Defining and identifying laboratory literacy as a component of health literacy: An assessment of existing health literacy tools.

Health literacy has been defined and studied as an important component of a patient's ability to understand and obtain appropriate healthcare. However, a laboratory component of health literacy, as it pertains to the understanding of laboratory tests and their results, has not been previously defined. An analysis of readily available health literacy tools was conducted to determine laboratory testing-specific content representation. One hundred and four health literacy tools from a publicly available database were analyzed. Many of the health literacy tools were found to be lacking items related to laboratory testing. Of the health literacy tools that did contain a laboratory component, they were categorized pertaining to the laboratory test/testing content. Emerging from this process, eight competencies were identified that encompassed the entire range of laboratory-related aspects of health literacy. We propose that these eight competencies form the basis of a set of competencies needed for one to access, interpret, and act on laboratory results-a capacity we are referring to as "laboratory literacy."

Prevalence of inherited retinal diseases in a large Egyptian cohort.

BACKGROUND: Inherited retinal diseases form a rare, highly heterogeneous group of genetic disorders characterized by retinal degeneration. It is considered one of the leading causes of debilitating visual loss and blindness in children and young adults. Despite this few population-based data studies on prevalence of inherited retinal diseases exist. Moreover, prevalence can vary widely depending on geographical area, population ethnicity and cultural habits. PURPOSE: To report the prevalence of different subtypes of Inherited retinal diseases in a large Egyptian cohort in a retrospective, hospital-based, cross-sectional study. METHODS: We conducted an extensive electronic medical record search for all the patients attending the outpatient clinic and investigation unit of Ain Shams University Hospital and the two branches of Watany Eye Hospital in the period between January 2015 and October 2022 aiming to identify the prevalence rate of different types of IRDs, patient demographics and stratify them according to their phenotype. RESULTS: We examined the electronic medical records of 478 222 patients, 971 patients were diagnosed with IRD by clinical examination with or without any of the following investigations: color fundus photography, fundus autofluorescence, fundus fluorescein angiography, optical coherence tomography and/or electrophysiological studies as electroretinogram, visual evoked potential and electrooculogram. The overall prevalence was 0.2%. The most common IRD encountered was isolated retinitis pigmentosa with a percentage of 78.9% followed by Stargardt disease at 6.3%, cone-rod dystrophy at 2.0%, autosomal recessive bestrophinopathy at 1.9% and unspecified IRD at 1.5%. CONCLUSION: Retinitis pigmentosa was the most common IRD encountered followed by Stargardt disease. Many of the dystrophies are the subject of clinical intervention trials, and population-based epidemiological data can guide phenotype-based genetic testing and help assess the future need for treatment.

Facilitating diversity of thought in learning environments for nursing students.

Human capital development is one of the goals of higher education and a decrease in open dialogue threatens these ideals and aspirations. A recent survey of undergraduate students showed that many students censor their point of view. There are many potential reasons for this, but it could be secondary to the current sociopolitical climate. Having educators who encourage and model open dialogue while supporting diversity of thought would provide alternative perspectives and innovation. Encouraging diversity of thought will enhance understanding of other's perspectives and unleash creative problem solving to address concerns in nursing practice and facilitate innovative research. The purpose of this article is to present strategies that can be employed to promote diversity of thought among nursing students in a learning environment. Exemplars are presented illustrating some of the strategies discussed.

"Was Test Designed for Africans?" Health Literacy and African Immigrants.

BACKGROUND: Immigrants experience barriers to accessing and utilizing health care. Language and cultural differences regarding health and healing impact use of health care. Limited health literacy is associated with decreased preventive health services and is reported among immigrant groups in the USA, but the health literacy of African immigrants is not known. OBJECTIVE: Assess health literacy, its association with engagement in primary care and select sociodemographic variables, and the use of two health literacy measures with African immigrants. METHODS: We conducted a community-based participatory research cross-sectional survey among African immigrants in Massachusetts. Participants completed the Newest Vital Sign, the Health Literacy Skills Instrument, acceptability questionnaires, and a Health Survey. We observed and recorded comments and questions as participants completed the surveys. KEY RESULTS: Out of 75 participants, 60% have limited health literacy. Over 80% are connected to a health care system and comfortable speaking with their doctor/nurse. Education, English proficiency, country of origin, and access to health care are associated with health literacy. Participants found the measures easy to understand but difficult to answer. Observation data revealed unfamiliarity with nutrition labels, cooking measurements, and navigation of internet links, and the need for clarification of select items. CONCLUSIONS: Most African immigrants in this study have limited health literacy despite English proficiency, college education, employment, and connection to a health system. Further research is needed to determine the value of aligning the measurement of health literacy with the cultural-linguistic identities of the population being assessed versus the need to understand their health literacy within the dominant culture.

Making explicit the development of PhD-prepared nurses to steward the discipline.

Leadership is a core curricular element of PhD programs in nursing. Our PhD faculty began a dialogue about being a leader, a steward of the discipline. We asked ourselves: (a) What expertise do PhD prepared nurse needs to begin to steward the discipline? (b) How do faculty engage PhD nursing students to assume responsibility for stewarding the discipline? Lastly, (c) How do we work with PhD nursing students to create their vision for how their work contributes to stewarding the discipline, from doctoral coursework throughout their career? We support the need for PhD graduates to have the skills to generate knowledge, conserve that which is important, and transform by disseminating new knowledge to a broad audience. Examples of nurses stewarding the discipline when pioneering research, critiquing traditional approaches to inquiry or trends in nursing practice, and developing policy, are highlighted along with examples of how PhD nursing students begin to steward the discipline.

Effects of an ActRIIB.Fc Ligand Trap on Cardiac Function in Simian Immunodeficiency Virus-Infected Male Rhesus Macaques.

An important safety consideration in the use of antagonists of myostatin and activins is whether these drugs induce myocardial hypertrophy and impair cardiac function. The current study evaluated the effects of a soluble ActRIIB receptor Fc fusion protein (ActRIIB.Fc), a ligand trap for TGF-ß/activin family members including myostatin, on myocardial mass and function in simian immunodeficiency virus (SIV)-infected juvenile rhesus macaques (Macaca mulatta). Fourteen pair-housed, juvenile male rhesus macaques were inoculated with SIVmac239; 4 weeks postinoculation, they were treated with weekly injections of 10 mg/kg ActRIIB.Fc or saline for 12 weeks. Myocardial mass and function were evaluated using two-dimensional echocardiography at baseline and after 12 weeks. The administration of ActRIIB.Fc was associated with a significantly greater increase in thickness of left ventricular posterior wall and interventricular septum both in diastole and systole. Cardiac output and cardiac index increased with time, more in animals treated with ActRIIB.Fc than in those treated with saline, but the difference was not statistically significant. The changes in ejection fraction, fractional shortening, and stroke volume did not differ significantly between groups. The changes in end-diastolic and end-systolic volumes did not differ between groups. In addition to a large reduction in IGF1 mRNA expression in the ActRIIB.Fc-treated animals, complex changes were detected in the myocardial expression of proteins related to calcium transport and storage. In conclusion, ActRIIB.Fc administration for 12 weeks was associated with increased myocardial mass but did not adversely affect myocardial function in juvenile SIV-infected rhesus macaques. Further studies are necessary to establish long-term cardiac safety.

Fatigue Among Adults With Type 1 Diabetes Mellitus and Implications for Self-Management: An Integrative Review.

Purpose The aim of this review was to integrate empirical and theoretical literature on fatigue among adults with type 1 diabetes mellitus (T1DM). A methodological review using an integrative approach was used. Databases MEDLINE via Pubmed, CINAHL, PsycINFO, and Science Direct were searched for peer-reviewed articles published in English from 2007-2017, using the following search terms and Boolean operators: "Type 1 Diabetes" and "Fatigue." Of 199 articles initially retrieved, 14 were chosen for inclusion. These articles included 13 quantitative (7 cross-sectional, 2 cohort, 2 secondary data analyses, 2 experimental) and 1 qualitative phenomenology. Fatigue was identified as one of the most troublesome symptoms reported in persons with T1DM. Four main themes emerged: fatigue in T1DM is multidimensional and related to psychological, physiological, situational, and sociodemographic factors. Conclusions Fatigue is considered a classic symptom of hyperglycemia; however, there were minimal data to support the theory that fatigue is related to hyperglycemia or hypoglycemia. Studies on fatigue among persons with T1DM are limited to small samples and cross-sectional designs with few randomized controlled trials addressing fatigue and diabetes-related symptoms. Evidence is conflicting regarding the onset of fatigue among persons with T1DM and the relationship between fatigue and diabetes duration. The prevalence of fatigue is likely influenced by disease physiology, psychological stress, and lifestyle factors, but more research is needed to confirm these relationships as causal inference is unclear.

Expanding horizons: Lonergan's philosophy as a guide to PhD program pedagogy.

Historically, research-focused doctoral programs in nursing have used the apprenticeship model to educate and prepare nurse scientists for research careers. The assumption is that students learn best when paired with a faculty member who is working on the same topic. This model works well when there is a stable workforce, adequate funding streams and sufficient faculty with diverse expertise to capture the enthusiasm and varied topics of incoming doctoral students. However, we believe there are alternative approaches that are worth exploring. We propose an alternative way of preparing students for entry into nursing science. The purpose of this paper is to describe one PhD program's new approach, based on the philosophical premises of Bernard Lonergan, to create a generation of creative, insightful thinkers who expand the horizons of the nursing discipline.

Macrocognition in the Healthcare Built Environment (mHCBE): A Focused Ethnographic Study of "Neighborhoods" in a Pediatric Intensive Care Unit.

OBJECTIVES: The objectives of this research were to describe the interactions (formal and informal), in which macrocognitive functions occur and their location on a pediatric intensive care unit, to describe challenges and facilitators of macrocognition using space syntax constructs (openness, connectivity, and visibility), and to analyze the healthcare built environment (HCBE) using those constructs to explicate influences on macrocognition. BACKGROUND: In high reliability, complex industries, macrocognition is an approach to develop new knowledge among interprofessional team members. Although macrocognitive functions have been analyzed in multiple healthcare settings, the effect of the HCBE on those functions has not been directly studied. The theoretical framework, "macrocognition in the healthcare built environment" (mHCBE) addresses this relationship. METHOD: A focused ethnographic study was conducted including observation and focus groups. Architectural drawing files used to create distance matrices and isovist field view analyses were compared to panoramic photographs and ethnographic data. RESULTS: Neighborhoods comprised of corner configurations with maximized visibility enhanced team interactions as well as observation of patients, offering the greatest opportunity for informal situated macrocognitive interactions (SMIs). CONCLUSIONS: Results from this study support the intricate link between macrocognitive interactions and space syntax constructs within the HCBE. These findings help increase understanding of how use of the framework of Macrocognition in the HCBE can improve design and support adaptation of interprofessional team practices, maximizing macrocognitive interaction opportunities for patient, family, and team safety and quality.

Health literacy in the urgent care setting: What factors impact consumer comprehension of health information?

BACKGROUND: An increasing number of Americans are using urgent care (UC) clinics due to: improved health insurance coverage, the need to decrease cost, primary care offices with limited appointment availability, and a desire for convenient care. Patients are treated by providers they may not know for episodic illness or injuries while in pain or not feeling well. Treatment instructions and follow-up directions are provided quickly. PURPOSE: To examine health literacy in the adult UC population and identify patient characteristics associated with health literacy risk. METHODS: As part of a larger cross-sectional study, UC patients seen between October 2013 and January 2014 completed a demographic questionnaire and the Newest Vital Sign. Descriptive, nonparametric analyses, and a multinomial logistic regression were done to assess health literacy, associated and predictive factors. RESULTS: A total of 57.5% of 285 participants had adequate health literacy. The likelihood of limited health literacy was associated with increased age (p < .001), less education (p < .001), and lower income (p = .006). CONCLUSIONS/IMPLICATIONS: Limited health literacy is common in a suburban UC setting, increasing the risk that consumers may not understand vital health information. Clear provider communication and confirmation of comprehension of discharge instructions for self-management is essential to optimize outcomes for UC patients.

CE: Defining and Understanding Pilot and Other Feasibility Studies.

: Nurses are becoming increasingly involved in conducting clinical research in which feasibility studies are often the first steps. Understanding why and how these studies are conducted may encourage clinical nurses to engage with researchers and take advantage of opportunities to participate in advancing nursing science. This article provides an overview of feasibility studies, including pilot studies, and explains the type of preliminary data they seek to provide in order to make larger, future studies more efficient and successful. By way of example, the authors discuss a feasibility study they conducted that illustrates the key components and necessary steps involved in such work.

Political Efficacy and Participation of Nurse Practitioners.

Twenty-eight states have laws and regulations limiting the ability of nurse practitioners (NPs) to practice to the full extent of their education and training, thereby preventing patients from fully accessing NP services. Revisions to state laws and regulations require NPs to engage in the political process. Understanding the political engagement of NPs may facilitate the efforts of nurse leaders and nursing organizations to promote change in state rules and regulations. The purpose of this study was to describe the political efficacy and political participation of U.S. NPs and gain insight into factors associated with political interest and engagement. In the fall of 2015, we mailed a survey to 2,020 NPs randomly chosen from the American Academy of Nurse Practitioners' database and 632 responded (31% response rate). Participants completed the Trust in Government (external political efficacy) and the Political Efficacy (internal political efficacy) scales, and a demographic form. Overall, NPs have low political efficacy. Older age ( p≤.001), health policy mentoring ( p≤.001), and specific education on health policy ( p≤.001) were all positively associated with internal political efficacy and political participation. External political efficacy was not significantly associated with any of the study variables. Political activities of NPs are largely limited to voting and contacting legislators. Identifying factors that engage NPs in grassroots political activities and the broader political arena is warranted, particularly with current initiatives to make changes to state laws and regulations that limit their practice.

Criminal offending and the family environment: Swedish national high-risk home-reared and adopted-away co-sibling control study.

BACKGROUND: Criminal offending is strongly transmitted across generations. AIMS: To clarify the contribution of rearing environment to cross-generational transmission of crime. METHOD: Using Swedish national registries, we identified 1176 full-sibling and 3085 half-sibling sets from high-risk families where at least one sibling was adopted and the other raised by the biological parents. RESULTS: Risk for criminal conviction was substantially lower in the full- and half-siblings who were adopted v. home-reared (hazard ratios (HR) = 0.56, 95% CI 0.50-0.64 and 0.60, 95% CI 0.56-0.65, respectively). The protective effect of adoption was significantly stronger in sibships with two v. one high-risk parent. CONCLUSIONS: Using matched high-risk full- and half-siblings, we found replicated evidence that (a) rearing environment has a strong impact on risk for criminal conviction, (b) high-quality rearing environments have especially strong effects in those at high familial risk for criminal offending and (c) the protective effects of adoption are stronger for more severe crimes and for repeated offending.

Learning About and Benefiting From Peer Review: A Course Assignment for Doctoral Students at Two Different Universities.

BACKGROUND: Peer review is an expectation of PhD-prepared nurses but a lack of evidence in the best methods to train students is of concern. METHOD: Guided by the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) model, faculty at two universities developed, implemented, and evaluated a peer review assignment for 22 second-year PhD nursing students. Quantitative and qualitative data were collected and analyzed using descriptive statistics and content analysis. RESULTS: Students reported the process of peer review was beneficial (82%) because it informed their own writing (59%), assisted them to read more critically (73%), and increased their appreciation of the role of peer review in the revision process (77%). Giving constructive feedback was difficult for students, but the feedback they received was helpful. CONCLUSION: Peer review is important to the development of science and an expectation of PhD-prepared nurses. Methods to include peer review in education are needed. [J Nurs Educ. 2016;55(6):342-344.].

The different faces of impulsivity as links between childhood maltreatment and young adult crime.

Crime is a major public health and safety threat. Many studies have suggested that early exposure to child maltreatment increases an individual's risk for persistent serious crime in adulthood. Despite these findings about the connection between child maltreatment and criminal behavior, there is a paucity of empirically-based knowledge about the processes or pathways that link child maltreatment to later involvement in crime. Using a community sample of 337 young adults (ages 18-25) in a U.S. metropolitan area, the present study examined the role of various facets of impulsivity in linking child maltreatment to crime. A series of factor analyses identified three types of crime including property crime, violent crime, and fraud. Structural equation modelings were conducted to examine the associations among childhood maltreatment, four facets of impulsivity, and criminal behavior, controlling for sociodemographic information, family income and psychological symptoms. The present study found that child emotional abuse was indirectly related to property crime and fraud through urgency while a lack of premeditation mediates the relationship between child neglect and property crime. Child physical abuse was directly related to all three types of crime. Personality traits of urgency and lack of premeditation may play a significant role in the maltreatment-crime link. Preventive interventions targeting impulsivity traits such as urgency and a lack of premeditation might have promising impacts in curbing criminal behavior among maltreatment victims.

A national Swedish longitudinal twin-sibling study of criminal convictions from adolescence through early adulthood.

BACKGROUND: Prior twin and adoption studies have demonstrated the importance of both genetic and shared environmental factors in the etiology of criminal behavior (CB). However, despite substantial interest in life-course theories of CB, few genetically informative studies have examined CB in a developmental context. METHOD: In 69,767 male-male twin pairs and full-sibling pairs with ≤ 2 years' difference in age, born 1958-1976 and ascertained from the Swedish Twin and Population Registries, we obtained information on all criminal convictions from 1973 to 2011 from the Swedish Crime Register. We fitted a Cholesky structural model, using the OpenMx package, to CB in these pairs over three age periods: 15-19, 20-24, and 25-29. RESULTS: The Cholesky model had two main genetic factors. The first began at ages 15-19 and declined in importance over development. The second started at ages 20-24 and was stable over time. Only one major shared environmental factor was seen, beginning at ages 15-19. Heritability for CB declined from ages 15-29, as did shared environmental effects, although at a slower rate. CONCLUSIONS: Genetic risk factors for CB in males are developmentally dynamic, demonstrating both innovation and attenuation. These results are consistent with theories of adolescent-limited and life-course persistent CB subtypes. Heritability for CB did not increase over time as might be predicted from active gene-environmental correlation. However, consistent with expectation, the proportion of variability explained by shared environmental effects declined slightly as individuals aged and moved away from their original homes and neighborhoods.

The association between health literacy and cancer-related attitudes, behaviors, and knowledge.

Using a multidimensional assessment of health literacy (the Cancer Message Literacy Test-Listening, the Cancer Message Literacy Test-Reading, and the Lipkus Numeracy Scale), the authors assessed a stratified random sample of 1013 insured adults (40-70 years of age). The authors explored whether low health literacy across all 3 domains (n =111) was associated with sets of variables likely to affect engagement in cancer prevention and screening activities: (a) attitudes and behaviors relating to health care encounters and providers, (b) attitudes toward cancer and health, (c) knowledge of cancer screening tests, and (d) attitudes toward health related media and actual media use. Adults with low health literacy were more likely to report avoiding doctor's visits, to have more fatalistic attitudes toward cancer, to be less accurate in identifying the purpose of cancer screening tests, and more likely to avoid information about diseases they did not have. Compared with other participants, those with lower health literacy were more likely to say that they would seek information about cancer prevention or screening from a health care professional and less likely to turn to the Internet first for such information. Those with lower health literacy reported reading on fewer days and using the computer on fewer days than did other participants. The authors assessed the association of low health literacy with colorectal cancer screening in an age-appropriate subgroup for which colorectal cancer screening is recommended. In these insured subjects receiving care in integrated health care delivery systems, those with low health literacy were less likely to be up to date on screening for colorectal cancer, but the difference was not statistically significant.

Change in health literacy over 2 years in older adults with diabetes.

PURPOSE: The purpose of this study was to evaluate the stability of health literacy in adults with diabetes over time. Understanding the dynamic nature of health literacy is important when tailoring health messages, especially those targeted at the management of chronic health conditions. METHOD: This was a descriptive longitudinal study of 751 adults with diabetes randomly selected from primary care practices in the Vermont Diabetes Information System study between July 2003 and December 2007. Participants were interviewed and completed questionnaires upon entrance into the study and again 24 months later. Health literacy was measured with the Short Test for Functional Health Literacy of Adults. Participants also completed the SF-12 and the Self-Administered Comorbidity Questionnaire and self-reported their sex, income, education, marital status, race/ethnicity, health insurance, duration of diabetes, and problems with vision. RESULTS: A significant decrease in health literacy was noted over 24 months. The largest decrease was in adults ≥65 years of age and those with higher physical function at baseline. Smaller declines were noted for women and participants who were white, higher educated, poly-pharmacy users, and with fair to excellent vision. CONCLUSIONS: Health literacy exhibits decline with increasing age among adults with diabetes. Individual variability in health literacy has implications for the best timing and approach to provide self-management education and support.

The HEAL, Phase II Project: enhancing features of an electronic medical record system to improve adherence to asthma guidelines.

This article describes the implementation of an enhanced electronic medical record (EMR) system in three community health care centers in the Greater New Orleans area of Louisiana. This report may aid efforts directed at the implementation of enriched tools, such as decision support, in an EMR with the goal of improving pediatric asthma outcomes.