Assessing health literacy among older adults living in subsidized housing: a cross-sectional study

OBJECTIVES

This study aimed to assess functional health literacy levels among older adults living in subsidized housing in Hamilton, Ontario, and to assess the relationships between health literacy and other important health indicators, such as education level, age, ethnicity, body mass index (BMI), and self-reported health status.

METHODS

Older adults (n = 237) living in subsidized housing buildings in Hamilton, ON, were assessed using the NVS-UK as a measure of functional health literacy in addition to a health indicator questionnaire through structured interview. Health literacy levels were analyzed using descriptive statistics and logistic regression to determine relationships between health literacy levels and other health indicators.

RESULTS

Participants' mean age was 73 years, 67% were female, 70% were not educated beyond high school, and 91% were white. Over 82% of participants had below adequate health literacy levels using the NVS-UK. Multivariable logistic regression revealed significant relationships between functional health literacy and BMI, education level, and pain and discomfort levels. No significant relationships were found between health literacy level and age group, anxiety and depression levels, CANRISK (Diabetes risk) score, gender, marital status, mobility issues, self-care issues, self-reported health status, or performance of usual activities.

CONCLUSIONS

As the population of older adults continues to grow, the appropriate resources must be available to both improve and support the health literacy level of the population. Future health research should gather information on the health literacy levels of target populations to ensure more equitable health service. This research provides a significant opportunity to better understand populations with health literacy barriers.

Effectiveness of a community paramedic-led health assessment and education initiative in a seniors' residence building: the Community Health Assessment Program through Emergency Medical Services (CHAP-EMS)

Background

Seniors living in subsidized housing have lower income, poorer health, and increased risk for cardiometabolic diseases and falls. Seniors also account for more than one third of calls to Emergency Medical Services (EMS). This study examines the effectiveness of the Community Health Assessment Program through EMS (CHAP-EMS) in reducing blood pressure, diabetes risk, and EMS calls.

Methods

Paramedics on modified duty (e.g. injured) conducted weekly, one-on-one drop-in sessions in a common area of one subsidized senior’s apartment building in Hamilton, Ontario. Paramedics assessed cardiovascular, diabetes, and fall risk, provided health education, referred participants to local resources, and encouraged participants to return to CHAP-EMS for follow-up. Reports were faxed to the family physician regularly. Blood pressure was collected throughout the one year intervention, while diabetes risk was assessed at baseline and after 6–12 months. EMS call volumes were collected from the Hamilton Paramedic Service for two years pre-intervention and one year during the intervention.

Results

There were 79 participants (mean age = 72.2 years) and 1,365 participant visits to CHAP-EMS. The majority were female (68%), high school educated or less (53%), had a family doctor (90%), history of hypertension (58%), high waist circumference (64%), high body mass index (61%), and high stress (53%). Many had low physical activity (42%), high fat intake (33%), low fruit/vegetable intake (30%), and were current smokers (29%). At baseline, 42% of participants had elevated blood pressure. Systolic blood pressure decreased significantly by the participant’s 3^rd visit to CHAP-EMS and diastolic by the 5^th visit (p < .05). At baseline, 19% of participants had diabetes; 67% of those undiagnosed had a moderate or high risk based on the Canadian Diabetes Risk (CANRISK) assessment. 15% of participants dropped one CANRISK category (e.g. high to moderate) during the intervention. EMS call volume decreased 25% during the intervention compared to the previous two years.

Conclusions

CHAP-EMS was associated with a reduction in emergency calls and participant blood pressure and a tendency towards lowered diabetes risk after one year of implementation within a low income subsidized housing building with a history of high EMS calls.

Trial registration

Retrospectively registered on May 12^th 2016 with clinicaltrials.gov: NCT02772263

[Sclerotic inflammation of the orbit and multifocal fibrosclerosis syndrome]

CLINICAL CASE

A fifty-two-year-old woman consulted our department because of a bilateral proptosis. The appearance of acute symptoms suggestive of a digestive disorder during her admission to hospital for the study of the proptosis, led to a diagnosis of multifocal fibrosclerosis with simultaneous affliction of orbital tissue, mesenteric fat and the brain stem.

DISCUSSION

Idiopathic Sclerotic Inflammation of the orbit is a rare pathological entity, with similar clinical and radiological characteristics to orbital pseudo-tumour. The differential diagnosis is important because both these conditions differ in treatment and prognosis.

Role of voltage-dependent anion channels in glutathione transport into yeast mitochondria

Glutathione (GSH) is imported into mitochondria from the extra-mitochondrial cytoplasm. Translocation across the inner membrane of mitochondria is thought to occur via the dicarboxylate and 2-oxoglutarate carriers; however, the means by which GSH passes through the outer membrane is unknown. Disruption of the outer membrane of yeast mitochondria using either digitonin or osmotic shock did not alter GSH accumulation as compared with accumulation in intact mitochondria. These results suggested that passage across the outer membrane was not the rate-limiting step in GSH accumulation. Mitochondria isolated from yeast strains with a disruption in the major pore-forming protein of the outer membrane, VDAC1, accumulated GSH to a greater extent than mitochondria isolated from a wild-type strain. Disruption of the gene for VDAC2 did not affect GSH import. Thus, neither VDAC form is essential for GSH translocation into mitochondria, and the participation of another outer membrane channel in GSH import is possible.

Mutations in the voltage-dependent anion channel of the mitochondrial outer membrane cause a dominant nonlethal growth impairment

Point mutations at K234 and K236 in the yeast voltage-dependent anion channel 1 (VDAC1) of the mitochondrial outer membrane have been shown to markedly impair the membrane insertion of this protein (Smith et al., 1995; Angeles et al., 1998). Mutants of this type were expressed in vivo in a strain of yeast with a disruption in the VDAC1 gene. Expression of the various VDAC1 forms was under the control of a Gall promoter. Wild-type VDAC1 expression fully complemented the slow growth phenotype caused by the disruption. VDAC1 mutants in which K234 and K236 were replaced by arginine, glutamate, or glutamine caused a more severe negative effect on growth. This effect appeared to be dominant since the mutant VDAC1 forms suppressed growth in a yeast strain that retained its VDAC1 gene. This apparent dominant negative effect on growth did not seem to be specific for any stage of the cell cycle. However, the growth defect was not lethal as the affected cells still could accumulate the vital stain, FUN1. Expression of a mutant in which K234 had been replaced by glutamate had more serious negative growth effects than did a similar mutation at K236. Expression of delta71-116 VDAC1 complemented the VDAC1 disruption; however, expression of the same deletion mutant in which the lysines corresponding to K234 and K236 were mutated to glutamate severely impaired growth. These results have shown that a deficiency of lysine at positions 234 and 236 in VDAC I causes a nonlethal growth defect that is more severe than deletion of 45 amino acids from VDACI or disruption of the VDAC1 gene. They also indicate that there is a hierarchy in the importance of these lysines with mutations at K234 being the more serious.

Mutation of K234 and K236 in the voltage-dependent anion channel 1 impairs its insertion into the mitochondrial outer membrane

Previous in vitro studies indicated that mutation of both K234 and K236 to arginine, glutamine, or glutamic acid impaired the ability of the voltage-dependent anion channel (VDAC1) to insert into the outer membrane of the mitochondria (Smith et al. 1995). These same mutants were expressed in a strain of Saccharomyces cerevisiae with a disruption in the VDAC1 gene. The mutant VDAC1 forms were found in the mitochondria suggesting that they were correctly sorted to the outer membrane. However, only very small amounts of the mutants were inserted into the mitochondrial membranes. Mitochondria isolated from the strains expressing the mutants were capable of catalyzing the translocation of both wild-type VDAC1 and pre-alcohol dehydrogenase III indicating that the translocation apparatus was functional. These results confirm the previously drawn conclusion that K234 and K236 are part of a membrane insertion motif. The failure of the mutant VDAC1 forms to insert did not cause VDAC1 precursors to accumulate in the soluble cell cytoplasm or in the microsomal fraction. The apparent lack of a "precursor pool" suggested that a post-transcriptional control mechanism might limit the amounts of VDAC1 precursors in the cell. Such a control mechanism is consistent with the observation that the amount of VDAC1 was very similar after epichromosomal (gene in a 2u plasmid controlled by a Gal1 promoter) and chromosomal expression (endogenous gene controlled by the endogenous promoter).

Impact of Phase I Pew National Dental education Program on U.S. schools of dental medicine

This paper presents the results of four telephone surveys conducted by the Leonard Davis Institute of Health Economics (LDI), University of Pennsylvania, as part of its evaluation of the Pew National Dental Education Program (PNDEP), a five year, +4F8.7 million program established by The Pew Charitable Trusts to help dental schools respond to the changing health care environment. The four annual surveys were conducted between 1985 and 1988. The interviews were conducted with the deans from nearly all dental schools operating in the United States at the time of study or the principal investigators of the schools funded under Phase I and Phase II PNDEP grants. Their purpose was to determine the level of each school's involvement in PNDEP and in specific strategic planning activities, as well as to evaluate the impact of the Pew Program on both the individual schools and dental education nationwide. All systematic differences between schools funded (FD) PNDEP and those not funded (NFD) were examined. Overall, schools gained a better understanding of their environment. Schools also reported increased participation in and commitment to planning among their different constituencies (e.g., faculty, administration, students, alumni). By the end of Phase I, more PNDEP Phase I funded schools reported being involved in implementing strategic plans. Funded schools also were more likely to report PNDEP increased their understanding of strategic planning, improved communication, and helped encourage the emergence of new leaders.