农村居民健康素养状况调查及影响因素分析

目的了解浙江省平阳县萧江镇农村居民健康素养现状。方法采用随机整群抽样的方法,于2009年12月—2010年2月在萧江镇下辖各个乡村,随机抽取1665户农户进行健康素养及相关情况调查。结果正确的健康认识占总调查对象的25.00%,有24.30%的人对慢性病采取放任自流的态度,主要原因是有31.00%的人是小学及以下文化水平,对健康知识的获取及理解有一定的困难;有25.40%的人处于浙江省农村低保线下,经济收入影响就诊的积极性。结论农村居民健康素养水平较低,影响健康素养水平的主要因素是人们的文化程度和经济收入。     

丹凤县农村居民口腔保健知识、行为调查分析

目的了解贫困县农村居民口腔保健知识、行为状况。方法采取分层随机抽样的方法,自行设计问卷,入户调查1个乡镇的3个行政村的居民。结果农村居民初中以上文化程度者占72.2%,从未体检者占71.4%,看病在村卫生室占44.1%,私人诊所占25.2%,每天刷牙2～3次者仅占16.1%,口腔保健知识知晓率在4.7%～58.9%之间。结论由于经济、交通等原因,居民自我保健意识和能力低,对于口腔保健知识知晓水平也低,开展口腔保健的宣传教育很必要。应利用村卫生室作为向村民开展健康教育的主要阵地,通过多种形式加强农村社区口腔保健的宣传教育。     

The Oral Health Needs of Wisconsin Farmers and the Need for Patient Activation: A Pilot Study

Objectives: This study aimed to determine the level of oral health need of Wisconsin farmers based on sociodemographic variables, perceived oral health, and actual oral health, and to evaluate the effectiveness of a dental hygiene patient activation intervention. Methods: Oral health screenings were administered by calibrated dental hygienists to 60 Wisconsin farmers attending the 2016 Wisconsin Farm Technology Days. Study participants self-administered the Oral Health Inventory Profile-14 survey and participated in an Adult Basic Screening Survey. Validity and reliability of both instruments have been established in previous studies. A follow-up phone call for Wisconsin farmers with a moderate- to high-risk oral health condition determined study participants followed the dental hygiene recommendations signified if study participants followed the dental hygiene recommendations and if patient activation had been achieved. Results: Study participants represented Wisconsin farmers (N = 60; n = 32 men, n = 28 women) with an average age range between 50 and 60 years old. The Oral Health Impact Profile-14 survey results indicated that this group of Wisconsin farmers did not perceive themselves to have an oral health problem. The Adult Basic Screening Survey results also indicated that the majority of study participants did not currently have active oral disease. There were 32% (n = 19) who qualified for follow-up phone call, with 15% (n = 3) seeking oral health care based on the dental hygiene recommendation. Significant associations between sociodemographic variables and actual oral health were not found, and the null hypotheses were not rejected. Conclusions: Findings suggest that this group of Wisconsin farmers is receiving regular oral health care and patient activation despite literature suggesting that farmers and rural individuals might face unique barriers to health and oral health care.     

Oral Health Literacy among Clients Visiting a Rural Dental College in North India-A Cross-Sectional Study

Background

Limited health literacy among adults is one of the many barriers to better oral health outcomes. It is not uncommon to find people who consider understanding oral health information a challenge. Therefore, the present study assessed oral health literacy among clients visiting Gian Sagar Dental College and Hospital, Rajpura.

Materials and Methods

A cross-sectional study was conducted on 450participants who visited the Out Patient Department (OPD) of Gian Sagar Dental College and Hospital for a period of two months (Nov–Dec, 2013). A questionnaire was given to each of the participants. Oral health literacy was graded on a 12-point Likert scale based on the total score. Oral Health Literacy of the participants was assessed as low, medium and high on the basis of responses. Statistical analysis was done using SPSS-15 statistical package. ANOVA and Student t-test were used to do comparisons between groups.

Results

Low oral health literacy scores were reported in 60.2% (271) participants. More than 60% of the study participants had knowledge about dental terms such as ‘dental caries,’ and ‘oral cancer.’ Only 22% of the graduates had a high literacy score. Mean oral health literacy score according to educational qualification was statistically significant (p<0.05), whereas there was no significant difference in terms of age and gender (p>0.05).

Conclusion

The majority of the participants had low literacy scores. There is a need to address these problems especially among rural population by health care providers and the government.     

The Nutrition Literacy Assessment Instrument is a Valid and Reliable Measure of Nutrition Literacy in Adults with Chronic Disease

Objective

To test the reliability and validity of the Nutrition Literacy Assessment Instrument (NLit) in adult primary care and identify the relationship between nutrition literacy and diet quality.

Health Needs and Health Care Utilization Among Rural,Low-Income Women

ABSTRACT

This study examined the correlates of health service utilization in a sample of low-income, rural women. Self-reported data were from Rural Families Speak (N = 275), a multi-state study of low-income, rural families in the U.S. collected in 2002. Findings indicated that women with health insurance, a regular doctor, and poorer overall physical health had higher incident rates of physician visits. Women who were divorced, separated or widowed and had more chronic health problems had higher incidence rates of emergency department (ED) use, while women living in counties with higher primary care physician rates had lower incidence rates of ED use. Future research and policies should focus on improved access to health insurance, increasing physician availability in rural areas, and providing rural women with a usual source of care, so as to reduce emergency services utilization for non-emergent needs and improve health status for this population.     

Low Health Literacy and Older Adults: Meanings,Problems, and Recommendations for Social Work

Many older adults struggle to manage their health care problems. Low health literacy exacerbates such struggles and contributes to a variety of adverse health behaviors and outcomes. Addressing how health literacy impinges on the lives of older adults is a neglected area of social work practice and knowledge. This article explores seven areas: defining health literacy, the problem and prevalence of low health literacy among older adults, health inequalities and health literacy, a brief literature review, neglected issues in the literature, suggestions for macro and micro social work interventions to improve health literacy for older adult populations, and conclusion.     

Associations of Health Literacy with Blood Pressure and Dietary Salt Intake among Adults: A Systematic Review

Health literacy has been recognized as a significant social determinant of health, defined as the ability to access, understand, appraise, and apply health-related information across healthcare, disease prevention, and health promotion. This systematic review aims to understand the relationship between health literacy, blood pressure, and dietary salt intake. A web-based search of PubMed, Web of Science, CINAHL, ProQuest, Scopus, Cochrane Library, and Prospero was performed using specified search/MESH terms and keywords. Two reviewers independently performed the data extraction and analysis, cross-checked, reviewed, and resolved any discrepancies by the third reviewer. Twenty out of twenty-two studies met the inclusion criteria and were rated as good quality papers and used in the final analysis. Higher health literacy had shown to have better blood pressure or hypertension knowledge. However, the relationship between health literacy with dietary salt intake has shown mixed and inconsistent findings. Studies looking into the main four domains of health literacy are still limited. More research exploring the links between health literacy, blood pressure, and dietary salt intake in the community is warranted. Using appropriate and consistent health literacy tools to evaluate the effectiveness of salt reduction as health promotion programs is required.     

Health Literacy,Cognitive Ability,and Functional Health Status among Older Adults

Objective

To investigate whether previously noted associations between health literacy and functional health status might be explained by cognitive function.

Data Sources/Study Setting

Health Literacy and Cognition in Older Adults (“LitCog,” prospective study funded by National Institute on Aging). Data presented are from interviews conducted among 784 adults, ages 55–74 years receiving care at an academic general medicine clinic or one of four federally qualified health centers in Chicago from 2008 to 2010.

Study Design

Study participants completed structured, in-person interviews administered by trained research assistants.

Data Collection

Health literacy was measured using the Test of Functional Health Literacy in Adults, Rapid Estimate of Adult Literacy in Medicine, and Newest Vital Sign. Cognitive function was assessed using measures of long-term and working memory, processing speed, reasoning, and verbal ability. Functional health was assessed with SF-36 physical health summary scale and Patient Reported Outcomes Measurement Information System short form subscales for depression and anxiety.

Principal Findings

All health literacy measures were significantly correlated with all cognitive domains. In multivariable analyses, inadequate health literacy was associated with worse physical health and more depressive symptoms. After adjusting for cognitive abilities, associations between health literacy, physical health, and depressive symptoms were attenuated and no longer significant.

Conclusions

Cognitive function explains a significant proportion of the associations between health literacy, physical health, and depression among older adults. Interventions to reduce literacy disparities in health care should minimize the cognitive burden in behaviors patients must adopt to manage personal health.     

Practical Guidelines for Physicians in Promoting Oral Health in Frail Older Adults

Good oral health in old age is particularly important for maintaining adequate oral function, preventing pain and discomfort, controlling localized or systemic inflammation, sustaining social interaction, and preserving quality of life. Given that oral health is an integral part of general health and well-being, and that major chronic systemic and oral diseases share common risk factors, oral health prevention and promotion should be embedded within routine medical assessment and care provision. The role of medical physicians, particularly primary care physicians, geriatricians, and elderly care physicians, in community and long-term care facilities in assessing and promoting oral health in frail older adults is critical and has been emphasized in recent European recommendations. All physicians should appreciate the importance of oral health and incorporate an initial oral health screening into routine medical assessment and care. A short interview with patients and carers on current oral health practices may help to assess the risk for rapid oral health deterioration. The interview should be followed by an oral health assessment, using validated tools, for nondental health care providers. Based on these findings, the physician should decide on necessary follow-up procedures, which may include oral health counseling and/or dental referral. Oral health counseling should include advice on daily oral, mucosal, and denture hygiene; denture maintenance; dietary advice; smoking cessation; limitation of harmful alcohol consumption; management of xerostomia; and frequent dental review. To enable physicians to perform the tasks recommended in this publication, appropriate teaching at both undergraduate and postgraduate levels must be delivered in addition to provision of appropriate continuing education courses.     

Frailty Predicts Increased Health Care Utilization Among Community-Dwelling Older Adults: A Longitudinal Study in China

ObjectivesFrailty, a multidimensional syndrome characterized by vulnerability to stressors, is an emerging public health priority with high prevalence in older adults. Frailty has been identified to predictive negative health outcomes, yet quantified evidence regarding its effect on health care systems is scarce. This study examines how frailty affects health care utilization, and explores whether these associations varied by gender.DesignCohort study with a 2-year follow-up.Settingand Participants: Data were derived from 2 waves (2011 and 2013) of the China Health and Retirement Longitudinal Study, and 3119 community-dwelling participants aged ≥60 years were analyzed.MethodsFrailty was assessed by a validated frailty phenotype scale, and measures for health care utilization were self-reported. Panel data approach of mixed-effects regression models was used to examine the associations.ResultsLongitudinal results demonstrated that compared with robustness, prefrailty and frailty were both significantly associated with increased likelihood of outpatient visit, inpatient visit, and inpatient length of stay, even after adjusting for multimorbidity in multivariate analyses (all P < .05). Every 1-component increase in frailty was also found to significantly increase the risk for health care utilization [any outpatient visit: adjusted odds ratio (OR) 1.30, 95% confidence interval (CI) 1.14–1.48; number of outpatient visits: adjusted incident rate ratio (IRR) 1.34, 95% CI 1.18–1.53; any inpatient visit: adjusted OR 1.44, 95% CI 1.22–1.71; number of inpatient visits: adjusted IRR 1.40, 95% CI 1.20–1.62; inpatient length of stay: adjusted IRR 1.50, 95% CI 1.18–1.92]. The preceding associations were similarly observed irrespective of gender.Conclusions and ImplicationsFrailty is a significant predictor for increased health care utilization among community-dwelling older adults. These findings have important implications for routine clinical practice and public health investment. Early screening and intervention for potentially modifiable frailty could translate into considerable savings for households and health care systems.     

The Contribution of Health Literacy to Disparities in Self-Rated Health Status and Preventive Health Behaviors in Older Adults

PURPOSE Health literacy is associated with a range of poor health-related outcomes. Evidence that health literacy contributes to disparities in health is minimal and based on brief screening instruments that have limited ability to assess health literacy. The purpose of this study was to assess whether health literacy contributes, through mediation, to racial/ethnic and education-related disparities in self-rated health status and preventive health behaviors among older adults.METHODS We undertook a cross-sectional study of a nationally representative sample of 2,668 US adults aged 65 years and older from the 2003 National Assessment of Adult Literacy. Multiple regression analysis was used to assess for evidence of mediation.RESULTS Of older adults in the United States, 29% reported fair or poor health status, and 27% to 39% reported not utilizing 3 recommended preventive health care services in the year preceding the assessment (influenza vaccination 27%, mammography 34%, dental checkup 39%). Health literacy and the 4 health outcomes (self-rated health status and utilization of the 3 preventive health care services) varied by race/ethnicity and educational attainment. Regression analyses indicated that, after controlling for potential confounders, health literacy significantly mediated both racial/ethnic and education-related disparities in self-rated health status and receipt of influenza vaccination, but only education-related disparities in receipt of mammography and dental care.CONCLUSIONS Health literacy contributes to disparities associated with race/ethnicity and educational attainment in self-rated health and some preventive health behaviors among older adults. Interventions addressing low health literacy may reduce these disparities.     

地震灾区居民健康素养干预效果评估

目的 调查2008年“5·12”汶川大地震后,汶川、北川、绵竹3个极重灾区群众健康素养状况在开展行为干预活动2年后的效果,对干预活动进行评估.方法 采用问卷调查方法,于干预活动开展的前后分别调查了360名居民的健康相关知识、健康相关行为等内容.结果 灾区居民健康素养基本知识知晓率于干预前后分别为57.1％和83.2％;健康行为形成率于干预前后分别为41.2％和68.5％.知晓率和形成率的提高均有统计学意义(X2=46.1,P＜0.01;X2=29.3,P＜0.01).结论 经过2年的行为干预活动,地震极重灾区的健康教育工作已取得一定成绩,但仍需不断深入开展有针对性地开展健康素养的宣传和普及.