Basic Health Information Research Articles

Promoting the Occupational Health of Indigenous Farmworkers

In the United States, approximately 78% of agricultural farmworkers are immigrants. In Oregon, a growing number of these farmworkers are indigenous and speak an indigenous language as their primary language. This group of farmworkers suffers from linguistic, cultural and geographic isolation and faces a unique set of challenges yet little has been done to identify their health needs. Using data from focus groups, partners from this community-based participatory research project examined indigenous farmworkers' concerns regarding occupational injury and illness, experiences of discrimination and disrespect, and language and cultural barriers. The data revealed examples of disrespect and discrimination based on the languages and cultures of indigenous farmworkers, and a lack of basic occupational health and safety information and equipment. For example, participants mentioned that occupational safety information was inaccessible because it was rarely provided in indigenous languages, and participants felt there were no legal means to protect farmworkers from occupational hazards. Community-based strategies designed to address the occupational health status of farmworkers must consider the unique circumstances of those farmworkers who do not speak Spanish or English.

Health literacy and transplant patients and practitioners

Low literacy levels have a significant impact on the healthcare system of the USA, acting as a barrier to accessing, understanding, and utilizing health information and services. In response to the unique relationship between literacy and healthcare, ‘health literacy’ was conceptualized as ‘‘the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions,’’ with the goal of taking action towards the improvement of individual health. Health literacy skills are needed in healthcare settings to accomplish a variety of tasks such as completing consent forms, communicating with healthcare professionals, providing information for assessment and diagnosis, and adhering to treatment regimens. The potential consequences of low health literacy include limited knowledge regarding medical conditions, increased hospitalizations, increased healthcare costs, and poorer health status. Adequate health literacy is vital to the health outcomes of renal transplant patients, as they face complicated, long-term post-transplant care and

WHO's Assessment Instrument for Mental Health Systems: Collecting Essential Information for Policy and Service Delivery

Information about mental health systems is essential for mental health planning to reduce the burden of neuropsychiatric disorders. Unfortunately, many low- and middle-income countries lack systematic information on their mental health systems. The objectives, scope, structure, and contents of mental health assessment and monitoring instruments commonly used in high-income countries may not be appropriate for use in middle- and low-income countries. The World Health Organization (WHO) has recently developed the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), a comprehensive assessment tool for mental health systems designed for middle- and low-income countries. WHO-AIMS was developed through an iterative process that included input from in-country and international experts on the clarity, content, validity, and feasibility of the instrument, as well as a pilot trial. The resulting instrument, WHO-AIMS 2.2, consists of six domains: policy and legislative framework, mental health services, mental health in primary care, human resources, public information and links with other sectors, and monitoring and research. These domains address the ten recommendations of the World Health Report 2001 through 28 facets and 155 items. All six domains need to be assessed to form a basic, yet broad, picture of a mental health system, with a focus on health sector activities. WHO-AIMS provides essential information for mental health policy and service delivery. Countries will be able to develop information-based mental health policy and plans with clear baseline information and targets. Moreover, they will be able to monitor progress in implementing reform policies, providing community services, and involving consumers, families, and other stakeholders in mental health promotion, prevention, care and rehabilitation. This article provides an overview of the rationale, development process, and potential uses and benefits of WHO-AIMS.

Ken Moritsugu, Acting U.S. Surgeon General: An Interview

Ken Moritsugu, Acting U.S. Surgeon General: An Interview

The National Niemann–Pick C1 disease database: Report of clinical features and health problems

Niemann-Pick type C1 (NPC1) disease is an autosomal recessive disorder characterized clinically by neonatal jaundice, hepatosplenomegaly, vertical gaze palsy, ataxia, dystonia, and progressive neurodegeneration. The present study provides basic clinical and health information from the National Niemann-Pick C1 disease database that was obtained using a clinical questionnaire of 83 questions mailed to families affected by NPC1 disease living in the United States. The study was conducted over a 1-year period, during which time parents/caregivers and physicians completed the clinical questionnaire. Sixty-four percent (87/136) of the questionnaires were returned, with 53% and 47% representing male and female NPC1 patients, respectively. The average age of diagnosis for NPC1 disease was 10.4 years, with one-half of patients being diagnosed before the age of 6.9 years. The average age of death for NPC1 disease was 16.2 years, with one-half of patients dying before the age of 12.5 years. A common clinical symptom reported at birth was neonatal jaundice (52%), followed by enlargement of the spleen (36%) and liver (31%); ascites (19%) and neonatal hypotonia (6%) were much less frequent. With respect to developmental difficulties, the most common findings included clumsiness (87%), learning difficulties (87%), ataxia (83%), dysphagia (80%), and vertical gaze palsy (81%). Together, these findings confirm and extend previous reports investigating the clinical features associated with NPC1 disease.

Moving Towards Shared Decision Making in Prostate Cancer Screening

Moving Towards Shared Decision Making in Prostate Cancer Screening

Designing Culturally and Linguistically Appropriate Health Interventions: The “Life Is Precious” Hmong Breast Cancer Study

Cancer is the number one cause of death for Asian American women, yet they have the lowest rates of cancer screening. Contributing factors, particularly for Hmong women, include the lack of culturally and linguistically appropriate educational interventions. This study aimed to develop a culturally and linguistically appropriate intervention to improve the breast cancer screening rates among Hmong women in Fresno and San Diego, California. Intervention elements included the development of a flipchart, brochure, and video that presented basic breast health and screening information, along with the targeting of not only women but men to support their wives' breast cancer screenings. Analyses of pre- and post workshop surveys showed increases in knowledge and more positive attitudes among all participants, behavioral intentions for clinical breast examinations and mammograms among women, and support for such exams and possible cancer treatment among men. Implications for further research and practice are discussed.

Introduction of an obstetric health information system: results of a pilot study in North Cameroon

International safe motherhood programs have placed increasing emphasis on assessing progress in reducing maternal mortality in developing countries. We assess the feasibility and relevance of an obstetric health information system introduced in Maroua urban district in North Cameroon. During the study period, an obstetric observation register was introduced for obstetric data collection, complemented by anthropological case studies on maternal deaths. At the end of the study period, implementation and data collection processes were correctly done, and the overall rate of completion of obstetric registers was 95% (ranging from 82.5% to 98.5% between maternity units). Eight hundred and twenty-six deliveries (n=826) were recorded and evenly distributed over the nine weeks of the study period. Eight women (1%) were transferred from non-surgical to surgical health facilities. Thirteen C-sections (n=13; 1.6%; CI: 0.8-2.7%) mainly in the provincial hospital of Maroua (11/13), and four maternal deaths were recorded, giving a maternal mortality rate of 4/826 (484 for 100,000; CI: 132-1240 for 100,000 deliveries). Nevertheless, anthropological enquiry recorded five maternal deaths during the same study period. Analysis of the geographical origin of these women showed that four of the five came from very remote areas. Rapid analysis and dissemination of results have initiated changes in obstetric practices (introduction of the partograph, modifications in the attitudes of health personnel), and also to the creation of a network between maternity units (those with and without surgical facilities) and provincial health headquarters. The introduction and use of a basic obstetric health information system combined with anthropological survey can provide a relatively accurate assessment of the maternal health situation. Such knowledge would be an excellent basis for implementing obstetric networking and relevant tools for active management of the obstetric pyramid at a regional level in developing countries.

Health literacy: more choice, but do cancer patients have the skills to decide?

As health care moves towards greater choice, with shared responsibility and decision making between doctors and patients, a variety of resources and skills are needed by individuals if they are to be active participants in their health. Health literacy is the ability to make the most out of health. For an individual, it is the capacity to obtain, interpret and understand basic health information and services in ways that enhance health. In developed countries, however, over half of the population have reading and comprehension difficulties, creating a gap between the educational expectations of health-care services and an individual's ability to understand. This review highlights the difficulty many cancer patients face as a consequence of their poor literacy and comprehension skills. It draws attention to a problem whose magnitude is not always easy to recognize and suggests simple ways health professionals can more effectively communicate with their patients.

A Report of the Vancouver Forum on the Care of the Live Organ Donor: Lung, Liver, Pancreas, and Intestine Data and Medical Guidelines

An international conference of transplant physicians, surgeons, and allied health professionals was held in Vancouver, Canada, on September 15 and 16, 2005 to address the care of the live lung, liver, pancreas, and intestine organ donor. The Vancouver Forum was convened under the auspices of the Ethics Committee of The Transplantation Society. Forum participants included over 100 leaders in organ transplantation, representing many countries from around the world, including participants from the following continents: Africa, Asia, Australia, Europe, North and South America. The objective of the Vancouver Forum was to develop an international standard of care for the live lung, liver, pancreas and intestinal organ donor. This Vancouver Forum followed a conference convened in Amsterdam on the care of the live kidney donor (1, 2). There were four organ specific work groups at the Vancouver Forum: lung, liver, pancreas and intestine. Each organ work group addressed the following topics in concert and reported their findings in a plenary presentation to all participants:

Élaborer de saines politiques gouvernementales

Policies in literacy and health need to address two perspectives: how basic literacy skills influence the health of populations and individuals; and health literacy — the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. There are three potential areas for action to improve literacy and health literacy: the health system, the education system, and within the broader sphere of culture and society. Despite some increasing attention in the last 20 years, low literacy levels remain a major problem in Canada. Policies need to be sensitive to culture, especially among Aboriginal peoples, Francophones and new Canadians. Public policies are needed to:

Building healthy public policy.

Policies in literacy and health need to address two perspectives: how basic literacy skills influence the health of populations and individuals; and health literacy--the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. There are three potential areas for action to improve literacy and health literacy: the health system, the education system, and within the broader sphere of culture and society. Despite some increasing attention in the last 20 years, low literacy levels remain a major problem in Canada. Policies need to be sensitive to culture, especially among Aboriginal peoples, Francophones and new Canadians. Public policies are needed to: Improve literacy outcomes (for example, support for a pan-Canadian literacy strategy, early childhood education and family literacy programs, and efforts to reduce high school drop out). Improve health literacy (for example, support integrated policy and program development across sectors, integrated research and knowledge translation initiatives, and efforts to build links between literacy and health networks). Reduce disparities by strengthening levels of literacy and health literacy among vulnerable groups.

Low Health Literacy

Health literacy-"the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions"-has been identified as a cross-cutting quality-of-care issue by the Institute of Medicine. This article defines the scope of the health literacy problem, discusses the literacy demands of critical care, and offers strategies for nurses to improve the quality of health communication with patients and families in the critical care environment.

Atenção a famílias com crianças e idosos, pelas Equipes de Saúde da Família, em município de médio porte

Family arrangements and some features of the Programa de Saúde da Família (PSF – Brazilian Health Family Program) in the east region of Maringá, Paraná State, were analyzed. A technique of proportional strata sampling was used by considering the number of families per area of residence and the age of family members, according to data from the Sistema de Informação da Atenção Básica (SIAB – Basic Health Information System). Among 385 families, 52.71% have one or more members in the age group of major risk, out of which 58.62% are elderly, 9.35% are less than one year old and 42.86% are between 1 and 6 years old. Some families had only one member aged 60 or older, which required assistance from the Equipes Saúde da Família (ESF – Family Health Workers). In 35% of the families, the ESF visits occurred every three or two months or never occurred. The assistance of the ESF to children, mainly to those less than 1 year old shows that only 9 of 17 families with a member in that age group are being visited monthly. The number of families with children and elderly, engaged in health group activities, is small (20%). Those results suggest that one of the main purposes of PSF is not being attained. In face of those evidences, it seems urgent to rethink work process established in the ESF

Use of Personal Digital Assistants To Deliver Education About Adherence to Antiretroviral Medications

National surveys indicate that slightly less than one half of adults in the United States have low or limited literacy skills,1 a hidden characteristic that often hinders effective communication among patients and their health care providers. Literacy is increasingly recognized as an important factor that may influence the course of treatment and several health outcomes.2 Critical to the success of drug therapy is health literacy or the “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”3 The importance of health literacy for the safety and effectiveness of health care is explained in a recent Institute of Medicine report, which includes all health care providers as part of a comprehensive plan to improve health literacy in America.

The impact of low health literacy on the medical costs of Medicare managed care enrollees

Purpose To examine the impact of low health literacy on medical care use and costs. Methods The study sample consisted of 3260 noninstitutionalized elderly persons enrolling in a Medicare managed care plan in 1997 in Cleveland, Ohio; Houston, Texas; South Florida; and Tampa, Florida. Health literacy—the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions—was measured using the Short Test of Functional Health Literacy in Adults. We used a 2-part regression model to examine the association between health literacy and medical costs, adjusting for age, sex, race/ethnicity, education, income, alcohol and tobacco consumption, and comorbid conditions. Results are presented as mean differences (with 95% confidence intervals [CI]) between the inadequate and adequate groups and, separately, the marginal and adequate groups. Results When compared to those with adequate health literacy, emergency room costs were significantly higher ($108; 95% CI: $62 to $154; P <0.0001) among those with inadequate health literacy, while differences in total ($1551; 95% CI: −$166 to $3267; P = 0.08) and inpatient ($1543; 95% CI: −$89 to $3175; P = 0.06) costs were marginally significant. Total costs were higher in the marginal health literacy group, but the difference was not significant ($596; 95% CI: −$1437 to $2630; P = 0.57). Conclusions Persons with inadequate health literacy incur higher medical costs and use an inefficient mix of services.

Beyond the Bench: Tox-in-a-Box

Vol. 113, No. 3 EnvironewsOpen AccessBeyond the Bench: Tox-in-a-Box Kris Freeman Kris Freeman Search for more papers by this author Published:1 March 2005https://doi.org/10.1289/ehp.113-a162Cited by:1AboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit The Tox Ambassador—a scientist visiting from a nearby university—squeezes several drops of blue dye into three different-sized beakers of water. The audience of sixth-grade students can easily see that although the same amount of dye is put in each beaker, the water in the smallest “baby” beaker turns much darker than that in the larger “big kid” and “adult” beakers. They are learning a key concept in toxicology: that your body size affects your dose, and that the dose makes the poison.Thousands of students have learned about environmental health science through presentations like these based on the Tox-in-a-Box™ resources kit, which includes activities for grades kindergarten through 12 (K–12), slides, demonstrations, instructions, tips for presenters, and a resource manual for teachers. The kit is designed for toxicologists and other environmental and public health professionals—Tox Ambassadors—to use in outreach efforts to students and teachers. It is produced and distributed by the Community Outreach and Education Program (COEP) of the NIEHS Center for Ecogenetics and Environmental Health at the University of Washington.Tox-in-a-Box was originally developed by COEP staff at the request of environmental health professionals who had been invited to give presentations in classrooms and weren’t sure how to explain toxicology to young audiences. Soon COEP staff also began training graduate students to serve as Tox Ambassadors. Since 2000, Tox Ambassadors have given presentations to almost 4,000 K–12 students in western Washington. Many of these presentations have been made through the NIEHS/University of Washington Integrated Environmental Health Middle School Project ( http://depts.washington.edu/ceeh/Outreach/k12.html).When Carlos Mata, a former visiting scholar and Tox Ambassador, returned to his native country of Costa Rica, he launched a program similar to Tox-in-a-Box called EcoAmigos. The EcoAmigos program disseminates basic environmental health information in regional schools. Tox-in-a-Box kits have also been sent to collaborators at the University of Alexandria in Egypt.Tox-in-a-Box fits well with many modules such as environment, biology, chemistry, social studies, risk, safety, reading, and debate. Learning themes include Living in a Chemical World, Routes of Exposure, Risks vs. Benefits, and Tox Tales: A Real Life Component. Overall, teachers give the kit high marks for both the relevance of the material to the students’ interests and concerns, and the ease of integrating the material into the curriculum they already teach.Tox-in-a-Box kits are available for purchase. A brochure is available online at http://depts.washington.edu/ceeh/Outreach/pdf/tib.pdf.Good things in small packages. The Tox-in-a-Box kit (top) has everything needed for a school presentation (left).FiguresReferencesRelatedDetailsCited by Gilbert S and Frevert K (2009) Public Education Information Resources in Toxicology, 10.1016/B978-0-12-373593-5.00073-2, (681-689), . Vol. 113, No. 3 March 2005Metrics About Article Metrics Publication History Originally published1 March 2005Published in print1 March 2005 Financial disclosuresPDF download License information EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted. Note to readers with disabilities EHP strives to ensure that all journal content is accessible to all readers. However, some figures and Supplemental Material published in EHP articles may not conform to 508 standards due to the complexity of the information being presented. If you need assistance accessing journal content, please contact [email protected]. Our staff will work with you to assess and meet your accessibility needs within 3 working days.

Domestic violence sourcebook: basic consumer health information about the causes and consequences of abusive relationships, including physical violence, sexual assault, battery, stalking, and emotional abuse ...

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