Self-management support for chronic disease in primary care: frequency of patient self-management problems and patient reported priorities, and alignment with ultimate behavior goal selection.

BackgroundTo enable delivery of high quality patient-centered care, as well as to allow primary care health systems to allocate appropriate resources that align with patients' identified self-management problems (SM-Problems) and priorities (SM-Priorities), a practical, systematic method for assessing self-management needs and priorities is needed. In the current report, we present patient reported data generated from Connection to Health (CTH), to identify the frequency of patients' reported SM-Problems and SM-Priorities; and examine the degree of alignment between patient SM-Priorities and the ultimate Patient-Healthcare team member selected Behavioral Goal.MethodsCTH, an electronic self-management support system, was embedded into the flow of existing primary care visits in 25 primary care clinics and was used to assess patient-reported SM-Problems across 12 areas, patient identified SM-Priorities, and guide the selection of a Patient-Healthcare team member selected Behavioral Goal. SM-Problems included: BMI, diet (fruits and vegetables, salt, fat, sugar sweetened beverages), physical activity, missed medications, tobacco and alcohol use, health-related distress, general life stress, and depression symptoms. Descriptive analyses documented SM-Problems and SM-Priorities, and alignment between SM-Priorities and Goal Selection, followed by mixed models adjusting for clinic.Results446 participants with ≥ one chronic diseases (mean age 55.4 ± 12.6; 58.5% female) participated. On average, participants reported experiencing challenges in 7 out of the 12 SM-Problems areas; with the most frequent problems including: BMI, aspects of diet, and physical activity. Patient SM-Priorities were variable across the self-management areas. Patient- Healthcare team member Goal selection aligned well with patient SM-Priorities when patients prioritized weight loss or physical activity, but not in other self-management areas.ConclusionParticipants reported experiencing multiple SM-Problems. While patients show great variability in their SM-Priorities, the resulting action plan goals that patients create with their healthcare team member show a lack of diversity, with a disproportionate focus on weight loss and physical activity with missed opportunities for using goal setting to create targeted patient-centered plans focused in other SM-Priority areas. Aggregated results can assist with the identification of high frequency patient SM-Problems and SM-Priority areas, and in turn inform resource allocation to meet patient needs.Trial registrationClinicalTrials.gov ID: NCT01945918

Patterns of isozyme variation in relation to population size, isolation, and phytogeographic history in royal catchfly

The distribution of genetic variation within and among plant populations is influenced by both contemporary and historical factors. I used isozyme analysis of band phenotypes to examine genetic structure in the rare prairie forb Silene regia. Relationships between current-day population size, isolation, and phenotypic variation were assessed for 18 populations in two regions with differing postglacial history. Western populations from unglaciated southern Missouri and Arkansas were more genetically diverse based on the Shannon-Weaver index (H) and a polymorphic index than were more eastern populations. These differences may be due to loss of variation with repeated founding of new populations in previously glaciated sites in Indiana and Ohio. Within the western region, population size was not significantly correlated with genetic variation. In the east, size was correlated with Shannon-Weaver diversity. There was no relationship between variation and isolation in either region, but eastern populations were slightly more differentiated. Greater among-population differentiation and the demonstrated connection between population size and variation in the eastern sites may reflect lower levels of interpopulation gene flow in the fragmented remnant prairies of Indiana and Ohio

Maternal Perception of Child Weight Among Mexicans in California and Mexico

The prevalence of childhood overweight is high in Mexican immigrant communities in the United States. Understanding mother’s perceptions of child weight in immigrants’ country of origin may help to understand this high prevalence. The goal of this study was to examine and compare mothers’ perception of weight in Mexico (MX) and in an immigrant community in California (CA). We assessed perceptions of child weight using a pictorial scale with 314 mothers of 5-year-old children in MX and 60 mothers of 5 year-old-children in CA. We compared maternal reports with children’s objectively measured weight. Using chi-square and Analysis of Variance, we investigated associations of maternal perception of and satisfaction with weight according to socio-demographic characteristics. Mothers were more likely to underestimate their children’s weight in CA than in MX. On average, CA mothers wanted their children to be smaller than they currently were and mothers in MX wanted their children to be bigger than they currently were. This differed by weight status in CA with mothers of normal weight and at-risk-for-overweight children wanting them to be bigger and mothers of overweight children wanting them to be smaller. In order for programs to be effective, mothers must be able to recognize their children as overweight and want to address it. Because underestimation of weight and a desire for a larger size is common in this population, programs to address overweight may be more effective if they focus on alternative benefits of weight control strategies, such as healthy child development

Seasonal patterns and controls on net ecosystem CO2 exchange in a boreal peatland complex

We measured seasonal patterns of net ecosystem exchange (NEE) of CO2 in a diverse peatland complex underlain by discontinuous permafrost in northern Manitoba, Canada, as part of the Boreal Ecosystems Atmosphere Study (BOREAS). Study sites spanned the full range of peatland trophic and moisture gradients found in boreal environments from bog (pH 3.9) to rich fen (pH 7.2). During midseason (July‐August, 1996), highest rates of NEE and respiration followed the trophic sequence of bog (5.4 to −3.9 μmol CO2 m−2 s−1) \u3c poor fen (6.3 to −6.5 μmol CO2 m−2 s−1) \u3c intermediate fen (10.5 to −7.8 μmol CO2 m−2 s−1) \u3c rich fen (14.9 to −8.7 μmol CO2m−2 s−1). The sequence changed during spring (May‐June) and fall (September‐October) when ericaceous shrub (e.g., Chamaedaphne calyculata) bogs and sedge (Carex spp.) communities in poor to intermediate fens had higher maximum CO2 fixation rates than deciduous shrub‐dominated (Salix spp. and Betula spp.) rich fens. Timing of snowmelt and differential rates of peat surface thaw in microtopographic hummocks and hollows controlled the onset of carbon uptake in spring. Maximum photosynthesis and respiration were closely correlated throughout the growing season with a ratio of approximately 1/3 ecosystem respiration to maximum carbon uptake at all sites across the trophic gradient. Soil temperatures above the water table and timing of surface thaw and freeze‐up in the spring and fall were more important to net CO2 exchange than deep soil warming. This close coupling of maximum CO2 uptake and respiration to easily measurable variables, such as trophic status, peat temperature, and water table, will improve models of wetland carbon exchange. Although trophic status, aboveground net primary productivity, and surface temperatures were more important than water level in predicting respiration on a daily basis, the mean position of the water table was a good predictor (r2 = 0.63) of mean respiration rates across the range of plant community and moisture gradients. Q10 values ranged from 3.0 to 4.1 from bog to rich fen, but when normalized by above ground vascular plant biomass, the Q10 for all sites was 3.3

Maternal depression and childhood obesity: A systematic review

Objective. Maternal depression is prevalent and has been associated with parenting practices that influence child weight. In this systematic review we aimed to examine the prospective association between maternal depression and child overweight.Methods. We searched four databases (PsycINFO, PubMed, Embase, and Academic Search Premier) to identify studies for inclusion. We included studies with a prospective design with at least one year follow-up, measuring maternal depression at any stage after childbirth, and examining child overweight or obesity status, body mass index z-score or percentile, or adiposity. Two authors extracted data independently and findingswere qualitatively synthesized.Results. We identified nine prospective studies for inclusion. Results were examined separately for episodic depression (depression at a single measurement occasion) and chronic depression (depression on multiple measurement occasions). Mixed results were observed for the relationship between episodic depression and indicators of child adiposity. Chronic depression, but not episodic depression,was associated with greater risk for child overweight.Conclusions.While chronic depression may be associated with child overweight, further research is needed. Research is also needed to determine whether maternal depression influences child weight outcomes in adolescence and to investigate elements of the family ecology that may moderate the effect of maternal depression on child overweight

Parallel evolution of the make–accumulate–consume strategy in Saccharomyces and Dekkera yeasts

Saccharomyces yeasts degrade sugars to two-carbon components, in particular ethanol, even in the presence of excess oxygen. This characteristic is called the Crabtree effect and is the background for the 'make–accumulate–consume' life strategy, which in natural habitats helps Saccharomyces yeasts to out-compete other microorganisms. A global promoter rewiring in the Saccharomyces cerevisiae lineage, which occurred around 100 mya, was one of the main molecular events providing the background for evolution of this strategy. Here we show that the Dekkera bruxellensis lineage, which separated from the Saccharomyces yeasts more than 200 mya, also efficiently makes, accumulates and consumes ethanol and acetic acid. Analysis of promoter sequences indicates that both lineages independently underwent a massive loss of a specific cis-regulatory element from dozens of genes associated with respiration, and we show that also in D. bruxellensis this promoter rewiring contributes to the observed Crabtree effect

Is spoken language all-or-nothing? Implications for future speech-based human-machine interaction

Recent years have seen significant market penetration for voice-based personal assistants such as Apple’s Siri. However, despite this success, user take-up is frustratingly low. This article argues that there is a habitability gap caused by the inevitablemismatch between the capabilities and expectations of human users and the features and benefits provided by contemporary technology. Suggestions aremade as to how such problems might be mitigated, but a more worrisome question emerges: “is spoken language all-or-nothing”? The answer, based on contemporary views on the special nature of (spoken) language, is that there may indeed be a fundamental limit to the interaction that can take place between mismatched interlocutors (such as humans and machines). However, it is concluded that interactions between native and non-native speakers, or between adults and children, or even between humans and dogs, might provide critical inspiration for the design of future speech-based human-machine interaction

Impact of a Boot Camp Translation Intervention on Self-Management Support in Primary Care

Purpose: Self-management support (SMS) is a pillar of the well-established chronic care model and a key component of improving outcomes for patients with chronic illnesses. The Implementing Networks’ Self-management Tools Through Engaging Patients and Practices (INSTTEPP) trial sought to determine whether a boot camp translation process could assist small to medium-sized primary care practices with care managers implement SMS tools. Methods: INSTTEPP used a stepped-wedge design across 16 practices from 4 practice-based research networks over 12 months. Each network completed a 2-month boot camp translation for creating SMS tools with 16 participants (2 patients, a clinician, and a care manager from each of 4 practices) and subsequent implementation. Outcome measures for patients were the Patient Activation Measure (PAM), self-rated health, and Patient Assessment of Chronic Illness Care (PACIC) process-of-care items at baseline, 1 and 2 months. Clinician Support for Patient Activation Measure (CS-PAM) and theory of planned behavior outcomes were assessed at 5 points over 10 months for clinicians and staff. Results: A total of 297 patients and 89 practice staff and clinicians completed surveys during the study. Over successive 2-month sampling periods, intervention patients experienced greater improvement in PACIC process of care and self-rated health compared to control patients (P 0.10 for all) were not significantly different. Conclusions: Significant effects on process of care and self-rated health are evidence that the boot camp translation intervention impacted SMS. A larger trial with a typical 6-month boot camp intervention may show significant effects on other outcomes

Adapting Boot Camp Translation Methods to Engage Clinician/Patient Research Teams Within Practice-Based Research Networks

Purpose: Boot camp translation is a proven process to engage community members and health professionals in translating and disseminating evidence-based “best practices” models for health prevention and chronic illness care. Primary care practice improvement studies, particularly involving patient-driven change, as seen with self-management support (SMS), require engaged practice teams that include patients. Models of engagement such as boot camp translation may be effective. Methods: Four geographically dispersed practice-based research networks (PBRNs) from the Meta-LARC consortium engaged 16 practices to form SMS implementation teams involving a clinician, care manager, and 2 patients in each team. Our study adapted the boot camp translation model to engage the implementation teams in describing patient SMS, studying the Agency for Healthcare Research and Quality’s SMS Resource Library, and adapting and implementing self-management tools at each practice site. Testimonials and quotes were collected across the 4 PBRNs through a facilitated brainstorming discussion and consensus model at each PBRN kickoff meeting to address the focused question, “What do patients want and need in order to self-manage their chronic illnesses?” Results: Testimonials collected across the 4 PBRNs and participation levels indicated there was a high degree of engagement in the boot camp translation process across the PBRNs and the practices. Each PBRN developed themes expressed by patients and the practices regarding what patients want and need to self-manage their illnesses. Each practice selected, adapted, and implemented an SMS tool. Conclusions: Results suggest that adapted boot camp translation was effective in guiding multiple practices to implement self-management support tools for the INSTTEPP trial. Additional study of the adapted boot camp translation process in practice quality improvement and practice redesign studies is needed