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PubMed1986

Computerized information resources in toxicology and industrial health--a review.

The explosion in scientific information presents problems for toxicologists and industrial health specialists who need to respond rapidly and comprehensively to the information needs of the public, government and industry. The application of information technology enables large volumes of toxicology and industrial health information to be stored and retrieved through a variety of data-base resources. Three different categories of databases are described: dictionary, bibliographic and informational types. Examples of specific toxicology and industrial health databases within each category are given; their origin, style and content are reviewed. Specialists in the industrial health field are encouraged to improve their knowledge and literacy in the new disciplines of information technology and information science.

Computers↗
PubMed2000

Hurdles to asepsis, universal literacy, and chronobiology-all to be overcome.

A joining of chronobiology and endocrinology was achieved in 1974 at a symposium focusing on the critical role of the hypothalamic-pituitary-adrenal network on the basic side and on the first drug to carry timing in its name. The next step is a section on chronobiology in this neuroendocrinology journal. An account of the problems encountered before both asepsis and universal literacy became the law of the profession and of the land serves here as background to endeavors in behalf of chronobiologic literacy. A step toward the latter goal is the use of systematically collected measurements of heart rate and blood pressure evaluated by computer against reference standards from peers of corresponding age, gender and ethnicity. Thereby, an illustrative, clinically relevant aspect of everyday physiology is resolved within the otherwise neglected normal range, and disease risk syndromes are detected so that preventive treatment can be instituted before catastrophic disease occurs. The scope of this chronobiology section of the Neuroendocrinology Letters is to map the time-qualified feedsideward interactions within the neuroendocrines, in the rest of an organism and in the environment. Thereby, we replace time-unqualified feedbacks and feedforwards, along imaginary axes, by neuroendocrine and cellular networks operating predictably insofar as rhythmically within the range of everyday physiology. Subtle effects are thus found that are otherwise covered by the curtain of ignorance drawn over the normal range. More important, feedsidewards account for opposite effects that recur rhythmically, and thus help clarify mechanisms that may underlie the difference between stimulating or inhibiting a malignancy and thus shortening or lengthening the lifespan.

Journal Article↗
PubMed1994

Reading ability of parents compared with reading level of pediatric patient education materials.

OBJECTIVES: To test the reading ability of parents of pediatric outpatients and to compare their reading ability with the ability necessary to read commonly used educational materials; to compare individual reading grade levels with the levels of the last grade completed in school; and to further validate a new literacy screening test designed specifically for medical settings. DESIGN: Prospective survey. SETTING: Pediatrics outpatient clinic in a large, public university, teaching hospital. PARTICIPANTS: Three hundred ninety-six parents or other caretakers accompanying pediatric outpatients. MEASUREMENTS: Demographics and educational status were assessed using a structured interview. Reading ability was tested using the Rapid Estimate of Adult Literacy in Medicine (REALM) and the Wide Range Achievement Test-Revised. Written educational materials were assessed for readability levels with a computer program (Grammatik IV). RESULTS: The mean score on the REALM for all parents placed them in the seventh to eighth grade reading range, despite the mean self-reported last grade completed in school being 11th grade 5th month. Wide Range Achievement Test-Revised scores correlated well with REALM scores (0.82). Eighty percent of 129 written materials from the American Academy of Pediatrics, the Centers for Disease Control, the March of Dimes, pharmaceutical companies, and commercially available baby books required at least a 10th grade reading level. Only 25% of 60 American Academy of Pediatrics items and 19% of all materials tested were written at less than a ninth grade level, and only 2% of all materials were written at less than a seventh grade level. CONCLUSION: This study demonstrates that parents' self-reported education level will not accurately indicate their reading ability. Testing is needed to screen at-risk parents for low reading levels. In a public health setting, a significant amount of available parent education materials and instructions require a higher reading level than most parents have achieved. In such settings, all materials probably should be written at less than a high school level if most parents are to be expected to read them. The REALM can easily be used in busy public health clinics to screen parents for reading ability.

Adolescent↗
PubMedDate not supplied

The Internet as a resource for healthcare information.

The Internet provides an additional means for healthcare providers to reach their patients. As more and more healthcare providers and patients get on-line and learn to use the Internet, the value of being on-line will increase. The Internet and other healthcare computing technologies will challenge us to look to the future for new ways to create partnerships with our patients. On-line skills and technological literacy will not replace more traditional approaches to patient care, but they most likely will change the model of how care is provided. Technology is an adjunct that will serve us well if it is incorporated as part of a multidimensional patient care environment. Above all, we will need to continue to foster good interpersonal relationships with patients to encourage ongoing dialogues about information obtained from all resources.

Diabetes Mellitus, Type 1↗
PubMed1999

Health informatics and community health: support for patients as collaborators in care.

Health informatics has much to offer community health care. Computer networks and telecommunications provide particular support that can enhance the collaboration among clinicians, care providers and patients. Special-purpose computer tools referred to as Consumer Health Informatics (CHI) represent the application of computer and information technologies specifically to support the health information and communication needs of patients and lay persons. Research projects like ComputerLink and CHESS demonstrate that CHI is acceptable to patients and promotes self-care and disease management. Three grand challenges must be faced to insure realization of the promise of health informatics to community health care: development of knowledge management and information discovery tools for patients, insurance of health information literacy for all persons, and re-engineering clinical practice to capitalize on patients as full partners in health care.

Community Health Services↗
PubMed2002

Use of a computerized risk-appraisal instrument for cancer prevention education of medical students.

BACKGROUND: Interactive computer-based tools are increasingly used for patient and medical student instruction. METHOD: To assess medical students' responses to a computer-based risk-appraisal instrument aimed at teaching concepts of risk and cancer prevention, and to evaluate perceived barriers to using such tools in clinical practice and knowledge about risk factors for colon cancer. DESIGN: An electronic survey of 133 second-year medical students elicited their responses to the instrument after using it for a case-based learning exercise. RESULTS: The students identified several potential barriers to use, including inadequate time during the office visit (75% of students) and problems with literacy (48%). They were generally knowledgeable about risk factors for colon cancer. 84% found the instrument "very helpful" or "somewhat helpful" in understanding a case patient's health and setting priorities for behavioral changes. CONCLUSIONS: Medical students may benefit from exposure to interactive, computer-based tools such as health-appraisal instruments when learning skills in risk counseling and cancer prevention. Second-year students were already concerned about having adequate time during office visits to use such instruments.

Clinical Competence↗
PubMed2006

Information literacy and library attitudes of occupational therapy students.

Information literacy, often described as a person's ability to effectively find and evaluate answers to questions using a variety of information resources, is of particular importance to health care workers. This paper presents the results of an information literacy survey presented to occupational therapy (OT) students at Thomas Jefferson University during a series of required class activities. Also described are the authors' activities with the faculty and courses at Jefferson. The survey was made available to first-, second-, third-, and fourth-year occupational therapy students along with nursing students and pharmacy students. The survey is designed to identify research habits, skills, and preferences. Results confirm some commonly held perceptions about searching skills of young adults and an interesting dichotomy in students' learning habits. The paper concludes with a discussion of recommendations to OT faculty and librarians on how to improve information literacy education. The survey can be obtained by contacting the authors.

Adult↗
PubMed2006

Lectures are such an effective teaching method because they exploit evolved human psychology to improve learning.

Lectures are probably the best teaching method for many students in many circumstances; especially for communicating conceptual knowledge, and where there is a significant knowledge gap between lecturer and audience. However, the lack of a convincing rationale has been a factor in under-estimating the importance of lectures, and there are many who advocate their replacement with written communications or electronic media. I suggest that lectures are so effective because they exploit the spontaneous human aptitude for learning from spoken (rather than written) information. Literacy is a recent cultural artefact, and for most of their evolutionary history humans communicated by direct speech. By contrast with speech, all communication technologies--whether reading a book or a computer monitor--are artificial and unnatural. Furthermore, learning is easier during formal, quiet, real-time social events. The structure of a lecture artificially manipulates human psychology to increase vigilance, focus attention, and generate authority for the lecturer--all of which make communications more memorable for the student. Instead of trying to phase-out lectures, we should strive to make them better by understanding that lectures are essentially formal, spoken, social events.

Humans↗
PubMed2004

The effect of format modifications and reading comprehension on recall of informed consent information by low-income parents: a comparison of print, video, and computer-based presentations.

A randomized trial comparing the amount of knowledge orally recalled from four different presentations of the same consent information was conducted in a non-clinic sample of 233 low-income parents who displayed a range of reading comprehension skill. The study simulated recruitment of children into one of two actual studies underway at another location: one involved high risk to participants, the other did not. Use of a non-clinic sample controlled for prior knowledge of the conditions, and avoiding discussion of the information further assured that differences in recalled information could be attributed more confidently to the format itself. The formats included the original written forms, enhanced print (simpler language, topic headings, pictures), narrated videotapes, and self-paced PowerPoint presentations via laptop computer with bulleted print information, pictures, and narration. No format-related differences in recalled information were found in the full sample but for the 124 individuals with reading comprehension scores at or below the 8th grade level, the enhanced print version tended to be more effective than either the original form or the video. Across all formats, more information was recalled about the low-risk study. The findings emphasize the necessity for clinicians and researchers to verify understanding of consent information, especially when there is risk of reduced literacy skill. Reliance on video to convey information in preference to well-done print media appeared questionable.

Adult↗
PubMed2005

Problem-based learning online: perceptions of health science students.

This qualitative study explored health sciences students' perceptions of their experiences in online problem based learning (PBL) and focused on their views about learning and group process in the online environment. Participants were novices to online learning and highly experienced in PBL, therefore, they could reflect on past face-to-face PBL experiences. Three groups of learners were involved, including undergraduate nursing and midwifery students and graduate students in a neonatal nurse practitioner program. Findings are presented using the six steps of the PBL process (Rideout & Carpio, 2001). Results indicated that it is feasible to conduct PBL online. Students felt that it increased their flexibility for learning, enhanced their ability to deeply process content, and provided access to valuable learning resources. Students experienced a period of adaptation to the online environment, perceived a heavy workload, and had difficulties making group decisions online. In addition to using asynchronous communication, chats (synchronous communication) were valued to support group decision-making online. Students appreciated validation of their online contributions from their peers and wanted clear expectations of what constituted successful tutorial participation from their tutors. Although online PBL can work effectively, tutors and students need to develop online literacy skills to smooth their transition to an online PBL environment.

Communication↗
PubMed2002

Emergent literacy skills and training time uniquely predict variability in responses to phonemic awareness training in disadvantaged kindergartners.

The factors that predicted variability in responses to phonemic awareness training were investigated in kindergartners who live in poverty. Treatment children (n=42) received both analytic and synthetic phonemic awareness computer-assisted instruction, while controls (n=34) received no special training. Mean age of participants was approximately 5 years 7 months. Pretests included initial phonemic awareness, letter knowledge, word-level reading, invented spelling, vocabulary knowledge, and print concepts. Spelling skills emerged as the best consistent predictor of variability in phonemic awareness in response to instruction. We propose that relations between phonemic awareness and spelling skills are bidirectional: Spelling influenced growth in phonemic awareness and phonemic awareness contributed to growth in spelling skills. The amount of exposure that children had to the treatment intervention contributed uniquely to individual differences in posttest levels of phonemic awareness and spelling.

Analysis of Variance↗
PubMed2002

Math and numeracy in young adults with spina bifida and hydrocephalus.

The developmental stability of poor math skill was studied in 31 young adults with spina bifida and hydrocephalus (SBH), a neurodevelopmental disorder involving malformations of the brain and spinal cord. Longitudinally, individuals with poor math problem solving as children grew into adults with poor problem solving and limited functional numeracy. As a group, young adults with SBH had poor computation accuracy, computation speed, problem solving, a ndfunctional numeracy. Computation accuracy was related to a supporting cognitive system (working memory for numbers), and functional numeracy was related to one medical history variable (number of lifetime shunt revisions). Adult functional numeracy, but not functional literacy, was predictive of higher levels of social, personal, and community independence.

Adolescent↗
PubMed1995

Future of dietary exposure assessment.

Nutritional epidemiology depends on valid assessment of exposure of individuals to food-borne factors. The tools being applied are generally blunt instruments that are simple for the scientist to administer and analyze. The burden of aggregating foods, combining amounts, drawing on episodic or generic memory, and interpreting the questions is placed on the subjects. Alternative approaches include enhanced use of biomarkers of exposure as external, internal, and target tissue markers. Because biomarkers exist for only a few substances of interest at the exposure time of interest, the future of subjective measures is likely to be in the development of subjective dietary assessment methods that apply modern technology, including audio systems to overcome literacy barriers and allow multilingual interviews, and pictures for identifying foods. Automated methods can ensure that all questions have been responded to and all responses outside of normal ranges have been double-checked. Computer-assisted self-interviewing (CASI) may prove to be the most economic and cognitively supportive approach for assessment of food-borne exposures in the future.

Biomarkers↗
PubMed2006

Preliminary testing of a just-in-time, user-defined values clarification exercise to aid lower literate women in making informed breast cancer treatment decisions.

OBJECTIVE: To report on the initial testing of a values clarification exercise utilizing a jewellery box within a computerized patient decision aid (CPtDA) designed to assist women in making a surgical breast cancer treatment decision. DESIGN: Pre-post design, with patients interviewed after diagnosis, and then after completing the CPtDA sometime later at their preoperative visit. SAMPLE: Fifty-one female patients, who are low literate and naïve computer users, newly diagnosed with early stage breast cancer from two urban public hospitals. INTERVENTION: A computerized decision aid that combines entertainment-education (edutainment) with enhanced (factual) content. An interactive jewellery box is featured to assist women in: (1) recording and reflecting over issues of concern with possible treatments, (2) deliberating over surgery decision, and (3) communicating with physician and significant others. OUTCOMES: Patients' use of the jewellery box to store issues during completion of the CPtDA, and perceived clarity of values in making a treatment decision, as measured by a low literacy version of the Decisional Conflict Scale (DCS). RESULTS: Over half of the participants utilized the jewellery box to store issues they found concerning about the treatments. On average, users flagged over 13 issues of concern with the treatments. Scores on the DCS Uncertainty and Feeling Unclear about Values subscales were lower after the intervention compared to before the decision was made. CONCLUSIONS: A values clarification exercise using an interactive jewellery box may be a promising method for promoting informed treatment decision making by low literacy breast cancer patients.

Adult↗
PubMed1988

Interactive video in health care: blending patient care, computer technology, and research results.

This article illustrates one method of combining research results and computer technology to produce a "high-tech" patient-education program that has demonstrated its applicability in clinical practice. A videodisc entitled The Story of Maria was produced as part of a large primary care research project along the southwestern U.S.-Mexico border. A needs assessment of approximately 200 Hispanic mothers preceded the scripting of the videodisc. The paper presents an overview of the production process, as well as a description of some special technological features, including the bilingual soundtrack, touchscreen control, and careful design of instructions to eliminate the need for literacy. Pilot testing of the interactive video program in two community health centers in the U.S.-Mexico border area indicates that the program is not only fulfilling its purpose, but also being enthusiastically received by the patients.

Adult↗
PubMed2003

Health outcomes assessment in vulnerable populations: measurement challenges and recommendations.

With growing recognition that some population subgroups are particularly vulnerable to receiving suboptimal health care and achieving poor health outcomes, innovative techniques are required for collecting and evaluating health outcomes data. Research is also needed to better understand the causal pathways linking vulnerability with health outcomes. This article focuses on patients with a chronic illness (cancer) who also have low literacy and/or poor English language skills. We summarize the association among literacy, language, ethnicity, and health outcomes; describe innovative technologies to enhance communication; and discuss the advantages of using psychometric measurement models in health outcomes assessment. Results from our ongoing research projects are presented, including the development of an audiovisual computer-based testing platform for self-administration of questionnaires. Such innovative multimedia technologies allow patients with limited or even no reading ability to participate in outcomes assessment and have the potential to be incorporated into a clinical setting with minimal burden on staff and patients. Appropriate methods are also needed to evaluate measurement equivalence across diverse patient groups, that is, the extent to which items in a questionnaire perform similarly across groups. Item response theory measurement models provide a strategy for differentiating between measurement bias and real differences that may exist between groups. Recommendations for clinical practice and research are offered specifically to address medically underserved and vulnerable populations.

Activities of Daily Living↗