Health literacy and its socio-demographic risk factors in Hebei: A cross-sectional survey

This study aimed to evaluate the prevalence of low health literacy in Hebei Province of China, and to investigate its socio-demographic risk factors.This study was a community-based, cross-sectional questionnaire survey with a multiple-stage randomization design and a sample size of 10,560. Participants’ health literacy status was evaluated by a questionnaire based on the 2012 Chinese Resident Health Literacy Scale. Meanwhile, participants’ socio-demographic characteristics were also collected by the questionnaire.A total of 9952 participants provided valid questionnaires and were included in the final analyses. The mean health literacy score was 63.1 ± 17.1 points; for its subscales, the mean basic knowledge and concepts score, lifestyle score, health-related skills score were 31.7 ± 9.0, 17.2 ± 4.8, 14.3 ± 4.1, respectively. Meanwhile, low health literacy prevalence was 81.0%; for its subscales, low basic knowledge and concepts prevalence (70.6%) was numerically reduced compared to low lifestyle prevalence (87.4%) and low health-related skills prevalence (86.1%). Further analyses showed that age, male, and rural area were positively associated, but education level and annual household income were negatively associated with low health literacy prevalence. Further multivariate logistic regression analyses showed that higher age, male, lower education level, lower annual household income, and rural area were closely correlated with the risks of low total health literacy or low health literacy in subscales in Hebei Province.The prevalence of low health literacy is 81.0% in Hebei Province. Meanwhile, higher age, male, lower education level, lower annual household income, and rural area closely associate with low health literacy risk.     

Health literacy and anticoagulation-related outcomes among patients taking warfarin

BACKGROUND: Little is known about whether health literacy affects anticoagulation-related outcomes. OBJECTIVE: To assess how health literacy is associated with warfarin knowledge, adherence, and warfarin control (measured by the international normalized ratio [INR]). DESIGN: Survey. PARTICIPANTS: Patients taking warfarin through an anticoagulation clinic. MEASUREMENTS: Health literacy was measured using the short-form Test of Functional Health Literacy in Adults (s-TOFHLA), dichotomized as "limited" (score 0 to 22) and "adequate" (score 23 to 36). We asked patients to answer questions relating to their warfarin therapy and used multivariable logistic regression to assess whether health literacy was associated with incorrect answers. We also assessed whether health literacy was associated with nonadherence to warfarin as well as time in therapeutic INR range. RESULTS: Bilingual research assistants administered the survey and s-TOFHLA to 179 anticoagulated English- or Spanish-speaking patients. Limited health literacy was associated with incorrect answers to questions on warfarin's mechanism (adjusted odds ratio [OR] 4.8 [1.3 to 17.6]), side-effects (OR 6.4 [2.3 to 18.0]), medication interactions (OR 2.5 [1.1 to 5.5]), and frequency of monitoring (OR 2.7 [1.1 to 6.7]), after adjusting for age, sex, race/ethnicity, education, cognitive impairment, and years on warfarin. However, limited health literacy was not significantly associated with missing warfarin doses in 3 months (OR 0.9 [0.4 to 2.0]) nor with the proportion of person-time in therapeutic INR range (OR 1.0 [0.7 to 1.4]). CONCLUSIONS: Limited health literacy is associated with deficits in warfarin-related knowledge but not with self-reported adherence to warfarin or INR control. Efforts should concentrate on investigating alternative means of educating patients on the management and potential risks of anticoagulation.     

Health literacy of college freshmen in jiangsu,China: A 3-year longitudinal survey

Health literacy (HL) has become an important public health issue and received growing attention in recent years. However, knowledge about the HL of adolescents and young adults is limited.^[1] This study aimed to investigate the awareness rate of HL and its related factors among college freshmen in Jiangsu, China. And the results were used to support the promotion intervention to improve the HL of at-risk groups among this population.A total of 25,272 freshmen were surveyed through multi-stage stratified random sampling from 20 colleges and universities in Jiangsu province between 2016 to 2018. Data were obtained using the “Chinese Citizen Health Literacy Questionnaire” (2013 edition). Multiple logistic regression analysis was conducted to determine the factors influencing HL levels.The awareness rate of HL of college freshmen in Jiangsu province was 26.6% among the 25,272 subjects. The awareness rate of HL tended to increase from 2016 to 2018, which was 17.9%, 21.5%, and 39.6%, respectively (P < 0.001). Specifically, except for chronic diseases, knowledge and attitudes, knowledge and attitudes toward health-related behavior and lifestyle, health-related skill and scientific views of health, infection diseases, safety and first aid, medical care, health information awareness rate all have improved to a certain degree (P < .001). The independent factors associated with HL awareness rate were sex (odds ratio [OR] = 1.099, (1.039 –1.164)), residence (urban: OR = 1.141, (1.056∼1.234)), educational system (OR = 2.133, (1.975–2.305)), only child or not (OR = 1.087, (1.018–1.161)), family structure (OR = 1.192, (1.078–1.319)) and maternal education level (high school: OR = 1.183 (1.067–1.313); university and more: OR = 1.481 (1.324–1.658)).Awareness rate of HL of college freshmen is associated with multi-complex factors, further works are recommended to improve the HL levels of college freshmen, especially for the aspect of chronic diseases.     

Marriage and parenthood among childhood cancer survivors: a report from the Italian AIEOP Off-Therapy Registry

Background

The aim of this study was to describe the patterns of marriage and parenthood in a cohort of childhood cancer survivors included in the Off-Therapy Registry maintained by the Italian Association of Pediatric Hematology and Oncology.

Design and Methods

We analyzed a cohort of 6,044 patients diagnosed with cancer between 1960 and 1998, while aged 0 to 14 years and who were 18 years old or older by December 2003. They were followed up through the regional vital statistics registers until death or the end of follow up (October 30, 2006), whichever occurred first, and their marital status and date of birth of their children were recorded. The cumulative probabilities of being married and having a first child were computed by gender and compared by tumor type within the cohort. Marriage and fertility rates (the latter defined as the number of live births per woman-year) were compared with those of the Italian population of the same age, gender, area of residence and calendar period by means of the observed to expected (O/E) ratios.

Results

During the follow-up period, 4,633 (77%) subjects had not married. The marriage O/E ratios were 0.56 (95% CI: 0.51–0.61) and 0.70 (95% CI: 0.65–0.76) among men and women, respectively. Overall, 263 men had 367 liveborn children, and 473 women had 697 liveborn children. The female fertility O/E ratio was 0.57 (95% CI: 0.53–0.62) overall, and 1.08 (95% CI: 0.99–1.17) when analyses were restricted to married/cohabiting women

Conclusions

Childhood cancer survivors are less likely to marry and to have children than the general population, confirming the life-long impact of their previous disease on their social behavior and choices. The inclusion of counseling in the strategies of management and long-term surveillance of childhood cancer patients could be beneficial to survivors as they approach adulthood.     

Health literacy,dementia knowledge and perceived utility of digital health modalities among future health professionals

Objectives

Studies of dementia knowledge (including dementia risk reduction) in health-care trainees highlight varying levels of understanding across countries and disciplines. This draws attention to the need for a well-trained health workforce with the knowledge to champion and implement such strategies. This study (a) assessed dementia knowledge and health literacy among a sample of Australian health-care students, (b) identified modality preferences of digital health interventions addressing dementia prevention and (c) examined potential relationships among health literacy, dementia knowledge, dementia prevention knowledge and a student's preferences for different digital health modalities.

Methods

A cross-sectional survey assessed dementia knowledge and health literacy in 727 health students across 16 Australian universities representing both metropolitan and regional cohorts. The All Aspects of Health Literacy Scale and the Dementia Knowledge Assessment Scale were administered. Questions about the perceived effectiveness of strategies and preferred digital health modalities for dementia prevention/risk reduction were asked.

Results

The students had relatively high health literacy scores. However, dementia knowledge and evidence-based dementia prevention knowledge were average. Only 7% claimed knowledge of available dementia-related digital health interventions. Associations among health literacy, dementia knowledge and dementia prevention, with recommendations for different digital modalities, are presented.

Conclusions

Health-related degrees need to increase dementia knowledge, health literacy and knowledge of effective dementia-related digital health interventions. It is imperative to equip the future health workforce amid an ageing population with increased dementia rates and where evidence-based digital health interventions will increasingly be a source of support.     

Influenza and pneumococcal vaccination in older veterans: results from the behavioral risk factor surveillance system

OBJECTIVES: To compare influenza and pneumococcal vaccination rates of older veterans with those of nonveterans and to compare vaccination rates of veterans who receive care at U.S. Department of Veterans Affairs (VA) medical centers with those of veterans who do not. DESIGN: Cross-sectional population-based study. SETTING: United States and territories. PARTICIPANTS: Persons aged 65 and older who participated in the 2003 Behavioral Risk Factor Surveillance System. MEASUREMENTS: Telephone survey of sociodemographics factors, including veteran status and VA care, health and behavioral characteristics, and influenza and pneumococcal vaccine use. RESULTS: Thirty percent of adults aged 65 and older were veterans, and 21% of veterans reported receiving care at VA health facilities. Veterans, especially VA users, were older and described poorer self-perceived health than nonveterans. Influenza and pneumococcal vaccination rates were higher for veterans than for nonveterans (74% vs 68% and 68% vs 63%, respectively, P < .001 for both) and for VA users than non-VA users (80% vs 72% and 81% vs 64%, respectively, P < .001 for both). For veterans, VA care was independently associated with influenza (odds ratio (OR) = 1.8, 95% confidence interval (CI) = 1.5-2.2) and pneumococcal (OR = 2.4, 95% CI = 2.0-2.9) vaccine use after adjusting for sociodemographics factors, perceived health status, diabetes mellitus, asthma, and smoking. Current smoking and black race were independent predictors of low influenza vaccine uptake. CONCLUSION: VA care was associated with improved influenza and pneumococcal vaccine coverage, although vaccination rates for all elderly veterans fell short of Healthy People 2010 goals. Increased efforts to reach undervaccinated groups, particularly blacks and smokers, are warranted.     

Self-reported asthma and health-related quality of life: findings from the behavioral risk factor surveillance system

STUDY OBJECTIVES: Few population-based data regarding the impact of asthma on health-related quality of life in the US adult population are available. DESIGN: Cross-sectional study of participants in 50 states in the United States. SETTING: Using data from 163,773 adult respondents in the 2000 Behavioral Risk Factor Surveillance System, we examined how self-reported asthma is associated with general self-reported health and four health-related quality-of-life measures. RESULTS: Participants with self-reported current asthma reported significantly more age-adjusted physically unhealthy days (6.5 days vs 2.9 days, p < 0.001), mentally unhealthy days (5.2 days vs 3.0 days, p < 0.001), days with activity limitation (3.7 days vs 1.6 days, p < 0.001), and unhealthy physical or mental days (10.0 days vs 5.4 days, p < 0.001) in the last 30 days than participants who never had asthma. After adjusting for age, sex, race or ethnicity, educational attainment, employment status, smoking status, physical activity status, and body mass index, the odds ratios among persons with asthma compared with persons who never had asthma, were 2.41 (95% confidence interval [CI], 2.21 to 2.63) for reporting poor or fair self-rated health, 2.26 (95% CI, 2.06 to 2.49) for reporting >or= 14 days of impaired physical health during the previous 30 days, 1.55 (95% CI, 1.40 to 1.72) for reporting >or= 14 days of poor mental health during the previous 30 days, 1.96 (95% CI, 1.73 to 2.21) for reporting >or= 14 activity limitation days, and 1.99 (95% CI, 1.84 to 2.15) for reporting >or= 14 days of physically or mentally unhealthy days during the previous 30 days. Results were consistent for all age groups, for both sexes, and for all race or ethnic groups. Participants who did not currently have asthma, but had it previously, reported having more unhealthy days with all four measures than participants who never had asthma, but fewer than participants who currently had asthma. CONCLUSIONS: These results provide additional measures to evaluate and monitor the impact of asthma on the health of the US adult population.     

Fracture risk among breast cancer survivors: results from the Women's Health Initiative Observational Study

BACKGROUND: Breast cancer and its treatment may compromise bone health. We tested the hypothesis in the Women's Health Initiative Observational Study that postmenopausal survivors of breast cancer have a higher risk for fractures compared with women who have no cancer history. METHODS: A prospective cohort (5.1 years' follow-up) study design was used. Breast cancer survivors were women who reported a history of breast cancer (n = 5298). A reference group included women who had no cancer history at baseline (n = 80 848). Fracture occurrence was ascertained from annual self-reports. Hip fractures were confirmed by reviewing medical records. RESULTS: After adjustment for age, weight, ethnicity, and geographic region of enrollment, the hazard ratios (HRs) of breast cancer survivors to women in the reference group were 0.93 (95% confidence interval [CI], 0.64-1.33) for hip; 1.36 (95% CI, 1.16-1.59) for forearm or wrist; 1.31 (95% CI, 1.19-1.43) for eligible fractures other than hip, vertebral, and forearm or wrist; and 1.31 (95% CI, 1.21-1.41) for these fractures combined. The increased risk for clinical vertebral fracture was statistically significant only among survivors who had a breast cancer diagnosis before age 55 years (HR, 1.78; 95% CI, 1.28-2.46). After adjusting for factors related to hormone levels, risk of fall, fracture history, medication use, comorbidity, and lifestyle, the increased risk for all fractures studied among survivors was reduced to 15% (HR, 1.15; 95% CI, 1.05-1.25). CONCLUSIONS: Postmenopausal survivors of breast cancer are at increased risk for clinical fractures. Preventions and therapeutic interventions are needed to reduce fracture risk in this large and growing population.     

Brief report: Resident recognition of low literacy as a risk factor in hospital readmission

BACKGROUND: Low literacy is associated with poor self-management of disease and increased hospitalization, yet few studies have explored the extent to which physicians consider literacy in their patient care. OBJECTIVE: To examine trainee recognition of low literacy as a potential factor in patient adherence and hospital readmission. DESIGN AND PARTICIPANTS: Randomized study of 98 Internal Medicine residents and medical students. Trainees reviewed a case history and completed a questionnaire pertaining to a fictional patient’s hospital readmission. Case version A contained clues to suggest limited patient literacy skills, while version B did not. Responses were reviewed for mention of low literacy and educational strategies recommended for low-literate patients. RESULTS: Few trainees raised the possibility of low patient literacy, even when provided clues (25% in Group A vs 4% in Group B, P=.003). Furthermore, while most trainees listed patient education as an important means of preventing another readmission, only 16% suggested using a strategy recommended for low-literate adults. CONCLUSION: Few trainees recognized low literacy as a potential factor in patient nonadherence and hospital readmission, and few recommended low-literate educational strategies. Medical residents and students may benefit from additional training in the recognition and counseling of low-literate patients. The content of this paper was presented in abstract form at the Society of Hospital Medicine national meeting in April 2003 and at the Society of General Internal Medicine national meeting in May 2003. Dr. Kripalani receives support from a K23 Mentored Patient-Oriented Research Career Development Award (1 K23 HL077597), a Pfizer Health Literacy Scholar Award, and an Heart Association Scientist Development Grant. While conducting the present research, he was supported by the Emory Mentored Clinical Research Scholars Program (NIH/NCRR K12 RR017643).     

An association between electronic nicotine delivery systems use and a history of stroke using the 2016 behavioral risk factor surveillance system

Electronic nicotine delivery systems (ENDS) are growing in use and many of the health implications with these devices remain unknown. This study aims to assess, using a survey representative of the USA general population, if an association exists between a history of ENDS use and a history of stroke.This cross-sectional study was a secondary data analysis using the 2016 behavioral risk factor surveillance system survey. The main exposure variable of the study was a self-reported history of ENDS use. The main outcome was a self-reported history of stroke. Covariates included sex, race, traditional cigarette use, smokeless tobacco use, chronic kidney disease, diabetes, myocardial infarction, and coronary artery disease. Unadjusted and adjusted logistic regression analyses were done. Adjusted odds ratios (AOR) and their corresponding 95% confidence intervals (CI) were calculated.Of the 486,303 total behavioral risk factor surveillance system survey participants, 465,594 met the inclusion criteria for this study of ENDS use and stroke. This study shows that current ENDS use was positively associated with a history of stroke. AOR of some daily ENDS use with stroke was 1.28 (95% CI: 1.02–1.61) and AOR of current daily ENDS use with stroke was 1.62 (95% CI: 1.18–2.31). The majority (55.9%) of current daily ENDS users reported former traditional cigarette smoking. Female sex, non-white ethnicity, elderly age, chronic kidney disease, coronary artery disease, diabetes, and traditional cigarette use characteristics were all also associated with increased odds of reporting a stroke.This study found a statistically significant and positive association between ENDS use and a history of stroke. Further research is warranted to investigate the reproducibility and temporality of this association. Nevertheless, this study contributes to the growing body of knowledge about the potential cardiovascular concerns related to ENDS use and the need for large cohort studies.     

A comparison of national estimates of obesity prevalence from the behavioral risk factor surveillance system and the National Health and Nutrition Examination Survey

BACKGROUND: Obesity interventions are implemented at state or sub-state level in the United States (US), where only self-reported weight and height data for adults are available from the Behavioral Risk Factor Surveillance System (BRFSS). The prevalence estimates of overweight and obesity generated from self-reported weight and height from BRFSS are known to underestimate the true prevalence. However, whether this underestimation is consistent across different demographic groups has not been fully investigated. METHODS: In this study, we compared the prevalence estimates of obesity (body mass index (BMI) > or =30 kg/m(2)) and overweight (BMI > or =25 kg/m(2)) in different demographic groups in the US from the National Health and Nutrition Examination Survey (NHANES) and BRFSS during 1999-2000. We also compared the rank orders of the obesity and overweight prevalence across different demographic groups from the two data sources. RESULTS: Compared to NHANES, BRFSS underestimated the overall prevalence of obesity and overweight by 9.5 and 5.7 percentage points, respectively. The underestimation differed across different demographic groups: the underestimation of obesity and overweight prevalence was higher among women (13.1 and 12.2 percentage points, respectively) than among men (5.8 and -0.6 percentage points, respectively). The variation of underestimation was higher among men. A clear inverse association between educational attainment and obesity prevalence among non-Hispanic African American women was observed from BRFSS data. However, no such association was found from NHANES. While BRFSS can identify correctly the population with the highest obesity and overweight burden, it did not accurately rank the obesity and overweight prevalence across different demographic groups. CONCLUSION: Compared to NHANES, BRFSS disproportionately underestimates the prevalence of obesity and overweight across different gender, race, age, and education subgroups.     

Diabetes mellitus and health-related quality of life among older adults. Findings from the behavioral risk factor surveillance system (BRFSS)

The aim of the present study was to examine associations between the presence of diabetes mellitus and health-related quality of life (HRQOL) among older adults. Using data from 37,054 adults aged 50 years or older who participated in the 2001 BRFSS, we examined the independent association between diabetes and four measures of HRQOL developed by the U.S. Centers for Disease Control and Prevention. Multivariate logistic regression was used to obtain adjusted odds ratios (ORs) and 95% confidence intervals (CIs). On average, older adults with diabetes reported nearly twice as many unhealthy days (physical or mental) as those without the condition (mean: 10.1 [S.E.: 0.32] versus 5.7 [0.43]) after age adjustment. The proportion of older adults reporting 14 or more unhealthy days (physical or mental) was significantly higher among those with diabetes (n = 4032; 11%) compared to those without the condition (OR: 1.64; 95% CI: 1.20, 2.23) after multivariate adjustment. Among older diabetic adults, the adjusted relative odds of having 14 or more unhealthy days (physical or mental) was 1.71 (95% CI: 1.31, 2.22) times greater for those treated with insulin compared to those not treated with insulin. Diabetes is independently associated with lower levels of HRQOL among older adults. These results reinforce the importance of preventing diabetes and its complications through health education messages stressing a balanced diet and increased physical activity.     

Health literacy and asthma management among African-American adults: an interpretative phenomenological analysis

Objective: African-Americans share a disproportionate burden of asthma and low health literacy and have higher asthma morbidity and mortality. Factors that link the relationship between health literacy and health outcomes are unclear. This study aimed to use patients’ experiences of managing asthma to better understand the relationship between health literacy and health outcomes. Methods: This study was the qualitative component of a mixed methods study. Following quantitative data collection, four participants, two with low print-related health literacy and two with adequate print-related health literacy, completed semi-structured interviews. Interview data were analyzed using interpretative phenomenological analysis. Results: Three themes emerged from the analysis: information desired versus information received, trial and error, and expectations of the patient–provider relationship. Individuals with adequate print-related health literacy had different strategies for overcoming barriers related to communicating with their providers, learning about their disease and experiences of discrimination within the healthcare system. Conclusions: Individuals with adequate print-related health literacy may be more equipped to participate in shared decision making and feel more confident to successfully manage their disease. It is also important that health literacy is discussed in the context of the cultural and racial background of the population of interest. This interdependent relationship between health literacy and culture is particularly important for African-Americans.     

卫生九项目部分省吸毒人群艾滋病行为监测调查结果分析

目的了解卫生九项目部分地区吸毒人群的艾滋病相关认知、态度和行为状况及其变化趋势,为制定有效干预措施和评估项目实施效果提供依据。方法以各轮调查的前一轮调查所获的共用针具比例,计算本轮监测调查样本量,采用“滚雪球（Snowball Sampling）”等非随机抽样方法,对吸毒者进行面对面匿名问卷调查。结果三轮行为监测调查结果显示：吸毒人群的艾滋病相关知识知晓率总体呈上升趋势（69．6％到95．1％）;对艾滋病持正确态度的比例明显提高;共针率有所下降（65．6％到25．3％）;安全套使用率有所提高。结论项目地区针对吸毒人群开展的干预工作成效显著,但仍需进一步有针对性地开展艾滋病防治宣传教育,深入持久地开展以减少毒品危害措施为主的综合干预活动,扩大针对吸毒人群的干预覆盖面,从而有效控制艾滋病疫情的进一步蔓延。     

Metabolic syndrome and cardiovascular risk among long‐term survivors of acute lymphoblastic leukaemia ‐ From the St. Jude Lifetime Cohort

Adult survivors of childhood acute lymphoblastic leukaemia (ALL) have a four‐fold excess risk of mortality from cardiovascular disease. This cardiovascular risk has not been fully characterized. ALL survivors [n = 784, median age 31·7 years (18·9–59·1)] in the St. Jude Lifetime Cohort Study underwent evaluation for cardiovascular risk and metabolic syndrome (MetS) according to National Cholesterol Education Program – Adult Treatment Panel III criteria. Comparisons were made to 777 age‐, sex‐, and race‐matched controls from the National Health and Nutrition Examination Survey (NHANES). MetS was identified in 259 survivors (33·6%) and associated with older age in 5‐year increments (relative risk [RR] 1·13, 95% confidence interval [CI] 1·06–1·19) and prior cranial radiotherapy (CRT) (with craniospinal radiation: RR 1·88, 95%CI 1·32–2·67; without: RR 1·67, 95%CI 1·26–2·23). Measures of obesity were highly prevalent among female survivors and CRT recipients. Compared to NHANES controls, ALL survivors had a higher risk of MetS (RR 1·43, 95%CI 1·22–1·69), hypertension (RR 2·43, 95%CI 2·06–2·86), low high‐density lipoprotein (RR 1·40, 95%CI 1·23–1·59), obesity (RR 1·47, 95%CI 1·29–1·68) and insulin resistance (1·64, 95%CI 1·44–1·86). This large study of clinically evaluated ALL survivors identified a high prevalence of MetS, obesity and cardiovascular risk, particularly in CRT recipients, underscoring the need for screening and aggressive reduction of modifiable risks.     

The prevalence and related factors for low health literacy in Xingtai: A cross-sectional survey in prefecture-level city

This study aimed to evaluate the low health literacy prevalence and its socio-demographic related factors in Xingtai.This study was a community-based, cross-sectional survey performed in Xingtai, with a sample size of 960. Participants’ socio-demographic characteristics were collected, and their health literacy status was evaluated by the questionnaire designed by the 2012 Chinese Resident Health Literacy Survey.There were 904 (94.2%) participants who provided valid questionnaires and they were included in the analyses. The mean health literacy score was 63.0 ± 16.6; for its subscales, the mean scores of health literacy of basic knowledge and concepts, lifestyle, and health-related skills were 31.6 ± 8.7, 17.1 ± 4.7, and 14.3 ± 3.9, respectively. Low total health literacy prevalence was 83.1%; as for its subscales, the prevalence of low health literacy of basic knowledge and concepts, lifestyle, and health-related skills was 72.5%, 87.8%, and 87.4%, respectively. Meanwhile, age, male and rural location were positively correlated, but education level and annual household income were negatively correlated with low health literacy risk. Further multivariate analysis revealed that lower education level was the only independent related factor for low total health literacy, and the most important independent related factor for low total health literacy of basic knowledge and concepts, lifestyle and health-related skills.Low health literacy prevalence is 83.1%, and lower education level is the most critical related factor for low health literacy in Xingtai.     

Abdominal volume index trajectories and risk of diabetes mellitus: Results from the China Health and Nutrition Survey

Aims/IntroductionAbdominal obesity is a risk factor for developing diabetes mellitus, but trajectories of abdominal obesity over time and incident diabetes mellitus have not been considered. We derived trajectories of abdominal volume index (AVI) over 16 years of follow up, and examined the associations between AVI trajectories and risk of diabetes mellitus.Materials and MethodsData were used from the China Health and Nutrition Survey, and 5,267 participants were enrolled to fit the trajectory of AVI by using latent class growth models. Multivariate logistic regression models explored the relationship between different AVI trajectories and risk of diabetes mellitus. In addition, we examined the slope of the AVI trajectories in relation to age to identify appropriate life course intervention opportunities for the prevention of diabetes mellitus.ResultsThree trajectories were derived reflecting graded categories in the speed and slope of increase in AVI over time: slow, intermediate and fast increase group, respectively. After multivariate adjustment, the odds ratios for diabetes mellitus among those in the intermediate and fast increase groups were 1.81 (95% confidence interval 1.37–2.38, P < 0.001) and 2.80 (95% confidence interval 1.85–4.24, P < 0.001) respectively, relative to the slow increase group. The distribution of AVI slope in the slow increase group showed an inverted "U" shape, whereas the fast increase group presented a "U" shape.ConclusionsAVI trajectory is associated with an increased risk of diabetes mellitus. These results provide new insights on the relationship between abdominal adiposity and diabetes mellitus, which in turn can help improve clinical and public health intervention for diabetes mellitus prevention.     

Effects of 12 weeks of probiotic supplementation on quality of life in colorectal cancer survivors: A double-blind,randomized, placebo-controlled trial

BackgroundProbiotics may help resolve bowel symptoms and improve quality of life. We investigated the effects of 12 weeks of probiotics administration in colorectal cancer patients.MethodsWe conducted a double-blind, randomized, placebo-controlled trial. The participants took probiotics (Lacidofil) or placebo twice a day for 12 weeks. The cancer-related quality of life (FACT), patient's health-9 (PHQ-9), and bowel symptom questionnaires were completed by each participant.ResultsWe obtained data for 32 participants in the placebo group and 28 participants in the probiotics group. The mean ages of total participants were 56.18 ± 8.86 years and 58.3% were male. Administration of probiotics significantly decreased the proportion of patients suffering from irritable bowel symptoms (0 week vs. 12 week; 67.9% vs. 45.7%, p = 0.03), improved colorectal cancer-related FACT (baseline vs. 12 weeks: 19.79 ± 4.66 vs. 21.18 ± 3.67, p = 0.04) and fatigue-related FACT (baseline vs. 12 weeks: 43.00 (36.50–45.50) vs. 44.50 (38.50–49.00), p = 0.02) and PHQ-9 scores (0 weeks vs. 12 weeks; 3.00 (0–8.00) vs. 1.00 (0–3.00), p = 0.01). We found significant differences in changes of the proportion of patients with bowel symptoms (p < 0.05), functional well-being scores (p = 0.04) and cancer-related FACT scores (p = 0.04) between the two groups.ConclusionProbiotics improved bowel symptoms and quality of life in colorectal cancer survivors.