Profile Effects in Early Bilingual Language and Literacy

Bilingual children's language and literacy is stronger in some domains than others. Reanalysis of data from a broad-scale study of monolingual English and bilingual Spanish-English learners in Miami provided a clear demonstration of "profile effects," where bilingual children perform at varying levels compared to monolinguals across different test types. The profile effects were strong and consistent across conditions of socioeconomic status, language in the home, and school setting (two way or English immersion). The profile effects indicated comparable performance of bilingual and monolingual children in basic reading tasks, but lower vocabulary scores for the bilinguals in both languages. Other test types showed intermediate scores in bilinguals, again with substantial consistency across groups. These profiles are interpreted as primarily due to the "distributed characteristic" of bilingual lexical knowledge, the tendency for bilingual individuals to know some words in one language but not the other and vice versa.

Improving Health Literacy in Connecticut: A Prescription for Healthy Lives and Communities

The Practicum Project is a supervised service-learning experience that integrates curriculum with hands-on experience in a public health setting. All 2nd year students are expected to work collaboratively in assessing the extent, causes and public health responses to a selected public health problem confronting citizens of Connecticut. The focal topic for the 2006 Project was Health Literacy in Connecticut. During this past spring, 17 students of our program, working alongside and in partnership with more than 75 community-based stakeholders across Connecticut, completed over 1800 hours of service-learning in pursuit of answers to 3 questions: Can the present and future burden of health literacy be estimated for Connecticut? What is the current capacity of Connecticut’s health and social service system to halt the crisis we confront today? Can new policy and regulatory strategies be put forth to reduce the severity and scope of the problem? This occasion and the accompanying report mark the completion of their project and acknowledge the considerable contributions that many have made to the success of this educational experience. Through those combined efforts, students gained experience and skill addressing one of the most significant public health issues of our time; also, they gained insight into the breadth and capacity of our public health system and established invaluable relationships with public health practitioners, agencies and institutions around the state. Their report documents a rich campus-community partnership to advance public health goals.

An International Professional Development Collaboration in Literacy Education

An International Professional Development Collaboration in Literacy Education is a report of an international professional development project in Guatemala designed to improve literacy instructional practices and thereby raise student achievement in reading and writing. The opportunity for coaching Guatemalan teachers in teaching literacy strategies and skills provides data for this participatory action research study. This research is intended to contribute to cross-cultural understanding by graduate and undergraduate students in literacy, improved pedagogical techniques, international outreach in developing countries, and student academic success worldwide.

The status of the Jews in Egypt

by W.M. Flinders Petrie

New Judea : Jewish life in modern Palestine and Egypt

by Benjamin L. Gordon

A process evaluation of a health literacy intervention targeting pediatric providers' communication skills at the Texas Children's Health Plan

Background. Health literacy is an important determinant for quality health care, and affects communication between patients and physicians. Poor communication may result in negative effects in health. Improved communication between patients and physicians could positively affect health outcomes. Communication skills are teachable.^ Objectives. (1) to evaluate the process involved in the design and implementation of a health literacy intervention targeting pediatric providers’ communication skills at the Texas Children’s Health Plan in Houston, Texas; and (2) to describe lessons learned from this process that may be used in future attempts to address the issue of health literacy and health communication. ^ Design/methods. The process evaluation of the implementation of a health literacy strategy at the Texas Children’s Health Plan (TCHP) consisted of a critical analysis of all documents and minutes from meetings of the team of investigators. It also involved a secondary analysis of data collected between December 2006 and June 2007. Descriptive statistics, paired t-test and Wilcoxon-signed-rank test were employed in analyzing the data. This information was complemented with a limited review of existing literature on communication skills training programs. ^ Results. The design of the educational intervention followed recommendations from experts in the field of health literacy. The delivery of the intervention was possible and benefited from existing resources and logistics within the TCHP. Very few targeted providers participated in two offerings of the workshop (6.6% and 1.7% respectively). After the educational intervention, providers showed increased knowledge of health literacy facts and its effects in health (p=0.001); increased awareness of the low health literacy problem (p=0.003); increased expectations for change in practice (p=0.002), and intent to use health literacy strategies for communication immediately following the intervention (p=0.001). Low participation indicated the need for further investigation of barriers to, and means for successful implementation of programs aimed to improving health communication. ^ Conclusions. A short, focused intervention utilizing health literacy strategies for communication appeared effective in increasing knowledge and intentions for change in a small group of pediatric providers. ^

Assessment of markers of medication literacy in a US-Mexico border community

Each year an estimated 180,000 people in the United States (U.S.) die as a result of medication errors, now considered a major public health problem. If a patient cannot correctly act on information related to medication use or "Medication Literacy" there is an increased potential for error. Medication use issues are unique on the US-Mexico border because they include high rates of herbal products and medication products from Mexico as well as issues related to the preferred language (English or Spanish) of the patient. To evaluate the medication literacy in a US-Mexico border community, this retrospective study evaluates 180 subjects representing four diverse economic segments of a metropolitan US-Mexico Border community who have taken a Medication Literacy Assessment. The assessment tool has been created to understand how patients interpret medication information for prescription, over-the-counter, herbal, and Mexican medication product use, and how they problem-solve medication questions. The Medication Literacy Assessment tool specifically assesses document literacy (e.g., prescription labels), prose literacy (e.g., patient leaflets), numeracy (e.g., calculations and measurements) as well as qualitative data related to medication use practices. The main hypothesis of this study is that the ability to interpret and use medications will vary based on education, language (Spanish or English), and recruitment sites (economically diverse communities). The results will provide information to better characterize medication use in a primarily Hispanic population on the US-Mexico border and may be used to influence policy decisions regarding prescription and over-the-counter product information.^

Revisiting health literacy and its impact on patient-physician communication

Objective. To review professional literature on health literacy and its impact on patient-physician communication, to describe significant literature on this issue, and to summarize implications of the findings from this literature. Design. Update of a review of literature. Data sources: MEDLINE. Review Methods. Articles dealing with the impact of health literacy on patient-physician communication were selected. The articles addressed at least one of four criteria on the subject: prevalence of the problem; effect of health literacy on patient-physician communication; association of health literacy to health outcomes; and interventions to enhance communication with patients exhibiting limited health literacy. Results. Approximately 623 articles were selected for review; 87 were fully reviewed and found to be relevant to the issue; and 25 articles were cited. Conclusion. Limited health literacy is extremely widespread throughout the U.S., particularly among specific populations. Providers must be aware that patients often process health care decision making differently from their own familiar procedures and that by taking the steps to make medical language and health information simpler and the time to confirm patient understanding, health outcomes of limited health literacy populations will improve. ^

The relationship between enterotoxigenic {\it Escherichia coli\/} infection and environmental risk factors in Bilbeis, Egypt, 1981--1983

Diarrheal disease associated with enterotoxigenic Escherichia coli (ETEC) infection is one of the major public health problems in many developing countries, especially in infants and young children. Because tests suitable for field laboratories have been developed only relatively recently, the literature on the environmental risk factors associated with ETEC is not as complete as for many other pathogens or for diarrhea of unspecified etiology.^ Data from a diarrheal disease surveillance project in rural Egypt in which stool samples were tested for a variety of pathogens, and in which an environmental questionnaire was completed for the same study households, provided an opportunity to test for an association between ETEC and various risk factors present in those households. ETEC laboratory-positive specimens were compared with ETEC laboratory-negative specimens for both symptomatic and asymptomatic children less than three years of age at the individual and household level using a case-comparison design.^ Individual children more likely to have LT infection were those who lived in HHs that had cooked food stored for subsequent consumption at the time of the visit, where caretakers used water but not soap to clean an infant after a diarrheal stool, and that had an indoor, private water source. LT was more common in HHs where the caretaker did not clean an infant with soap after a diarrheal stool, and where a sleeping infant was not covered with a net. At both the individual and HH level, LT was significantly associated with good water supply in terms of quantity and storage.^ ST was isolated more frequently at the individual level where a sleeping infant was covered with a net, where large animals were kept in or around the house, where water was always available and was not potable, and where the water container was not covered. At the HH level, the absence of a toilet or latrine and the indiscriminate disposal of animal waste decreased risk. Using animal feces for fertilizer, the presence of large animals, and poor water quality were associated with ST at both the individual and HH level.^ These findings are mostly consistent with those of other studies, and/or are biologically plausible, with the obvious exception of those from this study where poorer water supplies are associated with less infection, at least in the case of LT. More direct observation of how animal ownership and feces disposal relates to different types of water supply and usage might clarify mechanisms through which some ETEC infection could be prevented in similar settings. ^

Epidemiology of allergic gastroenteritis in socio-culture perspective of rural Egypt

Diarrhea is a major public health problem in developing countries among infants and young children. Not all episodes of diarrhea are confirmed as infectious, suggesting alternate mechanisms. One such is immunoglobulin E (IgE) mediated or allergic diarrhea that can be seen in food allergy. In order to determine the relation between allergic gastroenteritis and feeding practice, a cohort of 152 infants were followed from birth to one year age in a rural community of Egypt between October, 1987 to April, 1988 were analyzed. In multivariate analysis of the data, statistically conclusive higher risk had been observed with presence of factors, like consumption of milk pudding (RR = 7.4, CI = 1.5-36.2 and p = 0.01), infant's age 3-6 months (RR = 7.7, CI = 1.3-45.9 and p = 0.02), infants whose mothers were vaccinated antenatally (RR = 3.1, CI = 1.3-7.0 and p = 1.3-7.0, p = 0.0) and wet-nursed infants (RR = 2.7, CI = 1.1-6.5 and p = 0.02). In contrast, infants who were completely breast-fed (RR = 0.13, CI = 0.02-0.6 and p = 0.01), and infants family owning a television set (RR = 0.29, CI = 0.1-0.6 and p = 0.0) were less likely to develop allergic gastroenteritis. The role of IgE on development of persistent diarrhea was also examined in a nested case-control design. Multivariate analysis revealed a significant association between detection of fecal IgE and development of persistent diarrhea compared to acute diarrhea (OR = 3.32, CI = 1.0-10.9 and p = 0.04) and health or non diarrhea (OR = 4.8, CI = 1.07-21.7 and p = 0.03) controls. ^

A STUDY OF ILLNESS AND RESERVOIRS ASSOCIATED WITH GIARDIA LAMBLIA IN RURAL EGYPT

A longitudinal investigation of the health effects and reservoirs of Giardia lamblia was undertaken in forty households located in a rural Nile Delta region of Egypt. Stool specimens obtained once weekly for six months from two to four year old children were cyst or trophozoite-positive in 42 percent of the 724 examined. The mean duration of excretion in all but one Giardia-negative child was seven and one-half weeks with a range of one to 17 weeks. Clinical symptoms of illness were frequently observed within a month before or after Giardia excretion in stool of children, but a statistical inference of association was not demonstrated.^ Seventeen percent of 697 specimens obtained from their mothers was Giardia-positive for a mean duration of four weeks and a range of one to 18 weeks. Mothers were observed to excrete Giardia in stool less frequently during pregnancy than during lactation.^ Nine hundred sixty-two specimens were collected from 13 species of household livestock. Giardia was detected in a total of 22 specimens from cows, goats, sheep and one duck. Giardia cysts were detected in three of 899 samples of household drinking water.^ An ELISA technique of Giardia detection in human and animal stool was field tested under variable environmental conditions. The overall sensitivity of the assay of human specimens was 74 percent and specificity was 97 percent. These values for assay of animal specimens were 82 percent and 98 percent, respectively.^ Surface antigen studies reported from the NIH Laboratory of Parasitic Diseases show that antigens of three Egyptian human isolates are different from each other and from most other isolates against which they were tested.^ The ubiquity of human and animal fecal contamination combined with estimates of ill days per child per year in this setting are substantial arguments for the introduction of a suggested mass parasite control program to intervene in the cyclical transmission of agents of enteric disease. ^

Adherence to HIV /AIDS therapies among low -literacy populations: The ALP project

Adherence to HIV/AIDS therapies has been an important health problem since the early 1980s when AZT was first prescribed as a therapy for HIV/AIDS. It became particularly important between 1995 and 1997 with the advent of protease inhibitors (Chesney, Ickovics, Hecht, Sikipa, & Rabkin J., 1999) and became even more significant as persons with HIV/AIDS began to develop resistance to medications. Low-literacy populations have poorer health (Brez & Taylor, 1997) and higher AIDS rates (Simon, Hu, Diaz, & Kerndt, 1995), than their higher literacy counterparts due to delayed treatment (Baker, Parker, Williams, Clark, & Nurss, 1997), shame of literacy skills (Parikh, 1996), and poor access to care (Williams, et al., 1995). Poorer health and higher AIDS rates can also be attributed to poor patient-provider relationships (Crespo-Fierro, 1997; Eldred, Wu, Chaisson, & Moore, 1998) to a poorer understanding of medical protocols (Murphy, 1997), and inadequate patient education (Ungvarski, 1997; Davis, Michielutte, Askov, Williams, & Weiss, 1998, Doak, Doak, & Root, 1996). ^ The ALP intervention was developed for HIV positive low-literacy populations of African American women in Houston, Texas. The intervention was based on a needs assessment, using the PRECEDE model, an innovative process referred to as Intervention Mapping, and validated using formative evaluation methods with 54 individuals. The needs assessment resulted in a list of behavioral, environmental, predisposing, enabling, and reinforcing determinants of adherence. The Intervention Mapping framework was used to refine these determinants and develop a list of objectives describing what must be learned or changed to for the target population to adhere to HIV/AIDS therapies. Methods and strategies, were developed using theoretical constructs from the Health Belief Model (Rosenstock, 1974) and Social Cognitive Theory (Bandura, 1986). These theories, empirical evidence, and information from the target population indicated that perceived susceptibility, perceived severity, outcome expectations, and self-efficacy were important and changeable determinants of adherence to HIV/AIDS therapies for this population. ^ These components were brought together in the form of a theory-based color cartoon book and 10-minute cassette tape. The book was developed for people with 2.9 years of U.S. education as measured with the Flesch-Kincaid Grade Level method and the script was recorded onto a cassette tape to make it suitable for populations with even lower-literacy skills. A formative evaluation was conducted to ensure that the content and structure were accurate, clear, realistic, readable, appropriate, and likely to be used as intended. ^