The Canine Behavioral Assessment and Research Questionnaire (C-BARQ) is a 100-item owner-completed survey instrument used for assessing behavior and temperament of companion dogs. The shortened ...version of the C-BARQ (C-BARQ.sup.(S)) consists of 42 items of the long C-BARQ. We aimed to validate the shortened C-BARQ.sup.(S) by comparing it with the long questionnaire in the same human-dog pair. We examined data from a nationwide cohort of companion dogs enrolled in the large-scale longitudinal Dog Aging Project (DAP) study. Among 435 participating owners who completed both the long and shortened versions of the C-BARQ within 60 days of each other, agreement between individual questions of the long and shortened C-BARQ using an unweighted kappa statistic and percent agreement was examined. Associations between the two questionnaires for mean behavior and temperament domain scores and mean miscellaneous category scores were assessed using Pearson correlation coefficients. Of 435 dogs in the study, the mean (SD) age was 7.3 (4.3) years and 216 (50%) were female. Kappa values between the long and shortened C-BARQ for individual questions within the 14 behavior and temperament domains and a miscellaneous category ranged from fair to moderate (0.23 to 0.40 for 21 items and 0.41 to 0.58 for 26 items, respectively). Pearson correlation coefficients above 0.60 between both questionnaires for 12 of the 14 mean behavior and temperament domain scores and a category of miscellaneous items were observed. Kappa values for individual questions between the long and shortened C-BARQ ranged from fair to moderate and correlations between mean domain scores ranged from moderate to strong.
To examine the prevalence of parent-provider discussions of family and community health risks during well-child visits and the gaps between which issues are discussed and which issues parents would ...like to discuss.
Data came from the National Survey of Early Childhood Health, a nationally representative sample of parents of 2068 children aged 4 to 35 months. The outcome measures were 1) the reported discussions with pediatric clinicians about 7 family and community health risks and 2) whether the parent believes that pediatric clinicians should ask parents about each risk.
Most parents believe that pediatric providers should discuss topics such as smoking in the household, financial difficulties, and emotional support available to the parent. However, with the exception of "household smoking," fewer than half of parents have been asked about these topics by their child's clinician. Parents of black and Hispanic children were more likely than parents of white children to be asked about several of these issues, as were parents of the youngest children and those with publicly financed health insurance. The greatest gap between parents' views and their reports of discussion with the clinician occur for parents of white children and older children. Among parents who hold the view that a topic should be discussed, parents of white and older children are less likely than others to report discussing some or all family and community health risks.
The low frequency of discussions for many topics indicates potential unmet need. More universal surveillance of parents with young children might ensure that needs are not missed, particularly given that strong majorities of parents view family and community topics, with the exception of community violence, as appropriate for discussion in clinic visits.
While obesity is associated with a variety of complications including diabetes, hypertension, cardiovascular disease and premature death, observational studies have also found that obesity and ...increasing body mass index (BMI) can be linked with improved survival in certain patient populations, including those with conditions marked by protein-energy wasting and dysmetabolism that ultimately lead to cachexia. The latter observations have been reported in various clinical settings including end-stage renal disease (ESRD) and have been described as the “obesity paradox” or “reverse epidemiology”, engendering controversy. While some have attributed the obesity paradox to residual confounding in an effort to “debunk” these observations, recent experimental discoveries provide biologically plausible mechanisms in which higher BMI can be linked to longevity in certain groups of patients. In addition, sophisticated epidemiologic methods that extensively adjusted for confounding have found that the obesity paradox remains robust in ESRD. Furthermore, novel hypotheses suggest that weight loss and cachexia can be linked to adverse outcomes including cardiomyopathy, arrhythmias, sudden death and poor outcomes. Therefore, the survival benefit observed in obese ESRD patients can at least partly be derived from mechanisms that protect against inefficient energy utilization, cachexia and protein-energy wasting. Given that in ESRD patients, treatment of traditional risk factors has failed to alter outcomes, detailed translational studies of the obesity paradox may help identify innovative pathways that can be targeted to improve survival. We have reviewed recent clinical evidence detailing the association of BMI with outcomes in patients with chronic kidney disease, including ESRD, and discuss potential mechanisms underlying the obesity paradox with potential for clinical applicability.
This study uses the first national data on well-child care for young children to 1) assess how many children have a specific clinician for well-child care; 2) identify the health insurance, health ...care setting, and child and family determinants of having a specific clinician; and 3) assess how parents choose pediatric clinicians.
Data from the National Survey of Early Childhood Health (NSECH), a nationally representative survey of health care quality for young children fielded by the National Center for Health Statistics in 2000, were used to describe well-child care settings for children aged 4 to 35 months. Parents reported the child's usual setting of well-child care, whether their child has a specific clinician for well-child care, and selection method for those with a clinician. Bivariate and logistic regression analyses are used to identify determinants of having a specific clinician and of provider selection method, including health care setting, insurance, managed care, and child and family characteristics.
Nearly all young children aged 4 to 35 months in the United States (98%) have a regular setting, but only 46% have a specific clinician for well-child care. The proportion of young children who have a single clinician is highest among privately insured children (51%) and lowest among publicly insured children (37%) and uninsured children (28%). In multivariate logistic regression including health care and sociodemographic factors, odds of having a specific clinician vary little by health care setting. Odds are lower for children who are publicly insured (odds ratio OR: 0.7; 95% confidence interval CI: 0.45-0.97) and for Hispanic children with less acculturated parents (OR: 0.6; 95% CI: 0.39-0.91). Odds are higher for children in a health plan with gatekeeping requirements (OR: 1.4; 95% CI: 1.02-1.88). Approximately 13% of young children with a specific clinician were assigned to that provider. Assignment rather than parent choice is more frequent for children who are publicly insured, in managed care, cared for in a community health center/public clinic, Hispanic, and of lower income and whose mother has lower education. In multivariate logistic regression, only lack of health insurance, care in a community health center, and managed care participation are associated with lack of choice.
Anticipatory guidance is the foundation of health supervision visits and may be most effective when there is a continuous relationship between the pediatric provider and the parent. Only half of young children in the United States are reported to have a specific clinician for well-child care. Low rates of continuity are found across health care settings. Furthermore, not all parents of children with a continuous relationship exercised choice, particularly among children in safety net health care settings. These provisional findings on a new measure of primary care continuity for children raise important questions about the prevalence and determinants of continuity.
Postpartum psychiatric disorders include the postpartum blues (PBs), postpartum depression (PPD), and postpartum psychosis (PP). The focus of this thesis will be on PPD. PPD is a commonly ...unrecognized mood disorder affecting up to 15% of women. Of women with PPD, half may go untreated. Untreated PPD has shown significant potential for adverse effects in both mother and child. The reproductive hormone model attributes PPD to the rapid hormone changes following removal of the placenta at delivery. This is especially true of the withdrawal of the reproductive hormones estrogen and progesterone. A true causal pathway or causal factor in PPD depression, however, is yet to be established. Several factors must be taken into account when considering risk. These risk factors include women of low socioeconomic status (SES), women with a history of depression, women with a higher reported average of recent life stressors, women with neurotic and/or shy personalities, and women who experience past and/or present obstetric complications. ;
Currently, the Edinburgh Postpartum Depression Scale (EPDS), the Postpartum Depression Screening Scale (PDSS), the Patient Health Questionnaire-9 (PHQ-9), as well as several other screening tools are used in clinical practice to diagnose PPD. Each screening tool utilizes its own unique method to obtain depression scores from patients. The EPDS is most commonly used, yet, no statistically significant difference has been found between the use of one screening tool over the other.;
PPD screening tools are seen across OB/GYN practices, family practices, health centers, and pediatric practices. Routine well-child visits represent the most regular contact that mothers have with the healthcare system postpartum, making pediatric primary care practices ideal settings for PPD screening and management. PPD management within primary care primarily involves non-pharmacological interventions such as counseling, psychoeducation, motivating help seeking, encouraging social support, and referring to others as needed. On the other hand, medication management is integrated into the stepped care treatment approach, which screens for and treats PPD in a step-wise fashion tailored to a woman’s risk assessment and responsiveness to treatment.;
Treatments for PPD have varying success. They may include selective serotonin reuptake inhibitors (SSRIs), selective serotonin and norepinephrine reuptake inhibitors (SSNRIs), gamma aminobutyric acid receptor A positive allosteric modulators (GABAA receptor PAMs), norepinephrine and dopamine reuptake inhibitors (NDRIs), estrogen therapy, omega-3 polyunsaturated fatty acid supplementation (n-3 PUFA), cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), electroconvulsive therapy (ECT), and bright light therapy (BLT). More statistical evidence currently exists on the use of pharmacological and psychotherapeutic treatments, and less on the ECT and BLT clinical treatments. Mothers deciding on which treatment to pursue should consider the potential for psychotropic and estrogen medications to pass into their breast milk and onto their infant. New mothers should also outweigh the risks and benefits of pursuing pharmacological treatment rather than letting their depression go untreated.;
By conducting a thorough literature review, this thesis serves the purpose of identifying the most effective treatments to be integrated with a modified stepped care pathway, thereby creating a standardized PPD protocol that can be used across pediatric primary care practices. The aim of standardization of protocol using specific treatments in a modified stepped care approach is to effectively detect maternal PPD, minimize the potential for harm to mother and infant, as well as improve the consistency of care provided to mothers diagnosed with PPD. Implemented correctly, the protocol should show increased use of validated PPD screening tools such as the EDPS in practices managing care for postpartum mothers and/or infants up to the age of one, followed by risk assessment, and then treatment escalated from psychotherapy to antidepressants if required.
Research has shown that accounting for moral sentiment in natural language can yield insight into a variety of on- and off-line phenomena such as message diffusion, protest dynamics, and social ...distancing. However, measuring moral sentiment in natural language is challenging, and the difficulty of this task is exacerbated by the limited availability of annotated data. To address this issue, we introduce the Moral Foundations Twitter Corpus, a collection of 35,108 tweets that have been curated from seven distinct domains of discourse and hand annotated by at least three trained annotators for 10 categories of moral sentiment. To facilitate investigations of annotator response dynamics, we also provide psychological and demographic metadata for each annotator. Finally, we report moral sentiment classification baselines for this corpus using a range of popular methodologies.
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