Association of education levels with the risk of hypertension and hypertension control: a nationwide cohort study in Chinese adults

BackgroundEducation attainment can improve life expectancy and guide healthy behaviours throughout an entire lifetime. A nationwide longitudinal study of the association of education status with the risk of hypertension and its control in China is lacking.MethodsThe China Cardiometabolic Disease and Cancer Cohort Study is a multicentre, population-based, prospective cohort study. We performed the baseline survey from 2011 to 2012. A follow-up visit was conducted during 2014–2016. 101 959 subjects were included in the final data analyses. Cox proportional hazards regression was used to examine the associations of education levels with the risk of hypertension and uncontrolled hypertension.ResultsDuring follow-up, 11 189 (19.9%) participants had developed hypertension among subjects without hypertension at baseline. Among the participants with hypertension at baseline, only 40.6% had controlled hypertension. Compared with the participants’ education level at elementary school and below, the multivariable-adjusted HR for incident hypertension was 0.76 (95% CI, 0.72 to 0.80) in those with a middle school education level and 0.67 (95% CI, 0.63 to 0.70) in those with a high school degree or above. Correspondingly, multivariable-adjusted HRs associated with uncontrolled hypertension were 0.90 (95% CI, 0.87 to 0.92) in participants with a middle school education level and 0.85 (95% CI, 0.82 to 0.88) in participants with a high school degree or above level.ConclusionParticipants with education attainment at elementary school and below exhibited excess risks of newly diagnosed hypertension and worse blood pressure control compared with individuals with education attainment at middle school or above.

A 3-Item Measure of Digital Healthcare Literacy: Development and Validation (Preprint)

BACKGROUND With increased reliance on digital healthcare, including telehealth, efficient and effective ways are needed to assess patients’ comfort and confidence with utilizing these services. OBJECTIVE The goal of this study was to develop and validate a brief scale that assesses digital healthcare literacy. METHODS We first developed an item pool using the existing literature and expert review. We then administered the items to participants as part of a larger study. Participants were caregivers of children receiving care at a pediatric clinic who completed a survey either online or over the phone. We randomized participants into a development and confirmatory sample stratifying by language so that exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) could be performed with a separate sample of participants. We assessed the scale’s validity by examining its associations with participants’ demographics, digital access, and prior digital healthcare use. RESULTS Participants (N=507) were, on average, aged 33.7 (SD 7.7) years and 89% female. Approximately half (55%) preferred English as their primary language, 31% preferred Spanish, and 14% Arabic. Around half (45%) had a high school degree or less and 45% had an annual household income less than US $35,000. Using the EFA, three items were retained in a reduced score with excellent reliability (Cronbach’s alpha = 0.90) and a high variance explained (78%). The reduced scale had excellent CFA fit with factor loadings between 0.82 and 0.94. All fit statistics exceeded the criteria for good fit between the proposed factor structure and the data. We refer to this scale as the Digital Healthcare Literacy Scale (DHLS). The scale was positively associated with education (ρ =0.139, p=.005) and income (ρ =0.379, p<.001). Arabic speakers had lower scores compared to English (p<.001) and Spanish speakers (p=.015), and Spanish speakers had lower scores relative to English speakers (p<.001). Participants who did not own a smartphone (p=0.13) or laptop (p<.001) had lower scores than those who did own these devices. Finally, participants who had not used digital tools, including health apps (p<.001) and video telehealth (p<.001), had lower scores than those who had. CONCLUSIONS Despite the potential for digital healthcare to improve quality of life and clinical outcomes, many individuals may not have the skills to engage with and benefit from it. Moreover, these individuals may be those who already experience worse outcomes. A screening tool like DHLS could be a useful resource to identify patients who require additional assistance to use digital health services and help ensure health equity. CLINICALTRIAL N/A

Cycling as a Part of Recreation: An Awareness-Exploring Study

This study aimed to explore the awareness among individuals engaged in recreational cycling about the benefits of cycling. The study consists of 66 participants in the age group of 18-30 who are interested in recreational cycling in the province of Sakarya. The “Recreation Awareness Scale” developed by Ekinci and Özdilek (2019) was used as a data collection tool in the study. In the study, skewness and kurtosis (kurtosis) were evaluated to ensure the normal distribution of the data in addition to descriptive statistical methods such as percentage and frequency. As a result, we found the data to be normally distributed and, thus, utilized the parametric tests. Accordingly, the groups were compared using a t-test and an analysis of variance (ANOVA). In addition, we performed a Tukey test to find out the group(s) as the source of difference. Then, Pearson’s correlation analysis was performed to see the association between two continuous variables. The results revealed that the participants did not differ significantly on pleasure/entertainment, social/achievement, and self-development subscales by gender. Yet, the mean scores of the participants differed significantly on the social/achievement and self-development subscales by educational attainment. The post hoc test suggested that those having a high school degree got significantly higher scores on the social/achievement subscale than the participant with an associate degree. Moreover, the high school graduates obtained higher scores on the self-development subscale than those with a secondary school, associate, and undergraduate degree. Considering the relationship between recreation awareness and age, the Pearson’s correlation test revealed significant positive relationships between age and the participants’ scores on the social/achievement and self-development subscales. Yet, we could not find a significant relationship between age and the pleasure/entertainment subscale.

Factors influencing workplace accommodations requests among employees with visual impairments

People with visual impairments experience various challenges in the workplace such as under-employment, structural, and attitudinal barriers. Workplace accommodations are instrumental in assisting individuals to complete essential functions of their jobs and to increase job tenure and satisfaction. However, workplace accommodations are under-utilized. The current study examined influences of psychosocial and demographic factors on decisions to request accommodations amongst people with visual impairments. Participants included 116 people with visual impairments (e.g., female = 63.9%, Caucasian = 81%) from agencies and organizations serving people with visual impairments within United States. The results following logistic regression show that increased levels of psychosocial factors (i.e., self-efficacy in requesting accommodations and goal setting, non-personal cost related to accommodation, knowledge related to Americans with Disabilities Act (ADA), and accommodation policies and procedures) predicted participants’ decision to request accommodations. In addition, participants aged 55 or more and those with a high school degree or lower were less likely to request accommodations. Rehabilitation interventions for enhancing work participation self-efficacy in employees with visual impairment, as well as knowledge on ADA and accommodation policies and procedures, would create a more inclusive and accepting work environment for employees with visual impairment.

Willingness, beliefs, and barriers regarding the COVID-19 vaccine in Saudi Arabia: a multiregional cross-sectional study

Background The coronavirus disease 2019 (COVID-19) has spread worldwide, and the vaccine remains the ultimate cornerstone to overcoming its long-term impact. Vaccine hesitancy might obstruct the effort to achieve herd immunity and eradicate the virus. We assessed Saudi Arabian individuals’ willingness, beliefs, and barriers regarding the COVID-19 vaccine and their adherence to preventive measures during and after the pandemic. Methods A self-administered electronic validated questionnaire was distributed among the five major regions in Saudi Arabia between November and December 2020. The questionnaire addressed the sociodemographic data, beliefs, potential barriers, parents’ acceptance of COVID-19 vaccination for their children, and adherence to protective measures during and after the pandemic. Results Of 8,056 participants, 4,218 (52.4%) of a non-representative sample were willing to be vaccinated against COVID-19. Being a young adult, male, having less than a high school degree, being a smoker, having a chronic disease, and having a history of seasonal influenza vaccine uptake were positive predictors of COVID-19 vaccine acceptance. Hesitant participants reported concerns about vaccine side effects and safety as the main barriers to accepting the COVID-19 vaccine. Some refusers (26.1%) declared that they would reconsider vaccination only if the safety and effectiveness of the vaccine were reported by more studies. Conclusions Our study revealed a promising willingness to accept the vaccine among the population, with positive beliefs and attitudes toward COVID-19 vaccination. However, a considerable proportion of the population was reluctant to accept the vaccine. Thus, publicly providing information about vaccine safety and implementing health education programs is crucial for increasing the public’s confidence in the vaccine.

Shared Decision-Making and Colorectal Cancer Screening Behaviors Among Older Adults With Low Health Literacy

National guidelines recommend adults &gt;75 engage in shared decision making (SDM) around colorectal cancer (CRC) screening because of the uncertain benefit to risk ratio. There are no decision tools to support CRC decision making for adults &gt;75 years with low health literacy (LHL). The purpose of this mixed-methods study was to better understand the perspectives of adults &gt;75 with LHL on SDM around CRC screening and to obtain their feedback on an existing higher literacy CRC decision aid. Utilizing the Brief Health Literacy Screening Tool to identify participants with LHL, semi-structured interviews were conducted with 30 adults. Findings indicate that 80% of participants were non-Hispanic Black and 42% had &lt; high school degree. 76% felt they would benefit from CRC screening despite their age. Themes related to CRC screening included lack of knowledge of options and harms, but a desire to understand more to better take care of their health.

Characteristics of Our Patient Population

To date, 106 patients have completed behavioral health assessments across three sites: a rural primary care clinic (n = 32), urban federally qualified health center (n = 33), and state-certified residential rehabilitation facility (n = 41). Patients ranged from 18 to 65 years of age (M = 38.6, SD = 11.4). Approximately 51% were female and 75% were non-Hispanic White (followed by 22% African American). Over 60% had a high school degree or less and found it at least somewhat difficult to pay for basic needs. Most patients endorsed substantial (44%) or severe (39%) drug use, with 40% endorsing opioid use. There were no significant differences in substance use by age group. Moderate to severe symptoms of depression (43%) and anxiety (49%) were common. Approximately 70% endorsed adverse childhood experiences, and 44% reported clinically significant post-traumatic stress symptoms. Measures of cognitive functioning and objective health literacy are currently being collected.

Self-Reported Pain and Symptoms in Community Dwelling Older Adults: Results from the Study of Aging II

Pain is a common concern for community-dwelling older adults. There are a range of symptoms that may occur with pain that can be recurring and severe, which are associated with decreased quality of life. This study aims to characterize overall symptom load by utilizing the Brief Symptom Scale in community dwelling older adults who experience mild to severe pain. Data were extracted from the UAB Study of Aging II, a prospective, population-based study of mobility among community-dwelling older adults 75 years and older. Self-reported pain in the past 4 weeks and symptoms (e.g., pain, tired, nausea, depression, anxiety, shortness of breath) were included. The SPSS version 27.0 statistical package was used for analysis. Sixty-six percent were Non-Hispanic White, 58% were female, 40% lived in housing designed especially for the disabled, 49% were widowed, and 30% had a High School degree or GED. The mean age was 81 years (standard deviation 4.8). Of interest, over one third of the sample (38.1%) experienced moderate to severe pain, upper back pain was the most common area where pain occurred and feeling tired was the most common symptom. As the aging population continues to increase, so will the prevalence rates for pain. Findings suggests older adults with pain have multiple concomitant symptoms. Because the elderly represents a fragile and large group of the population, it is important to pay close attention to these symptoms.

Enhancing Group Bonding in an Acting Class of Older Adults in Urban Subsidized Housing

Creative arts such as acting can promote social contact and bonding among socially isolated populations. Yet the benefits of art programming among older adults in low-income urban settings remain unexplored. A professionally administered theater group comprised of older adults living in urban low-income housing met for 12 weeks to learn acting skills and perform a play. The purpose of this study was to identify: 1) why participants enroll in a residence-based acting and improvisation course, and 2) what aspects of the course contribute to group bonding. Participants (n=14) were African American. The average age was 63 years, 14% were men, 57% had a high school degree or less, 79% reported good to excellent health, and the mean ADL score was 1.45 (range: 1-2.5). A researcher was present at each class session to observe and take field notes. Pre-post interviews included closed and open-ended questions. The researchers reviewed field notes and interview transcripts for a priori themes and emergent themes through independently coding data, discussing similarities and discrepancies, and coming to consensus on themes. Results showed that participants were motivated to enroll to meet new people, come out of themselves, learn something new, and gain artistic skills. Participants indicated the course contributed to group bonding via teaching techniques, course structure, the teacher’s use of self, the expression of self, and mutually enhanced coping skills. Results from this study provide guidance for the design of theater groups in similar settings and inform recruitment efforts of older adults in creative arts programs.

Is oral hygiene performed by caregivers of children and adolescents with cerebral palsy effective?

Objective: To evaluate the effectiveness of oral hygiene performed by caregivers of children and adolescents with cerebral palsy (CP) during the moments before and after three months of oral health instructions. Methods: In a longitudinal study, 102 participants were joined in two groups: G1 (n=51) composed of children and adolescents (C/A) with CP and G2 (n=51), composed of their caregivers. Sociodemographic and oral hygiene habits were collected and evaluated using the Visible Plaque Index (VPI) and Gingival Bleeding Index (GBI), before and after oral hygiene orientation. The Qui-Squared, ANOVA 1, and tStudent tests were applied. P < 0,05. Results: The C/A group with pattern clinical CP tetraparesis, diparesis and hemiparesis were homogeneous in terms of gender (P = 0,07), however differed in age (P < 0,05), the youngest being diparetic. No difference was observed when comparing VPI and GBI before and after instructions in oral health for the three clinical types (P> 0,05). However, a reduction in the VPI and GBI indexes (P < 0,05) before and after, in each of the three clinical patterns. Most of the caregivers were female, married, with a high school degree, and they performed oral hygiene three times per day. The caregivers presented significant drops in VPI and GBI after receiving oral hygiene instructions. (P < 0,05). Conclusion: Oral hygiene instruction is fundamental for the caregivers of children and adolescents with cerebral palsy since it is an effective form of controlling health problems.