Lower literacy and a greater number of prescription medications were independently associated with misunderstanding the instructions on prescription medication labels.

Patients with low literacy had difficulty understanding prescription medication warning labels. Patients of all literacy levels had better understanding of warning labels that contained single-step versus multiple-step instructions. Warning labels should be developed with consumer participation, especially with lower literate populations, to ensure comprehension of short, concise messages created with familiar words and recognizable icons.

Furthermore, marginal functional literacy has been associated with poorer physical health, psychological health, and higher health care costs. [4][5][6] The implication for physicians is that at least one-fourth of our patients may not be able to discern prescription bottles, understand patient education materials, or use written directions to find a lab or get a mammogram. Identifying patients with potential literacy problems is important if physicians are to attempt to combat the adverse effects literacy has on health care. Because many illiterate patients will attempt to hide this disability from their physicians and because people with more schooling may still be functionally illiterate, physicians cannot merely ask a patient if they can read or what their educational achievement is. search attempting to identify a shorter literacy screening instrument was unsuccessful. We designed the Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R), a shortened version of the REALM. The REALM-R was designed as a rapid-screening instrument to assess how well primary care patients read words that they commonly experience and are expected to understand in the course of interacting with their physician. This pilot study was conducted to determine whether the REALM-R could be used as a screening instrument to identify patients with potential literacy problems. METHODSWe set out to revise the REALM, a well-validated and reliable instrument, but one that is still too long to practically administer in busy clinical settings. The 66-item REALM was administered to 50 patients in the Internal Medicine Clinic at the University of Kentucky. We examined 2 item characteristics of the 66 words from the full scale REALM. First, we identified items with an item-whole correlation of greater than 0.40, and then selected those that maximized discrimination by being as close as possible to a 50 / 50 correct / incorrect split. The new 8-item REALM-R demonstrated a Cronbach's α of 0.91. The part whole correlation between the REALM-R and the REALM was 0.72.

Hydrogen sulfide (H(2)S) is emerging as a physiological neuromodulator as well as a smooth muscle relaxant. We submit the first evidence that blood H(2)S levels are significantly lower in fasting blood obtained from type 2 diabetes patients compared with age-matched healthy subjects, and in streptozotocin-treated diabetic rats compared with control Sprague-Dawley rats. We further observed that supplementation with H(2)S or an endogenous precursor of H(2)S (l-cysteine) in culture medium prevents IL-8 and MCP-1 secretion in high-glucose-treated human U937 monocytes. These first observations led to the hypothesis that lower blood H(2)S levels may contribute to the vascular inflammation seen in diabetes.

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Resident physicians overestimated the literacy abilities of their patients. A significant portion of these residents' patients may not have the skills to effectively interact with the health care system and are at increased risk for adverse outcomes.

OBJECTIVES. The aims of this study were to determine parent and provider knowledge and awareness of newborn screening; to gather opinions from parents, providers, and newborn screening professionals about the content and timing of newborn screening education; and to use consensus data to formulate recommendations and to develop educational materials for parents and providers.METHODS. We conducted 22 focus groups and 3 individual interviews between October 2003 and May 2004, with English-and Spanish-speaking parents of infants Ͻ1 year of age who had experience with initial testing, retesting, or false-positive screenings; health professionals who provide prenatal care or health care for newborns; and state newborn screening program health professionals.RESULTS. Parents and providers had limited knowledge and awareness about newborn screening practices. Parents wanted brief to-the-point information on newborn screening and its benefits, including the possible need for retesting and the importance of returning promptly for retesting if initial results are abnormal. Parents wanted the information orally from the primary care provider. Parents, providers, and newborn screening professionals all thought that an accompanying concise, easy-to-read brochure with contact information would be helpful. All focus group participants thought that parents should receive this information before the birth of the infant, preferably in the third trimester of pregnancy. Providers wanted a brief checklist of information and resources to prepare them to educate parents effectively.CONCLUSIONS. We recommend prenatal and primary care providers be more involved in educating parents about newborn screening. Professional societies and state health officials should work together to encourage parent and provider education. User-friendly patient and provider education materials, such as those we developed, could form the basis for this educational approach. the United States operates a newborn screening program to test neonates for selected genetic and other disorders. State programs differ not only in the disorders for which testing is performed but also in the information given to parents and the process of reporting results, contacting parents, and referring them for care when an infant's test results are abnormal. [1][2][3] Newborn screening communication practices were recently addressed in a study by Kim et al, 1 who surveyed the program staff of all state newborn screening programs. Those investigators found that often the responsibility for informing parents about the testing is not clearly defined. Less than 50% of the states responded that primary care providers had some responsibility for informing parents about newborn screening, and only 25% indicated that they encouraged or required prenatal providers to educate parents. Most commonly, states reported that parents are informed about newborn screening procedures immediately before testing. Kim et al 1 concluded, "States should work with families, primary care physicians, ...

Patients with low literacy skills demonstrated a lower rate of correct interpretation of the eight most commonly used PWLs than did those with higher literacy skills. Multiple-step instructions, reading difficulty of text, the use of icons, the use of color, and message clarity were the common causes of label misinterpretation.