Assessing the dominance behavioral system in early childhood using observational methods.

BACKGROUND: The dominance behavioral system (DBS) is a biologically based system that underpins individual differences in motivation for dominance and power. However, little is known about the DBS in childhood. In order to make strong claims about the DBS's trait-like properties and predictive validity, a clearer understanding of its early development is required. PARTICIPANTS AND PROCEDURE: In a pilot study aimed at developing a behavioral coding system for dominance, a key facet of the DBS, we collected and coded observational data from 58 children, assessed at ages 3 and 5-6. These data were examined in conjunction with measures of child temperament via observational measures, and symptoms of psychopathology. RESULTS: Dominance was moderately stable in early childhood to a degree comparable to other early child temperament traits. Consistent with the study hypotheses, boys were more dominant than girls, and dominance was negatively associated with children's behavioral inhibition, effortful control, and internalizing symptoms. CONCLUSIONS: These results provide initial support for the validity and developmental sensitivity of an objective coding system for assessing facets of the DBS in early childhood. Ultimately, the use of this coding system will facilitate future studies of how early DBS predicts psychological adjustment later in life.

Vital Signs: Maternity Care Experiences - United States, April 2023.

Introduction: Maternal deaths increased in the United States during 2018-2021, with documented racial disparities. Respectful maternity care is a component of quality care that includes preventing harm and mistreatment, engaging in effective communication, and providing care equitably. Improving respectful maternity care can be part of multilevel strategies to reduce pregnancy-related deaths. Methods: CDC analyzed data from the PN View Moms survey administered during April 24-30, 2023, to examine the following components of respectful care: 1) experiences of mistreatment (e.g., violations of physical privacy, ignoring requests for help, or verbal abuse), 2) discrimination (e.g., because of race, ethnicity or skin color; age; or weight), and 3) reasons for holding back from communicating questions or concerns during maternity (pregnancy or delivery) care. Results: Among U.S. mothers with children aged <18 years, 20% reported mistreatment while receiving maternity care for their youngest child. Approximately 30% of Black, Hispanic, and multiracial respondents and approximately 30% of respondents with public insurance or no insurance reported mistreatment. Discrimination during the delivery of maternity care was reported by 29% of respondents. Approximately 40% of Black, Hispanic, and multiracial respondents reported discrimination, and approximately 45% percent of all respondents reported holding back from asking questions or discussing concerns with their provider. Conclusions and implications for public health practice: Approximately one in five women reported mistreatment during maternity care. Implementing quality improvement initiatives and provider training to encourage a culture of respectful maternity care, encouraging patients to ask questions and share concerns, and working with communities are strategies to improve respectful maternity care.

Supporting Individuals with Mental Health and/or Addictions Issues Through Patient Navigation: A Scoping Review.

Pathways through the mental health care system can be complex and laden with barriers that prevent individuals from finding the most appropriate care. Navigation has been proposed as a solution for improving access to and transition through complex health care systems. While several MHA navigation programs have emerged in the past decade, no study has explored the core themes of MHA navigation, which was the goal of the current review. A scoping review was conducted; the search yielded 11,525 unique results, of which 26 were entered into extraction and subsequent descriptive and thematic analysis. Barrier reduction, client-centered support, and integrated care emerged as the distinct themes underlying MHA services, and overall, navigation significantly improved outcomes for individuals experiencing MHA issues. These findings may support evidence-based implementation of navigation services and point to a need for increased exploration and reporting of MHA navigation outcomes in the literature.

Right frontal brain activity at rest in the early 20s predicts threat-related bias ten years later among extremely low birth weight survivors.

Exposure to early adversity is known to shape brain-behavior relations, which in turn can lead to hypersensitivity to threat and an increased risk of developing a range of psychopathologies. To date, much of the work in this area has considered exposure to negative post-natal events (e.g., maltreatment) in shaping these relations in humans. Here we examined the influence of prenatal adversity in the form of a suboptimal intra-uterine environment (i.e., being born at extremely low birth weight; [ELBW i.e., < 1000 g]). ELBW babies are the tiniest and most at-risk infants and are known to be at risk for internalizing problems (e.g., depression and anxiety) from childhood through early adulthood. However, we know relatively little about the mechanism(s) underlying this risk. Using the oldest known prospectively followed cohort of ELBW survivors, we examined associations among birth weight status, individual differences in frontal brain electrical activity (EEG) at rest (a marker of affective style) at age 22-26 years, and threat-related biases to angry faces (using the dot probe task) at 30-35 years of age. We found that among ELBW adults, those displaying greater relative right frontal EEG activity at rest exhibited greater vigilance to angry faces than those exhibiting greater relative left frontal EEG activity (n = 34, r = -0.40, p = .02). This pattern was not observed among normal birth weight (NBW) control participants (n = 47, r = .08, p > .05). As well, the relation between frontal EEG asymmetry and vigilance to angry faces was stronger for the ELBW group versus the NBW group (z = -2.21, p =  .03). These findings suggest that exposure to significant prenatal adversity may have long-term programming effects on biological and cognitive systems associated with emotion regulatory processes in the fourth decade of life. We speculate that these vulnerabilities may contribute to making some ELBW survivors susceptible to psychopathology.

Personality and opponent processes: Shyness, sociability, and visual afterimages to emotion.

The opponent process theory of emotion posits that emotional states evoke opposite emotion states as they wane, resulting in sequential approach and withdrawal motivations. However, whether opponent processes are associated with individual differences in personality remains an empirical question. Using visual afterimage responses to emotional faces as an index of opponent processes, we found that young adults (N = 101; Mage = 19.41 years, SD = 2.06 years) characterized by relatively high shyness and high sociability (i.e., conflicted shyness) were more likely to perceive a negative face emotion afterimage after adapting to happy faces and a positive face emotion afterimage after adapting to angry faces, compared with young adults classified by other combinations of high and low shyness and sociability. We speculate that conflicted shyness may result from strong opponent processes to both positive and negative emotions to real or anticipated social situations in some individuals, resulting in conflicting social motivations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Disparities in Tdap Vaccination and Vaccine Information Needs Among Pregnant Women in the United States.

Objectives The Advisory Committee on Immunization Practices (ACIP) and the American College of Obstetricians and Gynecologists (ACOG) recommend that pregnant women receive the Tdap vaccine during every pregnancy. The objectives of this paper are to evaluate disparities in Tdap vaccination among pregnant women in the U.S., and to assess whether race/ethnicity and other characteristics are associated with factors that inform pregnant women's decisions about Tdap vaccination. Methods We conducted a nationwide cross-sectional web-based survey of pregnant women in the U.S. during June-July 2014. The primary outcome was self-reported vaccination status with Tdap during pregnancy, categorized as vaccinated, unvaccinated with intent to be vaccinated during the current pregnancy, and unvaccinated with no intent to be vaccinated during the current pregnancy. Secondary outcomes included factors that influenced women's decisions about vaccination and information needs. We used multivariable logistic regression models to estimate odds ratios for associations between race/ethnicity and the outcomes. Results Among pregnant women who completed the survey, 41% (95% CI 36-45%) reported that they had received Tdap during the current pregnancy. Among those women in the third trimester at the time of survey, 52% (95% CI 43-60%) had received Tdap during the current pregnancy. Hispanic women had higher Tdap vaccination than white women and black women (53%, p < 0.05, compared with 38 and 36%, respectively). In logistic regression models adjusting for maternal age, geographic region, education, and income, Hispanic women were more likely to have been vaccinated with Tdap compared with white women (aOR 2.29, 95% CI 1.20-4.37). Higher income and residing in the western U.S. were also independently associated with Tdap vaccination during pregnancy. Twenty-six percent of surveyed women had not been vaccinated with Tdap yet but intended to receive the vaccine during the current pregnancy; this proportion did not differ significantly by race/ethnicity. The most common factor that influenced women to get vaccinated was a health care provider (HCP) recommendation. The most common reason for not getting vaccinated was a concern about safety of the vaccine. Conclusions This study found that some disparities exist in Tdap vaccination among pregnant women in the U.S., and HCPs have an important role in providing information and recommendations about the maternal Tdap recommendation to pregnant women so they can make informed vaccination decisions.

Provider insight on surmounting specialty practice challenges to improve Tdap immunization rates among pregnant women.

BACKGROUND: Pertussis, or "whooping cough," is an acute, contagious pulmonary disease that, despite being vaccine-preventable, has become an increasingly widespread problem in the United States. As a result, the Advisory Committee on Immunization Practices and American College of Obstetricians and Gynecologists updated recommendations stating clinicians should give a Tdap dose during every pregnancy, preferably at 27-36 weeks. Despite this recommendation, reported Tdap vaccine receipt rates during pregnancy vary from 16-61%, and previous studies have shown that clinician recommendation and vaccine administration are strongly associated with vaccine uptake among pregnant women. METHODS: Our aim was to inform new strategies to increase uptake of the Tdap vaccine among pregnant women and, ultimately, reduce pertussis-related morbidity and mortality in infants. We conducted interviews with a sample of 24 ob-gyns. We subsequently performed grounded theory analyses of transcripts using deductive and inductive coding strategies followed by intercoder reliability assessment. RESULTS: All physicians interviewed were familiar with the most recent recommendation of giving the Tdap vaccine during the third trimester of every pregnancy, and the majority of physicians stated that they felt that the vaccine was important and effective due to the transfer of pertussis antibodies from the mother to the fetus. Most physicians indicated that they recommended the vaccine to patients during pregnancy, but not all reported administering it on site because it was not stocked at their practice. Implementation challenges for physicians included insurance reimbursement and other challenges (i.e., patient refusal). Tdap vaccination during pregnancy was a lower clinical priority for some physicians. Physicians recognized the benefits associated with Tdap vaccination during pregnancy. CONCLUSIONS: Findings indicate while most ob-gyns recognize the benefits of Tdap and recommend vaccination during pregnancy, barriers such as insurance reimbursement and financial concerns for the practice can outweigh the perceived benefits. This resulted in some ob-gyns reporting choosing not to stock and administer the vaccine in their practice. Recommendations to address these concerns include 1) structural support for Tdap vaccine administration in ob-gyns practices; 2) Continuing medical education-equivalent educational interventions that address management techniques, vaccine coding, and other relevant information; and 3) interventions to assist physicians in communicating the importance of Tdap vaccination during pregnancy.

Changes in childhood immunization decisions in the United States: Results from 2012 & 2014 National Parental Surveys.

OBJECTIVE: Understanding the current status of parents' vaccine decision making is crucial to inform public policy. We sought to assess changes in vaccine decisions among parents of young children. METHODS: We conducted a web-based national poll of parents of children <7years in 2012 and 2014. Participants reported vaccine decisions for their youngest child. We calculated survey-weighted population estimates of overall immunizations decisions, and delay/refusal rates for specific vaccines. RESULTS: In 2012, 89.2% (95% CI, 87.3-90.8%) reported accepting or planning to accept all recommended non-influenza childhood vaccines, 5.5% (4.5-6.6%) reported intentionally delaying one or more, and 5.4% (4.1-6.9%) reported refusing one or more vaccines. In 2014, the acceptance, delay, and refusal rates were 90.8% (89.3-92.1%), 5.6% (4.6-6.9%), and 3.6% (2.8-4.5%), respectively. Between 2012 and 2014, intentional vaccine refusal decreased slightly among parents of older children (2-6years) but not younger children (0-1years). The proportion of parents working to catch up on all vaccines increased while those refusing some but not all vaccines decreased. The South experienced a significant increase in estimated acceptance (90.1-94.1%) and a significant decrease in intentional ongoing refusal (5.0-2.1%). Vaccine delay increased in the Northeast (3.2-8.8%). CONCLUSIONS: Nationally, acceptance and ongoing intentional delay of recommended non-influenza childhood vaccines were stable. These findings suggest that more effort is warranted to counter persistent vaccine hesitancy, particularly at the local level. Longitudinal monitoring of immunization attitudes is also warranted to evaluate temporal shifts over time and geographically.