The association of health literacy with adherence in older 2 adults, and its role in interventions: a systematic meta-review

Background: Low health literacy is a common problem among older adults. It is often suggested to be associated with poor adherence. This suggested association implies a need for effective adherence interventions in low health literate people. However, previous reviews show mixed results on the association between low health literacy and poor adherence. A systematic meta-review of systematic reviews was conducted to study the association between health literacy and adherence in adults above the age of 50. Evidence for the effectiveness of adherence interventions among adults in this older age group with low health literacy was also explored. Methods: Eight electronic databases (MEDLINE, ERIC, EMBASE, PsycINFO, CINAHL, DARE, the Cochrane Library, and Web of Knowledge) were searched using a variety of keywords regarding health literacy and adherence. Additionally, references of identified articles were checked. Systematic reviews were included if they assessed the association between health literacy and adherence or evaluated the effectiveness of interventions to improve adherence in adults with low health literacy. The AMSTAR tool was used to assess the quality of the included reviews. The selection procedure, data-extraction, and quality assessment were performed by two independent reviewers. Seventeen reviews were selected for inclusion. Results: Reviews varied widely in quality. Both reviews of high and low quality found only weak or mixed associations between health literacy and adherence among older adults. Reviews report on seven studies that assess the effectiveness of adherence interventions among low health literate older adults. The results suggest that some adherence interventions are effective for this group. The interventions described in the reviews focused mainly on education and on lowering the health literacy demands of adherence instructions. No conclusions could be drawn about which type of intervention could be most beneficial for this population. Conclusions: Evidence on the association between health literacy and adherence in older adults is relatively weak. Adherence interventions are potentially effective for the vulnerable population of older adults with low levels of health literacy, but the evidence on this topic is limited. Further research is needed on the association between health literacy and general health behavior, and on the effectiveness of interventions

Education for public health in Europe and its global outreach

Introduction: At the present time, higher education institutions dealing with education for public health in Europe and beyond are faced with a complex and comprehensive task of responding to global health challenges. Review: Literature reviews in public health and global health and exploration of internet presentations of regional and global organisations dealing with education for public health were the main methods employed in the work presented in this paper. Higher academic institutions are searching for appropriate strategies in competences-based education, which will increase the global attractiveness of their academic programmes and courses for continuous professional development. Academic professionals are taking advantage of blended learning and new web technologies. In Europe and beyond they are opening up debates about the scope of public health and global health. Nevertheless, global health is bringing revitalisation of public health education, which is recognised as one of the core components by many other academic institutions involved in global health work. More than ever, higher academic institutions for public health are recognising the importance of institutional partnerships with various organisations and efficient modes of cooperation in regional and global networks. Networking in a global setting is bringing new opportunities, but also opening debates about global harmonisation of competence-based education to achieve functional knowledge, increase mobility of public health professionals, better employability and affordable performance. Conclusions: As public health opportunities and threats are increasingly global, higher education institutions in Europe and in other regions have to look beyond national boundaries and participate in networks for education, research and practice

Systematic review of studies investigating the association between dietary habits and cutaneous malignant melanoma

Several papers have dealt with diet as a risk factor for cutaneous malignant melanoma (CMM). This study aimed to synthesize available data on the topic

Abitudini alimentari e melanoma cutaneo: nuove prospettive per la prevenzione?

OBIETTIVI: Il Melanoma Cutaneo (MC) colpisce ogni anno circa 200.000 soggetti, di cui 46.000 destinati a morire a causa della patologia. Il principale fattore di rischio \ue8 rappresentato dall\u2019esposizione alle radiazioni ultraviolette, ma diverse pubblicazioni hanno rivolto l\u2019attenzione all\u2019analisi dell\u2019impatto delle abitudini alimentari. Scopo del presente studio \ue8 effettuare una revisione sistematica dei lavori che hanno indagato l\u2019associazione tra abitudini alimentari e MC al fine di fornire evidenze utili ai decisori di Sanit\ue0 Pubblica. METO DI: Ai fini di identificare gli studi potenzialmente eleggibili sono state impiegate le banche dati PubMed, OvidSP e Cochrane Library; la ricerca \ue8 stata protratta dal 1990 a luglio 2011 e sono stati considerati eleggibili gli studi caso-controllo e di coorte. A seguito della selezione dei lavori, due ricercatori hanno valutato indipendentemente la qualit\ue0 attraverso la Newcastle-Ottawa Scale (NOS) ed estrapolato i dati. Sono stati estratti gli Odds Ratio o i Rischi Relativi, aggiustati per potenziali fattori confondenti, per i soggetti che avevano assunto le pi\uf9 elevate quantit\ue0 dei diversi gruppi alimentari a confronto con quelli con i livelli pi\uf9 bassi di assunzione. RISULTATI: La ricerca bibliografica ha prodotto 266 articoli di cui 15 considerati eleggibili: 13 sono risultati studi caso-controllo e 2 di coorte. Otto studi (53,3%) sono stati condotti in Europa, i restanti prevalentemente negli Stati Uniti. La numerosit\ue0 campionaria \ue8 risultata variabile da 98 a 1.400 per gli studi caso-controllo e da 50.757 a 121.700 per quelli di coorte. Secondo la NOS gli studi di coorte hanno conseguito un punteggio migliore rispetto a quelli casocontrollo. Gli studi sono risultati notevolmente eterogenei in termini di strumenti utilizzati per la valutazione delle abitudini alimentari essendo stati impiegati, nella maggior parte dei casi, questionari non standardizzati. Per tale ragione la combinazione dei dati non \ue8 stata considerata opportuna e si \ue8 proceduto a una sintesi qualitativa. La maggior parte degli studi non ha rivelato un\u2019associazione statisticamente significativa tra assunzione di alimenti e MC. Tuttavia, uno studio ha mostrato una riduzione del 46% del rischio di MC con il consumo di frutta, tre una riduzione del 30-50% con l\u2019assunzione di vegetali e due un declino di circa il 35-38% associato al consumo di pesce. CONCLUSIONI: Il lavoro mette in luce l\u2019esistenza di un\u2019associazione inversa tra rischio di MC e assunzione di pesce, vegetali e frutta. L\u2019eterogeneit\ue0 impedisce tuttavia di trarre conclusioni definitive che sarebbero necessarie per impostare campagne di educazione e promozione della salute volte alla prevenzione primaria del MC