The relationship between young children’s language abilities,creativity, play,and storytelling

This study examined the connection between young children’s social play, creativity, storytelling, and language abilities. Participants were 56 primarily European American preschool children. First, to assess creativity we asked children to draw several pictures. Children created stories about their pictures during the creative process. Second, children created an original story with access to multiple ethnic family doll sets to use as props. We analysed all storytelling episodes for mean length of utterance and parts of speech. Third, we observed children’s social play behaviours over 10-minute intervals recording behaviour at 1-minute intervals. Finally, we administered the Test of Early Language Development 3 to assess children’s receptive and expressive language skills. Our findings revealed positive relationships between storytelling abilities and language abilities, relationships between type of play, storytelling, and language abilities, and connections between play and creativity and language and creativity. Our findings provide avenues for future research.     

Estimated mammogram coverage in Goiás State, Brazil

This cross-sectional study aimed to estimate mammogram coverage in the State of Goiás, Brazil, describing the supply, demand, and variations in different age groups, evaluating 98 mammography services as observational units. We estimated the mammogram rates by age group and type of health service, as well as the number of tests required to cover 70% and 100% of the target population. We assessed the association between mammograms, geographical distribution of mammography machines, type of service, and age group. Full coverage estimates, considering 100% of women in the 40-69 and 50-69-year age brackets, were 61% and 66%, of which the Brazilian Unified National Health System provided 13% and 14%, respectively. To achieve 70% coverage, 43,424 additional mammograms would be needed. All the associations showed statistically significant differences (p < 0.001). We conclude that mammogram coverage is unevenly distributed in the State of Goiás and that fewer tests are performed than required.     

Patients�� Rights and the National Health Service in Britain, 1960s�C1980s

The language of rights has long permeated discussions about health care in Britain, but during the latter half of the 20th century, patients’ rights achieved a level of unprecedented prominence. By the end of the 1980s, the language of entitlement appeared to have spread into many areas of the National Health Service: consent to treatment, access to information, and the ability to complain were all legally established patients’ rights. Patient organizations played a critical role in both realizing these rights and in popularizing the discourse of rights in health care in Britain. “Rights talk,” however, was not without its drawbacks, as it was unclear what kinds of rights were being exercised and whether these were held by patients, consumers, or citizens.THE IDEA THAT PATIENTS HAVE rights in relation to health care is a powerful one, but it is a concept that has often generated problems when put into practice. As recent debates about health care reform in the United States make plain, both supporters and detractors of universal health care have been able to use the language of rights to make their case.1 The application of rights to health is no less challenging, however, in countries that do have systems guaranteeing population-wide access, such as Britain with its National Health Service (NHS). In January 2009, the Labour government introduced the NHS Constitution for England, a document that set out a series of rights, responsibilities, and pledges designed to embody the “principles and values” that guide the NHS. Patients were told that they had 25 rights, encompassing areas such as access to health services; quality of care and the environment; access to nationally approved treatments; respect, consent, and confidentiality; informed choice; involvement in their own health care and the wider NHS; and complaint and redress.2 The NHS Constitution, it was claimed, brought together “in one place for the first time in the history of the NHS what staff, patients and public can expect from the NHS.”3Although the introduction of the NHS Constitution was an important development in the reform of British health care under New Labour, it was certainly not the first attempt to formulate a list of patients’ rights, or to use these to shape the future of health services. From the 1960s onwards, a number of organizations claiming to represent the patient, such as the Patients Association, the Consumers’ Association, the National Consumer Council, and the Community Health Councils, drew on the language of rights to put forward their demands. Concerns about patients’ ability to complain, their access to information, and the presence of medical students during consultations and treatment were framed around the concept of rights. Patient organizations also expended much time and energy drawing up patients’ charters and guides to patients’ rights within the NHS. But where did this language of rights come from? What did it mean to talk about patients’ rights in the context of a collective health system like Britain’s NHS?In this article, I explore how the language of rights came to enter the discourse around British health care in the 1960s, and how it was developed and applied by patient groups in the 1970s and 1980s. Drawing on the papers of patient organizations, government records, newspapers, and medical journals, I suggest that although the language of patients’ rights held rhetorical power, putting such language into practice was to prove deeply problematic.     

The Public’s Preparedness: Self-Reliance,Flashbulb Memories,and Conservative Values

Objectives. We surveyed how many US residents engaged in 6 preparedness activities and measured the relationship between engagement and personal experience in hazard events, flashbulb memories of major events, self-reliance, and other indicators of a conservative philosophy.Methods. We used random digit dialing for national landline (75%) and cell phone (25%) surveys of 1930 US residents from July 6, 2011, to September 9, 2011; 1080 of the sample lived near 6 US Department of Energy nuclear waste management facilities and 850 were a national random sample.Results. The median respondent engaged in 3 of the 6 activities; those who disproportionately engaged in 4 or more had experienced a hazard event, had distressing and strong flashbulb memories of major hazard events, and had strong feelings about the need for greater self-reliance. The results for the national and US Department of Energy site–specific surveys were almost identical.Conclusions. A cadre of US residents are disproportionately engaged in disaster preparedness, and they typically have stronger negative memories of past disasters and tend to be self-reliant. How their efforts can or should be integrated into local preparedness efforts is unclear.Preparedness has been an important subject in the American Journal of Public Health, including in an electronic journal supplement in 2007.1–5 Much of the literature, with some important exceptions,1,3 has been about defining preparedness and the public health system’s capacity. Much less attention has been devoted to the public’s preparedness. The message from the literature is that much of the public is not ready to respond to serious events.6–10 Why do so many not have a fire extinguisher, not have a communication plan with loved ones in the case of an event, not have a food supply set aside, and not have taken other steps that would increase their probability of survival in a serious event?Our focus in this article was on identifying those individuals who are most prepared and comparing their attributes with those who are less prepared. Using survey responses collected in 2011, our purpose was to answer 2 questions:

1. What proportion of US respondents have engaged in preparedness actions ranging from knowing how to use a fire extinguisher to predetermining a place to meet if a hazardous event occurs?
2. What factors are most strongly associated with taking multiple preparedness actions?

Several key elements of the preparedness literature guided this research. Defining “preparedness” was one. Bourque et al.10 used National Survey of Disaster Experiences and Preparedness data that included developing emergency plans, stockpiling supplies, purchasing things to be safer, learning how to get information, duplicating documents, and becoming more vigilant. They also examined avoidance activities, such as reducing airplane, train, and public transportation use; avoiding some cities, tall buildings, and national landmarks, and changing mail-handling practices.They found that 94% of respondents engaged in 1 or more of the 6 proactive activities, 84% reported that they became more vigilant, 32% had an emergency plan, 37% had stockpiled supplies, and 60% had learned how to get information. The median response was to have engaged in 3 of 6 activities. Residents of New York City and Washington, DC; men; and high-income respondents reported more preparedness activities. The authors concluded that US households are “remarkably unprepared for disasters and emergencies, including terrorism,”10^(p402) a common conclusion in the literature.6–15Why are so few people prepared? One explanation is people are bombarded with so much information, including information about risks that seem more likely and threatening than a tornado or terrorist attack.16 Second, preparedness is not clearly defined in ways that lead them to take action.2,5,17 For some, preparedness might be learning how to access the latest information, but for others preparedness might mean leaving and knowing where to go before any warnings. Third, people may become numb to the threat if they have been warned and asked to move too many times and no threat materialized. Some may have already taken action and become less worried about the threat.18Given many people’s lack of engagement, researchers have been developing conceptual models to predict preparedness,19–22 and these models were the basis for our research design, including such factors as personal experience in a disaster, strong emotions about disasters, trust in authority, self-efficacy, optimistic bias, psychological distance from the issue, and demographic attributes.23–38This literature suggests that preparedness is a deliberative action requiring strong reasons to participate because the events are low probability and most people do not believe they will be affected. We expected, first, that personal experience with a hazard event that left strong distressing memories, such as horror and fear, is strong motivation for preparedness. Our second expectation was that deeply embedded memories of major national or international disasters drive preparedness because these events were so shocking, salient, and consequential that they left so-called “flashbulb” memories, which are detailed recollections about the event, including where the respondent was and what he or she was doing during the event.39–47 Indeed, deeply embedded memories can be used as one diagnostic to predict posttraumatic stress after wars, the 9/11 terrorist attacks, earthquakes, and hurricanes, even among those with Alzheimer’s disease.42–47 Hence, we expected personal experience in events, emotional reactions to those events, and flashbulb memories of some of the worst events in recent history to be the strongest correlates of preparedness.We expected that although strong negative memories and personal experiences would be signal events, they would not lead everyone to prepare for low-probability hazard events. Those who took action would tend to assert conservative values that emphasize self-help, lack of trust in authority to protect them, and a resistance to immediately agreeing with government-initiated policy proposals. In addition, we expected demographic attributes, as well as respondents’ location, to influence the results. Overall, our key expectation was focused on strong negative memories and personal experiences; secondarily, we focused on the role of self-reliance, demographic attributes, and location.     

Why, which, how, who, when? A personal view of smallpox vaccination for the 2000s

The uncertainty about the extent of proliferation of smallpox virus holdings since the early 1990s, and particularly whether terrorist groups or so-called rogue states might now hold the virus, confronts potential target countries with a continuing dilemma. An increasingly large majority of their populations have never been vaccinated, and those who have been vaccinated may have become susceptible to smallpox again. Yet recent attempts by the United States and other governments to persuade large numbers of key personnel and others to accept vaccination have at least partially failed and a different long-term strategy is needed. This strategy should be based on surveillance of rash illnesses, improved public education, more refined contingency planning and a new approach to smallpox vaccination. The last should if possible be based on cell-grown, less reactogenic vaccines, even though it may be some years before these can become available. Meanwhile this article examines other expedients including the use of existing lymph vaccines.     

Review of an Influenza Surveillance System, Beijing, People��s Republic of China

In 2007, a surveillance system for influenza-like illness (ILI) and virologic data was established in Beijing, China. The system tracked ILI and laboratory-confirmed influenza in 153 general hospitals from September 1, 2007, through April 30, 2008. To analyze the ILI surveillance data (weekly ILI rates and counts) and the effectiveness of the system, we used the US Centers for Disease Control and Prevention Early Aberration Reporting System. The data indicated that the highest rate of influenza isolation and the highest ILI count occurred in the first week of 2008. The system enabled us to detect the onset and peak of an epidemic.     

Do Mother’s Metacognitions,Beliefs, and Behaviors Predict Child Anxiety-Related Metacognitions?

Background

Recent research suggests that adults and children with anxiety disorders have a particular set of metacognitive beliefs and strategies. Knowing whether parents’ metacognitions, beliefs and behaviors are associated with their children’s metacognitions is important for understanding how anxiety-related metacognitions and clinical anxiety develop.

Objective

We hypothesized that there are positive relationships between mother and corresponding child anxiety-related metacognitions even after controlling for maternal depression, anxiety and stress symptoms. We also hypothesized that maternal beliefs about child anxiety and maternal controlling behavior would be positively related to child metacognitions and would account for any associations between mother and child metacognitions.

Methods

The study employed a cross-sectional design in a community sample of 7–12 year old children and their mothers. Mothers and children completed questionnaires to assess anxiety-related metacognitions and an interaction task to assess mothers’ overinvolvement. Mothers also completed questionnaires regarding their beliefs about child anxiety and controlling rearing behavior. We examined correlations between variables before investigating which maternal variables made unique contributions to the variation in children’s metacognitions in a series of multiple regressions and mediation analyses.

Results

Mothers’ positive worry beliefs and cognitive confidence contributed a modest amount of unique variance in the corresponding beliefs in children. Mothers’ and children’s metacognitions were positively associated.

Conclusions

The unique contributions of mothers’ anxiety-related metacognitions on children’s anxiety-related metacognitions found in our study indicate that a metacognitive-parental intervention for preventing and treating child anxiety is worth investigation. Our findings place anxious metacognitions in a developmental context.

     

Alzheimer’s Disease Services,Staffing, and Outcomes in Adult Day Health Centers

ObjectivesIncreasing rates of Alzheimer disease and related dementia (ADRD) has resulted in greater reliance on adult day health centers (ADHCs) and their skilled workforce. Little is known about staffing in ADHCs that provide ADRD services compared with ADHCs that do not. This study examines whether there are differences in staffing between ADHCs that offer ADRD services versus those that do not, and whether the percentage of ADHC participants with ADRD is associated with staffing levels. It also examines whether staffing levels and provision of ADRD services are associated with participant outcomes.DesignCross-sectional analysis of secondary survey data.Setting and ParticipantsWe used facility-level data from the 2014 National Post-acute and Long-term Care Study Adult Day Services Center module. This survey is completed by administrators of ADHCs, who provide information about their ADHC’s organization, services, participants, sources of payment, staffing, and participant outcomes.MethodsBivariate comparisons and multivariate regressions were used to compare scope of services, staffing, and participant outcomes for ADHCs that offered ADRD programs compared with those that did not.ResultsADHCs with ADRD programs had similar average daily attendance, less revenue from Medicaid and self-payment, and greater proportions of Black and female participants. ADHCs with ADRD programs had similar staff hours per participant day for all staff categories; licensed nurse staffing increased and social worker staffing decreased with the proportion of participants with ADRD. Staffing had significant associations with participant outcomes.Conclusions and ImplicationsADHCs that have more participants with ADRD have greater staffing of licensed nurses but fewer social workers. Participant outcomes are associated with staffing, but the results suggest that there are unmeasured dimensions of participant risk that confound the relationship.     

The Global Fund’s paradigm of oversight,monitoring, and results in Mozambique

Background

The Global Fund is one of the largest actors in global health. In 2015 the Global Fund was credited with disbursing close to 10 % of all development assistance for health. In 2011 it began a reform process in response to internal reviews following allegations of recipients’ misuse of funds. Reforms have focused on grant application processes thus far while the core structures and paradigm have remained intact. We report results of discussions with key stakeholders on the Global Fund, its paradigm of oversight, monitoring, and results in Mozambique.

Methods

We conducted 38 semi-structured in-depth interviews in Maputo, Mozambique and members of the Global Fund Board and Secretariat in Switzerland. In-country stakeholders were representatives from Global Fund country structures (eg. Principle Recipient), the Ministry of Health, health or development attachés bilateral and multilateral agencies, consultants, and the NGO coordinating body. Thematic coding revealed concerns about the combination of weak country oversight with stringent and cumbersome requirements for monitoring and evaluation linked to performance-based financing.

Results

Analysis revealed that despite the changes associated with the New Funding Model, respondents in both Maputo and Geneva firmly believe challenges remain in Global Fund’s structure and paradigm. The lack of a country office has many negative downstream effects including reliance on in-country partners and ineffective coordination. Due to weak managerial and absorptive capacity, more oversight is required than is afforded by country team visits. In-country partners provide much needed support for Global Fund recipients, but roles, responsibilities, and accountability must be clearly defined for a successful long-term partnership. Furthermore, decision-makers in Geneva recognize in-country coordination as vital to successful implementation, and partners welcome increased Global Fund engagement.

Conclusions

To date, there are no institutional requirements for formalized coordination, and the Global Fund has no consistent representation in Mozambique’s in-country coordination groups. The Global Fund should adapt grant implementation and monitoring procedures to the specific local realities that would be illuminated by more formalized coordination.

     

NICE’s Selective Application of Differential Discounting: Ambiguous,Inconsistent, and Unjustified

The National Institute for Health and Clinical Excellence (NICE) recently recommended differential discounting of costs and health effects in the economic appraisal of health care interventions in certain circumstances. The recommendation was published in an amendment to NICE’s Guide to the Methods of Technology Appraisal. The amendment states that differential discounting should be applied where “treatment effects are both substantial in restoring health and sustained over a very long period (normally at least 30 years).” Renewed interest in differential discounting from NICE is welcome; however, the recommendation’s selective application of differential discounting raises a number of concerns. The stated criteria for applying differential discounting are ambiguous. The rationale for the selective application of differential discounting has not been articulated by NICE and is questionable. The selective application of differential discounting leads to several inconsistencies, the most concerning of which is the lower valuation of health gains for those with less than 30 years remaining life expectancy, which can be interpreted as age discrimination. Furthermore, the discount rates chosen by NICE do not appear to be informed by recent advances in the theoretical understanding of differential discounting. NICE’s apparent motivation for recommending differential discounting was to ensure a favorable cost-effectiveness ratio for a pediatric oncology drug. While flexibility may be appropriate to allow some interventions that exceed conventional cost-effectiveness thresholds to be adopted, the selective adjustment of appraisal methods is problematic and without justification.