This study examined the prevalence, predictors, and outcomes of spanking and verbal punishment in 2,573 low-income White, African American, and Mexican American toddlers at ages 1, 2, and 3. Both spanking and verbal punishment varied by maternal race/ethnicity. Child fussiness at age 1 predicted spanking and verbal punishment at all three ages. Cross-lagged path analyses indicated that spanking (but not verbal punishment) at age 1 predicted child aggressive behavior problems at age 2 and lower Bayley mental development scores at age 3. Neither child aggressive behavior problems nor Bayley scores predicted later spanking or verbal punishment. In some instances, maternal race/ethnicity and/or emotional responsiveness moderated the effects of spanking and verbal punishment on child outcomes.

Background:Little population-level information exists about the delivery of palliative care across multiple health sectors, important in providing a complete picture of current care and gaps in care.Aim:Provide a population perspective on end-of-life palliative care delivery across health sectors.Design:Retrospective population-level cohort study, describing palliative care in the last year of life using linked health administrative databases.Setting/participants:All decedents in Ontario, Canada, from 1 April 2010 to 31 March 2012 (n = 177,817).Results:Across all health sectors, about half (51.9%) of all decedents received at least one record of palliative care in the last year of life. Being female, middle-aged, living in wealthier and urban neighborhoods, having cancer, and less multi-morbidity were all associated with higher odds of palliative care receipt. Among 92,276 decedents receiving palliative care, 84.9% received care in acute care hospitals. Among recipients, 35 mean days of palliative care were delivered. About half (49.1%) of all palliative care days were delivered in the last 2 months of life, and half (50.1%) had palliative care initiated in this period. Only about one-fifth of all decedents (19.3%) received end-of-life care through publicly funded home care. Less than 10% of decedents had a record of a palliative care home visit from a physician.Conclusion:We describe methods to capture palliative care using administrative data. Despite an estimate of overall reach (51.9%) that is higher than previous estimates, we have shown that palliative care is infrequently delivered particularly in community settings and to non-cancer patients and occurs close to death.

BackgroundMultimorbidity poses a significant clinical challenge and has been linked to greater health services use, including hospitalization; however, we have little knowledge about the influence of contextual factors on outcomes in this population. Objectives: To describe the extent to which the association between multimorbidity and hospitalization is modified by age, gender, primary care practice model, or continuity of care (COC) among adults with at least one chronic condition.MethodsA retrospective cohort study with linked population-based administrative data.Setting: Ontario, Canada. Cohort: All individuals 18 and older with at least one of 16 priority chronic conditions as of April 1, 2009 (baseline). Main Outcome Measures: Any hospitalization, 3 or more hospitalizations, non-medical discharge delay, and 30-day readmission within the 1 year following baseline.ResultsOf 5,958,514 individuals, 484,872 (8.1 %) experienced 646,347 hospitalizations. There was a monotonic increase in the likelihood of hospitalization and related outcomes with increasing multimorbidity which was modified by age, gender, and COC but not primary care practice model. The effect of increasing multimorbidity was greater in younger adults than older adults and in those with lower COC than with higher COC. The effect of increasing multimorbidity on hospitalization was greater in men than women but reversed for the other outcomes.ConclusionsThe effect of multimorbidity on hospitalization is influenced by age and gender, important considerations in the development of person-centred care models. Greater continuity of physician care lessened the effect of multimorbidity on hospitalization, further demonstrating the need for care continuity across providers for people with chronic conditions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1415-5) contains supplementary material, which is available to authorized users.

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North Carolina's Smart Start and More at Four early childhood programs were evaluated through the end of elementary school (age 11) by estimating the impact of state funding allocations to programs in each of 100 counties across 13 consecutive years on outcomes for all children in each county-year group (n=1,004,571; 49% female; 61% non-Latinx white, 30% African American, 4% Latinx, 5% other). Student-level regression models with county and year fixed effects indicated significant positive impacts of each program on reading and math test scores and reductions in special education and grade retention in each grade. Effect sizes grew or held steady across years. Positive effects held for both high-and low-poverty families, suggesting spillover of effects to non-participating peers. North Carolina's Early Childhood Programs 3Surging policy interest in early education and care programs for children from birth to age five has heightened demand for rigorous evaluation of programs and policies to determine which strategies produce the largest impacts on promoting child development. Because of inconsistent findings across studies (to be described below), policy and scientific interest has focused on whether positive effects of early childhood programs endure or fade. "Fadeout" refers to diminishing differences between an intervention and control group over time following an initial positive impact of a program, due to either decrement in performance by the intervention group or deferred improvement by the control group. The current study examines whether initial positive impacts of North Carolina's early childhood programs are sustained or fade out by the end of elementary school.The field has moved from exclusive reliance on the findings of a handful of small experiments begun in the 1960s to examination of the impact of policies and programs as they are implemented at scale. This progression follows from the Institute of Medicine's prescription for bringing basic science to policy by moving from scientifically-based small randomized trials of efficacy in the laboratory to larger, more naturalistic trials in the community and, finally, to evaluation of programs when implemented at scale (Mrazek & Hagerty, 1994). Coincident with the shift to evaluation of programs at scale is growing interest in whether state-level policies and programs can "move the needle" to improve population-level outcomes by exerting impact not only on program participants but also on their peers through a spillover effect, and whether these impacts are sustained or fade out by the end of elementary school.The current study evaluates fadeout and spillover of impact of North Carolina's two flagship early childhood programs on education outcomes for 13 cohorts of about one million children as they develop from birth through the end of elementary school. This study is the third North Carolina's Early Childhood Programs 4 in a series using similar methods and data. Ladd, Muschkin, and Dodge (2014) found initial positive impact of each program...

Objective. To investigate the current use of integrative therapies (IT) in the treatment of patients with amyotrophic lateral sclerosis (ALS). Methods. A cross-sectional, multicenter clinical epidemiological survey was conducted in 12 hospitals in Shanghai. We investigated the type and frequency of IT use and determined whether the use of IT correlated with demographic, social, or disease-specific characteristics in our patient population. Results. A total of 231 (89.5%) of 258 patients with ALS were eligible for the study and 229 (99% of all) of 231 reported the use of at least one IT for the treatment of ALS. Vitamins and Chinese herb decoctions, Chinese herb compounds, massage therapy, and acupuncture were the 5 most commonly used therapies. There was a strong association between education level, income, and use of IT. A household income of more than 75,000 RMB ($49,995) correlated with multiple IT use, and married patients used IT more often than single individuals. The main reasons for using IT were to treat weakness and fatigue, muscle atrophy, the development of ALS, depression, insomnia, limb pain or numbness, and side effects associated with Riluzole. Conclusion. The use of IT is common in patients with ALS in Shanghai. Vitamins and TCM are the most used additional therapies and the widespread and largely unexamined use of IT for ALS requires more attention.

Previous studies have shown that AgRP neurons in the arcuate nucleus (ARC) respond to energy deficits and play a key role in the control of feeding behavior and metabolism. Here, we demonstrate that chronic unpredictable stress, an animal model of depression, decreases spontaneous firing rates, increases firing irregularity and alters the firing properties of AgRP neurons in both male and female mice. These changes are associated with enhanced inhibitory synaptic transmission and reduced intrinsic neuronal excitability. Chemogenetic inhibition of AgRP neurons increases susceptibility to subthreshold unpredictable stress. Conversely, chemogenetic activation of AgRP neurons completely reverses anhedonic and despair behaviors induced by chronic unpredictable stress. These results indicate that chronic stress induces maladaptive synaptic and intrinsic plasticity, leading to hypoactivity of AgRP neurons and subsequently causing behavioral changes. Our findings suggest that AgRP neurons in the ARC are a key component of neural circuitry involved in mediating depression-related behaviors and that increasing AgRP neuronal activity coule be a novel and effective treatment for depression.

Meeting diabetes testing goals has the potential to reduce hospitalizations for diabetes-related complications; however, this depends on types of coexisting chronic conditions and diabetes-related complications in patients with diabetes.