tests used in those earlier grades, and that when children developed formal operational thought processes by seventh grade, these might build on their early play experiences. They suggest that more researchers engage in "empirical longitudinal research for the positions taken in the support of play learning and curriculum" p. There is still a great need for research on the relationship between high-quality pretend play and development of specific academic skills; however, perhaps because the typical school environment does not allow sufficient time for children to engage in extended themes of social pretense, this line of research has not been extensive.

More recently, due to state and national emphasis on proficiency test performance, even the small segments of social pretend play time that have been allowed if not encouraged in school, such as kindergarten "choice" time and recess breaks, are disappearing. The press for "academic readiness" through concentrated and direct teaching of alphabet, number, color, and other skills is now affecting the amount of time allocated for play in preschools. This trend has had a negative effect on social pretend play, which requires extended uninterrupted time periods to develop complexity.

Thus, one major challenge for proponents of such play is to be able to articulate to policy makers how children's development of the types of cognitive skills that are demonstrated in pretense is as important or even more important for academic readiness and later school success than memorizing the standard set of information officially targeted as early childhood competencies. Even if play has not yet been demonstrated to be the cause of long-term school success, the evidence is very clear that it is an integrated coexisting component of young children's developmental progress.

Further, because most tests now being designed for elementary-age children require strong representational skills, problem-solving abilities, and social-linguistic sophistication, proponents of play must be ready to demonstrate how the development of the cognitive skills exercised in pretend play are also essential for good test performance. In sum, there is a growing body of evidence supporting the many connections between cognitive competence and high-quality pretend play. If children lack opportunities to experience such play, their long-term capacities related to metacognition, problem solving, and social cognition, as well as to academic areas such as literacy, mathematics, and science, may be diminished.

These complex and multidimensional skills involving many areas of the brain are most likely to thrive in an atmosphere rich in high-quality pretend play. Indexical and symbolic referencing: What role do they play in children's success on theory of mind tasks? Cognition, 80 3 , Stages of play development.

In Doris Bergen Ed. Association for Childhood Education International. Brain research and childhood education: Symbolic play, phonological awareness, and literacy skills at three age levels. Research from multiple perspectives pp. Symbolic play of children with language impairment: Journal of Speech, Language, and Hearing Research, 40 3 , Preschoolers' use of desires to solve theory of mind problems in a pretense context.

Developmental Psychology, 34 3 , The effects of literacy play interventions on preschoolers' play patterns and literacy development. Early Education and Development, 3 3 , Social and mathematical talk in imaginative play. Early Child Development and Care, , When girls versus boys play alone: Nonsocial play and adjustment in kindergarten. Developmental Psychology, 37 4 , Constraints of pretend play: Implicit and explicit rules. Journal of Research in Childhood Education, 14 1 , Incorporating literacy resources into the play curriculum of two Icelandic preschools.

Title I funded preschools as a developmental context for children's play and verbal behaviors. Early Childhood Research Quarterly, 16 2 , The impact of play on development: Play and Culture, 5 2 , Sequential analysis of the social play of young children with mild developmental delays. Journal of Early Intervention, 22 3 , The play interactions of young children with and without disabilities: Individual and environmental influences. Early Childhood Research Quarterly, 15 2 , Generativity deficits in pretend play in autism.

British Journal of Developmental Psychology, 14 3 , Theory of mind and social behavior: Causal models tested in a longitudinal study. Merrill-Palmer Quarterly, 46 2 , Intention and knowledge in preschoolers' conception of pretend.

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  2. Pediatric Tuberculosis in Young Children in India: A Prospective Study?
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Child Development, 69 4 , The effects of storytelling and pretend play on cognitive processes, short-term and long-term narrative recall. Child Study Journal, 29 3 , Young children's understanding of pretense expressions of independent agency. Developmental Psychology, 33 5 , Private speech in two preschools: Significance of open-ended activities and make-believe play for verbal self-regulation.

Early Childhood Research Quarterly, 13 4 , The origins of "theory of mind. Playing with a theory of mind. State University of New York Press. Pretend play as twin earth: Developmental Review, 21 4 , Scripted play as a language intervention strategy for preschoolers with developmental disabilities.

Early Childhood Education Journal, 28 4 , Literacy objects as cultural tools: Effects on children's literacy behaviors in play. Reading Research Quarterly, 27 3 , A cognitive theory of pretense. Cognition, 74 2 , Acceptability and feasibility of classroom-based social interaction interventions for young children with disabilities.

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  • Exceptional Children, 60 3 , The role of action in the development of pretend play in young children. Developmental Psychology, 17 6 , The relationship between kindergartners' play and achievement in prereading, language, and writing. Psychology in the Schools, 17 4 , Play as an opportunity for literacy. Social and nonsocial play in childhood: An individual differences perspective. Social play and perspective taking. Reviews of research pp.

    National Association for the Education of Young Children. Saltz, Eli; Dixon, D. Training disadvantaged preschoolers on various fantasy activities: All children were evaluated at 2 and 6 weeks after the initial visit and mortality data was collected for up to 1 year. Drug susceptibility testing DST for isoniazid 0. Continuous variables were reported as medians and interquartile range IQR and compared using a Mann-Whitney nonparametric test. TB was defined as a child with either definite or probable TB and children in the no TB diagnostic category were defined as not having TB. Known risk factors for TB were added to the multivariable model irrespective of their P value in the univariable analysis.

    We screened children with suspected TB and enrolled Eighty six children were excluded: Characteristics of the enrolled children are listed in Table 1.

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    No significant differences for age, sex, BCG status, and the primary caregiver were noted amongst the different TB diagnostic categories. Details of the children with definite TB are summarized in Table 2. Children with TB were compared with those without TB. No significant differences for age, sex, rates of malnutrition, and BCG status were noted amongst these two groups.

    Children with TB were more likely to be HIV positive, be TST positive, reside in rural areas, be exposed to biomass cooking fuel, and have a mother with less than primary school education. In adjusted analyses, HIV infection Interestingly, exposure to a known TB case in the past 2 years was not found to be associated with TB. Decision to initiate TB treatment was made independently by the treating physician.

    Children more likely to have TB based on the TB diagnostic category were also more likely to be started on TB treatment within the first 6 weeks Table 3.

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    There was a nonsignificant trend towards increasing mortality in children more likely to have TB based on the TB diagnostic category. There were no significant differences between children with pulmonary or extra-pulmonary TB in initiation of TB treatment or mortality. While the prevalence of HIV in young children in India is not known, the prevalence nationally in adults is 0.

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    We also evaluated the possible risk factors associated with TB. The rates of malnutrition were not different between children with TB compared with those without TB, possibly due to the overall high rates of malnutrition in this cohort. There are limited data and continued controversy about the association of air pollution and TB risk, and only one prior study has identified exposure to fire-wood smoke as a potential risk factor for TB among children [ 23 ].

    Therefore, this is a new finding and needs additional followup. Interestingly, exposure to a known TB case in the past 2 years was also not found to be significantly associated with TB. While this may represent an overall high rate of TB in this region, the Revised Pediatric TB guidelines in India have relaxed this requirement [ 18 ]. Diagnosis of TB in young children is challenging, as they are less likely to produce adequate specimens for microscopy and culture and more likely to present with extra-pulmonary TB and the paucibacillary nature of childhood TB.

    Therefore, while culture is not the standard of care in India, we optimized TB detection by utilizing an automated liquid culture media system MGIT. However, compared with other recently published studies While several clinical algorithms and scores for pediatric TB exist, none are sufficiently sensitive or specific. We tried to limit diagnostic bias by applying a rigorous definition for children with probable TB Figure 1 derived from international consensus guidelines [ 15 , 17 , 18 ].

    It is possible that a longer followup could have made these diagnoses clearer. Similar discordance in chest radiography performed for the diagnosis of TB in children has been reported previously [ 25 , 26 ].

    Pediatric Tuberculosis in Young Children in India: A Prospective Study

    While the implications for clinical management of the TB diagnostic categories are unclear, it is reassuring to note that there was a trend correlating mortality by 1 year after entry with the TB diagnostic category, with increasing mortality in children more likely to have TB. Similarly, it is reassuring to note that children more likely to have TB based on the TB diagnostic category were also more likely to be started on TB treatment within the first 6 weeks.

    Knowledge of region-specific prevalence of DR-TB in young children is extremely important for determining appropriate empiric treatments. A recent meta-analysis by Lew et al. We therefore performed DST for all culture-confirmed isolates of M. While results on subsequent solid media cultures were concordant with MGIT, DST for one isolate patient was found to be discordant when tested using genotypic methods. This isolate was found to be resistant to both isoniazid and rifampin by phenotypic methods liquid and solid culture but susceptible by genotypic methods.

    While genotypic methods do not detect all resistance conferring mutations, discordance for both rifampin and isoniazid DST is less common [ 28 ]. Therefore, laboratory contamination or infection with more than one bacterial strain cannot be entirely ruled out. However, the drug-resistance data should be interpreted with caution, as culture confirmation was successful only in a minority. Furthermore, BJGMC is a tertiary level center, serving a highly underprivileged population, and thus these data may not be fully generalizable nationally.