Are childhood factors predictive of adult health literacy? A longitudinal birth cohort analysis.

Health literacy (HL), defined as the ability of an individual to understand and appraise health information to make informed decisions on their health, helps maintain and improve one's health and thus reduce the use of healthcare services. There is a recognised global effort to address insufficient HL in early life and understand how HL develops. This study examined the association of a range of factors including educational, speech and language ability, health and healthcare engagement, sleep problems, mental health, demographic, environmental, and maternal factors at different childhood stages (from 5 years to 11 years) with later adult HL at age 25. HL was measured using a HL ordinal score (insufficient, limited, or sufficient) derived from the European Literacy Survey Questionnaire-short version (HLS-EU-Q16) within a large UK based birth cohort (Avon Longitudinal Study of Parents and Children: ALSPAC study). Univariate proportional odds logistic regression models for the probability of having higher levels of HL were developed. Results of analysis of 4248 participants showed that poorer speech and language ability (aged 9 years, OR 0.18 95% CI 0.04 to 0.78), internalising in child (age 11 years, OR 0.62 95% CI 0.5 to 0.78), child depression (age 9 years, OR 0.67 95% CI 0.52 to 0.86), and the presence of maternal depression (child age 5, OR 0.80 95% CI 0.66 to 0.96), reduced the odds of sufficient HL when adult. Our results suggest some useful markers to identify children at potential risk of low HL that could be targeted for research into future interventions within school settings, for example, child's speech and language capability. In addition, this study identified child and maternal mental health as factors associated with later development of limited HL and future research should consider what potential mechanisms might explain this link.

Integrating Narcissus-derived galanthamine production into traditional upland farming systems.

Alzheimer's disease (AD) is a disorder associated with progressive degeneration of memory and cognitive function. Galantamine is a licenced treatment for AD but supplies of the plant alkaloid that it is produced from, galanthamine, are limited. This three-year system study tested the potential to combine Narcissus-derived galanthamine production with grassland-based ruminant production. Replicate plots of permanent pasture were prepared with and without bulbs of Narcissus pseudonarcissus sown as lines into the sward. Two different fertiliser regimes were imposed. The above-ground green biomass of N. pseudonarcissus was harvested in early spring and the galanthamine yield determined. In the second harvest year a split-plot design was implemented with lines of N. pseudonarcissus cut annually and biennially. All plots were subsequently grazed by ewes and lambs and animal performance recorded. Incorporation of N. pseudonarcissus into grazed permanent pasture had no detrimental effects on the health or performance of the sheep which subsequently grazed the pasture. There was no consistency to the effects of fertiliser rates on galanthamine yields. There was no difference in overall galanthamine yield if N. pseudonarcissus was cut biennially (1.64 vs. 1.75 kg galanthamine/ha for annual combined vs biennial cuts respectively; s.e.d = 0.117 kg galanthamine/ha; ns). This study verified the feasibility of a dual cropping approach to producing plant-derived galanthamine.

A cryogenic spin-torque memory element with precessional magnetization dynamics.

We present a study of precessional magnetization switching in orthogonal spin-torque spin-valve devices at low temperatures. The samples consist of a spin-polarizing layer that is magnetized out-of-the film plane and an in-plane magnetized free and reference magnetic layer separated by non-magnetic metallic layers. We find coherent oscillations in the switching probability, characterized by high speed switching (~200 ps), error rates as low as 10-5 and decoherence effects at longer timescales (~1 ns). Our study, which is conducted over a wide range of parameter space (pulse amplitude and duration) with deep statistics, demonstrates that the switching dynamics are likely dominated by the action of the out-of-plane spin polarization, in contrast to in-plane spin-torque from the reference layer, as has been the case in most previous studies. Our results demonstrate that precessional spin-torque devices are well suited to a cryogenic environment, while at room temperature they have so far not exhibited coherent or reliable switching.

What is the evidence on existing policies and linked activities and their effectiveness for improving health literacy at national, regional and organizational levels in the WHO European Region? / Que sait-on de l'efficacité des politiques existantes et des activités en rapport avec celles-ci, s'agissant d'améliorer l'éducation sanitaire aux niveaux national, régional et organisationnel dans la Région européenne de l'OMS ?

Health literacy is gaining increasing attention as a means of promoting health. This evidence synthesis describes health literacy policies in the WHO European Region: their distribution, organizational levels, antecedents, actors, activities and outcomes, along with the factors influencing their effectiveness. Evidence was obtained by a scoping review of academic literature in English, Dutch and German and of grey literature in English, Dutch, German and Italian, supported by a Region-wide expert enquiry. Emerging findings were presented to representatives from 19 Member States of the Region to check for accuracy and omissions. The report highlights much good health literacy policy-related activity, mostly in the health and education sectors, and proposes areas for future development. Policy considerations to facilitate the sharing of good health literacy policy practice, the development of policy aims and activities across all societal areas, and the development of robust health literacy metrics to identify the need for and monitor effectiveness are presented.

Le Réseau des bases factuelles en santé (HEN) est un service d'information destiné aux décideurs dans le domaine de la santé publique de la Région européenne de l'OMS. Actif depuis 2003, instauré et coordonné par le Bureau régional de l'OMS pour l'Europe, le Réseau HEN est placé sous l'égide de l'Initiative européenne d'information sanitaire ­ un réseau de coordination des activités d'information sanitaire de la Région européenne, comportant de multiples partenaires. Le Réseau soutient les décideurs en santé publique dans leur prise de décisions, en leur apportant les meilleures bases factuelles disponibles, et vise à créer des liens entre les bases factuelles, les politiques sanitaires et une meilleure santé publique. La série des rapports de synthèse du Réseau HEN est constituée de résumés sur le savoir disponible sur une question particulière, les lacunes dans les bases factuelles et les domaines soumis à débat. Sur la base de ces informations factuelles synthétisées, le Réseau propose non des recommandations, mais des options pouvant être étudiées par les responsables politiques, leur permettant de formuler leurs propres recommandations et politiques en fonction de leur contexte national.

Nonlinear Waves in the Terrestrial Quasiparallel Foreshock.

We provide strongly conclusive evidence that the cubic nonlinearity plays an important part in the evolution of the large amplitude magnetic structures in the terrestrial foreshock. Large amplitude nonlinear wave trains at frequencies above the proton cyclotron frequency are identified after nonharmonic slow variations are filtered out by applying the empirical mode decomposition. Numerical solutions of the derivative nonlinear Schrödinger equation, predicted analytically by the use of a pseudopotential approach, are found to be consistent with the observed wave forms. The approximate phase speed of these nonlinear waves, indicated by the parameters of numerical solutions, is of the order of the local Alfvén speed. We suggest that the feedback of the large amplitude fluctuations on background plasma is reflected in the evolution of the pseudopotential.

Si1-x Ge x /Si Interface Profiles Measured to Sub-Nanometer Precision Using uleSIMS Energy Sequencing.

The utility of energy sequencing for extracting an accurate matrix level interface profile using ultra-low energy SIMS (uleSIMS) is reported. Normally incident O2 (+) over an energy range of 0.25-2.5 keV were used to probe the interface between Si0.73Ge0.27/Si, which was also studied using high angle annular dark field scanning transmission electron microscopy (HAADF-STEM). All the SIMS profiles were linearized by taking the well understood matrix effects on ion yield and erosion rate into account. A method based on simultaneous fitting of the SIMS profiles measured at different energies is presented, which allows the intrinsic sample profile to be determined to sub-nanometer precision. Excellent agreement was found between the directly imaged HAADF-STEM interface and that derived from SIMS. Graphical Abstract ᅟ.

Nanosecond-Timescale Low Energy Switching of In-Plane Magnetic Tunnel Junctions through Dynamic Oersted-Field-Assisted Spin Hall Effect.

We investigate fast-pulse switching of in-plane-magnetized magnetic tunnel junctions (MTJs) within 3-terminal devices in which spin-transfer torque is applied to the MTJ by the giant spin Hall effect. We measure reliable switching, with write error rates down to 10-5, using current pulses as short as just 2 ns in duration. This represents the fastest reliable switching reported to date for any spin-torque-driven magnetic memory geometry and corresponds to a characteristic time scale that is significantly shorter than predicted possible within a macrospin model for in-plane MTJs subject to thermal fluctuations at room temperature. Using micromagnetic simulations, we show that in the three-terminal spin-Hall devices the Oersted magnetic field generated by the pulse current strongly modifies the magnetic dynamics excited by the spin-Hall torque, enabling this unanticipated performance improvement. Our results suggest that in-plane MTJs controlled by Oersted-field-assisted spin-Hall torque are a promising candidate for both cache memory applications requiring high speed and for cryogenic memories requiring low write energies.

Why some adults with intellectual disability consult their general practitioner more than others.

BACKGROUND: This research identifies factors affecting why some adults with intellectual disability (AWIDs) consult their general practitioner (GP) more than others. Little is known about these factors, despite AWIDs having higher health needs and reduced longevity. Current barriers to accessing health care need to be understood and overcome to achieve improved health outcomes. METHODS: A secondary analysis of data obtained from a stratified randomised sample of AWIDs participating in a cluster randomised trial of hand held health records. The number of GP consultations was obtained retrospectively for the year preceding initial health interviews from GP records. AWIDs and their carers were given separate health interviews using identical/adapted questions where possible. RESULTS: Two hundred and one AWIDs and or their carers from 40 practices participated (response rate 64.6%) with GP consultation data extracted for 187 AWIDs. Overall consulting levels were low, 3.2 per annum for women and 2.2 for men. Increased age, gender (women) and type of carer (paid) were all significantly associated with increased consultations. Carers reporting health problems, medications reported by AWIDs, medications recorded in GP records, and pain reported by AWIDs were also significant factors affecting consultations to GP practices after adjustment for age and type of carer. CONCLUSIONS: Overall consultation rates were lower than expected, and affected by age, gender and type of carer. Targeted interventions are needed to improve attendance and promote health.

Effects of allergen and trigger factor avoidance advice in primary care on asthma control: a randomized-controlled trial.

BACKGROUND: Allergy contributes significantly to asthma exacerbation, yet avoidance of triggers, in particular allergens, is rarely addressed in detail in regular asthma review in primary care. OBJECTIVE: To determine whether structured, individually tailored allergen and trigger avoidance advice, given as part of a primary care asthma review, improves lung function and asthma control. METHODS: In a randomized-controlled trial 214 adults with asthma in six general practices were either offered usual care during a primary care asthma review or usual care with additional allergen and trigger identification (by skin prick testing and structured allergy assessment) and avoidance advice according to a standardized protocol by trained practice nurses. Main outcome measures were lung function, asthma control, asthma self-efficacy. RESULTS: Both intervention groups were equivalent in demographic and asthma-related variables at baseline. At 3-6-month follow-up, patients receiving the allergen and trigger avoidance review showed significant improvements in lung function (assessed by blinded research nurses) compared with those receiving usual care. Significantly more patients in the intervention group than in the control group showed improvements in forced expiratory volume in 1 s > or =15%. No significant differences were found in self-report measures of asthma control. Asthma-specific self-efficacy improved in both groups but did not differ between groups. CONCLUSIONS: Allergen and trigger identification and avoidance advice, given as part of a structured asthma review delivered in primary care by nurses results in clinically important improvements in lung function but not self-report of asthma control. TRIAL REGISTRATION: ISRCTN45684820.

Analytically solvable model of nonlinear oscillations in a cold but viscous and resistive plasma.

A method for solving model nonlinear equations describing plasma oscillations in the presence of viscosity and resistivity is given. By first going to the Lagrangian variables and then transforming the space variable conveniently, the solution in parametric form is obtained. It involves simple elementary functions. Our solution includes all known exact solutions for an ideal cold plasma and a large class of new ones for a more realistic plasma. A new nonlinear effect is found of splitting of the largest density maximum, with a saddle point between the peaks so obtained. The method may sometimes be useful where inverse scattering fails.

Monitored and modeled coral population dynamics and the refuge concept.

With large-scale impacts on coral reefs due to global climatic change projected to increase dramatically, and suitability of many areas for reef growth projected to decrease, the question arises whether particular settings might serve as refugia that can maintain higher coral populations than surrounding areas. We examine this hypothesis on a small, local scale in Honduras, western Caribbean. Dense coral thickets containing high numbers of the endangered coral Acropora cervicornis occur on offshore banks while being rare on the fringing reef on nearby Roatán. Geomorphological setting and community dynamics were evaluated and monitored from 1996 to 2005. A model of population dynamics was developed to test assumptions derived from monitoring. Coral cover on the fringing reef declined in 1998 from >30% to <20%, but the banks maintained areas of very dense coral cover (32% cover by A. cervicornis on the banks but <1% on the fringing reef). Bathymetry from satellite images showed the banks to be well-separated from the fringing reef, making asexual connectivity between banks and fringing reef impossible but protecting the banks from direct land-runoff during storms. Exposure to SE tradewinds also causes good flushing. Only four A. cervicornis recruits were recorded on the fringing reef over 6 years. Runoff associated with hurricanes caused greater mortality than did bleaching in 1998 and 2005 on the fringing reef, but not on the banks. Since 1870, our analysis suggests that corals on the banks may have been favored during 17 runoff events associated with tropical depressions and storms and potentially also during five bleaching events, but this is more uncertain. Our model suggests that under this disturbance regime, the banks will indeed maintain higher coral populations than the fringing reef and supports the assumption that offshore banks could serve as refugia with the capacity to subsidize depleted mainland populations.

Late skin flap failure following cochlear implantation.

The objective of the study was to determine risk factors for late skin flap failure following cochlear implantation. The study design was a retrospective case series. Data were collated from 371 implanted patients over a ten-year period. Of these patients, 1.3 per cent (n = 5) developed late skin flap failure. It is concluded that skin flap failure is a significant, though relatively uncommon, complication of cochlear implant surgery. What causes flap failure and why it should occur in such a variable fashion are still largely unknown, though infection undoubtedly plays an important role. The aetiological factors associated with flap failure and possible prevention strategies are discussed.

Temporal and between-site variation in helminth communities of bank voles ( Myodes glareolus) from N.E. Poland. 1. Regional fauna and component community levels.

Helminth infections were studied in bank voles (Myodes glareolus) from 3 woodland sites in N.E. Poland in the late summers of 1999 and 2002, to assess the temporal stability of derived statistics describing the regional helminth fauna and component community structure, and spatial influence on the latter. Regional helminth fauna changed dramatically between the two years, primarily due to a fall in the abundance of Syphacia petrusewiczi but was partially compensated for by an increase in Mesocestoides lineatus and Cladotaenia globifera. It was dominated by nematodes overall, but more so in 1999 than in 2002 when larval cestodes were more frequent. Most derived parameters for component community structure varied considerably between sites and the two surveys, the hierarchical order for sites not being maintained between surveys. They were susceptible to the disproportionate influence of three relatively rare, unpredictable species with the greatest overall aggregated distribution among hosts. Jaccard's similarity index was less influenced by the rare species, showing greater stability between sites and across years. In conclusion, temporal variation confounded any site-specific characteristics of the summary measures quantified in this study and their usefulness is therefore restricted to the years in which the surveys were conducted.

Validation of a health literacy screening tool (REALM) in a UK population with coronary heart disease.

BACKGROUND: Health literacy (HL) has been recognized as an important public health issue in other developed countries such as the US. There is currently no HL screening tool valid for use in the UK. This study aimed to validate a US-developed HL screening tool (the Rapid Estimate for Adult Literacy in Medicine; REALM) for use in the UK against the UK's general literacy screening tool (the Basic Skills Agency Initial Assessment Test, BSAIT). METHODS: A cross-sectional survey involving 300 adult patients admitted to hospital for investigation of coronary heart disease were given the REALM and BSAIT tools to complete as well as specific questions considered likely to predict HL. These questions relate to the difficulty in understanding medical information, medical forms or instructions on tablets, frequency of reading books and whether the participant's job involves reading. RESULTS: The REALM was significantly correlated with the BSAIT (r = 0.70; P < 0.001), and significantly related to seven of the eight questions likely to be predictive of HL. CONCLUSIONS: This study has shown that the REALM has face, criterion and construct validity for use as an HL screening tool in the UK, in research and in everyday clinical practice. Further studies are needed to assess the prevalence of low HL in a wider population and to explore the links that may exist between low HL and poor health in the UK.

Temporal and between-site variation in helminth communities of bank voles ( Myodes glareolus) from N.E. Poland. 2. The infracommunity level.

The relative importance of temporal and spatial effects was assessed in helminth communities of bank voles (Myodes glareolus) in 3 woodland sites in N.E. Poland in the late summers of 1999 and 2002. Among common species the rank order of sites in relation to prevalence and abundance of infection was maintained between surveys. Site effects accounted for most of the deviance (in statistical models), and time was less important, so the exact location from which voles were sampled was of critical importance. The only exception was Syphacia petrusewiczi. In contrast, for derived measures such as species richness and diversity, most deviance was accounted for by host age, and the interaction between site and year was significant, implying that rank order of sites changed between years. Temporal effects on derived measures were generated primarily by a combination of relatively small changes in prevalence and abundance of the common, rather than the rare, species between the years of the study. In the medium-term, therefore, helminth communities of bank voles in N.E. Poland had a stable core, suggesting a substantial strong element of predictability.

Social deprivation and statin prescribing: a cross-sectional analysis using data from the new UK general practitioner 'Quality and Outcomes Framework'.

We aimed to study the relationship between the prescribing of lipid-lowering medication, social deprivation and other general practice characteristics. We conducted a cross-sectional survey of all general practices in England, 2004-05. For each practice, the following variables were obtained: standardized cost and volume data for lipid-lowering medication, descriptors of general practices, Index of Multiple Deprivation, 2004, ethnicity data from the 2001 Census and Quality and Outcomes Framework data. A regression model was constructed which explained 34.5% of the variation in statin prescribing by general practitioners. The most powerful predictors were higher social deprivation, higher prevalence of coronary heart disease and achievement of cholesterol targets for diabetics. Negative regression coefficients were demonstrated for the proportion of elderly patients in the practice and, to a lesser extent, for the proportion of south Asian and Afro-Caribbean patients. In conclusion, contrary to previous local studies, we found that statin prescribing was higher in more deprived communities, even after adjustment for increased disease prevalence and practice variables associated with deprivation. Statin prescribing was also independently associated with success at achieving cholesterol targets in established disease (secondary prevention). However, our findings suggest under-prescribing of statins to the elderly and possibly also to ethnic minorities.

Ethnicity recording in general practice computer systems.

BACKGROUND: Ethnicity data in general practice (GP) computerized medical records can be utilized to audit equity in health care. METHODS: We evaluated a patient profiling project targeted to improve ethnicity recording. RESULTS: Data extracted from 16 practices showed an increase in ethnicity recording from <1% before the intervention to 48% after. Recorded codes could be mapped onto the basic national statistics six-category ethnicity classification headings, and their proportions were similar to the 2001 census values. CONCLUSION: Recording of data using multiple coding hierarchies has reduced the utility of data as clinically important ethnic subgroups cannot be identified. Practitioners should be encouraged to use the single recommended ethnicity coding hierarchy.

Swallowing dysfunction in patients with unilateral vocal fold paralysis: aetiology and outcomes.

Although unilateral vocal fold palsy (UVFP) is a common problem, data relating to swallowing dysfunction are sparse. We reviewed the clinical findings (method of presentation, underlying diagnosis and position of the vocal folds) of 30 patients and conducted a follow-up telephone survey. Outcome measures used were direct visualization of fold function, position and compensation. In addition, standardized speech and language assessments for swallowing dysfunction and dysphonia were noted and compared to presentation. Our study indicates that 56 per cent of patients with UVFP have associated dysphagia. Outcome with speech therapy is significant, with 73 per cent showing improvement. These data indicate a significant link between UVFP and swallowing dysfunction. There is a marked therapeutic benefit from voice therapy. Further work is required to evaluate the long-term outcomes and establish the mechanism of swallowing dysfunction in these patients.