Early Engagement Research Articles

Preparing the Younger Generation for an Aging Society: Strategies, Challenges, and Opportunities.

The global demographic landscape is experiencing a monumental shift as populations age, driven by advances in healthcare and declining birth rates. This transition underscores the need to prepare the younger generation to navigate and contribute effectively to an aging society. This manuscript comprehensively reviews strategies to equip younger generations with the requisite knowledge, skills, and empathy to support an aging population. This study identifies critical challenges and opportunities in fostering intergenerational solidarity and understanding through an extensive analysis of existing literature and innovative educational programs. The review highlights the importance of early education, community engagement, and policy interventions in bridging the generational divide. Additionally, it explores the role of technology and digital media in facilitating awareness and empathy among young people. Key findings suggest that incorporating aging-related content into educational curricula, promoting volunteerism, and implementing supportive policies can significantly enhance the younger generation's readiness to support an aging society. The manuscript concludes with recommendations for future research and practical steps for educators, policymakers, and community leaders to foster a more inclusive and age-friendly environment. By preparing the younger generation today, we can build a more cohesive and supportive society for tomorrow.

Contribution and involvement of Hazbans in islamic civilization(648_923H/1250_1517AD), Bahri and Charkas mamluks era as an illustration

Al-Hazbany played a significant role in building and managing authority during the Middle Ages, establishing a Kurdish emirate within the Islamic state. Their influence extended beyond their homeland, as they journeyed thousands of kilometers towards Egypt and the Levant, actively participating in state affairs. Notably, the tribe made substantial contributions to scientific development, particularly during the eras of the Bahri Mamluks and Circassian kingdoms. The research comprises an introduction and two sections. The introduction sheds light on the origins of the Al-Hazbany tribe, their geographical presence, and their early political engagements, Especially in the Kurdistan regions, because they started their first political and military uprising in Kurdistan. The first section explores the multifaceted role of the tribe in the Bahri Mamluks kingdoms, covering administrative, scientific, religious, and literary aspects, Because with the disappearance of Ayyubid rule, the Hazbanis continued to provide scientific and administrative services. In the second section, the focus shifts to the Circassian kingdoms, providing insights into the administrative and scientific roles of the Hazbanys and their significant contributions to reconstruction. We note that during this period the Kurdish Hazbanis paid attention to the aspect of prayer، for example, the construction of mosques, scientific sites and even places known by their names, but it is not known why they were used.

Exploring early discontinuation of mental health outpatient treatment: language, demographics and clinical characteristics among migrant populations in Japan

BackgroundThe fast-growing migrant population in Japan and globally poses challenges in mental healthcare, yet research addressing migrants’ mental health treatment engagement remains limited.ObjectiveThis study examined language proficiency, demographic and clinical...

An evidence-based nipple care pathway for new breastfeeding mothers: a Delphi study

Background/Aims Only 1% of UK mothers maintain exclusive breastfeeding for the first 6 months, as per global recommendations. Early breastfeeding cessation often involves complex issues, with nipple-related injuries being a common cause. This study aimed to develop an evidence-based tool for early identification and management of breastfeeding-related nipple injuries through expert consensus. Methods A mixed method approach was used, including a 5-stage scoping review and a modified Delphi consensus technique with 26 UK-based maternal health experts and experienced breastfeeding mothers. Results Consensus (80% agreement) was reached on recommendations, including the provision of realistic information, early peer support engagement and Lanolin use. Some commonly recommended practices, such as letting the nipple air dry, did not reach consensus, highlighting a misalignment between expert consensus and published guidance. Conclusions This study generated evidence-based, expert-validated self-management guidance, emphasising the need for improved stakeholder engagement in policy development.

Implementing a Uniform Outcome Measurement Approach for Early Interventions of Autism Spectrum Disorders

Naturalistic developmental behavioral interventions for children with autism spectrum disorder show evidence for effectiveness for specific social communication targets such as joint attention or engagement. However, combining evidence from different studies and comparing intervention effects across those studies have not been feasible due to lack of a standardized outcome measure of broader social communication skills that can be applied uniformly across trials. This investigation examined the usefulness of the Brief Observation of Social Communication Change (BOSCC) as a common outcome measure of general social communication skills based on secondary analyses of data obtained from previously conducted randomized controlled trials of 3 intervention models, Early Social Intervention (ESI), Early Start Denver Model (ESDM) and Joint Attention Symbolic Play Engagement and Regulation (JASPER). The subset of datasets from the 3 randomized controlled trials was created to examine differences in the BOSCC scores between intervention and control groups over the course of the interventions. Based on 582 videos from 207 caregiver-child dyads, the BOSCC noted significant differences between intervention vs control groups in broad social communication skills within 2 of the 3 intervention models, which were longer in duration and focused on a broad range of developmental skills. The BOSCC offers the potential to take a uniform measurement approach across different intervention models to capture the effect of intervention on general social communication skills but may not pick up the effects of some brief interventions targeting proximal outcomes. Comparing Parent-Implemented Interventions for Toddlers With Autism Spectrum Disorders; https://www. gov/; NCT00760812. Intensive Intervention for Toddlers With Autism (EARLY STEPS); https://www. gov/; NCT00698997. Social and Communication Outcomes for Young Children With Autism; https://www. gov/; NCT00953095.

A Comprehensive Guide to Long-Acting Injectable Antipsychotics for Primary Care Clinicians.

We propose a paper that provides education on commonly used long-acting injectable antipsychotics (LAIs) to improve primary care based mental health interventions in patients with severe mental illnesses (SMIs) such as schizophrenia, schizoaffective disorder, and bipolar disorders. With the expanding interface of primary care and psychiatry across all healthcare settings, it has become increasingly important for primary care clinicians to have a broader understanding of common psychiatric treatments, including LAIs. Long-acting injectable antipsychotics have been shown to be helpful in significantly improving treatment adherence, preventing disease progression, improving treatment response, decreasing readmission rates, and reducing social impairment. We discuss evidence-based indications and guidelines for use of long-acting injectable antipsychotics. We provide an overview of the treatment of SMI with LAIs, mainly focusing on the most commonly used long-acting injectable antipsychotics, advantages and disadvantages of each, along with outlining important clinical pearls for ease of practical application. Equipped with increased familiarity and understanding of these essential therapies, primary care clinicians can better facilitate early engagement with psychiatric care, promote more widespread use, and thus significantly improve the wellbeing and quality of life of patients with severe mental illness.

Learning from Tomorrow's Recyclers: Extension of Hands-on Recycled Waste Activity.

We previously developed a plastic sorting activity for high school students. In that activity, several tools were provided to separate plastic waste materials based on their physical properties while considering the time and cost for each separation step. Here, we aimed to understand the impact of this activity on the awareness of and learning about plastic sorting in a younger age group (8 to 11 years old) and explored how parental involvement influenced students' interest in the topic. The activity was part of the STEM Zone Saturday program at the University of Houston. Pre- and post-evaluations were used to assess students' understanding of plastic sorting and overall experiences. While some insights into plastic sorting were derived from previous experiences, the activity improved awareness among students, particularly regarding sorting based on physical properties. The involvement of parents encouraged exploration, discovery, and enjoyment. These findings underscore the importance of early education and community engagement in fostering sustainable practices and advancing toward a circular economy.

What does a just transition mean for urban biodiversity? Insights from three cities globally

Just transitions – responses to environmental change that minimise negative impacts on the most affected people and places, while ensuring nobody is left behind – are gaining scholarly and policy significance in areas beyond their original focus on carbon-intensive jobs and sectors. Yet attention to what a just transition means for biodiversity, as another aspect of the global environmental crisis, remains limited. Given the critical role that biodiversity plays in supporting livelihoods and wellbeing, this is a notable gap. This paper assesses what a just transition means for biodiversity, focusing on urban environments as the spaces in which many people encounter biodiversity globally. We undertake interview research across three case study cities representing different geopolitical and environmental contexts: Bristol (UK); Yubari (Japan); and Cape Town (South Africa) and ask two questions: what does biodiversity tell us about the concept of just transitions in the lived environment; and what are the consequences of considering just transitions in the context of biodiversity in the lived urban environment? Based on our findings, we set out six principles for a just transition in relation to urban biodiversity, as areas for further empirical enquiry: a shared sense of what a just transition and biodiversity mean in the local context; diverse social and ecological knowledge systems informing decision-making; integration and cohesion across policies; inclusive, meaningful and early engagement; supporting communities during and after implementation; and measures for assessing the effectiveness of outcomes from an ecological and a social perspective.

Including the voice of children

Despite evidence of the benefits of including children's voices in global health research, they continue to be underrepresented. Implementation of how to include children's voices appears to remain an obstacle to their inclusion in global health research. In this manuscript, we present an epistemological frame that advocates children as experts of their own experiences and knowledge-bearers. Then we provide four case studies, to illustrate ongoing efforts to build equity in the design and execution of paediatric health research. Ensuring children's equitable inclusion requires recognizing them as active participants in their health and wellbeing, and empowering them to employ their agency in all interactions with researchers, while recognizing the dialogical nature of those interactions. Successfully involving children in global health research can lead to important psychosocial and clinical insights, that could be leveraged to inform future treatment and care practices. We present four case studies describing the inclusion of children in research and research development related to prevention, treatment and/or care of chronic and acute diseases (tuberculosis, HIV, cervical and other forms of cancer) in a number of global settings including India, Philippines, South Africa, United States, Zambia. The exemplars detail novel applications of a diversity of arts-based methods that are rooted in frameworks for participatory action research. They highlight the need to invest funds, training, time and resources for early and sustained engagement with children throughout the research process. We conclude by offering principles for equitably engaging children in global health research.

Does timing of sexual debut following menarche among female youth in Uganda matter? A discrete time analysis

BackgroundThe burden of early sexual engagement among youth is enormous. It directly raises the risk of sexually transmitted infections(STIs) and indirectly contributes to unintended pregnancy, unsafe abortion, premature childbirth, and psychosocial issues. The aim of this paper was to estimate the timing of sexual debut and examine the factors influencing the timing of first sexual intercourse following menarche among female youth aged between 15 and 24 in Uganda.MethodSelf-reported data were extracted from the 2016 Uganda Demographic and Health Survey (UDHS), with a sub-sample of 7964 female youth from the individual woman file. Kaplan-Meier survival curves, decrement life-table analysis, and the discrete-time logit model were used to examine the timing of sexual debut and associated factors.Results67.4% of the female youth had experienced first sexual initiation. Overall, the meantime to sexual debut was 4.4 years and the median time was 4.3 years, and all the female youth had experienced first sexual initiation by the end of the twelfth year following menarche. Significant factors found to influence the timing of sexual initiation include having higher education level (OR = 0.724: 95% CI = 0.59–0.89; p = 0.003), residing in the Northern region (OR = 0.877:95% CI = 0.79–0.97, p = 0.012), being employed (OR = 1.085: 95% CI = 1.01–1.16; p = 0.021), and being literate (OR = 1.155; 95% CI = 1.07–1.25; p < 0.001).ConclusionsThese findings are expected to be central in the bid to delay first sexual intercourse. Also they shed light on some of the factors associated with the timing of sexual debut which may be addressed at community level for non-school going youth and in schools, as school based prevention sexual and reproductive health programs. The findings highlight the need for future studies to collect more data to explore further the linkage between time to first debut since menarche and, mass media, religion, type of residence, and wealth index.

Knowing/ unknowing: the breath between in poetry

ABSTRACT Debates about decolonising research have a tendency to be theoretical without much focus on the embodied and methodological engagements that are required to shift the colonial gaze that research continues to have. This article contributes to decolonial debates with a focus on positionality and research methods as they emerge in research relationships. It argues for poetry as a decolonising tool for scholars to do good work, through exploring the author’s experiences as a graduate student navigating the intersection of their age, racial and gendered social location with their early career research engagements. It presents poetry as a form that can facilitate reflexivity for a humanising, decolonial, more ethical and healthier research praxis for all involved.

App Engagement as a Predictor of Weight Loss in Blended-Care Interventions: Retrospective Observational Study Using Large-Scale Real-World Data.

Early weight loss is an established predictor for treatment outcomes in weight management interventions for people with obesity. However, there is a paucity of additional, reliable, and clinically actionable early predictors in weight management interventions. Novel blended-care weight management interventions combine coach and app support and afford new means of structured, continuous data collection, informing research on treatment adherence and outcome prediction. Against this backdrop, this study analyzes app engagement as a predictor for weight loss in large-scale, real-world, blended-care interventions. We hypothesize that patients who engage more frequently in app usage in blended-care treatment (eg, higher logging activity) lose more weight than patients who engage comparably less frequently at 3 and 6 months of intervention. Real-world data from 19,211 patients in obesity treatment were analyzed retrospectively. Patients were treated with 3 different blended-care weight management interventions, offered in Switzerland, the United Kingdom, and Germany by a digital behavior change provider. The principal component analysis identified an overarching metric for app engagement based on app usage. A median split informed a distinction in higher and lower engagers among the patients. Both groups were matched through optimal propensity score matching for relevant characteristics (eg, gender, age, and start weight). A linear regression model, combining patient characteristics and app-derived data, was applied to identify predictors for weight loss outcomes. For the entire sample (N=19,211), mean weight loss was -3.24% (SD 4.58%) at 3 months and -5.22% (SD 6.29%) at 6 months. Across countries, higher app engagement yielded more weight loss than lower engagement after 3 but not after 6 months of intervention (P3 months<.001 and P6 months=.59). Early app engagement within the first 3 months predicted percentage weight loss in Switzerland and Germany, but not in the United Kingdom (PSwitzerland<.001, PUnited Kingdom=.12, and PGermany=.005). Higher age was associated with stronger weight loss in the 3-month period (PSwitzerland=.001, PUnited Kingdom=.002, and PGermany<.001) and, for Germany, also in the 6-month period (PSwitzerland=.09, PUnited Kingdom=.46, and PGermany=.03). In Switzerland, higher numbers of patients' messages to coaches were associated with higher weight loss (P3 months<.001 and P6 months<.001). Messages from coaches were not significantly associated with weight loss (all P>.05). Early app engagement is a predictor of weight loss, with higher engagement yielding more weight loss than lower engagement in this analysis. This new predictor lends itself to automated monitoring and as a digital indicator for needed or adapted clinical action. Further research needs to establish the reliability of early app engagement as a predictor for treatment adherence and outcomes. In general, the obtained results testify to the potential of app-derived data to inform clinical monitoring practices and intervention design.

Harmonizing Ouster Clauses and Pre-action Protocols in Nigerian Construction Disputes

This paper discusses how ouster clauses and pre-action protocols intersect when it comes to resolving construction disputes within the Nigerian context. Concerning dispelling ambiguity and providing sureness, ouster clauses point out ways of dispute resolution mechanisms. On the other hand, early resolution and cost saving can be encouraged through dialogue or cooperation before formal litigation thereby being said as the role of pre-action protocols in promoting such response before justice is sought. It is important to understand how these factors interrelate so that we can manage construction disputes effectively. While ouster clauses might influence when pre-action protocols are applied, they may also determine how parties understand and observe such provisions. Nigeria’s legal system as far as construction disputes are concerned, should be managed to maintain a harmonious balance between the two mechanisms. The interdependencies of the entities involved in this process are explored here and the aim is to provide information that could be useful for those practicing law or those responsible for making decisions in other areas The effectiveness of ouster clauses and pre-action protocols in construction disputes is assessed based on factors like resolution speed with a weighted mean of 2.53, legal enforcement (2.49), compliance rate (2.35), cost reduction (2.21). Ouster clauses limit the jurisdiction of courts or arbitrators by 34%, leading to prolonged litigation or arbitration (23%). Pre-action protocols impose procedural requirements (18%), causing delays and increased costs (16%). To improve the effectiveness of ouster clauses and pre-action protocols in construction disputes, it is crucial to enhance clarity, promote alternative dispute resolution, facilitate early engagement, strengthen enforcement mechanisms, and engage stakeholders. Keywords: Construction disputes, Litigation, Ouster clauses, Pre-action protocols, Resolution.

A Systematic Review of the Role of Multimodal Resources for Inclusive STEM Engagement in Early-Childhood Education

This paper presents the findings from a systematic review of 29 websites and 13 frameworks that provide STEM (Science, Technology, Engineering, Mathematics) educational resources for parents, educators, and children (birth–8 years of age). Our theoretical approach is rooted within a social semiotic perspective that has indicated that multimodality enables children to use different types of expression to communicate a message or share an idea. Using the PRISMA methodology and the narrative document analysis approach, the themes that emerged included how the content and resources available on the websites addressed whether multimodality supported STEM engagement in an inclusive manner. The findings revealed that there were scarce multimodal resources that engaged children with fun, interactive, and meaningful opportunities to be autonomous learners (e.g., children had agency) (n = 11 out of 29), moving between the digital and hands-on physical spaces (n = 8 out of 29), employing gamification for deep learning (n = 4 out of 29), and piquing children’s imagination, inquiry, and creativity, and links to everyday STEM scenarios were hardly present (n = 10 out of 29). The implications lie in addressing early STEM engagement by considering children’s learning abilities and agency, bearing in mind parents/educators’ sociocultural backgrounds, confidence in STEM awareness, and multimodal avenues for communicating STEM learning and inquiry.

Donor Limb Functional Restoration via a Novel Clinical Care Pathway following Fibula Free Flap Harvest for Head and Neck Reconstruction.

Patients undergoing head and neck skeletal reconstruction (HNR) often require free tissue transfer from the extremities to ensure proper restoration of form and function. This requires a team-based, highly reliable medical system centered around the patient needs. Surgical intervention across multiple sites and harvesting of donor tissue results in short- and long-term physical impairments. There is a paucity of research objectively measuring impairments resulting from the graft donor site. There is a lack of research that objectively measures impairments and protocols for the management of these patients postoperatively. Patients undergo little, if any, formal approach to dealing with the vast impairments, which are sequelae to this surgery. This leads to large discrepancies in proposed functional progressions, return to duty timelines, and utilization of rehabilitative resources. At a major military medical center, an innovative clinical care pathway for patients undergoing HNR using free tissue transfer was implemented using a multidisciplinary model that focuses on early engagement with rehabilitation. This model, paired with a single surgery, will attempt to return service members to duty months earlier than the traditional approach. This report describes the conceptual framework and implementation of a new criteria-based, multidisciplinary clinical care pathway for HNR patients. The collaboration amongst the multidisciplinary care team has optimized the holistic health of the patient and communication with their support network, yielding faster return to normalization of daily life activities. The long-term goal is to further develop and formalize this pathway to best serve this patient population.

Transitional Urology in Korea: Initial Insights Through a Cross-Sectional Study.

In Korea, the field of transitional urology (TU) is in its nascent stages, with its introduction only beginning. This study aims to evaluate the existing state of TU prior to implementing a transition protocol, and to identify key areas of focus for the development of an effective transition protocol. From June 1, 2021 to May 31, 2023, clinical data were retrospectively collected for patients who visited the adult urology or pediatric urology outpatient departments of this hospital and were aged 10 or older, with medical conditions falling under the category of TU. We analyzed the patient distribution across different disease groups. The transitional stages were categorized from T1, indicating initial care by pediatric urologists, to T4, denoting complete transition to adult care. 'T4x' was used for patients with unknown medical histories, and 'T4only' for those who had never been under pediatric urology care. During a 2-year period, a total of 1,484 patients received outpatient care for diseases in TU field. The most prevalent diseases were hypospadias (40.4%), spinal bifida (37.3%), and congenital ureteral anomalies (17.7%), with other conditions accounting for 4.6%. Among 553 spinal bifida patients, only 5.3% completed transitional care (T4), while 80.1% were in the initial phase (T1). For patients introduced to adult urology (T2-T4), 37.7% reached T4, highlighting a marked increase in transition completion within this subset (P<0.001). TU in Korea is in its nascent stage, with a significant gap in the initiation and completion of transitional care for patients with congenital urologic conditions. Early initiation and active engagement in transitional care are crucial for successful transition. This study highlights the need for structured transition protocols to address the complex needs of this patient population.

Rapid implementation of blood pressure self-monitoring in pregnancy at a UK NHS Trust during the COVID-19 pandemic: a quality improvement evaluation

BackgroundThis service evaluation describes the rapid implementation of self-monitoring of blood pressure (SMBP) into maternity care at a tertiary referral centre during the COVID-19 pandemic. It summarises findings, identifies knowledge...

Revolutionizing Healthcare with AI: Innovative Strategies in Cancer Medicine

By improving early detection, diagnosis, treatment planning, and patient management, artificial intelligence (AI) is transforming the way that cancer is treated. An overview of AI's function in cancer is given in this article, with special attention to how it advances precision medicine and improves patient outcomes. Numerous AI applications are discussed, such as predictive analytics, pathology interpretation, genetic profiling, and medical imaging analysis. Case studies highlight effective AI applications in cancer care, showcasing the technology's effectiveness in enhancing the precision of diagnoses, directing individualized treatment choices, and tracking treatment response. The paper delves into the possible advancements in early identification, therapy optimization, and patient engagement through an exploration of future directions and innovations in AI-driven oncology research. The conclusion emphasizes how AI has the ability to completely change the way cancer is treated and enhance the lives of cancer sufferers all over the world.

The Adaptation of a Postpartum Depression Prevention Evidence-Based Intervention in Family Homeless Shelters

Evidence-based interventions (EBIs) are considered the gold standard but it is unclear if they are effective across settings. Reach Out and Stay Strong, Essentials for new Mothers (ROSE) has been shown to prevent postpartum depression in clinical settings, but has not been implemented or tested in homeless populations. We used the Exploration, Preparation, Implementation and Sustainment (EPIS) model overlaid with the Dynamic Adaptation Process (DAP) to adapt ROSE for implementation in a homeless shelter system in a large U.S. city, using feedback from both the organization and community. The adapted intervention was called Strong in Shelter (SIS). In this paper, we present 4 DAPS (April, 2018- December, 2020); the EPIS stages within each DAP are described. The Exploration Stage is centered around early and ongoing engagement with shelter providers and residents. The Preparation Stage includes adaptations based on learnings from the Exploration and the Implementation Stages from previous DAPs. The Implementation Stage highlights what we learned from implementation and both quantitative and qualitative feedback from shelter staff and residents. Following the DAP cycles, we created scalable plans in the Sustainment Stage. Thematic analysis was used to identify, analyze and report patterns within qualitative data, and descriptive analyses were conducted with quantitative data. Participant engagement and satisfaction were high and facilitators reported implementing SIS with fidelity to ROSE’s core components. By engaging staff and the participants early and continually, and utilizing an iterative and flexible adaptation process, EBIs such as ROSE can be adapted and implemented with fidelity in new settings.

HOME-BASED EARLY WRITING ACTIVITIES: THE PERSPECTIVE OF PARENTS IN A LATVIAN CONTEXT

Students entering school with underdeveloped writing skills often face academic challenges. Addressing and improving these skills at the preschool level is a critical instructional goal. Early engagement in writing activities with parents and adults at home, beginning at a young age, is crucial in shaping children's writing identities and methods. While student motivation is vital in developing writing abilities, the role of parents in encouraging and nurturing these skills is equally important. This study aims to explore how parental involvement aids in developing early children's writing skills. Data were collected through surveys conducted with parents of 3-6-year-old preschoolers, focusing on their writing support and parenting practices. This research seeks to understand the role of parents in facilitating early writing activities at home. The study's primary objective is to examine parents' perspectives on enhancing their children's early writing skills within a home environment. Active participation by parents in their children's writing activities, including practices like reading together, encouraging daily writing, and providing constructive feedback, has shown positive outcomes. However, some parents reported challenges such as limited time or resources, affecting their ability to support their child's writing development effectively.