Health literacy : what is it and why is it important to measure?

This report summarizes the proceedings of the first Outcome Measures in Rheumatology Clinical Trials (OMERACT) Health Literacy Special Interest Group workshop at the OMERACT 10 conference. Health literacy refers to an individual’s capacity to seek, understand, and use health information. Discussion centered on the relevance of health literacy to the rheumatology field; whether measures of health literacy were important in the context of clinical trials and routine care; and, if so, whether disease-specific measures were required. A nominal group process involving 27 workshop participants, comprising a patient group (n = 12) and a healthcare professional and researcher group (n = 15), confirmed that health literacy encompasses a broad range of concepts and skills that existing scales do not measure. It identified the importance and relevance of patient abilities and characteristics, but also health professional factors and broader contextual factors. Sixteen themes were identified: access to information; cognitive capacity; disease; expression/communication; finances; health professionals; health system; information; literacy/numeracy; management skills; medication; patient approach; dealing with problems; psychological characteristics; social supports; and time. Each of these was divided further into subthemes of one or more of the following: knowledge, attitude, attribute, relationship, skill, action, or context. There were virtually no musculoskeletal-specific statements, suggesting that a generic health literacy tool in rheumatology is justified. The detailed concepts across themes provided new and systematic insight into what needs to be done to improve health literacy and consequently reduce health inequalities. These data will be used to derive a more comprehensive measure of health literacy.

Talking with their feet : student absenteeism and compulsory schooling

Universal access to elementary schooling is a goal that was largely achieved in western democracies by the mid twentieth century. Yet, at the beginning of the twenty-first century, students’ access to schooling appears to be back on the agenda; this time, students themselves rather than our social systems are regulating their access to school. Increasingly, schools throughout Australia and in several other OECD countries are recording a worrying decline in student attendance in the compulsory years, prompting a certain amount of societal ‘fear’, ‘anxiety’ and ‘moral panic’. This paper reviews the literature on student attendance and absenteeism as a feature of contemporary schooling. It begins with an account of how this literature variously defines absenteeism – its discursive categories – and where it locates the ‘problem’. The ‘solutions’ that flow from these accounts are also explicated, specifically in relation to their regulatory effects on students and on the education they are offered. The paper’s critical reading of these problems of and solutions for student absenteeism seeks to highlight the institutional authoring of such student behaviour and of students as ‘other’. It also uncovers the silences in the literature, particularly in relation to cultural difference, student subjectivity and teacher pedagogy – what teachers are doing (and not doing) to/with students. The paper concludes that issues of low socio-economic status do not feature very loudly in the literature (and, we suspect, in practice), despite being strongly associated with students who respond to the demands and relevance of schooling by ‘talking with their feet’.

A pilot study of a telephone-based parental intervention to increase fruit and vegetable consumption in 3-5 year old children

Objective : To examine the potential efficacy of a brief telephone-based parental intervention in increasing fruit and vegetable consumption in children aged 3–5 years and to examine the feasibility of intervention delivery and acceptability to parents.

Design : A pre–post study design with no comparison group. Telephone surveys were conducted approximately 1 week before and following intervention delivery.
Setting Participants were recruited through pre-schools in the Hunter region, New South Wales, Australia.

Subjects : Thirty-four parents of 3–5-year-olds received four 30-min interventional telephone calls over 4 weeks administered by trained telephone interviewers. The scripted support calls focused on fruit and vegetable availability and accessibility within the home, parental role modelling of fruit and vegetable consumption and on implementing supportive family eating routines.

Results : Following the intervention, the frequency and variety of fruit and vegetable consumption increased (P = 0·027), as measured by a subscale of the children's dietary questionnaire. The intervention was feasible to be delivered to parents, as all participants who started the intervention completed all four calls, and all aspects of the interventional calls, including the number, length, content, format and relevance, were considered acceptable by more than 90 % of parents.

Conclusions : A brief telephone-based parental intervention to encourage fruit and vegetable consumption in pre-school-aged children may be effective, feasible and acceptable. Further investigation is warranted in a randomised controlled trial.

Decision support and the effectiveness of web-based delivery and information tailoring for bowel cancer screening : an exploratory study

Background: Colorectal cancer (CRC) is the third most commonly diagnosed cancer in males and the second in females throughout the developed world. Population screening using fecal occult blood tests (FOBTs) facilitates early detection and greater chance of survival, but participation rates are low. We developed a Web-based decision tool to provide information tailored to an individual’s decision stage for CRC screening and attitude toward screening utilizing the Preventive Health Model (PHM) and Precaution Adoption Process Model (PAPM) as theoretical frameworks for screening behavior. We describe the practical steps employed in the tool’s design and the subsequent conduct of an exploratory study.
Objective: To design a decision tool for CRC screening and conduct an exploratory study among average-risk men and women to (1) test the impact of message type (tailored vs non-tailored) and message delivery modality (Web-based vs paper-based) on attitudes toward screening and screening uptake, and (2) investigate the acceptability of the decision tool and relevance of materials.
Methods: Participants (n = 100), recruited from a population sample of men and women aged 50-76 residing in urban Adelaide, Australia, were randomly assigned to a control group or one of 4 interventions: (1) Web-based and tailored information, (2) paper-based and tailored information, (3) Web-based and non-tailored (generic) information, or (4) paper-based and non-tailored information. Participation was augmented by snowball recruitment (n = 19). Questionnaires based on PHM variables were administered pre- and post-intervention. Participants were given the opportunity to request an FOBT. Following the intervention, participants discussed the acceptability of the tool.
Results: Full data were available for 87.4% (104/119) of participants. Post-intervention, perceived susceptibility scores for individuals receiving tailored information increased from mean 10.6 (SD 2.1) to mean 11.8 (SD 2.2). Scores on self-efficacy increased in the tailored group from mean 11.7 (SD 2.0) to mean 12.6 (SD 1.8). There were significant time x modality x message effects for social influence and salience and coherence, reflecting an increase in these scores for tailored Web-based participants only; social influence scores increased from mean 11.7 (SD 2.6) to mean 14.9 (SD 2.3), and salience and coherence scores increased from mean 16.0 (SD 2.2) to mean 17.7 (SD 2.1). There was no greater influence of modality or message type on movement toward a decision to screen or screening uptake, indicating that neither tailored messages nor a Web modality had superior effect. Overall, participants regarded tailored messages positively, but thought that the Web tool lacked “media richness.”
Conclusions: This exploratory study confirms that tailoring on PHM predictors of CRC screening has the potential to positively address attitudes toward screening. However, tailoring on these variables did not result in significantly increased screening uptake. Future research should consider other possible psychosocial influences. Mode of delivery did not affect outcomes, but as a delivery medium, the Web has economic and logistical advantages over paper.

The whole truth is both too much and not sufficient

Lawyers and fans of legal drama will recognise the phrase “the truth, the whole truth and nothing but the truth”. But relevance is also required. In a different context, students often mistakenly believe that quantity of truth will compensate for any deficiencies in quality and relevance.

The curricula of the various Australian jurisdictions, and the National Curriculum, encourage students to conduct research on the Internet. There is a wealth of good information on the Internet; there is also a lot of poor information. Students should learn to interrogate sources to discover if the author has expert knowledge in that area, and if the publisher or website has any quality assurance protocols.

Correctness and quantity of information does not compensate for deficiencies in quality and relevance. Useful scientific information has appropriate precision, accuracy and conciseness.

The Internet gives access to databases, to vast amounts of information, to primary and second-hand data, and to summaries and analyses of information. Nobel Laureate Linus Pauling often said that the use of computers is not a substitute for thinking, and the same is true of the Internet. Teachers will always be needed to guide students on the appropriate use of learning tools on the journey of discovery that we call education.

A cross-sectional examination of non-suicidal self-injury, disordered eating, impulsivity, and compulsivity in a sample of adult women

Non-suicidal self-injury has been classed as having both impulsive and compulsive characteristics (Simeon & Favazza, 2001). These constructs have been related to disordered eating behaviors such as vomiting (Favaro & Santonastaso, 1998). Utilizing an international sample of adult females, this paper further explored this model, aiming to identify whether all types of disordered eating could be classified as impulsive or compulsive, and whether the impulsive and compulsive groupings reflect underlying trait impulsivity and compulsivity. The hypothesized impulsive and compulsive dimensions did not emerge from the data. Notably however, all self-injurious and disordered eating behaviors were linked to Urgency (an impulsivity facet) to varying degrees; no relationship with trait compulsivity was found. These findings are discussed, study limitations are noted, and relevance for clinical practice is outlined.

Gender and ethnic diversity on boards and corporate responsibility : the case of the arts sector

This study provides insights on sector-specific characteristics, challenges and issues that affect corporate responsibility (CR) in relation to ethnicity and gender on arts boards. Using stakeholder theory, the study explores how arts board composition (e.g. gender and ethnicity) sets the scene for dynamics that affect CR. Data analysis is based on interviews with 92 board members and stakeholders sitting on 66 arts boards in Australia. Results suggest that the dynamism of gender and ethnic diversity on arts boards makes them responsive to CR; however, their presence does not always lead to CR. For diverse boards to lead to CR, our findings indicate the significance of board member attributes of passion, skill and capability of developing networks, irrespective of gender and ethnicity. The article advances understanding of the implications and relevance of ethnic and gender diversity on non-profit boards and contributes to an important yet under-researched body of literature.

Web-based alcohol screening and brief intervention for university students: a randomized trial

IMPORTANCE: Unhealthy alcohol use is a leading contributor to the global burden of disease, particularly among young people. Systematic reviews suggest efficacy of web-based alcohol screening and brief intervention and call for effectiveness trials in settings where it could be sustainably delivered. OBJECTIVE: To evaluate a national web-based alcohol screening and brief intervention program. DESIGN, SETTING, AND PARTICIPANTS: A multisite, double-blind, parallel-group, individually randomized trial was conducted at 7 New Zealand universities. In April and May of 2010, invitations containing hyperlinks to the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screening test were e-mailed to 14,991 students aged 17 to 24 years. INTERVENTIONS: Participants who screened positive (AUDIT-C score ≥4) were randomized to undergo screening alone or to 10 minutes of assessment and feedback (including comparisons with medical guidelines and peer norms) on alcohol expenditure, peak blood alcohol concentration, alcohol dependence, and access to help and information. MAIN OUTCOMES AND MEASURES: A fully automated 5-month follow-up assessment was conducted that measured 6 primary outcomes: consumption per typical occasion, drinking frequency, volume of alcohol consumed, an academic problems score, and whether participants exceeded medical guidelines for acute harm (binge drinking) and chronic harm (heavy drinking). A Bonferroni-corrected significance threshold of .0083 was used to account for the 6 comparisons and a sensitivity analysis was used to assess possible attrition bias. RESULTS: Of 5135 students screened, 3422 scored 4 or greater and were randomized, and 83% were followed up. There was a significant effect on 1 of the 6 prespecified outcomes. Relative to control participants, those who received intervention consumed less alcohol per typical drinking occasion (median 4 drinks [interquartile range {IQR}, 2-8] vs 5 drinks [IQR 2-8]; rate ratio [RR], 0.93 [99.17% CI, 0.86-1.00]; P = .005) but not less often (RR, 0.95 [99.17% CI, 0.88-1.03]; P = .08) or less overall (RR, 0.95 [99.17% CI, 0.81-1.10]; P = .33). Academic problem scores were not lower (RR, 0.91 [99.17% CI, 0.76-1.08]; P = .14) and effects on the risks of binge drinking (odds ratio [OR], 0.84 [99.17% CI, 0.67-1.05]; P = .04) and heavy drinking (OR, 0.77 [99.17% CI, 0.56-1.05]; P = .03) were not significantly significant. In a sensitivity analysis accounting for attrition, the effect on alcohol per typical drinking occasion was no longer statistically significant. CONCLUSIONS AND RELEVANCE: A national web-based alcohol screening and brief intervention program produced no significant reductions in the frequency or overall volume of drinking or academic problems. There remains a possibility of a small reduction in the amount of alcohol consumed per typical drinking occasion. TRIAL REGISTRATION: anzctr.org.au Identifier: ACTRN12610000279022.

Experience and the artist's body : resisting the Uber-artist construct in socially engaged performance

Looking back over the past 20 years of my practice, the vista is littered with ambiguities of process and form within socially engaged performance. Sifting through the debris, one question arises: what have I been doing?; another might be: what have I been making? What feels relevant to me is the aggregate of my experiences; the who I am. With the current sector creep towards instrumentalising arts for social agendas, the value and relevance of experience ebbs. Demands on artists extend well beyond aesthetic skill, process facilitation and project management. In this essay, I critique the risk within socially engaged practice of art becoming subservient to social agendas and consider how the shift towards an uber-artist construct renders the sector unsustainable.

Understanding the dynamics between social entrepreneurship and inclusive growth in subsistence marketplaces

This article explores how social entrepreneurs utilize their unique circumstances and resources at a micro level to facilitate the creation of shared value at the meso level, leading to inclusive growth at a macro level in the context of subsistence marketplaces. Drawing from explanatory case studies of two social enterprises—Waste Concern (Bangladesh) and Seven Women (Nepal)—the findings suggest that social entrepreneurs act as bricoleurs to integrate their operant and operand resources in subsistence marketplaces to facilitate inclusive growth. The authors further connect with and extend three discourses of research—social entrepreneurship, social bricolage, and service-dominant logic—to develop a framework providing insights into the “bottom-up” approach, the underlying dynamics of shared value creation, and inclusive growth in subsistence marketplaces by social entrepreneurs. The findings also strengthen Dees's (2001) definition of social entrepreneurship, confirming its applicability and relevance in subsistence marketplaces and further extending the theory of social bricolage. The authors discuss the implications of these findings, including tactical interventions aimed at providing better understanding of how social entrepreneurs create value in resource-constrained marketplaces, from a bottom-up perspective.

Involving people with diabetes and the wider community in diabetes research: a realist review protocol

BACKGROUND: Patient and public involvement in diabetes research is now actively encouraged in different countries because it is believed that involving people with experience of the condition will improve the quality and relevance of the research. However, reviews of patient involvement have noted that inadequate resources, patients' and communities' lack of research knowledge, and researchers' lack of skills to involve patients and communities in research may present significant contextual barriers. Little is known about the extent of patient/community involvement in designing or delivering interventions for people with diabetes. A realist review of involvement will contribute to assessing when, how and why involvement works, or does not work, to produce better diabetes interventions.

METHODS/DESIGN: This protocol outlines the process for conducting a realist review to map how patients and the public have been involved in diabetes research to date. The review questions ask the following: How have people with diabetes and the wider community been involved in diabetes research? What are the characteristics of the process that appear to explain the relative success or failure of involvement? How has involvement (or lack of involvement) in diabetes research influenced the development and conduct of diabetes research? The degree of support in the surrounding context will be assessed alongside the ways in which people interact in different settings to identify patterns of interaction between context, mechanisms and outcomes in different research projects. The level and extent of the involvement will be described for each stage of the research project. The descriptions will be critically reviewed by the people with diabetes on our review team. In addition, researchers and patients in diabetes research will be asked to comment. Information from researcher-patient experiences and documents will be compared to theories of involvement across a range of disciplines to create a mid-range theory describing how involvement (or lack of involvement) in diabetes research influences the development and conduct of diabetes research.

Library Privacy Policies in 2015: Strategies for Renewed Relevance

In recent decades, library associations have advocated for the adoption of privacy and confidentiality policies as practical support to the Library Code of Ethics with a threefold purpose to (1) define and uphold privacy practices within the library, (2) convey privacy practices to patrons and, (3) protect against potential liability and public relations problems. The adoption of such policies has been instrumental in providing libraries with effective responses to surveillance initiatives such as warrantless requests and the USA PATRIOT ACT. Nevertheless, as reflected in recent news stories, the rapid emergence of data brokerage relationships and technologies and the increasing need for libraries to utilize third party vendor services have increased opportunities for data surveillers to access patrons’ personal information and reading habits, which are funneled and made available through multiple online library service platforms. Additionally, the advice that libraries should “contract for the same level of privacy reflected in their privacy policies” is no longer realistic given that the existence of multiple vendor contracts negotiated at arms length is likely to produce varying privacy terms and even varying definitions of what constitutes personal information (PII). These conditions sharply threaten the effectiveness and relevance of library privacy policies and privacy initiatives in that such policies increasingly offer false comfort by failing to reflect privacy weaknesses in the data sharing landscape and vendor contracts when library-vendor contracts fail to keep up with vendor data sharing capabilities. While some argue that library privacy ethics are antiquated and rendered obscure in the current online sharing economy PEW studies point to pronounced public discomfort with increasing privacy erosion. At the same time, new directions in FTC enforcement raise the possibility that public institutions’ privacy policies may serve as swords to unfair or deceptive commercial trade practices – offering the potential of renewed relevance for library privacy and confidentiality policies. This dual coin of public concern and the potential for enhanced FTC enforcement suggests that when crafting privacy polices libraries must now walk the knife’s edge by offering patrons both realistic notice about the limitations of protections the library can ensure while at the same time publicly holding vendors accountable to library privacy ethics and expectations. Potential solutions for how to walk this edge are developed and offered as a subject for further discussion to assist the modification of model policies for both public and academic libraries alike.

CDKN2A promoter methylation is related to the tumor location and histological subtype and associated with Helicobacter pylori flaA(+) strains in gastric adenocarcinomas

Promoter hypermethylation of CDKN2A (p16INK4A protein) is the main mechanism of gene inactivation. However, its association with Helicobacter pylori infection is a controversial issue. Therefore, we examined a series of gastric adenocarcinomas to assess the association between p16INK4A inactivation and H. pylori genotype (vacA, cagA, cagE, virB11 and flaA) according to the location and histological subtype of the tumors. p16INK4A expression and CDKN2A promoter methylation were found in 77 gastric adenocarcinoma samples by immunohistochemistry and methylation-specific PCR, respectively. Helicobacter pylori infection and genotype were determined by PCR. A strong negative correlation between immunostaining and CDKN2A promoter region methylation was found. In diffuse subtype tumors, the inactivation of p16INK4A by promoter methylation was unique in noncardia tumors (p = 0.022). In addition, H. pylori-bearing flaA was associated with non-methylation tumors (p = 0.008) and H. pylori strain bearing cagA or vacAs1m1 genes but without flaA was associated with methylated tumors (p = 0.022 and 0.003, respectively). Inactivation of p16INK4A in intestinal and diffuse subtypes showed distinct carcinogenic pathways, depending on the tumor location. Moreover, the process of methylation of the CDKN2A promoter seems to depend on the H. pylori genotype. The present data suggest that there is a differential influence and relevance of H. pylori genotype in gastric cancer development.

Economic policy, institutions and productive development in Latin America

Includes bibliography

Report of the CDCC working group - redefining and revitalizing the role of the CDCC in Caribbean regional development

At the thirteenth meeting of the Monitoring Committee of the CDCC held in Port of Spain, Trinidad and Tobago on 23-24 August 2007, delegates agreed to the establishment of a working group to explore ways of improving the effectiveness, visibility and relevance of the CDCC. The need for the establishment of the working group arose out of the recognition that the CDCC has been handicapped by the following: (a) a loss of its original vision and mission as a result of its changing operational context; (b) institutional overload in the regional institutional architecture as a result of the deepening of CARICOM and the creation of the ACS; (c) difficulties in securing high-level representation at meetings; and (d) continuing concerns by the English- and Dutch-speaking Caribbean about their lack of representation/inclusion in the work of the wider ECLAC system.