What is the Prevalence of Low Health Literacy in European Union Member States? A Systematic Review and Meta-analysis

Abstract Background Many studies have shown that low health literacy (HL) is associated with several adverse outcomes. In this study, we systematically reviewed the prevalence of low HL in Europe. Methods PubMed, Embase, and Scopus were searched. Cross-sectional studies conducted in the European Union (EU), published from 2000, investigating the prevalence of low HL in adults using a reliable tool, were included. Quality was assessed with the Newcastle-Ottawa Scale. Inverse-variance random effects methods were used to produce pooled prevalence estimates. A meta-regression analysis was performed to assess the association between low HL and the characteristics of the studies. Results The pooled prevalence of low HL ranged from of 27% (95% CI: 18–38%) to 48% (95% CI: 41–55%), depending on the literacy assessment method applied. Southern, Western, and Eastern EU countries had lower HL compared to northern Europe (β: 0.87, 95% CI: 0.40–1.35; β: 0.59, 95% CI: 0.25–0.93; and β: 0.72, 95% CI: 0.06–1.37, respectively). The assessment method significantly influenced the pooled estimate: compared to word recognition items, using self-reported comprehensions items (β: 0.61, 95% CI: 0.15–1.08), reading or numeracy comprehensions items (β: 0.77, 95% CI: 0.24–1.31), or a mixed method (β: 0.66, 95% CI: 0.01–1.33) found higher rates of low HL. Refugees had the lowest HL (β: 1.59, 95% CI: 0.26–2.92). Finally, lower quality studies reported higher rates of low HL (β: 0.56, 95% CI: 0.06–1.07). Discussion We found that low HL is a public health challenge throughout Europe, where one in every three to almost one in every two Europeans may not be able to understand essential health-related material. Additional research is needed to investigate the underlying causes and to develop remedies. PROSPERO Registration CRD42019133377

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Mental health, compliance with measures and health prospects during the COVID-19 epidemic: the role of health literacy

BMC Public Health ◽

10.1186/s12889-021-11437-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lize Hermans ◽

Stephan Van den Broucke ◽

Lydia Gisle ◽

Stefaan Demarest ◽

Rana Charafeddine

Keyword(s):

Mental Health ◽

At Risk ◽

Health Literacy ◽

Prevalence Ratio ◽

Physical Distance ◽

Poor Mental Health ◽

Infection Prevalence ◽

Cross Sectional ◽

Normal Life ◽

Low Health Literacy

Abstract Background The importance of health literacy in dealing with the COVID-19 epidemic has been emphasized but scarcely addressed empirically. In this study, the association of health literacy with mental health, compliance with COVID-19 preventive measures and health prospects was assessed in a Belgian context. Methods Data were extracted from the third of a series of cross-sectional online COVID-related surveys (n = 32,794). Data collection took place for 1 week starting the 28th of May 2020. People residing in Belgium and aged 18 years or older could participate. Data were collected on sociodemographic background, health literacy, multimorbidity, mental health (depression, anxiety, sleeping disorder, vitality), knowledge about COVID-19, compliance with COVID-19 measures (hygiene, physical distance, covering mouth and nose on public transport and in places where physical distance cannot be respected), and health prospects (risk for health when returning to normal life and possibility of infection). Prevalence Ratio (PR) of poor mental health, non-compliance with the measures and health prospects in relation to health literacy were calculated using Poisson regressions. Results People showing sufficient health literacy were less likely to suffer from anxiety disorders (PR = 0.47, 95% CI = [0.42–0.53]), depression (PR = 0.46, 95% CI = [0.40–0.52]) and sleeping disorders (PR = 0.85, 95% CI = [0.82–0.87]), and more likely to have optimal vitality (PR = 2.41, 95% CI = [2.05–2.84]) than people with low health literacy. They were less at risk of not complying with the COVID-19 measures (PR between 0.60 and 0.83) except one (covering mouth and nose in places where physical distance cannot be respected). Finally, they were less likely to perceive returning to normal life as threatening (PR = 0.70, 95% CI = [0.65–0.77]) and to consider themselves at risk of an infection with COVID-19 (PR = 0.75, 95% CI = [0.67–0.84]). The associations remained significant after controlling for COVID-19 knowledge and multimorbidity. Conclusions These results suggest that health literacy is a crucial factor in managing the COVID-19 epidemic and offer a perspective for future studies that target health literacy in the context of virus outbreaks.

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Prevalence of Depression among Healthcare Workers during the COVID-19 Outbreak: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10153406 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3406

Author(s):

Beatriz Olaya ◽

María Pérez-Moreno ◽

Juan Bueno-Notivol ◽

Patricia Gracia-García ◽

Isabel Lasheras ◽

...

Keyword(s):

Systematic Review ◽

Healthcare Workers ◽

Mental Health Problems ◽

Meta Analysis ◽

Medical Doctors ◽

Cross Sectional ◽

Random Effects Models ◽

Pooled Prevalence ◽

Prevalence Of Depression ◽

Common Mental Health Problems

Background: There is evidence of a high psychological toll from the COVID-19 pandemic in healthcare workers. This paper was aimed at conducting a systematic review and meta-analysis of studies reporting levels of depression among healthcare workers during the COVID-19 and estimating the pooled prevalence of depression. Methods: We searched for cross-sectional studies listed on PubMed from 1 December 2019 to 15 September 2020 that reported prevalence of depression in healthcare workers, nurses, medical doctors, and COVID-19 frontline professionals. The pooled proportions of depression were calculated with random effects models. Results: We identified 57 studies from seventeen countries. The pooled prevalence of depression in healthcare workers was 24% (95% CI: 20%−28%), 25% for nurses (95% CI: 18%−33%), 24% for medical doctors (95% CI: 16%−31%), and 43% for frontline professionals (95% CI: 28%−59%). Conclusions: The proportion of depression in nurses and medical doctors during the COVID-19 pandemic was similar to that found in the general population as previously reported in other meta-analyses conducted with smaller numbers of studies. Importantly, almost half of the frontline healthcare workers showed increased levels of depression. There is need for a comprehensive, international response to prevent and treat common mental health problems in healthcare workers.

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Validity and Reliability of IPAQ-SF and GPAQ for Assessing Sedentary Behaviour in Adults in the European Union: A Systematic Review and Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094602 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4602

Author(s):

Kaja Meh ◽

Gregor Jurak ◽

Maroje Sorić ◽

Paulo Rocha ◽

Vedrana Sember

Keyword(s):

Physical Activity ◽

European Union ◽

Sedentary Behaviour ◽

Meta Analysis ◽

National Language ◽

The European Union ◽

Single Item ◽

Physical Activity Questionnaire ◽

Activity Questionnaires ◽

Activity Questionnaire

Current lifestyles are marked by sedentary behaviour; thus, it is of great importance for policymaking to have valid and reliable tools to measure sedentary behaviour in order to combat it. Therefore, the aim of this review and meta-analysis is to critically review, assess, and compile the reliability, criterion validity, and construct validity of the single-item sedentary behaviour questions within national language versions of most commonly used international physical activity questionnaires for adults in the European Union: The International Physical Activity Questionnaire-Short Form and the Global Physical Activity Questionnaire. A total of 1749 records were screened, 287 full-text papers were read, and 14 studies were included in the meta-analysis. The results and quality of studies were evaluated by the Quality Assessment of Physical Activity Questionnaires checklist. Meta-analysis indicated moderate to high reliability (rw = 0.59) and concurrent validity (rw = 0.55) of national language versions of single-item sedentary behaviour questions. Criterion validity was rather low (rw = 0.23) but in concordance with previous studies. The risk of bias analysis highlighted the poor reporting of methods and results, with a total bias score of 0.42. Thus, we recommend using multi-item SB questionnaires and smart trackers for providing information on SB rather than single-item sedentary behaviour questions in physical activity questionnaires.

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Low health literacy is associated with higher risk of type 2 diabetes: a cross-sectional study in Germany

BMC Public Health ◽

10.1186/s12889-021-10508-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Daniel Tajdar ◽

Dagmar Lühmann ◽

Regina Fertmann ◽

Tim Steinberg ◽

Hendrik van den Bussche ◽

...

Keyword(s):

Type 2 Diabetes ◽

Health Literacy ◽

Statistical Models ◽

Cross Sectional Study ◽

Diabetes Risk ◽

Sectional Study ◽

Cross Sectional ◽

Low Health Literacy ◽

The Individual

Abstract Background Low health literacy is believed to be associated with behaviours that increase the risk of type 2 diabetes. But there is limited knowledge on the relation between health literacy (HL) and diabetes risk, and whether improving HL could be a potential prevention strategy. Therefore, the main purpose of this study was to examine the link between HL and diabetes risk among non-diabetic adults. Methods We used data from the Hamburg Diabetes Prevention Survey, a population-based cross-sectional study in Germany. One thousand, two hundred and fifty-five non-diabetic subjects aged 18–60 years were eligible. The German Diabetes Risk Score (GDRS, ranging 0 to 123 points) was used to determine the individual risk of type 2 diabetes. The short version of the European Health Literacy Questionnaire (HLS-EU-Q16, ranging 0 to 16 points) was applied to assess the individual self-reported HL. Subjects were asked to self-estimate their diabetes risk, which was then compared with the calculated GDRS. Descriptive statistics were calculated to investigate group differences in the GDRS and self-estimated diabetes risk. Linear as well as logistic regression models were performed to analyse potential influencing variables of the GDRS as well as incorrect self-estimated diabetes risk. In three nested statistical models for each outcome, these analyses were adjusted for age, gender, educational level and the presence of chronic conditions. Results According to the criteria of the GDRS, 996 (79.4%) subjects showed “low risk”, 176 (14.0%) “still low risk”, 53 (4.2%) “elevated risk”, and 30 (2.4%) “high to very high risk” to develop type 2 diabetes within the next 5 years. In the statistical models including all control variables, subjects with “inadequate HL” scored 2.38 points higher on the GDRS (95% CI 0.378 to 4.336; P = 0.020) and had a 2.04 greater chance to estimate their diabetes risk incorrectly (OR 2.04; 95% CI 1.33 to 3.14; P = 0.001) compared to those with “sufficient HL”. Conclusion The risk of type 2 diabetes is increased in people with inadequate self-reported HL. People with high diabetes risk and inadequate HL might be provided with educational programs to improve diabetes knowledge and reduce behavioural risk factors.

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Psychological distress among healthcare providers during COVID-19 in Asia: Systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0257983 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0257983

Author(s):

Siew Mooi Ching ◽

Kar Yean Ng ◽

Kai Wei Lee ◽

Anne Yee ◽

Poh Ying Lim ◽

...

Keyword(s):

Meta Analysis ◽

Healthcare Providers ◽

Random Effects Model ◽

Depression And Anxiety ◽

Cross Sectional ◽

Funnel Plot ◽

Health And Wellbeing ◽

Pooled Prevalence ◽

Increased Risk ◽

Prevalence Of Depression

Introduction COVID-19 pandemic is having a devastating effect on the mental health and wellbeing of healthcare providers (HCPs) globally. This review is aimed at determining the prevalence of depression, anxiety, stress, fear, burnout and resilience and its associated factors among HCPs in Asia during the COVID-19 pandemic. Material and methods We performed literature search using 4 databases from Medline, Cinahl, PubMed and Scopus from inception up to March 15, 2021 and selected relevant cross-sectional studies. Publication bias was assessed using funnel plot. Random effects model was used to estimate the pooled prevalence while risk factors were reported in odds ratio (OR) with 95% CI. Results We included 148 studies with 159,194 HCPs and the pooled prevalence for depression was 37.5% (95%CI: 33.8–41.3), anxiety 39.7(95%CI: 34.3–45.1), stress 36.4% (95%CI: 23.2–49.7), fear 71.3% (95%CI: 54.6–88.0), burnout 68.3% (95%CI: 54.0–82.5), and low resilience was 16.1% (95%CI: 12.8–19.4), respectively. The heterogeneity was high (I2>99.4%). Meta-analysis reported that both females (OR = 1.48; 95% CI = 1.30–1.68) and nurses (OR = 1.21; 95%CI = 1.02–1.45) were at increased risk of having depression and anxiety [(Female: OR = 1.66; 95% CI = 1.49–1.85), (Nurse: OR = 1.36; 95%CI = 1.16–1.58)]. Females were at increased risk of getting stress (OR = 1.59; 95%CI = 1.28–1.97). Conclusion In conclusion, one third of HCPs suffered from depression, anxiety and stress and more than two third of HCPs suffered from fear and burnout during the COVID-19 pandemic in Asia.

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Are CO2 emissions converging in the European Union? Policy implications

Notas Económicas ◽

10.14195/2183-203x_49_5 ◽

2019 ◽

pp. 63-82

Author(s):

Rafael Morales-Lage ◽

Aurelia Bengochea-Morancho ◽

Immaculada Martínez-Zarzoso

Keyword(s):

European Union ◽

Co2 Emissions ◽

Agricultural Sector ◽

Industrial Sector ◽

Policy Implications ◽

Transport Sector ◽

The European Union ◽

Conditional Convergence ◽

European Union Policy ◽

Cross Sectional

This paper focuses on the process of convergence in per capita CO2 emissions that would occur if the measures taken by the European Union to meet the Kyoto Protocol commitments had been effective. We apply a time series and cross-sectional analysis to test for the existence of convergence among countries and for different economic sectors. The sample covers data for the 28 member countries from 1960 to 2012. The results show weak absolute convergence across countries but clear evidence of conditional convergence, with GDP, the weight of industrial sector and the use of renewable energies being the main drivers of divergence. Concerning sectors, there is an increase of emissions in the agricultural sector, but a reduction in the industrial and energy sectors. Different patterns arise in the energy subsectors where manufacturing and electricity notably reduced their emissions while the transport sector increased them in all countries.

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Cerebral microbleeds and risk of adverse outcomes in patients with atrial fibrillation: a systematic review and meta-analysis

European Heart Journal ◽

10.1093/eurheartj/ehab724.0448 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

B Corica ◽

G.F Romiti ◽

V Raparelli ◽

R Cangemi ◽

S Basili ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Meta Analysis ◽

Random Effect ◽

Adverse Outcomes ◽

Cerebral Microbleeds ◽

Funding Sources ◽

Conflicting Evidence ◽

Pooled Prevalence ◽

Increased Risk

Abstract Background Long-term anticoagulation in patients with atrial fibrillation (AF) imposes a careful balance between the thromboembolic and hemorrhagic risks. An association between cerebral microbleeds (CMBs) and an increased risk of intracranial hemorrhage (ICH) has already been described; however, conflicting evidence exist on the association with ischemic stroke (IS). Although CMBs are often observed in AF patients, the actual prevalence and the magnitude of the risk of adverse events in patients with CMBs is unclear. Purpose We aimed to estimate the pooled prevalence of CMBs in patients with AF through a systematic review and meta-analysis of the literature. Additionally, we evaluated the risk of ICH and IS according to the presence and burden of CMBs. Methods We perform a systematic search on PubMed and EMBASE from inception to 6th March 2021. We included all studies reporting the prevalence of CMBs, the incidence of ICH and/or IS in AF by presence of CMBs. Pooled prevalence and odds ratios (OR), along with their 95% Confidence Intervals (CI), were computed using random-effect models; we also calculated 95% Prediction Intervals (PI) for each outcome investigated. Additionally, we performed subgroup analyses according to the number and localization of CMBs. Results We retrieved 562 records from the literature search, and 17 studies were finally included. Pooled prevalence of CMBs in AF population was 28.3% (95% CI: 23.8%-33.4%; 95% PI: 12.2%-52.9%, Figure 1). Individuals with CMBs showed a higher risk of both ICH (OR: 3.04, 95% CI: 1.83–5.06) and IS (OR: 1.78, 95% CI: 1.26–2.49). Moreover, patients with more than 5 CMBs, as well as patients with both lobar and mixed CMBs, showed a higher risk of ICH. Conclusions CMBs were found in 28.3% of AF patients, with 95% PIs indicating a potentially higher prevalence. Moreover, CMBs were associated with an increased risk of both ICH and IS, with the effect potentially modulated by their number and localization. CMBs may represent an important and often overlooked risk factor for adverse outcomes in patients with AF. FUNDunding Acknowledgement Type of funding sources: None. Prevalence of CMBs in patients with AF

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Measuring innovation and institution: the creative economy index

Equilibrium ◽

10.24136/eq.v12i1.3 ◽

2017 ◽

Vol 12 (1) ◽

pp. 43 ◽

Cited By ~ 9

Author(s):

Rafał Żelazny ◽

Jacek Pietrucha

Keyword(s):

European Union ◽

Measurement Method ◽

Institutional Environment ◽

Meta Analysis ◽

Value Added ◽

Creative Economy ◽

The European Union ◽

Common Information ◽

Synthetic Index ◽

Joint Examination

Research background: A literature review on innovativeness and institutions pointing to their correlation and the possibility of their joint examination. Purpose of the article: This paper attempts to devise a measurement method for a creative economy, where as a result of feedback between institutions, human capital and technology conditions facilitating the development of creativity are created. Methods: An empirical meta-analysis of indicators characterising innovativeness and institutional environment was carried out, following the hypothesis that at least in part they contain common information on creative economy. Findings and Value added: The new synthetic index, a creative economy index (CEI), was constructed. The study was conducted for a group of 34 economies of the European Union and its associated states for the period of 2005–2014.

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Prevalence of epilepsy in autism spectrum disorders: A systematic review and meta-analysis

Autism ◽

10.1177/13623613211045029 ◽

2021 ◽

pp. 136236132110450

Author(s):

Xian Liu ◽

Xin Sun ◽

Caihong Sun ◽

Mingyang Zou ◽

Yiru Chen ◽

...

Keyword(s):

Systematic Review ◽

Intellectual Disability ◽

Human Development ◽

Human Development Index ◽

Clinical Sample ◽

Meta Analysis ◽

Population Based ◽

Cross Sectional ◽

Development Index ◽

Pooled Prevalence

The literature from inception to 2020 on the prevalence of epilepsy in autistic individuals was systematically reviewed and further explored by subgroup analyses and meta-regression models. This systematic review is registered with PROSPERO (CRD42020179725). A total of 66 studies from 53 articles were included. The updated pooled prevalence of epilepsy in autistic individuals was 10% (95% CI: 6–14). The respective prevalence estimate of epilepsy was 19% (95% CI: 6–35) in the clinical sample-based cross-sectional study, 7% (95% CI: 3–11) in the cohort study, and 9% (95% CI: 5–15) in the population-based cross-sectional study. The pooled prevalence of epilepsy was 7% (95% CI: 4–11) in autistic children and 19% (95% CI: 14–24) in autistic adults. Compared to the school-aged group, the adolescence group (OR: 1.15, 95% CI: 1.06–1.25) and the pre-school group (OR: 1.06, 95% CI: 0.94–1.19) were positively associated with the prevalence of epilepsy. The moderators of age, human development index of the country, gender, and intellectual function accounted for most of the heterogeneity. The prevalence estimates were associated with age, female gender, intellectual disability rate, and the human development index of countries. About 1/10 autistic individuals co-occurred with epilepsy, which was common in the clinical setting, adolescents, adults, females, or patients with intellectual disability, and less common in the country with high human development index. Lay abstract Autistic individuals experience higher co-occurring medical conditions than the general population, and yet the estimates of autistic individuals with epilepsy are not updated. Co-occurrence of epilepsy in autistic individuals often aggravated cognitive impairment and increased the risk of poor long-term prognosis. Thus, an updated systematic review and meta-analysis was conducted to study the relevant articles published from inception to 2020, evaluate the prevalence of epilepsy in autistic individuals, and further explore the putative factors influencing the prevalence. A total of 66 studies from 53 articles were included in this study. The results showed that epilepsy is more common in autistic individuals than in the general population. The prevalence of epilepsy in autistic individuals in the clinical sample-based studies was higher than that in the population-based based cross-sectional or cohort studies. The prevalence of epilepsy in autistic adults was higher than that in autistic children. A significantly increased prevalence of epilepsy was detected in the autistic adolescent group (11–17 years old), and a higher trend of prevalence of epilepsy was observed in the autistic pre-school group (⩽ 6 -years-old) than that of the autistic school-aged group (7–10 years-old). The prevalence of epilepsy increased with age, female rate, and low intellectual function rate of autistic individuals. However, the human development index of countries was negatively associated with the pooled prevalence, which could be attributed to the different levels of awareness, diagnostic technologies, and autism-service support worldwide. About 1/10 autistic individuals also had epilepsy, which was common in the clinical setting, adolescents, adults, females, or patients with intellectual disability and less common in the country with high human development index. Thus, these findings provided critical and innovative views on the prevalence of epilepsy in autistic individuals and contributed to the targeted clinical management and preventive measures.

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Prevalence of smoking in adults with spinal cord stimulators: a systematic review and meta-analysis

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2019-100996 ◽

2020 ◽

Vol 45 (3) ◽

pp. 214-218

Author(s):

W Michael Hooten ◽

Rajat N Moman ◽

Jodie Dvorkin ◽

E Morgan Pollard ◽

Robalee Wonderman ◽

...

Keyword(s):

Systematic Review ◽

Spinal Cord ◽

Smoking Status ◽

Meta Analysis ◽

Vascular Diseases ◽

Risk Of Bias ◽

Future Research ◽

Cross Sectional ◽

Prevalence Studies ◽

Pooled Prevalence

BackgroundSmoking adversely impacts pain-related outcomes of spinal cord stimulation (SCS). However, the proportion of SCS patients at risk of worse outcomes is limited by an incomplete knowledge of smoking prevalence in this population. Thus, the primary aim of this systematic review is to determine the prevalence of smoking in adults with chronic pain treated with SCS.MethodsA comprehensive search of databases from 1 January 1980 to 3 January 2019 was conducted. Eligible study designs included (1) randomized trials; (2) prospective and retrospective cohort studies; and (3) cross-sectional studies. The risk of bias was assessed using a tool specifically developed for prevalence studies. A total of 1619 records were screened, 19 studies met inclusion criteria, and the total number of participants was 10 838.ResultsThirteen studies had low or moderate risk of bias, and six had a high risk of bias. All 19 studies reported smoking status and the pooled prevalence was 38% (95% CI 30% to 47%). The pooled prevalence in 6 studies of peripheral vascular diseases was 56% (95% CI 42% to 69%), the pooled prevalence of smoking in 11 studies of lumbar spine diagnoses was 28% (95% CI 20% to 36%) and the pooled prevalence in 2 studies of refractory angina was 44% (95% CI 31% to 58%).ConclusionsThe estimated prevalence of smoking in SCS patients is 2.5 times greater than the general population. Future research should focus on development, testing and deployment of tailored smoking cessation treatments for SCS patients.

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