Objective: To perform a systematic review of interventions designed to improve health outcomes for persons with low literacy skills.
Data Sources: We searched MEDLINE, Cumulative Index to Nursing and ...Allied Health (CINAHL), Educational Resources Information Center (ERIC), Public Affairs Information Service (PAIS), Industrial and Labor Relations Review (ILLR), PsycInfo, and Ageline from 1980 to 2003.
Study Selection: We included controlled and uncontrolled trials that measured literacy and examined the effect of interventions for people with low literacy on health outcomes, including health knowledge, health behaviors, use of health care resources, intermediate markers of disease status, and measures of morbidity or mortality. Two ors reviewed each study for inclusion. Disagreements were resolved by consensus among the research team.
Data Extraction: One reviewer ed data from each article into an evidence table; the second reviewer checked each entry. Disagreements about information in evidence tables were resolved by team consensus. Both data extractors independently completed an 11‐item quality scale for each article; scores were averaged to give a final measure of article quality.
Data Synthesis: We identified 20 articles examining interventions designed to improve health among people with low literacy. The most common outcome studied was health knowledge; fewer studies examined health behaviors, intermediate markers, or measures of disease prevalence or severity. The effectiveness of interventions appeared mixed. Limitations in research quality and heterogeneity in outcome measures make drawing firm conclusions about effective strategies difficult. Only 5 articles examined the interaction between literacy level and the effect of the intervention; they also found mixed results.
Conclusions: Several interventions have been developed to improve health for people with low literacy. Limitations in study design, interventions tested, and outcomes assessed make drawing conclusions about effectiveness difficult. Further research is required to understand better the types of interventions that are most effective and efficient for overcoming literacy‐related barriers to good health.
As medical technology continues to expand and the cost of using all effective clinical services exceeds available resources, decisions about health care delivery may increasingly rely on assessing ...the cost-effectiveness of medical services. Cost-effectiveness is particularly relevant for decisions about how to implement preventive services, because these decisions typically represent major investments in the future health of large populations. As such, decisions regarding the implementation of preventive services frequently involve, implicitly if not explicitly, consideration of costs. Cost-effectiveness analysis summarizes the expected benefits, harms, and costs of alternative strategies to improve health and has become an important tool for explicitly incorporating economic considerations into clinical decision making. Acknowledging the usefulness of this tool, the third U.S. Preventive Services Task Force (USPSTF) has initiated a process for systematically reviewing cost-effectiveness analyses as an aid in making recommendations about clinical preventive services. In this paper, we provide an overview and examples of roles for using cost-effectiveness analyses to inform preventive services recommendations, discuss limitations of cost-effectiveness data in shaping evidence-based preventive health care policies, outline the USPSTF approach to using cost-effectiveness analyses, and discuss the methods the USPSTF is developing to assess the quality and results of cost-effectiveness studies. While this paper focuses on clinical preventive services (i.e., screening, counseling, immunizations, and chemoprevention), the framework we have developed should be broadly portable to other health care services.
To examine the features of available Framingham-based risk calculation tools and review their accuracy and feasibility in clinical practice.
medline, 1966-April 2003, and the google search engine on ...the Internet. TOOL AND STUDY SELECTION: We included risk calculation tools that used the Framingham risk equations to generate a global coronary heart disease (CHD) risk. To determine tool accuracy, we reviewed all articles that compared the performance of various Framingham-based risk tools to that of the continuous Framingham risk equations. To determine the feasibility of tool use in clinical practice, we reviewed articles on the availability of the risk factor information required for risk calculation, subjective preference for 1 risk calculator over another, or subjective ease of use.
Two reviewers independently reviewed the results of the literature search, all websites, and abstracted all articles for relevant information.
Multiple CHD risk calculation tools are available, including risk charts and computerized calculators for personal digital assistants, personal computers, and web-based use. Most are easy to use and available without cost. They require information on age, smoking status, blood pressure, total and HDL cholesterol, and the presence or absence of diabetes. Compared to the full Framingham equations, accuracy for identifying patients at increased risk was generally quite high. Data on the feasibility of tool use was limited.
Several easy-to-use tools are available for estimating patients' CHD risk. Use of such tools could facilitate better decision making about interventions for primary prevention of CHD, but further research about their actual effect on clinical practice and patient outcomes is required.
We present a 1:25,000 scale map of the coseismic surface ruptures following the 30 October 2016 M
w
6.5 Norcia normal-faulting earthquake, central Italy. Detailed rupture mapping is based on almost ...11,000 oblique photographs taken from helicopter flights, that has been verified and integrated with field data (>7000 measurements). Thanks to the common efforts of the Open EMERGEO Working Group (130 people, 25 research institutions and universities from Europe), we were able to document a complex surface faulting pattern with a dominant strike of N135°-160° (SW-dipping) and a subordinate strike of N320°-345° (NE-dipping) along about 28 km of the active Mt. Vettore-Mt. Bove fault system. Geometric and kinematic characteristics of the rupture were observed and recorded along closely spaced, parallel or subparallel, overlapping or step-like synthetic and antithetic fault splays of the activated fault systems, comprising a total surface rupture length of approximately 46 km when all ruptures were considered.
CONTEXT Low literacy is an important barrier for patients with diabetes, but
interventions to address low literacy have not been well examined. OBJECTIVE To examine the role of literacy on the ...effectiveness of a comprehensive
disease management program for patients with diabetes. DESIGN, SETTING, AND PARTICIPANTS Analysis of the influence of literacy on glycemic control and systolic
blood pressure using data from a randomized controlled trial (conducted from
February 2001 through April 2003) of a comprehensive diabetes management program.
Participants were 217 patients aged 18 years or older with type 2 diabetes
and poor glycemic control (glycosylated hemoglobin HbA1c levels
≥8.0%) and presenting to a US academic general internal medicine practice. INTERVENTIONS All communication to patients was individualized and delivered to enhance
comprehension among patients with low literacy. Intervention patients received
intensive disease management from a multidisciplinary team. Control patients
received an initial management session and continued with usual care. MAIN OUTCOME MEASURES Achievement of goal HbA1c levels and systolic blood pressure
at 12-month follow-up for control and intervention patients stratified by
literacy status. RESULTS Complete 12-month data were available for 193 patients (89%). Among
patients with low literacy, intervention patients were more likely than control
patients to achieve goal HbA1c levels (≤7.0%) (42% vs 15%, respectively;
adjusted odds ratio OR, 4.6; 95% confidence interval CI, 1.3 to 17.2; P = .02). Patients with higher literacy had similar
odds of achieving goal HbA1c levels regardless of intervention
status (24% vs 23%; adjusted OR, 1.0; 95% CI, 0.4 to 2.5; P = .98). Improvements in systolic blood pressure were similar
by literacy status. CONCLUSIONS Literacy may be an important factor for predicting who will benefit
from an intervention for diabetes management. A diabetes disease management
program that addresses literacy may be particularly beneficial for patients
with low literacy, and increasing access to such a program could help reduce
health disparities.
Screening and treating adults for lipid disorders Pignone, Michael P; Phillips, Christopher J; Atkins, David ...
American Journal of Preventive Medicine,
04/2001, Letnik:
20, Številka:
3
Book Review, Journal Article
Recenzirano
Context: Screening and treatment of lipid disorders in people at high risk for future coronary heart disease (CHD) events has gained wide acceptance, especially for patients with known CHD, but the ...proper role in people with low to medium risk is controversial.
Objective: To examine the evidence about the benefits and harms of screening and treatment of lipid disorders in adults without known cardiovascular disease for the U.S. Preventive Services Task Force.
Data Sources: We identified English-language articles on drug therapy, diet and exercise therapy, and screening for lipid disorders from comprehensive searches of the MEDLINE database from 1994 through July 1999. We used published systematic reviews, hand searching of relevant articles, the second
Guide to Clinical Preventive Services, and extensive peer review to identify important older articles and to ensure completeness.
Data Synthesis: There is strong, direct evidence that drug therapy reduces CHD events, CHD mortality, and possibly total mortality in middle-aged men (35 to 65 years) with abnormal lipids and a potential risk of CHD events greater than 1% to 2% per year. Indirect evidence suggests that drug therapy is also effective in other adults with similar levels of risk. The evidence is insufficient about benefits and harms of treating men younger than 35 years and women younger than 45 years who have abnormal lipids but no other risk factors for heart disease and low risk for CHD events (less than 1% per year). Trials of diet therapy for primary prevention have led to long-term reductions in cholesterol of 3% to 6% but have not demonstrated a reduction in CHD events overall. Exercise programs that maintain or reduce body weight can produce short-term reductions in total cholesterol of 3% to 6%, but longer-term results in unselected populations have found smaller or no effect. To identify accurately people with abnormal lipids, at least two measurements of total cholesterol and high-density lipoprotein cholesterol are required. The role of measuring triglycerides and the optimal screening interval are unclear from the available evidence.
Conclusions: On the basis of the effectiveness of treatment, the availability of accurate and reliable tests, and the likelihood of identifying people with abnormal lipids and increased CHD risk, screening appears to be effective in middle-aged and older adults and in young adults with additional cardiovascular risk factors.
Dietary restriction is often recommended during fecal occult blood testing (FOBT) as a means of increasing test accuracy, but concern surrounds whether such restriction also reduces the chance that ...patients will complete the test.
We conducted a systematic review and meta-analysis to determine if advice about dietary restrictions affects the rate of completion of FOBT and the rate of positive results.
We searched the MEDLINE database and hand-searched the bibliographies of other systematic reviews and clinical practice guidelines to identify randomized trials of advice to perform dietary restriction during FOBT. We included only trials that reported the proportion of patients who completed the occult blood tests (completion rate). When such information was available, we also recorded the proportion of patients who had positive test results (positivity rate).
Five randomized trials met our inclusion criteria. All used guaiac-based Hemoccult tests; none reported results from rehydrated test slides. In four trials, there was little or no difference in test completion between patients assigned to dietary restriction and those with no restriction. In one small trial that used an especially restrictive diet, completion was 21 percentage points lower in the restricted group. Positivity rates were reported in four trials, none of which found a statistically significant difference between groups. Meta-analysis showed no difference in the summary positivity rate between those assigned to dietary restriction versus those not restricted (difference in positivity rate, 0%; 95% CI, -1% to 1%).
Available data suggest that advice to perform modest dietary restriction during unrehydrated FOBT does not affect the completion rate, but more severe restrictions may. Dietary restriction also does not appear to affect positivity rates. On the basis of these data, physicians do not need to advise patients to restrict their diet for nonrehydrated FOBTs.
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