Search

Objective: To examine associations of individual exposure and knowledge of resuscitation mechanics and prognosis with specific decision: Do Not Resuscitate (DNR), Full Code (FC) or Undecided (UD)., Methods: Cross-sectional questionnaire at 3 sites: geriatric assessment center, internal medicine resident clinic, and inpatient palliative care service., Results: 407 completed the questionnaire: 27% identified as DNR, 24% as FC and 49% as UD. Few (11.8%) respondents reported discussion of DNR status with their primary care doctor. DNR choice was associated with knowledge of DNR mechanics, OR=2.30 (95%CI: 1.23-4.30), physician discussion, OR=5.58 (95%CI: 2.39-13.04) and confidence in understanding own health problems, OR=2.89 (95%CI: 1.04-8.04). FC choice was associated with knowledge of FC mechanics, OR=2.01 (95%CI: 1.03-3.93) and media code exposure, OR=3.80 (95%CI: 1.46-9.92). Knowledge of resuscitation prognosis was negatively associated with FC, OR =0.48 (95%CI: 0.23-0.98)., Conclusion: Many individuals lack knowledge or understanding of resuscitation procedure, its risks, and prognosis. Educational efforts, for both patients and healthcare professionals, are needed to improve individual knowledge needed for informed decision., Practice Implications: Scheduled time for physician-patient discussion remains important for education about individual health conditions and risk/benefits related to resuscitation., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objective: Hyperphosphatemia in end-stage renal disease is associated with significant morbidity and mortality. Because phosphorus is not effectively dialyzed, dietary adherence remains a significant problem. Previous studies have examined the health belief model, but none have looked at stages of change and dietary adherence in patients undergoing hemodialysis (HD)., Design: Cross-sectional survey., Setting: Three dialysis centers in Columbus, Ohio, between August 2012 and March 2013., Subjects: English-speaking patients age 18 or older on HD without dementia or developmental delay., Intervention: None., Main Outcome Measure: Associations between dietary adherence based on the Precaution Adoption Process Model (stages of change) and serum phosphorus levels via a conceptual model incorporating modifying factors and individual health beliefs., Results: Ninety-five patients completed the survey; 59 (62%) endorsed adherence to a low-phosphorus diet and 32 (34%) had phosphorus values ≤5.5 mg/dL. Modifying factors associated with diet adherence included nonminority status odds ratio (OR), 95%CI 8.99 (1.08-74.60), greater level of education OR 18.23 (1.62-205.00), better quality of life OR 9.28 (1.35-63.71), and time on dialysis OR 1.04 (1.01-1.07). Individual health beliefs associated with diet adherence included perceived benefits OR 3.18 (1.47-6.88) and self-efficacy OR 1.22 (1.09-1.38). Modifying factors associated with phosphorus control included: age OR 0.94 (0.90-0.99), minority status OR 0.11 (0.02-0.68), greater level of education OR 6.60 (1.41-31.04), knowledge about chronic kidney disease OR 1.48 (1.03-2.13), and time on dialysis OR 0.98 (0.96-0.99). Individual health beliefs associated with phosphorus control included self-efficacy OR 1.08 (1.01-1.16)., Conclusion: HD clinicians and educators may obtain better results with dietary adherence and phosphorus control if they focus not only toward disease and dietary education but also on understanding modifying factors and individual health beliefs. Assessing where the patient is with regard to stages of change may assist health care providers in better matching interventions that build patients' self-efficacy., (Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Current healthcare guidelines identify low health literacy as a major barrier to optimal health communication. Health literacy is defined as the degree to which individuals can obtain, process and understand basic health information and services needed to make appropriate health decisions. An estimated 90 million people in the U.S. have marginal health literacy. The Institute of Medicine and the U.S. Department of Education recommend that health related information be written at the 6th-8th grade level to address low health literacy. Epidemiological studies demonstrate that persons with epilepsy have significantly lower educational attainment and lower incomes placing them at risk for low health literacy and limited Internet access. While Internet users tend to have higher educational attainment, previous research indicates even good readers prefer simpler rather than more complex medical information. Health educational content that could be printed and given to patients addresses an important need in clinical epilepsy care. Previous reviews of health websites found they exceed recommended readability levels. Two online programs were used to assess the reading level of 1327 web pages on the www.epilepsy.com website using established readability formulas. Based on the Flesch Reading Ease assessment, only 3% of epilepsy.com web pages are written for a 6th grade reading level or below. If 8th grade level or below is used as the standard, only 15% are adequate. Recommendations and examples are provided for improving the readability of epilepsy-specific health education content.

Antiepileptic drugs (AEDs) are known to cause bone loss. People with epilepsy have twice the fracture rate of nonepilepsy populations. Osteoprotective knowledge related to calcium and exercise has not been assessed in people with epilepsy. The Osteoporosis Knowledge Test (OKT), a validated, 24-item test, was administered to 94 epilepsy patients (28 males and 66 females) to measure knowledge of risk factors for osteoporosis and strategies for prevention related to calcium and exercise. The mean age of participants was 45 years with an average AED exposure of 20 years. Fifty participants were Caucasian and 44 were non-Caucasian. No significant differences related to age or gender for the OKT were found. One-way analysis of variance (ANOVA) of ethnicity showed that non-Caucasians had much lower calcium (F = 8.15, p = .005) and exercise (F = 7.71, p = .007) knowledge. The total mean OKT score was 11.71 (4.92), reflecting a correct response rate of 49%. In previous studies of nonepilepsy populations, the mean OKT score ranged from 7.83 to 21.8, with a correct response ranging from 32.9% to 90.8%. Independent t tests of the individual OKT questions revealed specific knowledge deficiencies in the areas of risk factors, exercise, and reasons for calcium supplementation for non-Caucasians. Results of this study reveal that people with epilepsy, who are at greater risk for metabolic bone loss, have lower knowledge scores for calcium and exercise than nonepilepsy populations of various ages and genders. Culturally relevantepilepsy materials and programs may improve knowledge and adoption of preventative behavior.

In the neurology literature it is well established that anti-epileptic drugs (AEDs) lead to bone loss (osteopenia and osteoporosis). Several large epidemiologic studies have found twice the fracture rate in persons with epilepsy compared to the non-epilepsy population. While an increasing level of awareness for preventative measures and screening by neurologists and primary care physicians are recommended, so far no one has attempted to address how knowledge related to calcium and exercise, health beliefs (based on the Health Belief Model) and self-efficacy (confidence in abilities) impact osteoprotective behaviors in epilepsy, based on the Precaution Adoption Process Model (PAPM). The seven-stage PAPM, unlike other health behavior theories where a person is either practicing or not practicing the behavior, conceptualizes behavior change as dynamic and occurring over time. Validated instruments were used to assess knowledge, health beliefs, self-efficacy and stages of the precaution adoption process for four osteoprotective behaviors. For dietary calcium; exercise knowledge and calcium self-efficacy predicted higher stages of precaution adoption. For calcium supplements; age perceived susceptibility for osteoporosis and perceived benefits of calcium predicted higher stages. Exercise adoption stage was most predicted by exercise knowledge and health motivation. For DEXA screening adoption; age and perceived susceptibility predicted higher stages. This study provides hints how persons with epilepsy could be influenced to move from the unaware/unengaged positions into to the stages of adoption and maintenance for osteoprotective behaviors.

In epilepsy populations there are multiple barriers to the prevention, diagnosis, and treatment of metabolic bone disease. This study explored issues that may be unique to inner-city care. We screened 101 consecutive patient charts from our clinic to identify barriers to optimal care. According to the Health Belief Model, when patients view a condition as not severe and their perceived susceptibility is low, they are unlikely to comply with screening and/or adopt preventative behaviors. Despite routine communications to primary care doctors regarding bone health, its importance is still overlooked. In addition, the managed care referral process makes it difficult for a specialist to prevent, screen, and treat a primary care condition with no symptoms. For optimal patient care and to stimulate prevention and screening compliance, a communication style adapted to the patient's knowledge, beliefs, and attitudes toward antiepileptic drug-induced bone loss is crucial to help reduce barriers against change.