Leading Health Organizations Research Articles

Health Professionals Dynamic Role Amid COVID-19: Nursing Perspectives

A novel coronavirus (COVID-19) is a newly discovered virus in 2019 in Wuhan, China. Globally around the world, healthcare professionals (HCP), including nurses, are the front line health workers (FHW), considered as a vital member of the team trying to save several people's lives. Although leading health organizations and scientific papers consistently addressed the HCP challenging role concerning multidisciplinary approaches and support systems, along with evidence-based research implications for delivering the best possible quality care, this review resulted in four primary categories, such as challenges, domains, support systems (code of ethics), and evidence-based synthesis of health policy. A step further, this article will detail the tremendous role of brave healthcare workers, including nurses and pharmacists who proved themselves as health warriors, along with the key issues about the nurses' perspectives on the impact of COVID-19, and to debunk the mixed messages what is being reported every day is a virtual drive for nurses focusing on the significant domains of nursing practices as a motivating factor amid COVID-19.

Association Between Eliminating Water From Surgical Hand Antisepsis at a Large Ophthalmic Surgical Hospital and Cost

Alcohol-based surgical scrub is recommended for presurgical antisepsis by leading health organizations. Despite this recommendation, water-based scrub techniques remain common practice at many institutions. To calculate the potential financial savings that a large, subspecialty ophthalmic surgical center can achieve with a conversion to waterless surgical hand preparation. A review of accounting records associated with the purchase of scrubbing materials and water company invoices was conducted to assess direct costs attributable to water consumption and scrub materials for brushless, alcohol-based surgical scrub and water-based presurgical scrub. The flow rate of scrub sinks to estimate water consumption per year was tested. Savings associated with operating room (OR) and personnel time were calculated based on the prescribed scrub times for waterless techniques vs traditional running-water techniques. The study was conducted from January 5 to March 1, 2019. The primary outcomes for this study were the quantity of water consumed by aqueous scrubbing procedures as well as the cost differences between alcohol-based surgical scrub and water-based scrub procedures per OR per year. Scrub sinks consumed 15.9 L of water in a 2-minute period, projecting a savings of 61 631 L and $277 in water and sewer cost per operating room per year. Alcohol-based surgical scrub cost $1083 less than aqueous soap applied from wall-mounted soap dispensers and $271 less than preimpregnated scrub brushes per OR per year in supply costs. The decrease in scrub time from adopting waterless scrub technique could save between approximately $280 000 and $348 000 per OR per year. Adopting waterless scrub techniques has the potential for economic savings attributable to water. Savings may be larger for surgical facilities performing more personnel-intensive procedures.

Outcome Expectancies, Health Information Seeking, and Cancer Beliefs Associated with Multivitamin/Mineral Use in a National Sample, HINTS-FDA 2015

BackgroundDietary supplements, including multivitamins/minerals, are commonly reported by adults, yet little is known about multivitamin/mineral use in relation to information seeking, cancer-specific outcome expectancies, and cancer beliefs. ObjectiveTo examine the relationship of heath information seeking, beliefs about cancer, and outcome expectancies with multivitamin/mineral use within a national sample. DesignA secondary analysis of data collected by The Health Information National Trends Survey (HINTS) and the US Food and Drug Administration (FDA) (HINTS-FDA 2015) was conducted. HINTS-FDA 2015 evaluated information seeking, beliefs about cancer, and health behaviors and was a self-administered, two-stage mail survey sent to a random sample of US postal addresses stratified by county smoking rates. ParticipantsAdult household residents were invited to participate, resulting in a 33% response rate (n=3,738). Main outcome measuresParticipants self-reported use of multivitamin/mineral products. Statistical analysesAdjusting for covariates (demographics, single-ingredient and herbal supplement use) weighted stepwise binary logistic regression was used to examine correlates of self-reported multivitamin/mineral use. ResultsIntake was associated with less than a high school education, having health insurance, and single-ingredient and herbal supplement use. Trust in health organizations (odds ratio [OR]=1.67, P<0.001) and the expectancy that cancer could be avoided with dietary supplements (OR=1.76, P<0.001) correlated with use. Agreement that supplements labeled as “anticarcinogenic” could treat (OR=3.07, P<0.001) or prevent cancer (OR=6.06, P<0.001) correlated with multivitamin/mineral use. Fatalistic beliefs (P<0.001) and negative information-seeking experiences (P<0.001) were associated with slightly lower odds of use. ConclusionsDespite leading health organizations’ discouragement of dietary supplements for cancer prevention, this study found that trust in health organizations and outcome expectancies were associated with multivitamin/mineral use. This divergence presents a need to explore how dietary supplement evidence based recommendations can be translated and disseminated for the public.

Analysis of implementation of global nutrition policies to tackle the double burden of malnutrition in Nigeria, Zambia and Indonesia

AbstractThe double burden of malnutrition (DBM) is described as the co-existence of undernutrition and overweight or diet-related non-communicable diseases within a country, community or an individual (WHO). It is a major global issue, affecting approximately half of the worlds’ population. International organizations have published policy reports to function as guidelines for national implementation to tackle the double burden of malnutrition. The goal of this study is to analyze the advancement of the implementation of these recommendations in a number of middle-income countries.Reports and recommendations on policies against DBM from 10 leading international organizations are analyzed and compared on several aspects, such as proposed measures, stakeholder involvement and target population. These organizations are UN, FAO, WHO, EAT forum, GAIN, World Food Program, World Bank, UNICEF, IFPRI and Global Panel on Agriculture and food systems for Nutrition. The level of implementation of the described policies is studied for Nigeria, Zambia and Indonesia by means of desk research and stakeholder interviews. These (semi-structured) interviews are based on the encountered information gaps within the desk research. Stakeholders were selected from a variety of organizations, such as government, NGO's, consumer organizations, science and industry in order to be able to examine the subject from different angles.The study is still ongoing at the time of abstract submission. The (preliminary) results and conclusions will be presented and they are expected to describe per country which nutrition policies against DBM are initiated or implemented. Major learnings and best practices of these implementations will be reported and major differences and similarities between implementations in Nigeria, Zambia and Indonesia will be described and compared with the policy guidelines from the leading health organizations. These results may be used as learning when policies against DBM are newly implemented in other middle-income countries or to improve existing policies.

Professional training for future specialist in Bachelor’s degree in Norway

The article reveals the peculiarities of professional training of future specialists in bachelor degrees in Norway, presents information about higher education and duration of studies at the level of first bachelor, organizational and scientific activity of students, presents the difference between practical professional practice and theoretical training, theoretical, self-study search in the field of theory and practice in your chosen specialty. The curriculum provides students with the knowledge to master the general and professional competencies of a physical therapist through both theoretical and practical teaching methods.&#x0D; The overall purpose of organizing the training of future physical therapy professionals in Norway is to create the highest possible correspondence between the practical methods used by the physical therapist in professional practice and to foster students' professional competence in the learning process.&#x0D; In Norway, physical therapists are leading experts in health promotion and physical activity in the health field. Higher educational establishments of the department carry out the preparation of bachelors in physical therapy for three years through different educational courses and through the introduction of innovative methods and techniques of physical therapy. At the end of the program, graduates receive a diploma recognized by the leading health organizations in Norway and the world. Understanding the connection between practical professional practice and theoretical perspectives is basic. The educational program provides knowledge-based practice. The curriculum emphasizes the reciprocity and interaction between thought and action, assessment, and practical skills, since physical therapy is an activity of professional and ethical understanding, physical skills and the ability to evaluate should be integrated into specific situations of interaction with others.

Social media participatory CPD for nursing revalidation, professional development and beyond.

In 2016 the Nursing and Midwifery Council in the UK introduced revalidation, which is the process nurses are required to follow to renew their registration. This provides an opportunity for nurses to shape, develop and evolve social media to meet their professional requirements. to examine different ways nurses can use social media tools for continuous professional development (CPD) and revalidation. using a qualitative reflective design, data were gathered from content on the @WeNurses platform and activities organised with other leading health organisations in England. These data were analysed using the social media relationship triangle developed by the authors with a thematic analysis approach. analysis revealed that social media was used in six categories: publishing, sharing, messaging, discussing, collaborating, and networking. Organised social media events such as: blogs, tweetchats, Twitter storms, webinars, infographics, podcasts, videos and virtual book clubs can support nurses with revalidation and professional development. Through using a participatory CPD approach and embracing professional social media applications nurses have moved social media from the concept of a revolution to an evolution.

Climate change and its significance in the healthcare community: history, landmarks, and major players

Since the early 1990s, science has addressed anthropogenic climate change as ahealth issue. From about 2000 onwards, the scientific literature and evidence on the health effects of climate change has been rapidly increasing. Global warming is now considered an "existential threat to humankind," and leading health organizations call climate change "the defining issue for public health in the 21century" or a"public health emergency."In recent years, climate change as ahealth issue has become more and more prominent in health communities on the national and international level.The growing importance of this issue in the international health community and the stages, milestones, and topics of this development are described and what health professionals and health organizations can do to protect health from climate change is demonstrated. The decisive role of The Lancet and the reports of its international commissions, the British Medical Journal (BMJ), and the World Health Organisation (WHO) in setting the agenda is underlined. Important actors, organizations, initiatives as well as new concepts like "planetary health" and "planetary boundaries" are introduced. In the German health sector, however, climate change - apart from niches - has not been much of an issue so far. Neither in the health sector, climate policies, nor climate movement the connections between climate change and health are sufficiently understood, considered, or implemented. Alook beyond borders shows what might be possible and necessary in view of the possibly "greatest crisis we have ever faced."The article is based on the author's experience, cooperation, and exchange with parties that are engaged with the issue and on years of literature research. He initiated the campaign of German doctors calling on their pension funds to divest from fossil fuels and is afounding and present board member of the "German Alliance on Health and Climate Change," which was founded 2017.

Are cell-based therapies for kidney disease safe? A systematic review of preclinical evidence.

The number of individuals affected by acute kidney injury (AKI) and chronic kidney disease (CKD) is constantly rising. In light of the limited availability of treatment options and their relative inefficacy, cell based therapeutic modalities have been studied. However, not many efforts are put into safety evaluation of such applications. The aim of this study was to review the existing published literature on adverse events reported in studies with genetically modified cells for treatment of kidney disease. A systematic review was conducted by searching PubMed and EMBASE for relevant articles published until June 2018. The search results were screened and relevant articles selected using pre-defined criteria, by two researchers independently. After initial screening of 6894 abstracts, a total number of 97 preclinical studies was finally included for full assessment. Of these, 61 (63%) presented an inappropriate study design for the evaluation of safety parameters. Only 4 studies (4%) had the optimal study design, while 32 (33%) showed sub-optimal study design with either direct or indirect evidence of adverse events. The high heterogeneity of studies included regarding cell type and number, genetic modification, administration route, and kidney disease model applied, combined with the consistent lack of appropriate control groups, makes a reliable safety evaluation of kidney cell-based therapies impossible. Only a limited number of relevant studies included looked into essential safety-related outcomes, such as inflammatory (48%), tumorigenic and teratogenic potential (12%), cell biodistribution (82%), microbiological safety with respect to microorganism contamination and latent viruses' reactivation (1%), as well as overall well-being and animal survival (19%). In conclusion, for benign cell-based therapies, well-designed pre-clinical studies, including all control groups required and good manufacturing processes securing safety, need to be done early in development. Preferably, this should be performed side by side with efficacy evaluation and according to the official guidelines of leading health organizations.

Self-Reported, Current and Ideal Sleep Habits of Adolescent Athletes

BACKGROUND: Leading health organizations recommend adolescents obtain 8 to 10 hours of sleep each day. There is a growing body of literature that suggests many adolescents, including athletes, are not meeting these recommendations; however, barriers to obtaining adequate sleep are still largely unknown. PURPOSE: To quantify sleep habits in a group of athletes and to understand how their current habits compare with their self-reported ideal sleep durations. METHODS: One hundred seventy three adolescent team- and individual-sport athletes (16 ± 2 y; male: n=139, female: n=34) from 10 different sports completed both Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) surveys during a laboratory visit. The PSQI was analyzed to determine self-reported habitual bedtime, wake time, and sleep duration, as well as sleep quality over the previous month. The ESS was analyzed to determine self-reported ideal bedtime, wake time, and sleep duration. Data are presented as mean ± SD. A paired t-test was used to compare current and desired sleep durations. RESULTS: Habitual bedtime (n=171) was 22:37 ± 0:46. Habitual wake time (n=167) was 06:47 ± 0:58. Self-reported actual sleep duration was 7.6 ± 1.0 h with 54% of athletes obtaining less than the recommendation of 8 h of sleep per night. To feel their best, ideal self-reported bedtime (n=162) was 21:57 ± 0:41 and self-reported wake time (n=159) was 07:49 ± 1:18. Calculated ideal total sleep duration (n=158) was 9.9 ± 1.4 h, which was significantly longer than actual sleep duration (n=155; p<0.001). Habitual sleep quality, assessed as the mean Global PSQI score, (n=159) was 4.3 ± 2.2; however, 63 athletes (39.6%) had a score ≥5, which is the PSQI cutoff indicative of poor sleep quality. CONCLUSIONS: Self-reported habitual sleep duration in a group of adolescent athletes suggests the majority do not meet the minimum sleep duration recommendations and many have poor sleep quality. However, when reporting their ideal sleep habits, most athletes would prefer to obtain significantly more sleep, desiring durations at the top end of the recommendations even. This suggests lack of desire is not the main reason for sub-optimal sleep duration in this group. Therefore, researchers and practitioners should focus on identifying and creating solutions to overcome barriers to sleep.

The Knowledge, Attitudes and Preparedness of Australian Paramedics to Manage Intimate Partner Violence Patients – a Pilot Study

Introduction Australian ambulance services are currently attempting to improve their capacity to respond to intimate partner violence (IPV) patients, which is a significant contributing factor to the morbidity and mortality of women. Leading health organisations have called for increased training for frontline health care workers, however there is a paucity of literature on the current preparedness of Australian paramedics. A description of the preparedness of Australian paramedics to manage IPV patients has the potential to inform curricula and practice development. Methods We surveyed a cohort of qualified Australian paramedics using the modified Physician Readiness to Manage Intimate Partner Violence Survey. Results We received 28 completed surveys (16.5% response rate), that revealed most respondents (89.3%) believed they had encountered IPV patients while working as a paramedic, yet only one participant reported comprehensive education or training on the management of such patients. Participants reported low knowledge and preparedness to manage IPV patients. Participant attitudes were poor for self-efficacy, confidence and preparation, and generally neutral for items regarding attitudes toward women and IPV patients. Conclusions This study adds to mounting evidence that paramedics frequently encounter IPV patients, have insufficient education and training, and are not prepared to manage such patients. While the results of this study should be interpreted with caution due to a low response rate and small sample, it appears that Australian paramedics would benefit from targeted educational packages that provide the necessary knowledge to recognise and refer patients, modify inappropriate or insufficient attitudes, and prepare paramedics to effectively manage IPV patients.

Developing an alternative alcohol advertising complaint review system: lessons from a world-first public health advocacy initiative.

Young people in Australia are frequently exposed to alcohol marketing. Leading health organisations recommend legislative controls on alcohol advertising as part of a comprehensive approach to reduce alcohol-related harm. However, Australia relies largely on industry self-regulation. This paper describes the development and implementation of the Alcohol Advertising Review Board (AARB), a world-first public health advocacy initiative that encourages independent regulation of alcohol advertising. The AARB reviews complaints about alcohol advertising, and uses strategies such as media advocacy, community engagement and communicating with policy makers to highlight the need for effective regulation. In 4 years of operation, the AARB has received more complaints than the self-regulatory system across a similar period. There has been encouraging movement towards stronger regulation of alcohol advertising. Key lessons include the importance of a strong code, credible review processes, gathering support from reputable organisations, and consideration of legal risks and sustainability. The AARB provides a unique model that could be replicated elsewhere.

Environmental Contaminants and Reproductive Bodies: Provider Perspectives on Risk, Gender, and Responsibility.

Increasingly, leading health organizations recommend that women who are pregnant or considering pregnancy avoid certain toxic chemicals found in our products, homes, and communities in order to protect fetuses from developmental and future harm. In the contemporary United States, women's maternal bodies have been treated as sites of exceptional risk and individual responsibility. Many studies have examined this phenomenon through the lens of lifestyle behaviors like smoking, drinking, and exercise. However, we know little about how environmental hazards fit into the dominant framework of gendered, individual responsibility for risk regulation. I draw on in-depth interviews with 19 reproductive healthcare providers in the United States to explore how they think about their patients' exposure to environmental contaminants and sometimes subvert this gendered, individualized responsibility and adopt more collective frames for understanding risk.

Missing the Target for Routine Human Papillomavirus Vaccination: Consistent and Strong Physician Recommendations Are Lacking for 11- to 12-Year-Old Males

Rates of routine human papillomavirus (HPV) vaccination of adolescent males in the United States are low. Leading health organizations advocate consistent and strong physician recommendations to improve HPV vaccine dissemination. This study describes the prevalence and correlates of consistent and strong physician recommendations for HPV vaccination of adolescent males. We surveyed pediatric and family medicine physicians in Florida about their HPV vaccine recommendations for male vaccine-eligible age groups (11-12, 13-17, 18-21 years). Descriptive statistics compared consistency and strength of HPV recommendations across age groups. Multivariable logistic regression examined factors associated with consistent and strong recommendations for 11- to 12-year-olds. We received 367 completed surveys (51% response rate). Physicians most often consistently and strongly recommended HPV vaccine to males ages 13 to 17 (39%) compared with ages 11 to 12 (31%) and 18 to 21 (31%). Consistent and strong recommendation for 11- to 12-year-old males was more likely to be delivered by Vaccine for Children providers and less likely among physicians who reported more personal barriers to vaccination, particularly concerns about vaccine safety, concerns about adding vaccines to the vaccine schedule, and difficulty in remembering to discuss HPV vaccination. Physicians' current consistency and strength of HPV vaccine recommendations do not align with national recommendations. Interventions to improve HPV vaccine recommendations must also consider the influence of physicians' personal barriers to HPV vaccine delivery. As one of the first studies to examine both consistency and strength of physicians' HPV vaccine recommendations for males, our findings can inform future interventions focused on facilitating physicians' recommendations. Cancer Epidemiol Biomarkers Prev; 25(10); 1435-46. ©2016 AACR.

A systematic review of women's and health professional's attitudes and experience of preconception care service delivery.

The value and importance of preconception care (PCC) have been acknowledged by leading health organizations as a vital element within preventive medicine and health promotion for the wider population. The translation of PCC from position statement to relevant service and programme delivery is essential for the benefits of PCC to be realized and relies on insights from health services research. This article aims to review contemporary health services research literature examining women's and health professionals' perceptions and experiences of PCC services. A systematic review of original research published between 2003 and 2015 was conducted in November 2015. Multiple databases (PubMed, CINAHL, AMED and Maternity and Infant Care) were searched through two distinct searches to capture research literature reporting the perspective of health professionals and women towards PCC service delivery. The search identified 13 papers (4 reported the perceptions of women, 11 described the views of health professionals [2 papers reported findings from both groups]). The analyses of the contemporary literature revealed five broad areas of focus: women's service needs regarding PCC, PCC training and education requirements, role delineation around PCC, priority and value of PCC and barriers and obstacles to PCC. Despite the mounting evidence supporting the value and importance of PCC, there is insufficient research attention given to the clinical reality of PCC service and programme delivery. The transfer of PCC guidelines from broad policy to grass roots practice requires a more detailed consideration of the practicalities of implementing PCC within contemporary women's health care.

Success factors of new health-care services

Purpose The purpose of this study is to provide insights into the success factors of new-to-the-firm health services. Design/methodology/approach The study was based on the case study methodology with three leading health organizations. Findings The study’s findings indicate that the success factors of new health services are largely in line with the literature on new service development. Our study also revealed the significance of two factors that have not been identified by previous studies, namely, branding and doctors’ participation in the new service development process. Research limitations/implications Introducing a successful new health service into the market seems to require an emphasis on a variety of factors related to the company’s internal and external environment, while two important characteristics are the role of branding and doctors. Despite its acceptance as a scientific method, the case study approach that was selected limits the ability to generalize the results to the broader health industry. Originality/value The current study represents one of the first attempts to examine the above topic in a health-related service context.

Primary prevention of colorectal neoplasias: ample evidence, lack of guidelines.

Colorectal cancer (CRC) is the third most commonly diagnosed type of malignancy in males and the second in females, with over 1.2 million new cancer cases and 608,700 deaths estimated to have occurred in 2008 [1]. Sporadic CRC accounts for 75% of the total CRC cases, with colorectal adenoma regarded as the precursor lesion (adenoma-carcinoma sequence) [2]. Despite the major advances in the screening methods, treatment options and follow-up frameworks, there is ample evidence highlighting the preventability of colorectal neoplasias by the implementation of appropriate lifestyle modifications, with the most extensively studied parameters being the effects of physical activity, specific dietary patterns, smoking and alcohol consumption [3]. Moreover, the chemoprevention of colorectal neoplasias is an area of ongoing research, focusing on the potentially preventive role of certain drugs and micronutrients [4]. Although there is now solid evidence regarding the clear protective role of lifestyle modification in terms of preventing colorectal neoplasias, there is lack of specific guidelines from the leading health organizations and professional bodies, with the currently available guidelines providing general rather specific frameworks for establishing national preventive policies. Herein, we attempt to pinpoint in a best evidence topic frame the key findings in the field of primary prevention of colorectal neoplasias, underlining the necessity of a qualitive turn towards setting specific lifestyle modification targets instead of general guidance.

Climate change matters

One manifestation of climate change is the increasingly severe extreme weather that causes injury, illness and death through heat stress, air pollution, infectious disease and other means. Leading health organisations...

Wicked Problems and Worthy Pursuits

About 83 million American adults (≈one third of the adult population) have 1 or more types of cardiovascular disease (CVD), and CVD is the underlying cause for ≈33% of American deaths (2008 data).1 Put in stark terms, CVD claims 1 American life every 39 seconds and is responsible for more deaths annually than cancer, chronic lower respiratory disease, and accidents combined.2 In 2004, the American Heart Association (AHA), the leading health organization devoted to CVDs and stroke, set an ambitious goal to reduce the mortality rates of coronary heart disease and stroke risk by 25% by the year 2010, using 1999 rates as the baseline. This goal stimulated the AHA to boldly pursue prevention, treatment, and acute-care goals through implementation of policy initiatives, scientific discovery and communication, and other strategic resources. The impact of AHA's 2010 mortality goals was dramatic: during the first decade of this century, death rates resulting from coronary heart disease and stroke fell by ≈30%.3 An optimistic reading of these data on the whole points to an obvious conclusion: although much work remains to be done, the assiduous efforts of public health advocates, researchers, and clinicians can dramatically reduce Americans' cardiovascular mortality. Article see p 2595 The significant declines in CVD and stroke mortality rates have no doubt been attributable to a complex mix of factors, not all quantifiable, and perhaps some unknowable. However, campaigns of primordial, primary, and secondary prevention have concentrated on known cardiovascular risk factors and have likely had considerable influence on mortality rates. Some of these efforts have targeted modifiable lifestyle factors such as diet, physical activity, and smoking behaviors—and with some success. Although the trends toward increasing physical activity were modest, smoking prevalence has decreased from baseline levels by 16%.3 Medical therapies have dramatically impacted risk factors …

Evaluation of Respondent-driven Sampling

Respondent-driven sampling is a novel variant of link-tracing sampling for estimating the characteristics of hard-to-reach groups, such as HIV prevalence in sex workers. Despite its use by leading health organizations, the performance of this method in realistic situations is still largely unknown. We evaluated respondent-driven sampling by comparing estimates from a respondent-driven sampling survey with total population data. Total population data on age, tribe, religion, socioeconomic status, sexual activity, and HIV status were available on a population of 2402 male household heads from an open cohort in rural Uganda. A respondent-driven sampling (RDS) survey was carried out in this population, using current methods of sampling (RDS sample) and statistical inference (RDS estimates). Analyses were carried out for the full RDS sample and then repeated for the first 250 recruits (small sample). We recruited 927 household heads. Full and small RDS samples were largely representative of the total population, but both samples underrepresented men who were younger, of higher socioeconomic status, and with unknown sexual activity and HIV status. Respondent-driven sampling statistical inference methods failed to reduce these biases. Only 31%-37% (depending on method and sample size) of RDS estimates were closer to the true population proportions than the RDS sample proportions. Only 50%-74% of respondent-driven sampling bootstrap 95% confidence intervals included the population proportion. Respondent-driven sampling produced a generally representative sample of this well-connected nonhidden population. However, current respondent-driven sampling inference methods failed to reduce bias when it occurred. Whether the data required to remove bias and measure precision can be collected in a respondent-driven sampling survey is unresolved. Respondent-driven sampling should be regarded as a (potentially superior) form of convenience sampling method, and caution is required when interpreting findings based on the sampling method.

Health Literacy and Children: Recommendations for Action

Health literacy is a cross-cutting priority for transforming quality of health care in the United States. The informative work of the articles published in this supplement to Pediatrics creates an imperative for pediatricians to optimize communication with parents and children and to develop necessary tools and strategies. In the commentary that follows, we address what we believe are needed actions in the arenas of policy, practice, education, and research to address the health literacy–related issues, problems, and opportunities with reference to children and children's health. ### Responsibilities of Public and Private Agencies and Organizations Public and private agencies and organizations that affect child health policy and health care delivery, public health, and education (eg, the Maternal and Child Health Bureau, the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the US Food and Drug Administration, the American Academy of Pediatrics [AAP], and the Academic Pediatric Association), whose visibility, credibility, and resources can drive change, improvement, and funding, should be at the forefront of efforts to highlight the importance of health literacy, adopt, model, teach, and incentivize clear health communication strategies, and support evaluation and research to advance the field. Health literacy should be explicitly incorporated into the medical home model, including both implementation activities and evaluation. Instruments such as the Medical Home Index, Consumer Assessment of Healthcare Providers and Systems (CAHPS), and Hospital CAHPS should include health literacy–specific items, especially related to teach-back and the extent to which care environments foster communication, invite questions, and simplify navigation. Data from such surveys can be used to guide policy, evaluate program interventions, and improve quality. ### Support for Plain-Language Principles and Materials in Health Communication Federal agencies and other leading health organizations should ensure that written materials for patients or caregivers use plain-language principles by reducing their complexity and cognitive burden and developing standards for reader-friendly print materials beyond consideration of reading level. For example, family … Address correspondence to Benard P. Dreyer, MD, New York University School of Medicine, Department of Pediatrics, 550 First Ave, NBV 8S4-11, New York, NY 10016. E-mail: bpd1{at}nyu.edu