1,296 research outputs found
Total Medical Expense (TME) for Privately Insured Adolescents: Understanding the Causes of High Cost Care
An observational study of delivered and received aggression, gender, and social-psychological adjustment in preschool: Abstract This White Crayon Doesn\u27t Work ...
A semi-structured observational study investigated gender differences in delivered and received relational, physical, verbal, and nonverbal aggression in a young preschool sample (N = 60). Findings revealed that gender differences in subtypes of aggression may be apparent as early as 3 years of age. Specifically, girls were found to deliver and receive more relational aggression than males, whereas boys tended, although not significantly, to deliver and significantly received more physical aggression than females. Relational and physical subtypes of delivered and received aggression were differentially associated with preschoolers\u27 social-psychological adjustment
How do you define recovery? A qualitative study of patients with eating disorders, their parents, and clinicians
ObjectiveRecovery from an eating disorder (ED) may be defined differently by different stakeholders. We set out to understand the definition of ED recovery from the perspective of patients, their parents, and clinicians.MethodWe recruited patients with EDs (n = 24, ages 12â23âyears) representing different diagnoses (anorexia nervosa n = 17, bulimia nervosa n = 4, bingeâED n = 2, avoidant/restrictive food intake disorder n = 1), along with their parents (n = 20), dietitians (n = 11), therapists (n = 14), and primary care providers (n = 9) from three sites: Boston Childrenâs Hospital, University of Michigan C. S. Mott Childrenâs Hospital, and Penn State Hershey Childrenâs Hospital. Inâdepth, semiâstructured, qualitative interviews explored participantsâ definitions of recovery. Interviews were analyzed using inductive dataâdriven thematic analysis. Statistical analyses followed to examine the distribution within each theme by respondent type.ResultsQualitative analysis resulted in the emergence of four overarching themes of ED recovery: (a) psychological wellâbeing, (b) eatingârelated behaviors/attitudes, (c) physical markers, and (d) selfâacceptance of body image. Endorsement of themes two and four did not significantly differ between patients, parents, and clinicians. Clinicians were significantly more likely to endorse theme one (Ï2 =â9.90, df =â2, p =â.007, Ïc =â0.356) and theme three (Ï2 =â6.42, df =â2, p =â.04, Ïc =â0.287) than patients and parents.DiscussionOur study demonstrates overwhelming support for psychological markers as indicators of ED recovery by all three groups. Clinicians should remain open to additional markers of recovery such as body acceptance and eatingârelated behaviors/emotions that may be of critical importance to patients and their caregivers.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/156211/2/eat23294_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156211/1/eat23294.pd
Early parenting and children\u27s relational and physical aggression in the preschool and home contexts
This study investigated early parent- child relationships and how children\u27s use of relational and physical aggression varies with aspects of those relationships during the preschool years. Specifically, parenting styles, parents\u27 use of psychological control, and parents\u27 report of their children\u27s reunion behaviors were assessed. Analyses revealed significant associations between children\u27s use of both relational and physical aggression and parents\u27 reports of their own and their partner\u27s parenting style, psychological control behaviors, and indicators of the attachment relationship. The results highlight the importance of investigating both mothers\u27 and fathers\u27 parenting and the sex of the child in studies of potential links between parenting behaviors and young childrenâs relational and physical aggression. Findings were considered in the context of each perspective and suggestions for future research and implications for intervention and prevention are discussed
Inter-cultural differences in response to a computer-based anti-bullying intervention
Background and purpose: Many holistic anti-bullying interventions have been attempted, with mixed success, while little work has been done to promote a 'self-help' approach to victimisation. The rise of the ICT curriculum and computer support in schools now allows for approaches that benefit from technology to be implemented. This study evaluates the cross-cultural effects of a computer-based anti-bullying intervention on primary school-aged children's knowledge about bullying and relevant coping strategies.
Programme description: FearNot! is an interactive computer-based virtual learning environment designed for use as an anti-bullying intervention. It includes interactive virtual agents who assume the most common participant roles found in episodes of bullying. FearNot! was used by children over three consecutive weeks to allow its effectiveness to be evaluated in a longitudinal in situ programme.
Sample: Two comparable samples were drawn from the UK and Germany. In the UK, 651 participants (aged 8-11) were recruited from primary schools in Hertfordshire, Coventry and Warwickshire, whereas the 535 German participants (aged 7-10) were sourced from Grundschulen in the Bayern and Hessen regions. Because of lack of parental consent, late joiners and absences/missing responses, data from 908 participants (UK 493; Germany 415) were analysed.
Design and methods: A quasi-experimental, pre/post-tests control group design employed pre-published and bespoke questionnaires to collect data. Descriptive and inferential analyses were conducted.
Results: UK students possessed higher coping strategy knowledge scores than German participants, but German children's scores improved over time and as a result of the FearNot! intervention.
Conclusions: Overall, while not effective at increasing children's coping strategy knowledge in this study, the FearNot! intervention could prove a useful classroom tool to approach the issue of bullying as part of a wider initiative. Cultural differences at baseline and reactions to the intervention are discussed
Impaired cholecystokinin-induced gallbladder emptying incriminated in spontaneous âblackâ pigment gallstone formation in germfree Swiss Webster mice
âBlackâ pigment gallstones form in sterile gallbladder bile in the presence of excess bilirubin conjugates (âhyperbilirubinbiliaâ) from ineffective erythropoiesis, hemolysis, or induced enterohepatic cycling (EHC) of unconjugated bilirubin. Impaired gallbladder motility is a less well-studied risk factor. We evaluated the spontaneous occurrence of gallstones in adult germfree (GF) and conventionally housed specific pathogen-free (SPF) Swiss Webster (SW) mice. GF SW mice were more likely to have gallstones than SPF SW mice, with 75% and 23% prevalence, respectively. In GF SW mice, gallstones were observed predominately in heavier, older females. Gallbladders of GF SW mice were markedly enlarged, contained sterile black gallstones composed of calcium bilirubinate and <1% cholesterol, and had low-grade inflammation, edema, and epithelial hyperplasia. Hemograms were normal, but serum cholesterol was elevated in GF compared with SPF SW mice, and serum glucose levels were positively related to increasing age. Aged GF and SPF SW mice had deficits in gallbladder smooth muscle activity. In response to cholecystokinin (CCK), gallbladders of fasted GF SW mice showed impaired emptying (females: 29%; males: 1% emptying), whereas SPF SW females and males emptied 89% and 53% of volume, respectively. Bilirubin secretion rates of GF SW mice were not greater than SPF SW mice, repudiating an induced EHC. Gallstones likely developed in GF SW mice because of gallbladder hypomotility, enabled by features of GF physiology, including decreased intestinal CCK concentration and delayed intestinal transit, as well as an apparent genetic predisposition of the SW stock. GF SW mice may provide a valuable model to study gallbladder stasis as a cause of black pigment gallstones.National Institutes of Health (U.S.) (Training Grant T32-OD10978-26)National Institutes of Health (U.S.) (Training Grant P30-ES002109)Kinship Foundation. Searle Scholars Progra
The study of HIV and antenatal care integration in pregnancy in Kenya: design, methods, and baseline results of a cluster-randomized controlled trial
Background: Despite strong evidence for the effectiveness of anti-retroviral therapy for improving the health of women living with HIV and for the prevention of mother-to-child transmission (PMTCT), HIV persists as a major maternal and child health problem in sub-Saharan Africa. In most settings antenatal care (ANC) services and HIV treatment services are offered in separate clinics. Integrating these services may result in better uptake of services, reduction of the time to treatment initiation, better adherence, and reduction of stigma.
Methodology/Principal Findings: A prospective cluster randomized controlled trial design was used to evaluate the effects of integrating HIV treatment into ANC clinics at government health facilities in rural Kenya. Twelve facilities were randomized to provide either fully integrated services (ANC, PMTCT, and HIV treatment services all delivered in the ANC clinic) or non-integrated services (ANC clinics provided ANC and basic PMTCT services and referred clients to a separate HIV clinic for HIV treatment). During June 2009â March 2011, 1,172 HIV-positive pregnant women were enrolled in the study. The main study outcomes are rates of maternal enrollment in HIV care and treatment, infant HIV testing uptake, and HIVfree infant survival. Baseline results revealed that the intervention and control cohorts were similar with respect to sociodemographics, male partner HIV testing, sero-discordance of the couple, obstetric history, baseline CD4 count, and WHO Stage. Challenges faced while conducting this trial at low-resource rural health facilities included frequent staff turnover, stock-outs of essential supplies, transportation challenges, and changes in national guidelines.
Conclusions/Significance: This is the first randomized trial of ANC and HIV service integration to be conducted in rural Africa. It is expected that the study will provide critical evidence regarding the implementation and effectiveness of this service delivery strategy, with important implications for programs striving to eliminate vertical transmission of HIV and improve maternal health
Parent experiences with a nurse-supervised community health worker asthma home-visiting program.
OBJECTIVE: This study seeks to identify helpful components of a nurse-supervised Community Health Worker (CHW) asthma home-visiting program, obtain feedback from parents and families about their experiences, and receive suggestions for new services that the program could provide. METHODS: Likert scale ratings and semi-structured qualitative interviews were conducted with parents who were selected from a representative sample and previously participated in the program. Five-point Likert scale ratings from 1 (not helpful) to 5 (very helpful) were obtained for 11 program components. Interviews were analyzed using a grounded theory participatory approach. Data were analyzed and themes were identified by two different coders using Dedoose software. RESULTS: A total of 22 participants were enrolled and 20 participants completed Likert scale ratings and qualitative interviews. Likert scale ratings (mean standard deviation [SD]) show that program strengths include asthma education (4.75 [0.55]), supplies (4.65 [0.99]), help with housing conditions (3.94 [1.56], pest management (3.79 [1.69]) and greater access to community resources (3.70 [1.30]). The ratings suggest that families need more help with other social determinants of health, such as school, lack of enough money or food, and mental health and behavioral concerns (3.05 [1.78]). Interviews echoed these ratings and revealed several themes about family and parental stress, children's activity limitations, desire for outreach after the 12-month intervention, a need for help with other social determinants and more emotional support. CONCLUSIONS: This study shows that the program was well received and reveals the importance of addressing social determinants of health and behavioral health concerns
Monotonicity of Fitness Landscapes and Mutation Rate Control
A common view in evolutionary biology is that mutation rates are minimised.
However, studies in combinatorial optimisation and search have shown a clear
advantage of using variable mutation rates as a control parameter to optimise
the performance of evolutionary algorithms. Much biological theory in this area
is based on Ronald Fisher's work, who used Euclidean geometry to study the
relation between mutation size and expected fitness of the offspring in
infinite phenotypic spaces. Here we reconsider this theory based on the
alternative geometry of discrete and finite spaces of DNA sequences. First, we
consider the geometric case of fitness being isomorphic to distance from an
optimum, and show how problems of optimal mutation rate control can be solved
exactly or approximately depending on additional constraints of the problem.
Then we consider the general case of fitness communicating only partial
information about the distance. We define weak monotonicity of fitness
landscapes and prove that this property holds in all landscapes that are
continuous and open at the optimum. This theoretical result motivates our
hypothesis that optimal mutation rate functions in such landscapes will
increase when fitness decreases in some neighbourhood of an optimum, resembling
the control functions derived in the geometric case. We test this hypothesis
experimentally by analysing approximately optimal mutation rate control
functions in 115 complete landscapes of binding scores between DNA sequences
and transcription factors. Our findings support the hypothesis and find that
the increase of mutation rate is more rapid in landscapes that are less
monotonic (more rugged). We discuss the relevance of these findings to living
organisms
- âŠ