Are childhood factors predictive of adult health literacy? A longitudinal birth cohort analysis

Health literacy (HL), defined as the ability of an individual to understand and appraise health information to make informed decisions on their health, helps maintain and improve one's health and thus reduce the use of healthcare services. There is a recognised global effort to address insufficient HL in early life and understand how HL develops. This study examined the association of a range of factors including educational, speech and language ability, health and healthcare engagement, sleep problems, mental health, demographic, environmental, and maternal factors at different childhood stages (from 5 years to 11 years) with later adult HL at age 25. HL was measured using a HL ordinal score (insufficient, limited, or sufficient) derived from the European Literacy Survey Questionnaire-short version (HLS-EU-Q16) within a large UK based birth cohort (Avon Longitudinal Study of Parents and Children: ALSPAC study). Univariate proportional odds logistic regression models for the probability of having higher levels of HL were developed. Results of analysis of 4248 participants showed that poorer speech and language ability (aged 9 years, OR 0.18 95% CI 0.04 to 0.78), internalising in child (age 11 years, OR 0.62 95% CI 0.5 to 0.78), child depression (age 9 years, OR 0.67 95% CI 0.52 to 0.86), and the presence of maternal depression (child age 5, OR 0.80 95% CI 0.66 to 0.96), reduced the odds of sufficient HL when adult. Our results suggest some useful markers to identify children at potential risk of low HL that could be targeted for research into future interventions within school settings, for example, child's speech and language capability. In addition, this study identified child and maternal mental health as factors associated with later development of limited HL and future research should consider what potential mechanisms might explain this link.

Health literacy policy to promote public health in Europe

Background

Health literacy is gaining increasing attention as a means of promoting individual- community- and population-level health, and is key to delivery of the European Health 2020 policy. European policy frameworks promote a holistic approach to policy at multiple levels in society and across multiple arenas in every-day life.

Methods

An evidence synthesis was undertaken to describe health literacy policies in the WHO European Region: their distribution, organizational levels, antecedents, actors, activities and outcomes, along with the factors influencing their effectiveness. Evidence was obtained by a scoping review of academic literature in English, Dutch and German and of grey literature in English, Dutch, German and Italian, supported by a Region-wide expert enquiry. Emerging findings were presented to representatives from 19 Member States of the Region to check for accuracy and omissions.

Results

The report highlights much good health literacy policy-related activity, mostly in the health and education sectors. Fewer policy-related activities were identified in other areas, such as the lived environment, employment, the media, and digital health. Robust evaluation of policy-related activities was identified in some, but not all, policies.

Conclusions

Suggestions are made for policy-makers to share good health literacy policy practice, and to further develop policy aims and activities across all societal areas. An additional need is the development of robust health literacy metrics to direct resources and monitor the effectiveness of policy activities.

Nonlinear Waves in the Terrestrial Quasiparallel Foreshock

We provide strongly conclusive evidence that the cubic nonlinearity plays an important part in the evolution of the large amplitude magnetic structures in the terrestrial foreshock. Large amplitude nonlinear wave trains at frequencies above the proton cyclotron frequency are identified after nonharmonic slow variations are filtered out by applying the empirical mode decomposition. Numerical solutions of the derivative nonlinear Schrödinger equation, predicted analytically by the use of a pseudopotential approach, are found to be consistent with the observed wave forms. The approximate phase speed of these nonlinear waves, indicated by the parameters of numerical solutions, is of the order of the local Alfvén speed. We suggest that the feedback of the large amplitude fluctuations on background plasma is reflected in the evolution of the pseudopotential.

Si1-x Ge x /Si Interface Profiles Measured to Sub-Nanometer Precision Using uleSIMS Energy Sequencing

The utility of energy sequencing for extracting an accurate matrix level interface profile using ultra-low energy SIMS (uleSIMS) is reported. Normally incident O2 (+) over an energy range of 0.25-2.5 keV were used to probe the interface between Si0.73Ge0.27/Si, which was also studied using high angle annular dark field scanning transmission electron microscopy (HAADF-STEM). All the SIMS profiles were linearized by taking the well understood matrix effects on ion yield and erosion rate into account. A method based on simultaneous fitting of the SIMS profiles measured at different energies is presented, which allows the intrinsic sample profile to be determined to sub-nanometer precision. Excellent agreement was found between the directly imaged HAADF-STEM interface and that derived from SIMS. Graphical Abstract ᅟ.

Why some adults with intellectual disability consult their general practitioner more than others

BACKGROUND

This research identifies factors affecting why some adults with intellectual disability (AWIDs) consult their general practitioner (GP) more than others. Little is known about these factors, despite AWIDs having higher health needs and reduced longevity. Current barriers to accessing health care need to be understood and overcome to achieve improved health outcomes.

METHODS

A secondary analysis of data obtained from a stratified randomised sample of AWIDs participating in a cluster randomised trial of hand held health records. The number of GP consultations was obtained retrospectively for the year preceding initial health interviews from GP records. AWIDs and their carers were given separate health interviews using identical/adapted questions where possible.

RESULTS

Two hundred and one AWIDs and or their carers from 40 practices participated (response rate 64.6%) with GP consultation data extracted for 187 AWIDs. Overall consulting levels were low, 3.2 per annum for women and 2.2 for men. Increased age, gender (women) and type of carer (paid) were all significantly associated with increased consultations. Carers reporting health problems, medications reported by AWIDs, medications recorded in GP records, and pain reported by AWIDs were also significant factors affecting consultations to GP practices after adjustment for age and type of carer.

CONCLUSIONS

Overall consultation rates were lower than expected, and affected by age, gender and type of carer. Targeted interventions are needed to improve attendance and promote health.

Effects of allergen and trigger factor avoidance advice in primary care on asthma control: a randomized-controlled trial

BACKGROUND

Allergy contributes significantly to asthma exacerbation, yet avoidance of triggers, in particular allergens, is rarely addressed in detail in regular asthma review in primary care.

OBJECTIVE

To determine whether structured, individually tailored allergen and trigger avoidance advice, given as part of a primary care asthma review, improves lung function and asthma control.

METHODS

In a randomized-controlled trial 214 adults with asthma in six general practices were either offered usual care during a primary care asthma review or usual care with additional allergen and trigger identification (by skin prick testing and structured allergy assessment) and avoidance advice according to a standardized protocol by trained practice nurses. Main outcome measures were lung function, asthma control, asthma self-efficacy.

RESULTS

Both intervention groups were equivalent in demographic and asthma-related variables at baseline. At 3-6-month follow-up, patients receiving the allergen and trigger avoidance review showed significant improvements in lung function (assessed by blinded research nurses) compared with those receiving usual care. Significantly more patients in the intervention group than in the control group showed improvements in forced expiratory volume in 1 s > or =15%. No significant differences were found in self-report measures of asthma control. Asthma-specific self-efficacy improved in both groups but did not differ between groups.

CONCLUSIONS

Allergen and trigger identification and avoidance advice, given as part of a structured asthma review delivered in primary care by nurses results in clinically important improvements in lung function but not self-report of asthma control.

TRIAL REGISTRATION

ISRCTN45684820.

Analytically solvable model of nonlinear oscillations in a cold but viscous and resistive plasma

A method for solving model nonlinear equations describing plasma oscillations in the presence of viscosity and resistivity is given. By first going to the Lagrangian variables and then transforming the space variable conveniently, the solution in parametric form is obtained. It involves simple elementary functions. Our solution includes all known exact solutions for an ideal cold plasma and a large class of new ones for a more realistic plasma. A new nonlinear effect is found of splitting of the largest density maximum, with a saddle point between the peaks so obtained. The method may sometimes be useful where inverse scattering fails.

Late skin flap failure following cochlear implantation

The objective of the study was to determine risk factors for late skin flap failure following cochlear implantation. The study design was a retrospective case series. Data were collated from 371 implanted patients over a ten-year period. Of these patients, 1.3 per cent (n = 5) developed late skin flap failure. It is concluded that skin flap failure is a significant, though relatively uncommon, complication of cochlear implant surgery. What causes flap failure and why it should occur in such a variable fashion are still largely unknown, though infection undoubtedly plays an important role. The aetiological factors associated with flap failure and possible prevention strategies are discussed.

Validation of a health literacy screening tool (REALM) in a UK population with coronary heart disease

BACKGROUND

Health literacy (HL) has been recognized as an important public health issue in other developed countries such as the US. There is currently no HL screening tool valid for use in the UK. This study aimed to validate a US-developed HL screening tool (the Rapid Estimate for Adult Literacy in Medicine; REALM) for use in the UK against the UK's general literacy screening tool (the Basic Skills Agency Initial Assessment Test, BSAIT).

METHODS

A cross-sectional survey involving 300 adult patients admitted to hospital for investigation of coronary heart disease were given the REALM and BSAIT tools to complete as well as specific questions considered likely to predict HL. These questions relate to the difficulty in understanding medical information, medical forms or instructions on tablets, frequency of reading books and whether the participant's job involves reading.

RESULTS

The REALM was significantly correlated with the BSAIT (r = 0.70; P < 0.001), and significantly related to seven of the eight questions likely to be predictive of HL.

CONCLUSIONS

This study has shown that the REALM has face, criterion and construct validity for use as an HL screening tool in the UK, in research and in everyday clinical practice. Further studies are needed to assess the prevalence of low HL in a wider population and to explore the links that may exist between low HL and poor health in the UK.

Social deprivation and statin prescribing: a cross-sectional analysis using data from the new UK general practitioner ‘Quality and Outcomes Framework’

We aimed to study the relationship between the prescribing of lipid-lowering medication, social deprivation and other general practice characteristics. We conducted a cross-sectional survey of all general practices in England, 2004-05. For each practice, the following variables were obtained: standardized cost and volume data for lipid-lowering medication, descriptors of general practices, Index of Multiple Deprivation, 2004, ethnicity data from the 2001 Census and Quality and Outcomes Framework data. A regression model was constructed which explained 34.5% of the variation in statin prescribing by general practitioners. The most powerful predictors were higher social deprivation, higher prevalence of coronary heart disease and achievement of cholesterol targets for diabetics. Negative regression coefficients were demonstrated for the proportion of elderly patients in the practice and, to a lesser extent, for the proportion of south Asian and Afro-Caribbean patients. In conclusion, contrary to previous local studies, we found that statin prescribing was higher in more deprived communities, even after adjustment for increased disease prevalence and practice variables associated with deprivation. Statin prescribing was also independently associated with success at achieving cholesterol targets in established disease (secondary prevention). However, our findings suggest under-prescribing of statins to the elderly and possibly also to ethnic minorities.

Ethnicity recording in general practice computer systems

BACKGROUND

Ethnicity data in general practice (GP) computerized medical records can be utilized to audit equity in health care.

METHODS

We evaluated a patient profiling project targeted to improve ethnicity recording.

RESULTS

Data extracted from 16 practices showed an increase in ethnicity recording from <1% before the intervention to 48% after. Recorded codes could be mapped onto the basic national statistics six-category ethnicity classification headings, and their proportions were similar to the 2001 census values.

CONCLUSION

Recording of data using multiple coding hierarchies has reduced the utility of data as clinically important ethnic subgroups cannot be identified. Practitioners should be encouraged to use the single recommended ethnicity coding hierarchy.

Swallowing dysfunction in patients with unilateral vocal fold paralysis: aetiology and outcomes

Although unilateral vocal fold palsy (UVFP) is a common problem, data relating to swallowing dysfunction are sparse. We reviewed the clinical findings (method of presentation, underlying diagnosis and position of the vocal folds) of 30 patients and conducted a follow-up telephone survey. Outcome measures used were direct visualization of fold function, position and compensation. In addition, standardized speech and language assessments for swallowing dysfunction and dysphonia were noted and compared to presentation. Our study indicates that 56 per cent of patients with UVFP have associated dysphagia. Outcome with speech therapy is significant, with 73 per cent showing improvement. These data indicate a significant link between UVFP and swallowing dysfunction. There is a marked therapeutic benefit from voice therapy. Further work is required to evaluate the long-term outcomes and establish the mechanism of swallowing dysfunction in these patients.

Do primary care professionals work as a team: a qualitative study

Teamworking is a vital element in the delivery of primary healthcare. There is evidence that well organised multidisciplinary teams are more effective in developing quality of care. Personal Medical Services (PMS) is a health reform that allows general practices more autonomy and flexibility in delivering quality based primary care. Practices in the locality where this study was conducted were offered resources to employ additional staff. Such arrangements provided the opportunity to expand and develop Primary Care Teams. In this qualitative study, semi-structured interviews were conducted with primary care professionals in 21 second wave PMS practices. Some participants felt they had used PMS to build their teams and develop quality based patient care. For other practices teamworking was limited by the absence of a common goal, recruitment difficulties, inadequate communication and hierarchical structures, and prevented practices from moving forward with clear direction. The study indicates that changing the contractual arrangements does not necessarily improve teamworking. It highlights the need for more sustained educational and quality improvement initiatives to encourage greater collaboration and understanding between healthcare professionals.

Stability analysis of three-dimensional breather solitons in a Bose–Einstein condensate

We investigated the stability properties of breather soliton trains in a three-dimensional Bose–Einstein condensate (BEC) with Feshbach-resonance management of the scattering length. This is done so as to generate both attractive and repulsive interaction. The condensate is confined only by a one-dimensional optical lattice and we consider strong, moderate and weak confinement. By strong confinement we mean a situation in which a quasi two-dimensional soliton is created. Moderate confinement admits a fully three-dimensional soliton. Weak confinement allows individual solitons to interact. Stability properties are investigated by several theoretical methods such as a variational analysis, treatment of motion in effective potential wells, and collapse dynamics. Armed with all the information forthcoming from these methods, we then undertake a numerical calculation. Our theoretical predictions are fully confirmed, perhaps to a higher degree than expected. We compare regions of stability in parameter space obtained from a fully three-dimensional analysis with those from a quasi two-dimensional treatment, when the dynamics in one direction are frozen. We find that in the three-dimensional case the stability region splits into two parts. However, as we tighten the confinement, one of the islands of stability moves toward higher frequencies and the lower frequency region becomes more and more like that for the quasi two-dimensional case. We demonstrate these solutions in direct numerical simulations and, importantly, suggest a way of creating robust three-dimensional solitons in experiments in a BEC in a one-dimensional lattice.

Community pharmacy treatment of minor ailments in refugees

OBJECTIVE

To evaluate a scheme offering pharmacy referrals for minor ailments in a refugee community. To determine if minor ailments could be managed by pharmacists offering over-the-counter (OTC) medication, free of charge, to refugees exempt from prescription charges.

DESIGN

Refugees presenting with minor illnesses were offered a voucher. This voucher could be taken to the pharmacist, who, after a consultation, could exchange the voucher for appropriate OTC medication.

SETTING

A refugee community in south London.

OUTCOME MEASURES

The presenting minor ailment and corresponding medication as recorded by the pharmacist.

RESULTS

A total of 200 vouchers were distributed to 184 refugees over a 5-month period resulting in the dispensing of 264 items. The five most frequent minor ailments were: upper respiratory tract infections (37%), headache (14%), musculo-skeletal pains (7%), allergy including hay fever (6%), indigestion (6%). The five most frequently dispensed items were: paracetamol (28%), sudafed (16%), ibuprofen (11%), aspirin (10%) and simple linctus (8%). Only two clients were referred directly to the GP and two advised to attend if symptoms persisted.

CONCLUSIONS

Minor ailment schemes elsewhere have demonstrated the potential to divert about one-third of patients with minor illnesses out of general practice and to care in the pharmacy. Such a scheme is being widely adopted in Scotland this year. Our results are the first to demonstrate the feasibility and acceptability of such a scheme in the refugee community.

A Simplified physical model of pressure wave dynamics and acoustic wave generation induced by laser absorption in the retina

Shock waves have been proposed in the literature as a mechanism for retinal damage induced by ultra-short laser pulses. For a spherical absorber, we derive a set of linear equations describing the propagation of pressure waves. We show that the formation of shock fronts is due to the form of the absorber rather than the inclusion of nonlinear terms in the equations. The analytical technique used avoids the need for a Laplace transform approach and is easily applied to other absorber profiles. Our analysis suggests that the 'soft' nature of the membrane surrounding retinal melanosomes precludes shock waves as a mechanism for the retinal damage induced by ultra-short pulse lasers. The quantitative estimates of the pressure gradients induced by laser absorption which are made possible by this work, together with detailed meso-scale or molecular modelling, will allow alternative damage mechanisms to be identified.

A new model for laser-induced thermal damage in the retina

We describe a new model for laser-induced retinal damage. Our treatment is prompted by the failure of the traditional approach to accurately describe the image size dependence of laser-induced retinal injuries and by a recently reported study which demonstrated that laser injuries to the retina might not appear for up to 48 h post exposure. We propose that at threshold a short-duration, laser-induced, temperature rise melts the membrane of the melanosomes found in the pigmented retinal epithelial cells. This results in the generation of free radicals which initiate a slow chain reaction. If more than a critical number of radicals are generated then cell death may occur at a time much later than the return of the retina to body temperature. We show that the equations consequent upon this mechanism result in a good fit to the recent image size data although more detailed experimental data for rate constants of elementary reactions is still required. This paper contributes to the current understanding of damage mechanisms in the retina and may facilitate the development of new treatments to mitigate laser injuries to the eye. The work will also help minimize the need for further animal experimentation to set laser eye safety standards.

Referrals and relationships: in-practice referrals meetings in a general practice

BACKGROUND

GP referrals to secondary care are an important factor in the cost of running the NHS. The known variation in referral rates between doctors has the potential to cause tension within primary care which will be exacerbated by the latest reorganization of primary care and the trend towards capitation-based budgets. The importance of postgraduate learning for GPs has been recognized; continuing professional development is moving towards self-directed practice-based learning programmes. Educational interventions have been shown to alter doctors' prescribing behaviour. This, together with the pressure on accounting for referral activity, makes the prospect of improving, and possibly reducing, referral activity through educational interventions very attractive.

OBJECTIVES

This study complemented a randomized controlled trial (RCT) which investigated whether an intervention of the type which had reduced prescribing costs would have a similar effect on referral activity.

METHODS

The context of the study, description of the characteristics of the practice and the issues seen as important by the doctors and practice manager were identified through preliminary semi-structured interviews. The practice then held a series of educational in-practice meetings to discuss referrals and issues arising from referrals. The audio- and videotaped transcripts were interpreted using content and group dynamic analysis. Participants commented upon our preliminary findings. In addition, we used dimensional analysis to induce a preliminary theory describing the effect of the intervention on this general practice which enabled us to review the findings of the parallel RCT. The educational value of the meetings and the learning needs of the participants were also assessed.

RESULTS

Our complementary study showed no alteration of practice referral rates following the educational intervention. The qualitative study, unencumbered by the assumptions inherent in the development of the hypothesis tested in the RCT, highlighted the complexity of decision making in general practice and the likely impact of historical background and a variety of internal and external pressures on this self-directive educational intervention. The practice members described the individual and group learning needs identified as a result of the meetings.

CONCLUSION

The findings of this study raise important questions for developing practice-based learning. The outcomes of self-directive interventions in practices will be influenced by internal and external events both past and present. Such outcomes may be qualitative and difficult to measure. They are likely to differ from outcomes seen when interventions are applied to groups of doctors who are not all members of the same practice.

Referrals. Risky business

There are wide variations in referral rates between GPs. The reasons for this are not well understood. Reduction in referrals will require protocols and the involvement of patients.

Identifying patients with ischaemic heart disease in general practice: cross sectional study of paper and computerised medical records

OBJECTIVES

To identify patients with ischaemic heart disease by using a practice computer and to estimate the work required to do so.

DESIGN

Cross sectional study. Data from the notes and from the computer records of 1680 patients were used to build a database. This was used to compare different methods of identifying patients with ischaemic heart disease.

SETTING

11 general practices in the Battersea primary care group in south London.

SUBJECTS

1 in 40 random sample of patients aged 45 or older.

MAIN OUTCOME MEASURES

Numbers of patients identified with ischaemic heart disease.

RESULTS

The combination of the Read code for ischaemic heart disease (G3) and a prescription for a nitrate had a 73% sensitivity and a yield (100/positive predictive value) of one case of ischaemic heart disease for every 1.2 sets of notes reviewed. By searching the records of patients also receiving aspirin, atenolol, digoxin, or a statin, the sensitivity was increased to 96% but the yield fell to one in three.

CONCLUSION

Although commonly used to identify cases, a computer search for G3 code or nitrate missed almost 30% of patients with ischaemic heart disease. A substantially higher percentage of patients can be identified by adding other drugs to the search strategy.

Towards a conceptual framework for evaluating primary care research networks

We describe a conceptual framework that we have developed for evaluating primary care research networks. The framework includes objectives, process indicators, and outcome indicators. We propose the framework as a provisional model that we hope will promote further research and debate.

Effective drift velocities and effective diffusivities of swimming microorganisms in external flows

In this note we calculate the effective drift velocities and the effective diffusivities of swimming microorganisms in an external flow field. It is shown that if the ambient velocity field is incompressible then the effects of reorientation of the cells can under certain circumstances enhance the effective drift velocity along the preferred direction.

Exactly solvable sandpile with fractal avalanching

A simple one-dimensional sandpile model is constructed which possesses exact analytical solvability while displaying both scale-free behavior and fractal properties. The sandpile grows by avalanching on all scales, yet its shape and energy content are described by a simple, continuous (but nowhere differentiable) analytical formula. The avalanche energy distribution and the avalanche time series are both power laws with index -1 ("1/f spectra").