Challenges and Opportunities: What Can We Learn from Patients Living with Chronic Musculoskeletal Conditions, Health Professionals and Carers about the Concept of Health Literacy Using Qualitative Methods of Inquiry?

The field of health literacy continues to evolve and concern public health researchers and yet remains a largely overlooked concept elsewhere in the healthcare system. We conducted focus group discussions in England UK, about the concept of health literacy with older patients with chronic musculoskeletal conditions (mean age = 73.4 years), carers and health professionals. Our research posed methodological, intellectual and practical challenges. Gaps in conceptualisation and expectations were revealed, reiterating deficiencies in predominant models for understanding health literacy and methodological shortcomings of using focus groups in qualitative research for this topic. Building on this unique insight into what the concept of health literacy meant to participants, we present analysis of our findings on factors perceived to foster and inhibit health literacy and on the issue of responsibility in health literacy. Patients saw health literacy as a result of an inconsistent interactive process and the implications as wide ranging; healthcare professionals had more heterogeneous views. All focus group discussants agreed that health literacy most benefited from good inter-personal communication and partnership. By proposing a needs-based approach to health literacy we offer an alternative way of conceptualising health literacy to help improve the health of older people with chronic conditions

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

Reducing bias in auditory duration reproduction by integrating the reproduced signal

Duration estimation is known to be far from veridical and to differ for sensory estimates and motor reproduction. To investigate how these differential estimates are integrated for estimating or reproducing a duration and to examine sensorimotor biases in duration comparison and reproduction tasks, we compared estimation biases and variances among three different duration estimation tasks: perceptual comparison, motor reproduction, and auditory reproduction (i.e. a combined perceptual-motor task). We found consistent overestimation in both motor and perceptual-motor auditory reproduction tasks, and the least overestimation in the comparison task. More interestingly, compared to pure motor reproduction, the overestimation bias was reduced in the auditory reproduction task, due to the additional reproduced auditory signal. We further manipulated the signal-to-noise ratio (SNR) in the feedback/comparison tones to examine the changes in estimation biases and variances. Considering perceptual and motor biases as two independent components, we applied the reliability-based model, which successfully predicted the biases in auditory reproduction. Our findings thus provide behavioral evidence of how the brain combines motor and perceptual information together to reduce duration estimation biases and improve estimation reliability

A resolution analysis of two geophysical imaging methods for characterizing and monitoring hydrologic conditions in the Vadose zone.

This research project analyzed the resolution of two geophysical imaging techniques, electrical resistivity tomography (ERT) and cross-borehole ground penetrating radar (XBGPR), for monitoring subsurface flow and transport processes within the vadose zone. The study was based on petrophysical conversion of moisture contents and solute distributions obtained from unsaturated flow forward modeling. This modeling incorporated boundary conditions from a potable water and a salt tracer infiltration experiment performed at the Sandia-Tech Vadose Zone (STVZ) facility, and high-resolution spatial grids (6.25-cm spacing over a 1700-m domain) and incorporated hydraulic properties measured on samples collected from the STVZ. The analysis process involved petrophysical conversion of moisture content and solute concentration fields to geophysical property fields, forward geophysical modeling using the geophysical property fields to obtain synthetic geophysical data, and finally, inversion of this synthetic data. These geophysical property models were then compared to those derived from the conversion of the hydrologic forward modeling to provide an understanding of the resolution and limitations of the geophysical techniques

The attentional blink is related to phonemic decoding, but not sight-word recognition, in typically reading adults

This research investigated the relationship between the attentional blink (AB) and reading in typical adults. The AB is a deficit in the processing of the second of two rapidly presented targets when it occurs in close temporal proximity to the first target. Specifically, this experiment examined whether the AB was related to both phonological and sight-word reading abilities, and whether the relationship was mediated by accuracy on a single-target rapid serial visual processing task (single-target accuracy). Undergraduate university students completed a battery of tests measuring reading ability, non-verbal intelligence, and rapid automatised naming, in addition to rapid serial visual presentation tasks in which they were required to identify either two (AB task) or one (single target task) target/s (outlined shapes: circle, square, diamond, cross, and triangle) in a stream of random-dot distractors. The duration of the AB was related to phonological reading (n=41, ß=-0.43): participants who exhibited longer ABs had poorer phonemic decoding skills. The AB was not related to sight-word reading. Single-target accuracy did not mediate the relationship between the AB and reading, but was significantly related to AB depth (non-linear fit, R2 = .50): depth reflects the maximal cost in T2 reporting accuracy in the AB. The differential relationship between the AB and phonological versus sight-word reading implicates common resources used for phonemic decoding and target consolidation, which may be involved in cognitive control. The relationship between single-target accuracy and the AB is discussed in terms of cognitive preparation

Body size adaptation alters perception of test stimuli, not internal body image

Recent studies have reported that adaptation to extreme body types produces aftereffects on judgments of body normality and attractiveness, and also judgments of the size and shape of the viewer’s own body. This latter effect suggests that adaptation could constitute an experimental model of media influences on body image. Alternatively, adaptation could affect perception of test stimuli, which should produce the same aftereffects for judgments about participant’s own body or someone else’s body. Here, we investigated whether adaptation similarly affects judgments about one’s body and other bodies. We were interested in participants’ own body image judgements, i.e. we wanted to measure the mental representations to which the test stimuli were compared to and not the perception of test stimuli per se. Participants were adapted to pictures of thin or fat bodies and then rated whether bodies were fatter or thinner than either: their own body, an average body (Experiment 1) or the body of another person (Experiments 2-3). By keeping the visual stimuli constant but changing the task/type of judgement, i.e. the internal criterion participants are asked to judge the bodies against, we investigated how adaptation affects different stored representations of bodies, specifically. own body image vs representations of others. After adaptation, a classic aftereffect was found, with judgments biased away from the adapting stimulus. Critically, aftereffects were nearly identical for judgments of one’s own body and for other people’s bodies. These results suggest that adaptation affects body representations in a generic way and may not be specific to the own body image

The Role of Attention in Ambiguous Reversals of Structure-From-Motion

Multiple dots moving independently back and forth on a flat screen induce a compelling illusion of a sphere rotating in depth (structure-from-motion). If all dots simultaneously reverse their direction of motion, two perceptual outcomes are possible: either the illusory rotation reverses as well (and the illusory depth of each dot is maintained), or the illusory rotation is maintained (but the illusory depth of each dot reverses). We investigated the role of attention in these ambiguous reversals. Greater availability of attention – as manipulated with a concurrent task or inferred from eye movement statistics – shifted the balance in favor of reversing illusory rotation (rather than depth). On the other hand, volitional control over illusory reversals was limited and did not depend on tracking individual dots during the direction reversal. Finally, display properties strongly influenced ambiguous reversals. Any asymmetries between ‘front’ and ‘back’ surfaces – created either on purpose by coloring or accidentally by random dot placement – also shifted the balance in favor of reversing illusory rotation (rather than depth). We conclude that the outcome of ambiguous reversals depends on attention, specifically on attention to the illusory sphere and its surface irregularities, but not on attentive tracking of individual surface dots

Human Breast Milk and Antiretrovirals Dramatically Reduce Oral HIV-1 Transmission in BLT Humanized Mice

Currently, over 15% of new HIV infections occur in children. Breastfeeding is a major contributor to HIV infections in infants. This represents a major paradox in the field because in vitro, breast milk has been shown to have a strong inhibitory effect on HIV infectivity. However, this inhibitory effect has never been demonstrated in vivo. Here, we address this important paradox using the first humanized mouse model of oral HIV transmission. We established that reconstitution of the oral cavity and upper gastrointestinal (GI) tract of humanized bone marrow/liver/thymus (BLT) mice with human leukocytes, including the human cell types important for mucosal HIV transmission (i.e. dendritic cells, macrophages and CD4+ T cells), renders them susceptible to oral transmission of cell-free and cell-associated HIV. Oral transmission of HIV resulted in systemic infection of lymphoid and non-lymphoid tissues that is characterized by the presence of HIV RNA in plasma and a gradual decline of CD4+ T cells in peripheral blood. Consistent with infection of the oral cavity, we observed virus shedding into saliva. We then evaluated the role of human breast milk on oral HIV transmission. Our in vivo results demonstrate that breast milk has a strong inhibitory effect on oral transmission of both cell-free and cell-associated HIV. Finally, we evaluated the effect of antiretrovirals on oral transmission of HIV. Our results show that systemic antiretrovirals administered prior to exposure can efficiently prevent oral HIV transmission in BLT mice

Bright light in elderly subjects with nonseasonal major depressive disorder: a double blind randomised clinical trial using early morning bright blue light comparing dim red light treatment

<p>Abstract</p> <p>Background</p> <p>Depression frequently occurs in the elderly. Its cause is largely unknown, but several studies point to disturbances of biological rhythmicity. In both normal aging, and depression, the functioning of the suprachiasmatic nucleus (SCN) is impaired, as evidenced by an increased prevalence of day-night rhythm perturbations, such as sleeping disorders. Moreover, the inhibitory SCN neurons on the hypothalamus-pituitary adrenocortical axis (HPA-axis) have decreased activity and HPA-activity is enhanced, when compared to non-depressed elderly. Using bright light therapy (BLT) the SCN can be stimulated. In addition, the beneficial effects of BLT on seasonal depression are well accepted. BLT is a potentially safe, nonexpensive and well accepted treatment option. But the current literature on BLT for depression is inconclusive.</p> <p>Methods/Design</p> <p>This study aims to show whether BLT can reduce non-seasonal major depression in elderly patients. Randomized double blind placebo controlled trial in 126 subjects of 60 years and older with a diagnosis of major depressive disorder (MDD, DSM-IV/SCID-I). Subjects are recruited through referrals of psychiatric outpatient clinics and from case finding from databases of general practitioners and old-people homes in the Amsterdam region. After inclusion subjects are randomly allocated to the active (bright blue light) vs. placebo (dim red light) condition using two Philips Bright Light Energy boxes type HF 3304 per subject, from which the light bulbs have been covered with bright blue- or dim red light- permitting filters. Patients will be stratified by use of antidepressants. Prior to treatment a one-week period without light treatment will be used. At three time points several endocrinological, psychophysiological, psychometrically, neuropsychological measures are performed: just before the start of light therapy, after completion of three weeks therapy period, and three weeks thereafter.</p> <p>Discussion</p> <p>If BLT reduces nonseasonal depression in elderly patients, then additional lightning may easily be implemented in the homes of patients to serve as add-on treatment to antidepressants or as a stand-alone treatment in elderly depressed patients. In addition, if our data support the role of a dysfunctional biological clock in depressed elderly subjects, such a finding may guide further development of novel chronobiological oriented treatment strategies.</p> <p>Trial registration</p> <p>ClinicalTrials.gov identifier: NCT00332670</p