Literacia em saúde da pessoa internada em serviço de cirurgia oncológica / Health literacy of patients admitted to a surgical oncology unit / Alfabetización en salud de las personas ingresadas en un servicio de cirugía oncológica

Resumo Enquadramento: A literacia em saúde (LS) é a capacidade da pessoa obter e traduzir informações a fim de manter e melhorar a saúde. Objetivo: Caracterizar o nível de LS da pessoa internada num hospital oncológico; avaliar a fiabilidade do instrumento European Health Literacy Survey in Portuguese (HLS-EU-PT). Metodologia: Estudo transversal, quantitativo, descritivo e metodológico. Amostra de 188 pessoas internados num serviço de cirurgia oncológica entre maio e setembro de 2020, os dados foram colhidos através de formulário de caracterização sociodemográfica, de saúde e instrumento de avaliação da LS. Resultados: O HLS-EU-PT apresentou elevado nível de consistência interna. Todos os domínios e níveis de processamento do instrumento se correlacionam positivamente entre si. Os participantes apresentam em média um nível problemático de LS. Conclusão: Os resultados indiciam a necessidade de um maior investimento na capacitação da LS. São necessários mais estudos nesta e noutras populações e contextos de prestação de cuidados de saúde, de forma a direcionar a prática de cuidados na resposta eficaz aos problemas de saúde.

Abstract Background: Health literacy (HL) is the ability of an individual to obtain and translate information in order to maintain and improve their health. Objective: To characterize the level of HL of patients admitted to an oncology hospital and assess the reliability of the Portuguese version of the European Health Literacy Survey (HLS-EU-PT). Methodology: Cross-sectional, quantitative, descriptive, and methodological study. Sample of 188 patients admitted to a surgical oncology unit between May and September 2020. Data were collected through a sociodemographic and health characterization form and a HL assessment tool. Results: The HLS-EU-PT had a high level of internal consistency. All domains and information-processing levels correlated positively with each other. Participants had on average a problematic level of HL. Conclusion: The results indicate the need for greater investment in HL training. Further studies are needed in this population and in other populations and healthcare settings to provide an effective response to health problems.

Resumen Marco contextual: La alfabetización en salud (AS) es la capacidad de una persona para obtener y traducir información con el fin de mantener y mejorar su salud. Objetivo: Caracterizar el nivel de AS de las personas ingresadas en un hospital oncológico; evaluar la fiabilidad del instrumento European Health Literacy Survey in Portuguese (HLS-EU-PT). Metodología: Estudio transversal, cuantitativo, descriptivo y metodológico. Muestra de 188 personas ingresadas en un servicio de cirugía oncológica entre mayo y septiembre de 2020, se recogieron datos mediante un formulario de caracterización sociodemográfica y de salud, y una herramienta de evaluación de AS. Resultados: El HLS-EU-PT mostró un alto nivel de consistencia interna. Todos los dominios y niveles de procesamiento del instrumento correlacionaron positivamente entre sí. Por término medio, los participantes tienen un nivel problemático de AS. Conclusión: Los resultados indican la necesidad de una mayor inversión en formación en AS. Son necesarios más estudios en esta y otras poblaciones, y en entornos sanitarios para orientar la práctica asistencial hacia una respuesta eficaz a los problemas de salud.

Competencias digitales en los ingresantes a la carrera de Licenciatura en Enfermería

Objetivo: Determinar las habilidades y conocimientos sobre las tecnologías de la información y la comunicación (TIC) de los ingresantes a la carrera de Licenciatura en Enfermería de una institución superior pública de Bahía Blanca, Provincia de Buenos Aires, Argentina. Metodología: Estudio observacional, descriptivo, transversal y cuantitativo. Se implementó un instrumento conformado por 59 preguntas con opciones de respuesta cerrada orientado a valorar las competencias digitales en los ingresantes a la carrera. Resultados: Participaron 386 ingresantes, mayormente de género femenino (85.49 %), del primer ciclo (74.35 %) y con 20 años o menos de edad (47.15 %). El 98.19 % tenía acceso a internet, el 79.27 % tiene computadora y más del 80 % tiene un amplio uso de redes sociales (WhatsApp, Instagram) y correo electrónico. Los ingresantes se autoevaluaron competentes en el programa MS Word, mientras que en MS Excel se declararon menos competentes. Hay desconocimiento y bajo desarrollo de habilidades para generar contenido, y un amplio despliegue de habilidades para buscar y descargar información de la web. La edad, el género, el tiempo diario de uso de internet y el ciclo de ingreso mostraron relación con el dominio de las herramientas digitales aplicadas a la educación. Conclusiones: Se identificó un desarrollo intermedio de competencias digitales aplicadas a la educación, lo que podría ameritar el diseño de programas que nivelen estas habilidades durante el proceso de ingreso o durante la formación.

Objetivo: determinar habilidades e conhecimentos sobre as tecnologias da informação e comunicação (TIC) dos calouros no curso de bacharelado em enfermagem em uma instituição pública de ensino superior na cidade de Bahía Blanca, província de Buenos Aires, Argentina. Metodologia: estudo observacional, descritivo, transversal e quantitativo. Foi utilizado um instrumento composto por 59 perguntas com opções de resposta fechada para avaliar as competências digitais dos calouros do curso. Resultados: Participaram 386 estudantes, em sua maioria do gênero feminino (85,49 %), do primeiro ciclo estudantil (74,35 %) e com idade igual ou inferior a 20 anos (47,15 %). 98,19 % tinham acesso à internet, 79,27 % tinham computador e mais de 80 % usavam amplamente as redes sociais (WhatsApp, Instagram) e o e-mail. Os calouros se auto-avaliaram competentes no programa MS Word, enquanto no MS Excel se declararam menos competentes. Há desconhecimento e baixo desenvolvimento de habilidades para gerar conteúdo e uma ampla demonstração de habilidades para pesquisar e baixar informações da web. A idade, o gênero, o tempo diário de uso da Internet e o ciclo de ingresso estudantil mostraram relação com o domínio das ferramentas digitais aplicadas à educação. Conclusões: Foi identificado um desenvolvimento intermediário de competências digitais aplicadas à educação, o que poderia demandar a concepção de programas que nivelem essas competências durante o processo de admissão ou durante a formação.

Objective: To determine the skills and knowledge about information and communication technologies (ICT) of entrants to the Bachelor's Degree in Nursing at a public higher institution in Bahía Blanca, Province of Buenos Aires, Argentina. Methodology: Observational, descriptive, transversal and quantitative study. An instrument was implemented consisting of 59 questions with closed response options aimed at assessing digital competencies in those entering the career. Results: 386 entrants participated, mostly female (85.49 %), from the first cycle (74.35 %) and 20 years old or younger (47.15%). 98.19 % had access to the internet, 79.27 % have a computer and more than 80 % have extensive use of social networks (WhatsApp, Instagram) and email. The entrants evaluated themselves as competent in the MS Word program, while in MS Excel they declared themselves less competent. There is a lack of knowledge and low development of skills to generate content and a wide range of skills to search and download information from the web. Age, gender, daily time of Internet use and entry cycle showed a relationship with the mastery of digital tools applied to education. Conclusions: An intermediate development of digital competencies applied to education was identified, and a high one for the use of social networks. The variables age, gender, daily time of Internet use and entry cycle were related to the knowledge and skills for using ICT applied to education.

Neurodiversity in the Minds of Students: From Perception to Campus Programming.

Neurodiversity is a social justice movement at the nexus of neuroscience, academia, and public policy. A contemporary view of neurodiversity is one that embraces neurological differences, encompassing all "neurotypes," including more specific identifiers like autistic or dyslexic. The goal of this study was to investigate student awareness and perception of neurodiversity since they are the next generation of public policy makers. Students enrolled in Introduction to Behavioral Neuroscience (N=146) were exposed to different information sources (popular, academic, TED talk, or choose/find their own) on the topic of neurodiversity. They then wrote a paper where they summarized: a) the information source used, b) their ideas to better support a neurodiverse society, and c) their opinions on aspects of neurodiversity. Several important findings emerged. First, 64% of the sample had never heard of the term neurodiversity; this class was their first exposure to it. Second, students conducting their own searches on neurodiversity had the highest level of optimism (p < 0.05) that society was ready to accept neurodiversity. Students identified even higher rates of receptivity (85%) amongst their friends. Third, student ideas to advance neurodiversity were organized into more salient categories for campuses to consider. Our findings challenge neuroscience programs to consider their role in providing "first exposure" opportunities to students in the diversity, equity, and inclusion realm, especially in areas directly related to our field. We also discuss the growing relevance of neurodiversity in research and academia and offer programming possibilities to enhance neurodiversity awareness and support on college campuses.

To participate or not to participate? Influence mechanism of artificial intelligence on Chinese college students' willingness to participate in online politics.

This study probes the mechanism of artificial intelligence's (AI's) influence on Chinese college students' willingness to participate in online politics and constructs a theoretical model based on the theory of planned behavior. Through the analysis of questionnaire data acquired from up to 317 Chinese college students in total, it turns out that the use of AI affects Chinese college students' willingness to the participation of online political practice significantly and positively, and such online political participation cognition of Chinese college students plays a mediating role, three aspects of which included as the followings on behavioral attitudes, subjective norms, and perceived behavioral control. Additionly, media literacy level plays a moderating role in online political participation cognition and willingness to participate. All the findings highlight the importance of optimizing the online political participation environment, enhancing college students' cognition of political participation, and improving media literacy in the context of the digital era, which provides practical guidance for promoting healthy and positive online political participation among college students.

Evaluating the capability of ChatGPT in predicting drug-drug interactions: Real-world evidence using hospitalized patient data.

Drug-drug interactions (DDIs) present a significant health burden, compounded by clinician time constraints and poor patient health literacy. We assessed the ability of ChatGPT (generative artificial intelligence-based large language model) to predict DDIs in a real-world setting. Demographics, diagnoses and prescribed medicines for 120 hospitalized patients were input through three standardized prompts to ChatGPT version 3.5 and compared against pharmacist DDI evaluation to estimate diagnostic accuracy. Area under receiver operating characteristic and inter-rater reliability (Cohen's and Fleiss' kappa coefficients) were calculated. ChatGPT's responses differed based on prompt wording style, with higher sensitivity for prompts mentioning 'drug interaction'. Confusion matrices displayed low true positive and high true negative rates, and there was minimal agreement between ChatGPT and pharmacists (Cohen's kappa values 0.077-0.143). Low sensitivity values suggest a lack of success in identifying DDIs by ChatGPT, and further development is required before it can reliably assess potential DDIs in real-world scenarios.

Health literacy in adolescents and young adults in Benin: French translation and validation of the health literacy measure for adolescents (HELMA).

Background: The Health Literacy Measure for Adolescents (HELMA) is a self-assessment validated tool used to measure health literacy in adolescents. This study aims to evaluate the psychometric properties of the French translation of the Health Literacy Measure for Adolescents (F-HELMA). Methods: The HELMA questionnaire was translated according to the World Health Organization's (WHO) recommendation for translation and adaptation of instruments. It was pre-tested with 30 students. Subsequently, 495 adolescents and young adults from five senior secondary high schools in Benin completed the questionnaire. A sample of 44 participants completed the questionnaire twice over a 2-week period to determine the test-retest reliability. Construct validity was evaluated using confirmatory factor analysis (CFA) and convergent validity was analyzed the Health Literacy Assessment Tool. Results and discussion: The F-HELMA-French translation of the Health Literacy Measure for Adolescents, showed moderate to good psychometric properties. CFA showed good fit indices for a seven-factor model. Reliability figures fell within an acceptable range; Cronbach's alpha ranged from 0.64 (moderate) to 0.89 (good) across the different subscales, and the intraclass coefficient (ICC) ranged from 0.82 to 0.96, indicating good test-retest reliability. Pearson correlation with HLAT-8 showed good convergent validity (r = 0.54, p < 0.001). This study provides support for the use of the F-HELMA, as a valid and reliable instrument to measure health literacy in adolescents and young adults in West African French speaking countries.

A Pilot Study of BRAIN BOOTCAMP, a Low-Intensity Intervention on Diet, Exercise, Cognitive Activity, and Social Interaction to Improve Older Adults' Dementia Risk Scores.

BACKGROUND: Little is known about the impact of short, low-intensity multidomain dementia risk reduction interventions in older adults. OBJECTIVES: To examine the effectiveness and feasibility of a low-intensity multidomain lifestyle intervention on dementia risk and dementia literacy in Australian older adults. DESIGN: Single-group pre-post design. SETTING: Community-dwelling. PARTICIPANTS: A total of 853 older Australians (Mean age=73.3 years, SD=6.1) recruited from the community. INTERVENTION: A 3-month dementia risk reduction program, BRAIN BOOTCAMP, including education, personalised risk information, physical cues for healthier choices and goal setting and planning to target four modifiable risk factors of diet, exercise, cognitive activity and social interaction in older adults. MEASUREMENTS: The 'LIfestyle for BRAin health' (LIBRA) index was used to assess participants' modifiable dementia risk based on 12 factors, with higher scores indicating greater risk. Dementia literacy was measured using a modified questionnaire derived from Dutch and British surveys, encompassing knowledge, risk reduction, and awareness aspects. Paired t-tests were used to compare dementia risk scores and dementia literacy before and after the program. Multivariate regressions were performed to identify sociodemographic and psychological factors associated with change in the LIBRA index. RESULTS: Program attrition was high (58.3%). Participants who completed the program had decreased dementia risk scores (Cohen's d=0.59, p<0.001), increased dementia literacy and awareness (Cohen's d=0.64, p<0.001) and increased motivation to change lifestyle behaviors (Cohen's d=0.25-0.52, p<0.016). Participants with higher motivational beliefs had greater dementia risk reduction. CONCLUSIONS: Improving older adults' motivation and knowledge may help modify lifestyle behaviors to reduce dementia risk. However, program attrition remains a challenge, suggesting the need for strategies to enhance participant engagement and retention in such interventions.

Health Literacy Levels of Women Attending a Perinatology Outpatient Clinic for High-Risk Pregnancy Follow-Up.

BACKGROUND: Health literacy, defined as the ability to obtain, understand, evaluate, and apply health information with knowledge, motivation, and skills, is crucial for maintaining and improving quality of life. Despite the availability of health information, limited health literacy is linked to health disparities, inadequate self-management of chronic diseases, and poorer health outcomes. OBJECTIVE: The purpose of this study is to assess the health literacy of pregnant women who visit the Perinatology Outpatient Clinic for follow-up care. It seeks to identify gaps in knowledge and understanding that may impede effective healthcare delivery and inform targeted health education and public awareness programs to enhance health literacy. METHODS: This prospective survey study included 210 pregnant women aged 18 to 40 years attending the Perinatology Outpatient Clinic at Giresun Obstetrics and Gynecology Training and Research Hospital, Turkey. Participants completed a questionnaire on health literacy, sociodemographics, and basic health status via Google Forms (Google Inc., Mountain View, CA, USA). Statistical analysis was performed using SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA), employing tests such as Kolmogorov-Smirnov, Mann-Whitney U, Kruskal-Wallis, Student's t-test, ANOVA, Spearman, and Pearson correlation, and multivariate linear regression analysis. RESULTS: The mean age of participants was 29.97±5.44 years, with a mean health literacy score of 29.89±7.05. Education level and living place significantly influenced health literacy scores, with higher scores among those with higher education and urban living (p = 0.014 and p = 0.038, respectively). Economic status also significantly impacted health literacy, with lower scores among those with poor economic status (p<0.001). Health literacy scores were higher among those receiving health information from healthcare professionals (p = 0.006) and lower among those finding medical information from doctors insufficient (p = 0.008). CONCLUSION: Health literacy is significantly influenced by education level, living place, and economic status. The study emphasizes the necessity of focused health education initiatives, especially for individuals with lower educational attainment and those residing in rural regions. Improving health literacy via efficient communication from medical professionals can benefit expectant mothers and their unborn children by lowering medical expenses and improving health outcomes.

Who should be screened for colorectal cancer and how can it be prevented more effectively?

In this editorial, we comment on the article published by Agatsuma et al in a recent issue of the World J Gastroenterol (2024; 30: 1368-1376). We firmly concur with Agatsuma et al regarding the vital significance of colorectal cancer (CRC) screening as a public health strategy to diminish disease burden. Individuals exposed to risk factors for CRC, those with comorbid conditions, and those with limited health literacy should undergo screening. However, we believe that more regular screenings should be accompanied by a greater focus on primary prevention (PP) of CRC. CRC remains a significant global health challenge, and its incidence is strongly linked to age, lifestyle, and socioeconomic factors. It is particularly noteworthy that the majority of CRC patients are diagnosed outside of established screening pathways and frequently at an advanced stage of the disease, and the majority of patients possess inadequate or even nonexistent knowledge regarding CRC, which significantly impacts the prognosis and imposes a substantial economic burden. This study revealed that CRC identified during hospital visits for comorbid conditions was typically diagnosed at an earlier stage than detected via symptomatic pathways. Remarkably, early incidental detection of CRC aligns closely with the timing of discovery through routine cancer screenings. This suggests that by adopting more inclusive screening protocols that combine opportunistic testing with traditional screening methods, health care systems can create a more comprehensive safety net for individuals at risk of CRC. However, before maximizing the health benefits of screening programs, it is essential to make additional efforts prior to screening, such as raising awareness via public education, risk assessment, and personalized recommendations, enhancing the knowledge and skills of health care professionals, optimizing the accessibility and convenience of screening processes, ensuring the quality and safety of screening services, strengthening follow-up and support systems, and providing policy support and financial investment. The establishment of a comprehensive screening system often requires substantial investment in human, material, and financial resources, which can be challenging to achieve in regions with limited health care resources. Strengthening PP strategies can reduce the disease burden by targeting the cause, representing a more cost-effective and impactful approach. Establishing a comprehensive cancer PP service platform that integrates authoritative public education on malignant tumor PP, individualized malignant tumor risk assessment, and self-health management assistance accessible to the entire population will significantly enhance the overall effectiveness of CRC PP strategies.

Eating disorders and health literacy in Germany: results from two representative samples of adolescents and adults.

Introduction: Eating disorders are associated with substantial burden for the affected individuals including negative health outcomes and increased mortality. So far, prevention programs for eating disorders have yielded mixed results concerning their efficacy. Therefore, more targeted prevention programs need to be developed. Health literacy has been identified as a potential influencing factor of eating disorders. This study aimed at exploring the relationship between likely cases of eating disorders and health literacy, alongside additional sociodemographic factors. Materials and methods: Two large samples of adults (N = 3,011) and adolescents (N = 1,021) representative of the German-speaking population in Germany were recruited. Likely cases of eating disorders were identified using the SCOFF questionnaire. Health literacy was assessed with the HLS-EU-Q16 questionnaire. Sociodemographic information, including age, gender, social status and level of education, and subjective body image were obtained. χ2-tests of independence were calculated to determine the association between the investigated constructs. Results: Suspected eating disorders were more likely in female than male adolescents but were not related to gender in adults. Rates of suspected eating disorders increased with increasing age in adolescents and decreased with increasing age in adults. While levels of education were unrelated to suspected eating disorders, low social status was associated with higher rates of suspected eating disorders in adults but not adolescents. Inadequate or problematic health literacy and negative body image were associated with higher rates of suspected eating disorders compared to adequate health literacy and more positive body image. Discussion: Likely cases of eating disorders are related to health literacy and body image as well as sociodemographic factors. These constructs should therefore be addressed in future research to improve prevention programs.

Preventive health behaviour differences across racial groups during the early stages of COVID-19.

Background: Throughout the COVID-19 pandemic, the practice of preventative health behaviours had been used disparately across different racial groups. This study seeks to identify any differences in preventative health behaviours across racial groups, controlling for other socio-demographic factors. Methods: A US national survey study was electronically conducted from July through November 2020, to measure racial/ethnic differences in health preventive behaviours about COVID-19. We performed 2-part regression models to assess whether preventive health behaviours differed by race and ethnicity. Specifically, we employed generalized logistic regressions for investigating the predictors of the use of complementary or alternative medicine (CAM), or stay-at-home strategy, then performed ordinal logistic regression to examine the predictors of social distancing, face mask wearing, and hand hygiene strategy practice. Results: The results show that non-White respondents were more likely to practice social distancing, mask wearing, and hand hygiene strategy to prevent COVID-19, compared to their White counterparts. Additionally, the findings indicate that individuals who experienced COVID-19-related racial abuse or depression had a higher likelihood of practicing preventive health behaviours. Discussion: We found ethnicity can be a predictor of health preventive behaviours, in accordance with previous research. The causes of these disparities will require further investigation in order to be addressed.

Bridging the Telehealth Digital Divide With Collegiate Navigators: Mixed Methods Evaluation Study of a Service-Learning Health Disparities Course.

BACKGROUND: Limited digital literacy is a barrier for vulnerable patients accessing health care. OBJECTIVE: The Stanford Technology Access Resource Team (START), a service-learning course created to bridge the telehealth digital divide, trained undergraduate and graduate students to provide hands-on patient support to improve access to electronic medical records (EMRs) and video visits while learning about social determinants of health. METHODS: START students reached out to 1185 patients (n=711, 60% from primary care clinics of a large academic medical center and n=474, 40% from a federally qualified health center). Registries consisted of patients without an EMR account (at primary care clinics) or patients with a scheduled telehealth visit (at a federally qualified health center). Patient outcomes were evaluated by successful EMR enrollments and video visit setups. Student outcomes were assessed by reflections coded for thematic content. RESULTS: Over 6 academic quarters, 57 students reached out to 1185 registry patients. Of the 229 patients contacted, 141 desired technical support. START students successfully established EMR accounts and set up video visits for 78.7% (111/141) of patients. After program completion, we reached out to 13.5% (19/141) of patients to collect perspectives on program utility. The majority (18/19, 94.7%) reported that START students were helpful, and 73.7% (14/19) reported that they had successfully connected with their health care provider in a digital visit. Inability to establish access included a lack of Wi-Fi or device access, the absence of an interpreter, and a disability that precluded the use of video visits. Qualitative analysis of student reflections showed an impact on future career goals and improved awareness of health disparities of technology access. CONCLUSIONS: Of the patients who desired telehealth access, START improved access for 78.7% (111/141) of patients. Students found that START broadened their understanding of health disparities and social determinants of health and influenced their future career goals.

Online resources for strabismus: an evaluation of readability, complexity, and suitability.

INTRODUCTION: Over one-third of US adults have never attended college, creating a large disparity in the readability of online health materials. Decreased health literacy and accessibility to medical information negatively affect patients and well-informed patients are more likely to experience better health outcomes (1). The NIH and AMA recommend patient-intended education materials be written at a sixth-grade reading level (2), therefore, this study analyzed the accessibility of the top ten web pages for "strabismus." METHODS: The first ten online resources returned in a Google search for "strabismus" were analyzed. Web pages were then assessed for the readability level (Simple Measure of Gobbledygook), complexity (PMOSE/IKIRSCH), and suitability (Suitability Assessment of Materials). Two independent raters assessed the complexity and suitability. RESULTS: Readability analysis of the strabismus resources revealed an average reading grade level of 11.4 ± 1.07. There was a statistical difference in the reading grade level between the .com and .gov, and the .org and .com websites (p = .029 and p = .031, respectively). Complexity analysis revealed a mean score of 6.50 ± 2.29, corresponding to an 8th-12th grade reading level. The suitability assessment showed a mean value of 70.3 ± 10.1%, representing a "superior" score for the information provided to the reader. The inter-rater agreement was similar for the complexity and fair for the suitability analysis. DISCUSSION: On average, online resources for strabismus have a low complexity level. However, the majority of the top ten articles reviewed are above the recommended literacy level, indicating a need for revision. CLINICAL IMPLICATIONS: The vast amount of available online health resources have significantly affected the field of medicine. Most patients research their disease process using online sources and many reference this material before their initial ophthalmologic consultation. Considering that more than half of Americans read below the equivalent of a sixth-grade level and that the AMA/NIH recommend all patient-intended materials to be written above this level, there is a health literacy disconnect. This limits patients' ability to educate themselves about their medical conditions and participate in informed conversations regarding their healthcare. Patients who are unable to interpret health information accurately have increased rates of hospitalization, develop more medical conditions, and experience a higher rate of mortality. This preventable impediment to informed healthcare care magnifies the urgency for easily readable online resources that are formatted in a manner that is clear to understand and suitable for patients with lower health literacy.

Differential correlations of changes in in vivo neuroimaging markers of hippocampal volume and arteriolosclerosis with declining financial and health literacy in old age.

Financial and health literacy is essential for older adults to navigate complex decision processes in late life. However, the neurobiological basis of age-related decline in financial and health literacy is poorly understood. This study aimed to characterize progression of neurodegenerative and vascular conditions over time, and to assess how these changes coincide with declining financial and health literacy in old age. Data came from 319 community-living older adults who were free of dementia at baseline, and underwent annual literacy assessments, as well as biennial 3-Tesla neuroimaging scans. Financial and health literacy was assessed using a battery of 32 items. Two in vivo neuroimaging markers of neurodegenerative and cerebrovascular conditions were used, i.e., hippocampal volume and the ARTS marker of arteriolosclerosis. A multivariate linear mixed effects model estimated the simultaneous changes in financial and health literacy, hippocampal volume, and the ARTS score. Over a mean of 7 years of follow-up, these older adults experienced a significant decline in financial and health literacy, a significant reduction in hippocampal volume, and a significant progression in ARTS score. Individuals with faster hippocampal atrophy had faster decline in literacy. Similarly, those with faster progression in ARTS also had faster decline in literacy. The correlation between the rates of hippocampal atrophy and declining literacy, however, was stronger than the correlation between the progression of ARTS with declining literacy. These findings suggest that neurodegeneration and, to a lesser extent, cerebrovascular conditions are correlated with declining financial and health literacy in old age.

The Status of Food and Nutrition Literacy and its determinants among Elementary School students in Egypt: community nursing-led design.

AIM: To assess food and nutrition literacy status and its determinants among elementary school students in El-Beheira Governorate, Egypt. BACKGROUND: Developing strategies to enhance food and nutrition literacy necessitates a deeper understanding of the food and nutrition literacy situation among elementary school students and associated factors. DESIGN: A cross-sectional descriptive research design was adopted. METHODS: A final sample of 400 primary school students (aged 6-12 years) at Itay El Barud public elementary schools in El-Beheira Governorate were administered (1) a socio-demographic characteristics and anthropometric measurements questionnaire developed by the researchers, and (2) the Food and Nutrition Literacy Scale. The derived data were analyzed using descriptive and non-parametric tests. RESULTS: The majority (61%) of students had low food and nutrition literacy scores. The results have shown that overall socio-demographic variables were significant in predicting understanding food and nutrition information, nutritional health knowledge, interactive functional and nutritional literacy, critical food and nutritional literacy, and food labeling. CONCLUSION: The study reveals that elementary school students in Egypt have poor knowledge and skills in food and nutrition literacy, largely due to a lack of nutrition education and family awareness. Factors like residential location, income, and education level also contribute to this disparity. IMPLICATIONS FOR THE PROFESSION: To improve nutrition literacy among students, a nursing approach involving community stakeholders and school nurses is recommended. This includes integrating nutrition-related topics into the school curriculum, organizing workshops, and conducting age-appropriate health education sessions. Active engagement between community health and school nurses is crucial for raising awareness about healthy nutritional choices. IMPACT: These findings hold an important impact on the education system and those designing curricula, emphasizing the need for significant incorporation of knowledge and skills related to food and nutrition within schools. REPORTING METHOD: Compliance with the STROBE checklist for cross-sectional studies was maintained throughout the research. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Supporting literacy development in kindergarten through teacher-facilitated play.

Teacher-facilitation of play is proposed as an effective method for supporting early literacy learning, however, educators remain uncertain how to balance child-autonomy in play while also directing play toward explicit academic objectives. In response, this study sought to understand how kindergarten teachers can successfully facilitate play to support early literacy development. Classroom observations and semistructured interviews were gathered and qualitatively analyzed to identify key perspectives and classroom practices that lead to the educators' successful facilitation of play to support literacy. Results of this study showed how different core literacy skills can be supported through different types of play, with each offering unique and critical opportunities for learning. Results also demonstrated how a multitude of core literacy skills can be supported through guided approaches to play, and begin to illustrate how teachers are facilitating a continuum of guided play to support literacy learning.

Evaluating cancer patient-reported experience measures against health literacy best practices.

PURPOSE: Positive patient experiences can lead to better adherence to cancer treatment and greater patient health outcomes. The primary aim of this descriptive study was to determine whether commonly used cancer PREMs have been developed according to health literacy best practices. The secondary and third aims were to examine the development of PREMs and to assess their comprehensiveness against principles of patient-centered care. METHODS: To assess adherence to best practice literacy principles regarding readability and understandability of commonly used cancer PREMs, three validated readability calculators and a validated instrument were utilized. To better understand how PREMs were developed, data about survey items, patient involvement, and expert consultation were collected. Finally, the Picker framework was used to evaluate the comprehensiveness of PREMs against principles of patient-centered care. RESULTS: Thirty-five PREMs studies met inclusion criteria for the study. The mean reading grade level of cancer PREMs was 9.7 (SD = 0.75, range = 8.2-11.2) with best practice recommendation being a grade 6 reading grade level. Twenty-eight PREMs were rated on understandability, with a mean score of 74% (SD = 10.6, range = 46-93%, with optimal score of greater than 80%). The mean number of items across PREMs was 49 (SD = 31, range = 13-136). Recommendations for the number of items to include in a questionnaire is 25-30 items. Most PREMs (n = 33, 94.3%) asked ≥ 1 double-barreled question. All PREMs addressed ≥ 2 patient-centered care principles. CONCLUSION: Cancer PREMs included in this study did not meet evidence-informed thresholds for readability and understandability. As such, it is possible that there may be gaps in how we understand the care experiences of low health literacy populations. Future development of PREMs should engage patients with low health literacy to ensure their perspectives are accurately captured and that PREMs are designed to meet the needs of all patients.

Moving Towards Ethical-Practical Recommendations for Alzheimer's Disease Prediction: Addressing Interindividual, Interprofessional, and Societal Aspects.

Biomarkers for predicting Alzheimer's disease (AD) are advancing and their implementation in various healthcare systems is imminent. There is a need for ethical standards addressing information needs, socio-ethical concerns, and expectations of healthy and at-risk persons. We present an ethical approach that integrates different existing ethical frameworks and discussion of our empirical, cross-cultural findings in a multi-layered perspective by addressing three levels. The micro-level focuses on the communication between counseling professionals, persons at risk or in an early stage of dementia, and family members. The meso-level addresses interprofessional cooperation and exchange as a key element for best person-centered care. The macro-level considers public health promotion, the media, and public-funded research. This approach allows to address key ethical concepts including beneficence, non-maleficence, autonomy, informational self-determination, empowerment, and justice. Our contribution specifically examines the ethical challenges associated with AD prediction by means of biomarkers, based on insights from a German-Israeli comparison, and promotes a transdisciplinary discussion across different healthcare contexts. We propose a reflection on three levels to go beyond the clinical counseling context and to consider the rapidly evolving field of biomarkers in the coming years. Our ethical-practical recommendations should not be considered final, but rather procedural and will require continuous adaptation regarding culturally varying practices, new algorithms, meta-analyses, and re-evaluation of established recommendations.

Associations between smartphone addiction, parenting styles, and mental well-being among adolescents aged 15-19 years in Gujarat, India.

BACKGROUND: The pervasive use of smartphones among adolescents has raised concerns about addiction and its impact on mental well-being. This study investigates the prevalence of smartphone addiction and its associations with socio-demographic factors, parenting styles, and mental health among Indian adolescents. METHODS: A cross-sectional study was conducted among 560 school-going adolescents (aged 15-19) in Gujarat, India, from January to October 2023. Data was collected using validated scales: the Smartphone Addiction Scale-Short Version (SAS-SV), the Parenting Styles and Dimensions Questionnaire (PSDQ), and the Depression Anxiety Stress Scale-21 (DASS-21). Bivariate and multivariate logistic regression analyses were performed to identify factors associated with smartphone addiction. RESULTS: The prevalence of smartphone addiction was 64.6%. Urban residence (AOR: 2.4, 95% CI: 1.8-3.3), higher parental education (AOR: 3.3, 95% CI: 1.7-4.3 for graduate fathers), longer smartphone use (AOR: 2.08, 95% CI: 1.7-3.6 for > 3 years), and higher socioeconomic status (AOR: 1.9, 95% CI: 1.5-3.51) were associated with increased odds of addiction. Authoritarian and permissive parenting styles in both parents were positively associated with smartphone addiction, while authoritative parenting was negatively associated. Smartphone addiction was strongly associated with mental health issues, particularly with severe stress (AOR: 10.82, 95% CI: 5.11-22.88, p < 0.001). CONCLUSION: Smartphone addiction is highly prevalent among Indian adolescents and is significantly associated with urban living, higher socioeconomic status, non-authoritative parenting styles, and poor mental health. These findings underscore the need for digital literacy programs, parenting interventions promoting authoritative styles, and mental health support to foster healthy smartphone use among adolescents.

Digital health literacy and its determinants among community dwelling elderly people in Taiwan.

Background: Digital Health Literacy (DHL) is crucial in navigating digital health environments, yet few studies focus on older adults. Objective: Explore the associations of digital health information and resource utilization, IT-related social support, and barriers/enhancers to digital health service usage with DHL among older adults. Methods: A cross-sectional study was conducted from January 2022 to April 2023, involving 417 individuals over the age of 60 who were interviewed using an instrument for collecting data on DHL, social support, barriers/enhancers influencing use of digital health resources and personal/demographic data. Multi-regression models were used to examine the associations. Results: Higher DHL scores were associated with daily use of digital interaction with healthcare (B = 0.28; 95% confidence interval [CI] = 0.07, 0.49; p = .01), daily use of other digital health resources (B = 0.22; 95% CI = 0.05, 0.40; p = .01), ease in finding assistance for online navigation (B = 0.27; 95% CI = 0.08, 0.45; p = .01), self-perceived digital proficiency ("usually very good at surfing the internet," B = 0.35; 95% CI = 0.18, 0.52; p = .01), assistance from relatives/others in internet browsing (B = 0.20; 95% CI = 0.02, 0.37; p = .02), and having access to a computer, tablet, or smartphone (B = 0.29; 95% CI = 0.11, 0.47, p = .01). Conversely, barriers like "no access to a computer, tablet, or phone at all times" (B = -0.19; 95% CI = -0.34, -0.04; p = .01), "difficulty understanding online content" (B = -0.22; 95% CI = -0.36, -0.07; p = .01), and "believing to be too old for online services" (B = -0.18; 95% CI = -0.32, -0.03; p = .02) were associated with lower DHL scores. Conclusions: Engagement with digital health platforms, including making online appointments and accessing personal health records, is associated with higher DHL levels. Support from relatives or others, a modifiable attribute, is also associated with elevated DHL among older adults.