Gaps in understanding health and engagement with healthcare providers across common long-term conditions: a population survey of health literacy in 29 473 Danish citizens

OBJECTIVES: To (1) quantify levels of subjective health literacy in people with long-term health conditions (diabetes, cardiovascular disease, chronic obstructive pulmonary disease, musculoskeletal disorders, cancer and mental disorders) and compare these to levels in the general population and (2) examine the association between health literacy, socioeconomic characteristics and comorbidity in each long-term condition group.

DESIGN: Population-based survey in the Central Denmark Region (n=29,473). MAIN

OUTCOME MEASURES: Health literacy was measured using two scales from the Health Literacy Questionnaire (HLQ): (1) Ability to understand health information and (2) Ability to actively engage with healthcare providers.

RESULTS: People with long-term conditions reported more difficulties than the general population in understanding health information and actively engaging with healthcare providers. Wide variation was found between disease groups, with people with cancer having fewer difficulties and people with mental health disorders having more difficulties in actively engaging with healthcare providers than other long-term condition groups. Having more than one long-term condition was associated with more difficulty in engaging with healthcare providers and understanding health information. People with low levels of education had lower health literacy than people with high levels of education.

CONCLUSIONS: Compared with the general population, people with long-term conditions report more difficulties in understanding health information and engaging with healthcare providers. These two dimensions are critical to the provision of patient-centred healthcare and for optimising health outcomes. More effort should be made to respond to the health literacy needs among individuals with long-term conditions, multiple comorbidities and low education levels, to improve health outcomes and to reduce social inequality in health.

Addressing the physical health of people with serious mental illness : a potential solution for an enduring problem

People with serious mental illness face significant inequalities in physical health care. As a result, the risk of cardiometabolic disorders and premature mortality is far greater than that observed in the general population. Contributiung to this disparity, is the lack of routine physical health screening by mental health clinicians. One possible solution is the implimentation of a physical health nurse consultant, whose role is to monitor and coordinate the physical health care of people with serious mental illness. Current evidence supports the implimentation of such a role, and a failure to address the widening gaps in physical health care will only serve to increase the disparities faced by people with serious mental illness.

Characterising the extent of misreporting of high blood pressure, high cholesterol, and diabetes using the Australian Health Survey

BACKGROUND: Measuring and monitoring the true prevalence of risk factors for chronic conditions is essential for evidence-based policy and health service planning. Understanding the prevalence of risk factors for cardiovascular disease (CVD) in Australia relies heavily on self-report measures from surveys, such as the triennial National Health Survey. However, international evidence suggests that self-reported data may substantially underestimate actual risk factor prevalence. This study sought to characterise the extent of misreporting in a large, nationally-representative health survey that included objective measures of clinical risk factors for CVD.

METHODS: This study employed a cross-sectional analysis of 7269 adults aged 18 years and over who provided fasting blood samples as part of the 2011-12 Australian Health Survey. Self-reported prevalence of high blood pressure, high cholesterol and diabetes was compared to measured prevalence, and univariate and multivariate logistic regression analyses identified socio-demographic characteristics associated with underreporting for each risk factor.

RESULTS: Approximately 16 % of the total sample underreported high blood pressure (measured to be at high risk but didn't report a diagnosis), 33 % underreported high cholesterol, and 1.3 % underreported diabetes. Among those measured to be at high risk, 68 % did not report a diagnosis for high blood pressure, nor did 89 % of people with high cholesterol and 29 % of people with high fasting plasma glucose. Younger age was associated with underreporting high blood pressure and high cholesterol, while lower area-level disadvantage and higher income were associated with underreporting diabetes.

CONCLUSIONS: Underreporting has important implications for CVD risk factor surveillance, policy planning and decisions, and clinical best-practice guidelines. This analysis highlights concerns about the reach of primary prevention efforts in certain groups and implications for patients who may be unaware of their disease risk status.

Factors affecting maritime pilots' health and well-being : a systematic review

Background: Maritime pilotage is a demanding occupation where pilots are required to perform complex procedures in sometimes unfamiliar working environments. These psychological stressors, in addition tothe physical demands associated with the role (e.g., reduced sleep, boarding, and departing vessels), may over time have a damaging effect on pilots’ physical and mental health. Therefore the aim of this paper was to systematically review the existing literature on maritime pilots’ health and well-being.Materials and methods: The databases academic search complete, MEDLINE and MEDLINE complete, PsycINFO, PsycARTICLES, PubMed, and ScienceDirect were searched from the earliest available record until 1 May 2015. From an initial pool of 167 manuscripts retrieved, only 18 were peer-reviewed original research and discussed topics associated with maritime pilots’ health and well-being.Results: In total, 29 factors associated with maritime pilot health and well-being were identified. These were loosely categorised into physical (n = 14), psychosocial (n = 8), and workplace issues (n = 7). The most commonly investigated factors were blood pressure or heart rate, sleep or fatigue, smoking and alcohol consumption, perceived stress, and shift duration or cycle. Conclusions: Findings from the review suggest that the prevention of cardiovascular diseases and associated cardio-metabolic risk factors seems to be of paramount importance, with ample evidence indicating that modern-day pilots present as being overweight or obese. What remains unknown is whether these physical factors are associated with variations in psychosocial functioning. Therefore, it is recommended that future pilotage investigations adopt a multidisciplinary approach to better quantify the impact of maritimepilotage on long-term health and well-being.

Physical activity guidelines and cardiovascular risk in children: a cross sectional analysis to determine whether 60 minutes is enough

BACKGROUND: Physical activity reduces cardiovascular mortality and morbidity. The World Health Organisation (WHO) recommends children engage in 60 min daily moderate-to-vigorous physical activity (MVPA). The effect of compliance with this recommendation on childhood cardiovascular risk has not been empirically tested. To evaluate whether achieving recommendations results in reduced composite-cardiovascular risk score (CCVR) in children, and to examine if vigorous PA (VPA) has independent risk-reduction effects.

METHODS: PA was measured using accelerometry in 182 children (9-11 years). Subjects were grouped according to achievement of 60 min daily MVPA (active) or not (inactive). CCVR was calculated (sum of z-scores: DXA body fat %, blood pressure, VO2peak, flow mediated dilation, left ventricular diastolic function; CVR score ≥ 1SD indicated 'higher risk'). The cohort was further split into quintiles for VPA and odds ratios (OR) calculated for each quintile.

RESULTS: Active children (92 (53 boys)) undertook more MVPA (38 ± 11 min, P < 0.001), had greater VO2peak (4.5 ± 0.8 ml/kg/min P < 0.001), and lower fat % (3.9 ± 1.1 %, P < 0.001) than inactive. No difference were observed between active and inactive for CCVR or OR (P > 0.05). CCVR in the lowest VPA quintile was significantly greater than the highest quintile (3.9 ± 0.6, P < 0.05), and the OR was 4.7 times higher.

CONCLUSION: Achievement of current guidelines has positive effects on body composition and cardiorespiratory fitness, but not CCVR. Vigorous physical activity appears to have beneficial effects on CVD risk, independent of moderate PA, implying a more prescriptive approach may be needed for future VPA guidelines.

Is the health burden associated with obesity changing?

Prioritization of obesity prevention and management policy is based on one's understanding of the health risks associated with increasing body weight. However, there is evidence that the magnitude of these health risks may be changing over time. Here, the authors analyze the theoretical drivers of these changes and then examine whether there is empirical evidence to support the theory. They conclude that, although the mortality risks associated with increasing body weight may be decreasing over time, the overall health burden appears likely to increase.

Comment on: Does bariatric surgery reduce the risk of major cardiovascular events? A retrospective cohort study of morbidly obese surgical patients.

The prevalence of morbid obesity has been shown to be increasing at an even greater rate than general obesity in many developed countries and is likely to continue to ncrease. The high risks of a range of chronic diseases associated with morbid obesity make this a critical ealthcare challenge. Although comprehensive epidemiologic data are not yet available for all the health risks associated with morbid obesity, it is likely to be associated with very high risks of diseases with a large impact on the individual and the health system, including diabetes, cardiovascular disease, sleep apnea, cancer, osteoarthritis, infertility, depression, and mortality.