Note-taking by nursing students: the case for implementing writing strategies to encourage best practice

BACKGROUND

Note-taking is an integral component of professional nursing practice. If students are to complete this effectively, a range of teaching, learning and assessment strategies are required to support their development of this skill.

OBJECTIVES

This study aimed to identify lecturers' perspectives of students' note-taking on placement to identify factors that limit the development of this skill; these perspectives could be used to explore strategies to support students to develop this skill while at university.

DESIGN

A qualitative study taking a phenomenological approach was carried out.

PARTICIPANTS

Three senior nursing practice visitors agreed to be interviewed.

METHODS

Semistructured interviews were carried out and thematic analysis carried out to explore lecturers' perspectives of students' experiences of note-taking while on placement. These interviews were intended to obtain detailed accounts of note-taking and allow challenges to be explored.

RESULTS

Each participant observed and supported students' note-taking within practice placement settings. Three main themes emerged from the data: limitations to students' vocabulary and literacy; inconsistency between trusts resulting in an inability to articulate experience; and note-taking clarity and accuracy.

CONCLUSION

Note-taking is central to nurses' education and professional documentation to support best practice and high-quality patient care. Variations in processes between trusts, stringency of standards required by the trusts where students attend placements, and students' writing abilities differ widely, which directly affect the consistency and accuracy of written notes.

Help-seeking attitudes and intentions for generalised anxiety disorder in adolescents: the role of anxiety literacy and stigma

Help seeking for anxiety tends to be low in adolescents. Identifying modifiable factors that may facilitate help seeking is important. The aim of the current study is to test the effects of generalized anxiety disorder (GAD) literacy and stigma (personal and perceived) on attitudes and intentions toward seeking help from professionals and key adult sources. 1767 adolescents aged 12-18 years participated in the current study and completed measures of GAD literacy, GAD stigma, professional help-seeking attitudes, and intentions to seek help from a range of sources. The results of the study found that participants had limited GAD literacy and up to 20% personally agreed with stigmatising statements about GAD. Participants reported greater intentions to seek help from parents than from formal sources. More positive attitudes toward seeking help were associated with higher levels of GAD literacy (p < 0.001) and lower personal GAD stigma (p < 0.001). Lower perceived GAD stigma was associated with increased intentions to seek help from their mothers (p < 0.05) or fathers (p < 0.01), while lower personal GAD stigma was also associated with help-seeking intentions from their mothers (p < 0.05). Higher perceived GAD stigma was associated with intentions to seek help from nobody (p < 0.001). Overall, the current study highlights the important role that parents can play in the help-seeking process for adolescents, with parents often the most accessible source of help. Improving parent and adolescent knowledge and attitudes towards GAD may help to improve early help seeking in young people.

Emergent academic skills growth in New Zealand pre-school children undergoing treatment for sleep disordered breathing: a case-control pilot study

OBJECTIVES

The main objective of this study was to explore the feasibility and treatment sensitivity of measures of preschool oral language and emergent literacy and numeracy for assessing developing skills of preschool children with sleep disordered breathing (SDB) in New Zealand following adenotonsillectomy.

METHODS

Eight preschool children aged 3 years 1 month-4 years 5 months were recruited from a surgical waiting list and matched to controls for age (±3 months) and sex. Tasks designed to be sensitive to growth in oral language and emergent literacy and numeracy were reviewed for contextual fit, adapted as necessary for the New Zealand context, and administered before surgery (baseline), three months post-surgery, and at a seven-month follow-up alongside other measures.

RESULTS

Growth in oral language and emergent literacy was greater for case children than matched controls, suggesting that the tasks were sensitive to treatment effects. No such effect was observed for early numeracy tasks. Case children had more symptoms of SDB and behavioral and emotional difficulties than matched controls prior to surgery, and improvements were reported in these domains following surgery.

CONCLUSIONS

Oral language and emergent literacy measures trialled in the present research showed potential for evaluating treatment outcomes in pre-schoolers with SDB, and provided preliminary evidence that early treatment of SDB could have positive effects on learning in these domains.

The Structure of Processing Speed in Children and its Impact on Reading

The present study had two aims. First, we set out to evaluate the structure of processing speed in children by comparing five alternative models: two conceptual models (a unitary model, a complexity model) and three methodological models (a stimulus material model, an output response model, and a timing modality model). Second, we then used the resulting models to predict multiple types of reading, a highly important developmental outcome, using other well-known predictors as covariates. Participants were 844 children enrolled in third through fifth grade in urban public elementary schools who received 16 measures of processing speed that varied in the above dimensions. A two-factor complexity model that differentiated between simple and complex processing speed was the preferred model and fit the data well. Both types of PS predicted reading fluency, and complex (but not simple) PS predicted single word reading and comprehension. Results offer insight to the structure of processing speed, its relation to closely related concepts (such as executive function), and provide nuance to the understanding of the way processing speed influences reading.

A Multifactorial Interpretation of a Teenager's Suicide: Based on Krystal's Death in Casual Vacancy

Objectives

It is hard to accumulate research data on adolescents’ suicide, because friends and family of the suicide completers might be reluctant to share the experience. To overcome the lack of information on adolescent suicide victims, the authors examined the risk and protective factors for adolescents’ suicide from a character in a novel.

Methods

Krystal, an adolescent female in the novel The Casual Vacancy by Joanne Rowling, failed to overcome her unfortunate cir-cumstances and committed suicide. The authors analysed Krystal’s case based on the guideline for patients with suicidal behaviours to address the complicated situation of her death.

Results

Krystal grew up in a poor and dangerous environment. Despite the environmental hardships, she developed ego maturation with affectionate help from Mr Fairbrother, an assistant coach of the Girls’ Rowing Team and a parish councillor. The sudden passing away of Mr Fairbrother brought on a crisis of identity for Krystal. In addition, a villainous character raped her and her brother drowned to death, which brought her great sorrow. She felt helpless and committed suicide.

Conclusion

In spite of many risk factors for suicide, Krystal was able to keep her life with a few protective factors, a younger brother in the home, and a sense of responsibility for the family. After the loss of her brother, however, she collapsed in a moment. Krystal’s suicide might not only be a personal choice but a breakdown of the social protection system for the youth.

Adherence to medication, physical activity and diet among older people living with diabetes mellitus: Correlation between cognitive function and health literacy

Background

Diabetes mellitus (DM) is a public health problem, which requires enhanced self-care in order to avoid complications. However, cognitive impairment can reduce these abilities and may affect health literacy (HL) of patients in terms to understand and apply information. Therefore, this study evaluated the correlation between cognitive condition and HL related to medication adherence, physical activity and nutritional status among people living with DM.

Methods

A cross-sectional study was carried out among elderly people (≥ 60 years old) with DM. The cognitive condition was evaluated using the Mini-Mental State Examination (MMSE) and the HL using the following questionnaires: Literacy Assessment for Diabetes (LAD-60), Nutritional Literacy among People with Diabetes (NLD), Health Literacy on the Practice of Physical Activities among Diabetics (HLPPA - D), and Health Literacy regarding Drug Adherence among Diabetics (HLDA-D). Sociodemographic and biochemical profile was also evaluated. Spearman correlation was used (p < 0.05).

Results

187 individuals with DM were included. Regarding laboratory analyses, insulin dosage had a mean value of 12.3 microUI/mL (SD: ±15.7), mean blood glucose was 148.1 mg/dl (SD: ±59.7) and mean HbA1c was 7.54 % (SD: ±1.8). In the correlation analysis, higher age and lower income were weakly correlated with lower cognitive level. No correlation was identified for biochemical variables and cognitive condition. A positive and weak correlation between cognition and HL was observed in the studied population.

Conclusions

In older people living with DM the cognitive condition is correlated to specific topics of HL (nutritional status, physical activity and medication adherence).

What information do patients want about their medicines? An exploration of the perspectives of general medicine inpatients

BACKGROUND

Medicines are one of the most common healthcare interventions, yet evidence shows patients often do not receive the information they want about their medicines. This affects their adherence and healthcare engagement. There is limited research exploring what information patients want about their medicines, from whom and in what format. The aim of this study was to determine the medicines information needs of patients admitted to the general medical service of a large New Zealand (NZ) hospital, and identify the barriers and enablers to meeting these needs.

METHODS

A descriptive exploratory approach using semi-structured interviews was used to understand the needs and preferences of patients for information about their regular medicines and the barriers and facilitators to obtaining this information. Patients admitted to a general medical ward at a large NZ hospital, aged 18 years and over, prescribed one or more regular medicines, and self-managing their own medicines prior to hospitalisation were included. Semi-structured interviews were conducted with each participant (n = 30) and transcribed, then analysed using a general inductive thematic analysis approach.

RESULTS

Five overarching themes captured the medicines information needs of patients: (1) autonomy; (2) fostering relationships; (3) access; (4) communication; and (5) minimal information needs. Patients desired information to facilitate their decision-making and self-management of their health. Support people, written information, and having good relationships with health providers enabled this. Having access to information at the right time, communicated in a clear and consistent way with opportunities for follow-up, was important. A significant portion of participants were satisfied with receiving minimal information and had no expectations of needing more medicines information.

CONCLUSIONS

Although patients' medicines information needs varied between individuals, the importance of receiving information in an accessible, timely manner, and having good relationships with health providers, were common to most. Considering these needs is important to optimise information delivery in general medical patients.

More than individual factors; is there any contextual effect of unemployment, poverty and literacy on the domestic spousal violence against women? A multilevel analysis on Indian context

PURPOSE

Despite successful enactment of Domestic Violence act, 2005 in India to protect Indian women from any kind of domestic violation offence, the decline trend of prevalence of spousal violence against women still remains low. The study aims to explain the factors associated with spousal violence against women through a multilevel modeling framework.

METHOD

We used multilevel logistic regression model, basically here we carried out two-level random intercept model where the data base is used from National Family Health survey 2015-16 data for the fulfillment of our study objectives. A total 34,921 women, who were selected for 2015-16 domestic violence modules by NFHS, were included in this present study.

RESULTS

Result of multilevel logistic regression model showed that women who were belonged to poorest economic background, lived in rural areas, had low level of education or no education were at more risk in experiencing violence from their husband. Factors as large family size with more children in a household have a significant positive association with the prevalence of spousal violence against women. In case of higher level contextual variables unemployment, poverty has a crucial effect for upbringing spousal violence where higher literacy rate of a region has a strength that can reduce the probability of violence against women.

CONCLUSIONS

The Govt. promptness as a collective responsibility to enhance educational facilities for men and women, create employment opportunities and take policies for overall economic and societal development, these may change the individual perception of a person to cause the spousal violence against women.

Development and Validation of Food and Nutrition Literacy Assessment Tool for Iranian High-school Graduates and Youth

Background:

Food and nutrition literacy (FNL) is an emerging concept that emphasizes not only on personal knowledge, but food and nutrition skills about. This study aimed to develop and validate a food and nutrition literacy assessment tool (FNLAT) for youth and high-school graduates in Iran.

Methods:

The study protocol included the following steps: First, FNL components for Iranian high-school graduates and youth were identified through literature review and interviews with experts. Delphi method was used in order to achieve consensus about FNL components. Then, the questionnaire items were generated, and its content and face validity were assessed. Construct validity of the questionnaire was evaluated through applying principal component analysis (PCA) and confirmatory factor analyses (CFA) in the next step. Finally, reliability of the FNLAT was assessed by calculating Cronbach's Alpha and evaluating test-retest reliability.

Results:

A 104-item questionnaire was developed. S-CVI was ≥90 which confirmed content validity of the questionnaire. PCA suggested that it was constructed of 6 factors, one in knowledge domain (food and nutrition knowledge) and five in skill domain (functional skills, interactive skills, advocacy, critical analysis of information, and food label reading skills). On the basis of CFA, the fit indices of the model had acceptable fit and confirmed construct validity of the FNLAT (X²/df = 1.58, RMSEA = 0.041; P = 1.00, RMR = 0.034, GFI = 0.79). The values of Cronbach's Alpha and intraclass correlation coefficient (ICC) confirmed internal consistency and time stability of the FNLAT and its subscales.

Conclusions:

The developed FNLAT is a valid and reliable tool to assess FNL in Iranian late adolescents and youth.

Measuring consumer access, appraisal and application of services and information for dementia (CAAASI-Dem): a key component of dementia literacy

BACKGROUND

The ability to locate, navigate and use dementia services and information, either for oneself or in providing care for others, is an essential component of dementia literacy. Despite dementia literacy being understood to be inadequate in many settings, no validated instrument exists to measure these elements. Here we describe the development and preliminary validation of the Consumer Access, Appraisal and Application of Services and Information for Dementia (CAAASI-Dem) tool.

METHODS

Items were adapted from existing health literacy tools and guided by discussion posts in the Understanding Dementia Massive Open Online Course (UDMOOC). Following expert review and respondent debriefing, a modified CAAASI-Dem was administered to UDMOOC participants online. On the basis of descriptive statistics, inter-item and item total correlations and qualitative feedback, this was further refined and administered online to a second cohort of UDMOOC participants. Exploratory factor analysis identified underlying factor structure. Items were retained if they had significant factor loadings on one factor only. Each factor required at least three items with significant factor loadings. Internal consistency of factors in the final model was evaluated using Cronbach's alpha coefficients.

RESULTS

From a pool of 70 initial items with either a 5-point Likert scale (Not at all confident - Extremely confident; or Strongly agree - Strongly disagree) or a binary scale (Yes - No), 65 items were retained in CAAASI-Dem-V1. Statistical and qualitative analysis of 1412 responses led to a further 34 items being removed and 11 revised to improve clarity. The 31 item CAAASI-Dem-V2 tool was subsequently administered to 3146 participants, one item was removed due to redundancy and EFA resulted in the removal of an additional 4 items and determination of a five factor structure: Evaluation and engagement; Readiness; Social supports; Specific dementia services; and Practical aspects.

CONCLUSIONS

The five factors and 26 constituent items in CAAASI-Dem align with functional, critical, and communicative aspects of dementia health literacy from the perspective of the carer. As a screening tool for people living with dementia and their carers, CAAASI-Dem potentially provides a means to determine support needs and may be a key component of the dementia literacy assessment toolbox.

Developing an assessment scale for long-term care reablement literacy in home care workers in Taiwan using a modified Delphi method

Background

Reablement is a philosophy of change in long-term care (LTC). Assessing the knowledge and competence of LTC professionals who provide reablement services is vital in LTC research. This study aimed to develop a scale for the assessment of long-term care reablement literacy (LTCRL) and employ this scale to assess the performance of home care workers in Taiwan.

Methods

To develop this scale, we employed the modified Delphi technique based on the theoretical framework of health literacy and the content of service delivery in reablement. Home care workers from northern, central, and southern Taiwan were selected through purposive sampling (N = 119). Participants answered a self-administered questionnaire that included items related to basic demographic characteristics and questions to assess LTCRL.

Results

Based on the experts’ consensus on the procedure of the modified Delphi technique, the LTCRL assessment sale consists of 29 questions on four aspects of knowledge acquisition: the abilities to access/obtain, understand, process/appraise, and apply/use. The results revealed that higher education levels and better Chinese language proficiency are associated with higher LTCRL outcomes among home care workers.

Conclusions

The LTCRL assessment scale based on a modified Delphi technique is useful and feasible for evaluating LTCRL in home care workers who provide reablement services in Taiwan.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-020-01854-8.

Health Literacy of Adolescents

PURPOSE

The purpose of this study is to describe influencing factors of adolescent health literacy.

METHODS

This study is a descriptive, correlational, cross-sectional study. Based on an a priori power analysis and utilizing convenience sampling, 105 adolescents completed the Newest Vital Sign (NVS) health literacy instrument via the Qualtrics online platform. Health literacy was correlated with potential influencing factors to determine relationships between variables.

RESULTS

The mean NVS score was 3.78 (SD = 1.96), indicating possible limited health literacy in this population. There was a moderate, positive correlation between adolescent health literacy and race (r = 0.34, p = .00), with non-white adolescents scoring lower than white adolescents. There was a moderate, positive correlation between adolescent health literacy and income (r = 0.24, p < .05). There were no statistically significant correlations between adolescent health literacy and age or grade level. Regression analysis showed that the overall model accounts for a significant amount of the variance in health literacy scores (F (2, 95) =7.99, p = .001; R² = 0.144; R²_adjusted = 0.126). Race was the only variable that significantly contributed to the model (β = 1.26; SE(β) = 0.40; Standardized β = 0.30, p < .01).

CONCLUSIONS

This study adds to the paucity of adolescent health literacy literature. Furthermore, this study indicates that race and income may play significant roles in adolescent health literacy. Future research is needed to further investigate influencing factors of adolescent health literacy.

PRACTICE IMPLICATIONS

This article provides unique information for nurses to consider alongside other individualized assessments as they continue to design health promotion and patient education practices for adolescents.

The rise of languaging

In this paper, we turn to languaging, defined here as activity in which wordings play a part. On such a view, while activity is paramount, people also orient to acts of vocalization as wordings. These physical wordings can be used as tools that shape attending, with recourse to neither mental representations nor symbols that store and transmit information. The view is consistent with macroevolutionary continuity and will be used to challenge appeal to a major evolutionary transition to 'language'. On the languaging view, like many modern social primates, hominins have long undertaken encultured activities. Infants, human and nonhuman, act epistemically and, by so doing, align skills with objects to practice. They develop a 'stance' to pragmatic, goal-directed action. In human ontogenesis, we argue, both epistemic action and the stance-taking are extended by vocalizing. Caregiver-infant coordination enables vocalizing to be integrated with acting, attending, perceiving and managing one's attention. Infants also self-entrain vocalizing through 'babble'. Once the developmental threads unite, social reaching (Bates, 1976) favors a special stance to articulatory gestures (one that allows wordings to be made and heard). Just as in orienting to cultural tools, a child grasps a community's ways-with-wordings. The latter often express abstract relations which we can illustrate with modern non-literate use of reciprocal expressions. In Australian and Pacific languages, reciprocals sustain coordinating that, for speakers, is neither symbolic nor arbitrary. Further, cross-linguistic comparison shows the same 'patchy distribution' of reciprocals that characterizes primate tool use. Of course, we do not deny that, in many language games, people can undertake activity that makes symbolic use of wordings. In modern literate societies, abilities based on social reaching are further extended into skills that use notational practices (e.g. letters, numbers, graphics). This opens up whole new fields or domains of languaging. Yet, ostensive use of symbols is plainly a cultural invention - not a direct legacy of hominin evolution.

Accuracy and comprehensiveness of publicly-available online data about bedwetting: An actionable opportunity to improve parent and caregiver self-education

INTRODUCTION

Monosymptomatic nocturnal enuresis (MNE) is one of the most common reasons for referral to pediatric urologists. Prior to subspecialist visits, many parents seek electronically available information online to gather information about this condition and potential treatment options. Previous publications suggest that electronically available information on medical conditions do not always align with evidence-based or expert recommendations. We wondered if the same was true for MNE.

OBJECTIVE

To describe the content and accessibility of electronically available information on MNE, and its alignment with recommendations from the International Children's Continence Society (ICCS-MNE).

STUDY DESIGN

We simulated a layperson's electronic search using 10 pertinent search terms associated with bedwetting. We evaluated the first five pages (50 results) for each search. We evaluated all publicly-available (non-paywalled) sites for concordance with ICCS-MNE in eight domains (increasing fluid intake, limiting bladder irritants, optimizing bowel habits, utilizing timed voiding, pelvic floor relaxation, endorsing alarm use, avoiding medications as standard first-line therapies, and pediatrician referral), as well as statements discouraging blaming or punishing the child. Sites were classified as layperson-derived (blogs, communities/forums) or commercially-derived (medical institutions, commercial medical sites, corporations, government). Reading level was assessed by readable.io (compound scoring algorithms).

RESULTS

Of 500 pages, 410 (82%) met inclusion criteria. Of these, 49.3% were layperson-derived and 47.8% were commercially-derived. Publication year ranged from 1999 to 2017. A median three (range 0-8) therapeutic domains were mentioned per site. Only one site discussed all eight therapeutic domains. Commercial sites discussed more ICCS-MNE domains than blogs and communities/forums (median 4.1 vs. 2.4, p < 0.0001; Figure). Blogs and forums were less likely to recommend subspecialist evaluation (53.0% vs. 81.1%, p < 0.0001), but more likely to recommend alternative medicine therapies (57.9% vs. 28.6%, p < 0.0001). The overall median readability grade level was lower for blogs/communities than for commercial sites (7.9 vs. 8.6, p < 0.0001).

DISCUSSION

Our findings show that the vast majority of electronically available information on MNE is not congruent with or does not include all ICCS-MNE recommendations. About half of websites are blogs and forums; these not only are more likely to recommend alternative medicine therapies and less likely to recommend subspecialist evaluation, but have lower reading levels and thus may be accessible to more laypersons.

CONCLUSION

Neither commercially-derived nor layperson-derived websites are comprehensive with regard to ICCS-MNE recommendations. Our findings underscore the need to ensure that electronically published data are accurate, and to understand what data patients may have acquired before visiting with clinicians.

[Promoting early reading in a social exclusion district in primary care]

INTRODUCTION

Reading is a tool that stimulates brain activity, increasing its cognitive reserve and providing innumerable benefits such as the stimulation of empathy, concentration or language development. Promoting reading at a very early age helps develop reading skills correctly. However, social inequalities can result in this practice being carried out less in groups of low socioeconomic, social or cultural levels. The purpose of this study was to assess the outcomes of a promoting reading habits intervention in a primary health care center located in a social transformation district by talking to the parents, providing books to families and encouraging books to become a part of children's play preferences.

MATERIALS AND METHODS

A non-random intervention study in which children born in 2015 and registered in a particular health center took part. A reading promotion intervention was carried out at the ages of 4, 6, 12 and 18 months and at 24 months their preference for reading activities was assessed in relation to other leisure activities.

RESULTS

Three hundred forty-two subjects were included, 154 allocated in the intervention group and 188 in the control group. The children in the intervention group exhibited a greater preference for reading as a leisure activity as compared to those in the control group (reading ranked in last position of favourite activities in 18.8 vs. 33.9%; p=0.003). The variables found on multivariate analysis to have a greater influence on reading position in the ranking of favorite activities were not having participated in the intervention OR: 2.06 (1.19-3.58) and gipsy ethnicity, OR: 2.37 (1.38-4.09).

CONCLUSIONS

Results reveal a slight improvement in the preference for reading as an activity in the children that took part in the literacy program.

[Diabetes education of Turkish people with low literacy skills: Results of an online survey of training practices]

INTRODUCTION

For patients with diabetes mellitus, training is an essential part of therapy. There is a lack of empirical data regarding training experiences for people with a (Turkish) migration background and low literacy skills concerning the established training programmes. The objective of this research was to collect data from general practices based on their experiences in training these particular groups of patients.

METHODS

In a quantitative cross-sectional study design, 795 general practices throughout Germany with the additional designation of diabetology were invited via e-mail to participate in a fully structured, standardised online survey. An exploratory data analysis was performed using the statistics software IBM SPSS.

RESULTS

Out of 146 participating practices (response rate 18%), 66 (45%) estimated the proportion of patients with migration background in their practice to be more than 20%. Approximately 76% of the practices providing diabetes training (n=119) trained patients of Turkish origin. Forty six percent of these practices estimated the ratio of patients of Turkish origin with low literacy skills to be 10 to 50%. Less than 36% of the practices were aware of suitable training programmes for this target group. Existing programmes were modified to special needs and new materials creatively developed. Additional culturally sensitive and visually enriched materials are needed. Forty two percent of the interviewed practices reported billing difficulties concerning frequently needed individual trainings.

DISCUSSION

Training was carried out in different ways due to individual addition or deletion of content elements. There is a lack of evaluated materials that are adapted to the users' cultural background and level of education. In the face of a significantly changed immigration structure, information and materials as well as interpreters for additional languages are increasingly required.

CONCLUSION

Further development of evidence-based, multi-lingual, image-based, culturally sensitive and educationally diverse materials and training units and their scientific evaluation is needed. Learning contents adapted to the level of education and promoting cultural sensitivity in the provision of healthcare should be implemented increasingly in the training and continuous professional development of health professionals.

Parental understanding of crucial medical jargon used in prenatal prematurity counseling

BACKGROUND

Parent-clinician shared decision making is the recommended model for the care of premature infants; thus, clinicians provide prenatal prematurity counseling to parents in the event of a mother's hospitalization for premature birth. However, parental understanding of medical jargon commonly used during prematurity counseling is unknown.

METHODS

Within an overall research agenda to develop and test an educational aid for prenatal prematurity education, we designed the Parental Knowledge of Premature Birth questionnaire. To evaluate parental comprehension of the medical jargon contained within the questionnaire, we conducted cognitive interviews, a formal method for evaluating comprehension and response to questionnaire items. Parents were recruited from a Level IV Neonatal Intensive Care Unit; purposeful recruitment ensured diversity with respect to gender, race, literacy level, and child's gestational age. Data collection and analysis followed standard qualitative methods for cognitive interviewing. We report on the insights gained from these cognitive interviews regarding parental understanding of crucial medical jargon commonly used during prenatal prematurity counseling.

RESULTS

Participants included 10 women and 6 men who ranged in age from 23 to 38 years and represented Black/African-American (38%), Asian (6%), and white (56%) backgrounds. Five participants (31%) had less than a high school education or reading level below 9th grade (Wide Range Achievement Test version 4 reading subtest). In the first round of interviews, parents of all education and literacy levels had difficulty with medical jargon commonly used in prematurity counseling. Terms that parents found difficult to understand included "gestational age", "mild or no developmental problems", and "neonatologist". Modified terms tested in a second round of interviews showed improved comprehension.

CONCLUSION

Cognitive interviews provided empirical testing of parental understanding of crucial medical jargon and highlighted that language commonly used during prenatal prematurity counseling is not understood by many parents. For parents to participate in shared decision making, plain language should be used to maximize their understanding of medical information.

Distinct rhythmic abilities align with phonological awareness and rapid naming in school-age children

Difficulty in performing rhythmic tasks often co-occurs with literacy difficulties. Motivated by evidence showing that people can vary in their performance across different rhythmic tasks, we asked whether two rhythmic skills identified as distinct in school-age children and young adults would reveal similar or different relationships with two literacy skills known to be important for successful reading development. We addressed our question by focusing on 55 typically developing children (ages 5-8). Results show that drumming to a beat predicted the variability of rapid naming but not of phonological awareness, whereas tapping rhythmic patterns predicted phonological awareness, but not rapid naming. Our finding suggests that rhythmic interventions can be tailored to address PA and RAN deficits specifically in reading disabled children.

Protocol for a cluster randomised trial in Madhya Pradesh, India: community health promotion and medical provision and impact on neonates (CHAMPION2); and support to rural India's public education system and impact on numeracy and literacy scores (STRIPES2)

Background

Rural areas of India exhibit high neonatal mortality, and low literacy and numeracy. We assess the effect of a complex package of health interventions on neonatal survival and the effect of out-of-school-hours teaching on children’s literacy and numeracy in rural Madhya Pradesh.

Methods/design

This is a cluster-randomised controlled trial with villages (clusters) receiving either a health (CHAMPION2) or education (STRIPES2) intervention. Building on the design of the earlier CHAMPION/STRIPES trial, villages receiving the health intervention are controls for the education intervention and vice versa.

The clusters are 196 villages in Satna district, Madhya Pradesh, India: each is at least 5 km from a Community Health Centre, has a population below 2500, and has at least 15 children eligible for the education intervention. The participants in CHAMPION2 are resident married women younger than 50 years of age who had not undergone a family planning operation, provided they are enumerated pre-randomisation or marry a man enumerated pre-randomisation. The participants in STRIPES2 are resident children born 16 June 2010 to 15 June 2013, not in school before the 2018–2019 school year and intending to enrol in first grade in 2018–2019 or 2019–2020.

Discussion

In CHAMPION2, the NICE Foundation will deliver a 3.5-year programme comprising Accredited Social Health Activists or village health workers and midwives promoting health knowledge and providing antenatal, postnatal, and neonatal healthcare; community mobilisation; referrals to appropriate government health facilities; and a health education campaign. In STRIPES2, the Pratham Education Foundation will deliver a programme of village-based, before/after school support focusing on literacy and numeracy. As controls, the CHAMPION2 control villages will receive the usual health services (plus the STRIPES2 intervention). STRIPES2 control villages will receive the usual education services (plus the CHAMPION2 intervention). The primary outcome in CHAMPION2 is neonatal mortality. Secondary outcomes include antenatal, delivery, immediate neonatal and postnatal care practices, maternal mortality, stillbirths, early neonatal deaths, perinatal deaths, health knowledge, hospital admissions, maternal blood transfusions, and cost effectiveness. The primary outcome in STRIPES2 is a composite literacy and numeracy test score. Secondary outcomes include separate literacy and numeracy scores, reported school enrolment and attendance, parents’ engagement with children’s learning, and cost effectiveness. Independent research and implementation teams will conduct the trial. Trial Steering and Data Monitoring Committees, with independent members, will supervise the trial.

Trial registration

Clinical Trial Registry of India: CTRI/2019/05/019296. Registered on 23 May 2019. http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=31198&EncHid=&modid=&compid=%27,%2731198det%27

Literacy skill and intra-individual variability in eye-fixation durations during reading: Evidence from a diverse community-based adult sample

To understand the effects of literacy on fundamental processes involved in reading, we report a secondary data analysis examining individual differences in global eye-movement measures and first-pass eye-movement distributions in a diverse sample of community-dwelling adults aged 16 to 64. Participants (n = 80) completed an assessment battery probing verbal and non-verbal cognitive abilities and read simple two-sentence passages while their eye movements were recorded. Analyses were focused on characterising the effects of literacy skill on both global indices of eye-fixation distributions and distributional differences in the sensitivity to lexical features. Global reading measures showed that lower literate adults read more slowly on average. However, distributional analyses of fixation durations revealed that the first-pass fixation durations of adults with lower literacy skill were not slower in general (i.e., there was no shift in the fixation duration distribution among lower literate adults). Instead, lower literacy was associated with greater intra-individual variability in first-pass fixation durations, including an increased proportion of extremely long fixations, differentially skewing the distribution of both first-fixation and gaze durations. Exploratory repeated-measures quantile regression analyses of gaze duration revealed differentially greater influences of word length among lower literate readers and greater activation of phonological and orthographic neighbours among higher literate readers, particularly in the tail of the distribution. Collectively, these findings suggest that literacy skill in adulthood is associated with systematic differences in both global and lexically driven eye-movement control during reading.

Literacy Profile of Children with Language Impairment: Evidence from an Alphasyllabary

BACKGROUND

Most of the evidence explaining the language-literacy link is derived from children learning to read and write alphabetic orthography.

AIM

This study investigated the literacy deficits in children learning to read Kannada, a Dravidian language that employs an alphasyllabary.

METHODS

A group of 15 children with language impairment (CwLI) was compared with two groups of control (age- and language-matched) participants on a range of literacy measures.

RESULTS

The results showed that, compared to the age-matched group, the CwLI group performed significantly poorer on reading (words and nonwords) and written spelling tasks. However, the performance on akshara (the written symbol in the alphasyllabary) recognition task was comparable between groups. Similarly, comparison of the CwLI group with the language-matched control group revealed poorer performance in the former group on most literacy measures but not the akshara recognition task. Akshara recognition emerged as the most significant predictor of literacy performance in children learning to read and write the Kannada alphasyllabary. Detailed analyses of the written spelling errors unveiled several unique error types in the language-impaired group.

CONCLUSION

The findings of our study revealed both orthography-independent and orthography-dependent deficits in the literacy skills of CwLI mastering the Kannada alphasyllabary.

Examining Health Literacy Levels in Homeless Persons and Vulnerably Housed Persons with Mental Health Disorders

Health care use is high in persons who are homeless and vulnerably housed, but their health literacy (ability to read and understand health information) is often not known. The purpose of this study was to determine health literacy rates in a Canadian population of homeless and vulnerably housed individuals with mental health disorders. Higher levels of health literacy were associated with being housed, higher levels of education, non-psychotic mental health diagnoses and lower levels of drug use. This suggests that health literacy may be a potential barrier for accessing and utilizing health services and information for vulnerable populations.

Literacy critical to heart failure management: a scoping review

Heart failure is a complex clinical syndrome most commonly encountered among older adults. This complex clinical syndrome is associated with poor health outcomes such as frequent admissions and mortality. These adverse outcomes are commonly associated with poor self-care and lower health literacy. Literacy is a combination of knowledge and skills and often reflected by appropriate interaction with the community, while health literacy is the cognitive and social skills reflected by accessing and comprehending health information and making appropriate health decisions. These decisions are common and challenging to patients with heart failure. Poor outcomes are said to be reduced by adequate self-care, which is associated with health literacy among heart failure patients. Better self-care was also shown to be associated with self-efficacy and self-confidence that were in turn associated with health literacy. Hence, enhancing health literacy among patient with heart failure is critical to enable them to increase control over their disease by better understanding and participating in health care, while being empowered to take part in designing health care services and even tailoring research to serve their needs and consequently improve outcome at the individual and community level. In clinical practice, assessing health literacy, measuring health literacy, and identifying patients at risk of low nutrition literacy is important to enhance health literacy and health outcomes. Hence, developing reliable and valid methods and tools for assessment and developing tailored and targeted interventions is of critical importance.

The Effects of Adolescent Childbearing on Literacy and Numeracy in Bangladesh, Malawi, and Zambia

Global investments in girls’ education have been motivated, in part, by an expectation that more-educated women will have smaller and healthier families. However, in many low- and middle-income countries, the timing of school dropout and first birth coincide, resulting in a rapid transition from the role of student to the role of mother for adolescent girls. Despite growing interest in the effects of pregnancy on levels of school dropout, researchers have largely overlooked the potential effect of adolescent childbearing on literacy and numeracy. We hypothesize that becoming a mother soon after leaving school may cause the deterioration of skills gained in school. Using longitudinal data from Bangladesh, Malawi, and Zambia, we test our hypothesis by estimating fixed-effects linear regression models to address the endogeneity in the relationship between childbearing and academic skills. To our knowledge, this is the first study to examine the effects of adolescent childbearing on academic skills in low- and middle-income countries. Our results indicate that among those with low levels of grade attainment, first birth has a negative effect on English literacy and numeracy. Among those with higher levels of grade attainment, we find little evidence of effects of childbearing on academic skills. Childbearing also has little effect on local language literacy. Beyond the immediate loss of English literacy and numeracy, if these skills lead to better health and more economic productivity, then adolescent childbearing may have longer-term repercussions than previously understood. In addition to ongoing efforts to increase educational attainment and school quality in low- and middle-income countries, investments are needed to strengthen the academic skills of adolescent mothers to secure the demographic and economic promise of expanded education for girls and women.

Enabling community-based metrology for wood-degrading fungi

BACKGROUND

Lignocellulosic biomass could support a greatly-expanded bioeconomy. Current strategies for using biomass typically rely on single-cell organisms and extensive ancillary equipment to produce precursors for downstream manufacturing processes. Alternative forms of bioproduction based on solid-state fermentation and wood-degrading fungi could enable more direct means of manufacture. However, basic methods for cultivating wood-degrading fungi are often ad hoc and not readily reproducible. Here, we developed standard reference strains, substrates, measurements, and methods sufficient to begin to enable reliable reuse of mycological materials and products in simple laboratory settings.

RESULTS

We show that a widely-available and globally-regularized consumer product (Pringles™) can support the growth of wood-degrading fungi, and that growth on Pringles™-broth can be correlated with growth on media made from a fully-traceable and compositionally characterized substrate (National Institute of Standards and Technology Reference Material 8492 Eastern Cottonwood Whole Biomass Feedstock). We also establish a Relative Extension Unit (REU) framework that is designed to reduce variation in quantification of radial growth measurements. So enabled, we demonstrate that five laboratories were able to compare measurements of wood-fungus performance via a simple radial extension growth rate assay, and that our REU-based approach reduced variation in reported measurements by up to ~ 75%.

CONCLUSIONS

Reliable reuse of materials, measures, and methods is necessary to enable distributed bioproduction processes that can be adopted at all scales, from local to industrial. Our community-based measurement methods incentivize practitioners to coordinate the reuse of standard materials, methods, strains, and to share information supporting work with wood-degrading fungi.

Skilled readers show different serial-position effects for letter versus non-letter target detection in mixed-material strings

The study explored whether target detection in a five-character string depends on whether a letter or a non-letter was presented, as a predesignated target. Skilled readers had to identify a single letter or non-letter in a five-character string, randomly composed of letters and non-letters. It was found that an analytic processing strategy is automatically elicited if participants were instructed to detect a letter target. In this instance, a linear model best explained the RT variance for letters: with increasing RTs from left to right, suggesting a serial item-by-item reading-specific strategy comparable to alphabetic reading. For non-letters, in contrast, a symmetrical U-shaped function best explained the RT variance, suggesting a symmetrical scanning-out from the central to the terminal positions of the string. Since the design precludes orthographic and semantic influences, it can be concluded that a reading-specific strategy for alphabetic processing is automatically activated if the string is scanned for a letter-target. Thus, the pre-designated target triggers the strategy for processing the string and determines related position effects. The results suggest that effects from earlier studies, which showed an analytic processing preference for isolated letters (APPLE) in recognition tasks, as a consequence of literacy acquisition, generalize to the processing of letters in strings.

A Systematic Review of Neuropsychological Tests for the Assessment of Dementia in Non-Western, Low-Educated or Illiterate Populations

OBJECTIVE

Neuropsychological tests are important instruments to determine a cognitive profile, giving insight into the etiology of dementia; however, these tests cannot readily be used in culturally diverse, low-educated populations, due to their dependence upon (Western) culture, education, and literacy. In this review we aim to give an overview of studies investigating domain-specific cognitive tests used to assess dementia in non-Western, low-educated populations. The second aim was to examine the quality of these studies and of the adaptations for culturally, linguistically, and educationally diverse populations.

METHOD

A systematic review was performed using six databases, without restrictions on the year or language of publication.

RESULTS

Forty-four studies were included, stemming mainly from Brazil, Hong Kong, Korea, and considering Hispanics/Latinos residing in the USA. Most studies focused on Alzheimer's disease (n = 17) or unspecified dementia (n = 16). Memory (n = 18) was studied most often, using 14 different tests. The traditional Western tests in the domains of attention (n = 8) and construction (n = 15), were unsuitable for low-educated patients. There was little variety in instruments measuring executive functioning (two tests, n = 13), and language (n = 12, of which 10 were naming tests). Many studies did not report a thorough adaptation procedure (n = 39) or blinding procedures (n = 29).

CONCLUSIONS

Various formats of memory tests seem suitable for low-educated, non-Western populations. Promising tasks in other cognitive domains are the Stick Design Test, Five Digit Test, and verbal fluency test. Further research is needed regarding cross-cultural instruments measuring executive functioning and language in low-educated people.

Prevalence of Consumption of Smokeless Tobacco Products and Exposure to Second-Hand Smoke among Women in the Reproductive Age Group in a Rural Area of Koppal, Karnataka

Background:

Tobacco use is one of the most important causes of death and disease globally. Nearly one-third of the population in India uses tobacco, and smokeless form is culturally acceptable even among women.

Objectives:

(1) To estimate the prevalence of consumption of smokeless tobacco (SLT) products among women in the reproductive age group in the study setting. (2) To determine the various factors associated with the consumption of SLT. (3) To estimate the prevalence of exposure to second-hand smoke among the study participants.

Materials and Methods:

A cross-sectional study was conducted in the field area of primary health center Irkalgad, Koppal in March 2018. A cluster sampling technique was used and a total of 829 women were included. Data were collected using pretested and semi-structured questionnaire and analyzed using the Epi info software version 3.5.4 (Centers for Disease Control and Prevention” (CDC), Atlanta, Georgia, United States of America).

Results:

The prevalence of consumption of SLT products was 17.85%, and the most common product consumed was tobacco with betel quid. Tobacco consumption was found to be significantly associated with age, literacy, marital, and employment status of the study participants.

Conclusion:

The present study concludes that SLT consumption is high among women in the reproductive age group in the study setting and identifies multiple determinants for effective planning of interventions.

Levels of health literacy and English comprehension in patients presenting to South African primary healthcare facilities

Background

Health literacy is a relatively new concept in the South African primary healthcare (PHC) sector as well as globally, and limited new literature is available on the topic. In this study, we focused on investigating, describing and comparing health literacy scores calculated using three different tools to assess a patient’s level of English comprehension. Health literacy is defined as the degree to which patients have the capacity to obtain, process and understand basic health information and services to make appropriate health decisions. South Africa is a linguistically and culturally diverse country, yet English is often used as the main language for imparting health education in PHC facilities. Patients often do not comprehend the health education received. Primary healthcare workers need to determine the health literacy levels of their patients before imparting health education. The REALM-R (SA 1, 2 and 3) tools are adapted from the original REALM-R to test health literacy levels of South African PHC patients. The Learning Ability Battery (LAB) is a tool used to determine English comprehension levels.

Aim

The aim of this was to investigate, describe and compare health literacy and English comprehension levels of PHC patients using three locally adapted REALM-R (SA) tools and the LAB.

Setting

This study was conducted at five PHC facilities in the City of Tshwane, Gauteng.

Methods

A prospective, quantitative and comparative design was chosen for this study. In general, a descriptive design was applied for the presentation of the results. The sample size was 200 patients from five different PHC clinics. Data were collected using REALM-R (SA 1, 2 and 3) to determine the health literacy levels and the LAB to determine the English comprehension levels.

Results

Majority of the patients scored high using the REALM-R (SA) tools. For the LAB, 68% scored 11–40 out of 50. Only 8% scored 41–50 out of 50. A significant difference was found between the actual school grade achieved and the school grade according to the LAB.

Conclusion

The results of the study indicated that although patients are able to read and pronounce medical words as such used in the REALM-R (SA) tools, it does not necessarily mean that they are able to comprehend the meaning of the words as indicated by the results of the LAB. Currently, the REALM-R (SA) tools only test health literacy levels based on word recognition and pronunciation. It is recommended that a word comprehension section be added to determine patients’ understanding of the words.

Health Literacy Considerations for a New Cancer Prevention Initiative

Cancer prevention efforts are newly focused on the older adult population. Adult literacy and health literacy findings and suggestions can help shape more efficacious health communication strategies and thereby increase the “accessibility” of important health information and the potential for healthful action. National and international surveys of adult literacy skills have consistently offered problematic findings that older adults have more limited proficiencies than do younger working adults and face difficulties using commonly available materials to accomplish everyday tasks. Clinical as well as population-based studies of health literacy similarly find limited health literacy among a majority of U.S. adults and even poorer health literacy among older adults. This is of concern because health literacy studies have established clear links between limited literacy and poor health outcomes as well as diminished participation in activities related to disease prevention. Literacy experts note difficulties associated with abstract concepts and with sophisticated numeracy tasks, both associated with disease prevention. Health literacy findings and insights are important considerations in the development of health messages and materials to promote cancer prevention among older adults.

The Canadian anaphylaxis action plan for kids: development and validation

OBJECTIVES

We designed a written Canadian Anaphylaxis Action Plan for Kids (Kids' CAP) which incorporates validated pictograms with written instructions. Using a patient-centered approach, we aimed to validate the Kids' CAP and assess its impact on anaphylaxis recognition and treatment, and to determine its' perceived usefulness.

PATIENT INVOLVEMENT

Children and their parents were involved in appraising the design and written contents of the Kids' CAP.

METHODS

The design process consisted of a development phase and clinical validation phase. First, we assessed the readability and understandability of the Kids' CAP using validated instruments. Then, patients (12-17 years of age) and parents of patients (<12 years of age) were given the Kids' CAP during the first consultation with allergy specialists or an Emergency Department visit for anaphylaxis. Subsequently, we conducted a phone interview 2-3 weeks later to assess their comprehension of anaphylaxis management. We also used the Consumer Information Rating Form to measure the participants' perception of the design quality and usefulness of the Kids' CAP.

RESULTS

Of the 230 participants enrolled, 205 (89%) completed the follow-up interview. The written contents of the Kid's CAP were modified to match grade 7 readability level. The total mean score of the Consumer Information Rating Form for comprehensibility was 23.1 (SD 2.4), and 25.1 (SD 2.3) for design quality. The mean comprehension score was 11.3 (SD 1.8) (reference range 0-12), with no significant difference between participants with and without previous experience with anaphylaxis, or high vs. low literacy level.

CONCLUSION

Engaging children and parents in the design and contents of written anaphylaxis action plan is an innovative approach to produce a useful document for the end-users.

PRACTICE IMPLICATIONS

The Kids' CAP is a valid tool that can be used in emergency departments and allergy clinics to improve patient's comprehension of anaphylaxis manifestations and treatment.

Global differences in geography, religion and other societal factors are associated with sex differences in mortality from suicide: An ecological study of 182 countries

BACKGROUND

Over 800,000 individuals die as a consequence of suicide annually, and almost two thirds of these deaths are in males. This analysis aimed to explore sex differences in global suicide rates with regards to geographic location, religion and other societal factors.

METHODS

Data on sex-specific suicide rates were collated for 182 countries in 2015. The exposures of interest were geographical location, majority religion, life expectancy, total fertility rate (TFR), literacy percentage, gender development index and gross domestic product.

RESULTS

Both continent and predominant religion were strongly associated with the male:female ratio for deaths from suicide (p < 0.001 for both variables). The highest male:female suicide ratio was observed in the Americas with a median value of 4.0 (interquartile range IQR: 3.0-5.0) and the lowest gender suicide ratios were observed in Africa (2.7, IQR: 2.4-3.3) and Asia (2.7, IQR: 1.8-3.9). The predominantly Christian countries revealed the highest male:female suicide ratio (3.3, IQR: 2.7-4.4) whereas the predominantly Hindu countries revealed the lowest (1.3, IQR 1.3-3.8). The following variables were all positively associated with male:female ratio of suicide mortality: Life expectancy (Spearman's correlation coefficient r = +0.21, p = 0.004), GDP per capita (r = +0.26, p = 0.003), literacy percentage (r = +0.46, p < 0.0001), and Gender Development Index (r = +0.56, p < 0.0001). TFR was negatively associated with sex suicide ratio (-0.30, p < 0.0001).

CONCLUSION

There are significant differences between male and female suicide rates across continents and cultures. Markers of societal development are associated with a higher proportion of male suicides compared to females.

Perinatal depression-knowledge gap among service providers and service utilizers in India

INTRODUCTION

Lack of access to perinatal mental health (PMH) services is a significant public health problem in India. Barriers to accessing PMH services include the stigma, non-availability of services, poor knowledge, negative perception, attitude among perinatal women (PWs) and service providers. The present study attempted to examine the knowledge gap regarding perinatal depression (PD) among service providers [Nursing providers (NPs), Medical Practitioners (MPs)] and service utilizers (PWs).

METHODS

This cross-sectional study was conducted in two tertiary care teaching hospitals of India, one in a major metro and the other in a rural area. PWs, MPs and NPs were assessed for knowledge about PD using a semi-structured proforma and Perinatal Depression Monitor.

RESULTS

Among the 270 PWs, 8.51% were knowledgeable (PWA) and 91.49% were ignorant (PWB) about depression. PWB group were low educated (n = 140, 56.68%), and unemployed (n = 207, 83.80%) with lower family income [(≤₹10,356 per month), n = 170, 68.28%)]. There was knowledge discrepancy among NPs, MPs and PWA group in terms of a) PD is a normal part of pregnancy (agree- NPs = 71.52%, MPs = 10.00%, PWA-17.39%), b)biological causes of PD (agree- NPs = 45.23%, MPs = 70.00%, PWA = 26.03%) and c)antidepressant medications for PD (useful- NPs = 23.80%, MPs = 70.00%, PWA = 21.73%). Majority of the respondents agreed that all women should be screened for depression during pregnancy (NPs = 34.78%, MPs = 80.95%, PWA = 95.00%) and postpartum periods (NPs = 34.78%, MPs = 76.19%, PWA = 90.00%).

CONCLUSIONS

Low PD literacy among the PWs, misconception about aetiology and management among the NPs could be major barrier for delivery and utilisation of PD services. Thus, there is an urgent need to improve PD literacy among PWs and NPs.

Hypothesis: improving literacy about health workforce will improve rural health workforce recruitment, retention and capability

BACKGROUND

One of the key barriers to health in rural areas is health workforce. Poor understanding and communication about health workforce across all stakeholder groups (including the broad community) is very common and can negatively affect the health workforce, recruitment, experiences and outcomes.

HYPOTHESIS

In this paper, we propose the concept of literacy about health workforce. We propose this as a specific, actionable extension of the existing and well accepted health literacy concept. We hypothesise that improving literacy about health workforce will improve, in particular, rural health workforce recruitment, retention and capability.

IMPLICATIONS OF THE HYPOTHESIS

We propose that literacy about health workforce is important for all members of the health and broader system (e.g. local GP, mayor, workforce agency, health manager, Aboriginal health worker, carers, community health facilitators, patients, schools, local businesses, cultural and recreation groups) because we hypothesise their literacy about health workforce affects their capacity to make informed decisions and take action to manage their health workforce needs in direct synchrony with the community's health needs. We hypothesise that improving literacy about health workforce will improve the effectiveness and efficiency of attracting, recruiting, training, and retaining a high quality, capable, health workforce, and further, will support the development and acceptance of innovative solutions to health workforce crises such as new models of care. This hypothesis is action orientated, is testable and includes the consideration of methods to engage and improve literacy of those within and external to the health workforce.

Observing individual children in early childhood classrooms using Optimizing Learning Opportunities for Students (OLOS): A feasibility study

In this study, we present a newly developed observational system, Optimizing Learning Opportunities for Students (OLOS). OLOS is designed to elucidate the learning opportunities afforded to individual children within early childhood classrooms and as they transition to formal schooling (kindergarten through third grade). OLOS records the time spent in different types of learning opportunities (e.g., play, literacy, math) and the frequency of specific discourse moves children and teachers use (child talk and teacher talk). Importantly, it is being designed to be used validly and reliably by practitioners. Using OLOS, we explored individual children's experiences (n = 68 children in 12 classrooms) in four different types of early childhood programs; state-funded, state-funded PK serving children with disabilities, Head Start, and a tuition-based (non-profit) preschool. Results of our feasibility study revealed that we could feasibly and reliably use OLOS in these very different kinds of pre-kindergarten programs with some changes. OLOS provided data that aligned with our hypotheses and that our practitioner partners found useful. In analysing the observations, we found that individual children's learning opportunities varied significantly both within and between classrooms. In general, we observed that most of the PK day (or half day) was spent in language and literacy activities and non-instructional activities (e.g., transitions). Very little time in math and science was observed yet children were generally more likely to actively participate (i.e., more child talk) during academic learning opportunities (literacy, math, and science). The frequency of teacher talk also varied widely between classrooms and across programs. Plus, the more teacher talk we observed, the more likely we were to observe child talk. Our long-term aim is that OLOS can inform policy and provide information that supports practitioners in meeting the learning and social-behavioral needs of the children they serve.

Morphological processing in Chinese engages left temporal regions

Morphological awareness, the ability to manipulate the smallest units of meaning, is critical for Chinese literacy. This is because Chinese characters typically reflect the morphemic, or morpho-syllabic units of language. Yet, the neurocognitive mechanisms underlying Chinese speakers' morphological processing remain understudied. Proficient readers (N = 14) completed morphological and phonological judgment tasks in Chinese, in both auditory and visual modalities, during fMRI imaging. Key to our inquiry were patterns of activation in left temporal regions, especially the superior temporal gyrus, which is critical for phonological processing and reading success. The findings revealed that morphological tasks elicited robust activation in superior and middle temporal regions commonly associated with automated phonological and lexico-semantic analyses. In contrast, the rhyme judgment task elicited greater activation in left frontal lobe regions, reflecting the analytical complexity of sound-to-print mapping in Chinese. The findings suggest that left temporal regions are sensitive to salient morpho-syllabic characteristics of a given language.

Association between numeracy and self-rated poor health in 33 high- and upper middle- income countries

The association between numeracy proficiency and health outcomes has been the subject of several studies. However, it is not known if this association is independent of educational attainment and literacy proficiency. In this study, we used logistic regression to model numeracy proficiency as a predictor of self-rated poor health after accounting for educational attainment and literacy proficiency. The prevalence of self-rated poor health among 166,863 adults aged 16-65 years from 33 high- and upper middle-income countries was 24%. Compared to those with the highest numeracy proficiency (level 4), the odds ratio of self-rated poor health for those with the lowest numeracy proficiency (level 1) was 2.2 (95% CI 1.9-2.7) and attenuated to 1.8 (95% CI 1.5-2.1) and 1.5 (95% CI 1.1, 2.0), respectively, after sequential addition of self-education and literacy proficiency. For those who were assessed to have low levels of both numeracy and literacy proficiency, the odds ratio of self-rated poor health was 1.4 (95% CI 1.3 to 1.5), relative to those who had high levels of both numeracy and literacy proficiencies. Numeracy and literacy proficiencies show both independent and interdependent correlations with poor self-rated health. Further, these associations varied by sociodemographic characteristics and across countries. Policies aimed at improving numeracy and literacy may be beneficial in preventing adverse health outcomes.

Language Proficiency, Reading Comprehension and Home Literacy in Bilingual Children: The Impact of Context

Numerous studies on reading comprehension with monolingual children have shown that oral language, such as vocabulary, is an important factor in predicting reading comprehension success. However, few studies have looked at the reading comprehension performance of bilinguals, and less is known about the contributors to its success, linguistic or otherwise. Based on previous research showing weaker oral language among bilingual children, the goals of the present study are to examine how bilinguals perform in reading comprehension, along with possible contributors such as oral language and home literacy practices, in comparison with their monolingual peers. Participants were 82 children in the third grade who completed standardized language measures assessing vocabulary, grammar, and reading comprehension and whose parents completed a home literacy questionnaire. Bilingual children's reading comprehension was comparable to monolinguals despite having lower language, and bilingual parents reported reading rate was higher than that of the monolinguals. Moreover, the contributors to this success in reading comprehension were different for the bilingual group, with oral language and home literacy playing a role. Overall, this suggests bilinguals are unique from monolinguals in the manner in which they make use of the resources available to them, linguistic and otherwise, to achieve reading comprehension success.

Developing a Persian test battery of prereading skills for screening Preschool-aged children

Background: The lack of screening test battery has made it difficult for early identification and intervention of Persian-speaking children with risk of reading problems prior to formal education. The purpose of this study was to develop and introduce a Persian prereading test battery based on the multidimensional reading perspective for screening preschool children.

Methods: First, the predicators of reading skill and dyslexia along with the subscales of each predictor were identified through literature review and holding expert’s panel. The batteries of tests were performed on 48 typically-developing children (5.6–6.6 years old) selected using the random (cluster) method. The Pearson correlation coefficient, item analysis and then reliability were measured.

Results: The 5-component test battery with 8 subtests was formed. Findings indicated there were moderate and significant correlations between subtests (all r>0.4, p<0.001). Internal consistency reliability for the subscales was 0.51 to 0.89.

Conclusion: The Persian test battery of prereading skills including phonological awareness, identification of first and closing phonemes, visual discrimination skill, rapid automatic naming and phonological working memory may identify children who are at risk. A longitudinal study is warranted to evaluate its detailed psychometric properties.

Dialogic reading vs screen exposure intervention is related to increased cognitive control in preschool-age children

AIM

Shared reading leads to better language and executive functions. This study was designed to examine the effect of dialogic reading compared to screen-exposed intervention on executive functions using behavioural and electroencephalogram measures.

METHODS

The effect of six weeks of dialogic reading intervention on executive functions was examined in 16 children (seven females, 61.73 months, SD 7.07, min-max 50-170) vs 16 children exposed to screen (six females, 64.31 months, SD 64.31, min-max 52-74) recruited through posted ads in daycares in the north of Israel. Behavioural and attention/inhibition electroencephalogram tasks were used to assess the effects of intervention.

RESULTS

Comparisons using t-test showed that the dialogic reading group demonstrated higher executive functions and language scores vs the screen-exposed group. Greater accuracy rates, shorter reaction times and a smaller gap between P300 amplitudes were found for the dialogic reading group compared to the screen group for the electroencephalogram task.

CONCLUSION

Dialogic reading intervention is related to improved executive functions and language abilities compared to screen-based story-telling. Parents and teachers should consider employing this method in preschool children as a facilitator for future academic abilities.

Studies in the Mentality of Literates: Searching for the Cultural Great Divide at the Individual Level of Analysis

Today it is usually agreed that cultures are different but no culture is more developed than some other. It follows that culture did not develop hierarchically. Otherwise some cultures must be more developed than the others. This position, however, contradicts ample evidence that individual mental development is hierarchical. As culture can develop only on the basis of individual development, cultural development has to be hierarchical too. In this paper a research program to study cultural and individual development in one framework is outlined. Particularly it is discussed whether it is possible to define a Great Divide, a characteristic that would distinguish more developed cultures from less developed cultures today. Both literacy and formal education are rejected as candidates for a Great Divide. Then, following and extending Vygotsky's theory, it is demonstrated that a Great Divide can be defined in terms of the development of word meaning structure (WMS). A novel theory of the development of WMS over five hierarchical stages is shortly described and it is suggested that both individuals and cultures develop over the same stages in invariant order. Particularly differences between everyday and logical (or "scientific" in Vygotsky's terms) concepts are discussed. It is theoretically explained how study of adult individuals can be used to support the presented theory of developmental similarities between cultures and individuals. Specific hypotheses for the study are put forward.

A Rasch Analysis Study Determining the Internal Validity and Separation Reliability of the Inventory of Reading Occupations - Adult: A Measure of Functional Literacy Participation

The objective of this study was to determine the internal validity and separation reliability of the Inventory of Reading Occupations - Adult (IRO-Adult), an assessment of functional literacy participation for adults. Participants included 69 adults with typical reading abilities and difficulties with reading. The fit of the IRO-Adult items was analyzed with the Rasch model of unidimensionality using goodness-of-fit analysis and analysis of standardized residuals. Also analyzed was the tool's ability to reliably separate distinct levels of reading participation and the optimal functioning of its rating scales. The IRO-Adult items fit the Rasch model of unidimensionality. Three test items can be further refined to strengthen internal validity. Items are able to reliably detect multiple levels of reading participation and change in functional literacy participation over time. Several categories in the tool's rating scale can be combined for better clarity and to optimize rating scale functioning. The study provides preliminary evidence of validity and reliability of the IRO-Adult as a useful tool to assess functional literacy participation of adults. Further studies on other psychometric properties and clinical utility are warranted.

Assessment of Visual Association Memory in Low-Educated, Non-Western Immigrants with the Modified Visual Association Test

BACKGROUND

Neuropsychological tests are influenced by culture, language, level of education, and literacy, but there are few cognitive tests of which the applicability in ethnic minority populations has been studied.

OBJECTIVES

The aim of this study was to assess the reliability and validity of the Visual Association Test (VAT), a test of visual association memory, in a non-Western, low-educated memory clinic population. Additionally, a modified version of the VAT using colored photographs instead of line drawings was studied (mVAT).

METHOD

Both the original VAT and the mVAT were administered to non-Western immigrants (n = 73) from 2 multicultural memory clinics in Rotterdam, The Netherlands, and a control sample of non-demented Turkish elderly (n = 14) with low education levels (32 and 29% illiterate, respectively).

RESULTS

Both the VAT and the mVAT were able to discriminate persons with and without dementia (area under the curve: VAT, 0.77-0.88; mVAT, 0.85-0.95). The mVAT had more homogeneous item difficulty levels than the VAT. Administration of parallel versions of the VAT and the mVAT within the same person revealed higher scores on the mVAT (Z = -3.35, p = 0.001).

CONCLUSIONS

The mVAT is a reliable and valid measure of memory in non-Western immigrants. Clinicians and researchers should be aware that the memory performance of immigrants may be systematically underestimated when using tests with black-and-white line drawings, such as the original VAT.

Oral Health Literacy and Oral Health Knowledge among 2,263 First-time Pregnant Urban Women: A Cross-sectional Questionnaire Study

AIM

The present study aimed to see the oral health literacy rate among first-time pregnant women across 12 corporate hospital setups in the city of Pune, India.

MATERIALS AND METHODS

For the survey, the REALD 30 questionnaires were used to assess the adult literacy rate (with 0 being least score and 30 being the highest score) and the knowledge of the participants related to oral health was assessed using a set of 6 questions. The study was carried out for a period of 1 year from January 2018 to December 2018. The total participants at the end of the study were 2,263. All the women were pregnant for the first time, in their 1st trimester of pregnancy. Written consent was taken from all the participants. Epi Info was used to carry out the statistical analysis. All the p values less than 0.05 was considered to be statistically significant.

RESULTS

The mean REALD 30 score was 23.8 ± 8.34. The REALD score was higher for those with a postgraduate degree; this could be due to more number of participants in the group. There were higher percentages of women with correct answers to all the knowledge-based questions. We observed that there was a positive correlation with the REALD total scores and the correct answers provided to the questions on oral health (r = 0.76). There was a positive correlationship between the REALD scores and the oral health knowledge of the participants.

CONCLUSION

The educated pregnant women had a high oral health literacy rate. There was a positive correlation of literacy with the REALD 30 score.

CLINICAL SIGNIFICANCE

Healthcare providers should focus on clearing the myths and misconceptions that are still prevalent in a small portion of the urban population.

Looking to the Future: Speech, Language, and Academic Outcomes in an Adolescent with Childhood Apraxia of Speech

OBJECTIVE

The clinical course of childhood apraxia of speech (CAS) is poorly understood. Of the few longitudinal studies in the field, only one has examined adolescent outcomes in speech, language, and literacy. This study is the first to report long-term speech, language, and academic outcomes in an adolescent, Liam, with CAS.

METHODS

Speech, language, literacy, and academic outcome data were collected, including 3 research-based assessments. Overall, data were available at 17 time points from 3;10 to 15 years.

RESULTS

Liam had moderate-to-severe expressive language impairment and poor reading, writing, and spelling up to 10 years. His numeracy was at or above the national average from 8 to 14 years. He made gains in preadolescence, with average expressive language at 11 years and above average reading and writing at 14 years. Nonword reading, reading comprehension, and spelling remained areas of weakness. Receptive language impairment was evident at 13 years, which was an unexpected finding.

CONCLUSION

Findings from single cases can be hypothesis generating but require verification in larger cohorts. This case shows that at least some children with CAS may gain ground in adolescence, relative to same age peers, in expressive language and academic areas such as reading and writing.

Prospective comparison of the novel visual prostate symptom score (VPSS) versus the international prostate symptom score (IPSS), and assessment of patient pain perception with regard to transrectal ultrasound guided prostate biopsy

Objective:

To compare the International Prostate Symptom Score (IPSS) and novel Visual Prostate Symptom Score (VPSS) in patients with lower urinary tract symptoms (LUTS), to correlate scores with uroflowmetry and prostate volume and assess patient perceptions regarding pain prior to, and after prostate biopsy.

Materials and Methods:

Patients with LUTS who had an indication for transrectal ultrasound (TRUS) biopsy were included. Patients completed the IPSS-, VPSS- and prostate biopsy pain assessment questionnaires. Assessment included uroflowmetry, post- void residual volume and prostate volume (measured with TRUS).

Results:

One hundred men were included. There were statistically significant correlations between the VPSS score and IPSS score (correlation coefficient (r) = 0.802); VPSS and Qmax (r = −0.311); VPSS and. Qave (r = −0.344); prostate volume with VPSS (r = 0.194) and Qmax (r = −0.260). The VPSS was quicker to complete than the IPSS (mean 100 vs. 165 seconds). The mean anticipated pain score before biopsy was 2.8 (range 0-6), and after biopsy (experienced pain) it was 1.8 (range 0-5). The pain during biopsy was less than expected in 67% of patients.

Conclusion:

In men with LUTS scheduled to undergo prostate biopsy, the VPSS score correlated positively with the IPSS score. Men with limited education take less time to complete the VPSS. Patient's perception of expected pain or discomfort during TRUS-guided prostate biopsy was significantly higher than the pain actually experienced during biopsy. Men with lower education level had significantly higher expectation of pain prior to biopsy, but similar pain during biopsy.

Health literacy and abdominal aortic aneurysms

OBJECTIVE

Little is known about the public's knowledge of abdominal aortic aneurysms (AAA). Although preventive screening is available, millions of Americans remain unaware of their risk. Improved health literacy has been associated with increased screening and improvement in health outcomes. This study assessed the level of AAA literacy among respondents who participated in a free AAA screening event.

METHODS

Thirteen key words used by vascular surgeons to describe the risk, diagnosis, and treatment options for AAA were extracted from the screening tool used by the nation's largest provider of free AAA diagnostic services, AAAneurysm Outreach. The National Institutes of Health recommends readability of patient education materials to be at the sixth-grade level, but a readability analysis of these words placed them at a grade level of 14.6. A self-administrated questionnaire was developed that allowed respondents to compare each of the extracted words with a definitionally correct or incorrect word that reflected a sixth-grade readability score. These scores were then compared with the available demographics.

RESULTS

There were 570 completed questionnaires. Of the participants, 57.6% were female, 61.4% were 60 and above, and 32.6% were veterans. The average number of correct answers was 9.31 out of 13 (72% correct). Only 4.7% answered all questions correctly, with 29.1% missing five or more answers. The most frequently missed words were asymptomatic, screening, and cholesterol (56.5%, 44%, and 41.4% incorrect, respectively). The most frequently known terms were abdominal, diagnosis, and genetic (96%, 95.3%, and 91.9% correct, respectively). The remaining words fell between these extremes. Those aged 60 and above scored significantly lower than younger respondents (P < .0001). A post hoc power analysis indicated that the power to detect the obtained effects of age at the .05 level was greater than 0.95. Gender and veteran status did not produce any significant differences.

CONCLUSIONS

These data suggest an important communication gap between the words used by clinicians to describe the risks, diagnostic results, and treatment options of AAA and the targeted at-risk population, especially those 60 years and older.

Prevalence and Association of Pain Experiences, Medication Literacy, and Use of Medication among Children and Adolescents in Taiwan

OBJECTIVE

This study assessed the prevalence of children's and adolescents' pain experiences and use of medicine and examined the relationships between pain experiences, medication knowledge, literacy, and use of medicine.

METHOD

A probability-proportionate-to-size sampling method was used to systematically draw a random sample of schools. In 2014, a national representative sample of 2309 students from 35 primary schools (5th-6th grade), 2700 students from 30 middle schools, and 2013 students from 20 high schools completed the online survey.

RESULTS

Overall, 85.6% of children and adolescents reported experiencing pain during the past year that included headache (63.0%), throat ache (59.3%), muscle ache (58.3%), stomach pain (42.9%), menstrual pain (girls: 42.1%), and dental pain (38.5%). Children and adolescents had taken cold/cough medicine (48.1%), acetaminophen (15.0%), antacids (14.8%), and nonsteroidal anti-inflammatory drugs (NSAIDs) (10.5%) in the past year. Multivariate analysis results indicated that after controlling for pain experiences children and adolescents who had lower levels of medication knowledge and literacy were more likely to use pain medication and antacids more frequently. In addition, children and adolescents who had lower medication knowledge, lower literacy, asked doctors to prescribe antacids, and co-administered with antacids were more likely to report long-term use of antacids.

CONCLUSIONS

Lower levels of medication knowledge and literacy among children and adolescents were associated with more frequent use of pain medication and antacids.

Dementia Stigma Reduction (DESeRvE): Study protocol for a randomized controlled trial of an online intervention program to reduce dementia-related public stigma

Background

Dementia is considered to be a highly stigmatized condition leading to significant negative effects on the health and well-being of people with dementia and people supporting someone living with dementia. Even though there has been an increasing amount of research on dementia-related stigma over the past two decades, research on effective, evidence-based approaches to reduce dementia-related public stigma is still lacking.

Methods

A 2 × 2 factorial randomized controlled trial (RCT) is being conducted to evaluate the feasibility and short-term efficacy of an online intervention program. It compares different approaches to reduce dementia-related public stigma: 1) Education (ED) that is designed to provide written information on dementia; 2) Contact (CT) that is designed to offer indirect virtual contact with people with dementia and/or people supporting someone with dementia; 3) Education plus contact (ED + CT) that is designed to provide both written information on dementia and indirect virtual contact with people with dementia and/or people supporting someone living with dementia; and 4) an active control condition receiving written information on general health. We aim to recruit 500 lay persons aged 40 and over, to complete a questionnaire measuring the level of dementia-related public stigma, assessed with a modified Attribution Questionnaire and dementia knowledge, assessed with the Dementia Knowledge Assessment Scale version 2 at baseline and follow-up assessments (immediately after the intervention and 12 weeks post-intervention).

Discussion

Results from this trial will provide evidence on the most effective approach in reducing dementia-related public stigma. The results are also likely to form an evidence base for the feasibility of dementia-related public stigma campaigns to educate the general public.

The profile of very preterm children on academic achievement. A cross-population comparison with children with specific learning disorders

BACKGROUND

Very preterm (VPT) children showed delays in reading, spelling and maths, but their academic achievement profile is not clearly understood.

AIMS

VPT children were compared with children with specific learning disorders (SLD) and typically developing (TD) children on academic achievement, considering cognitive and linguistic phenotypic markers. A learning profile analysis was also performed.

METHODS

We included 170 10-year old monolingual Italian-speaking children (37 VPT, 28 SLD, 105 TD) assessing cognitive, linguistic and academic skills.

RESULTS

On academic achievements VPT children fell behind TD peers in some reading (text speed, comprehension), spelling (non-word), and math (number knowledge, written calculations and problem-solving) tasks. SLD children underperformed in all academic tasks with respect to VPT and TD peers. Concerning cognitive and linguistic phenotypic markers, compared to TD peers, VPT children showed lower scores in verbal IQ and phonological fluency, SLD children in phonological processing and rapid automatized naming. VPT children showed a higher rate of at-risk performance in reading compared to TD group, but a minor percentage of impaired profiles and comorbidity among learning areas compared to SLD group.

CONCLUSIONS AND IMPLICATIONS

The academic achievement profile of VPT children shows persistent delays, but it differs to that of SLD children, since delays are less widespread and severe, and differences were found in phenotypic markers and comorbidity. Follow-up programs and effective interventions are needed for VPT children.