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

Multilingual assessment of early child development: Analyses from repeated observations of children in Kenya.

In many low- and middle-income countries, young children learn a mother tongue or indigenous language at home before entering the formal education system where they will need to understand and speak a countrys official language(s). Thus, assessments of children before school age, conducted in a nations official language, may not fully reflect a childs development, underscoring the importance of test translation and adaptation. To examine differences in vocabulary development by language of assessment, we adapted and validated instruments to measure developmental outcomes, including expressive and receptive vocabulary. We assessed 505 2-to-6-year-old children in rural communities in Western Kenya with comparable vocabulary tests in three languages: Luo (the local language or mother tongue), Swahili, and English (official languages) at two time points, 5-6 weeks apart, between September 2015 and October 2016. Younger children responded to the expressive vocabulary measure exclusively in Luo (44%-59% of 2-to-4-year-olds) much more frequently than did older children (20%-21% of 5-to-6-year-olds). Baseline receptive vocabulary scores in Luo (β = 0.26, SE = 0.05, p < 0.001) and Swahili (β = 0.10, SE = 0.05, p = 0.032) were strongly associated with receptive vocabulary in English at follow-up, even after controlling for English vocabulary at baseline. Parental Luo literacy at baseline (β = 0.11, SE = 0.05, p = 0.045) was associated with child English vocabulary at follow-up, while parental English literacy at baseline was not. Our findings suggest that multilingual testing is essential to understanding the developmental environment and cognitive growth of multilingual children

The Status Of Two New England “Endemic” Carices: Carex Elachycarpa And C. Josselynii (Cyperaceae)

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149729/1/tax00494.pd

Intergenerational Transmission of Poverty and Inequality: Young Lives

Parents play major roles in determining the human capital of children, and thus the income of children when they become adults. Models of investments in children’s human capital posit that these investments are determined by parental resources (financial and human capital) and child endowments within particular market and policy environments. Many empirical studies are consistent with significant associations between parental resources and investments in their children. And there is considerable emphasis in the scholarly and the policy literatures on the degree of intergenerational mobility and the intergenerational transmission of economic opportunities, and therefore the intergenerational transmission of poverty – or of affluence. Therefore policies or other developments that affect the extent of poverty and/or inequality in the parents’ generation are likely to have impacts on the extent of poverty and/or inequality in the children’s generation. However the extent of these intergenerational effects is an empirical question that this paper explores using the Young Lives data to estimate intergenerational associations between parental resources and investments in human capital of children and then, under the assumption that these associations reflect causal effects, to simulate what impacts changes in poverty and inequality in the parents’ generation have on poverty and inequality in the children’s generation. The results suggest that reductions in poverty and in inequality in the parents’ generation reduce poverty and inequality in the children’s generation some, but not much

Linear growth through 12 years is weakly but consistently associated with language and math achievement scores at age 12 years in four low- or middle-income countries

Background: Whether linear growth through age 12 y is associated with language and math achievement at age 12 remains unclear. Objective: Our objective was to investigate associations of linear growth through age 12 with reading skill, receptive vocabulary, and mathematics performance at age 12 y in four low- or middle-income countries (LMICs). Methods: We analyzed data from the Young Lives Younger Cohort study in Ethiopia (N=1275), India (N=1350), Peru (N=1402), and Vietnam (N=1594). Age 1, 5, 8, and 12 y height-for-age z-scores (HAZ) were calculated. Language and math achievement at age 12 y was assessed using country-specific adaptations of the Peabody Picture Vocabulary Test, the Early Grades Reading Assessment, and a mathematics test; all test scores were standardized by age within country. We used path analysis to examine associations of HAZ with achievement scores. Twelve models were examined at each age (three tests across four countries). Results: Mean HAZ in each country was <-1.00 at all ages. Overall, linear growth through age 12 y was associated with 0.4% to 3.4% of the variance in achievement scores. HAZ at 1 y was positively and significantly associated with the test score in 11 of the 12 models. This association was significantly mediated through HAZ at 5, 8, and 12 y in 9 of the models. HAZ at 5, 8, and 12 y was positively and significantly associated with test scores in 8, 8, and 6 models, respectively. These associations were mediated through HAZ at older ages in 6 of the HAZ at 5 y models and in 6 of the HAZ at 8 y models. Conclusions: Child linear growth between ages 1-12 y was weakly though consistently associated with language and math achievement at age 12 y in four LMICs

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