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For: Curtis LM, Wolf MS, Weiss KB, Grammer LC. The impact of health literacy and socioeconomic status on asthma disparities. J Asthma 2012;49:178-83. [PMID: 22277072 PMCID: PMC3509174 DOI: 10.3109/02770903.2011.648297] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]

For:	Curtis LM, Wolf MS, Weiss KB, Grammer LC. The impact of health literacy and socioeconomic status on asthma disparities. J Asthma 2012;49:178-83. [PMID: 22277072 PMCID: PMC3509174 DOI: 10.3109/02770903.2011.648297] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]

Number

Cited by Other Article(s)

Stafford IA, Viertel VG, Wilken LA, Olmsted KE, Porter MR, Armstrong JM, Go G, Roberts AW. Health Care Disparities and the Emergency Management of Postpartum Patients with Cardiovascular Complaints. Am J Perinatol 2024;41:e2129-e2134. [PMID: 37230477 DOI: 10.1055/a-2099-8662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]

Abstract

OBJECTIVE

This study aimed to determine health care disparities in evaluation and admission among underserved racial and ethnic minority groups presenting with cardiovascular complaints during the first postpartum year according to patient and provider demographics.

STUDY DESIGN

A retrospective cohort study was performed on all postpartum patients who sought emergency care between February 2012 and October 2020 in a large urban care center in Southeastern Texas. Patient information was collected according to International Classification of Diseases 10th Revision codes and individual chart analysis. Race, ethnicity, and gender information were self-reported for both patients on hospital enrollment forms and emergency department (ED) providers on their employment records. Statistical analysis was performed with logistic regression and Pearson's chi-square test.

RESULTS

Of 47,976 patients who delivered during the study period, 41,237 (85.9%) were black, Hispanic, or Latina and 490 (1.1%) presented to the ED with cardiovascular complaints. Baseline characteristics were similar between groups; however, Hispanic or Latina patients were more likely to have had gestational diabetes mellitus during the index pregnancy (6.2 vs. 18.3%). There was no difference in hospital admission between groups (17.9% black vs. 16.2% Latina or Hispanic patients). There was no difference in the hospital admission rate by provider race or ethnicity overall (p = 0.82). There was no difference in the hospital admission rate when a patient was evaluated by a provider of a different race or ethnicity (relative risk [RR] = 1.08, CI: 0.6-1.97). There was no difference in the rate of admission according to the self-reported gender of the provider (RR = 0.97, CI: 0.66-1.44).

CONCLUSION

This study illustrates that disparities did not exist in the management of racial and ethnic minority groups who presented to the ED with cardiovascular complaints during the first postpartum year. Patient-provider discordance in race or gender was not a significant source of bias or discrimination during the evaluation and treatment of these patients.

KEY POINTS

· Adverse postpartum outcomes disproportionately affect minorities.. · There was no difference in admissions between minority groups.. · There was no difference in admissions by provider race and ethnicity..

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Holmen H, Flølo T, Tørris C, Løyland B, Almendingen K, Bjørnnes AK, Albertini Früh E, Grov EK, Helseth S, Kvarme LG, Malambo R, Misvær N, Rasalingam A, Riiser K, Sandbekken IH, Schippert AC, Sparboe-Nilsen B, Sundar TKB, Sæterstrand T, Utne I, Valla L, Winger A, Torbjørnsen A. Unpacking the Public Health Triad of Social Inequality in Health, Health Literacy, and Quality of Life-A Scoping Review of Research Characteristics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023;21:36. [PMID: 38248501 PMCID: PMC10815593 DOI: 10.3390/ijerph21010036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024]

Affiliation(s)

Heidi Holmen Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.) Intervention Centre, Oslo University Hospital, 4950 Oslo, Norway
Tone Flølo Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.) Department of Surgery, Voss Hospital, Haukeland University Hospital, 5704 Voss, Norway
Christine Tørris Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
Borghild Løyland Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
Kari Almendingen Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
Ann Kristin Bjørnnes Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
Elena Albertini Früh Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
Ellen Karine Grov Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
Sølvi Helseth Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
Lisbeth Gravdal Kvarme Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
Rosah Malambo Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
Nina Misvær Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
Anurajee Rasalingam Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
Kirsti Riiser Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.) Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
Ida Hellum Sandbekken Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
Ana Carla Schippert Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
Bente Sparboe-Nilsen Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.) Faculty of Medicine and Health, Örebro University, 701 82 Örebro, Sweden
Turid Kristin Bigum Sundar Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
Torill Sæterstrand Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
Inger Utne Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
Lisbeth Valla Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.) Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), 0484 Oslo, Norway
Anette Winger Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
Astrid Torbjørnsen Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)

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Larson JH, Heinlein J, Morris C, Ramsey K, Michaels LC, Vu A, Williams HC, Simpson E. Frequency of newborn bathing in the first 9 weeks of life and related factors: An observational study in a community-based sample from Meta-LARC. Pediatr Dermatol 2023;40:1042-1048. [PMID: 37800475 DOI: 10.1111/pde.15449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/09/2023] [Indexed: 10/07/2023]

Abstract

PURPOSE

Environmental factors such as bathing may play a role in atopic dermatitis (AD) development. This analysis utilized data from the Community Assessment of Skin Care, Allergies, and Eczema (CASCADE) Trial (NCT03409367), a randomized controlled trial of emollient therapy for AD prevention in the general population, to estimate bathing frequency and associated factors within the first 9 weeks of life.

METHODS

Data were collected from 909 parent/newborn dyads recruited from 25 pediatric and family medicine clinics from the Meta-network Learning and Research Center (Meta-LARC) practice-based research network (PBRN) consortium in Oregon, North Carolina, Colorado, and Wisconsin for the CASCADE trial. Ordinal logistic regression was used to conduct a cross-sectional analysis of the association between bathing frequency (measured in baths per week) and demographic, medical, and lifestyle information about the infant, their family, and their household. Variables were selected using a backwards-stepwise method and estimates from the reduced model are reported in the text.

RESULTS

Moisturizer use (OR = 2.03, 95% CI: 1.54-2.68), Hispanic or Latino ethnicity (OR = 1.97, 95% CI: 1.42-2.72), a parental education level lower than a 4-year college degree (OR = 2.48, 95% CI: 1.70-3.62), living in North Carolina or Wisconsin (compared to Oregon; OR = 2.12 and 1.47, 95% CI: 1.53-2.93 and 1.04-2.08, respectively), and increasing child age (in days; OR = 1.02, 95% CI: 1.01-1.02) were significantly associated with more frequent bathing, while pet ownership (OR = 0.67, 95% CI: 0.52-0.87) was significantly associated with less frequent bathing.

CONCLUSIONS

We found significant ethnic, geographic, and socioeconomic variation in bathing frequency before 9 weeks of age that may be of relevance to AD prevention studies.

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Bell SK, Dong J, Ngo L, McGaffigan P, Thomas EJ, Bourgeois F. Diagnostic error experiences of patients and families with limited English-language health literacy or disadvantaged socioeconomic position in a cross-sectional US population-based survey. BMJ Qual Saf 2023;32:644-654. [PMID: 35121653 DOI: 10.1136/bmjqs-2021-013937] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 01/12/2022] [Indexed: 11/03/2022]

Abstract

BACKGROUND

Language barrier, reduced self-advocacy, lower health literacy or biased care may hinder the diagnostic process. Data on how patients/families with limited English-language health literacy (LEHL) or disadvantaged socioeconomic position (dSEP) experience diagnostic errors are sparse.

METHOD

We compared patient-reported diagnostic errors, contributing factors and impacts between respondents with LEHL or dSEP and their counterparts in the 2017 Institute for Healthcare Improvement US population-based survey, using contingency analysis and multivariable logistic regression models for the analyses.

RESULTS

596 respondents reported a diagnostic error; among these, 381 reported LEHL or dSEP. After adjusting for sex, race/ethnicity and physical health, individuals with LEHL/dSEP were more likely than their counterparts to report unique contributing factors: "(No) qualified translator or healthcare provider that spoke (the patient's) language" (OR and 95% CI 4.4 (1.3 to 14.9)); "not understanding the follow-up plan" (1.9 (1.1 to 3.1)); "too many providers… but no clear leader" (1.8 (1.2 to 2.7)); "not able to keep follow-up appointments" (1.9 (1.1 to 3.2)); "not being able to pay for necessary medical care" (2.5 (1.4 to 4.4)) and "out-of-date or incorrect medical records" (2.6 (1.4 to 4.8)). Participants with LEHL/dSEP were more likely to report long-term emotional, financial and relational impacts, compared with their counterparts. Subgroup analysis (LEHL-only and dSEP-only participants) showed similar results.

CONCLUSIONS

Individuals with LEHL or dSEP identified unique and actionable contributing factors to diagnostic errors. Interpreter access should be viewed as a diagnostic safety imperative, social determinants affecting care access/affordability should be routinely addressed as part of the diagnostic process and patients/families should be encouraged to access and update their medical records. The frequent and disproportionate long-term impacts from self-reported diagnostic error among LEHL/dSEP patients/families raises urgency for greater prevention and supportive efforts.

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Hohn RE, Kopec JA, Sawatzky R, Poureslami I, FitzGerald JM. Measuring skill-based health literacy in chronic airway disease patients: the development and psychometric evaluation of the Vancouver airways health literacy tool (VAHLT). Qual Life Res 2023;32:2875-2886. [PMID: 37428406 DOI: 10.1007/s11136-023-03447-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 07/11/2023]

Howard A, Mansour A, Warren-Myers G, Jensen C, Bentley R. Housing typologies and asthma: a scoping review. BMC Public Health 2023;23:1766. [PMID: 37697282 PMCID: PMC10494403 DOI: 10.1186/s12889-023-16594-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/23/2023] [Indexed: 09/13/2023] Open

Silverstein GD, Styke SC, Kaur S, Singh A, Green S, Jariwala SP, Feldman J. The Relationship Between Depressive Symptoms, eHealth Literacy, and Asthma Outcomes in the Context of a Mobile Health Intervention. Psychosom Med 2023;85:605-611. [PMID: 36799736 PMCID: PMC10372190 DOI: 10.1097/psy.0000000000001170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]

Abousayed MM, Tartaglion JP, Zonshayn S, Rai N, Johnson CK, Rosenbaum AJ. Republication of "Online Patient Resources for Ankle Instability: An Objective Analysis of Available Materials". FOOT & ANKLE ORTHOPAEDICS 2023;8:24730114231195334. [PMID: 37655906 PMCID: PMC10467190 DOI: 10.1177/24730114231195334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open

Abstract

Background

The Internet has drastically changed how patients access health-related information. There are several ways the public can access online health-related information such as search engines, blogs, support groups, and webinars. A recent study found that 45% of orthopedic patients searched for information online regarding their injury. Also, 78% believed they had better understanding of their condition after visiting these websites; furthermore, 41% felt the Internet supplied them with questions and concerns to discuss with their physicians. The aim of our study is to evaluate the accuracy, quality, and readability of online available information using the search terms "ankle sprain" and "ankle instability."

Methods

Three search engines (Google, Bing, and Yahoo) were used to search for the terms "ankle sprain" and "ankle instability." The first 25 websites from each search were collected. Each website was assessed for quality, accuracy, and readability by 3 orthopedic residents blinded to the search term used. Websites were also evaluated for commercial bias and whether written by physicians or not.

Results

Twenty sites were identified using Google, 14 using Bing, and 3 using Yahoo while the remaining 19 appeared in multiple search engines. Sixty-nine percent of the websites (39/56) were written by physicians whereas only 21% (12/56) were associated with commercial bias. The mean quality and accuracy of the websites written above a seventh-grade level was statistically significantly higher than those at or below a seventh-grade level (P = .01). The mean accuracy of websites written by physicians was not statistically different from those not written by physicians (P = .055).

Conclusion

The current study highlights the poor quality and accuracy of online information related to ankle sprains, especially those with commercial bias. Furthermore, although websites written by or under supervision of physicians were found to be of superior quality, a majority of sites were found to have an unacceptably high reading level.

Level of Evidence

Level IV, case series.

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Heath DM, Ghali AN, Momtaz DA, Nagel S, Gonuguntla R, Menon S, Krishnakumar HN, Landrum MR, Hogue GD. Socioeconomic Status Affects Postoperative Time to Union in Pediatric Patients with a Surgically Treated Fracture. JB JS Open Access 2023;8:e22.00137. [PMID: 37484901 PMCID: PMC10358791 DOI: 10.2106/jbjs.oa.22.00137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open

Abstract

Fractures account for 10% to 25% of all pediatric injuries, and surgical treatment is common. In such cases, postoperative healing can be affected by a number of factors, including those related to socioeconomic status (SES). The purpose of this study was to investigate the relationship between time to fracture union and SES, which was measured with use of the median household income (MHI) and Child Opportunity Index (COI).

Methods

A retrospective review was conducted of pediatric patients with a long-bone fracture that had been surgically treated at a Level-I pediatric trauma center between January 2010 and June 2020. Demographic and relevant medical data were collected. Patients were sorted into union and nonunion groups. The ZIP code of each patient was collected and the MHI and COI of that ZIP code were identified. Income brackets were created in increments of $10,000 ranging from $20,000 to $100,000, with an additional category of >$100,000, and patients were sorted into these groups according to MHI. Comparisons among the income groups and among the union status groups were conducted for each of the collected variables. A multiple regression analysis was utilized to determine the independent effect of each variable on time to union.

Results

A total of 395 patients were included in the final sample, of whom 51% identified as Hispanic. Patients in the union group had a higher mean COI and MHI. Nonunion occurred in only 8 patients. Patients who achieved fracture union in ≤4 months had a significantly higher mean COI and MHI. When controlling for other demographic variables, the time to union increased by a mean of 9.6 days for every $10,000 decrease in MHI and increased by a mean of 6.8 days for every 10-unit decrease in the COI.

Conclusions

The present study is the first, to our knowledge, to investigate the relationship between SES and time to fracture union in pediatric patients. When controlling for other demographic factors, we found a significant relationship between SES and time to union in pediatric patients with a surgically treated fracture. Further investigations of the relationship between SES and time to union in pediatric patients are needed to determine potential mechanisms for this relationship.

Level of Evidence

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Reeves PT, Kenny TM, Mulreany LT, McCown MY, Jacknewitz-Woolard JE, Rogers PL, Echelmeyer S, Welsh SK. Development and assessment of a low literacy, pictographic asthma action plan with clinical automation to enhance guideline-concordant care for children with asthma. J Asthma 2023;60:655-672. [PMID: 35658804 DOI: 10.1080/02770903.2022.2087188] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]

Abstract

OBJECTIVE

Asthma is characterized by reversible pulmonary symptoms, frequent hospitalizations, poor quality of life, and varied treatment. Parents with low health literacy (HL) is linked to poor asthma outcomes in children. Recent practice updates recommended inhaled corticosteroids for the management of persistent asthma, but guideline-concordant care is suboptimal. Our aim was to develop and assess an Asthma Action Plan (AAP) that could serve as an individualized plan for low HL families and facilitate guideline-concordant care for clinicians.

METHODS

We followed the National Institute of Health 5-step "Clear & Simple" approach to develop the Uniformed Services AAP. Our AAP included symptom pictographs (dyspnea, cough, sleep, activity) and guideline-concordant clinical automation tools. Caregivers assessed the pictograms for validity (transparency of ≥ 85%; translucency score ≥ 5; and ≥ 85% recall). Readability was assessed using 7 formulas. (<6th Grade was acceptable). Comprehensibility, design quality, and usefulness was assessed by caregivers using the Consumer Information Rating Form (CIRF) (>80% was acceptable). Understandability and actionability was assessed by medical librarians using the Patient Education Materials Assessment Tool-Printable (>80% was acceptable). Suitability was assessed by clinicians using the modified Suitability Assessment of Materials (SAM) instrument (>70% was superior).

RESULTS

All 12 pictograms were validated (N = 118 respondents). Readability demonstrated a 4th grade level. Overall CIRF percentile score = 80.4%. Understandability and Actionability = 100%. Suitability score = 75%.

CONCLUSIONS

Our AAP was formally endorsed by the Allergy & Asthma Network. The Uniformed Services AAP is a novel tool with embedded clinical automation that can address low HL and enhance guideline-concordant care.

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Ludden T, O’Hare K, Shade L, Reeves K, Patterson CG, Tapp H. Implementation of Coach McLungsSM into primary care using a cluster randomized stepped wedge trial design. BMC Med Inform Decis Mak 2022;22:285. [PMID: 36333727 PMCID: PMC9636750 DOI: 10.1186/s12911-022-02030-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022] Open

Abstract

Background

Asthma is a prevalent chronic disease that is difficult to manage and associated with marked disparities in outcomes. One promising approach to addressing disparities is shared decision making (SDM), a method by which the patient and provider cooperatively make a decision about asthma care. SDM is associated with improved outcomes for patients; however, time constraints and staff availability are noted implementation barriers. Use of health information technology (IT) solutions may facilitate the utilization of SDM. Coach McLungs^SM is a collaborative web-based application that involves pediatric patients, their caregivers, and providers in a personalized experience while gathering patient-reported data. Background logic provides decision support so both audiences can develop a well-informed treatment plan together. The goal of this study is to evaluate the implementation of the Coach McLungs^SM intervention into primary care.

Methods

Implementation will be evaluated using a stepped wedge randomized control study design at 21 pediatric and family medicine practices within a large, integrated, nonprofit healthcare system. We will measure changes in emergency department visits, hospitalizations, and oral steroid use, which serve as surrogate measures for patient-centered asthma outcomes. We will use a generalized linear mixed models with logit link to test the hypothesis for the reduction in exacerbation rates specifying the fixed effects of intervention and time and random effects for practice and practice*time. This design achieves 84% power to detect the hypothesized effect size difference of 10% in overall exacerbation between control (40%) and intervention (30%) periods (two-sided, p = 0.05). Implementation will be guided using the Expert Recommendations for Implementing Change (ERIC), a compilation of implementation strategies, and evaluated using the CFIR (Consolidated Framework for Implementation Research) and RE-AIM (Reach Effectiveness, Adoption, Implementation, Maintenance).

Discussion

We anticipate that a tailored implementation of Coach McLungs^SM across diverse primary care practices will lead to a decrease in emergency department visits, hospitalizations, and oral steroid use for patients in the intervention group as compared to the control condition.

Trial Registration: Clincaltrials.gov, NCT05059210. Registered 28 September 2021, https://www.clinicaltrials.gov/ct2/show/NCT05059210

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-022-02030-1.

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Okoro ON, Hillman LA, Cernasev A. Intersectional invisibility experiences of low-income African-American women in healthcare encounters. ETHNICITY & HEALTH 2022;27:1290-1309. [PMID: 33734922 DOI: 10.1080/13557858.2021.1899138] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 03/01/2021] [Indexed: 06/12/2023]

Assessing the Readability of Anesthesia-Related Patient Education Materials from Major Anesthesiology Organizations. BIOMED RESEARCH INTERNATIONAL 2022;2022:3284199. [PMID: 35872854 PMCID: PMC9300304 DOI: 10.1155/2022/3284199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/18/2022] [Accepted: 06/13/2022] [Indexed: 11/21/2022]

Larsen MH, Staalesen Strumse YA, Borge CR, Andersen MH, Wahl AK. Relevant associations between alexithymia and health-literacy in persons with psoriasis. J DERMATOL TREAT 2022;33:380-388. [PMID: 32286098 DOI: 10.1080/09546634.2020.1756204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]

Espinosa J, Raja S. Social Disparities in Benign Lung Diseases. Thorac Surg Clin 2022;32:43-49. [PMID: 34801194 PMCID: PMC9760325 DOI: 10.1016/j.thorsurg.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]

Håkansson KEJ, Backer V, Ulrik CS. Socioeconomic status is associated with healthcare seeking behaviour and disease burden in young adults with asthma - A nationwide cohort study. Chron Respir Dis 2022;19:14799731221117297. [PMID: 35938497 PMCID: PMC9364195 DOI: 10.1177/14799731221117297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open

Gupta K, Walton R, Ghani N, Vasudevan V. Multi-Dimensional Assessment and Interdisciplinary Care to Reduce Asthma Readmissions in Safety Net Hospitals. Respir Care 2021;66:1768-1776. [PMID: 34465573 PMCID: PMC9993546 DOI: 10.4187/respcare.08646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]

Schillinger D. Social Determinants, Health Literacy, and Disparities: Intersections and Controversies. Health Lit Res Pract 2021;5:e234-e243. [PMID: 34379549 PMCID: PMC8356483 DOI: 10.3928/24748307-20210712-01] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open

Caldwell EP, Killingsworth EE. The Online Use of the Newest Vital Sign in Adolescents. Clin Nurs Res 2021;31:55-59. [PMID: 34078117 DOI: 10.1177/10547738211021423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]

Dee EC, Lee G. Adverse Effects of Radiotherapy and Chemotherapy for Common Malignancies: What Is the Quality of Information Patients Are Finding Online? JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021;36:178-188. [PMID: 31485916 DOI: 10.1007/s13187-019-01614-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]

Caldwell EP, Melton K. Health Literacy of Adolescents. J Pediatr Nurs 2020;55:116-119. [PMID: 32949850 DOI: 10.1016/j.pedn.2020.08.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/25/2020] [Accepted: 08/29/2020] [Indexed: 10/23/2022]

Abstract

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.

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Dee EC, Varady NH. Radiation Oncology Online: Quality, Strategies, and Disparities. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020;35:988-996. [PMID: 31161582 DOI: 10.1007/s13187-019-01553-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]

Abstract

Although much is known about the quality of online health information (OHI) for many malignancies, the availability of high-quality OHI for oncologic treatments remains undefined. Furthermore, search strategies that improve quality of radiation oncology OHI, and disparities in availability of high-quality OHI, are not well-described. Forty phrases describing malignancies and their treatment modalities (radiation, chemotherapy, and surgery), and 57 phrases describing radiation oncology treatments, including abbreviations for some treatments and translations in different languages, were generated. The Health on the Net Foundation framework for assessing OHI quality was applied to the top 100 websites listed for each search phrase. The availability of high-quality OHI between malignancies and treatment modalities, and among treatment modalities, was compared. The roles of radiation oncology term abbreviation, search result order, patient gender, and language, on availability of high-quality OHI, were also assessed. Among the first 10, 20, and 50 websites for each search phrase, there were significantly more high-quality websites for phrases describing malignancies compared with respective treatment modalities (P < 0.02 for all). There were no differences among treatment modalities. Among radiation oncology treatment phrases, there were no significant differences between searches for full-name phrases and their respective abbreviations, though earlier results were more likely to be of high quality. Gender did not affect quality of OHI, though language did. Availability of high-quality OHI for cancer treatments lags behind that of cancer OHI. For radiation oncology treatment OHI, search strategies and patient disparities highlight potential areas for provider intervention and increased quality of OHI.

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Schillinger D. The Intersections Between Social Determinants of Health, Health Literacy, and Health Disparities. Stud Health Technol Inform 2020;269:22-41. [PMID: 32593981 DOI: 10.3233/shti200020] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]

Roychowdhury P, Badwal J, Alkhatib F, Singh DK, Lindenauer PK, Knee A, Lagu T. Spirometry Utilization Among Patients with Asthma. J Asthma Allergy 2020;13:193-203. [PMID: 32636652 PMCID: PMC7335289 DOI: 10.2147/jaa.s254431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/29/2020] [Indexed: 11/23/2022] Open

Stormacq C, Van den Broucke S, Wosinski J. Does health literacy mediate the relationship between socioeconomic status and health disparities? Integrative review. Health Promot Int 2020;34:e1-e17. [PMID: 30107564 DOI: 10.1093/heapro/day062] [Citation(s) in RCA: 367] [Impact Index Per Article: 91.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open

Klinker CD, Aaby A, Ringgaard LW, Hjort AV, Hawkins M, Maindal HT. Health Literacy is Associated with Health Behaviors in Students from Vocational Education and Training Schools: A Danish Population-Based Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020;17:ijerph17020671. [PMID: 31968667 PMCID: PMC7014204 DOI: 10.3390/ijerph17020671] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/17/2020] [Accepted: 01/19/2020] [Indexed: 01/16/2023]

Darling EK, Grenier L, Nussey L, Murray-Davis B, Hutton EK, Vanstone M. Access to midwifery care for people of low socio-economic status: a qualitative descriptive study. BMC Pregnancy Childbirth 2019;19:416. [PMID: 31718569 PMCID: PMC6849230 DOI: 10.1186/s12884-019-2577-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 10/31/2019] [Indexed: 11/25/2022] Open

Abstract

Background

Despite public funding of midwifery care, people of low-socioeconomic status are less likely to access midwifery care in Ontario, Canada, but little is known about barriers that they experience in accessing midwifery care. The purpose of this study was to examine the barriers and facilitators to accessing midwifery care experienced by people of low-socioeconomic status.

Methods

A qualitative descriptive study design was used. Semi-structured interviews were conducted with 30 pregnant and post-partum people of low-socioeconomic status in Hamilton, Ontario from January to May 2018. Transcribed interviews were coded using open coding techniques and thematically analyzed.

Results

We interviewed 13 midwifery care recipients and 17 participants who had never received care from midwives. Four themes arose from the interviews: “I had no idea…”, “Babies are born in hospitals”, “Physicians as gateways into prenatal care”, and “Why change a good thing?”. Participants who had not experienced midwifery care had minimal knowledge of midwifery and often had misconceptions about midwives’ scope of practice and education. Prevailing beliefs about pregnancy and birth, particularly concerns about safety, drove participants to seek care from a physician. Physicians are the entry point into the health care system for many, yet few participants received information about midwifery care from physicians. Participants who had experienced midwifery care found it to be an appropriate match for the needs of people of low socioeconomic status. Word of mouth was a primary source of information about midwifery and the most common reason for people unfamiliar with midwifery to seek midwifery care.

Conclusions

Access to midwifery care is constrained for people of low-socioeconomic status because lack of awareness about midwifery limits the approachability of these services, and because information about midwifery care is often not provided by physicians when pregnant people first contact the health care system. For people of low-socioeconomic status, inequitable access to midwifery care may be exacerbated by lack of knowledge about midwifery within social networks and a tendency to move passively through the health care system which traditionally favours physician care. Targeted efforts to address this issue are necessary to reduce disparities in access to midwifery care.

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Vaidya V, Gabriel MH, Patel P, Gupte R, James C. The impact of racial and ethnic disparities in inhaled corticosteroid adherence on healthcare expenditures in adults with asthma. Curr Med Res Opin 2019;35:1379-1385. [PMID: 30793988 DOI: 10.1080/03007995.2019.1586221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]

Baek J, Huang K, Conner L, Tapangan N, Xu X, Carrillo G. Effects of the home-based educational intervention on health outcomes among primarily Hispanic children with asthma: a quasi-experimental study. BMC Public Health 2019;19:912. [PMID: 31288792 PMCID: PMC6617892 DOI: 10.1186/s12889-019-7272-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/02/2019] [Indexed: 01/12/2023] Open

Abstract

BACKGROUND

Childhood asthma is a significant health issue with 8.3% prevalence in the U.S. Its prevalence is particularly higher among low-income communities in the Texas-Mexico border region, as they often lack access to clinical care and health insurance. This study examines the impact of a home-based education led by Community Health Workers (CHWs) on health outcomes for asthmatic, predominantly Hispanic children in these communities.

METHODS

The study was a quasi-experimental design to learn the effectiveness of the asthma home-based education by comparing changes of health outcomes between baseline and follow-up of intervention and control groups. This study enrolled 290 participants, consisting of 130 in the intervention group and 160 in the control group. The educational intervention led by the CHWs referenced the Asthma and Healthy Homes curriculum and contents of the Seven Principles of Healthy Homes. The multiple linear regression analysis was conducted to estimate the associations between the intervention and each health outcome.

RESULTS

When comparing the intervention group with the control group, the intervention group showed a significantly greater decrease in asthma attacks than the control group (p = 0.049). Although all of the five Children's Health Survey for Asthma (CHSA) scores showed significant improvements between baseline and follow-up in both groups, we found that increases of CHSA scores in the intervention group were higher than the control group except for emotional health of children (EC) score. The multiple linear regression models demonstrated that the mean changes in asthma attacks (p = 0.036) and emotional health of families (EF) score (p = 0.038) were significantly better in the intervention group than the control group, adjusting for children's age of diagnosis, household income, use of steroids, family history of allergy, and type of insurance.

CONCLUSIONS

This study concluded that the home-based education by CHWs effectively improve health outcomes among children in communities lacking access to medical resources. The findings suggest the importance of the home-based education program in promoting emotional and medical care for children and their families in low-income communities like those in the Texas-Mexico border region.

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Kumarihamy RMK, Tripathi NK. Geostatistical predictive modeling for asthma and chronic obstructive pulmonary disease using socioeconomic and environmental determinants. ENVIRONMENTAL MONITORING AND ASSESSMENT 2019;191:366. [PMID: 31254075 DOI: 10.1007/s10661-019-7417-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 03/20/2019] [Indexed: 06/09/2023]

Abstract

The spatial distribution of the prevalence of asthma and chronic obstructive pulmonary disease (COPD) remains under the influence of a wide array of environmental, climatic, and socioeconomic determinants. However, a large proportion of these influences remain unexplained. In completion, this study examined the spatial associations between asthma/COPD morbidity and their determinants using ordinary least squares (OLS) and geographically weighted regressions (GWR). Inpatient records collected from the secondary and tertiary care hospitals in Kandy from 2010 to 2014 were considered as the dependent variable. Potential risk factors (explanatory variables) were identified in four distinguished classes: 1) meteorological factors, (2) direct and indirect factors of air pollution, (3) socioeconomic factors, and (4) characteristics of the physical environment. All possible combinations of candidate explanatory variables were evaluated through an exploratory regression. A comparison between the regression models was also explored. The best OLS regression models revealed about 55% of asthma variation and 62% of COPD variation while GWR models yielded 78% and 74% of the variation of asthma and COPD occurrences respectively. Relative humidity, proximity to roads (0-200 m), road density, use of firewood as a source of fuel, and elevation play a vital role in predicting morbidity from asthma and COPD. Both local and global regression models are important in assessing spatial relationships of asthma and COPD. However, the local models exhibit a better prediction capability for assessing non-stationary relationships of asthma and COPD than global models. The geostatistical aspects used in this study may also provide insights for evaluating heterogeneous environmental risk factors in other epidemiological studies across different spatial settings.

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Gleeson PK, Perez L, Localio AR, Morales KH, Han X, Bryant-Stephens T, Apter AJ. Inhaler Technique in Low-Income, Inner-City Adults with Uncontrolled Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019;7:2683-2688. [PMID: 31173936 DOI: 10.1016/j.jaip.2019.05.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 05/21/2019] [Accepted: 05/24/2019] [Indexed: 01/22/2023]

Xie Y, Ma M, Zhang Y, Tan X. Factors associated with health literacy in rural areas of Central China: structural equation model. BMC Health Serv Res 2019;19:300. [PMID: 31077197 PMCID: PMC6509858 DOI: 10.1186/s12913-019-4094-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 04/12/2019] [Indexed: 11/23/2022] Open

Oh H, Stickley A, Singh F, Koyanagi A. Self-reported asthma diagnosis and mental health: Findings from the Collaborative Psychiatric Epidemiology Surveys. Psychiatry Res 2019;271:721-725. [PMID: 30791347 DOI: 10.1016/j.psychres.2018.12.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 12/27/2022]

Seibert RG, Winter MR, Cabral HJ, Wolf MS, Curtis LM, Paasche-Orlow MK. Health Literacy and Income Mediate Racial/Ethnic Asthma Disparities. Health Lit Res Pract 2019;3:e9-e18. [PMID: 31294300 PMCID: PMC6608912 DOI: 10.3928/24748307-20181113-01] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 07/12/2018] [Indexed: 12/29/2022] Open

Abstract

BACKGROUND

Health literacy and socioeconomic status (SES) are associated with both race/ethnicity and asthma outcomes. The extent to which health literacy and SES mediate racial/ethnic asthma disparities is less clear.

OBJECTIVE

To determine if health literacy and SES mediate racial/ethnic asthma disparities using advanced mediation analyses.

METHODS

A secondary analysis was performed using a Chicago-based longitudinal cohort study conducted from 2004 to 2007 involving 342 adults age 18 to 41 years with persistent asthma. Phone interviews were conducted every 3 months assessing asthma quality of life (AQOL; scored 1-7, with 7 being the highest) and asthma-related health care use measures. Structural equation models assessed mediation of race/ethnicity effects on AQOL and health care use through health literacy and SES. Covariates in the best-fit model included sex, year and season of interview, and cigarette smoking.

KEY RESULTS

The study sample was 77.8% female, 57.3% African American/non-Hispanic, and 28.7% Hispanic. Race/ethnicity was significantly associated with AQOL and asthma-related emergency department (ED) visits, but only indirectly, through the effects of health literacy and income. Compared with White/non-Hispanics, African American/non-Hispanics and Hispanics had significantly higher odds of low health literacy and lower income. Low health literacy was associated with significantly lower AQOL scores (β = -0.24, 95% confidence interval (CI) [-0.38, -0.10]) and higher odds of an ED visit (adjusted odds ratio = 1.24, 95% CI [1.07, 1.43]). Increasing income was associated with significantly higher AQOL scores (β = 0.18, 95% CI [0.08, 0.28]) and lower odds of an ED visit (adjusted odds ratio = 0.88, 95% CI [0.80, 0.97]).

CONCLUSIONS

The relationships between race/ethnicity and several asthma outcomes were mediated by health literacy and income. Interventions to improve racial/ethnic asthma disparities should target health literacy and income barriers. [HLRP: Health Literacy Research and Practice. 2019;3(1):e9-e18.].

PLAIN LANGUAGE SUMMARY

Using advanced statistical methods, this study suggests racial/ethnic differences in several asthma outcomes are largely due to effects of health literacy and income. Interventions to improve racial/ethnic asthma disparities should target health literacy and income barriers.

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Bourne A, Peerbux S, Jessup R, Staples M, Beauchamp A, Buchbinder R. Health literacy profile of recently hospitalised patients in the private hospital setting: a cross sectional survey using the Health Literacy Questionnaire (HLQ). BMC Health Serv Res 2018;18:877. [PMID: 30458773 PMCID: PMC6247774 DOI: 10.1186/s12913-018-3697-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/08/2018] [Indexed: 11/26/2022] Open

Abstract

Background

Health service providers should understand and attend to the health literacy needs of their population in view of the known association between low health literacy and poorer health outcomes. This study aimed to determine the health literacy profile of patients treated at a large private hospital in Melbourne, Australia, and any associations between this profile and socio-economic position, health behaviours, health status and use of hospital services.

Methods

A mailed survey was sent to 9173 people aged ≥18 years with a hospital admission between February and October 2014. It included the Health Literacy Questionnaire (HLQ), a multidimensional tool comprising nine independent scales, and socio-demographic and clinical questions. For both respondents and non-respondents, we also extracted residential postcode and admission and follow up details from the Patient Administrative Services database. Differences in demographic, socio-economic and hospital use patterns between respondents and non-respondents were analysed using descriptive statistics. Regression-tests were used to identify differences in health literacy between socio-economic subgroups, with the magnitude of these differences determined using Cohen’s d effect sizes.

Results

There were 3121 respondents (response rate: 35% excluding 154 returned invitations), the majority born in Australia (74.6%) and living in areas of high socio-economic advantage. Respondents were slightly older than non-respondents (mean (SD) age 65.6 (17.0) versus 60.6 (20.8) years) and included proportionately less females (51.9 versus 59.1%) but were similar with regard to other socio-demographic factors and health service use. Participants who did not speak English at home, reported lower scores across several HLQ scales, including those that measure health provider support and engagement. Those who smoked and reported low physical activity had lower scores for actively managing their health. No relationship was seen between HLQ scale scores and use of hospital services.

Conclusions

Based upon the health literacy profile of a large cohort of patients attending a large private hospital, we found no relationship between HLQ scale scores and use of hospital services. However we did identify significant health literacy needs particularly among patients whose primary language at home was not English and patients needing assistance completing the survey. Identifying ways of addressing these needs may improve patient outcomes.

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Affiliation(s)

Allison Bourne Monash Department of Clinical Epidemiology, Cabrini Institute, 4 Drysdale Street, Malvern, VIC, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, Australia
Shehzaad Peerbux Monash Department of Clinical Epidemiology, Cabrini Institute, 4 Drysdale Street, Malvern, VIC, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, Australia
Rebecca Jessup Monash Department of Clinical Epidemiology, Cabrini Institute, 4 Drysdale Street, Malvern, VIC, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, Australia
Margaret Staples Monash Department of Clinical Epidemiology, Cabrini Institute, 4 Drysdale Street, Malvern, VIC, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, Australia
Alison Beauchamp Department of Medicine, Western Health, The University of Melbourne, Sunshine Hospital, Level 3, 176 Furlong Road, WCHRE Building, St Albans, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Sunshine Hospital, Level 3, 176 Furlong Road, WCHRE Building, St Albans, VIC, Australia.,Health Systems Improvement Unit, Deakin University, 221 Burwood Highway, Burwood, VIC, Australia
Rachelle Buchbinder Monash Department of Clinical Epidemiology, Cabrini Institute, 4 Drysdale Street, Malvern, VIC, Australia. .,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, Australia.

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Kwa MC, Silverberg JI, Ardalan K. Inpatient burden of juvenile dermatomyositis among children in the United States. Pediatr Rheumatol Online J 2018;16:70. [PMID: 30424778 PMCID: PMC6234588 DOI: 10.1186/s12969-018-0286-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/29/2018] [Indexed: 11/24/2022] Open

Abstract

BACKGROUND

Juvenile dermatomyositis (JDM) is a rare autoimmune disease that causes significant morbidity and quality of life impairment. Little is known about the inpatient burden of JDM in the US. Our goal was to determine the prevalence and risk factors for hospitalization with juvenile dermatomyositis and assess inpatient burden of JDM.

METHODS

Data on 14,401,668 pediatric hospitalizations from the 2002-2012 Nationwide Inpatient Sample (NIS) was analyzed. ICD-9-CM coding was used to identify hospitalizations with a diagnosis of JDM.

RESULTS

There were 909 and 495 weighted admissions with a primary or secondary diagnosis of JDM, respectively. In multivariable logistic regression models with stepwise selection, female sex (logistic regression; adjusted odds ratio [95% confidence interval]) (2.22 [2.05-2.42]), non-winter season (fall: 1.18[1.06-1.33]; spring (1.13 [1.01-1.27]; summer (1.53 [1.37-1.71]), non-Medicaid administered government insurance coverage (2.59 [2.26-2.97]), and multiple chronic conditions (2-5: 1.41[1.30-1.54]; 6+: 1.24[1.00-1.52]) were all associated with higher rates of hospitalization for JDM. The weighted total length of stay (LOS) and inflation-adjusted cost of care for patients with a primary inpatient diagnosis of JDM was 19,159 days and $49,339,995 with geometric means [95% CI] of 2.50 [2.27-2.76] days and $7350 [$6228-$8674], respectively. Costs of hospitalization in primary JDM and length of stay and cost in secondary JDM were significantly higher compared to those without JDM. Notably, race/ethnicity was associated with increased LOS (log-linear regression; adjusted beta [95% confidence interval]) (Hispanic: 0.28 [0.14-0.41]; other non-white: 0.59 [0.31-0.86]) and cost of care (Hispanic: 0.30 [0.05-0.55]).

CONCLUSION

JDM contributes to both increased length of hospitalization and inpatient cost of care. Non-Medicaid government insurance was associated with higher rates of hospitalization for JDM while Hispanic and other non-white racial/ethnic groups demonstrated increased LOS and cost of care.

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Zheng M, Jin H, Shi N, Duan C, Wang D, Yu X, Li X. The relationship between health literacy and quality of life: a systematic review and meta-analysis. Health Qual Life Outcomes 2018;16:201. [PMID: 30326903 PMCID: PMC6192335 DOI: 10.1186/s12955-018-1031-7] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 10/08/2018] [Indexed: 12/19/2022] Open

Abstract

Background

Low health literacy often has an association with poor health outcomes such as low levels of self-efficacy, increased mortality, poor health status and reduced quality of life (QOL). The aim of the study was to quantitatively evaluate the relationship between health literacy (HL) and QOL based on a systematic review and meta-analysis.

Methods

EMBASE, PubMed, Web of Science, Elsevier, Cochrane Library, and Chinese electronic databases such as CNKI, and Wanfang were searched from 1970 until February 1, 2018. The pooled correlation coefficient (PCOR) and its 95% confidence interval (CI) between HL and QOL were estimated using R software. Potential sources of heterogeneity were explored using subgroup analysis, sensitivity analysis, and meta-regression.

Results

Twenty-three studies, with a total of 12,303 subjects,were included. The PCOR between HL and QOL was 0.35 (95%CI: 0.25–0.44). Considering different dimensions of HL, the PCOR between QOL and health knowledge, health behavior, health belief, and health skill were 0.36 (95% CI: 0.04–0.61), 0.36 (95%CI: 0.13–0.55), 0.39 (95%CI: 0.10–0.62), and 0.42 (95%CI: 0.03–0.69), respectively. The PCOR between HL and the two dimensions of QOL was lower than the total PCOR between HL and QOL. In subgroup analysis, the PCOR between HL and QOL was 0.46 (95%CI: 0.13, 0.69) among community residents, 0.45 (95%CI: 0.27, 0.61) in China, and 0.45 (95%CI: 0.24, 0.62) based on cohort studies. Sensitivity analyses showed that the stability of results had no significant after excluding the study (p < 0.001). Meta-regression showed that cohort study design, studies conducted in China, and publication before 2012 may be important influencing factors.

Conclusions

Health literacy was moderately correlated with quality of life, but this finding needs to be supported by more evidence.

Electronic supplementary material

The online version of this article (10.1186/s12955-018-1031-7) contains supplementary material, which is available to authorized users.

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Improving Health Literacy. The New American Thoracic Society Guidelines for Patient Education Materials. Ann Am Thorac Soc 2018;13:1208-11. [PMID: 27509148 DOI: 10.1513/annalsats.201605-337ot] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open

Abousayed MM, Tartaglion JP, Zonshayn S, Rai N, Johnson CK, Rosenbaum AJ. Online Patient Resources for Ankle Instability. FOOT & ANKLE ORTHOPAEDICS 2018. [DOI: 10.1177/2473011418782492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open

Abstract Background: The Internet has drastically changed how patients access health-related information. There are several ways the public can access online health-related information such as search engines, blogs, support groups, and webinars. A recent study found that 45% of orthopedic patients searched for information online regarding their injury. Also, 78% believed they had better understanding of their condition after visiting these websites; furthermore, 41% felt the Internet supplied them with questions and concerns to discuss with their physicians. The aim of our study is to evaluate the accuracy, quality, and readability of online available information using the search terms “ankle sprain” and “ankle instability.” Methods: Three search engines (Google, Bing, and Yahoo) were used to search for the terms “ankle sprain” and “ankle instability.” The first 25 websites from each search were collected. Each website was assessed for quality, accuracy, and readability by 3 orthopedic residents blinded to the search term used. Websites were also evaluated for commercial bias and whether written by physicians or not. Results: Twenty sites were identified using Google, 14 using Bing, and 3 using Yahoo while the remaining 19 appeared in multiple search engines. Sixty-nine percent of the websites (39/56) were written by physicians whereas only 21% (12/56) were associated with commercial bias. The mean quality and accuracy of the websites written above a seventh-grade level was statistically significantly higher than those at or below a seventh-grade level ( P = .01). The mean accuracy of websites written by physicians was not statistically different from those not written by physicians ( P = .055). Conclusion: The current study highlights the poor quality and accuracy of online information related to ankle sprains, especially those with commercial bias. Furthermore, although websites written by or under supervision of physicians were found to be of superior quality, a majority of sites were found to have an unacceptably high reading level. Level of Evidence: Level IV, case series. Collapse

Chan HW, Russell AM, Smith MY. What is the quality of drug safety information for patients: An analysis of REMS educational materials. Pharmacoepidemiol Drug Saf 2018;27:969-978. [PMID: 30003610 PMCID: PMC6646909 DOI: 10.1002/pds.4614] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 04/05/2018] [Accepted: 06/11/2018] [Indexed: 11/24/2022]

Abstract

Background

Poor‐quality patient drug information has been identified as a major cause of preventable medication errors in the United States. The US Food and Drug Administration (FDA) has the authority to require marketing authorization holders of medicinal products to implement risk evaluation and mitigation strategies (REMS) to ensure that the benefits of a drug or biological product outweigh its risks. Aside from medication guides, no research has been conducted to assess the quality of patient‐targeted REMS materials, including whether, and to what extent, patients find these materials understandable and actionable.

Purpose

To describe the readability, understandability, and actionability of patient educational materials in currently approved REMS programs, and to highlight opportunities for improving both the quality and effectiveness of these important drug safety tools.

Methods

Seventy‐seven REMS programs were identified from the FDA REMS database. We excluded medication guides (MGs) from our analysis because of the fact that there is a mandatory MG template. Based on this, we identified a total of 27 (non‐MG) REMS patient materials on the FDA REMS website for analysis purposes. The materials were tested for readability using the Lexile Measure, the Gunning Fog Index, and Flesch Kincaid and then assessed using the Patient Education Materials Assessment Tool for printable materials, for understandability and actionability.

Results

Twenty‐three of 77 (30%) REMS programs used educational materials to communicate serious risks to patients, yielding a total of 27 REMS patient materials for analysis. The median readability score for these materials was at a ninth‐grade reading level or higher. While most (89%) of these patient education materials met established criteria for being understandable, less than half (49%) were deemed actionable.

Discussion

Currently approved REMS patient materials fell short in terms of recommended reading level, and over half did not meet recommended standards for actionability. Developers of these materials should apply plain language principles when design these materials to improve their readability and to assess both understandability and actionability in order to increase the effectiveness when distributed to patients.

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The Relationship between Health Literacy and General Health Level of Hemodialysis Patients: A Case Study in Iran. Nephrourol Mon 2018. [DOI: 10.5812/numonthly.66034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open

Predictors of Hospitalization, Length of Stay, and Costs of Care Among Adult and Pediatric Inpatients With Atopic Dermatitis in the United States. Dermatitis 2018;29:22-31. [DOI: 10.1097/der.0000000000000323] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]

Washington DM, Curtis LM, Waite K, Wolf MS, Paasche-Orlow MK. Sociodemographic Factors Mediate Race and Ethnicity-associated Childhood Asthma Health Disparities: a Longitudinal Analysis. J Racial Ethn Health Disparities 2017;5:928-938. [PMID: 29188553 DOI: 10.1007/s40615-017-0441-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 10/05/2017] [Accepted: 10/09/2017] [Indexed: 11/24/2022]

Abstract

BACKGROUND

Race and ethnicity-based disparities in childhood asthma are well established. We characterized the longitudinal effects associated with being African-American/Black or Hispanic/Latino on a range of asthma outcomes, and the extent to which sociodemographic factors, caregiver health literacy, education level, and asthma knowledge mediate these associations.

METHODS

Children ages 8-15 and their caregivers (n = 544) in the Chicago Initiative to Raise Asthma Health Equity (CHIRAH) cohort completed interviews every 3 months for 1.5 years. Health literacy was measured with the Rapid Estimate of Adult Literacy in Medicine (REALM). Other covariates include sex, age, education level, income, smoke exposure, asthma duration, employment status, and insurance status. We conducted a series of models to evaluate these factors as mediators of the relationship between race/ethnicity and (1) asthma knowledge, (2) asthma-related quality of life, (3) asthma severity, and (4) asthma control based on NAEPP/EPR-3 2007 guidelines.

RESULTS

African-American race and Hispanic/Latino ethnicity were significantly associated with all outcomes when compared to Whites. Adjusting for sociodemographic factors resulted in the most significant mediation of racial/ethnic disparities in all outcomes. Health literacy was a partial mediator of race/ethnic disparities in asthma knowledge and asthma-related quality of life. Asthma knowledge remained significantly associated with race and ethnicity, and race remained associated with asthma-related quality of life.

CONCLUSIONS

African-American race and Hispanic/Latino ethnicity are significantly associated with worse asthma compared to Whites in longitudinal analyses. Sociodemographic factors are potent mediators of these disparities, and should be considered when designing interventions to reduce asthma disparities. Health literacy and education level are partial mediators.

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Readability assessment of online patient education materials provided by the European Association of Urology. Int Urol Nephrol 2017;49:2111-2117. [PMID: 28905177 DOI: 10.1007/s11255-017-1695-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]

Kwa MC, Ardalan K, Laumann AE, Silverberg JI. Predictors of Hospitalization, Length of Stay, and Cost of Care Among Adults With Dermatomyositis in the United States. Arthritis Care Res (Hoboken) 2017;69:1391-1399. [PMID: 28556622 DOI: 10.1002/acr.23190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 01/05/2017] [Accepted: 01/10/2017] [Indexed: 12/21/2022]

Abstract

OBJECTIVE

To determine the prevalence and risk factors for hospitalization with dermatomyositis and assess inpatient burden of dermatomyositis.

METHODS

Data on 72,651,487 hospitalizations from the 2002-2012 Nationwide Inpatient Sample, a 20% stratified sample of all acute-care hospitalizations in the US, were analyzed. International Classification of Diseases, Ninth Revision, Clinical Modification coding was used to identify hospitalizations with a diagnosis of dermatomyositis.

RESULTS

There were 9,687 and 43,188 weighted admissions with a primary or secondary diagnosis of dermatomyositis, respectively. In multivariable logistic regression models with stepwise selection, female sex (logistic regression: adjusted odds ratio 2.05 [95% confidence interval (95% CI) 1.80, 2.34]), nonwhite race (African American: 1.68 [1.57, 1.79]; Hispanic: 2.38 [2.22, 2.55]; Asian: 1.54 [1.32, 1.81]; and multiracial/other: 1.65 [1.45, 1.88]), and multiple chronic conditions (2-5: 2.39 [2.20, 2.60] and ≥6: 2.80 [2.56, 3.07]) were all associated with higher rates of hospitalization for dermatomyositis. The weighted total length of stay (LOS) and inflation-adjusted cost of care for patients with a primary inpatient diagnosis of dermatomyositis was 80,686 days and $168,076,970, with geometric means of 5.38 (95% CI 5.08, 5.71) and $11,682 (95% CI $11,013, $12,392), respectively. LOS and costs of hospitalization were significantly higher in patients with dermatomyositis compared to those without. Notably, race/ethnicity was associated with increased LOS (log-linear regression: adjusted β [95% CI] for African American: 0.14 [0.04, 0.25] and Asian: 0.38 [0.22, 0.55]) and cost of care (Asian: 0.51 [0.36, 0.67]).

CONCLUSION

There is a significant and increasing inpatient burden for dermatomyositis in the US. There appear to be racial differences, as nonwhites have higher prevalence of admission, increased LOS, and cost of care.

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Vargas CR, Ricci JA, Lee M, Tobias AM, Medalie DA, Lee BT. The accessibility, readability, and quality of online resources for gender affirming surgery. J Surg Res 2017;217:198-206. [PMID: 28587891 DOI: 10.1016/j.jss.2017.05.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/15/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]

Abstract

BACKGROUND

The transgender population is disproportionally affected by health disparities related to access to care. In many communities, transgender specialists are geographically distant and locally available medical professionals may be unfamiliar with unique needs of transgender patients. As a result, use of Internet resources for information about gender affirming surgery is particularly important. This study simulates a patient search for online educational material about gender affirming surgery and evaluates the accessibility, readability, and quality of the information.

METHODS

An Internet search for the term "transgender surgery" was performed, and the first 10 relevant hits were identified. Readability was assessed using 10 established tests: Coleman-Liau, Flesch-Kincaid, FORCAST, Fry, Gunning Fog, New Dale-Chall, New Fog Count, Raygor Estimate, Simple Measure of Gobbledygook, and Flesch Reading Ease. Quality was assessed using Journal of the American Medical Association criteria and the DISCERN instrument.

RESULTS

Review of 69 results was required to identify 10 sites with relevant patient information. There were 97 articles collected; overall mean reading level was 14.7. Individual Web site reading levels ranged from 12.0 to 17.5. All articles and Web sites exceeded the recommended sixth grade level. Quality ranged from 0 to 4 (Journal of the American Medical Association) and 35 to 79 (DISCERN) across Web sites.

CONCLUSIONS

Web sites with relevant patient information about gender affirming surgery were difficult to identify from search results. The content of these sites universally exceeded the recommended reading level. A wide range of Web site quality was noted, and this may further complicate successful navigation. Barriers in access to appropriately written patient information on the Internet may contribute to disparities in referral, involvement, satisfaction, and outcomes.

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Mantwill S, Schulz PJ. Does acculturation narrow the health literacy gap between immigrants and non-immigrants-An explorative study. PATIENT EDUCATION AND COUNSELING 2017;100:760-767. [PMID: 27856066 DOI: 10.1016/j.pec.2016.10.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 09/22/2016] [Accepted: 10/22/2016] [Indexed: 06/06/2023]

Rayess H, Zuliani GF, Gupta A, Svider PF, Folbe AJ, Eloy JA, Carron MA. Critical Analysis of the Quality, Readability, and Technical Aspects of Online Information Provided for Neck‐Lifts. JAMA FACIAL PLAST SU 2017;19:115-120. [DOI: 10.1001/jamafacial.2016.1219] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]

McRoy L, Rust G, Xu J. Factors Associated with Asthma ED Visit Rates among Medicaid-enrolled Children: A Structural Equation Modeling Approach. AIMS MEDICAL SCIENCE 2017;4:71-82. [PMID: 30519630 PMCID: PMC6277032 DOI: 10.3934/medsci.2017.1.71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open

Valerio MA, Peterson EL, Wittich AR, Joseph CLM. Examining health literacy among urban African-American adolescents with asthma. J Asthma 2016;53:1041-7. [PMID: 27359106 PMCID: PMC5056364 DOI: 10.1080/02770903.2016.1175473] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 03/31/2016] [Accepted: 04/03/2016] [Indexed: 10/21/2022]