Effect of cognitive dysfunction on the relationship between age and health literacy.

OBJECTIVE: Age is generally an inverse predictor of health literacy. However, the role of cognitive dysfunction among older adults in this relationship is not understood. METHODS: We conducted a cross-sectional survey of 446 adult patients in a large urban academic level one trauma center, assessing health literacy and cognitive dysfunction. RESULTS: Removing older patients (60 years of age and older) who screened positive for cognitive dysfunction attenuated the relationship between age and health literacy (r=-0.16, p=0.001 vs. r=-0.35, p<0.0001). Older patients screening positive for cognitive dysfunction had significantly lower health literacy than older patients screening negative and patients less than 60 years; health literacy scores did not generally differ significantly between the latter groups. CONCLUSION: Much of the relationship between age and health literacy was driven by cognitive dysfunction among a subset of older adults. PRACTICE IMPLICATIONS: Our findings suggest that older patients with cognitive dysfunction have the greatest need for health literacy interventions.

Left versus right intra-abdominal umbilical arteries: comparison of their Doppler waveforms.

OBJECTIVES: The purpose of this study was to compare Doppler velocimetric indices between the left and right intra-abdominal umbilical arteries in normally grown and growth-restricted fetuses. METHODS: In this cross-sectional study, Doppler indices of the intra-abdominal segment of the left and right umbilical arteries were measured lateral to the fetal bladder. Measurements, including the systolic to diastolic ratio and pulsatility index, were obtained from both anatomic locations. The Student t test was used to make comparisons. RESULTS: Differences between left and right Doppler indices were noted in 98% of patients, and these differences were greater than 20% in at least one-third. Overall, the left umbilical artery had a higher systolic to diastolic ratio (P = .025) and pulsatility index (P = .007) than the right umbilical artery. CONCLUSIONS: The laterality of the umbilical artery, whether on the left or right side of the fetus, influences important Doppler blood flow parameters.

Components of the systemic fetal inflammatory response syndrome as predictors of impaired neurologic outcomes in children.

OBJECTIVE: The purpose of this study was to compare interleukin-6 and funisitis as predictors of impaired neurologic outcomes in children by performing a secondary analysis on data that were collected prospectively for another purpose. STUDY DESIGN: We examined umbilical cords for funisitis and obtained cord blood for interleukin-6 levels. A psychomotor developmental index score was determined for each child at age 18 months. RESULTS: The prevalence (46%) of elevated interleukin-6 levels (> or = 10 pg/mL) among children with low psychomotor developmental index scores (<100) was not significantly different from that of children with normal scores (47%). Among children with funisitis (n = 21), the median psychomotor developmental index score was 94; for children without funisitis (n = 92), it was 99 (P <.02). When the data were regressed for confounding, funisitis remained significant (adjusted odds ratio, 1.3; 95% CI, 1.1-1.9). Furthermore, funisitis was a more specific predictor of low psychomotor developmental index scores (P <.001), although elevated interleukin-6 levels were more sensitive. CONCLUSION: When used for the prediction of impaired neurologic outcomes in children, funisitis has better specificity and thus a better positive predictive value than does interleukin-6.