Early Care Research Articles

From Rhetoric to Action: Justice, Equity, Diversity, and Inclusion in Coordinated Specialty Care for Early Psychosis.

Attention to inclusivity and equity in health research and clinical practice has grown in recent years; however, coordinated specialty care (CSC) for early psychosis lags in efforts to improve equity despite evidence of ongoing disparities and inequities in CSC care. This Open Forum argues that marginalization and disparities in early psychosis research and clinical care are interrelated, and the authors provide suggestions for paths forward. Commitment to equity and justice demands recentering the perspectives of those most affected by early psychosis services and investing in the integration of historically excluded perspectives across all aspects of practice, policy, and research.

Leadership as a profession in early childhood education and care

ABSTRACT Background Early childhood education and care (ECEC) centres have historically been overlooked and undervalued globally. However, recent economic investments and numerous changes have significantly impacted the role of ECEC centre leaders and their requirements. Moreover, recent research on educational leadership highlights its importance for both child development and employee well-being, as well as for maintaining pedagogical quality. Despite this recognition, ECEC centre leaders still lack systematic leadership education and adequate working structures. Purpose This study aimed to review research evidence to understand how Finnish ECEC centre leaders position themselves within the realm of leadership as a profession. Specifically, the focus was on identifying the key components of leader competence. Method We conducted a narrative structural analysis, following the framework developed by using data from 20 short writings by ECEC centre leaders. Four types of narrative were constructed to capture the essence of ECEC centre leaders’ competence. Subsequently, these narrative types were analysed using levels of narrative positioning to gain insights into how these different narratives relate to leadership as a profession. Findings Through this two-step narrative analysis, we identified four types of narratives among ECEC centre leaders: professional leader, contextual leader, teacher leader, and leader persona. The findings underscore the importance of pedagogical understanding and competence as central themes in the narratives of ECEC centre leaders. However, a comprehensive understanding of general leadership competence as a learnable practice was not consistently evident across the narrative types. Conclusion The reflection on these findings suggests that ECEC leadership as a profession is still an emerging phenomenon. Moving forward, there is a need for systematic leadership education and the development of functional leadership structures to clarify the concept of leadership as a shared practice and to ensure its effective implementation in ECEC centres.

End of life and palliative care decisions in advanced head neck cancer

The complexity of care for patients with advanced head and neck cancer is a significant issue, and current healthcare systems must focus on appropriate referral criteria, increased integration and coordination of care, and robust evaluation of specific care components. Linkage between research and service design delivery across teams, disciplines, and care settings is also important. Palliative care needs of patients with advanced head and neck cancer pose unique complexities due to the impact the illness has on eating, speaking, appearance, and breathing. Specialty palliative care consultation by trained experts helps primary teams facilitate goals of care discussions, symptom management, and medical resource navigation for the terminally ill patient. Early initiation of palliative care results in less invasive and more cost-effective patient-centered care. There is little literature on care practices in this population, and hospital-based care may increase towards the end of life to address potentially reversible conditions or uncertain prognosis. Early advanced care planning and end-of-life care options should be supported alongside continuation of therapy lines.

Early care and education professionals’ perspectives on mealtime in the US and Taiwan

ABSTRACT Many children today are in full-time early care and education settings; they may obtain one-half to two-thirds of daily nutrient needs during their time at the centers. Because of that, early care and education professionals can play a key role not only to offer nutritious food but also to help children establish healthy eating habits. The purpose of this study was to explore 344 early care and education (ECE) professionals’ perspectives on feeding young children during mealtimes at center-based programs in the US and Taiwan. The results found both groups of professionals think it is important for children to have appropriate serving utensils for the food being offered, and menu planning is based on a nutritionally sound meal pattern. However, there are a few different perspectives between the US and Taiwan including whether children should be required to eat all the food on their plates and whether children should be quiet during mealtime. A list of recommended practices is provided for ECE professionals who feed young children with diverse backgrounds at mealtimes.

Changes in an early childhood education and care teacher’s practical theory in language pedagogy as a nexus:

This case study focuses on an expert early childhood education and care teacher’s practical theory in language pedagogy when implementing bilingual pedagogy (Finnish–Swedish) in a linguistically heterogeneous group of children aged 3–5 years. Practical theory refers to teachers’ views of good teaching that guide their practices. Applying a mediated discourse analysis approach (nexus analysis), we examine the interplay of factors that promote and challenge changes in the practical theory of language pedagogy in early childhood education and care. The discourses show that the changes are related to Swedish use (a new language for the children) and the use of the children’s home languages. Several personal, interactional, and contextual factors circulate in the expert teacher’s discourses, affecting the changes in her practical theory. Personal factors include reflection, beliefs, and experiences. Feedback from parents and children represents interactional factors, whereas contextual factors cover concepts such as participation and language-enriched teaching. This study highlights the significance of the multiple interrelated factors that are present when an expert teacher’s practical theory of language pedagogy changes, which needs to be reflected upon both in the practice of early childhood education and in teacher training.

Accueillir l’enfant suivant un deuil périnatal : l’examen de Brazelton comme intervention thérapeutique précoce

IntroductionPrevious studies have shown that children whose births occur after a childless pregnancy tend to be more prone to psychological and affective disorders, with a moderate and nonspecific degree of significance. These pathologies are most often described as a consequence of altered family dynamics rather than an actual impairment of the child's cognitive pathways. Such alterations in familial balance, when occurring in the traumatic shadow of a childless pregnancy be it from spontaneous miscarriage, stillbirth or voluntary termination due to foetal abnormalities, often take root in the prenatal period due to anticipatory representations and thoughts and can express themselves as early as the first days of the newborn's life ex utero. Aim of studyWe used the standardized Brazelton assessment scale to observe three such newborns in the presence of their parents and paid particular attention to the parents’ reactions and attitudes to the child's behavior and the impact our explanations had on their understanding of the newborn's response. ResultsThis study highlights the value of early postnatal care of these dyads with a focus on the issues of caring for the individual discovery of the child by his parents, supported by psychoaffective elements of childcare. However, the specific relevance of the Brazelton's tool in this indication remains to be discussed due to its limited nature by the absence of precise indications, the absence of a reproducible equivalent later in the baby's life, as well as the absence of a result that can be communicated to parents who therefore do not systematically carry the meaning that the caregivers confer on it. ConclusionThe study asserts the fundamental benefit of an early child-based intervention in these families to facilitate genuine bonding and secure attachment, but the nature of such an intervention is yet to be determined.

Provision of palliative care for people with chronic obstructive pulmonary disease: a narrative review.

Chronic obstructive pulmonary disease (COPD) is characterized by persistent and progressive airflow restriction and is the third leading cause of death and disability, globally. People with severe COPD generally experience long-term functional decline punctuated by periods of acute exacerbation. Symptom burden can be severe and debilitating, and typically includes breathlessness, cough, fatigue, pain, anxiety, depression, and overall reduced quality of life. Understanding current palliative care needs and provisions in this group is an essential step to expanding access in future. A narrative review of specialist and generalist (primary) palliative care provisions for people with COPD, with an emphasis on breathlessness symptom management. This paper aims to examine the current landscape of palliative care provision and highlight barriers and facilitators to palliative care access for people with severe COPD. People living with severe COPD, as well as the people who care for them, are routinely under-serviced in best-practice end-of-life care, despite having symptom burden that is comparable to that of people with advanced cancer. Barriers to palliative care in this group include lack of specialist palliative care resources, uncertainty surrounding prognostication, and poor recognition of need from both patients and clinicians. Routine early palliative care involvement, including integration of specialist palliative care into respiratory services and upskilling of other healthcare providers to adopt palliative care principals within usual care (primary palliative care), have been shown to improve outcomes indicative of high-quality end-of-life care in this group, including symptom control, place of death, and legal preparations. Ongoing integration of specialist palliative care and professional education for generalist and non-palliative care specialist healthcare providers in the recognition and management of unmet palliative care needs is required to increase capacity beyond traditional specialist palliative care models. Despite high level of symptom burden, many people with COPD miss out on palliative care. Expanding capacity of traditional specialist palliative care by upskilling generalist healthcare providers and integrating specialist palliative care into existing respiratory services is necessary to improve access for people with COPD.

A Study on the Direction of Integrated Early Childhood Education and Care Policies through the Perception of Prospective Early Childhood Educators

A Study on the Direction of Integrated Early Childhood Education and Care Policies through the Perception of Prospective Early Childhood Educators

Ruhiyah Attachment: Integrating Spirituality into Attachment Theory for Enhanced Child Development

Purpose – This article aims to introduce a new perspective in attachment theory called ruhiyah attachment. Ruhiyah attachment emphasizes the role of caregivers as mediators to connect children spiritually with Allah SWT, proposing this spiritual connection as a potential solution to the mental health crisis among teenagers. Design/methods/approach – This paper employs a literature research methodology. The research involves (1) selecting the topic, (2) searching academic databases for relevant articles and journals, (3) collecting data from primary sources (articles and books on attachment theory) and secondary sources (application and implementation studies), (4) analyzing literature to identify patterns, themes, or differences across ten sources, (5) presenting findings, and (6) conducting a critical assessment of ruhiyah attachment as a new perspective in attachment studies. Findings – The research presents ruhiyah attachment as a new perspective in child attachment studies. It emphasizes that spiritual attachment, facilitated by caregivers as mediators, is crucial for children's development. Ruhiyah attachment extends beyond the mother-child bond to include a spiritual connection with the Creator, potentially addressing mental health crises by fostering a strong spiritual foundation in children. Research implications/limitations – This research broadens the discourse on child attachment studies. The literature review methodology allows a comprehensive examination of various perspectives in attachment research. Ruhiyah attachment offers a new viewpoint that may stimulate future studies. Limitations include the reliance on secondary sources and the need for empirical validation of the proposed perspective. Practical implications – Ruhiyah attachment can enhance early childhood education and care by integrating spirituality into attachment theory. This perspective allows children to develop a direct spiritual connection with Allah SWT through their bond with caregivers, promoting long-term mental and spiritual well-being. It suggests that spiritual strength can help prevent mental health crises and encourage moral development. Originality/value – This research introduces a spiritual dimension to child attachment studies, addressing the mental health crisis by proposing ruhiyah attachment as a novel perspective. Paper type Literature review

Can we play with science? Preschool teachers’ discussion about play-responsive teaching and how science content can be introduced into play with support of digital tools

ABSTRACT This article is from a continuous professional development project where preschool teachers are introduced to the framework Play-Responsive Early Childhood Education and Care (PRECEC). Aspects of play and teaching are discussed in focus groups, before and after a first attempt to enact and re-enact play-responsive teaching, with science content. In the attempts, digital pictures or videos are projected in play to create an experience of science content. The technological pedagogical and content knowledge (TPACK) framework is used to analyse the complex and dynamic connections between pedagogical knowledge (PK), here with a focus on PRECEC, content knowledge (CK) and technological knowledge (TK). The results show that the preschool teachers often separate play and teaching. A concern is raised by the preschool teachers that they might influence or ruin the play if they participate. However, promising possibilities for play-responsive teaching were created when preschool teachers projected digital pictures and videos representing science content in a created play world.

Exploring acceptability, opportunities, and challenges of community-based home pregnancy testing for early antenatal care initiation in rural Kenya

BackgroundMany women in low- and middle-income countries, including Kenya, access antenatal care (ANC) late in pregnancy. Home pregnancy testing can enable women to detect pregnancy early, but it is not widely available. Our study explored the acceptability and potential of home pregnancy testing delivered by community health volunteers (CHV) on antenatal care initiation in rural Kenya.MethodsThis study was part of a public health intervention to improve uptake and quality of ANC. Between November and December 2020, we conducted 37 in-depth interviews involving women who tested positive or negative for a urine pregnancy test provided by CHVs; CHVs and their supervisors involved in the delivery of the pregnancy tests; facility healthcare workers; and key informants. Using Sekhon et al.‘s framework of acceptability, the interviews explored participants’ perceptions and experiences of home pregnancy testing, including acceptability, challenges, and perceived effects on early ANC uptake. Data were analysed thematically in NVivo12 software.ResultsHome pregnancy testing was well-received by women who trusted test results and appreciated the convenience and autonomy it offered. Adolescents cherished the privacy, preferring home testing to facility testing which could be a stigmatising experience. Testing enabled earlier pregnancy recognition and linkage to ANC as well as reproductive decision-making for those with undesired pregnancies. Community delivery of the test enhanced the reputation and visibility of the CHVs as credible primary care providers. CHVs in turn were motivated and confident to deliver home pregnancy testing and did not find it as an unnecessary burden; instead, they perceived it as a complement to their work in providing ANC in the community. Challenges identified included test shortages, confidentiality and safeguarding risks, and difficulties accessing facility-based care post-referral. Newly identified pregnant adolescents hesitated to seek ANC due to stigma, fear of reprimand, unwanted parental notification, and perceived pressure from healthcare workers to keep the pregnancy.ConclusionHome pregnancy testing by CHVs can improve early ANC initiation in resource-poor settings. Mitigating privacy, confidentiality, and safeguarding concerns is imperative. Additional support for women transitioning from pregnancy identification to ANC is essential to ensure appropriate care. Future research should focus on integrating home pregnancy testing into routine community health services.

Norwegian ECEC teachers’ play practices with children aged 2-3 years

ABSTRACT The present study investigated early childhood education and care (ECEC) teachers’ practices when they were engaged in play with children aged 2 to 3 years old. Both in a Norwegian context and internationally the number of younger children in ECEC is increasing, and there is a need for knowledge about what characterizes high-quality teacher practices at play. Eighteen Norwegian teachers were filmed interacting with small groups of two to five children (a total of 54 children, mean age 35 months; range 28–41). The video data (18 play situations; total = 4 hours) were transcribed and analyzed using the theoretical framework of intersubjective space, emphasizing the sematic, material, and social dimensions of the interactions between the teachers and children. The results revealed three main characteristics of teachers’ play practices: creating connections in play, expanding play, and regulating play. Although these characteristics were present in many observations, our analysis revealed variations between the teachers in terms of creating connections, expanding, and regulating. These variations can be decisive for play to continue, develop, or end. In addition, teachers’ practices appear to be crucial for some children to be included in play.

Early palliative care and overall survival in patients with metastatic upper gastrointestinal cancers (EPIC): a multicentre, open-label, randomised controlled phase 3 trial

Early palliative care and overall survival in patients with metastatic upper gastrointestinal cancers (EPIC): a multicentre, open-label, randomised controlled phase 3 trial

Early Intervention in pediatric Dentistry: Nurturing lifelong Oral health Habits

Early intervention in pediatric dentistry is crucial in influencing children’s oral health trajectory and establishing habits that may last a lifetime. Pediatric dentists strive to develop good dental hygiene habits in young children via early detection, treatment, education, and prevention (Happykidsdental, 2024). To foster good dental hygiene habits for life, this study explores the many aspects of early intervention in pediatric dentistry. Pediatric dentistry is essential for youngsters to have healthy teeth and gums. It considers the specific requirements and difficulties during infancy and goes beyond regular dental checkups (Wang, 2023). Pediatric dentists provide the groundwork for optimal dental health throughout a child’s life by concen trating on early intervention, individualized treatments, and preventative care (Krol and Whelan, 2022). They make the dentist’s office a fun place for kids, encouraging them to have good experiences there and teaching their parents how to care for their teeth better (Happykidsdental, 2024). Issues such as thumb-sucking, teething, and assisting youngsters with orthodontic troubles are also part of a pediatric dentist’s expertise (Lin, 2022). Pediatric dentists are medical professionals who focus on children’s oral and dental health (dentalcare.com, 2023). They help children maintain good teeth and jaw development, which benefits their general health. Pediatric dentistry is a subspecialty of general dentistry that focuses on the specific problems and requirements of dental health in children. It covers a lot of ground, from general dental checkups and education to more precise treatments for common problems in children and teenagers (Clinical Affairs Committee, 2012). Dental treatment for children goes beyond just fixing cavities; pediatric dentists also work to alleviate anxiety and promote a good attitude toward the dentist from a young age (Happykidsdental, 2024). Building a solid foundation for excellent dental health throughout a child’s life begins in the early years (Baker, Lee and Wright, 2019). The importance of early interventions in establishing excellent oral hygiene habits and avoiding dental disorders before they happen is acknowledged in this particular area (Krol and Whelan, 2022). Pediatric dentists play a dual role as healthcare practitioners and educators, helping children and their families maintain good oral health and wellness. The field of pediatric dentistry focuses on the dental health and welfare of children from the time they are infants until they reach puberty (Wang, 2023). Encouraging youngsters to form good habits with their teeth and gums is integral to this niche field’s mission to promote dental health (Lin, 2022). The formative years are essential to provide the groundwork for excellent dental health throughout a child’s life.

Standardisation and diversification – policy tools to govern early childhood education and care

ABSTRACT Policy tools have become widespread in education, which indicates efforts to standardise content and professional practices. However, such standardisation might be in contrast to Nordic early childhood education and care (ECEC) traditions of diversity and local variation. We therefore study the distributors and enactment of policy tools in ECEC in light of content regulations and calls for evidence-based practices in ECEC through comparative case studies of 14 Norwegian centres. We identify the tools that are used in ECEC centres and analyse how they are enacted by staff. The material consists of documents from ECEC centres and semi-structured interviews with heads and staff. By employing a theoretical framework based on discursive institutionalism, we find that efforts are being made to standardise didactical practices. The tools are distributed by a range of actors, but our analysis reveals that staff shape and develop tools through coordinative discourses.

Effects of early palliative care integration on patients with newly diagnosed multiple myeloma.

While numerous studies underscore the benefits of early palliative care (EPC) for patients with solid tumors, its effects on patients with multiple myeloma (MM) are not as widely known. This study aims to determine the effects of EPC integration on patients with newly diagnosed symptomatic MM and the feasibility of this approach. This prospective cohort study enrolled patients within eight weeks of diagnosis. Participants met with a palliative care team monthly for 12months. Functional Assessment of Cancer Therapy-General (FACT-G) plus Multiple Myeloma Subscale (FACT-MM), and Hospital Anxiety and Depression Scale (HADS) were administered upon enrollment and every three months. Proportion of completed visits and assessments determined the feasibility of EPC. Of the twenty participants enrolled from January 2020 to November 2022, median age was 65 (range 40, 77), 15 (75%) were female, 15 (75%) were white, 65% completed assessments at six months, and 60% at 12months. The following measures significantly improved at 12months versus baseline: FACT-G scoresincreased by 15.1 points (adjusted 95% CI: 2.2-28.1, adjusted p = 0.02); Functional Well-Being scores increased by 6.0 points (adjusted 95% CI: 1.1-10.9, adjusted p = 0.01); and Pain Subscale scores increased by 3.4 points (adjusted 95% CI: 0.5-6.4, adjusted p = 0.02). Depression and anxiety scores did not significantly change over time. Functional well-being, pain experience and overall QOL improved in a cohort of patients with newly diagnosed MM after 12months of EPC involvement. Although monthly visits seemed feasible, the findings suggest thatfurther researchis needed to explore the optimal timing of palliative care interventionsin the MM trajectory. ClinicalTrials.gov ID NCT04248244 (Registration Date: January 30, 2020).

Challenges encountered in maintaining mobile early childhood care and education centres: Practitioners’ perspectives

This research aims to examine the challenges faced by practitioners who maintain mobile Early Childhood Care and Education (ECCE) centers. Using a qualitative approach, ten practitioners from one organization that provides mobile ECCE in the Free State Province participated in this study. A semi-structured interview guide was used for data for this study. ATLAS.ti software was used to analyze qualitative data. The findings showed that the language barrier is one of the greatest challenges presented by mobile ECCE programs. Further, psychosocial challenges, such as the abuse of alcohol by parents and poverty as well as rain and wind, dust and cold are also challenges to practitioners. Therefore, these findings have strong policy implications for the need for ECCE policy frameworks to mitigate language barriers and psychosocial challenges in mobile ECCE centers by knowing the different home languages of the children.

Management of serotonin syndrome (toxicity)

Serotonin syndrome (toxicity), resulting from an excessive accumulation of serotonin in the central nervous system, it can occur due to various factors such as the initiation of medication, overdose or drug interactions. Diagnosing serotonin toxicity presents challenges as there are no definitive criteria. This review delves into the pathophysiology, incidence, clinical assessment and management of serotonin toxicity, stressing the significance of promptly recognizing and managing severe cases. Diagnosis relies primarily relies on clinical assessment due to the absence of specific laboratory tests. The Hunter Serotonin Toxicity criteria are commonly utilized but have only been validated in the overdose setting. Assessing the severity of toxicity is crucial for guiding management decisions. Supportive care, discontinuation of causative agents and symptomatic treatment are prioritized in management. Mild toxicity often requires withdrawal or reduction of the serotonergic agent, while more severe toxicity requires more aggressive resuscitative and supportive care. Severe serotonin toxicity characterized by hyperthermia and rigidity requires aggressive supportive measures, including benzodiazepines, intubation, paralysis and active cooling. Animal studies suggest potential benefits of 5-HT2A receptor antagonists in preventing hyperthermia and fatalities, but only at high doses. Their clinical effectiveness remains uncertain, and evidence is predominately from case series and case reports. Although commonly used, serotonin antagonists like cyproheptadine lack conclusive evidence of efficacy. Other serotonin antagonists such as chlorpromazine and olanzapine have been explored but evidence is limited to case reports. Hence, the cornerstone of treating severe cases does not lie in 'antidote' administration or even diagnosis but in effective early resuscitative and supportive care.

A Randomized Crossover Trial Evaluating the Impact of Cultural Dexterity Training on Surgical Residents' Knowledge, Cross-Cultural Care, Skills, and Beliefs: The Provider Awareness and Cultural Dexterity Training for Surgeons (PACTS) Trial.

This trial examines the impact of the Provider Awareness and Cultural dexterity Toolkit for Surgeons (PACTS) curriculum on surgical residents' knowledge, cross-cultural care, skills, and beliefs. Cross-cultural training of providers may reduce health care outcome disparities, but its effectiveness in surgical trainees is unknown. PACTS focuses on developing skills needed for building trust, working with patients with limited English proficiency, optimizing informed consent, and managing pain. The PACTS trial was a randomized crossover trial of 8 academic general surgery programs in the United States: The Early group ("Early") received PACTS between periods 1 and 2, while the Delayed group ("Delayed") received PACTS between periods 2 and 3. Residents were assessed preintervention and postintervention on Knowledge, Cross-Cultural Care, Self-Assessed Skills, and Beliefs. χ 2 and Fisher exact tests were conducted to evaluate within-intervention and between-intervention group differences. Of 406 residents enrolled, 315 were exposed to the complete PACTS curriculum. Early residents' Cross-Cultural Care (79.6%-88.2%, P <0.0001), Self-Assessed Skills (74.5%--85.0%, P <0.0001), and Beliefs (89.6%-92.4%, P =0.0028) improved after PACTS; knowledge scores (71.3%-74.3%, P =0.0661) were unchanged. Delayed resident scores pre-PACTS to post-PACTS showed minimal improvements in all domains. When comparing the 2 groups in period 2, Early residents had modest improvement in all 4 assessment areas, with a statistically significant increase in Beliefs (92.4% vs 89.9%, P =0.0199). The PACTS curriculum is a comprehensive tool that improved surgical residents' knowledge, preparedness, skills, and beliefs, which will help with caring for diverse patient populations.

Association of early parent–child separation with depression, social and academic performance in adolescence and early adulthood: a prospective cohort study

ObjectiveThe present study aimed to investigate the long-term effects of parent–child separation during infancy and early childhood on depression, social relationships including parent–child and peer relationships, and academic performance during adolescence and early adulthood.MethodsData from the China Family Panel Studies (CFPS) were analyzed, which included a sample of 3829 children aged 4–15 years from 25 provinces over a period of 8 years. The study examined the association between early parent–child separation and outcomes related to depression, social and academic performance, comparing outcomes between individuals with and without early separation experiences. A series of subgroup analyses were conducted to further explore these associations.ResultsParent–child separation lasting 3 months or longer was found to be associated with moderate to severe levels of depression and impaired social relationships during adolescence and early adulthood, particularly among males, adolescents, urban dwellers, and those with less educated mothers. Children who experienced parent–child separation for 3 months or longer showed a positive correlation between separation duration and depression. Short-term separations under 3 months did not show this association. The duration of separation also had a negative correlation with parent–child and peer relationships, as well as academic performance.ConclusionEarly parent–child separation has significant adverse effects on the mental health, social and academic performance of adolescents and early adulthood, especially among males, adolescents, urban residents, and those with lower maternal education. The severity of depression was found to be related to the duration of separation, highlighting the importance of minimizing separation to less than 3 months for children under the age of 3. These findings underscore the critical role of early parental care and the need for targeted interventions for high-risk populations.