Adaptation of a culturally relevant nutrition and physical activity program for low-income, Mexican-origin parents with young children.

Latino children experience higher rates of obesity than do non-Latino white children. Family-centered nutrition interventions can slow the rate of weight gain in this population. Niños Sanos, Familia Sana (Healthy Children, Healthy Family) is a 5-year, community-based, participatory research study that targets rural Mexican-origin farmworker families with children aged 2 to 8 years in California's Central Valley. Adaptation of a culturally relevant obesity prevention program involved qualitative research to tailor key obesity prevention messages, pilot testing and implementation of key messages and activities at family nights, and continual modification to incorporate culturally innovative elements. Of the 238 families enrolled, 53% (125) attended the recommended minimum of 5 (of 10 possible) classes during the first year. A university and community partnership can guide development of a culturally tailored obesity prevention program that is suitable for reaching a high-risk Mexican-origin audience through cooperative extension and other public health programs

Using Theory to Develop Healthy Choices in Motion, a Comprehensive, Experiential Physical Activity Curriculum.

Background: Research has shown that engaging in regular physical activity supports physiologic, metabolic, and immunologic processes, as well as quality of life. However, few youth in the United States meet the U.S. Department of Health and Human Services recommendation of 60 min of moderate-to-vigorous physical activity every day. School-based programs can be an effective avenue for engaging youth in physical activity, particularly when the design of the health education is based on theory, research, and practice. The purpose of this study was to design, implement, and evaluate a theory-driven physical activity curriculum for the Shaping Healthy Choices Program (SHCP) using a systematic approach. Methods: The experiential, inquiry-based physical activity curriculum, Healthy Choices in Motion (HCIM), was developed with an optional technology enhancement using Backward Design. A questionnaire to assess the curriculum's effect on physical activity knowledge was developed and assessed for content validity, internal consistency (α = 0.84), and test-retest reliability (r = 0.73). The curriculum was piloted in two phases among upper elementary-aged youth: to ensure the learning goals were met (Pilot I) and to determine the curriculum's impact on physical activity knowledge, behavior, and self-efficacy (Pilot II). Pilot II was implemented among eight 4th and 5th-grade classrooms participating in the UC CalFresh Nutrition Education Program: (1) Comparison (no intervention) (n = 25); (2) SHCP only (n = 22); (3) SHCP + HCIM (n = 42); (4) SHCP + HCIM with technology enhancement (n = 47). Analyses included unadjusted ANOVA and Bonferroni for multiple comparisons and paired t-test (p < 0.05). Results: Through the use of a methodical design approach, a comprehensive physical activity curriculum, called HCIM, was developed. Youth participating in HCIM improved physical activity knowledge compared to youth receiving no intervention (+2.8 points, p = 0.009) and youth only in the SHCP (+3.0 points, p = 0.007). Youth participating in HCIM with technology enhancement demonstrated improvements compared to youth only in the SHCP (+2.3 points, p = 0.05). Conclusion: Improvements in physical activity knowledge in youth participating in HCIM may contribute to improvements in physical activity and should be further explored in conjunction with behavioral measurements

Designing prenatal care for low-income, black patients in urban settings using human centered design

Objective: Black and low-income pregnant patients face significant inequities in health care access and outcomes in the United States. Yet, these patients’ voices have been largely absent from designing improved prenatal care models. Our objective was to use Human Centered Design to examine patients’ and health care workers’ experiences with prenatal care delivery in a largely low-income, Black population, to inform future care innovations to improve access, quality, and outcomes. Study Design: Using snowball sampling, we conducted Human Centered Design-informed interviews with low-income, Black patients and health care workers in a large, urban setting. Interview questions addressed the first two Human Centered Design phases: 1) observation: understanding the problem from the end-user’s perspective, and 2) ideation: generating novel potential solutions. We assessed these questions for the three key components of prenatal care: medical care, anticipatory guidance, and psychosocial support. Results: Nineteen patients and 19 health care workers were interviewed. All patients were Black, and the majority had public insurance (17/19, 89.5%). Health care workers included doctors, midwives, breastfeeding counselors, doulas, and social workers. Participants affirmed the three goals of prenatal care. Participants reported failures of current prenatal care delivery and potential solutions for each of the three goals (medical care, anticipatory guidance, and psychosocial support) and two overarching categories: maternity care professionals and care structure. Participants reported in an ideal model, patients would have strong relationships with their maternity care professional who would be at the center of all prenatal care services. Additionally, care would be tailored to individual patients and use care navigators, flexible models, and colocation of services, to reduce barriers. Conclusion: Current prenatal care delivery fails to meet low-income, Black patients’ needs. Ideal prenatal care delivery includes more comprehensive, integrated services tailored to patients’ medical needs and preferences

Experiences With Prenatal Care Delivery Reported by Black Patients With Low Income and by Health Care Workers in the US: A Qualitative Study

IMPORTANCE: Black pregnant people with low income face inequities in health care access and outcomes in the US, yet their voices have been largely absent from redesigning prenatal care. OBJECTIVE: To examine patients\u27 and health care workers\u27 experiences with prenatal care delivery in a largely low-income Black population to inform care innovations to improve care coordination, access, quality, and outcomes. DESIGN, SETTING, AND PARTICIPANTS: For this qualitative study, human-centered design-informed interviews were conducted at prenatal care clinics with 19 low-income Black patients who were currently pregnant or up to 1 year post partum and 19 health care workers (eg, physicians, nurses, and community health workers) in Detroit, Michigan, between October 14, 2019, and February 7, 2020. Questions focused on 2 human-centered design phases: observation (understanding problems from the end user\u27s perspective) and ideation (generating novel potential solutions). Questions targeted participants\u27 experiences with the 3 goals of prenatal care: medical care, anticipatory guidance, and social support. An eclectic analytic strategy, including inductive thematic analysis and matrix coding, was used to identify promising strategies for prenatal care redesign. MAIN OUTCOMES AND MEASURES: Preferences for prenatal care redesign. RESULTS: Nineteen Black patients (mean [SD] age, 28.4 [5.9] years; 19 [100%] female; and 17 [89.5%] with public insurance) and 17 of 19 health care workers (mean [SD] age, 47.9 [15.7] years; 15 female [88.2%]; and 13 [76.5%] Black) completed the surveys. A range of health care workers were included (eg, physicians, doulas, and social workers). Although all affirmed the 3 prenatal care goals, participants reported failures and potential solutions for each area of prenatal care delivery. Themes also emerged in 2 cross-cutting areas: practitioners and care infrastructure. Participants reported that, ideally, care structure would enable strong ongoing relationships between patients and practitioners. Practitioners would coordinate all prenatal services, not just medical care. Finally, care would be tailored to individual patients by using care navigators, flexible models, and colocation of services to reduce barriers. CONCLUSIONS AND RELEVANCE: In this qualitative study of low-income, Black pregnant people in Detroit, Michigan, and the health care workers who care for them, prenatal care delivery failed to meet many patients\u27 needs. Participants reported that an ideal care delivery model would include comprehensive, integrated services across the health care system, expanding beyond medical care to also include patients\u27 social needs and preferences

Residents transitioning between hospital and care homes: protocol for codesigning a systems-level response to safety issues (SafeST study)

Introduction: The aim of this study is to develop a better understanding of incident reporting in relation to transitions in care between hospital and care home, and to codesign a systems- level response to safety issues for patients transitioning between hospital and care home. Methods and analysis: Two workstreams (W) will run in parallel. W1 will aim to develop a taxonomy of incident reporting in care homes, underpinned by structured interviews (N=150) with care home representatives, scoping review of care home incident reporting systems, and a review of incident reporting policy related to care homes. The taxonomy will be developed using a standardised approach to taxonomy development. W2 will be structured in three phases (P). P1a will consist of ≤40 interviews with care home staff to develop a better understanding of their specific internal systems for reporting incidents, and P1b will include ≤30 interviews with others involved in transitions between hospital and care home. P1a and P1b will also examine the impact of the SARS- CoV- 2 pandemic on safe transitions. P2 will consist of a retrospective documentary analysis of care home data relating to resident transitions, with data size and sampling determined based on data sources identified in P1a. A validated data extraction form will be adapted before use. P3 will consist of four validation and codesign workshops to develop a service specification using National Health Service Improvement’s service specification framework, which will then be mapped against existing systems and recommendations produced. Framework analysis informed by the heuristic of systemic risk factors will be the primary mode of analysis, with content analysis used for analysing incident reports. Ethics and dissemination: The study has received university ethical approval and Health Research Authority approval. Findings will be disseminated to commissioners, providers and regulators who will be able to use the codesigned service specification to improve integrated care

Inflation and Dark Energy from spectroscopy at z > 2

The expansion of the Universe is understood to have accelerated during two epochs: in its very first moments during a period of Inflation and much more recently, at z < 1, when Dark Energy is hypothesized to drive cosmic acceleration. The undiscovered mechanisms behind these two epochs represent some of the most important open problems in fundamental physics. The large cosmological volume at 2 < z < 5, together with the ability to efficiently target high-$z$ galaxies with known techniques, enables large gains in the study of Inflation and Dark Energy. A future spectroscopic survey can test the Gaussianity of the initial conditions up to a factor of ~50 better than our current bounds, crossing the crucial theoretical threshold of $\sigma(f_{NL}^{\rm local})$ of order unity that separates single field and multi-field models. Simultaneously, it can measure the fraction of Dark Energy at the percent level up to $z = 5$, thus serving as an unprecedented test of the standard model and opening up a tremendous discovery space

Constraining Running Non-Gaussianity

The primordial non-Gaussian parameter fNL has been shown to be scale-dependent in several models of inflation with a variable speed of sound. Starting from a simple ansatz for a scale-dependent amplitude of the primordial curvature bispectrum for two common phenomenological models of primordial non-Gaussianity, we perform a Fisher matrix analysis of the bispectra of the temperature and polarization of the Cosmic Microwave Background (CMB) radiation and derive the expected constraints on the parameter nNG that quantifies the running of fNL(k) for current and future CMB missions such as WMAP, Planck and CMBPol. We find that CMB information alone, in the event of a significant detection of the non-Gaussian component, corresponding to fNL = 50 for the local model and fNL = 100 for the equilateral model of non-Gaussianity, is able to determine nNG with a 1-sigma uncertainty of Delta nNG = 0.1 and Delta nNG = 0.3, respectively, for the Planck mission. In addition, we consider a Fisher matrix analysis of the galaxy power spectrum to determine the expected constraints on the running parameter nNG for the local model and of the galaxy bispectrum for the equilateral model from future photometric and spectroscopic surveys. We find that, in both cases, large-scale structure observations should achieve results comparable to or even better than those from the CMB, while showing some complementarity due to the different distribution of the non-Gaussian signal over the relevant range of scales. Finally, we compare our findings to the predictions on the amplitude and running of non-Gaussianity of DBI inflation, showing how the constraints on a scale-dependent fNL(k) translate into constraints on the parameter space of the theory.Comment: 37 pages, 14 figure