Assessing Knowledge-Based and Perceived Health Literacy Among Japanese Adolescents: A Cross-Sectional Study.

Health literacy assessment is a major aspect of planning health education for adolescents. We evaluated the health literacy of Japanese adolescents using both perceived and knowledge-based health literacy scales. Study questionnaires were administered to 773 junior and senior high school students aged 12 to 18 years. We tested a model describing the hierarchical relations between functional, communicative, critical, and knowledge-based health literacy using path analysis. Critical health literacy was found to be influenced by functional, communicative, and knowledge-based health literacy, while functional and knowledge-based health literacy were correlated. The model, with slight modification, was supported. The result indicates that perceived functional health literacy scores did not directly correlate with higher perceived critical health literacy; rather, they only informed critical health literacy when participants had high knowledge-based health literacy.

Prevalence of hypertension and hypertension control rates among elderly adults during the cold season in rural Northeast China: a cross-sectional study.

Objective: The burden of noncommunicable diseases (NCDs) is increasing in China, together with economic development and social changes. The prevalence of risk factors for NCDs, such as overweight/obesity, hypertension, diabetes, and dyslipidemia, is reported to be high even among poor residents of rural areas. We aimed to investigate the prevalence of hypertension among elderly adults in rural Northeast China and the proportion with controlled hypertension among those on antihypertensive medication (hypertension control rate). We also aimed to examine the association of hypertension control with health facilities that provide treatment. Methods: We conducted a community-based cross-sectional study in six rural villages of Northeast China from February to early March, 2012. We interviewed 1593 adults aged 50-69 years and measured their blood pressure. We examined the differences in mean blood pressure between participants who obtained antihypertensive medication from village clinics and those who obtained medication from other sources, using analysis of covariance adjusted for several covariates. Results: The prevalence of hypertension among participants was as high as 63.3%, but the hypertension control rate was only 8.4%. Most villagers (98.1%) were not registered in the chronic disease treatment scheme of the public rural health insurance. The mean systolic blood pressure, adjusted for the covariates, of participants who obtained antihypertensive medication from village clinics was significantly lower than that of participants who obtained medication from township hospitals (by 16.5 mmHg) or from private pharmacies (by 7.3 mmHg). Conclusion: The prevalence of hypertension was high and the hypertension control rate low among elderly villagers during the cold season. As treatment at village clinics, which villagers can access during the cold season seems to be more effective than self-medication or treatment at distant hospitals, improving the quality of treatment in village clinics is urgently needed.

Item response theory analysis of the Utrecht Work Engagement Scale for Students (UWES-S) using a sample of Japanese university and college students majoring medical science, nursing, and natural science.

OBJECTIVES: The Utrecht Work Engagement Scale for Students has been used internationally to assess students' academic engagement, but it has not been analyzed via item response theory. The purpose of this study was to conduct an item response theory analysis of the Japanese version of the Utrecht Work Engagement Scale for Students translated by authors. Using a two-parameter model and Samejima's graded response model, difficulty and discrimination parameters were estimated after confirming the factor structure of the scale. RESULTS: The 14 items on the scale were analyzed with a sample of 3214 university and college students majoring medical science, nursing, or natural science in Japan. The preliminary parameter estimation was conducted with the two parameter model, and indicated that three items should be removed because there were outlier parameters. Final parameter estimation was conducted using the survived 11 items, and indicated that all difficulty and discrimination parameters were acceptable. The test information curve suggested that the scale better assesses higher engagement than average engagement. The estimated parameters provide a basis for future comparative studies. The results also suggested that a 7-point Likert scale is too broad; thus, the scaling should be modified to fewer graded scaling structure.

A New Functional Health Literacy Scale for Japanese Young Adults Based on Item Response Theory.

Health literacy predicts health outcomes. Despite concerns surrounding the health of Japanese young adults, to date there has been no objective assessment of health literacy in this population. This study aimed to develop a Functional Health Literacy Scale for Young Adults (funHLS-YA) based on item response theory. Each item in the scale requires participants to choose the most relevant term from 3 choices in relation to a target item, thus assessing objective rather than perceived health literacy. The 20-item scale was administered to 1816 university students and 1751 responded. Cronbach's α coefficient was .73. Difficulty and discrimination parameters of each item were estimated, resulting in the exclusion of 1 item. Some items showed different difficulty parameters for male and female participants, reflecting that some aspects of health literacy may differ by gender. The current 19-item version of funHLS-YA can reliably assess the objective health literacy of Japanese young adults.

Comprehensive medication management services influence medication adherence among Japanese older people.

OBJECTIVE: Assistance from health professionals is very important to ensure medication adherence among older people. The present study aimed to assess the relationship between receipt of comprehensive medication management services by primary care physicians and medication adherence among community-dwelling older people in rural Japan. METHODS: Data including medication adherence and whether or not a doctor knew all the kinds of medicines being taken were obtained from individuals aged 65 years or older who underwent an annual health checkup between February 2013 and March 2014 at a public clinic in Asakura. The subjects were divided into 2 groups: adherent (always) and non-adherent (not always). A logistic regression analysis was performed to assess the association between the presence of a doctor who was fully responsible for medication adherence and self-reported adherence. Predictors that exhibited significant association (p-value < 0.05) with medication adherence in a univariate analysis were entered in the model as possible confounding factors. The results were presented as odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Among four-hundred ninety-seven subjects in total, the adherent group included 430 subjects (86.5%), and its members were older than those of the non-adherent group. Significant predictors of good medication adherence included older age, no discomforting symptoms, eating regularly, diabetes mellitus and having a doctor who knew all the kinds of medicines being taken. After being adjusted for confounding variables, the subjects with a doctor who knew all the kinds of medicines they were taking were three times more likely to be adherent to medication (OR 3.01, 95% CI 1.44-6.99). CONCLUSION: Receipt of comprehensive medication management services for older people was associated with medication adherence.

Effects of the health insurance coverage extension on the use of outpatient services among small children in rural China.

A new public health insurance scheme has been gradually introduced in rural provinces in China since 2003. This would likely cause an increment in the use of health services. It is known that the association between health insurance coverage and health service utilization varies among different age groups. This study aims to examine the association between extending health insurance coverage and increment in outpatient service utilization of small children in rural China, and to identify other factors associated with the outpatient service utilization. A household survey was conducted in 2 counties in north China in August 2010, targeting 107 selected households with a child aged 12-59 months. The questionnaire included modules on demographic information such as ages of children and parents, enrollment status of health insurance, the number of episodes of illness as perceived by parents, month of incidence of episode and outpatient service utilization at each episode. Based on the utilization at each episode of illness, a random effects logistic regression model was employed to analyze the association. It was found that eligibility for the reimbursement of outpatient medical expenses was not significantly associated with decision to seek care or choice of health facility. This might be in part due to the low level of reimbursement which could discourage the use of insured, and to the close relationship with village clinic workers which would encourage the use of uninsured. Three other factors were significantly associated with increment in the outpatient service utilization; age of children, mother's education, and number of children in a household.

Smoking and diabetes: is the association mediated by adiponectin, leptin, or C-reactive protein?

BACKGROUND: Although the association between cigarette smoking and risk of type 2 diabetes is well established, its mechanisms are yet to be clarified. This study examined the possible mediating effects of adiponectin, leptin, and C-reactive protein (CRP) concentrations on the smoking-diabetes association. METHODS: Between 2002 and 2011, we followed 3338 Japanese workers, aged 35-66 years, who were enrolled in the second Aichi workers' cohort study. We used multivariable-adjusted Cox regression models to determine the hazard ratios and respective 95% confidence intervals (CIs) of the association between smoking status and risk of diabetes. A multiple mediation model with bootstrapping was used to estimate the magnitude and the respective bias-corrected (BC) 95% CIs of the indirect effects of smoking on diabetes through the three biomarkers. RESULTS: Relative to never smokers, the risk of diabetes was significantly elevated in current (hazard ratio 1.75, 95% CI 1.25-2.46) and ex-smokers (hazard ratio 1.54, 95% CI 1.07-2.22). The indirect effects of smoking on diabetes through adiponectin levels were statistically significant among light (point estimate 0.033, BC 95% CI 0.005-0.082), moderate (point estimate 0.044, BC 95% CI 0.010-0.094), and heavy smokers (point estimate 0.054, BC 95% CI 0.013-0.113). In contrast, neither the indirect effects of smoking on diabetes through leptin nor CRP levels were significant, as the corresponding BC 95% CIs included zero. CONCLUSIONS: In our analysis, adiponectin concentration appeared to partially mediate the effect of smoking on diabetes, while leptin and CRP levels did not.