Sophie-Caroline Schwarzkopf, Marius Distler, Thilo Welsch, Grit Krause-Jüttler, Jürgen Weitz, Fiona R Kolbinger
Case-Based Serious Gaming for Complication Management in Colorectal and Pancreatic Surgery: Prospective Observational Study
JMIR serious games
worldwide large number infants toddlers preschoolers enroled formal nonparental early childhood education care ecec theoretically lower adultchild ratios fewer children per adult smaller group sizes hypothesised associated positive child outcomes ecec lower adultchild ratio smaller group size may increase extent quality adultchild interactions day objective review synthesise data studies assess impact adultchild ratio group size ecec measures process characteristics quality care child outcomes relevant studies identified electronic searches bibliographic databases governmental grey literature repositories internet search engines hand search specific targeted journals citation tracking contact experts primary searches carried september 2020 additional searches carried february 2022 intervention changes adultchild ratio group size ecec children aged 05 years old study designs used welldefined control group eligible inclusion total number potential relevant studies constituted 14060 hits total 31 studies met inclusion criteria critically appraised review authors 31 studies analysed 26 different populations 12 studies analysing 8 different populations n 4300 could used data synthesis included studies published 1968 2019 average publication year 1992 used randomeffects metaanalysis applying robustvariance estimation restricted maximum likelihood procedures synthesise effect sizes conducted separate analyses process quality measures language literacy measures metaanalysis using measures process quality outcome included 84 effect sizes 5 studies 6256 observations weighted average effect size positive statistically significant effect size es 010 95 confidence interval ci 007 027 using robustvariance estimation adjusted degrees freedom 4 df 15 meaning results unreliable similarly low number studies made estimation heterogeneity statistics difficult i2 2 estimates 0 qstatistic 23 p 069 found similar statistically significant weighted average effect size using restricted maximum likelihood procedure es 010 95 ci 0004 020 similar low levels heterogeneity q 07 i2 0 2 0 metaanalysis language literacy outcomes based three studies exploring different changes group size andor adultchild ratio ecec metaanalysis language literacy measures included 12 effect sizes 3 studies 14625 observations weighted average effect size negative statistically significant es 004 95 ci 061 053 using robust variance estimation procedure adjusted degrees freedom 4 df 19 results unreliable heterogeneity statistics indicated substantial heterogeneity q 93 i2 785 2 007 restricted maximum likelihood procedure yielded similar results es 006 95 ci 057 046 q 61 i2 643 2 003 main finding present review surprisingly quantitative studies exploring effects changes adultchild ratio group size ecec measures process quality child outcomes overall quality included studies low two randomised studies used metaanalysis risk bias majority included studies high also studies used metaanalysis due limited number studies could used data synthesis unable explore effects adultchild ratio group size separately study examined effects changes adultchildratio andor group size socioemotional child outcomes could included metaanalysis high quality study examined effects large changes adultchild ratio group size measures process quality explored effects children younger 2 years included studies 3 metaanalysis investigated measures language literacy results outcomes inconclusive one specification found small statistically significant effect process quality suggesting fewer children per adult smaller group sizes increase process quality ecec caution regarding interpretation must exerted due heterogeneity study designs limited number studies generally high risk bias within included studies results present review implications research practice first findings present review tentatively support theoretical hypothesis lower adultchild ratios fewer children per adult smaller group sizes beneficially influence process quality ecec hypothesis reflected existence standards regulation minimum requirements regarding adultchild ratios maximum group size ecec however research literature date provides little guidance appropriate adultchild ratios group sizes second findings present review may seen testimony urgent need contemporary highquality research exploring effects changes adultchild ratio group size ecec measures process quality child developmental socioemotional outcomes