Writing a New Story: Culturally Competent Care for American Indians

Providing culturally competent healthcare to American Indians requires a methodological shift from providers. Education on cultural competence is a vital piece of service provision, but is not enough on its own. Knowledge of the history of a person and their culture, respect for their past and personal experiences, and for their beliefs about health and wellness are key components to providing care. Humility and patience, and the knowledge that you will be learning from your client as much as they will learn from you, are also important aspects of developing a relationship with your client and being effective in providing care to a diverse population

Interactions of Overweight, Poor Oral Health, and Stress Related to Chronic Disease in an Aging Population

The prevalence of excess body mass (XBM), poor oral health (POH), and stress in a secluded population of aged (≥60 years) Hmong immigrants was surveyed. The findings were related to the prevalence of diabetes in the same population. Diabetes was associated separately with POH (OR 2.4; CL 1.3, 4.2) or with XBM (OR 2.5; CL 1.4, 4.8). The association of diabetes with the combination of XBM and POH was striking (OR 5.1; CL 3.4, 7.5); that apparent synergism has not been fully appreciated. We describe a mechanism that explains the synergism. The concept of “thrifty genotype” is a plausible explanation of XBM in the elderly Hmong immigrants and possibly the current older Laotian population. POH is common among elderly Laotians as it is in most developing countries. We conclude that synergism of XBM and POH significantly elevates the prevalence of diabetes among aging populations and probably other age groups as well

Microsatellite DNA markers, multiple paternity, and the inheritance of morphology and behavior in Butler\u27s garter snake (Thamnophis butleri)

Variation in behavior can be the result of many environmental and genetic factors. Quantitative genetics has provided a contextual basis in which to study traits, such as behavior, that vary in a continuous manner. Estimating quantitative parameters with precision depends on complete knowledge of pedigrees. Molecular genetic techniques, such as microsatellite DNA markers, allow researchers to more accurately determine relatedness. Garter snakes (Thamnophis) and other natricine snakes are suitable models for genetic studies due to the relatively large number of precocial offspring born to each dam. In addition, multiple paternity in Thamnophis litters is widespread. Thamnophis butleri, the subject of this thesis, is a threatened species in Wisconsin as a result of both human and genetic intrusion. The presence of morphological T. radix- T. butleri hybrids provides evidence that the parapatric species, T. radix, may be able to interbreed and genetically swamp T. butleri. Preliminary studies found primers developed for T. sirtalis and Nerodia sipedon amplified T. butleri microsatellite DNA regions as well. Using this microsatellite information, I determined if multiple paternity was present in T. butleri. As expected, I found multiple paternity in 55% to 78% of the sample litters. In addition, I employed microsatellite allele distribution to deduce full and half-sibship with a litter. Data was also collected on scale counts, body and head measurements, antipredator responses, and chemical extract and live prey preference. Disparity among litters, or dam effects, was determined using an analysis of variance. Several characteristics, such as body size, head size, number of ventral scales, propensity to strike and flee when confronted with threatening stimuli, and preference for live fish was found to vary among litters. Dam variance could be the result of maternal genetic, maternal environmental or additive genetic effects. I performed a nested analysis of variance to establish sire-within-dam effects, which are a consequence of genetics only; therefore, the difference between dam and sire-within-dam variances is attributable to maternal environment. I found no sire-within-dam differences for any traits measured. Low sample size for the sire-within-dam analysis probably masked any true differences

Identifying and Implementing Assessments of Upper Extremity Motor Control for Patients with Stroke or Parkinson’s Disease

The authors collaborated with a team of clinicians at a skilled nursing facility (SNF) in Gig Harbor, WA to identify the need for measures of UE functional use that are most appropriate to utilize with the two largest client populations at their facility, stroke and Parkinson’s disease (PD). In order to meet the clinical utility characteristics identified as important by the clinicians, the authors searched two databases that contain overviews of assessments. This search identified five stroke assessments and two PD assessments that met the clinical utility parameters outlined by the clinicians. The authors then conducted a systematic literature search to identify any relevant studies pertaining to each assessment. These studies were reviewed and the results presented in the form of a critical appraisal of the topic (CAT) that included the purpose, measure, population, psychometric characteristics, results and limitations of the studies. The initial search for articles yielded 869 articles, 33 of which met the inclusion criteria. The authors recommend use of the Chedoke Arm and Hand Activity Inventory-9 assessment with clients post-stroke due to its robust evidence and wide variety of levels of impairments post-stroke included in the studies, and use of the Muscle Disorder Society’s Unified Parkinson’s Disease Rating Scale assessment with clients with PD due to its inclusion of functional tasks and higher volume of research. The knowledge translation implementation phase of the project involved an in-service (interactive demonstration and scoring) and two brochures outlining the findings related to each assessment. A follow-up survey measured the effectiveness of the in-service and the value of the research to clinicians’ occupational therapy practice at their clinic. The survey results indicated that the clinicians found the research helpful and the knowledge translation process efficient. In addition, they indicated that it is likely that they will implement the CAHAI and the MDS-UPDRS assessments at their facility

Genetic architecture of reciprocal social behavior in toddlers: Implications for heterogeneity in the early origins of autism spectrum disorder

Impairment in reciprocal social behavior (RSB), an essential component of early social competence, clinically defines autism spectrum disorder (ASD). However, the behavioral and genetic architecture of RSB in toddlerhood, when ASD first emerges, has not been fully characterized. We analyzed data from a quantitative video-referenced rating of RSB (vrRSB) in two toddler samples: a community-based volunteer research registry (n = 1,563) and an ethnically diverse, longitudinal twin sample ascertained from two state birth registries (n = 714). Variation in RSB was continuously distributed, temporally stable, significantly associated with ASD risk at age 18 months, and only modestly explained by sociodemographic and medical factors (r2 = 9.4%). Five latent RSB factors were identified and corresponded to aspects of social communication or restricted repetitive behaviors, the two core ASD symptom domains. Quantitative genetic analyses indicated substantial heritability for all factors at age 24 months (h2 ≥ .61). Genetic influences strongly overlapped across all factors, with a social motivation factor showing evidence of newly-emerging genetic influences between the ages of 18 and 24 months. RSB constitutes a heritable, trait-like competency whose factorial and genetic structure is generalized across diverse populations, demonstrating its role as an early, enduring dimension of inherited variation in human social behavior. Substantially overlapping RSB domains, measurable when core ASD features arise and consolidate, may serve as markers of specific pathways to autism and anchors to inform determinants of autism\u27s heterogeneity

Wild flies hedge their thermal preference bets in response to seasonal fluctuations

Fluctuating environmental pressures can challenge organisms by repeatedly shifting the optimum phenotype. Two contrasting evolutionary strategies to cope with these fluctuations are 1) evolution of the mean phenotype to follow the optimum (adaptive tracking) or 2) diversifying phenotypes so that at least some individuals have high fitness in the current fluctuation (bet-hedging). Bet-hedging could underlie stable differences in the behavior of individuals that are present even when genotype and environment are held constant. Instead of being simply ‘noise,’ behavioral variation across individuals may reflect an evolutionary strategy of phenotype diversification. Using geographically diverse wild-derived fly strains and high-throughput assays of individual preference, we tested whether thermal preference variation in Drosophila melanogaster could reflect a bet-hedging strategy. We also looked for evidence that populations from different regions differentially adopt bet-hedging or adaptive-tracking strategies. Computational modeling predicted regional differences in the relative advantage of bet-hedging, and we found patterns consistent with that in regional variation in thermal preference heritability. In addition, we found that temporal patterns in mean preference support bet-hedging predictions and that there is a genetic basis for thermal preference variability. Our empirical results point to bet-hedging in thermal preference as a potentially important evolutionary strategy in wild populations