Longitudinal associations between parental mathematics anxiety and attitudes and young children's mathematics attainment.

The associations between parental mathematics anxiety and attitudes and children's mathematics attainment in early primary school were explored. Initially, parents of preschool children (Mage = 3;11 [years;months]) completed a questionnaire indexing parental mathematics anxiety and attitudes and the frequency of preschool home number experiences. The children completed mathematics assessments in their first year (n = 231, Mage = 5;2) and second year (n = 119, Mage = 6;3) of schooling and a mathematics anxiety questionnaire in their third year of schooling (n = 119, Mage = 6;7). A questionnaire indexing the frequency of primary school home number experiences was completed by 119 of the parents in their children's second year of schooling (Mage = 6;0). All indices of parental mathematics anxiety and attitudes predicted children's mathematics attainment in their first school year. These associations were independent of parental mathematics attainment and were not mediated by the frequency of preschool home number experiences. Furthermore, the positive association between preschool home number experiences and children's mathematics attainment was not weaker in the context of high parental mathematics anxiety or negative parental mathematics attitudes. One index of parental mathematics attitudes predicted children's mathematics attainment in their second school year, but this association was not significant when prior attainment was controlled. There was a stronger association between maternal mathematics anxiety and girls' attainment versus boys' attainment. Parental mathematics anxiety did not predict children's mathematics anxiety. The findings suggest that children whose parents have high mathematics anxiety or negative mathematics attitudes are more likely to have lower mathematics attainment in their first year of school. However, the mechanism underpinning this association is not yet established.

Point Tenderness for 35 Years: A Rare Presentation of a Glomus Tumor in the Proximal Upper Extremity.

Glomus tumors are rare benign neoplasms that are commonly found on the fingers and distal extremities. Clinically, they are often associated with a symptom triad of moderate pain, cold sensitivity, and point tenderness. These tumors are often not considered during a clinical workup due to their rarity and can be misdiagnosed due to their diverse clinical presentations. Glomus tumors are made up of mesenchymal cells derived from glomus bodies, which are specialized arteriovenous (AV) anastomoses primarily responsible for thermoregulation. Microscopically, they present as intricate nests of endothelial cells surrounding glomus bodies, which can clinically manifest as point tenderness. Glomus tumors are usually benign and are commonly found in locations with a high concentration of glomus bodies such as the fingers. Extradigital tumors are very rare and usually not considered in primary diagnosis. This can lead to patients experiencing years and, in this case, decades of unexplained pain. The diagnostic workup for glomus tumors should include an initial Doppler ultrasound and a definitive diagnosis via immunohistochemistry (IHC). They can be completely cured with surgical excision. Although most glomus tumors are benign and easily treatable, they are often not considered in differential diagnoses when assessing for point tenderness.  This case illustrates an atypical presentation of a glomus tumor that caused 35 years of chronic pain and was incidentally misdiagnosed on imaging, leading to treatment delay by an additional eight months. This exemplifies the necessity of including glomus tumors within the differential diagnosis and diagnostic workup for point tenderness and soft tissue masses of the upper extremity.

Health Professional Education And Universal Health Coverage: A Summary Of Challenges And Selected Case Studies.

Low- and middle-income countries are experiencing serious shortages in meeting health workforce requirements for universal health coverage. We examine how national-level policies can address these deficiencies and support the development of an appropriately skilled health workforce in line with population needs. We discuss three innovative, government-led solutions that are designed to align health workforce training with the demands of universal health coverage. Specifically, we discuss two initiatives to train and retain doctors in rural areas of Thailand, the large-scale training of community health workers within multidisciplinary primary health care teams in Brazil, and the introduction of a postgraduate diploma program in primary care for nurses in India. Several positive outcomes have been associated with these initiatives, including improvements in the rural retention of doctors in Thailand and reductions in infant and child mortality rates in Brazil. However, further research is needed to assess the impact of such initiatives on the long-term retention of workers-particularly doctors-and the adequacy of the training offered to lower-skilled workers to effectively plug medical personnel gaps. Systematic monitoring of program affordability and cost-effectiveness over time must be prioritized, alongside efforts to disseminate lessons learned.

Global Lessons In Frugal Innovation To Improve Health Care Delivery In The United States.

In a 2015 global study of low-cost or frugal innovations, we identified five leading innovations that scaled successfully in their original contexts and that may provide insights for scaling such innovations in the United States. We describe common themes among these diverse innovations, critical factors for their translation to the United States to improve the efficiency and quality of health care, and lessons for the implementation and scaling of other innovations. We highlight promising trends in the United States that support adapting these innovations, including growing interest in moving care out of health care facilities and into community and home settings; the growth of alternative payment models and incentives to experiment with new approaches to population health and care delivery; and the increasing use of diverse health professionals, such as community health workers and advanced practice providers. Our findings should inspire policy makers and health care professionals and inform them about the potential for globally sourced frugal innovations to benefit US health care.

Argentina's Successful Implementation Of A National Human Papillomavirus Vaccination Program.

Every year around fourteen million people globally are infected with human papillomavirus (HPV), the sexually transmitted virus that is the cause of most cervical cancers. A number of vaccines have been developed to protect against HPV, but in many countries, HPV vaccination rates have been low compared with rates for other recommended vaccines. Parental concerns, cost, and lack of information and awareness among both health professionals and parents are cited as important barriers to HPV vaccination. In Argentina the HPV vaccine has been provided to all eleven-year-old girls since 2011 as part of a comprehensive national program to prevent cervical cancer. Coverage increased from negligible levels before 2011 to a national average of 87.9 percent for the first dose, 71.6 percent for the second dose, and 52.2 percent for the third dose in 2013. There was a large variance in HPV vaccine coverage across the country's provinces. This article describes key strategies to overcome barriers to implementation of HPV vaccination and provides recommendations for policy makers.

The Science And Art Of Delivery: Accelerating The Diffusion Of Health Care Innovation.

There is a widely acknowledged time lag in health care between an invention or innovation and its widespread use across a health system. Much is known about the factors that can aid the uptake of innovations within discrete organizations. Less is known about what needs to be done to enable innovations to transform large systems of health care. This article describes the results of in-depth case studies aimed at assessing the role of key agents and agencies that facilitate the rapid adoption of innovations. The case studies-from Argentina, England, Nepal, Singapore, Sweden, the United States, and Zambia-represent widely varying health systems and economies. The implications of the findings for policy makers are discussed in terms of key factors within a phased approach for creating a climate for change, engaging and enabling the whole organization, and implementing and sustaining change. Purposeful and directed change management is needed to drive system transformation.

Lessons from eight countries on diffusing innovation in health care.

Health care systems are under increasing pressure to cope with shifting demographics, the threat of chronic and noncommunicable disease, and rising health care costs. The uptake of innovations to meet these challenges and to advance medicine and health care delivery is not as rapid as the pace of change. Greater emphasis on the diffusion of innovation and greater understanding of the structural and organizational levers that can be used to facilitate systemwide improvement are essential. This article describes the results of a qualitative and quantitative study to assess the factors and behaviors that foster the adoption of health care innovation in eight countries: Australia, Brazil, England, India, Qatar, South Africa, Spain, and the United States. It describes the front-line cultural dynamics that must be fostered to achieve cost-effective and high-impact transformation of health care, and it argues that there is a necessity for greater focus on vital, yet currently underused, organizational action to support the adoption of innovation.