Health literacy concerns the knowledge and competences of persons to meet the complex demands of health in modern society. Although its importance is increasingly recognised, there is no consensus ...about the definition of health literacy or about its conceptual dimensions, which limits the possibilities for measurement and comparison. The aim of the study is to review definitions and models on health literacy to develop an integrated definition and conceptual model capturing the most comprehensive evidence-based dimensions of health literacy.
A systematic literature review was performed to identify definitions and conceptual frameworks of health literacy. A content analysis of the definitions and conceptual frameworks was carried out to identify the central dimensions of health literacy and develop an integrated model.
The review resulted in 17 definitions of health literacy and 12 conceptual models. Based on the content analysis, an integrative conceptual model was developed containing 12 dimensions referring to the knowledge, motivation and competencies of accessing, understanding, appraising and applying health-related information within the healthcare, disease prevention and health promotion setting, respectively.
Based upon this review, a model is proposed integrating medical and public health views of health literacy. The model can serve as a basis for developing health literacy enhancing interventions and provide a conceptual basis for the development and validation of measurement tools, capturing the different dimensions of health literacy within the healthcare, disease prevention and health promotion settings.
We present the macroscopic dynamics of ferroelectric smectic
A
, smectic
A
F
, liquid crystals reported recently experimentally by three groups. In this fluid and orthogonal smectic phase, the ...macroscopic polarization,
P
, is parallel to the layer normal thus giving rise to
C
∞
v
overall symmetry for this phase in the spatially homogeneous limit. A combination of linear irreversible thermodynamics and symmetry arguments is used to derive the resulting dynamic equations applicable at sufficiently low frequencies and sufficiently long wavelengths. Compared to non-polar smectic
A
phases, we find a static cross-coupling between compression of the layering and bending of the layers, which does not lead to elastic forces, but to elastic stresses. In addition, it turns out that a reversible cross-coupling between flow and the magnitude of the polarization modifies the velocities of both, first and second sound. At the same time, the relaxation of the polarization gives rise to dissipative effects for second sound at the same order of the wavevector as for the sound velocity. We also analyze reversible cross-coupling terms between elongational flow and electric fields as well as temperature and concentration gradients, which lend themselves to experimental detection. Apparently this type of terms has never been considered before for smectic phases. The question how the linear
P
·
E
coupling in the energy alters the macroscopic response behavior when compared to usual non-polar smectic
A
phases is also addressed.
Graphical abstract
Experiments have shown that spatial heterogeneities can arise when the glass transition in polymers as well as in a number of low molecular weight compounds is approached by lowering the temperature. ...This formation of “clusters” has been detected predominantly by small angle light scattering and ultrasmall angle x-ray scattering from the central peak on length scales up to about 200 nm and by mechanical measurements including, in particular, piezorheometry for length scales up to several microns. Here we use a macroscopic two-fluid model to study the formation of clusters observed by the various experimental techniques. As additional macroscopic variables, when compared to simple fluids, we use a transient strain field to incorporate transient positional order, along with the velocity difference and a relaxing concentration field for the two subsystems. We show that an external homogeneous shear, as it is applied in piezorheometry, can lead to the onset of spatial pattern formation. To address the issue of additional spectral weight under the central peak we investigate the coupling to all macroscopic variables. We find that there are additional static as well as dissipative contributions from both, transient positional order, as well as from concentration variations due to cluster formation, and additional reversible couplings from the velocity difference. We also briefly discuss the influence of transient orientational order. Finally, we point out that our description is more general, and could be applied above continuous or almost continuous transitions
We present the macroscopic dynamics of polar nematic liquid crystals in a two-fluid context. We investigate the case of a nonchiral as well as of a chiral solvent. In addition, we analyze how the ...incorporation of a strain field for polar nematic gels and elastomers in a solvent modifies the macroscopic dynamics. It turns out that the relative velocity between the polar subsystem and the solvent gives rise to a number of cross-coupling terms, reversible as well as irreversible, unknown from the other two-fluid systems considered so far. Possible experiments to study those novel dynamic cross-coupling terms are suggested. As examples we just mention that gradients of the relative velocity lead, in polar nematics to heat currents and in polar cholesterics to temporal changes of the polarization. In polar cholesterics, shear flows give rise to a temporal variation in the velocity difference perpendicular to the shear plane, and in polar nematic gels uniaxial stresses or strains generate temporal variations of the velocity difference.
Graphical abstract
Health literacy concerns the capacities of people to meet the complex demands of health in modern society. In spite of the growing attention for the concept among European health policymakers, ...researchers and practitioners, information about the status of health literacy in Europe remains scarce. This article presents selected findings from the first European comparative survey on health literacy in populations.
The European health literacy survey (HLS-EU) was conducted in eight countries: Austria, Bulgaria, Germany, Greece, Ireland, the Netherlands, Poland and Spain (n = 1000 per country, n = 8000 total sample). Data collection was based on Eurobarometer standards and the implementation of the HLS-EU-Q (questionnaire) in computer-assisted or paper-assisted personal interviews.
The HLS-EU-Q constructed four levels of health literacy: insufficient, problematic, sufficient and excellent. At least 1 in 10 (12%) respondents showed insufficient health literacy and almost 1 in 2 (47%) had limited (insufficient or problematic) health literacy. However, the distribution of levels differed substantially across countries (29-62%). Subgroups within the population, defined by financial deprivation, low social status, low education or old age, had higher proportions of people with limited health literacy, suggesting the presence of a social gradient which was also confirmed by raw bivariate correlations and a multivariate linear regression model.
Limited health literacy represents an important challenge for health policies and practices across Europe, but to a different degree for different countries. The social gradient in health literacy must be taken into account when developing public health strategies to improve health equity in Europe.
Launched in September 2018, the ABPMJAY is the world's largest publicly funded health insurance (PFHI) program with population coverage of 500 million. A systematic review was conducted.
A ...comprehensive literature search was conducted in four databases: PubMed, Web of Science, Scopus, and Google Scholar. The literature search was conducted with the search terms: "Ayushman Bharat OR ABPMJAY OR modicare AND RSBY." The search was set to title and abstract. Gray literature and government websites were also searched for relevant documents. A total of 881 documents were identified (PubMed: 53, Web of Science: 46, Scopus: 97, Google Scholar: 681, government websites: two, and gray literature: two). Fifty-two duplicates were identified. After the elimination of the duplicates, 829 unique documents were identified. These 829 unique citations were then subjected to a review of title and abstract independently by 2 reviewers. Six-hundred and ninety-two articles were rejected after review of title and abstract. One-hundred and thirty-seven articles were screened for full text independently by two reviewers. Sixty-six articles were rejected after review of the full text. Disagreements were resolved by discussion. Seventy-one unique articles were included in the final review. To attain the objective of the study, which is to critically analyze and provide an overview of Ayushman Bharat, a narrative synthesis was performed.
Seven themes were identified from the review: (1) health and wellness centers (HWCs); (2) out-of-pocket health expenditure (OOPHE); (3) fraud; (4) upcoding and provision of unnecessary medical care; (5) moving focus away from primary care; (6) coverage; and (7) lop-sided access, exclusion at the periphery, and brain drain. There is very little impact evidence of the ABPMJAY available.
The government could plan impact evaluation studies in every state that the ABPMJAY is functional in. Any high-quality feedback generated might enable the National Health Authority, the government body leading and coordinating the ABPMJAY, to take necessary steps operationally and advice the government on strategy. Another concern is that the ABPMJAY PFHI might negatively impact the ongoing process of continuous strengthening and development of the government health-care system at all levels-primary, secondary, and tertiary. Continual recalibration and course corrections on the basis of high-quality feedback might enable ABPMJAY reduce catastrophic OOPHE for 500 million Indians. This is more than 6% of humanity: the largest block of people served by a single PFHI in history.
•Civic literacy refers to the ability to engage meaningfully with one's community.•Digital, health, and civic literacy are key predictors for digital health literacy.•The extent to which these three ...affect digital health literacy remains unclear.•Building digital health literacy is vital to limit inequalities from expanding.
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