Poor Numeracy Research Articles

Parents’ characteristics, the home environment, and children’s numeracy skills: How are they related in low- to middle-income families in the Philippines?

The home numeracy environment is often assumed to play a role in early numeracy development. This study aimed to provide a comprehensive picture of the home numeracy environment of children living in low- to middle-income communities in the Philippines. Moreover, it examined the relations among various parents’ characteristics, the home numeracy environment parents created, and their young children’s numeracy skills. Data were collected from 290 families through parental questionnaires, numeracy tests for children, and numeracy tests for parents. Results of structural equation modeling showed that parents’ education level, calculation fluency, own reported math activities, home numeracy resources and home numeracy activities all had direct associations with children’s numeracy skills. Parents’ calculation fluency and own math activities also had indirect links with children’s numeracy skills through home numeracy resources and home numeracy activities. These findings provide insights into the question of which children are at risk for poor numeracy development and how to support children’s early numeracy learning.

El significado del desarrollo anidado de las literacidades y numeracidades académicas en el currículum universitario.

Ante el gran desafío de los deficientes niveles de literacidad y numeracidad en Chile, la Facultad de Educación de la Universidad Santo Tomás impulsó desde el año 2011 un modelo anidado o transversal de desarrollo de estas habilidades. El presente artículo detalla los resultados en torno al significado de esta estrategia para sus estudiantes y académicos, que se sustanciaron a través de grupos focales, analizados a través de categorización y triangulación. Los hallazgos sustentan la relevancia de estas habilidades en la profesión, su presencia en las actividades prácticas y su anidamiento en contextos concretos, lo que reduce la visibilidad de las actividades de apoyo. Futuras investigaciones debieran abordar el desarrollo de la numeracidad académica, y las literacidades profesionales.

Health Care Professionals' Clinical Perspectives and Acceptance of a Blood Glucose Meter and Mobile App Featuring a Dynamic Color Range Indicator and Blood Sugar Mentor: Online Evaluation in Seven Countries.

BackgroundDespite many new therapies and technologies becoming available in the last decade, people with diabetes continue to struggle to achieve good glycemic control. Innovative and affordable solutions are needed to support health care professionals (HCPs) to improve patient outcomes.ObjectiveTo gather current self-management perceptions of HCPs in seven countries and investigate HCP satisfaction with a new glucose meter and mobile app featuring a dynamic color range indicator and a blood sugar mentor.MethodsA total of 355 HCPs, including 142 endocrinologists (40.0%), 108 primary care physicians (30.4%), and 105 diabetes nurses (29.6%), were recruited from the United Kingdom (n=50), France (n=50), Germany (n=50), India (n=54), Algeria (50), Canada (n=51), and the United States (n=50). HCPs experienced the OneTouch Verio Reflect glucose meter and the OneTouch Reveal mobile app online from their own office computers using interactive demonstrations via webpages and multiple animations. After providing demographic and clinical practice insights, HCPs responded to statements about the utility of the system.ResultsConcerning current practice, 83.1% (295/355) of HCPs agreed that poor numeracy or health literacy was a barrier for their patients. A total of 85.9% (305/355) and 92.1% (327/355) of HCPs responded that type 2 diabetes (T2D) and type 1 diabetes (T1D) patients were aware of what represented a low, in-range, or high blood glucose result. Only 62.0% (220/355) felt current glucose meters made it easy for patients to understand if results were in range. A total of 50.1% (178/355) and 78.0% (277/355) of HCPs were confident that T1D and T2D patients took action for low or high results. A total of 87.0% (309/355) agreed that the ColorSure Dynamic Range Indicator could help them teach patients how to interpret results and 88.7% (315/355) agreed it made them more aware of hyper- and hypoglycemic results so they could take action. A total of 83.7% (297/355) of HCPs agreed that the Blood Sugar Mentor feature gave personalized guidance, insight, and encouragement so patients could take action. A total of 82.8% (294/355) of HCPs also agreed that the Blood Sugar Mentor provided real-time guidance to reinforce the goals HCPs had set so patients could take steps to manage their diabetes between office visits. After experiencing the full system, 85.9% (305/355) of HCPs agreed it was beneficial for patients with lower numeracy or health literacy; 96.1% (341/355) agreed that it helped patients understand when results were low, in range, or high; and 91.0% (323/355) agreed that the way it displayed diabetes information would make patients more inclined to act upon results. A total of 89.0% (316/355) of HCPs agreed that it would be helpful for agreeing upon appropriate in-range goals for their patients for their next clinic visit.ConclusionsThis multi-country online study provides evidence that HCPs were highly satisfied with the OneTouch Verio Reflect meter and the OneTouch Reveal mobile app. Each of these use color-coded information and the Blood Sugar Mentor feature to assist patients with interpreting, analyzing, and acting upon their blood glucose results, which is particularly beneficial to keep patients on track between scheduled office visits.

The Dynamics of Households' Stock Market Beliefs

We analyse a long panel of households’ stock market beliefs to gain insights into the nature of their expectations formation processes. We classify respondents into one of five groups based on their data and estimate group-wise models of expectations formation. Two of the groups are at opposite extremes in terms of optimism: Pessimists who expect substantially negative returns and financially sophisticated individuals whose expectations are close to the historical average. Two groups expect returns around zero and differ only in how they respond to information: Extrapolators who become more optimistic following positive information and mean-reverters for whom the opposite is the case. The final group is characterised by poor probability numeracy; its individuals are not willing or able to quantify their beliefs about future returns. None of the estimated belief formation processes passes a rational expectations test.

How to Best Convey Information About Intensive/Comfort Care to the Family Members of Premature Infants to Enable Unbiased Perinatal Decisions.

Background: As the infant's best interests are determined through the perinatal decisions of family members and physicians, it is important to understand the factors that affect such decisions. This paper investigated the separate and combined effects of various factors related to perinatal decision making and sought to determine the best way to convey information in an unbiased manner to family members.Methods: In total, 613 participants were consecutively recruited. Each participant completed a series of surveys. All responses to four items were examined via a latent class analysis (LCA) to identify subgroups of participants with similar preferences for intensive care (IC) and comfort care (CC) regarding their potentially premature infant. Multiple logistic regression analyses were applied to identify the sociodemographic predictors for the classification of participants into different subgroups.Results: χ2-tests indicated that perinatal decision making for Item 2 was influenced by framing information, whereas decision making wasn't affected by presentation modes. Furthermore, the endorsement rates of IC significantly decreased with the information increased from brief to detailed, regardless of framing or presentation mode. The LCA indicated that a 3-subgroup model, which included the IC, CC, and variation subgroups, was optimal. Logistic regression analyses demonstrated that, compared with the IC subgroup, negative framing, higher education, parenthood, and poor numeracy predicted participants' preferences for CC. Meanwhile, worrying about physical or mental disabilities predicted preferences for CC and sensitivity to the amount of information provided regarding treatment options (variation subgroup).Conclusions: Perinatal decision making is affected by many factors, suggesting that more detailed information, improved understandability of numerical data, and a neutral tone of voice regarding therapeutic outcomes would be helpful for the families of premature infants to make unbiased decisions. Our findings should be replicated in future research.

The impact of the decision environment on consumer choice of mobile service plans: An experimental examination

Determining the most suitable mobile communications network and service plan can be daunting for many consumers. We consider whether individuals with lower numeracy need more assistance than other consumers when making choices amongst hypothetical mobile service tariffs and whether changes to the environment will improve consumers' decisions. We find that people with poor numeracy are less likely to choose the lowest cost plan and overpay for their mobile services. We also find that the regulatory initiatives currently available to help consumers’ decisions should be customized to address the interests of low numerate and other consumers.

Label reading, numeracy and food & nutrition involvement

The purpose of this study was to investigate objective performance on a nutrition label comprehension task, and the influence of numeracy and food-related involvement on this performance level. A pilot study (n = 45) was run to prepare the scales in French. For the main study (n = 101), participants provided demographic information and answered the nutrition label survey, the short numeracy scale and two different food-related involvement scales (i.e. the food involvement scale and the nutrition involvement scale). Both studies were conducted online, and consent was obtained from all participants. Participants answered correctly only two-thirds of the nutrition label task items. Numeracy and food involvement scores were positively correlated with performance on this task. Finally, food involvement interacted with numeracy. Specifically, people scoring low in numeracy performed generally more poorly on the task, but if they had high food involvement scores, their performance increased. This suggests that high food-related motivation may compensate for poor numeracy skills when dealing with nutrition labels.

The impact of general anesthesia on child development and school performance: a population-based study.

There has been considerable interest in the possible adverse neurocognitive effects of exposure to general anesthesia and surgery in early childhood. The aim of this data linkage study was to investigate developmental and school performance outcomes of children undergoing procedures requiring general anesthesia in early childhood. We included children born in New South Wales, Australia of 37+ weeks' gestation without major congenital anomalies or neurodevelopmental disability with either a school entry developmental assessment in 2009, 2012, or Grade-3 school test results in 2008-2014. We compared children exposed to general anesthesia aged <48months to those without any hospitalization. Children with only 1 hospitalization with general anesthesia and no other hospitalization were assessed separately. Outcomes included being classified developmentally high risk at school entry and scoring below national minimum standard in school numeracy and reading tests. Of 211978 children included, 82156 had developmental assessment and 153025 had school test results, with 12848 (15.7%) and 25032 (16.4%) exposed to general anesthesia, respectively. Children exposed to general anesthesia had 17%, 34%, and 23% increased odds of being developmentally high risk (adjusted odds ratio [aOR]: 1.17; 95% CI: 1.07-1.29); or scoring below the national minimum standard in numeracy (aOR: 1.34; 95% CI: 1.21-1.48) and reading (aOR: 1.23; 95% CI: 1.12-1.36), respectively. Although the risk for being developmentally high risk and poor reading attenuated for children with only 1 hospitalization and exposure to general anesthesia, the association with poor numeracy results remained. Children exposed to general anesthesia before 4years have poorer development at school entry and school performance. While the association among children with 1 hospitalization with 1 general anesthesia and no other hospitalization was attenuated, poor numeracy outcome remained. Further investigation of the specific effects of general anesthesia and the impact of the underlying health conditions that prompt the need for surgery or diagnostic procedures is required, particularly among children exposed to long duration of general anesthesia or with repeated hospitalizations.

Abstract 219: Health Literacy and Numeracy in Patients Considering a Left Ventricular Assist Device: Findings From the DECIDE-LVAD Trial

Introduction: The DECIDE-LVAD Trial demonstrated the benefit of a decision support tool for patients considering destination-therapy left ventricular assist device (DT LVAD) implantation. We hypothesized that patients with low health literacy or numeracy may have benefited most from the intervention. Methods: We used the Rapid Estimate of Adult Literacy in Medicine (REALM-R) and the Subjective Numeracy Scale (SNS) to assess patients’ health literacy and numeracy, respectively. A REALM-R score of six or less out of eight identified patients at risk for poor literacy based on the original measure validation. An SNS score less than four out of six identified patients with poor subjective numeracy based on the mean score of the DECIDE-LVAD cohort. We assessed the effect of the decision support tool on LVAD knowledge and values-treatment concordance—concordance between patients’ stated values and their treatment outcome of LVAD or continued medical therapy—and their interaction with health literacy and numeracy. This interaction was assessed using linear mixed models for LVAD knowledge and the difference in Kendall’s tau correlation coefficient for values-treatment concordance. Results: Of the 248 DECIDE-LVAD patients, 228 with complete literacy and numeracy data were analyzed: 51% (116) had high literacy and numeracy; 18 (8%) had low literacy and high numeracy; 55 (25%) had high literacy and low numeracy; 39 (17%) had low scores for both measures. Average age was 63, 15% were female, 19% were racial/ethnic minorities. Patients with high scores for both measures were older, had more formal education, and higher total household income compared to the other 3 groups. Patients with low literacy and/or numeracy had significantly lower LVAD knowledge scores at baseline. In all groups, LVAD knowledge improved over time. The difference in LVAD knowledge between those with low literacy and high literacy decreased over time (baseline difference 9.4%, p=0.002; 6 month follow-up difference 1.4%, p=0.65). In those with high literacy, the decision support tool intervention increased the LVAD knowledge score by 4.2% relative to the control (p=0.15), while in those with low literacy, the intervention increased the score by 10.6% (p=0.04). For patients with low literacy, values-treatment concordance improved with use of the decision support tool (control vs. intervention tau: 0.234 vs 0.673, p=0.028). We did not observe differences in the effect of the intervention by participant numeracy score. Conclusion: All patient groups in the DECIDE-LVAD cohort of patients considering DT LVAD had improved LVAD knowledge with the use of the decision support tool. We did not observe a differential effect of the intervention by numeracy score. Compared to those with higher health literacy, patients with low health literacy improved their LVAD knowledge and values-treatment concordance after the intervention.

Limitations of the S-TOFHLA in measuring poor numeracy: a cross-sectional study

BackgroundAlthough the Short Test of Functional Health Literacy in Adults (S-TOFHLA) is widely used, misidentification of individuals with low health literacy (HL) in specific HL dimensions, like numeracy, is a concern. We examined the degree to which individuals scored as “adequate” HL on the S-TOFHLA would be considered as having low HL by two additional numerical measures.MethodsEnglish-speaking adults aged 45–75 years were recruited from a large, urban academic medical center and a community foodbank in the United States. Participants completed the S-TOFHLA, the Subjective Numeracy Scale (SNS), and the Graphical Literacy Measure (GL), an objective measure of a person’s ability to interpret numeric information presented graphically. Established cut-points or a median split classified participants and having high and low numeracy.ResultsParticipants (n = 187), on average were: aged 58 years; 63% female; 70% Black/African American; and 45% had a high school degree or less. Of those who scored “adequate” on the S-TOFHLA, 50% scored low on the SNS and 40% scored low on GL. Correlation between the S-TOFHLA and the SNS Total was moderate (r = 0.22, n = 186, p = 0.01), while correlation between the S-TOFHLA and the GL Total was large (r = 0.53, n = 187, p ≤ 0.01).ConclusionsFindings suggest that the S-TOFHLA may not capture an individuals’ HL in the dimension of numeracy. Efforts are needed to develop more encompassing and practical strategies for identifying those with low HL for use in research and clinical practice.Trial registrationNCT02151032 (retrospectively registered: May 30, 2014).

Numeracy and Interpretation of Prognostic Estimates in Intracerebral Hemorrhage Among Surrogate Decision Makers in the Neurologic ICU.

Clinicians caring for patients with intracerebral hemorrhage must often discuss prognosis and goals of care with their patients' surrogate decision makers, and may make numeric estimates of likelihood of survival and functional independence, informed by validated prediction models. Surrogates' prognostic estimates are often discordant with physicians', suggesting that physicians' numeric statements may not be accurately interpreted. We sought to assess the relationship between numeracy and interpretation of prognostic estimates in intracerebral hemorrhage among surrogate decision makers. We also assessed surrogates' application of prognostic estimates to decisions regarding goals of care. Single-center, survey-based, cross-sectional study. Twenty-two-bed neurologic ICU at an urban, academic hospital. Surrogate decision makers for patients admitted to the neurologic ICU. Participants completed a survey containing five clinical vignettes describing patients with nontraumatic intracerebral hemorrhage. For each patient, numerical estimates of survival and functional independence were explicitly provided, based on the validated outcome risk stratification scale (intracerebral hemorrhage score) and the Prediction of Functional Outcome in Patients with Primary Intracerebral Hemorrhage score. Participants were asked to make their own prognostic estimates, as well as to describe their preferred goals of care for each hypothetical patient. Respondent demographics were collected, and numeracy was assessed using a modified Lipkus 11-item scale. Poor numeracy was common (42 of 96 total subjects) in this relatively highly educated population. Most prognostic estimates (55%) made by surrogates were discordant with the provided estimates. High numeracy correlated with better concordance (odds ratio, 23.9 [5.57-97.64]; p < 0.001), independent of several factors, including level of education and religion. Numeracy also affected goals-of-care decisions made by surrogates. Poor numeracy is common among surrogate decision makers in an intensive care setting and poses a barrier to communication between surrogates and clinicians regarding prognosis and goals of care.

Protocol for a systematic review: Interventions to improve mathematics achievement in primary school-aged children: a systematic review.

Protocol for a systematic review: Interventions to improve mathematics achievement in primary school-aged children: a systematic review.

Fatherhood in Australian Aboriginal and Torres Strait Islander communities: An Examination of Barriers and Opportunities to Strengthen the Male Parenting Role.

Traditional Australian Aboriginal and Torres Strait Islander societies value men’s role as parents; however, the importance of promoting fatherhood as a key social determinant of men’s well-being has not been fully appreciated in Western medicine. To strengthen the Aboriginal and Torres Strait Islander male parenting role, it is vital to examine current barriers and opportunities. The first author (a male Aboriginal health project officer) conducted yarning sessions in three remote Australian communities, two being Aboriginal, the other having a high Aboriginal population. An expert sample of 25 Aboriginal and 6 non-Aboriginal stakeholders, including maternal and child health workers and men’s group facilitators, considered barriers and opportunities to improve men’s parenting knowledge and role, with an aim to inform services and practices intended to support men’s parenting. A specific aim was to shape an existing men’s group program known as Strong Fathers, Strong Families. A thematic analysis of data from the project identified barriers and opportunities to support men’s role as parents. Challenges included the transition from traditional to contemporary parenting practices and low level of cultural and male gender sensitivity in maternal and child health services. Services need to better understand and focus on men’s psychological empowerment and to address shame and lack of confidence around parenting. Poor literacy and numeracy are viewed as contributing to disempowerment. Communities need to champion Aboriginal and Torres Strait Islander male father role models. Biases and barriers should be addressed to improve service delivery and better enable men to become empowered and confident fathers.

Clinician Numeracy: Use of the Medical Interpretation and Numeracy Test in Foundation Trainee Doctors

Patient safety is a priority in healthcare today. Good clinician numeracy in doctors contributes to patient safety, since it is essential for accuracy in prescribing, and in data interpretation. Evidence, however, suggests that although doctors are assumed to be highly numerate, they often make errors in drug dose calculation and struggle to interpret medical statistics. Having developed a new assessment measure, the Medical Interpretation and Numeracy Test (MINT), we describe its use to evaluate clinician numeracy in 135 recently qualified doctors in the UK ("foundation trainees," i.e., in their first two years post-graduation). The maximum possible test score was 43; the range of scores was 14 – 42 (33 – 98% correct), with an interquartile range of 29 – 38 (67 – 88%). Mean score was 32.76 (76%), with a 95% confidence interval of 31.6 to 33.9. Drug dose calculation errors were common, and potentially hazardous. Two thirds of participants had difficulty with simple data interpretation tasks designed for patients. Almost a quarter could not select the better of two treatment options when data were presented as relative risk reduction, absolute risk reduction or number needed to treat. Our study suggests that a significant proportion of medical graduates have poor clinician numeracy. Such doctors may harm patients by making mistakes in drug dose calculation and through flawed medical decision making. While further research is needed to investigate clinician numeracy in doctors, we believe that there is sufficient evidence to incorporate clinician numeracy into undergraduate and postgraduate medical education programs as a matter of patient safety.

Exploring factors influencing HbA1c and psychosocial outcomes in people with type 1 diabetes after training in advanced carbohydrate counting.

The purpose of this secondary analysis of the StenoABC Study was to identify determinants of the changes in HbA1c observed after training of people with type 1 diabetes in advanced carbohydrate counting (ACC) and automated bolus calculator (ABC) use, and further to investigate psychosocial effects of these insulin dosing approaches. Validated diabetes-specific questionnaires were used to assess diabetes treatment satisfaction, problem areas in diabetes, fear of hypoglycemia and diabetes dependent quality of life before and one year after the training. In addition, numeracy was tested (using a non-validated test developed specifically for this study) and behavioral measures (number of daily blood glucose measurements and self-reported use of ACC) were obtained. Associations between change in HbA1c and these measures plus sex, age, diabetes duration and BMI were tested. Numeracy was the only baseline predictor of yearly change in HbA1c identified. Higher levels of numeracy were associated with greater reductions in HbA1c (P=0.031). No associations between change in HbA1c and the behavioral measures investigated were found, nor were any clinically relevant associations between changes in HbA1c and questionnaire scores. Treatment satisfaction increased in all users of ACC (P<0.001). People who also used an ABC reported significantly lower levels of fear of hypoglycemia than people who practiced ACC without such device (P=0.005). Improvements in HbA1c after training in ACC were inversely related to numeracy. Use of an ABC did not compensate for poor numeracy skills. However, device use reduced fear of hypoglycemia compared with ACC without ABC use.

Validation of a diabetes numeracy test in Arabic.

BackgroundThe prevalence of diabetes Mellitus in Saudi Arabia is 24%, ranking it among the top ten Worldwide. Diabetes education focuses on self-management and relies on numeracy skills. Poor numeracy may go unrecognized and it is important to have an assessment tool in Arabic to measure such a skill in diabetes care.ObjectivesTo validate a 15-item Diabetes Numeracy Test (DNT-15) in the Arabic Language as a tool to assess the numeracy skills of patients with diabetes and to test its properties among Saudi patients with diabetes.MethodsA 15-question Arabic-language test to assess diabetes numeracy among patients with diabetes on the basis of the diabetes numeracy test (DNT-15) was validated among a sample Arabic speaking Saudi patients with diabetes. Data collection included patients’ demographics, long-term glycemic control, diabetes type, duration, co-morbidities, and diabetes related knowledge questions. Internal reliability was assessed using Kuder-Richardson Formula 20 (KR-20).ResultsThe average score of Arabic DNT-15 was 53.3% and took an average of 30 minutes to complete. The scores significantly correlated with education, income, HbA1c, and diabetes knowledge (p<0.05). Content Validity Ratio (CVR) of 0.75 and Content Validity Index (CVI) of 0.89 supported good content validity. The Arabic DNT-15 also had good internal reliability (KR20 = 0.90).ConclusionPatients with diabetes need numeracy skills to manage their disease. Level of education does not reflect level of numeracy, and low numeracy skills might be unnoticed by health care providers. The Arabic DNT-15 is a valid and reliable scale to identify Arabic speaking patients with difficulties in certain diabetes-related numeracy skills.

Gestational age and school achievement: a population study

ObjectiveAcademic achievement varies according to gestational age but it is unclear whether achievement varies within ‘term’ (37–41 weeks gestation) or for ‘post-term’ births (≥42 weeks). We examined gestational age from...

Establishing a research agenda for Foundation Phasei initial teacher education: A systematic review (1994–2014)

Poor literacy and numeracy levels in schools have raised questions in South Africa, as they have internationally, on the quality and appropriateness of initial teacher education for preparing teachers for the complexities faced in schools generally and for the mediation of literacy and numeracy in the early years in particular. This paper profiles empirical research relating to initial teacher education over two decades of South African democracy, derived from a systematic review of journal articles, with the aim of proposing an agenda for research into foundation phase initial teacher education. It concludes that in the period between the birth of South Africa’s democracy and the present, there is little evidence of sustained research on initial teacher education in general, and a dearth of research focused on teacher preparation for the foundation phase in particular. The paper argues for the development of a research agenda that better takes account of the iterative relationship between researching classrooms and researching initial teacher education, especially as it relates to the foundation phase, where research is patchy and unsystematic. Evidence from such research might not only provide a base for policy and curriculum decisions but also lead to more responsive and contextually relevant teacher preparation. Keywords: diversity; foundation phase; literacy; numeracy; research agenda; teacher education

Association between borderline neonatal thyroid-stimulating hormone concentrations and educational and developmental outcomes: a population-based record-linkage study

Congenital hypothyroidism causes intellectual delay unless identified and effectively treated soon after birth. Newborn screening has almost eliminated intellectual disability associated with congenital hypothyroidism. However, clinical uncertainty remains about infants with thyroid-stimulating hormone (TSH) concentrations less than the newborn screening cutoffs. We assessed the association between neonatal TSH concentrations and educational and developmental outcomes. We did a population-based record-linkage study of all liveborn infants undergoing newborn screening from 1994 to 2008 in New South Wales, Australia, with assessments of childhood development or school performance. Very-low-birthweight babies (<1500 g) were excluded. Developmental and educational outcomes were obtained and these were linked to individual records by the New South Wales Centre for Health Record Linkage. The primary educational outcome was the proportion of students with National Assessment Program Literacy and Numeracy (NAPLAN) results lower than the national minimum standard in reading or numeracy measured at all ages, and the primary developmental outcome was the proportion of children who were classified as being developmentally high risk (vulnerable in two or more of the five developmental domains assessed by the Australian Early Development Census) at age 4-6 years. The proportions of infants with each outcome were calculated per percentile (0-100) of TSH concentration. Multivariable logistic regression was used to account for potential confounding by maternal and fetal variables known to affect neonatal TSH concentrations or neurodevelopmental outcomes. 503 706 infants had a neonatal TSH result that linked to a developmental or educational outcome. 149 569 infants born between 2002 and 2008 were linked to an Australian Early Development Census developmental outcome and 354 137 were linked to a NAPLAN educational outcome. Median follow-up for educational outcome was 10 years (IQR 8-12) and for developmental outcome was 5 years (5-6). 5·5% (14 137 of 257 752) of infants scored less than the national minimum standard for numeracy in percentiles lower than the 75th percentile and this increased with each increase of percentile group to 11·3% (15 of 133) of infants with a TSH concentration between the 99·90th and 99·95th percentile. Infants with a neonatal TSH concentration in the 99·95th percentile or higher (above newborn screening cutoff) and likely to have diagnosed and treated congenital hypothyroidism had similar results to infants with a TSH concentration lower than the 75th percentile for both educational and developmental outcomes. Infants with a neonatal TSH concentration between the 99·5th and 99·9th percentile were more likely to have special needs (adjusted odds ratio [aOR] 1·68, 95% CI 1·23-2·30), poor numeracy performance (aOR 1·57, 1·29-1·90), and developmentally high risk (aOR 1·52, 1·20-1·93). We found an association between neonatal TSH concentrations lower than the present newborn screening thresholds and poor educational and developmental outcomes. This association needs further investigation to assess whether assessment and treatment of these infants might improve their long-term cognitive outcomes. Australian National Health and Medical Research.

The Impact of Consumer Numeracy on the Purchase of Long-Term Care Insurance.

To determine the effect of consumers' numeric abilities on the likelihood of owning private long-term care insurance. The 2010 wave of the Health and Retirement Study, a nationally representative survey of Americans age 50 and older, was used (n=12,796). Multivariate logistic regression was used to isolate the relationship between numeracy and long-term care insurance ownership. Each additional question answered correctly on a numeracy scale was associated with a 13 percent increase in the likelihood of holding LTCI, after controlling for predictors of policy demand, education, and cognitive function. Poor numeracy may create barriers to long-term care insurance purchase. Policy efforts aimed at increasing consumer decision support or restructuring the marketplace for long-term care insurance may be needed to increase older adults' ability to prepare for future long-term care expenses.