Health literacy [Document électronique] : an economic perspective and data for Switzerland. Part 2, A review of health literacy measures and a cost assessment of limited health literacy

Summary : 1. Measuring health literacy in Switzerland: a review of six surveys: 1.1 Comparison of questionnaires - 1.2 Measures of health literacy in Switzerland - 1.3 Discussion of Swiss data on HL - 1.4 Description of the six surveys: 1.4.1 Current health trends and health literacy in the Swiss population (gfs-UNIVOX), 1.4.2 Nutrition, physical exercise and body weight : opinions and perceptions of the Swiss population (USI), 1.4.3 Health Literacy in Switzerland (ISPMZ), 1.4.4 Swiss Health Survey (SHS), 1.4.5 Survey of Health, Ageing and Retirement in Europe (SHARE), 1.4.6 Adult literacy and life skills survey (ALL). - 2 . Economic costs of low health literacy in Switzerland: a rough calculation. Appendix: Screenshots cost model

Treatment intensification and risk factor control: toward more clinically relevant quality measures.

BACKGROUND: Intensification of pharmacotherapy in persons with poorly controlled chronic conditions has been proposed as a clinically meaningful process measure of quality. OBJECTIVE: To validate measures of treatment intensification by evaluating their associations with subsequent control in hypertension, hyperlipidemia, and diabetes mellitus across 35 medical facility populations in Kaiser Permanente, Northern California. DESIGN: Hierarchical analyses of associations of improvements in facility-level treatment intensification rates from 2001 to 2003 with patient-level risk factor levels at the end of 2003. PATIENTS: Members (515,072 and 626,130; age >20 years) with hypertension, hyperlipidemia, and/or diabetes mellitus in 2001 and 2003, respectively. MEASUREMENTS: Treatment intensification for each risk factor defined as an increase in number of drug classes prescribed, of dosage for at least 1 drug, or switching to a drug from another class within 3 months of observed poor risk factor control. RESULTS: Facility-level improvements in treatment intensification rates between 2001 and 2003 were strongly associated with greater likelihood of being in control at the end of 2003 (P < or = 0.05 for each risk factor) after adjustment for patient- and facility-level covariates. Compared with facility rankings based solely on control, addition of percentages of poorly controlled patients who received treatment intensification changed 2003 rankings substantially: 14%, 51%, and 29% of the facilities changed ranks by 5 or more positions for hypertension, hyperlipidemia, and diabetes, respectively. CONCLUSIONS: Treatment intensification is tightly linked to improved control. Thus, it deserves consideration as a process measure for motivating quality improvement and possibly for measuring clinical performance.

Correcting Interdevice Bias of Horizontal White-to-White and Sulcus-to-Sulcus Measures Used for Implantable Collamer Lens Sizing.

PURPOSE: To assess the agreement and repeatability of horizontal white-to-white (WTW) and horizontal sulcus-to-sulcus (STS) diameter measurements and use these data in combination with available literature to correct for interdevice bias in preoperative implantable collamer lens (ICL) size selection. DESIGN: Interinstrument reliability and bias assessment study. METHODS: A total of 107 eyes from 56 patients assessed for ICL implantation at our institution were included in the study. This was a consecutive series of all patients with suitable available data. The agreement and bias between WTW (measured with the Pentacam and BioGraph devices) and STS (measured with the HiScan device) were estimated. RESULTS: The mean spherical equivalent was -8.93 ± 5.69 diopters. The BioGraph measures of WTW were wider than those taken with the Pentacam (bias = 0.26 mm, P < .01), and both horizontal WTW measures were wider than the horizontal STS measures (bias >0.91 mm, P < .01). The repeatability (Sr) of STS measured with the HiScan was 0.39 mm, which was significantly reduced (Sr = 0.15 mm) when the average of 2 measures was used. Agreement between the horizontal WTW measures and horizontal STS estimates when bias was accounted for was г = 0.54 with the Pentacam and г = 0.64 with the BioGraph. CONCLUSIONS: Large interdevice bias was observed for WTW and STS measures. STS measures demonstrated poor repeatability, but the average of repeated measures significantly improved repeatability. In order to conform to the US Food and Drug Administration's accepted guidelines for ICL sizing, clinicians should be aware of and account for the inconsistencies between devices.

Many valued algebraic structures as measures of comparison

This thesis studies the properties and usability of operators called t-norms, t-conorms, uninorms, as well as many valued implications and equivalences. Into these operators, weights and a generalized mean are embedded for aggregation, and they are used for comparison tasks and for this reason they are referred to as comparison measures. The thesis illustrates how these operators can be weighted with a differential evolution and aggregated with a generalized mean, and the kinds of measures of comparison that can be achieved from this procedure. New operators suitable for comparison measures are suggested. These operators are combination measures based on the use of t-norms and t-conorms, the generalized 3_-uninorm and pseudo equivalence measures based on S-type implications. The empirical part of this thesis demonstrates how these new comparison measures work in the field of classification, for example, in the classification of medical data. The second application area is from the field of sports medicine and it represents an expert system for defining an athlete's aerobic and anaerobic thresholds. The core of this thesis offers definitions for comparison measures and illustrates that there is no actual difference in the results achieved in comparison tasks, by the use of comparison measures based on distance, versus comparison measures based on many valued logical structures. The approach has been highly practical in this thesis and all usage of the measures has been validated mainly by practical testing. In general, many different types of operators suitable for comparison tasks have been presented in fuzzy logic literature and there has been little or no experimental work with these operators.

"Attitude is a little thing that makes a big difference" : further exploration of attitude alignment in the context of close relationship dyads /

One hundred and five primarily Caucasian undergraduate couples were tested to study the phenomenon of attitude alignment, or the way in which individuals change their opinions to achieve greater attitudinal congruence with their romantic partners, and the hypotheses that relationship closeness, affect, attachment, social desirability, and centrality are each related to attitude alignment for individuals in close couples. The couples filled out an attitude questionnaire consisting of 50 issues in which they were asked to give their attitude on a scale from 1 to 9 as well as to rate the centrality, or importance, of that issue on a scale from 1 to 9. Before discussing four of these issues with each other - 2 were more central to the man and less central, or peripheral, to the woman, whereas the other 2 were central to the woman and peripheral to the man - the individuals completed established measures of relationship closeness, affect, attachment, and social desirability. The couples then filled out the identical attitudes questionnaire again, and their answers on the four discussion issues were compared to their prediscussion answers to determine whether attitude alignment had occurred. There were two experimental groups: a social desirability group, where the couples were told it was natural and normal to disagree with their partners, and a control group. Results indicated that attitude alignment did significantly occur across all couples, but most other variables - including centrality, relationship closeness, and affect - did not predict attitude alignment behaviour. As well, the social desirability experimental groups did not significantly differ on attitude alignment behaviours, but higher scores on the social desirability scale, specifically self-deception, significantly predicted higher attitude alignment scores across all couples. Large differences between individuals' frequency.

Assessing evaluative measures for Internet-based courseware

Although there is a consensus in th~ literature on the many uses of the Internet in education, as well as the unique features of the Internet for presenting facts and information, there is no consensus on a standardized method for evaluating Internetbased courseware. Educators rarely have the opportunity to participate in the development of Internet-based courseware, yet they are encouraged to use the technology in their learning environments. This creates a need for summative evaluation methods for Internet-based health courseware. The purpose ofthis study was to assess evaluative measures for Internet-based courseware. Specifically, two entities were evaluated within the study: a) the outcome of the Internet-based courseware, and b) the Internet-based courseware itself. To this end, the Web site www.bodymatters.com was evaluated using two different approaches by two different cohorts. The first approach was a performance appraisal by a group of endusers. A positive, statistically significant change in the students performance was observed due to the intervention ofthe Web site. The second approach was a productoriented evaluation ofthe Web site with the use of a criterion-based checklist and an open-ended comments section. The findings indicate that a summative, criterion-based evaluation is best completed by a multidisciplinary team. The findi~gs also indicated that the two different cohorts reported different product-oriented appraisals of the Web site. The current research confirmed previous research that found that experts returning a poor evaluation of a Web site did not have a relationship to whether or not the end-users performance improved due to the intervention of the Web site.

Comparison of two measures of PSI electron transport in winter rye

The number of P700 (the reaction centre of Photosystem I) converted to P700+, in winter rye, was determined by measuring the absorbance change at 820nm . It was found, with a single turnover flash, that thylakoids isolated from cold grown plants have a 50% greater number of P700 oxidized than thylakoids isolated from warm grown plants. Incubation of thylakoids in the dark at 35 C did not change the number of P700 oxidized. The conversion of P700 to P700+ with a single flash can be compared to a steady state rate of electron transport using a Clark electrode. The results for P700 oxidation using the absorbance change at 820 nm measure effects within the PSI complex whereas the results obtained from a Clark electrode measures steady state electron transport between the cytochrome blf complex and the PSI complex. In contrast to the results for P700 oxidation it was shown, using a Clark electrode, that both thylakoids from cold grown plants and thylakoids incubated at in the dark 35 C exhibited 50% higher rates of electron transport than thylakoids from warm grown plants. The correlation between the higher rate of steady state PSI electron transport observed in thylakoids isolated from cold grown winter rye and number of active PSI reaction centres localizes the site of the increase to the PSI reaction centre. In contrast the lack of correlation after incubation at 35 C indicates the increase in the rate of light saturated electron transport in thylakoids isolated from cold grown plants and thylakoids incubated in the dark at 35 C occur by different mechanisms.

The condition of Niagara Falls, and the measures needed to preserve them : eight letters published in the New York Evening post, the New York tribune, and the Boston daily advertiser, during the summer of 1882 /

Appendix: Extracts from Harper's weekly, New York herald, New York tribune and the Nation.

Role of family eating practices on daily nutrient intakes, dietary patterns and measures of body composition in peri-adolescents

Although family eating practices (FEPs) playa role in the formation of eating practices in children, there is a lack of evidence regarding the role of FEPs on obesity (DB) risk. The purpose of this thesis was to assess the role of child, mother 'and father eating practices (CEPs; MEPS; FaEPs) on nutrient intakes, dietary patterns and body composition. Data were collected on approximately 2,400 peri-adolescents (s250 with complete covariate data). Dietary patterns were assessed using scores that reflected how closely participants followed DASH and Health Canada (HC) recommendations. In girls, poor CEPs, MEPs and FaEPs were associated with increased BMI and risk of overweight and poor dietary patterns according to DASH, and DASH and HC, respectively. In boys, poor CEPs and FaEPs were associated with increased monounsaturated and trans fat, and Vitamin C intakes, respectively. These findings suggest FEPs are associated with DB risk, particularly in girls.

Autonomy and Relatedness in Mainland Chinese Adolescents: Social or Personal? Accommodation or Distinctiveness?

Three studies comprised the current research program, in which the major goals were to propose and validate empirically the proposed two-level (universal and culture-specific) model of both autonomy and relatedness, as well as to develop reliable and valid measures for these two constructs. In Study 1, 143 mainland Chinese adolescents were asked open-ended questions about their understanding of autonomy and relatedness in three social contexts (peer, family, school). Chinese youth’s responses captured universal and culturally distinctive forms of autonomy (personal vs. social) and relatedness (accommodation vs. distinctiveness), according to a priori criteria based on the theoretical frameworks. Also, scenarios designed to reflect culture-specific forms of autonomy and relatedness suggested their relevance to Chinese adolescents. With a second sample of 201 mainland Chinese youth, in Study 2, the obtained autonomy and relatedness descriptors were formulated into scale items. Those items were subject to refinement analyses to examine their psychometric properties and centrality to Chinese youth. The findings of Study 1 scenarios were replicated in Study 2. The primary goal of Study 3 was to test empirically the proposed two-level (universal and culture-specific) models of both autonomy and relatedness, using the measures derived from Studies 1 and 2. A third sample of 465 mainland Chinese youth completed a questionnaire booklet consisting of autonomy and relatedness scales and scenarios and achievement motivation orientations measures. A series of confirmatory factor analysis (CFA) autonomy and relatedness measurement models (first-order and second-order), as well as structural models linking culture-specific forms of autonomy and relatedness and achievement motivation orientations, were conducted. The first-order measurement models based on scale and scenario scores consistently confirmed the distinction between personal autonomy and social autonomy, and that of accommodation and distinctiveness. Although the construct validity of the two culture-specific forms of autonomy gained additional support from the structural models, the associations between the two culture-specific forms of relatedness and achievement motivation orientations were relatively weak. In general, the two-level models of autonomy and relatedness were supported in two ways: conceptual analysis of scale items and second-order measurement models. In addition, across the three studies, I explored potential contextual and sex differences in Chinese youth’s endorsement of the diverse forms of autonomy and relatedness. Overall, no substantial contextual variability or sex differences were found. The current research makes an important theoretical contribution to the field of developmental psychology in general, and autonomy and relatedness in particular, by proposing and testing empirically both universal and culture-specific parts of autonomy and relatedness. The current findings have implications for the measurement of autonomy and relatedness across social contexts, as well as for socialization and education practice.

Relationship between Surface and Indwelling EMG Spike Shape Measures

Indwelling electromyography (EMG) has great diagnostic value but its invasive and often painful characteristics make it inappropriate for monitoring human movement. Spike shape analysis of the surface electromyographic signal responds to the call for non-invasive EMG measures for monitoring human movement and detecting neuromuscular disorders. The present study analyzed the relationship between surface and indwelling EMG interference patterns. Twenty four males and twenty four females performed three isometric dorsiflexion contractions at five force levels from 20% to maximal force. The amplitude measures increased differently between electrode types, attributed to the electrode sensitivity. The frequency measures were different between traditional and spike shape measures due to different noise rejection criteria. These measures were also different between surface and indwelling EMG due to the low-pass tissue filtering effect. The spike shape measures, thought to collectively function as a means to differentiate between motor unit characteristics, changed independent of one another.

Network Similarity Measures and Automatic Construction of Graph Models using Genetic Programming

A complex network is an abstract representation of an intricate system of interrelated elements where the patterns of connection hold significant meaning. One particular complex network is a social network whereby the vertices represent people and edges denote their daily interactions. Understanding social network dynamics can be vital to the mitigation of disease spread as these networks model the interactions, and thus avenues of spread, between individuals. To better understand complex networks, algorithms which generate graphs exhibiting observed properties of real-world networks, known as graph models, are often constructed. While various efforts to aid with the construction of graph models have been proposed using statistical and probabilistic methods, genetic programming (GP) has only recently been considered. However, determining that a graph model of a complex network accurately describes the target network(s) is not a trivial task as the graph models are often stochastic in nature and the notion of similarity is dependent upon the expected behavior of the network. This thesis examines a number of well-known network properties to determine which measures best allowed networks generated by different graph models, and thus the models themselves, to be distinguished. A proposed meta-analysis procedure was used to demonstrate how these network measures interact when used together as classifiers to determine network, and thus model, (dis)similarity. The analytical results form the basis of the fitness evaluation for a GP system used to automatically construct graph models for complex networks. The GP-based automatic inference system was used to reproduce existing, well-known graph models as well as a real-world network. Results indicated that the automatically inferred models exemplified functional similarity when compared to their respective target networks. This approach also showed promise when used to infer a model for a mammalian brain network.

Psychocentricity and participant profiles: implications for lexical processing among multilinguals

Lexical processing among bilinguals is often affected by complex patterns of individual experience. In this paper we discuss the psychocentric perspective on language representation and processing, which highlights the centrality of individual experience in psycholinguistic experimentation. We discuss applications to the investigation of lexical processing among multilinguals and explore the advantages of using high-density experiments with multilinguals. High density experiments are designed to co-index measures of lexical perception and production, as well as participant profiles. We discuss the challenges associated with the characterization of participant profiles and present a new data visualization technique, that we term Facial Profiles. This technique is based on Chernoff faces developed over 40 years ago. The Facial Profile technique seeks to overcome some of the challenges associated with the use of Chernoff faces, while maintaining the core insight that recoding multivariate data as facial features can engage the human face recognition system and thus enhance our ability to detect and interpret patterns within multivariate datasets. We demonstrate that Facial Profiles can code participant characteristics in lexical processing studies by recoding variables such as reading ability, speaking ability, and listening ability into iconically-related relative sizes of eye, mouth, and ear, respectively. The balance of ability in bilinguals can be captured by creating composite facial profiles or Janus Facial Profiles. We demonstrate the use of Facial Profiles and Janus Facial Profiles in the characterization of participant effects in the study of lexical perception and production.

Dynamic Measures of Individual Deprivation

We introduce and axiomatize a one-parameter class of individual deprivation measures. Motivated by a suggestion of Runciman, we modify Yitzhaki’s index by multiplying it by a function that is interpreted as measuring the part of deprivation generated by an agent’s observation that others in its reference group move on to a higher level of income than itself. The parameter reflects the relative weight given to these dynamic considerations, and the standard Yitzhaki index is obtained as a special case. In addition, we characterize more general classes of measures that pay attention to this important dynamic aspect of deprivation.