To examine the validity of the Patient Health Questionnaire 2 (PHQ-2), a 2-item depression-screening scale, among adolescents.
After completing a brief depression screen, 499 youth (aged 13-17 years) ...who were enrolled in an integrated health care system were invited to participate in a full assessment, including a longer depression-screening scale (Patient Health Questionnaire 9-item depression screen) and a structured mental health interview (Diagnostic Interview Schedule for Children). Eighty-nine percent (n = 444) completed the assessment. Criterion validity and construct validity were tested by examining associations between the PHQ-2 and other measures of depression and functional impairment.
A PHQ-2 score of > or =3 had a sensitivity of 74% and specificity of 75% for detecting youth who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for major depression on the Diagnostic Interview Schedule for Children and a sensitivity of 96% and specificity of 82% for detecting youth who met criteria for probable major depression on the Patient Health Questionnaire 9-item depression screen. On receiver operating characteristic analysis, the PHQ-2 had an area under the curve of 0.84 (95% confidence interval: 0.75-0.92), and a cut point of 3 was optimal for maximizing sensitivity without loss of specificity for detecting major depression. Youth with a PHQ-2 score of > or =3 had significantly higher functional-impairment scores and significantly higher scores for parent-reported internalizing problems than youth with scores of <3.
The PHQ-2 has good sensitivity and specificity for detecting major depression. These properties, coupled with the brief nature of the instrument, make this tool promising as a first step for screening for adolescent depression in primary care.
Purpose: Although peer support has received research attention within different health related contexts, there is limited research considering individuals who have experienced an amputation. In ...particular, the peer mentoring role is under-explored. Therefore, this research aimed to explore the experiences of participants delivering peer support interventions to individuals with lower limb loss.
Methods: Eight people who acted as peer mentors for people with limb loss took part in semi-structured interviews. Data were analyzed using Interpretative Phenomenological Analysis (IPA). Results: Two overarching themes were identified from the data: "Developing a Helpful Self", in which the personal value and meaning of being a peer mentor is presented, and "Connecting with Vulnerability", which addresses the emotional challenges of peer mentoring and the impact of these on wellbeing.
Conclusions: Findings suggest positive experiences of providing support, including increased hope, resilience and a sense of belonging and connection to others. However, peer mentors experienced challenges related to uncertainty and doubt about their mentoring abilities and with developing and maintaining resilience in the role. Recommendations include the development of training packages and increased clarity for volunteers of the peer mentor role.
Implications for rehabilitation
It is important to define clearly the role of a peer mentor and the responsibilities this involves.
Peer mentors should be provided with support and training to increase their confidence and ability to act appropriately when encountering distress.
It is important to provide transparent guidelines and procedures to support peer mentors to minimize concerns over risk and safety.
Feedback regarding how effective the support offered is and how it could be improved should be provided.
The availability of habitat structure across spatial scales can determine ecological organization and resilience. However, anthropogenic disturbances are altering the abundance and composition of ...habitat-forming organisms. How such shifts in the composition of these organisms alter the physical structure of habitats across ecologically important scales remains unclear. At a time of unprecedented coral loss and homogenization of coral assemblages globally, we investigate the inherent structural complexity of taxonomically distinct reefs, across five ecologically relevant scales of measurement (4-64 cm). We show that structural complexity was influenced by coral species composition, and was not a simple function of coral cover on the studied reefs. However, inter-habitat variation in structural complexity changed with scale. Importantly, the scales at which habitat structure was available also varied among habitats. Complexity at the smallest, most vulnerable scale (4 cm) varied the most among habitats, which could have inferences for as much as half of all reef fishes which are small-bodied and refuge dependent for much of their lives. As disturbances continue and species shifts persist, the future of these ecosystems may rely on a greater concern for the composition of habitat-building species and prioritization of particular configurations for protection of maximal cross-scale habitat structural complexity.
The aim of this study is to test the effects of an electronic screening and feedback tool and training for primary care clinicians on care and adolescent health behaviors.
We conducted a ...stepped-wedge cluster randomized trial with six clinics randomly assigned to sequential crossover from control to intervention periods with clinician training between periods. Adolescents (ages 13–18) with a well visit during the control periods (n = 135) received usual care, while adolescents during the intervention periods (n = 167) received the electronic screening and feedback tool prior to their well visit, with results sent to their clinicians. Adolescents completed surveys at baseline, 1 day, 3 months, 6 months, and 12 months. Linear mixed effects models were used to examine associations between outcomes and treatment, controlling for time as a fixed effect and clinic as a random effect. All analyses employed intent-to-treat analyses and utilized multiple imputations for missing data.
Adolescents who received the intervention had a higher rate of counseling for their endorsed risk behaviors during the well visit (45% vs. 33%, Wald’s T = 2.29, p = .02). There were no significant intervention effects on adolescent satisfaction with the clinician or perception of patient centeredness. The intervention was associated with a small but statistically significant reduction in overall risk score relative to control at 3 months (−.63, 95% confidence interval −1.07, −.19, Cohen’s d = .21), but not at 6 or 12 months.
The results suggest that electronic screening and feedback may be associated with small reductions in risk behaviors at 3 months but that changes do not persist at longer term follow-up.
Anti-teleological reproduction is a Barnesian aesthetic that bridges both content and practice in Djuna Barnes' late work. Contrary to a scholastic tradition that reads Barnes' revision practices as ...barriers to her success as an author, this essay understands her obsessive relationship with iteration as a key component of her oeuvre. In its refusal of traditional goals of authorship, namely completion and publishing, Barnes' late work betrays the Enlightenment expectation that literature and its authors conform to models of progress, teleology, and rationality in the realm of aesthetics and public persona. These characteristics emerge in Barnes' late play The Antiphon (1958), where the compulsive restaging of an original trauma abjures catharsis in favour of 'pointless', antihumanist reproductions.
Rapid and unprecedented ecological change threatens the functioning and stability of ecosystems. On coral reefs, global climate change and local stressors are reducing and reorganizing ...habitat-forming corals and associated species, with largely unknown implications for critical ecosystem functions such as herbivory. Herbivory mediates coral-algal competition, thereby facilitating ecosystem recovery following disturbance such as coral bleaching events or large storms. However, relationships between coral species composition, the distribution of herbivorous fishes and the delivery of their functional impact are not well understood. Here, we investigate how herbivorous fish assemblages and delivery of two distinct herbivory processes, grazing and browsing, differ among three taxonomically distinct, replicated coral habitats. While grazing on algal turf assemblages was insensitive to different coral configurations, browsing on the macroalga
cf.
varied considerably among habitats, suggesting that different mechanisms may shape these processes. Variation in browsing among habitats was best predicted by the composition and structural complexity of benthic assemblages (in particular the cover and composition of corals, but not macroalgal cover), and was poorly reflected by visual estimates of browser biomass. Surprisingly, the lowest browsing rates were recorded in the most structurally complex habitat, with the greatest cover of coral (branching
habitat). While the mechanism for the variation in browsing is not clear, it may be related to scale-dependent effects of habitat structure on visual occlusion inhibiting foraging activity by browsing fishes, or the relative availability of alternate dietary resources. Our results suggest that maintained functionality may vary among distinct and emerging coral reef configurations due to ecological interactions between reef fishes and their environment determining habitat selection.
Coral community composition varies considerably due to both environmental conditions and disturbance histories. However, the extent to which coral composition influences associated fish assemblages ...remains largely unknown. Here an ecological trait-based ordination analysis was used to compare functional richness (range of unique trait combinations), functional evenness (weighted distribution of fishes with shared traits), and functional divergence (proportion of total abundance supported by species with traits on the periphery of functional space) of fish assemblages among six distinct coral habitats. Despite no significant variation in species richness among habitats, there were differences in the functional richness and functional divergence, but not functional evenness, of fish assemblages among habitats. Structural complexity of coral assemblages was the best predictor of the differences in functional richness and divergence among habitats. Functional richness of fish assemblages was highest in branching
Porites
habitats, lowest in
Pocillopora
and soft coral habitats, and intermediate in massive
Porites
, staghorn
Acropora
, and mixed coral habitats. Massive and branching
Porites
habitats displayed greater functional divergence in fish assemblages than the
Pocillopora
habitat, whilst the remaining habitats were intermediate. Differences in functional richness and divergence were largely driven by the presence of small schooling planktivores in the massive and branching
Porites
habitats. These results indicate that differential structural complexity among coral communities may act as an environmental filter, affecting the distribution and abundance of associated species traits, particularly those of small-bodied schooling fishes.
Both affirming environments and access to gender-affirming medical care have a positive impact on the mental health of transgender and gender diverse (TGD) youth, however, many TGD youth experience ...barriers in accessing this care. Pediatric primary care providers (PCPs) can play an important role in expanding access to gender-affirming care for TGD youth; however, few currently provide this care. The purpose of this study was to explore pediatric PCPs' perspectives regarding barriers they experience to providing gender-affirming care in the primary care setting.
Pediatric PCPs who had sought out support from the Seattle Children's Gender Clinic were recruited via email to participate in semistructured, one-hour Zoom interviews. All interviews were transcribed and then subsequently analyzed in Dedoose qualitative analysis software using a reflexive thematic analysis framework.
Provider participants (n = 15) represented a wide range of experiences with respect to years in practice, number of TGD youth seen, and practice location (urban, rural, suburban). PCPs identified both health system and community-level barriers to providing gender-affirming care to TGD youth. Health system-level barriers included: (1) lack of foundational knowledge and skills, (2) limited clinical decision-making support, and (3) health system design limitations. Community-level barriers included (1) community and institutional biases, (2) provider attitudes regarding gender-affirming care provision, and (3) challenges identifying community resources to support TGD youth.
A multitude of health system and community-level barriers must be overcome in the pediatric primary care setting to ensure that TGD youth receive timely, effective, and more equitable gender-affirming care.
We aimed to examine transgender youths' interest in receiving gender-affirming care via telemedicine or through primary care with telehealth support.
We surveyed 12- to 26-year-old transgender youth ...receiving care in a multidisciplinary gender clinic. Descriptive statistics and bivariate analyses were used to assess relationships between demographic and gender-related characteristics and interest in receiving care via telemedicine.
Almost half (47%) of the 204 youth surveyed expressed interest in receiving gender care via telemedicine. Additionally, youth with lower levels of perceived parental support were more likely to express an interest in utilizing telemedicine (p = .001). Approximately half (45%) of youth were interested in receiving gender care in the primary care setting, with a majority expressing willingness to do so if their primary care provider had telehealth support.
Many transgender youth expressed interest in receiving gender care via telehealth, particularly for ongoing care and monitoring. Increased interest in telemedicine was seen among youth with lower perceived parental support.
To further elucidate the various aspects of the triadic relationship between health-care providers (HCP), adolescents, and caregivers during adolescent health-care visits, with the goal of helping ...HCPs better understand how they can best support adolescents to choose healthy behaviors.
Adolescents (ages 13-18 years) and caregivers of adolescents were recruited to participate in qualitative interviews regarding preferences for provider interactions around health behavior change. Data analysis was conducted using inductive thematic analysis to identify and describe patterns of themes across the dataset.
Thirty one adolescents and 30 caregivers participated. Fourteen themes emerged in the analysis regarding adolescent and caregiver preferences for direct and indirect relationships between adolescents, caregivers, and HCPs in promoting healthy behavior. These themes were organized into a triadic collaboration framework to promote healthy behavior using an adolescent-centered and caregiver-involved approach.
This study supports findings of previous research on triadic interactions between HCPs, adolescents, and caregivers while deepening our understanding of the HCP's role in helping adolescents to choose healthy behaviors. These themes are representative of the continuing shift toward an adolescent-centered and caregiver-involved approach to adolescent health care and provide further guidance to HCPs on how to work collaboratively with both adolescents and caregivers to promote healthy behaviors and improve health outcomes.
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