PURPOSE Health literacy is associated with a range of poor health-related outcomes. Evidence that health literacy contributes to disparities in health is minimal and based on brief screening instruments that have limited ability to assess health literacy. The purpose of this study was to assess whether health literacy contributes, through mediation, to racial/ethnic and education-related disparities in self-rated health status and preventive health behaviors among older adults. METHODSWe undertook a cross-sectional study of a nationally representative sample of 2,668 US adults aged 65 years and older from the 2003 National Assessment of Adult Literacy. Multiple regression analysis was used to assess for evidence of mediation. RESULTSOf older adults in the United States, 29% reported fair or poor health status, and 27% to 39% reported not utilizing 3 recommended preventive health care services in the year preceding the assessment (infl uenza vaccination 27%, mammography 34%, dental checkup 39%). Health literacy and the 4 health outcomes (self-rated health status and utilization of the 3 preventive health care services) varied by race/ethnicity and educational attainment. Regression analyses indicated that, after controlling for potential confounders, health literacy significantly mediated both racial/ethnic and education-related disparities in self-rated health status and receipt of infl uenza vaccination, but only education-related disparities in receipt of mammography and dental care.CONCLUSIONS Health literacy contributes to disparities associated with race/ethnicity and educational attainment in self-rated health and some preventive health behaviors among older adults. Interventions addressing low health literacy may reduce these disparities.

Mature natural killer (NK) cells use Ca2+-dependent granule exocytosis and release of cytotoxic proteins, Fas ligand (FasL), and membrane-bound or secreted cytokines (tumor necrosis factor [TNF]-α) to induce target cell death. Fas belongs to the TNF receptor family of molecules, containing a conserved intracytoplasmic “death domain” that indirectly activates the caspase enzymatic cascade and ultimately apoptotic mechanisms in numerous cell types. Two additional members of this family, DR4 and DR5, transduce apoptotic signals upon binding soluble TNF-related apoptosis-inducing ligand (TRAIL) that, like FasL, belongs to the growing TNF family of molecules. Here, we report that TRAIL produced or expressed by different populations of primary human NK cells is functional, and represents a marker of differentiation or activation of these, and possibly other, cytotoxic leukocytes. During differentiation NK cells, sequentially and differentially, use distinct members of the TNF family or granule exocytosis to mediate target cell death. Phenotypically immature CD161+/CD56− NK cells mediate TRAIL-dependent but not FasL- or granule release–dependent cytotoxicity, whereas mature CD56+ NK cells mediate the latter two.

Although heterogeneity in the timing and persistence of maternal depressive symptomatology has implications for screening and treatment as well as associated maternal and child health outcomes, little is known about this variability. A prospective observational study of 1,735 low-income, multiethnic, inner-city women recruited in pregnancy from 2000 to 2002 and followed prospectively until 2004 (1 prenatal and 3 postpartum interviews) was used to determine whether distinct trajectories of depressive symptomatology can be defined from pregnancy through 2 years postpartum. Analysis was carried out through general growth mixture modeling. A model with 5 trajectory classes characterized the heterogeneity seen in the timing and magnitude of depressive symptoms among the study participants from Philadelphia, Pennsylvania. These classes included the following: 1) always or chronic depressive symptomatology (7%); 2) antepartum only (6%); 3) postpartum, which resolves after the first year postpartum (9%); 4) late, present at 25 months postpartum (7%); and 5) never having depressive symptomatology (71%). Women in these trajectory classes differed in demographic (nativity, education, race, parity) health, health behavior, and psychosocial characteristics (ambivalence about pregnancy and high objective stress). This heterogeneity should be considered in maternal depression programs. Additional research is needed to determine the association of these trajectory classes with maternal and child health outcomes.

To assess understanding of numerical concepts in asthma self-management instructions, a 4-item Asthma Numeracy Questionnaire (ANQ) was developed and read to 73 adults with persistent asthma. Participants completed the Short Test of Functional Health Literacy in Adults (STOFHLA), 12(16%) answered all 4 numeracy items correctly; 6(8%) answered none correctly. Participants were least likely to understand items involving risk and percentages. Low numeracy but not STOFHLA score was associated with a history of hospitalization for asthma. At higher STOFHLA levels there was a wide range of the total number of correct numeracy responses. Numeracy is a unique and important component of health literacy.

No abstract

.Patient-centered interactive communication between physicians and patients is recommended to improve the quality of medical care. Numerical concepts are important components of such exchanges and include arithmetic and use of percentages, as well as higher level tasks like estimation, probability, problem-solving, and risk assessment -the basis of preventive medicine. Difficulty with numerical concepts may impede communication. The current evidence on prevalence, measurement, and outcomes related to numeracy is presented, along with a summary of best practices for communication of numerical information. This information is integrated into a hierarchical model of mathematical concepts and skills, which can guide clinicians toward numerical communication that is easier to use with patients.

Background Postpartum physical health problems are common and have been understudied. This study explored the relationship between reported physical symptoms, functional limitations and emotional well-being of postpartum women. Methods The study involved data from interviews conducted at 9-12 months postpartum from 1,323 women who had received prenatal care at 9 community health centers located in Philadelphia, Pa. (February 2000 and November 2002). Emotional well-being was assessed with the CES-D Scale and perceived emotional health. Functional limitations measures were related to child care, daily activities (housework, shopping), and work. A summary measure of postpartum morbidity burden was constructed from a checklist of potential health problems typically associated with the postpartum period, such as backaches, abdominal pain, and dyspareunia. Results More than two-thirds (69%) of the women reported experiencing at least one physical health problem since childbirth. Forty-five percent reported at least one problem of moderate or major (as opposed to simply minor) severity, and 20 percent reported at least one problem of major severity. The presence, severity and cumulative morbidity burden associated with postpartum health problems was consistently correlated with reports of one or more functional limitations, and measures of emotional well-being, including depressive symptomatology. Conclusions Although physical problems typically associated with the postpartum period are often regarded as transient or comparatively minor, they are strongly related to both the functional impairment and poor emotional Health. Careful assessment of the physical, functional, as well as emotional health status of women in the year following childbirth may improve the quality of postpartum care.

Background Low health literacy is associated with poor outcomes in asthma and other diseases but the mechanisms governing this relationship are not well-defined. Objective To assess whether literacy is related to subsequent asthma self-management, measured as adherence to inhaled steroids, and asthma outcomes. Methods In a prospective longitudinal cohort study, numeric (Asthma Numeracy Questionnaire (ANQ)) and print literacy (Short Test of Functional Health Literacy in Adults (S-TOFHLA)) were assessed at baseline in adults with moderate or severe asthma for their impact on subsequent electronically monitored adherence and asthma outcomes (asthma control, asthma-related quality of life, and FEV1) over 26 weeks, using mixed-effects linear regression models. Results 284 adults participated: 48±14 years, 71% female, 70% African American, 6% Latino, mean FEV1 66% ± 19%, 86 (30%) with hospitalizations and 148 (52%) with ED visits for asthma in the prior year. Mean ANQ score (range 0–4) was 2.3 ± 1.2; mean S-TOFHLA score 31 ± 8 (range 0–36). In unadjusted analyses numeric and print literacy were associated with better adherence (p=0.01, p=0.08), asthma control (p=0.005, p <0.001), and quality of life (p<0.001, p<0.001). After controlling for age, sex, and race/ethnicity, the associations diminished and only quality of life (numeric: p=0.03, print p=0.006) and asthma control (print p=0.005) remained significantly associated with literacy. Race/ethnicity, income, and educational attainment were correlated (p<0.001). Conclusion While the relationship between literacy and health is complex, interventions which account for and address the literacy needs of patients may improve asthma outcomes. Clinical Implications/Key Summary In adults with moderate or severe asthma, higher health literacy scores were associated with better subsequent quality of life and asthma control.