The Role of Interactive and Critical Health Literacy in Appointment Cancellations: A Quality Assurance Survey

Objective: An agency located in the Midwest identified a 30 percent cancellation rate in their federally funded Part C early intervention (EI) program. Parents and caregivers of children with developmental delays tend to access and utilize the health care system and programs aimed at improving developmental outcomes more frequently. These children will likely benefit from caregivers who have ample health literacy to navigate the complicated systems of care. Although the role of functional health literacy (i.e., reading and numeracy skills) on health and developmental outcomes is well documented in the literature, limited research exists on the importance of interactive and critical health literacy on successful navigation and informed-decision making. Thus, this research sought to establish the role of caregivers\u27 interactive and critical health literacy on level of attendance in the EI program. Background: The most common measures of health literacy, the Rapid Estimate of Adult Literacy in Medicine (REALM) and the Test of Functional Health Literacy in Adults (TOFHLA), appear to be both valid and reliable assessment tools (Davis et al., 1993; Parker et al., 1995). However, these measures are not always true indicators of an individual\u27s level of health literacy (Freidman et al., 2009); likely due to the exclusive focus on reading and numeracy skills (i.e., functional health literacy). Interactive and critical health literacy involves complex skills that individuals use to abstract, apply, evaluate, and analyze health-related information (Nutbeam, 2000). The purpose of this research is to provide support to the notion that interactive and critical health literacy is a vital construct and one that needs to be measured to better understand participation in developmental or EI programs. Methods: Forty parents and caregivers with children enrolled in the EI program were recruited by their case coordinator at the center. Eligible participants were categorized as either `low attenders\u27 ( \u3c 50% of appointments) or `regular attenders\u27 ( \u3e 80% of appointments), and completed a 28-item questionnaire over the phone. Responses were transcribed and coded to develop an overall interactive and critical health literacy score which was used to assess the relationship with level of attendance. Results: The findings from the binary logistic regression identified that participant interactive and critical health literacy score was a significant predictor variable to level of attendance, with an odds ratio Exp(B) = 1.962 (CI 95%, 1.016-3.791). These results indicate that participants with a higher health literacy score were almost 2 times more likely to be regular attenders than low attenders. It was also discovered that interactive and critical health literacy score had a statistically significant correlation with percent attendance in participants in the low attender group, r = .598, n = 40, p \u3c 0.0005. Specifically, higher interactive and critical health literacy scores were associated with higher percent attendance. Conclusion: This study lent support to the value of interactive and critical health literacy on cancellations rates. Results found interactive and critical health literacy scores to be both predictive and strongly correlated with appointment attendance. These findings suggest that the development of an instrument to measure the construct of interactive and critical health literacy may be possible. Developing instrumentation that spans beyond functional health literacy could lead to an improvement in the understanding of the role of interactive and critical health literacy in family participation in EI programs

Which Principal is the Right Principal? Student Achievement, School Finances, and Community Stakeholders

When a struggling high school may be placed on turnaround status during a bid for a school bond, the district considers replacing a beloved principal with a record of low test scores with an unpopular principal whose record shows increased student achievement. The school board must decide whether to prioritize finances, community support, student achievement, or state-level demands. This case presents many difficult decisions schools and districts are required to make. Key factors discussed in the case include principal turnover, student academic achievement, teacher retention, school culture, and power

Trends and characteristics of accidental and intentional codeine overdose deaths in Australia

Examines trends in codeine-related mortality rates in Australia, and the clinical and toxicological characteristics of codeine-related deaths. Abstract Objectives: To examine trends in codeine-related mortality rates in Australia, and the clinical and toxicological characteristics of codeine-related deaths. Design and setting: Analysis of prospectively collected data from the National Coronial Information System on deaths where codeine toxicity was determined to be an underlying or contributory cause of death. The study period was 2000–2013. Main outcome measures: Population-adjusted numbers (per million persons) of (1) codeine-related deaths, classified by intent (accidental or intentional); and (2) heroin- and Schedule 8 opioid-related deaths (as a comparator). Results: The overall rate of codeine-related deaths increased from 3.5 per million in 2000 to 8.7 per million in 2009. Deaths attributed to accidental overdoses were more common (48.8%) than intentional deaths (34.7%), and their proportion increased during the study period. High rates of prior comorbid mental health (53.6%), substance use (36.1%) and chronic pain (35.8%) problems were recorded for these deaths. For every two Schedule 8 opioid-related deaths in 2009, there was one codeine-related death. Most codeine-related deaths (83.7%) were the result of multiple drug toxicity. Conclusions: Codeine-related deaths (with and without other drug toxicity) are increasing as the consumption of codeine-based products increases. Educational messages are needed to better inform the public about the potential harms of chronic codeine use, especially in the context of polypharmacy

Improving institutional memory on challenges and methods for estimation of pig herd antimicrobial exposure based on data from the Danish Veterinary Medicines Statistics Program (VetStat)

With the increasing occurrence of antimicrobial resistance, more attention has been directed towards surveillance of both human and veterinary antimicrobial use. Since the early 2000s, several research papers on Danish pig antimicrobial usage have been published, based on data from the Danish Veterinary Medicines Statistics Program (VetStat). VetStat was established in 2000, as a national database containing detailed information on purchases of veterinary medicine. This paper presents a critical set of challenges originating from static system features, which researchers must address when estimating antimicrobial exposure in Danish pig herds. Most challenges presented are followed by at least one robust solution. A set of challenges requiring awareness from the researcher, but for which no immediate solution was available, were also presented. The selection of challenges and solutions was based on a consensus by a cross-institutional group of researchers working in projects using VetStat data. No quantitative data quality evaluations were performed, as the frequency of errors and inconsistencies in a dataset will vary, depending on the period covered in the data. Instead, this paper focuses on clarifying how VetStat data may be translated to an estimation of the antimicrobial exposure at herd level, by suggesting uniform methods of extracting and editing data, in order to obtain reliable and comparable estimates on pig antimicrobial consumption for research purposes.Comment: 25 pages, including two Appendices (pages not numbered). Title page, including abstract, is on page 1. Body of text, including references, abbreviation list and disclaimers for conflict of interest and funding, are on pages 2-18. Two figures embedded in the text on pages 3 and 5. Appendix 1 starts on page 19, and Appendix 2 on page 2

Friends’ Experiences and Sense-Making of Providing Support for a Socially Anxious Young Person: An Interpretative Phenomenological Analysis

This study investigates how friends experience and make sense of providing support for a socially anxious young person. The experiences of friends who provide support for people with mental illnesses are rarely studied in their own right; studies tend to group friends with the experiences of partners or parents. This study aimed at analysing the overlooked perspective of the friends. Friends’ experiences were attained through semi-structured interviews with five self-identified friends of a young person with social anxiety. Through an Interpretative Phenomenological Analysis, three super-ordinate themes were generated: experiencing responsibility, the challenges in providing support, and the meaning of providing support. The analysis demonstrated that friends are a great source of support for socially anxious young people. Participants experienced a great responsibility because the socially anxious friends were dependent upon the support provided. Providing support was challenging; participants dealt with self-blame, worries about providing the right support and being a good supporter. However, participants valued their friendships, and providing support was also linked to feelings of reward, pride, success and achievement. The discussion indicated that great responsibility and dependency is commonly experienced among carers of people with mental illnesses, and that friends could benefit from sharing the responsibility with more people to reduce the challenges associated with providing support. Future research was recommended to examine the consequences of providing support alone versus in a group, and engage with the self-blame experienced among friends providing support. Last, more qualitative research on the experiences of friends was recommended for future studies