Regional distribution of poverty in Moldova

Although poverty is the most stringent problem in Moldova, the existing research had been done primarily by the WB and the UNDP. Measurement of poverty rates, rural poverty, and socio-economic characteristics of poor people had been the major focuses of the existing research, however very little information exists on the distribution of poverty. This research explains how poverty is distributed in Moldova using the minimum of existence level as poverty estimate.poverty, regional distribution

Poverty in Moldova

Moldova is the poorest nation in Europe and the Moldavian society has one f the highest degrees of economic inequality among the Soviet states. Official statistics as well as the World Bank poverty reports suggest that the number of people who live below the absolute poverty line is around 30%. In reality poverty is a massive phenomenon in Moldova and the real poverty rate exceeds 70% for both rural and urban areas

Participation in the special supplemental nutrition program for women, infants, and children is not associated with early childhood socioemotional development: Results from a longitudinal cohort study

AbstractSocioemotional development in early childhood has long-term impacts on health status and social outcomes, and racial and socioeconomic disparities in socioemotional skills emerge early in life. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an early childhood nutrition intervention with the potential to ameliorate these disparities. Our objective was to assess the impact of WIC on early socioemotional development in a longitudinal study. We examined the association between WIC participation and scores on the Brief Infant Toddler Social Emotional Assessment (BITSEA) in 327 predominantly African American mother–child dyads who were participants in the longitudinal Conditions Affecting Neurocognitive Development in Early Life (CANDLE) Study (Memphis, TN). To account for selection bias, we used within-child fixed effects to model the variability in each child's BITSEA scores over two measurement occasions (ages 12 and 24months). Final models were adjusted for time-varying characteristics including child age, maternal stress, mental health, child abuse potential, marital status, and food stamp participation. In fully adjusted models, we found no statistically significant effect of WIC on change in socioemotional development (β=0.22 [SD=0.39] and β=−0.58 [SD=0.79] for BITSEA Competence and Problem subdomains, respectively). Using rigorous methods and a longitudinal study design, we found no significant association between WIC and socioemotional development in a high needs population. This finding suggests that early childhood interventions that more specifically target socioemotional development are necessary if we are to reduce racial disparities in socioemotional skills and prevent poor social and health outcomes across the life course

Comparative evaluation of the health utilities index mark 3 and the short form 6D : evidence from an individual participant data meta-analysis of very preterm and very low birthweight adults

Background The most appropriate preference-based health-related quality of life (HRQoL) instruments for trials or research studies that ascertain the consequences of individuals born very preterm and/or low birthweight (VP/VLBW) are not known. Agreement between the HUI3 and SF-6D multi-attribute utility measures have not been previously investigated for VP/VLBW and normal birthweight or term-born controls. This study examined the agreement between the outputs of the HUI3 and SF-6D measures among adults born VP/VLBW and normal birthweight or term born controls. Methods We used two prospective cohorts of individuals born VP/VLBW and controls contributing to the ‘Research on European Children and Adults Born Preterm’ (RECAP) consortium which assessed HRQoL using two preference-based measures. The combined dataset of individual participant data (IPD) included 407 adult VP/VLBW survivors and 367 controls, ranging in age from 18 to 26 years. Bland–Altman plots, intra-class correlation coefficients, and generalized linear mixed models in a one-step approach were used to examine agreement between the measures. Results There was significant discordance between the HUI3 and SF-6D multi-attribute utility measures in the VP/VLBW sample, controls, and in the combined samples. Agreement between the HUI3 and SF-6D multi-attribute utility measures was weaker in controls compared with VP/VLBW individuals. Conclusions and relevance The HUI3 and SF-6D each provide unique information on different aspects of health status across the groups. The HUI3 better captures preterm-related changes to HRQoL in adulthood compared to SF-6D. Studies focused on measuring physical or cognitive aspects of health will likely benefit from using the HUI3 instead of the SF-6D, regardless of gestational age at birth and birthweight status

The effectiveness of generic emails versus a remote knowledge broker to integrate mood management into a smoking cessation program in team based primary care : A cluster randomized trial

Background: Knowledge brokering is a knowledge translation approach that has been gaining popularity in Canada although the effectiveness is unknown. This study evaluated the effectiveness of generalised, exclusively email-based prompts versus a personalised remote knowledge broker for delivering evidence-based mood management interventions within an existing smoking cessation programme in primary care settings. Methods: The study design is a cluster randomised controlled trial of 123 Ontario Family Health Teams participating in the Smoking Treatment for Ontario Patients programme. They were randomly allocated 1:1 for healthcare providers to receive either: a remote knowledge broker offering tailored support via phone and email (group A), or a generalised monthly email focused on tobacco and depression treatment (group B), to encourage the implementation of an evidence-based mood management intervention to smokers presenting depressive symptoms. The primary outcome was participants’ acceptance of a self-help mood management resource. The secondary outcome was smoking abstinence at 6-month follow-up, measured by self-report of smoking abstinence for at least 7 previous days. The tertiary outcome was the costs of delivering each intervention arm, which, together with the effectiveness outcomes, were used to undertake a cost minimisation analysis

Diagnostic Yield and Treatment Impact of Targeted Exome Sequencing in Early-Onset Epilepsy

Targeted whole-exome sequencing (WES) is a powerful diagnostic tool for a broad spectrum of heterogeneous neurological disorders. Here, we aim to examine the impact on diagnosis, treatment and cost with early use of targeted WES in early-onset epilepsy. WES was performed on 180 patients with early-onset epilepsy (≤5 years) of unknown cause. Patients were classified as Retrospective (epilepsy diagnosis >6 months) or Prospective (epilepsy diagnosis <6 months). WES was performed on an Ion Proton™ and variant reporting was restricted to the sequences of 620 known epilepsy genes. Diagnostic yield and time to diagnosis were calculated. An analysis of cost and impact on treatment was also performed. A molecular diagnoses (pathogenic/likely pathogenic variants) was achieved in 59/180 patients (33%). Clinical management changed following WES findings in 23 of 59 diagnosed patients (39%) or 13% of all patients. A possible diagnosis was identified in 21 additional patients (12%) for whom supporting evidence is pending. Time from epilepsy onset to a genetic diagnosis was faster when WES was performed early in the diagnostic process (mean: 145 days Prospective vs. 2,882 days Retrospective). Costs of prior negative tests averaged $8,344 per patient in the Retrospective group, suggesting savings of$5,110 per patient using WES. These results highlight the diagnostic yield, clinical utility and potential cost-effectiveness of using targeted WES early in the diagnostic workup of patients with unexplained early-onset epilepsy. The costs and clinical benefits are likely to continue to improve. Advances in precision medicine and further studies regarding impact on long-term clinical outcome will be important

Health-related quality-of-life outcomes of very preterm or very low birth weight adults : evidence from an individual participant data meta-analysis

Background and Objective Assessment of health-related quality of life for individuals born very preterm and/or low birthweight (VP/VLBW) offers valuable complementary information alongside biomedical assessments. However, the impact of VP/VLBW status on health-related quality of life in adulthood is inconclusive. The objective of this study was to examine associations between VP/VLBW status and preference-based health-related quality-of-life outcomes in early adulthood. Methods Individual participant data were obtained from five prospective cohorts of individuals born VP/VLBW and controls contributing to the ‘Research on European Children and Adults Born Preterm’ Consortium. The combined dataset included over 2100 adult VP/VLBW survivors with an age range of 18–29 years. The main exposure was defined as birth before 32 weeks’ gestation (VP) and/or birth weight below 1500 g (VLBW). Outcome measures included multi-attribute utility scores generated by the Health Utilities Index Mark 3 and the Short Form 6D. Data were analysed using generalised linear mixed models in a one-step approach using fixed-effects and random-effects models. Results VP/VLBW status was associated with a significant difference in the Health Utilities Index Mark 3 multi-attribute utility score of − 0.06 (95% confidence interval − 0.08, − 0.04) in comparison to birth at term or at normal birthweight; this was not replicated for the Short Form 6D. Impacted functional domains included vision, ambulation, dexterity and cognition. VP/VLBW status was not associated with poorer emotional or social functioning, or increased pain. Conclusions VP/VLBW status is associated with lower overall health-related quality of life in early adulthood, particularly in terms of physical and cognitive functioning. Further studies that estimate the effects of VP/VLBW status on health-related quality-of-life outcomes in mid and late adulthood are needed

Early Life Environments and Long Term Outcomes

A large literature has linked “in utero” environment to health and socio-economic outcomes in adulthood. We consider the effect of early life environments on health and skill formation outcomes. We first evaluate the impact of perinatal-neonatal level of technology at birth, which varies across delivery institutions, on the long-term neurodevelopmental outcomes of children with Cerebral Palsy. The level of technology at delivery determines the type of therapy newborns receive immediately after birth. The type of therapy is critical to prevent or treat adverse events around labor and delivery which determine later neurological and neurocognitive impairments such as CP. We evaluate the relationship between availability of neonatal technology, which is associated with levels of care at delivery hospitals, and CP nonambulatory status, using data from the Canadian Multi-Regional Cerebral Palsy Registry. In a follow-up paper we further explore the efficiency of neonatal transfers across Quebec neonatal system. We find robust evidence that there is no statistical significant relationship between level of neonatal care at birth and CP severity. This finding means that differences in levels of neonatal care and associated technology available at delivery are not associated at the margin with the risk of a non-ambulatory CP phenotype among children with CP. Overall we conclude that, in the Quebec regionalized neonatal care system, there is no gain to increasing the level of care assigned to mothers at risk of CP. We estimate the effect of mothers’ participation in the Supplementary Nutrition Assistance Program and the Special Supplemental Nutrition Program for Women, Infants, and Children on early cognitive and non-cognitive developmental outcomes as measured by the Bayley Scales of Infant Development. Our data are from a large, prospective, community-based panel study of mother-infant pairs. In this rich data set we can directly identify the change in neurodevelopmental outcomes associated with changes in food programs uptake. In a model where unobserved heterogeneity only affects the level of neurodevelopmental outcomes this can be interpreted as a causal effect. Our results suggest that brief prenatal investments may be more cost effective than traditional educational interventions in improving early childhood developmental outcome

Visible minorities` educational choices in Canada

Paper investigates educational choices of visible minorities in Canada, educational attainment and choices over fields of study. Using 2001 Canada Census data and multinomial logistic regression, research finds that choices over level of education and field of study significantly differ among visible minorities. The choices of visible minorities’ males and females differentiate substantially; insights into visible minorities` culture and role of education might explain those differences. Mathematics, computer and physical sciences, engineering, medicine and business are among the most likely choices of Chinese, and South Asians men visible minorities. Compared to Chinese and South Asian visible minority, Black visible minority does not display the same propensity to achieve superior educational outcomes. Paper argues that research on visible minorities` culture and values could illuminate choices over education