Health literacy: applying current concepts to improve health services and reduce health inequalities

The concept of 'health literacy' refers to the personal and relational factors that affect a person's ability to acquire, understand and use information about health and health services. For many years, efforts in the development of the concept of health literacy exceeded the development of measurement tools and interventions. Furthermore, the discourse about and development of health literacy in public health and in clinical settings were often substantially different. This paper provides an update about recently developed approaches to measurement that assess health literacy strengths and limitations of individuals and of groups across multiple aspects of health literacy. This advancement in measurement now allows diagnostic and problem-solving approaches to developing responses to identified strengths and limitations. In this paper, we consider how such an approach can be applied across the diverse range of settings in which health literacy has been applied. In particular, we consider some approaches to applying health literacy in the daily practice of health-service providers in many settings, and how new insights and tools--including approaches based on an understanding of diversity of health literacy needs in a target community--can contribute to improvements in practice. Finally, we present a model that attempts to integrate the concept of health literacy with concepts that are often considered to overlap with it. With careful consideration of the distinctions between prevailing concepts, health literacy can be used to complement many fields from individual patient care to community-level development, and from improving compliance to empowering individuals and communities.

Socioeconomic inequalities in fruit and vegetable intakes

Socioeconomic position (SEP) refers to an individual’s social and economicranking within society based on access to resources (such asmaterial and social assets, including income, wealth, and educational credentials)and prestige (ie, an individual’s status in a social hierarchy, linkedfor instance to their occupation, income, or education level) (Krieger et al.,1997). Individual SEP can be measured using a variety of indicators whichcommonly include education, occupation, and income (Galobardes et al.,2006). Composite measures are frequently used when examining neighborhoodlevel measures of SEP and are commonly created by combining censusdata on a range of indicators.

Predicting driving direction with weighted markov model

Driving direction prediction can be useful in different applications such as driver warning and route recommendation. In this paper, a framework is proposed to predict the driving direction based on weighted Markov model. First the city POI (Point of Interesting) map is generated from trajectory data using weighted PageRank algorithm. Then, a weighted Markov model is trained for the near term driving direction prediction based on the POI map and historical trajectories. The experimental results on real-world data set indicate that the proposed method can improve the original Markov prediction model by 10% at some circumstances and 5% overall.

New finite-sum inequalities with applications to stability of discrete time-delay systems

This paper is concerned with the problem of stability analysis of discrete time-delay systems. New finite-sum inequalities, which encompass the ones based on Abel lemma or Wirtinger type inequality, are first proposed. The potential capability of the newly derived inequalities is then demonstrated by establishing less conservative stability conditions for some classes of linear discrete-time systems with delay. The derived stability criteria are theoretically and numerically proved to be less conservative than existing results.

Minimum-order filter design for partial state estimation of linear systems with multiple time-varying state delays and unknown input delays

Designing delay-dependent functional observers for LTI systems with multiple known time-varying state delays and unknown time-varying input delays is studied. The input delays are arbitrary, but the state delays should be upper-bounded. In addition, two scenarios of slow-varying and fast-varying state delays are investigated. The results of the paper can also be considered as one of the first contributions considering unknown-input functional observer design for linear systems with multiple time-varying state delays. Based on the Lyapunov Krasovskii approach, delay-dependent sufficient conditions of the exponential stability of the observer in each scenario are established in terms of linear matrix inequalities. Because of using effective techniques, such as the descriptor transformation and an advanced weighted integral inequality, the proposed stability criteria can result in larger stability regions compared with the other papers that study functional observers for time-varying delay systems. Furthermore, to help with the design procedure, a genetic algorithm-based scheme is proposed to adjust a weighting matrix in the established linear matrix inequalities. Two numerical examples illustrate the design procedure and demonstrate the efficacy of the proposed observer in each scenario.

Stability of two-dimensional Roesser systems with time-varying delays via novel 2D finitesum inequalities

This study considers the problem of stability analysis of discrete-time two-dimensional (2D) Roesser systems with interval time-varying delays. New 2D finite-sum inequalities, which provide a tighter lower bound than the existing ones based on 2D Jensen-type inequalities, are first developed. Based on an improved Lyapunov-Krasovskii functional, the newly derived inequalities are then utilised to establish delay-range-dependent linear matrix inequality-based stability conditions for a class of discrete time-delay 2D systems. The effectiveness of the obtained results is demonstrated by numerical examples.

Idempotent weighted aggregation based on binary aggregation trees

We propose weighted aggregation algorithms for creating general idempotent weighted aggregators of n variables derived from related symmetric idempotent aggregators of two variables. This computational method, together with interpolative aggregation, can be used for the development of general idempotent logic aggregators that satisfy a variety of conditions necessary for building decision models in the area of weighted compensative logic.

Inequalities and agencies in workplace learning experiences: international student perspectives

National systems of vocational education and training around the globe are facing reform driven by quality, international mobility, and equity. Evidence suggests that there are qualitatively distinctive challenges in providing and sustaining workplace learning experiences to international students. However, despite growing conceptual and empirical work, there is little evidence of the experiences of these students undertaking workplace learning opportunities as part of vocational education courses. This paper draws on a four-year study funded by the Australian Research Council that involved 105 in depth interviews with international students undertaking work integrated learning placements as part of vocational education courses in Australia. The results indicate that international students can experience different forms of discrimination and deskilling, and that these were legitimised by students in relation to their understanding of themselves as being an ‘international student’ (with fewer rights). However, the results also demonstrated the ways in which international students exercised their agency towards navigating or even disrupting these circumstances, which often included developing their social and cultural capital. This study, therefore, calls for more proactively inclusive induction and support practices that promote reciprocal understandings and navigational capacities for all involved in the provision of work integrated learning. This, it is argued, would not only expand and enrich the learning opportunities for international students, their tutors, employers, and employees involved in the provision of workplace learning opportunities, but it could also be a catalyst to promote greater mutual appreciation of diversity in the workplace.

Prioritising and tackling socio-economic inequalities in obesity

This article discusses some of the recent trends in obesity and demonstrates why deeper consideration of differences in trends and intervention effectiveness across socioeconomicgroups is critical.

The impact of trans fat regulation on social inequalities in coronary heart disease in Australia

To The Editor: The evidence that industrially produced trans fatty acids (TFAs) increase the risk of coronary heart disease is compelling, and it is widely agreed that their use in food products should be minimised.1-3 Dietary TFAs are generally found in higher quantities in “unhealthy” food products,4 consumption of which is also found to follow predictable sociodemographic patterns.5 Thus, although the average TFA intake for Australians is relatively low, socioeconomically disadvantaged people are likely to disproportionately represent those with above average intakes.

Examining health literacy disparities in the United States: a third look at the National Assessment of Adult Literacy (NAAL)

BACKGROUND: In the United States, disparities in health literacy parallel disparities in health outcomes. Our research contributes to how diverse indicators of social inequalities (i.e., objective social class, relational social class, and social resources) contribute to understanding disparities in health literacy.

METHODS: We analyze data on respondents 18 years of age and older (N = 14,592) from the 2003 National Assessment of Adult Literacy (NAAL) restricted access data set. A series of weighted Ordinary Least Squares (OLS) regression models estimate the association between respondent's demographic characteristics, socioeconomic status (SES), relational social class, social resources and an Item Response Theory (IRT) based health literacy measure.

RESULTS: Our findings are consistent with previous research on the social and SES determinants of health literacy. However, our findings reveal the importance of relational social status for understanding health literacy disparities in the United States. Objective indicators of social status are persistent and robust indicators of health literacy. Measures of relational social status such as civic engagement (i.e., voting, volunteering, and library use) are associated with higher health literacy levels net of objective resources. Social resources including speaking English and marital status are associated with higher health literacy levels.

CONCLUSIONS: Relational indicators of social class are related to health literacy independent of objective social class indicators. Civic literacy (e.g., voting and volunteering) are predictors of health literacy and offer opportunities for health intervention. Our findings support the notion that health literacy is a social construct and suggest the need to develop a theoretically driven conceptual definition of health literacy that includes a civic literacy component.

Neither fixed nor random: weighted least squares meta-analysis

This study challenges two core conventional meta-analysis methods: fixed effect and random effects. We show how and explain why an unrestricted weighted least squares estimator is superior to conventional random-effects meta-analysis when there is publication (or small-sample) bias and better than a fixed-effect weighted average if there is heterogeneity. Statistical theory and simulations of effect sizes, log odds ratios and regression coefficients demonstrate that this unrestricted weighted least squares estimator provides satisfactory estimates and confidence intervals that are comparable to random effects when there is no publication (or small-sample) bias and identical to fixed-effect meta-analysis when there is no heterogeneity. When there is publication selection bias, the unrestricted weighted least squares approach dominates random effects; when there is excess heterogeneity, it is clearly superior to fixed-effect meta-analysis. In practical applications, an unrestricted weighted least squares weighted average will often provide superior estimates to both conventional fixed and random effects.

Neither fixed nor random: weighted least squares meta-regression

Our study revisits and challenges two core conventional meta-regression estimators: the prevalent use of‘mixed-effects’ or random-effects meta-regression analysis and the correction of standard errors that defines fixed-effects meta-regression analysis (FE-MRA). We show how and explain why an unrestricted weighted least squares MRA (WLS-MRA) estimator is superior to conventional random-effects (or mixed-effects) meta-regression when there is publication (or small-sample) bias that is as good as FE-MRA in all cases and better than fixed effects in most practical applications. Simulations and statistical theory show that WLS-MRA provides satisfactory estimates of meta-regression coefficients that are practically equivalent to mixed effects or random effects when there is no publication bias. When there is publication selection bias, WLS-MRA always has smaller bias than mixed effects or random effects. In practical applications, an unrestricted WLS meta-regression is likely to give practically equivalent or superior estimates to fixed-effects, random-effects, and mixed-effects meta-regression approaches. However, random-effects meta-regression remains viable and perhaps somewhat preferable if selection for statistical significance (publication bias) can be ruled out and when random, additive normal heterogeneity is known to directly affect the ‘true’ regression coefficient.

A novel approach to exponential stability of continuous-time Roesser systems with directional time-varying delays

This paper addresses the problem of exponential stability analysis of two-dimensional (2D) linearcontinuous-time systems with directional time-varying delays. An abstract Lyapunov-like theorem whichensures that a 2D linear system with delays is exponentially stable for a prescribed decay rate is exploitedfor the first time. In light of the abstract theorem, and by utilizing new 2D weighted integral inequalitiesproposed in this paper, new delay-dependent exponential stability conditions are derived in terms oftractable matrix inequalities which can be solved by various computational tools to obtain maximumallowable bound of delays and exponential decay rate. Two numerical examples are given to illustrate theeffectiveness of the obtained results.