To review the relationship between literacy and health outcomes.
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), PsychInfo, and Ageline from 1980 to 2003.
We included observational studies that reported original data, measured literacy with any valid instrument, and measured one or more health outcomes. Two abstractors reviewed each study for inclusion and resolved disagreements by discussion.
One reviewer abstracted data from each article into an evidence table; the second reviewer checked each entry. The whole study team reconciled disagreements about information in evidence tables. Both data extractors independently completed an 11-item quality scale for each article; scores were averaged to give a final measure of article quality.
We reviewed 3,015 titles and abstracts and pulled 684 articles for full review; 73 articles met inclusion criteria and, of those, 44 addressed the questions of this report. Patients with low literacy had poorer health outcomes, including knowledge, intermediate disease markers, measures of morbidity, general health status, and use of health resources. Patients with low literacy were generally 1.5 to 3 times more likely to experience a given poor outcome. The average quality of the articles was fair to good. Most studies were cross-sectional in design; many failed to address adequately confounding and the use of multiple comparisons.
Low literacy is associated with several adverse health outcomes. Future research, using more rigorous methods, will better define these relationships and guide developers of new interventions.
Current health literacy screening instruments for health care settings are either too long for routine use or available only in English. Our objective was to develop a quick and accurate screening ...test for limited literacy available in English and Spanish.
We administered candidate items for the new instrument and also the Test of Functional Health Literacy in Adults (TOFHLA) to English-speaking and Spanish-speaking primary care patients. We measured internal consistency with Cronbach's alpha and assessed criterion validity by measuring correlations with TOFHLA scores. Using TOFLHA scores <75 to define limited literacy, we plotted receiver-operating characteristics (ROC) curves and calculated likelihood ratios for cutoff scores on the new instrument.
The final instrument, the Newest Vital Sign (NVS), is a nutrition label that is accompanied by 6 questions and requires 3 minutes for administration. It is reliable (Cronbach alpha >0.76 in English and 0.69 in Spanish) and correlates with the TOFHLA. Area under the ROC curve is 0.88 for English and 0.72 for Spanish versions. Patients with more than 4 correct responses are unlikely to have low literacy, whereas fewer than 4 correct answers indicate the possibility of limited literacy.
NVS is suitable for use as a quick screening test for limited literacy in primary health care settings.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Terra Nova, 22, 43–51, 2010
An earthquake of Mw = 6.3 struck L’Aquila town (central Italy) on 6 April 2009 rupturing an ∼18‐km‐long SW‐dipping normal fault. The aftershock area extended for a length ...of more than 35 km and included major aftershocks on 7 and 9 April and thousands of minor events. Surface faulting occurred along the SW‐dipping Paganica fault with a continuous extent of ∼2.5 km. Ruptures consist of open cracks and vertical dislocations or warps (0.1m maximum throw) with an orientation of N130°–140°. Small triggered slip and shaking effects also took place along nearby synthetic and antithetic normal faults. The observed limited extent and small surface displacement of the Paganica ruptures with respect to the height of the fault scarps and vertical throws of palaeo‐earthquakes along faults in the area put the faulting associated with the L’Aquila earthquake in perspective with respect to the maximum expected magnitude and the regional seismic hazard.
In this paper we present the geological effects induced by the 2012 Emilia seismic sequence in the Po Plain. Extensive liquefaction phenomena were observed over an area of similar to 1200 km super(2) ...following the 20 May, M sub(L) 5.9 and 29 May, M sub(L) 5.8 mainshocks; both occurred on about E-W trending, S dipping blind thrust faults. We collected the coseismic geological evidence through field and aerial surveys, reports from local people and Web-based survey. On the basis of their morphologic and structural characteristics, we grouped the 1362 effects surveyed into three main categories: liquefaction (485), fractures with liquefaction (768), and fractures (109). We show that the quite uneven distribution of liquefaction effects, which appear concentrated and aligned, is mostly controlled by the presence of paleo-riverbeds, out-flow channels and fans of the main rivers crossing the area; these terrains are characterised by the pervasive presence of sandy layers in the uppermost 5 m, a local feature that, along with the presence of a high water table, greatly favours liquefaction. We also find that the maximum distance of observed liquefaction from the earthquake epicentre is similar to 30 km, in agreement with the regional empirical relations available for the Italian Peninsula. Finally, we observe that the contour of the liquefaction observations has an elongated shape almost coinciding with the aftershock area, the InSAR deformation area, and the I greater than or equal to 6 EMS area. This observation confirms the control of the earthquake source on the liquefaction distribution, and provides useful hints in the characterisation of the seismogenic source responsible for historical and pre-historical liquefactions.
Is This Patient Clinically Depressed? Williams, Jr, John W; Noël, Polly Hitchcock; Cordes, Jeffrey A ...
JAMA : the journal of the American Medical Association,
03/2002, Letnik:
287, Številka:
9
Journal Article
Recenzirano
CONTEXT Depressive disorders are highly prevalent in the general population,
but recognition and accurate diagnosis are made difficult by the lack of a
simple confirmatory test. OBJECTIVE To review ...the accuracy and precision of depression questionnaires and
the clinical examination for diagnosing clinical depression. DATA SOURCES We searched the English-language literature from 1970 through July 2000
using MEDLINE, a specialized registry of depression trials, and bibliographies
of selected articles. STUDY SELECTION Case-finding studies were included if they used depression questionnaires
with easy to average literacy requirements, evaluated at least 100 primary
care patients, and compared questionnaire results with accepted diagnostic
criteria for major depression. Eleven questionnaires, ranging in length from
1 to 30 questions, were assessed in 28 published studies. Reliability studies
for the clinical examination required criterion-based diagnoses made by at
least 2 clinicians who interviewed the patient or reviewed a taped examination.
Fourteen studies evaluated interrater reliability. DATA EXTRACTION Pairs of authors independently reviewed articles. For case-finding studies,
quality assessment addressed sample size and whether patients were selected
consecutively or randomly, the criterion standard was administered and interpreted
independently of and blind to the results of the case-finding instrument,
and the proportion of persons receiving the criterion standard assessment
was less than or more than 50% of those approached for criterion standard
assessment. For reliability studies, quality assessment addressed whether
key patient characteristics were described, the interviewers collected clinical
history independently, and diagnoses were made blinded to other clinicians'
evaluations. DATA SYNTHESIS In case-finding studies, average questionnaire administration times
ranged from less than 1 minute to 5 minutes. The median likelihood ratio positive
for major depression was 3.3 (range, 2.3-12.2) and the median likelihood ratio
negative was 0.19 (range, 0.14-0.35). No significant differences between questionnaires
were found. For mental health care professionals using a semistructured interview,
agreement was substantial to almost perfect for major depression (κ
= 0.64-0.93). Nonstandardized interviews yielded somewhat lower agreement
(κ = 0.55-0.74). A single study showed that primary care clinicians
using a semistructured interview have high agreement with mental health care
professionals (κ = 0.71). CONCLUSIONS Multiple, practical questionnaires with reasonable performance characteristics
are available to help clinicians identify and diagnose patients with major
depression. Diagnostic confirmation by mental health care professionals using
a clinical interview or by primary care physicians using a semistructured
interview can be made with high reliability.
We evaluated the usefulness of case-finding instruments for identifying patients with major depression or dysthymia in primary care settings using English language literature from Medline, a ...specialized trials registry and bibliographies of selected papers. Studies were done in primary care settings with unselected patients and compared case-finding instruments with accepted diagnostic criterion standards for major depression were selected. A total of 16 case-finding instruments were assessed in 38 studies. More than 32,000 patients received screening with a case-finding instrument; approximately 12,900 of these received criterion standard assessment. Case-finding instruments ranged in length from 1 to 30 questions. Average administration times ranged from less than 2 min to 6 min. Median sensitivity for major depression was 85% (range 50% to 97%); median specificity was 74% (range 51% to 98%). No significant differences between instruments were found. However for individual instruments, estimates of sensitivity and specificity varied significantly between studies. For the combined diagnoses of major depression or dysthymia, overall sensitivity was 79% (CI, 74% to 83%) and overall specificity 75% (CI, 70% to 81%). Stratified analyses showed no significant effects on overall instrument performance for study methodology, criterion standard choice, or patient characteristics. We found that multiple instruments with reasonable operating characteristics are available to help primary care clinicians identify patients with major depression. Because operating characteristics of these instruments are similar, selection of a particular instrument should depend on issues such as feasibility, administration and scoring times, and the instruments’ ability to serve additional purposes, such as monitoring severity or response to therapy.
To clarify whether screening adults for depression in primary care settings improves recognition, treatment, and clinical outcomes.
The MEDLINE database was searched from 1994 through August 2001. ...Other relevant articles were located through other systematic reviews; focused searches of MEDLINE from 1966 to 1994; the Cochrane depression, anxiety, and neurosis database; hand searches of bibliographies; and extensive peer review.
The researchers reviewed randomized trials conducted in primary care settings that examined the effect of screening for depression on identification, treatment, or health outcomes, including trials that tested integrated, systematic support for treatment after identification of depression.
A single reviewer abstracted the relevant data from the included articles. A second reviewer checked the accuracy of the tables against the original articles.
Compared with usual care, feedback of depression screening results to providers generally increased recognition of depressive illness in adults. Studies examining the effect of screening and feedback on treatment rates and clinical outcomes had mixed results. Many trials lacked power to detect clinically important differences in outcomes. Meta-analysis suggests that overall, screening and feedback reduced the risk for persistent depression (summary relative risk, 0.87 95% CI, 0.79 to 0.95). Programs that integrated interventions aimed at improving recognition and treatment of patients with depression and that incorporated quality improvements in clinic systems had stronger effects than programs of feedback alone.
Compared with usual care, screening for depression can improve outcomes, particularly when screening is coupled with system changes that help ensure adequate treatment and follow-up.
In 1996, the U.S. Preventive Services Task Force (USPSTF) recommended screening adults for hypertension. Since that time, the published literature on hypertension has expanded rapidly, necessitating ...a new examination of the evidence supporting screening.
Update the 1996 evidence review on screening for hypertension.
The 1996
Guide to Clinical Preventive Services, recent systematic reviews, and focused searches of MEDLINE were used to identify new evidence relevant to detecting and treating hypertension.
When a good quality, recent systematic review was available, it was used to summarize previous research; MEDLINE was searched only for more recent articles. Two authors reviewed abstracts (and full texts, if necessary) of potentially relevant articles to determine if they should be included.
One author extracted data from included studies into evidence tables.
Hypertension can be effectively detected through office measurement of blood pressure. Treatment of elevated blood pressure in adults can reduce cardiovascular events. The magnitude of risk reduction depends on the degree of hypertension and the presence of other cardiovascular risk factors. Available studies have found no important adverse effects on psychological well-being and mixed effects on the absenteeism rates of adults who are screened and labeled as being hypertensive.
Substantial indirect evidence supports the effectiveness of screening adults to detect hypertension and treating them to reduce cardiovascular disease.
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