Head and neck cancer patient journey's health literacy: a multidisciplinary team perspective. VOICE study.

PURPOSE: Health literacy is a current Public Health priority in Portugal. The participation of well-informed patients in their care and shared decision making are essential, especially in chronic aggressive and debilitating pathologies such as recurrent or metastatic (R/M) Head and Neck Squamous Cell Carcinoma (HNSCC). AIMS: This study aimed to characterize R/M HNSCC patients' and caregivers' information needs identified by healthcare professionals (HCPs). METHODS: Two online Focus Groups, one with only medical doctors and the other with other HCPs involved in the treatment of R/M HNSCC patients, were conducted, using a modified Metaplan, Lean or adapted PDCA methodology. The discussions were audio recorded in full and content analysis was performed using ATLAS.ti qualitative data analysis software. RESULTS: Topics addressed were diagnosis, treatment, quality of life, and global evaluation. In general, all experts agreed that only essential information should be cautiously given, according to patients' and caregivers' wishes. It was consensual that patients are given the necessary information to adhere to treatment. Two main barriers were identified: one barrier was associated with verbal communication due to the lack of health literacy of these patients, and the other barrier regarded healthcare access. It was also considered important to remind patients of the daily and social activities that they could and should maintain, as well as providing sufficient social resources and problem-solving training to caregivers. CONCLUSIONS: This qualitative study highlights the complexity of R/M HNSCC patients' care. Immediate availability of psychologists and psychiatrists should be implemented in all centers that treat HNSCC patients. The differences found between the physicians' Focus Group and other HCPs' Focus Group in some of the addressed topics emphasize the importance of a multidisciplinary and holistic approach, in a biomedical model integrated with a biopsychosocial model.

Physical literacy assessment in adults: A systematic review.

Physical literacy is a multidimensional construct that has been defined and interpreted in various ways, one of the most common being "the motivation, confidence, physical competence, knowledge and understanding to maintain physical activity throughout the life course". Although its improvement can positively affect many behavioral, psychological, social, and physical variables, debate remains over an appropriate method of collecting empirical physical literacy data. This systematic review sought to identify and critically evaluate all primary studies (published and unpublished, regardless of design or language) that assessed physical literacy in adults or have proposed measurement criteria. Relevant studies were identified by searching four databases (Pubmed, SportDiscus, APA PsycINFO, Web of Science), scanning reference lists of included articles, and manual cross-referencing of bibliographies cited in prior reviews. The final search was concluded on July 15, 2022. Thirty-one studies, published from 2016 to 2022, were analyzed. We found seven instruments measuring physical literacy in adults, of which six were questionnaires. The Perceived Physical Literacy Instrument was the first developed for adults and the most adopted. The included studies approached physical literacy definition in two ways: by pre-defining domains and assessing them discretely (through pre-validated or self-constructed instruments) and by defining domains as sub-scales after factorial analyses. We found a fair use of objective and subjective measures to assess different domains. The wide use of instruments developed for other purposes in combined assessments suggests the need for further instrument development and the potential oversimplification of the holistic concept, which may not result in a better understanding of physical literacy. Quality and usability characteristics of measurements were generally insufficiently reported. This lack of data makes it impossible to compare and make robust conclusions. We could not identify if any of the existing physical literacy assessments for adults is appropriate for large-scale/epidemiological studies.

An Interview Study of College Students' Health Emergency Literacy in the Context of COVID-19 Normalized Prevention and Control.

Objective: To explore the changes in college students' awareness of health protection under the normalization of COVID-19, and to seek its connection with the epidemic management in colleges and universities, so as to provide reference information for continuous health education activities and the cultivation of college students' health emergency literacy in colleges and universities. Methods: Qualitative interviews were used to understand the extent of health emergency literacy among college students enrolled in the context of a normalized epidemic and the factors associated with it that cause changes around a question outline. Results: The interviewees generally had a lax mentality in the late stage of the interview, the importance they attached to epidemic prevention and control decreased significantly, and the way to know about epidemic protection measures and other knowledge was mainly through the mass news media. All respondents affirm the importance of social software for outbreak prevention and control. All 17 interviewees were able to mention basic outbreak protection methods, but 15 of them showed inconsistent behavior in words and actions later. Conclusion: The vast majority of respondents' health emergency literacy appears to weaken in the late stages of epidemic normalization, and the effect of traditional approaches used by universities to improve college students' health emergency literacy is weak.

Assessing the impact of patient-involvement healthcare strategies on patients, providers, and the healthcare system: A systematic review.

BACKGROUND: Patient involvement has become an important and lively field of research, yet existing findings are fragmented and often contested. Without a synthesis of the research field, these findings are of limited use to scholars, healthcare providers, or policy-makers. OBJECTIVE: Examine the body of knowledge on patient involvement to determine what is known, contested, and unknown about benefits, risks, and effective implementation strategies. PATIENT INVOLVEMENT: Patients were not involved. METHODS: Systematic literature review of 99 journal articles using a conceptual model integrating three levels: health systems, health providers, and patients. We extracted individual research findings and organized them into the structure of our model to provide a holistic picture of patient involvement. RESULTS: The review highlights overlaps and conflicts between various patient involvement approaches. Our results show benefits for individual patients and the health system as a whole. At the provider level, however, we identified clear barriers to patient involvement. DISCUSSION: Patient involvement requires collaboration among health systems, healthcare providers, and patients. We showed that increasing patient responsibility and health literacy requires policy-maker interventions. This includes incentives for patient education by providers, adapting medical education curricula, and building a database of reliable health information and decision support for patients. Furthermore, policies supporting a common infrastructure for digital health data and managed patient data exchange will foster provider collaboration. PRACTICAL VALUE: Our review shows how an approach integrating health systems, healthcare providers, and patients can make patient involvement more effective than isolated interventions. Such systematic patient involvement is likely to improve population health literacy and healthcare quality.

Digital Health Literacy as a Predictor of Awareness, Engagement, and Use of a National Web-Based Personal Health Record: Population-Based Survey Study.

BACKGROUND: Web-based personal health records (PHRs) have the potential to improve the quality, accuracy, and timeliness of health care. However, the international uptake of web-based PHRs has been slow. Populations experiencing disadvantages are less likely to use web-based PHRs, potentially widening health inequities within and among countries. OBJECTIVE: With limited understanding of the predictors of community uptake and use of web-based PHR, the aim of this study was to identify the predictors of awareness, engagement, and use of the Australian national web-based PHR, My Health Record (MyHR). METHODS: A population-based survey of adult participants residing in regional Victoria, Australia, was conducted in 2018 using telephone interviews. Logistic regression, adjusted for age, was used to assess the relationship among digital health literacy, health literacy, and demographic characteristics, and the 3 dependent variables of MyHR: awareness, engagement, and use. Digital health literacy and health literacy were measured using multidimensional tools, using all 7 scales of the eHealth Literacy Questionnaire and 4 out of the 9 scales of the Health Literacy Questionnaire. RESULTS: A total of 998 responses were analyzed. Many elements of digital health literacy were strongly associated with MyHR awareness, engagement, and use. A 1-unit increase in each of the 7 eHealth Literacy Questionnaire scales was associated with a 2- to 4-fold increase in the odds of using MyHR: using technology to process health information (odds ratio [OR] 4.14, 95% CI 2.34-7.31), understanding of health concepts and language (OR 2.25, 95% CI 1.08-4.69), ability to actively engage with digital services (OR 4.44, 95% CI 2.55-7.75), feel safe and in control (OR 2.36, 95% CI 1.43-3.88), motivated to engage with digital services (OR 4.24, 95% CI 2.36-7.61), access to digital services that work (OR 2.49, 95% CI 1.32-4.69), and digital services that suit individual needs (OR 3.48, 95% CI 1.97-6.15). The Health Literacy Questionnaire scales of health care support, actively managing health, and social support were also associated with a 1- to 2-fold increase in the odds of using MyHR. Using the internet to search for health information was another strong predictor; however, older people and those with less education were less likely to use MyHR. CONCLUSIONS: This study revealed strong and consistent patterns of association between digital health literacy and the use of a web-based PHR. The results indicate potential actions for promoting PHR uptake, including improving digital technology and skill experiences that may improve digital health literacy and willingness to engage in web-based PHR. Uptake may also be improved through more responsive digital services, strengthened health care, and better social support. A holistic approach, including targeted solutions, is needed to ensure that web-based PHR can realize its full potential to help reduce health inequities.

Big Data and Learning Analytics Model for Promoting Physical Literacy in College Students in China.

Physical literacy has gained much popularity in educational circles who are working on the improvement of curriculum and overall standard of education. It involves a holistic lifelong comprehensive learning approach that includes movements and physical activities. Overall, it has positive effects on physical, psychological, social, and cognitive health of individuals, so physical literacy exemplifies the dedication to raise a healthier, more active generation. Numerous factors interacting between humanities and social sciences affect the promotion of physical literacy, so such a study will be interdisciplinary which will consider across all social and individual factors. The current research proposes a system dynamic "SD" model to promote students' physical literacy by building a complete causal loop diagram of the model to illustrate the general system. Based on the casual loop diagram, the system is then presented as four subsystems. The model is simulated by allocating 14 different changes of indexes in the physical literacy promotion system to find better allocations for optimal effectiveness in promoting physical literacy. Simulations are carried out by using the Apache Spark architecture utilizing "Big Data" tools for effective, speedy, and reliable analysis and results. The study proposes that different physical literacy indexes in different grades require attention; the optimal promotion of physical literacy can be achieved by increasing the physical knowledge of lower-grade students and increasing the physical attitude of higher-grade students. The model can be used to make decisions about efficient physical literacy management and physical literacy promotion planning.

Think Health Literacy to Improve the Patient Experience.

Nurses directly influence the experience that patients and their families have in their interactions with the health care system. This article addresses how nurses holistically influence the patient experience through the lens of health literacy, as nurses guide their patients and families through a confusing and complex system of care, replete with jargon and labyrinthine paths.

The Associations Among Individual Factors, Media Literacy, and Dietary Supplement Use Among College Students: Cross-Sectional Study.

BACKGROUND: The mass media have been condemned for encouraging young people to take dietary supplements (DS). Media literacy, which includes authors and audiences (AA), messages and meanings (MM), and representation and reality (RR) domains, is a new approach to teaching young adults to make better informed health decisions. However, it is not clear which domains are the most important for media literacy education. OBJECTIVE: The purpose of this study is to investigate the associations among individual factors, media literacy, and DS use. METHODS: The survey instrument included demographic items, the DS Media Literacy Scale (DSMLS), and DS use items (users or nonusers, types of DS, current use of DS, and intention to use DS in the future). The DSMLS is an 11-item instrument designed to assess college students' AA, MM, and RR media literacy in relation to DS. A total of 467 Taiwanese college students participated in the study. Descriptive statistical analysis, logistic regression analysis, and multiple regression analysis were conducted. RESULTS: A total of 338/467 (72.4%) participants reported using DS, and 176/467 (37.7%) consumed 3 or more supplements. Moreover, the MM media literacy domain was associated with having been a DS user (odds ratio 0.63, P=.002), current DS use (ß=-.10, P=.02), and intention to use DS in the future (ß=-.12, P=.011). Finally, perceived importance of health was positively related to current DS use (ß=.18, P=.001) and intention to use DS in the future (ß=.18, P=.001). CONCLUSIONS: This study showed that the majority of Taiwanese college students were DS users and used multiple types of supplements. Moreover, students with lower MM media literacy were more likely to be DS users, to take DS more frequently, and to have higher intentions for future frequent DS use. Finally, those who placed extreme importance on health were more likely to take DS frequently and have higher intentions for future frequent DS use.

Internet Use, eHealth Literacy, and Dietary Supplement Use Among Young Adults in Pakistan: Cross-Sectional Study.

BACKGROUND: Increased access to the internet has facilitated widespread availability of health information. Thus, electronic health (eHealth) literacy-the ability to seek, find, understand, and appraise health information from electronic resources and apply that knowledge in making a health-related decision-is a crucial skill. Despite the increasing use of the internet as a source of health information in developing countries, only a few studies have examined the eHealth literacy of young adults, who frequently use the internet to access health information in these developing countries. OBJECTIVE: The aim of this study was to assess the patterns of internet use and eHealth literacy levels among university students pursuing a non-health-related degree in Pakistan. We also examined the association of the eHealth literacy levels of these young adults with their physical activity levels and dietary supplement intake. METHODS: Students from 2 leading engineering universities in Pakistan were invited to participate in a cross-sectional anonymous web-based survey in order to collect data on their internet use, eHealth literacy, and dietary supplement intake. Of the 900 eligible university students who were invited to participate, 505 (56.1%) students who completed the questionnaire were included in the analysis. The findings were converted to median values and frequency analyses were performed. The associations between the variables were determined using the chi-square test; P≤.05 was considered significant. RESULTS: In this study, the median eHealth literacy scale (eHEALS) score was 29, which did not vary across gender. The most common type of health-related information that was searched by the participants was that related to maintaining a healthy lifestyle (305/505, 60.4%). Participants with high eHEALS scores were those who used the internet frequently for finding people with similar health issues (P<.001). The use of specific social media platforms was not associated with the perceived eHealth literacy levels. Neither the frequency of physical activity nor the dietary supplement use was associated with the eHealth literacy of the participants. CONCLUSIONS: University students in non-health-related disciplines in Pakistan expressed high confidence in their skills to find health-related information on the internet, as indicated by the aggregate eHEALS scores. However, the findings of our study show that the perceived eHealth literacy was not associated with health behaviors such as physical activity and dietary supplement intake. Further research is necessary to investigate the extent to which eHealth literacy can be considered as a panacea for solving public health challenges in developing countries.

An education intervention to improve decision making and health literacy among older Australians: a randomised controlled trial.

BACKGROUND: National policies seek to involve older Australian's in decisions regarding their care; however, research has found varying levels of decision self-efficacy and health literacy skills. An increasing number of older Australians use complementary medicine (CM). We examined the effectiveness of a CM educational intervention delivered using a web or DVD plus booklet format to increase older adults' decision self-efficacy and health literacy. METHODS: A randomised controlled trial was conducted. We recruited individuals aged over 65 years living in retirement villages or participating in community groups, in Sydney Australia. Participants were randomly allocated to receive a CM education intervention delivered using a website or DVD plus booklet versus booklet only. The primary outcome was decision self-efficacy. A secondary outcome included the Preparation for Decision-Making scale and health literacy. Outcomes were collected at 3 weeks, and 2 months from baseline, and analysed using an adjusted ANOVA, or repeated measures ANOVA. RESULT: We randomised 153 participants. Follow up at 3 weeks and 2 months was completed by 131 participants. There was a 14% (n = 22) attrition rate. At the end of the intervention, we found no significant differences between groups for decision self-efficacy (mean difference (MD) 3.8, 95% confidence interval (CI) -2.0 to 9.6 p = 0.20), there were no differences between groups on nine health literacy domains, and the Preparation for Decision-Making scale. Over 80% of participants in both groups rated the content as excellent or good. CONCLUSION: Decision self-efficacy improved for participants, but did not differ between groups. Decision self-efficacy and health literacy outcomes were not influenced by the delivery of education using a website, DVD or booklet. Participants found the resources useful, and rated the content as good or excellent. CM Web or DVD and booklet resources have the potential for wider application. TRIAL REGISTRATION: The trial was registered with the Australian New Zealand Clinical Trials Registry: ACTRN ( ACTRN12616000135415 ). The trial was registered on 5 February 2016.

The perceived therapeutic benefits of complementary medicine in eating disorders.

OBJECTIVES: The purpose of this study was to investigate the perception of Complementary Medicines (CMs) in community women; to identify which CM approaches people perceived as the most beneficial; and the impact of Eating Disorder (ED) symptoms on one's perception of treatment. DESIGN & SETTING: Electronic and paper-based surveys were distributed to a pre-existing cohort of community women (n = 100) aged 18 years and over. The survey included questions about the perception of CMs' benefits in EDs regarding a vignette of a women with Anorexia Nervosa (AN), and whether CMs helped the participant's own personal health. MAIN OUTCOME MEASURE: The mental health literacy of women with regards to the recognition, evidence-based and CM treatment, and outcomes of a fictional person with AN. RESULTS: Exercise, yoga, meditation, relaxation, vitamins and minerals, massage and creative therapy were perceived as very helpful for someone with AN and for general health. Excluding meditation, there was no significant relationship between the levels of ED symptoms and perceived helpfulness of the therapies. Positive benefits were perceived for the use of CMs for AN. CONCLUSION: Considering the positive regard for these approaches, empirical studies are required to test their efficacy in the treatment of EDs.

Psychometric evaluation of the MSU CAM health literacy scale.

BACKGROUND/PURPOSE: The rise in the use of alternative health care approaches (CAM) increases the need for adequate health literacy. The MSU Health Literacy Scale was developed to measure CAM health literacy. Psychometric evaluation of the scale is presented in this article. METHODS: A test retest design was utilized and data from this instrument evaluation research project were used to explore the validity and several forms of reliability of the MSU Health Literacy Scale. The data analysis was based on the scores of 241 individuals at the T1 data collection and the scores of 188 at the T2 administration of the instrument. RESULTS: There were significant correlations between the MSU CAM Health Literacy Scale and Newest Vital Sign (r = 0.330 p = .000) and with a single question health literacy measure (r = .255 (p = .000). Cronbach's alphas were adequate for each administration of the scale (T1 = .774 and T2 = .754). The correlation of scores between the T1 administration and the T2 administration were significant (r = .696 (p = .000). CONCLUSIONS: This psychometric evaluation provides confirmation of convergent validity and stable reliability. The scale can be used in future research and clinical endeavors.

EHealth literacy in patients with cancer and their usage of web-based information.

OBJECTIVE: Our aim was to learn more about the association between the sources of information cancer patients and caregivers use and their eHealth literacy. METHODS: We distributed a standardized questionnaire among participants of a lecture program on complementary and alternative medicine (CAM). RESULTS: Among 182 attendants, the Internet was the third most important source of information (57%), preceded by the oncologist (67%) and print media (61%). Print media was associated with female participants and web-based information with younger ones. Regarding eHealth literacy, more than half (58.5%) had an above average eHEALS score. Nevertheless, the biggest concern was not being able to differentiate between reliable and not reliable websites. The correlation between a high eHealth literacy and regular search of web-based cancer information was significant (p < 0.001). CONCLUSION: The number of people using the Internet as a source of cancer information has increased over the past years and will rise in the future. However, only half of the population has the knowledge and capability to access and differentiate the massive web-based data. Improving eHealth literacy within the public will expand the knowledge of regular patients and help them become a well-informed and equal partner in decision making.

A Representative Survey of Knowledge, Use, Perceived Benefits, Barriers, and Risks of Select Herbal Drugs Among Female Students in Gorgan City (Northeast Iran).

We conducted a representative survey among young women to determine knowledge, use, and perceptions on barriers, benefits, and risks related to selected herbal drugs ( Crocus sativus, Borago officinalis, Citrus aurantium, Thymus vulgaris, Matricaria chamomilla, Lavandula angustifolia, Valeriana officinalis, Hypericum perforatum, and Panax ginseng) in Gorgan by using an internally validated questionnaire. There were 344 participants (mean age 16.3 years; 16.2% in science course). Saffron had most reported knowledge (n = 265, 77.0%) and ever use (n = 324, 94.1%). The average number of source of knowledge was 2.5; parents (n = 224, 65.1%) were the single most frequent source. Media (combined magazine, the Internet, TV, radio) was the source of knowledge for 283 (82.2%) participants. Actual use was "harmful" for the majority (n = 182, 52.9%; no idea n = 83, 24.1%). Parents and media provided knowledge on herbal drugs for most, supporting unsurprisingly high perceived knowledge but harmful actual experience. Programs to educate people are needed to not take herbal drugs lightly.

An integrated workplace mental health intervention in a policing context: Protocol for a cluster randomised control trial.

BACKGROUND: In this paper, we present the protocol for a cluster-randomised trial to evaluate the implementation and effectiveness of a workplace mental health intervention in the state-wide police department of the south-eastern Australian state of Victoria. n. The primary aims of the intervention are to improve psychosocial working conditions and mental health literacy, and secondarily to improve mental health and organisational outcomes. METHODS/DESIGN: The intervention was designed collaboratively with Victoria Police based on a mixed methods pilot study, and combines multi-session leadership coaching for the senior officers within stations (e.g., Sergeants, Senior Sergeants) with tailored mental health literacy training for lower and upper ranks. Intervention effectiveness will be evaluated using a two-arm cluster-randomised trial design, with 12 police stations randomly assigned to the intervention and 12 to the non-intervention/usual care control condition. Data will be collected from all police members in each station (estimated at >20 per station). Psychosocial working conditions (e.g., supervisory support, job control, job demands), mental health literacy (e.g., knowledge, confidence in assisting someone who may have a mental health problem), and mental health will be assessed using validated measures. Organisational outcomes will include organisational depression disclosure norms, organisational cynicism, and station-level sickness absence rates. The trial will be conducted following CONSORT guidelines. Identifying data will not be collected in order to protect participant privacy and to optimise participation, hence changes in primary and secondary outcomes will be assessed using a two-sample t-test comparing summary measures by arm, with weighting by cluster size. DISCUSSION: This intervention is novel in its integration of stressor-reduction and mental health literacy-enhancing strategies. Effectiveness will be rigorously evaluated, and if positive results are observed, the intervention will be adapted across Victoria Police (total employees ~16,500) as well as possibly in other policing contexts, both nationally and internationally. TRIAL REGISTRATION: Current Controlled Trials: ISRCTN82041334. Registered 24th July, 2014.

Web site construction for information and treatment on liver cancer.

Liver cancer requires a considerable attention of health care scientists worldwide. A holistic treatment includes patient information about risk factors, education on pragmatic evaluation of the symptoms, as well as presentation of best and individualized treatment methods. In this direction, Internet seems to be a powerful tool that has an essential role. The aim of this study is the development of a web site in order to inform and present treatment options on liver cancer, it consists of four parts. In the first part, the presentation of the disease's knowledge base is attempted, whereas in the second part this knowledge base is organized in two conceptual entities: (a) information and (b) treatment. In the third part the importance of internet in the health care sector is highlighted. In the fourth and last part the web site is presented and a brief illustration of several relevant theories and specific implementation tools. The critical success factor of the implementation phase is considered to be the selection of the appropriate methods and development tools. Finally, the constant need for ongoing site maintenance is discussed and thus, is proposed to formulate one of the main aspects for further research, along with several issues concerning site usability.

Multidisciplinary collaborative development of a plain-language prenatal education book.

During pregnancy, women actively seek out health information that promotes the well-being of themselves and their fetuses. For those with health literacy challenges, access to understandable health information can be difficult. Written information, in particular, needs to be readable and usable by the women served. Plain language is an essential component of effective health education material. In an effort to create standardized prenatal education materials for a diverse population of childbearing women, Boston Medical Center's midwifery service led a multidisciplinary initiative to develop a comprehensive plain-language prenatal education book. Midwives, obstetricians, family physicians, nurses, and community doulas contributed to the content of the book; art students provided graphic design skills; and a literacy consultant assisted in the wording and layout. The Hey Mama! book provides women with woman-centered, readable, comprehensive information about pregnancy, labor, postpartum, and newborn care.

Experiences with nutrition-related information during antenatal care of pregnant women of different ethnic backgrounds residing in the area of Oslo, Norway.

OBJECTIVE: to explore experiences with nutrition-related information during routine antenatal care among women of different ethnical backgrounds. DESIGN: individual interviews with seventeen participants were conducted twice during pregnancy. Data collection and analysis were inspired by an interpretative phenomenological approach. SETTING: participants were purposively recruited at eight Mother and Child Health Centres in the area of Oslo, Norway, where they received antenatal care. PARTICIPANTS: participants had either immigrant backgrounds from African and Asian countries (n=12) or were ethnic Norwegian (n=5). Participants were pregnant with their first child and had a pre-pregnancy Body Mass Index above 25 kg/m(2). FINDINGS: participants experienced that they were provided with little nutrition-related information in antenatal care. The information was perceived as presented in very general terms and focused on food safety. Weight management and the long-term prevention of diet-related chronic diseases had hardly been discussed. Participants with immigrant backgrounds appeared to be confused about information given by the midwife which was incongruent with their original food culture. The participants were actively seeking for nutrition-related information and had to navigate between various sources of information. CONCLUSIONS: the midwife is considered a trustworthy source of nutrition-related information. Therefore, antenatal care may have considerable potential to promote a healthy diet to pregnant women. Findings suggest that nutrition communication in antenatal care should be more tailored towards women's dietary habits and cultural background, nutritional knowledge as well as level of nutrition literacy.

[Mindfulness and the development of professional health competence in nursing]. / Achtsamkeitspraxis und die Entwicklung von professioneller Gesundheitskompetenz in der Pflege.

Health competence is not only a requirement for personal health action; it is also a condition for professionalisation of health promotion. Health promotion has meanwhile become a well recognised part of nursing. This is the reason why in this study the term "health competence", which is actually very much discussed in health sciences, is presented. This concept is knowledge based (health literacy). It is focused on the ability to read, understand and work with health information to be able to do decisions in daily life which are positive for the health. An experienced-based understanding, which focuses on the ability to feel and to perceive and which is regarded as a precondition of self care, is added to this knowledge-based understanding of "health competence". The concept for this interpretation is the "Leibkonzept" which has already been discussed as a fruitful concept in nursing science in other publications.

Vitamin D deficiency, eosinophilic esophagitis, and health literacy.

PURPOSE OF REVIEW: To review the recent literature on three topics that are important in pediatric office practice: vitamin D deficiency, eosinophilic esophagitis, and health literacy. Review of current literature will help pediatricians understand the prevalence of vitamin D deficiency, its potential negative health effects, and vitamin D supplementation guidelines. This article also provides practitioners with current knowledge of the evaluation and treatment of eosinophilic esophagitis. The article concludes with a summary of recent literature on health literacy and available techniques to improve patient education. RECENT FINDINGS: Vitamin D deficiency in pediatric and adolescent patients is extremely common and has potential negative skeletal and extra-skeletal effects. Eosinophilic esophagitis is an increasingly recognized problem. Pediatric patients benefit from early recognition and treatment of the disease. There are effective techniques that improve patient health literacy. SUMMARY: Vitamin D deficiency, eosinophilic esophagitis, and poor health literacy are three important problems that potentially negatively impact the lives of children and adolescents. Pediatricians should regularly counsel their patients regarding appropriate vitamin D intake. Practitioners should be aware of the clinical presentation of eosinophilic esophagitis. Pediatricians should utilize strategies to improve patient education with the goal of improving health outcomes.