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CLINICAL RELEVANCE Children with uncorrected visual impairment have lower scores on a variety of motor and cognitive tests. Exploring the influencing factors of low-income groups seeking vision care services is helpful for identifying relevant barriers and necessary measures to improve the utilization rate of vision care services. BACKGROUND The community-based vision center (VC) is a popular model for solving vision problem of students in rural China. Compliance is the key factor to the success of the VC model. Factors determining compliance with visitations to VC among primary school students after screening were explored. METHODS A cross-sectional study was conducted with 15,763 students from 228 primary schools. Information was collected through questionnaires and vision examinations. The determinants that affect visits of students to the VC were analyzed using logistic regression. RESULTS Among the 15,763 sample, 5,361 (34%) students had a visual impairment. At baseline, only 962 (18%) of students with visual impairment sought vision care services. After a local VC was established, among the 5,163 students who needed to be referred, only 2,237 (43.33%) students visited the VC. Multivariate logistic regression models for predicting students visit the VC revealed that the following characteristics were significant predictors: poor uncorrected visual acuity (P

Introduction Tobacco 21 (T21) policies have shown promise in reducing cigarette use among adolescents. This study examined whether local T21 policies affected adolescent use of a variety of tobacco products and whether results differed by grade level. Methods We used repeated cross-sectional data from eighth, ninth, and eleventh-grade respondents to the 2016 (n = 107 981) and 2019 (n = 102 196) Minnesota Student Surveys. Generalized estimating equations modeled eight adolescent tobacco use outcomes in 2019 (past 30-day use of any tobacco, cigarettes, cigars, e-cigarettes, hookah, chewing tobacco, flavored tobacco, and multiple products) by T21 exposure, defined as respondents’ attendance at a school within a jurisdiction with T21 policy implementation between the two surveys. Models controlled for demographic characteristics and product-specific baseline tobacco use at the school level in 2016 and were stratified by grade. Results After adjusting for baseline tobacco use and other demographics, T21-exposed eighth and ninth-grade students had significantly lower odds of tobacco use than unexposed peers in five of eight models, i.e. any tobacco (aOR = 0.80, 95% CI: 0.74, 0.87), cigarettes (aOR = 0.81, 95% CI: 0.67, 0.99), e-cigarettes (aOR = 0.78, 95% CI: 0.71, 0.85), flavored tobacco (aOR = 0.79, CI: 0.70, 0.89), and dual/poly tobacco (aOR = 0.77, 95% CI: 0.65, 0.92). T21-exposed eleventh-grade students did not differ significantly in their odds of any tobacco use outcomes relative to their unexposed peers. Conclusions T21 exposure is associated with lower odds of multiple forms of tobacco use, particularly among younger adolescent populations, supporting the implementation of T21 policies to reduce tobacco use in this population.

BACKGROUND: As spine surgery in the ambulatory setting becomes more frequent, patients should comprehend the difference from traditional hospital-based, outpatient settings. Limited research exists on the readability of online articles surrounding spine surgery in the ambulatory surgery center (ASC). In this study, we intend to evaluate the readability of online articles pertaining to spine surgery in the outpatient and ambulatory surgical settings. METHODS: Three search engines were queried, and the first 100 articles pertaining to each outpatient spine surgery search term were collected. Advertisements, videos, and peer-reviewed scientific articles were excluded. Articles were categorized by publishing source as follows: hospital or institution, general medical Websites, private practice, or surgery center. Flesch-Kincaid (FK) grade level, Flesch Reading Ease (FRE) score, word count, sentences per paragraph, words per sentence, and characters per word were evaluated for each article. Student's t tests compared readability metrics between groups based on setting and procedure region. RESULTS: A total of 342 articles was analyzed; 279 articles were outpatient hospital related, and 63 ASC related. Flesch-Kincaid grade levels or FRE scores were not significantly different between outpatient hospital and ambulatory center. Comparison of ASC to outpatient articles from a hospital or institution source significantly differed in FRE score (40.7 versus 32.4) and FK grade level (12.3 versus 13.9; all P < .05). Articles addressing procedure type were significantly different in FRE score (36.2 versus 30.0) and FK grade level (13.0 ± 2.1 versus 14.3 ± 1.8). CONCLUSIONS: Hospital, private practice, and medical journalists should be aware of significant differences in readability of patient-accessible ASC articles. These articles may be more difficult to read than outpatient hospital articles, and production of more reading-level-appropriate online literature is required. LEVEL OF EVIDENCE: 3 CLINICAL RELEVANCE: There is a significant difference in the readability of patient-accessible ASC articles.

Objective Idiopathic subglottic stenosis (ISS) is a chronic condition characterized by disease recurrence and multiple surgeries. These frustrated patients may utilize the internet to research their condition. The aim of this study was to determine the quality and readability of online ISS information. Methods “Idiopathic subglottic stenosis” was entered into Google. The first 50 websites that met inclusion criteria were extracted. The DISCERN instrument, Flesch Reading Ease Score (FRES), and Flesch‐Kincaid Grade Level (FKGL) assessed the quality and readability, respectively. Means, SDs, Pearson correlation coefficients, and two‐tailed Student's t‐test were calculated. Results The 50 websites consisted of 17 patient‐targeted and 33 professional‐targeted websites, plus 30 major and 20 minor websites. The overall DISCERN, FRES, and FKGL scores were 2.81 ± 0.99, 27.75 ± 15.27, and 13.65 ± 2.79, respectively (mean ± SD). Patient‐targeted websites had significantly lower quality (DISCERN [P

Nasal smear is a valid method used to distinguish inflammatory and non-inflammatory conditions. The present study was conducted to evaluate the cytological picture and neutrophilic infiltration of nasal secretions of children from a primary school within Enugu metropolis in Enugu State, Nigeria. The study included 100 apparently normal pupils, 20 each from grade levels 1 to 5. The blow-out technique was used to obtain samples from the nasal cavity for smear preparation on slides. May-Grunwald-Giemsa was used to stain the smears for light microscopical examination. Smears were assessed for the presence of infiltrating inflammatory cells and a semi-quantitative grading of neutrophilic infiltration was conducted on each sample to indicate either absent, few, moderate or many. Mean age of participants is 6.25±0.44 years (range: 6–11 years). Results revealed that age and grade level of study had a strong association with the grade score of neutrophilic infiltration (p

The aim of this study was to examine the mediating role of interpersonal cognitive distortions between perceived parental rejection and dating anxiety in emerging adults. The study also examined whether gender and grade level also differ in terms of dating anxiety. Participants were 574 (334 women, 240 men) university students studying in a state university in Turkey who were reached with stratified sampling method. The data were collected with Adult Parental Acceptance-Rejection Questionnaire- Short Form, Dating Anxiety Scale and Interpersonal Cognitive Distortions Scale. The results of the study showed positive correlations between perceived parental rejection and dating anxiety and interpersonal cognitive distortions. According to the path analysis results, interpersonal cognitive distortions were partial mediator in relationship between perceived maternal rejection and dating anxiety. However, it was found that paternal rejection had a direct effect on dating anxiety, and cognitive distortions did not have a mediating role on this relationship. It was found that dating anxiety did not differ significantly in terms of gender, while it differed in terms of grade level. Warmth and acceptance centred parent-child relationship can be considered as a protective factor that can increase the dating anxiety by increasing the cognitive distortions.

Background Guidelines recommend patient health-related information be written at or below the sixth-grade level. This study evaluates the readability level and quality of online appendectomy patient education materials. Methods Webpages were evaluated using seven readability formulae: Flesh-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), Automated Readability Index (ARI), Simple Measure of Gobbledygook (SMOG), Flesch Reading Ease (FRE), and New Dale-Chall (NDC). Two evaluators assessed quality using the Brief DISCERN tool. Results Thirty seven webpages were analyzed. The mean readability scores were: FKGL = 9.11, GFI = 11.82, CLI = 10.84, ARI = 7.99, SMOG = 11.88, FRE = 51.17, and NDC = 5.48. 6 of the 7 readability formulae indicate that the materials were written at too high a level. The average Brief DISCERN score was 17.81, indicating good quality. Conclusions Readability levels for online appendectomy patient education materials are higher than recommended but are of good quality. Authors of such materials should not only provide good quality information but also ensure readability.

The current study examined (a) the associations of COVID-19 stress with anxiety and depression and whether those associations differed by gender or grade level, and (b) how different coping strateg...

Breast cancer remains the leading cause of cancer-related death in US Hispanic women. When present, lower health literacy levels potentially within this patient population require tailored materials to address health disparities. We aim to evaluate and compare Spanish and English online health care informative resources on preventive mastectomy. A Google web search using “preventive mastectomy” and “mastectomia preventiva” was conducted. The first ten institutional/organizational websites in each language were selected. Assessment of mean reading grade level, cultural sensitivity, understandability, and actionability was carried out utilizing validated tools. The mean reading grade level for English materials was 14.69 compared with 11.3 for Spanish, both exceeding the recommended grade level established by the AMA and NIH. The mean cultural sensitivity score for English information was 2.20 compared with 1.88 for Spanish information, both below the acceptability benchmark of 2.5. English webpages scored 65% and 35% for understandability and actionability, respectively, while Spanish webpages scored 47% and 18%. Online English and Spanish preventive mastectomy materials were written at an elevated reading level and lacked cultural sensitivity. Spanish language information demonstrated inferior understandability, actionability, and cultural sensitivity. Addressing these issues provides an opportunity to help resolve health literature disparities regarding preventive mastectomy for US Hispanic women.

Chachu Genale, Arebu Issa, Bezawit Negash, Kebede Wondu Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Kebede WonduDepartment of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, P.O. Box 1176, Addis Ababa, EthiopiaEmail kebede.wondu@aau.edu.etBackground: Patients are frequently provided with medicine information materials (MIMs). Rendering medicine information through written material is a reliable method. Readability is an important attribute of written material that can affect the reader’s ability to comprehend. Patient’s perception can also affect the comprehensibility of written MIMs.Objective: The objectives of the study were to assess the readability of medicine information in Tikur Anbessa Specialized Hospital (TASH); and assessing patients’ perception and understanding of medicine information materials.Methods: This was a cross-sectional study conducted from September 21, 2019 to November 24, 2020, at TASH. Quantitative and qualitative data collection approaches were used in this research. The readability value of each material was determined in accordance with the Flesch Reading ease scores (FRE) and Flesch-Kincaid Grade Level (FKGL). The tools compute readability based on an average number of syllables per word and an average number of words per sentence. FRE provides scores from 0 to 100; higher scores mean easily comprehensible while FKGL sets grade levels for written texts. A structured interview was administered with questions about how MIMs had been used, and was analyzed qualitatively.Results: The results of this research showed low readability scores of MIMs found in TASH. Most patients do not get MIMs and are unaware of how to use them. They are interested to receive and read medicines information from pharmacists and physicians. Moreover, most of them preferred information through both verbal and written forms.Conclusion: The readability levels of selected MIMs obtained from TASH are found to be not compliant with the patients’ needs. This might be worsening their health outcomes and resulting in poorer use of healthcare services.Keywords: Flesch readability formula, information, medicine, readability, reading grade level, Tikur Anbessa Specialized Hospital

This pilot survey was designed to evaluate the characteristics of anaphylactic events and epinephrine autoinjector (EAI) use in children in U.S. schools. A cross-sectional, web-based, pilot survey of schools participating in the EPIPEN4SCHOOLS® program (Mylan Specialty L.P., Canonsburg, PA) assessed characteristics of anaphylactic events and EAI use during the 2013–2014 academic year. Respondents reported 757 anaphylactic events experienced by students; student grade level was noted for 724 events. Of these events, 32.3% (234/724) were experienced by students in grade school, 18.6% (135/724) by students in middle school, and 49.0% (355/724) by students in high school. Frequency of food-related triggers was consistently high across grade levels. However, many events experienced by students in high school (22.3%, 79/355), middle school (15.0%, 20/135), and grade school (14.1%, 33/234) had an unknown trigger. In 36.0% of schools (2008/5579), only the school nurse and select staff received training to recogni...

Background The purpose of this study is to assess the readability, understandability, and quality of information on retinopathy of prematurity presented at websites frequently visited by parents. Methods A total of 220 websites were assessed, which were recruited by searching for "retinopathy of prematurity" at the Google search engine. The readability of each web page was assessed by Flesch Reading Ease Score, Gobbledygook's Gunning Frequency, Flesch Kincaid Grade Level, Coleman Liau score, The Simple Measure of Gobbledygook, Fry Graph Readability Formula, and Automated readability score. The understandability of the web pages included in the study was measured by using the Patient Education Materials Assessment Tool. Quality was evaluated using Health in Net code and JAMA. The ALEXA traffic tool was used to reference the domains' popularity and visibility. Results Sixty-four websites were included to the study. The average Flesch Reading Ease Score was 50.1 ± 11.4, Gunning Frequency of Gobbledygook level was 13.4 ± 2.5, The Flesch-Kincaid Grade level was 10.7 ± 2.2, Coleman Liau level was 10.8 ± 1.7, Simple Measure of Gobbledygook level was 10.0 ± 1.9, and Fry Graph Readability Formula 11.9 ± 2.7, Automated readability score 10.4 ± 2.5. The average understandability score for all website-based patient education materials was 76.9 ± 15.2. Total JAMA Benchmark score is 2.27 ± 1.14 (range from 1 to 4). The quality of information at most websites were determined by our chosen assessments to not to be good. Conclusion Websites addressed to parents for retinopathy of prematurity had found to have high understandability. It was concluded based on this study that readability and quality of presented written materials at online sources need to be improved.

Objectives: In this study, we sought to determine the prevalence of problematic Internet use (PIU) among high school students and identify demographic and socioeconomic factors related to PIU. Methods: Using a cross-sectional design, we conducted this study between November 2017 and January 2018 of 1412 students attending high schools in the Silivri District of Istanbul in Turkey. We administered a questionnaire inquiring about sociodemographic information, Internet use, and Young's Internet Addiction Test to participating students. Results: Among participants, 18.5% (male = 17.2%; females = 19.8%) were found to show PIU. PIU rates were higher among those with a high household income and lower among those who studied in science high schools, performed physical activities at least 2 days a week, and read at least one book a month. PIU rates were also higher among those who had their own bedrooms, phones, smartphones, Internet connections at home, and social networking accounts. Conclusion: The prevalence of PIU among the participants was 18.5%. Female sex, high household income, low physical activity, grade level, school type, reading fewer than one book per month, and Internet use experience were risk factors for PIU. PIU is considered a significant public health concern across the world, including in Turkey.

The study aimed to determine the prevalence of ADHD symptoms in Saudi children aged 6 to 13 years in Jeddah city. The study also explored the effect of variables namely teacher's knowledge, years of experience and teachers' gender on reported ADHD symptoms among primary grade students. A questionnaire survey methodology was adopted for the study. 550 children were included in the teachers' survey. Teachers assessed the ADHD symptoms in children using an 18-item scale based on DSM-V. The results indicated that the prevalence rates of ADHD among school-age differed according to ADHD subtypes. The Inattention type was rated by 35.34%, Hyperactivity/Impulsivity type was rated by 28.60%, and ADHD-C type was rated by 21.3% of the respondents. According to gender, for the Inattention subtype, the ratio between boys and girls was 1.7:1, for the Hyperactivity/Impulsivity subtype, the ratio between boys and girls was 2.03:1, and for combined subtype, the ratio between boys and girls was 2.2:1. According to the grade level, the highest prevalence of ADHD overall was found in grade three and the lowest prevalence was in grade six in all ADHD types. The present findings indicated that teachers' knowledge and gender (female) successfully predicted teacher-rated ADHD status.

Breastfeeding the infants within one hour of birth can reduce infant mortality. Knowledge of exclusive breastfeeding among women is essential when promoting optimal breastfeeding practices. Hence, this study was conducted to evaluate initiation and establishment of lactation, level of knowledge and attitude, and actual practices of breastfeeding among postnatal primigravida mothers. This cross-sectional study was carried out on 400 postnatal primigravida mothers for one year. Mothers were interviewed and their socio-demographic details and data on time of initiation of prelacteal feeds, number of times of feeding per day, and breastfeeding duration were collected using semi-structured questionnaires. Proper counseling on breastfeeding practices including initiation and establishment of lactation was provided on the basis of the responses to the questionnaire. Pre- and post-counseling scores were interpreted and compared for all the primiparous mothers. The association between variables was examined using t-test. P-value of

Objective To examine the readability of postoperative urology handouts and assess for areas of improvement. We hypothesize that the majority of provider handouts exceed the National Institutes of Health recommendation of writing at a sixth-grade reading level. Methods We reviewed 238 postoperative patient handouts in the public domain representing United States academic and private practices. All handouts were categorized and re-formatted into text-only using Microsoft Word. A median reading grade was calculated using the Readability.io web application using Flesch-Kincaid Grade Level, Gunning Fog index, Coleman-Liau index, Simple Measure of Gobbledygook, and Automated-Reading Index. Word count was also assessed. Results Provider handouts were written at a median 9.3 grade reading level (range 5.8-14, IQR 8.45-10). A total of 15 (6.8%) handouts were written at a sixth-grade reading level, with only 1 (0.4%) handout written below the target. Six (2.7%) handouts were written at college-level. There were no significant differences between different subspecialties. Median word count was 509 (range 90-3796, IQR 361-738). Although a high word count may make it more difficult for patients to follow suggestions, the readability of each handout did not correlate with word count. Conclusions Our data show that over 93% of analyzed handouts failed to meet National Institutes of Health recommendations for grade level. Longer word counts did not correlate with higher reading levels. It will be important to assess patient satisfaction with handouts and to correlate the complexity of postoperative handouts with outcome, such as unplanned phone calls and unscheduled visits.

ObjectiveTo determine whether high school start time is associated with headache frequency in adolescents with migraine.BackgroundAdolescence is marked by a physiologic delayed circadian phase, characterized by later bedtimes and wake times. The American Academy of Pediatrics (AAP) recommends that high schools start no earlier than 8:30a.m., but most high schools in the United States start earlier. The study hypothesis was that adolescents with migraine whose high schools start at 8:30a.m. or later (late group) would have lower headache frequency than those whose schools start earlier than 8:30a.m. (early group).MethodsThis was a cross-sectional Internet survey study of US high schoolers with migraine recruited online through social media. Comparisons were made between the late group and the early group. The primary outcome measure was self-reported headache days/month.ResultsIn total, 1012 respondents constituted the analytic set: n=503 in the late group versus n=509 in the early group. Mean (SD) self-reported headache days/month was 4.8 (4.6) versus 7.7 (6.1) in the late and early groups, respectively (p&nbsp

Background The aim of this study was to conduct a readability analysis on both patient take-home information and consent forms for common foot and ankle procedures. Our hypothesis was that the objective reading skills required to read and comprehend the documentation currently in use would exceed the recommendations in place by both national and international bodies. Methods The current Queensland Health consent forms are divided into specific subsections. The readability of consent form subsections C and G (sections containing detailed information on risks of the procedure and pertaining to informed patient consent specifically) and patient take-home information (provided as take-home leaflet from the consent form which is procedure specific) was assessed by an online readability software program using five validated methods calculated by application of the algorithms for (i) Flesch-Kincaid grade level, (ii) the SMOG (Simple Measure of Gobbledygook), (iii) Coleman-Liau index, (iv) automated readability index and the (v) Linsear Wriste formula. Results The mean ± standard deviation reading grade level of risk (section C), grade level of patient consent (section G) and grade level for procedure-specific take-home patient information were 8.7 ± 0.9, 11.6 ± 1.2 and 7.5 ± 0.2, respectively. Conclusion The readability of sections C and G of the Queensland Health consent form exceeds the recommendations by national and international bodies, but the patient take-home information appears suitable. Consideration should be given to lower the reading grade level of patient consent forms to better reflect the reading grade of the Australian population.

Evaluate quality and readability of online information for common rheumatologic diseases. Compare rheumatology patients' internet use and preferences to an objective evaluation of internet quality and readability. Five common rheumatologic diseases were searched on the web browser Google using English language. The first twenty websites from each of the five searches were evaluated for internet quality (e.g. content that is current, balanced, has specific aims, and is appropriately cited) using the DISCERN criteria and readability using the Flesch-Kincaid Grade Level (FKGL). The results were contrasted with a survey sent to patients with rheumatic disease. The survey measured patient likeliness to use and trust identified websites. Internet quality was similar (good) for all five diseases searched while readability was poor. There was an inverse relationship between internet quality and readability. Internet quality significantly differed across website sponsor, and readability significantly differed across disease and website sponsor. Common medical website sponsors with the highest combined quality and readability scores were Mayo Clinic and Web MD. Eight hundred and fifty-eight patients were sent a survey, of which 147 (17%) completed. Patients indicated they were most likely to use and trust a Mayo Clinic-sponsored website when compared to other common sponsored websites from our evaluation, followed by the American College of Rheumatology. Although we found good-quality information, all websites evaluated had readability levels above the recommended sixth-grade reading level. The website sponsor with the highest combined readability and quality score was also the most used and trusted by patients. Patients would like more information about credible and trusted websites from their medical providers.

Background This systematic review aimed to determine whether enhanced recovery after caesarean delivery (ERAC) protocols should be adopted. Methods We searched four databases and abstracts from meetings for studies comparing ERAC to standard care. We report interventions, outcomes, qualitative impact of ERAC implementation and use GRADE scoring to determine quality of evidence and make recommendations regarding ERAC adoption, based on key outcomes (length of stay, financial savings, satisfaction, re-admission, opioid usage, breastfeeding success and maternal-neonatal bonding). Results Eleven published studies and 36 abstracts evaluating ERAC were included. Forty-two study interventions (40 in published studies) and 90 outcome measures (60 in published studies) were used. Most studies showed a reduction in hospital stay (6/7 studies) and reduced costs (2/2 studies) with ERAC compared with standard care. Satisfaction was inconsistently reported. Re-admission rates were similar between groups. Two studies showed a reduction and two showed no difference in opioid consumption with ERAC. One study showed improvement and another showed no change in outpatient breastfeeding rates with ERAC. One study showed better inpatient maternal-neonatal bonding. The GRADE level of evidence was low or very low for all outcomes. Conclusions Studies evaluating ERAC used heterogeneous interventions and outcomes. Although there is currently low- or very low-level evidence supporting all outcomes evaluated, the majority of studies showed some benefits and none reported harm. On balance, we recommend the use of ERAC. Future studies are needed to strengthen ERAC recommendations by standardising interventions and reported outcomes.

Purpose As cigarette rates have decreased, the proportion of menthol cigarette use among youth smokers has increased. Thus, it is important to monitor the menthol-associated behaviors among youth. The present study examined the associations between menthol cigarette use and smoking frequency, intention to continue smoking, and quit intention among youth. Methods We used data from the 2017 and 2018 National Youth Tobacco Surveys. Separate multivariable logistic regression models were used to examine the associations between menthol cigarette use and smoking frequency, intention to continue smoking, and intention to quit. Results Across both years, 1,707 youth reported past 30-day cigarette use, 50.7% of whom used menthol cigarettes. Menthol cigarette users had significantly higher odds of smoking at least 10 out of the 30 days before the survey than nonmenthol smokers (adjusted odds ratio [aOR] 1.48, 95% confidence interval [CI] 1.14–1.94). We found similar results in the stratified analysis by grade level. Menthol cigarette smokers in middle (aOR 2.36, 95% CI 1.01–5.49) and high school (aOR 1.41, 95% CI 1.09–1.82) were more likely to have smoked at least 10 out of the 30 days before the survey than nonmenthol smokers. Menthol cigarette users had higher odds of intention to continue smoking (aOR 1.54, 95% CI 1.08–2.19) than nonmenthol cigarette users. Menthol use was not significantly associated with intention to quit. Conclusions Compared with nonmenthol cigarette use, menthol cigarette use was associated with smoking more frequently as well as the intention to continue smoking among middle school and high school students.

Background: Visual impairment is one of the major public health problems worldwide, especially in developing countries. Objective: To determine the prevalence of visual impairment and its associated factors among school children in Gurage Zone, Southern Ethiopia. Methods: A cross sectional study was conducted in eight primary schools of Gurage Zone. A total of 1064 pupils, of whom589 boys and 475 girls were selected using multistage sampling technique. Socio-demographic characteristics of the participants were collected using structured questionnaires and visual acuity was measured using Snellen’s chart. Logistic regression analysis was used to determine the associated factors of visual impairment. Results: The prevalence of visual impairment was 5.2%. Factors significantly associated with visual impairment were age group of 13-18 years (AOR = 9.44, 95% CI = 3.83 – 23.25), school grade level of 5- 8 (AOR = 2.97, 95% CI = 1.23 – 7.17), rural residents (AOR = 2.59, 95% CI = 1.22 – 5.54), family’s monthly income of less than 2000 Ethiopian Birr (AOR = 2.87, 95% CI = 1.08 – 7.61) and visually impaired parents (AOR = 2.16, 95% CI = 1.06 – 4.39). Conclusion: This study found that the prevalence of visual impairment was 5.2%. Keywords: Visual impairment; primary school children; Gurage Zone; Southern Ethiopia.

PURPOSE: Survivorship care plans (SCPs) serve to communicate critical information needed for cancer survivors’ long-term follow-up care. The extent to which SCPs are tailored to meet the specific needs of underserved patient populations is understudied. To fill this gap, this study aimed to assess the content and communication appropriateness of SCPs collected from diverse health care settings. METHODS: We analyzed collected SCPs (n=16) for concordance with Institute of Medicine (IOM) recommendations for SCP content and for communication appropriateness using the Suitability Assessment of Materials (SAM) instrument. RESULTS: All plans failed to incorporate all IOM criteria, with the majority of plans (n=11) incorporating less than 60% of recommended content. The average reading grade level of all the plans was 14, and only one plan received a superior rating for cultural appropriateness. CONCLUSION: There is significant variation in the format and content of SCPs used in diverse hospital settings and most plans are not written at an appropriate reading grade level nor tailored for underserved and/or minority patient populations. IMPLICATIONS FOR CANCER SURVIVORS: Co-designing SCPs with diverse patient populations is crucial to ensure that these documents are meeting the needs and preferences of all cancer survivors.

Phenylketonuria (PKU) is a condition that results in the build-up of phenylalanine in the blood. This can cause severe brain damage and neurological issues if left untreated. Management can be complex and many individuals may turn to the internet to access further information. It is important that resources are understood as misinterpretation could result in harm to health. The aim of this study was to assess the readability of online resources for PKU and to assess their visual appearance using a communication sciences assessment framework. We searched the top five websites through Google using the search term “phenylketonuria/PKU”. We then analysed the text content of the identified websites using five readability formulae to determine the USA and UK reading grade. The median readability level across the five websites was US grade/UK grade 10.6/11.6, with individual grades ranging from 10/11 to 13.3/14.3. We found wide differences in the focus, layout and general appearance of the websites. The readability of resources was much higher than the recommended US 6th grade level. Online resources for PKU need to be simplified to ensure they can be easily understood.

Background Despite effectiveness in delaying the spread of the pandemic, frequent and extended disruption to children’s livelihoods have fomented new norms in which learning routines encounter immense change. In particular, increased sedentary e-learning engagement with electronic screens and exposure to stressful circumstances are likely to pose adverse risks for children’s vision development. Methods This present study examines the link between near-sighted refractive error, and sedentary exposure to electronic screens, psychosocial stress level, and outdoor activities. A Rapid Survey Methodology (RSM) design was utilized to collect information on subject’s vision condition, sedentary electronic screen use, and level of psychosocial stress, in addition to detailed socio-demographic background characteristics. Results This study involves 2234 subjects enrolled in 1st to 6th grade in primary schools. Every 1 diopter hour increase in electronic screen use per day is associated with 1.036 OR (95% CI =1.024–1.047, p-value− 2 sr− 1 of illuminance-weighted electronic screen use per day is associated with 2.285 OR (95% CI =1.829–2.855, p-valuep-valuep-valuep-value> 0.050). Conclusions Findings in this study show that many factors, including grade level and prior vision condition, contribute to increased risks of near-sighted refractive error during the COVID-19 pandemic. More strikingly, pandemic-related behavioral modifications such as lengthy sedentary electronic screen use and elevated levels of psychosocial stress are two critical channels affecting children’s eye health.

This study investigated the extent to which public school K–12 staff in the United States teaching physical education were certified in physical education and had an academic major in physical education during the 2015–2016 school year. Data were collected from a nationally representative sample of public school teachers in the United States. Descriptive statistics were used in the description of physical education teachers’ certification and academic major. These characteristics were investigated with regard to school grade level, census region, urbanicity, and newly hired. Results showed that over 30% of public high school physical education teachers did not have an undergraduate or graduate degree in physical education. Nearly 20% of physical education teachers were not certified in physical education. Furthermore, less than 70% of physical education teachers had both characteristics of a qualified teacher. Results from this study show the need for an increase in the percentage of high-quality physical education teachers who have both teaching certification and an academic major in physical education, which would positively impact public health in the United States. Subscribe to TPE

IntroductionThe SARS-CoV-2 secondary attack rate (SAR) in schools is low when mitigation measures are adopted, Data on the relative impact of such strategies are limited. We evaluated the SARS-CoV-2 SAR in Massachusetts schools during 2020-21 and factors associated with transmission risk. MethodsIn a convenience sample of 25 Massachusetts public K-12 school districts, de-identified information about SARS-CoV-2 cases and their school-based contacts was reported using a standardized contact-tracing tool. Index cases were included if they were in school while infectious. SAR was defined as the proportion of in-school contacts acquiring SARS-CoV-2 infection and designated as possible or probable in-school transmission by school-based teams. We compared exposure-specific SAR using unadjusted risk ratios (RR) with 95% confidence intervals (CI); p-values were calculated using Fishers exact tests. ResultsEight districts (70 schools with >33,000 enrolled students) participated. There were 435 index cases and 1,771 school-based contacts (Table 1). Most contacts (1327/1771 [75%]) underwent SARS-CoV-2 testing and 39/1327 (2.9%) contacts tested positive. Of 39 positive contacts, 10 (25.6%) had clear out-of-school exposures and were deemed not in-school transmissions, so were excluded from further calculations. Twenty-nine (74.4%) contacts were deemed possible or probable in-school transmissions, resulting in an in-school SAR of 2.2%. Of the 29 in-school transmissions, 6 (20.7%) were staff-to-staff, 7 (24.1%) were staff-to-student, 3 (10.3%) were student-to-staff, and 13 (44.8%) were student-to-student; 6 (20.7%) occurred from index cases attending work/school while symptomatic. The unadjusted SAR (Table 2) was significantly higher if the index case was a staff member versus a student (RR 2.18, 95% CI 1.06-4.49; p=0.030), if the index case was identified via in-school contact tracing versus via school-based asymptomatic testing (RR 8.44, 95% CI 1.98-36.06; p=0.001), if the exposure occurred at lunch versus elsewhere (RR 5.74, 95% CI 2.11-15.63; p

The purpose of this study was to develop criteria for an adolescent circuit exercise program. The subjects of this study were 5268 middle- and high-school students. It consisted of three types of circuit exercise programs which were conducted in the physical education class. In the result of this study, we have found two significant finding. First, there were statistically significant differences by grade level and gender in three types of circuit exercise programs. Second, in order to improve the utilization rate and convenience of various adolescents’ physical activity environments and the field of school physical education, the gender of each circuit exercise program was classified and the five-grade evaluation criteria were presented. The criteria for circuit exercise program developed in this study will be utilized for various youth physical activities to contribute to improving health and physical fitness. In addition, physical education teachers are expected to use this criteria as a standard for evaluating the physical fitness level of adolescents.

Background The Internet has become a popular resource for patients to research diagnosed or suspected medical diseases. Medical institutions provide comprehensive online education resources about various conditions to the general public. The U.S. National Institutes of Health and American Medical Association recommend that patient education materials aimed at the general population should be written at or below eighth-grade reading level. The goal of this study is to assess the readability of patient education materials for central nervous system tumors across tertiary-care institutions. Methods Patient education materials were collected from National Cancer Institute designated cancer centers in October 2019. Materials were analyzed by Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) score using Microsoft Office Word software. Subgroups were formed based on regions in the United States (Northeast, Southeast, Midwest, Southwest, and West) as well as diagnostic and treatment information. Results A total of 180 documents were collected across 50 institutions. Overall median FKGL was 12.5, and median FRE was 38.2. Median FKGL for diagnostic information was 11.6 and FRE was 43.0, whereas median FKGL for treatment information was 12.9 and median FRE was 34.3. No statistically significant differences were seen for both FKGL and FRE among geographic regions (P > 0.05). Conclusions Online neuro-oncology patient education materials from tertiary institutions are written above recommended reading levels. Future efforts should be taken to improve the readability of brain tumor–specific patient education materials, particularly with information relating to treatment.

Background: The average readability level in the USA is a sixth grade level and for patients with chronic disease it is lower. Cirrhosis is a prevalent chronic disease that requires complex knowledge and instructions to manage. No research has been done about the understandability of online educational content for cirrhotic patients. Patients can find online materials curated by both general health platforms and high-volume liver transplant centers, and thus these materials were analyzed. Methods: After determining exclusion criteria, the websites of the top 20 general health platform results and the websites of the top 20 high-volume hepatology centers were analyzed. Readability was assessed using the Patient Education Materials Assessment Tool (Audiovisual Materials) (PEMAT-A/V), Flesch-Kincaid Grade Level tests, word counts, sentence counts, words per sentence, and time for an average sixth grader to read. Results: The mean grade level readabilities were 12.3 and 11.3 for the general resources and the transplant center resources, respectively. The online resources ranged from 9 to 389 sentences requiring an average of 9.8 min to read. The mean PEMAT-A/V scores were 70.05% for the general resources and 72.45% for the transplant center resources. There was a statistically significant difference in the Flesch-Kincaid grade level, sentence number, words per sentence, word count, and time for an average sixth grader to read the general resources and transplant center resources (P < 0.05). Conclusions: The online resources both from health platforms and hepatology centers available to patients with cirrhosis are too long and complex and underscore the need for simpler and shorter resources. J Curr Surg. 2020;10(1-2):1-6 doi: https://doi.org/10.14740/jcs401

Bu calismada, dusuk ve yuksek performans gosteren okullarda besinci, altinci ve sekizinci sinifta okuyan ogrenciler ile kiz ve erkek ogrenciler arasindaki fen basari farklari incelenmistir. Bu amac dogrultusunda yuksek basarili okullari temsilen Temel Egitimden Ortaogretime Gecis Sinavi’nda merkez ilcede en basarili on okul icinden ucu ve dusuk basarili okullari temsilen ise basari siralamasina gore son on okul icinden ikisi secilmistir. Calisma orneklemini, yuksek basarili okullarda toplam 612 besinci, 816 altinci ve 604 sekizinci sinif ogrencisi; dusuk basarili okullarda ise 231 besinci, 364 altinci ve 328 sekizinci sinif ogrencisi olusturmustur. Ogrencilerin fen bilimleri dersi donem sonu notlari fen basari olcutu olarak kullanilmistir. Sonuclar ogrencilerin fen basarisinin hem dusuk hem de yuksek basarili okullarda besinci siniftan ust siniflara gidildikce dustugunu gostermistir. Ayrica sonuclar, kiz ogrencilerin fen basarisinin hem dusuk hem de yuksek basarili okullarda cesitli sinif seviyelerinde erkek ogrencilerden daha yuksek oldugunu gostermistir. Son olarak arastirmanin sonuclari, kiz ve erkek ogrenciler arasindaki fen basari farkinin, yuksek basari gosteren okullarda daha belirgin oldugunu gostermistir.

Research has demonstrated that inattentive and hyperactive/impulsive behaviors are associated with peer rejection. Adding to prior research, which has relied on third-party raters or used aggregated peer nominations, we used Quadratic Assignment Procedure (QAP) correlations and logistic regressions (LRQAP) to examine concordance in peer nomination patterns, controlling for gender homophily between nominator/nominee. We also explored if classroom behavioral norms helped explain in which classrooms LRQAP models were significant. Participants (387 fourth and fifth graders from 21 general education classrooms) nominated classmates for three problem behaviors (i.e., inattention, disorganization, and hyperactivity/impulsivity) and as liked-most and liked-least. Teachers also rated each participating student on two scales—distractible and organized; classroom means were used to characterize the behavioral norms in each classroom. In QAP correlations, nominations for at least one problem behavior were significantly tied with dislike in 81% of classrooms (e.g., child nominated the peer as both inattentive and as liked-least), with inattention the most consistent predictor. Gender homophily had a significant, positive relation to dislike in LRQAP models for 43% of classrooms, but results were largely unchanged. Chi-square analyses of teacher ratings indicated that perceived inattention was more often tied to disliking in classrooms with low and moderate levels of distractibility than high distractibility. Variability of the LRQAP results was otherwise unrelated to classroom norms and grade level. Children who perceived peers as inattentive or hyperactive/impulsive also reported disliking those same peers in the majority of classrooms suggesting a targeted dislike in response to these behaviors.

Background: Patient information leaflets (PILs) are effectively used to improve the patient's knowledge about medications, disease, diet, and lifestyle modifications. Aim: This study aims to develop and evaluate PILs for coronary heart disease patients. Materials and Methods: Primary, secondary, and tertiary resources were used to develop PILs. The developed PILs were validated by four doctors, four academic pharmacists, and one dietician. PILs design and layout was prepared using barker able leaflet design (BALD) criteria. PILs readability was assessed using the Flesch Reading Ease test (FRE), Flesch–Kincaid Grade Level (FKGL), and user readability methods. User opinion on PILs content and design was obtained from patients. Results: The FRE and FKGL readability scores were 61.5 and 7.4, respectively. The BALD criteria scores for English, Kannada, and Malayalam PILs were 28, 27, and 26, respectively. The overall user testing readability means scores had significantly improved from 45 to 79.30. Nearly 82.55% of patients rated the PILs as good design and content. Conclusion: The developed leaflet met the standard criteria for easy reading and comprehension. The majority of the patients gave good opinion on the content and design of the PILs.

Purpose Prior research suggests that patient education materials on radiation therapy from various professional groups are written at reading levels above national recommendations of sixth to eighth grade. Since publication of these initial findings, many materials from these sources have been updated or newly created. However, the extent to which readability was considered in the design of these new documents remains unknown. Therefore, the goal of this investigation was to evaluate readability of online education materials for radiation therapy, comparing readability of updated materials with those included in the previous study. Methods and Materials Patient education materials related to radiation oncology were identified from websites of the 3 professional societies used in the original investigation (the American College of Radiology, the American Cancer Society, and the American Society for Radiation Oncology). The documents included in the first analysis were used as a comparator. To allow for accurate evaluation across groups, materials were matched by content; when necessary, documents were combined from the original cohort to create topically equivalent materials to reflect those currently available on society websites. Identified materials were analyzed using 7 validated readability indices, and results are reported in grade-level equivalents. Original materials were also reanalyzed with the same method. Results American Cancer Society materials had the lowest average baseline levels (9.4-11.3 grade level) and showed improved readability in the more recent materials (8.0-10.5 grade level). By contrast, the American Society for Radiation Oncology materials had high average baseline readability levels (11.1-13.9 grade level) that actually worsened in the more recent materials (11.7-16.2 grade level). The number of documents meeting national recommendations did not improve in the updated cohort. Conclusion Despite evidence that readability levels of patient education materials in radiation oncology are unacceptably high, the readability of newly created materials is not consistently improving across professional societies. Although certain groups may incorporate readability in the design of educational documents, more consistent consideration across all organizations is needed.

OBJECTIVE. As patients increasingly turn to the Internet for healthcare information, it is imperative that patient educational materials be written at an appropriate readability level. Although RadiologyInfo.org, a patient education library sponsored by the American College of Radiology (ACR) and Radiological Society of North America, was shown in 2012 to be written at levels too high for the average patient to adequately comprehend, it is unclear if there has been progress made in the past 5 years. The purpose of this study was to provide a 5-year update on the readability of patient education materials from RadiologyInfo.org. MATERIALS AND METHODS. All patient education articles available in 2017 from the ACR and RSNA-sponsored RadiologyInfo.org patient education library were reviewed. We assessed each article for readability using 6 quantitative readability scales: the Flesch-Kincaid (FK) grade level, Flesch Reading Ease, Gunnin-Fog Index, Coleman-Liau Index, Automated Readability Index, and the Simple Measure of Gobbledygook (SMOG). The number of articles with readability ≤ the 8th grade level (average reading ability of US adults) and the 6th-grade level (NIH-recommended level for patient materials) were determined. RESULTS. 131 patient education articles were reviewed. The mean readability grade level was greater than the 11th grade reading level for all readability scales. None of the articles were written at less than the 8th-grade or the 6th-grade levels. CONCLUSION. Although there has been an increasing awareness of the issue of readability of patient educational materials within the radiological community, the patient educational materials within the ACR and RSNA-sponsored RadiologyInfo.org website are still written at levels too high for the average patient. Future efforts should be made to improve the readability of those patient education materials.

A cross-sectional study design was utilized to evaluate the readability of patient education materials on the newborn hearing screen from Google and major institutions.The top 55 websites from the Google search "failed newborn hearing screen" and websites from major institutions (the U.S. NewsWorld Report ranked top 10 children's hospitals, the top 5 pediatric otolaryngology fellowships as ranked by Doximity Residency Navigator, the Centers for Disease and Control, the American Academy of Pediatrics and the American Academy of Otolaryngology-Head and Neck Surgery) were compiled. Text from each website was edited to remove extraneous text. Readability grade was calculated using the Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score, Gunning-Fog Index (GFI), Simple Measure of Gobbledygook (SMOG), Coleman-Liau Index, and Automated Readability Index. Intra- and inter-observer reliability were assessed.26 websites from Google and 29 websites from major institutions were evaluated. From Google, provider-oriented websites (n = 2) were more difficult to read than patient-oriented websites (n = 24) with statistical significance for FKGL (p 0.001), GFI (p 0.013) and SMOG (p 0.001). From the major institutions, more than half were at a reading level that exceeded the average American adult with an average FKGL 9.71 ± 2.69. Intra- and inter-observer reliability were both excellent with an intra-class correlation coefficient for each readability tool ≥0.950 (p 0.001).Online patient education materials about the newborn hearing screen may be too difficult for the average reader. Revisions to these materials and redirection to more readable online resources may be necessary to benefit a more inclusive patient population.

Teachers in urban schools confront significant and unique workplace challenges which put them at high risk for chronic stress, burnout, and attrition when unaddressed via training or support. The current mixed methods study investigated the challenging classroom situations reported by 164 predominantly White and female urban teachers in the United States, the prevalence of these challenges, and factors that predicted their prevalence. Results revealed the most prevalent types of teacher challenges were student misbehavior, aggressive student behavior, student motivation, lack of effective consequences, and behavioral health problems. Approximately half of teachers reported aggressive student behavior as a challenge and a majority related multiple challenges in the situations they confronted. Additionally, classroom discipline-related concern and middle school grade level taught predicted, respectively, a greater likelihood of challenges pertaining to student misbehavior and lack of effective consequences, and student motivation and behavioral health problems. These findings suggest that urban teachers find multiple aspects of student behavior challenging, commonly experience extreme student behavior, and that various factors impact the presence of these challenges. Implications for how to best support teachers on an individual, classroom, and organizational-level are discussed.

Inadequate sleep arising from various lifestyle and behavioral factors can affect the daytime functioning in adolescents and influence their health and well-being We studied the influence of various biopsychosocial correlates (age, gender, grade level, problems at home, afterschool classes, extracurricular activities, parental influence at bedtimes and rise times) on adolescents’ sleep behavioral variables (sleep hygiene practices, sleep quality, sleep duration, daytime sleepiness). Design: A cross-sectional study design was used. Socio-demographic questionnaire on sleep and activities, standardized questionnaires on sleep hygiene, sleep quality and daytime sleepiness were distributed to a sample of 660 healthy adolescents, aged 11–17 years, studying from grade 6 to grade 12 in various schools in Mangalore, India. Participants’ age was significantly associated with sleep quality and daytime sleepiness, with a higher level of daytime sleepiness and poor sleep quality noticed in older adolescents’ age group. Grade level, average time spent on additional classes, and home atmosphere of the participants were significantly associated with the entire target variables, with higher grade levels, more hours spent on additional classes, and problems at home contributing to worsening of sleep practices. Gender or time spent on extracurricular activities was not significantly associated with target variables. Sleep hygiene, daytime sleepiness, weekdays and weekends sleep duration were found to be significantly associated with parental influence at rising times, whereas only sleep hygiene and sleep quality was significantly associated with parental influence at bedtimes. The study results suggest that various biopsychosocial correlates significantly influence sleep behavioral practices in adolescents.

Introduction Online resources have become a major source of medical information for the general public. To date, there has not been an assessment of patient-oriented online resources for face and upper extremity transplantation candidates and patients. The goal of this study is to perform a comprehensive assessment of these resources. Methods Our analysis relied on 2 dimensions: comprehensiveness and readability. Comprehensiveness was evaluated using 14 predetermined variables. Readability was evaluated using 8 different readability scales through the Readability Studio Professional Edition Software (Oleander Software, Ltd, Vandalia, Ohio). Data were also collected from solid organ transplantation (SOT), specifically kidney and liver, programs for comparison. Results Face and upper extremity transplantation programs were significantly more likely to list exclusion criteria (73.9% vs 41.2%; P = 0.02), the need for life-long immunosuppression (87.0% vs 58.8%; P = 0.02), and benefits of transplantation (91.3% vs 61.8%; P = 0.01) compared with SOT programs. The average readability level of online resources by all face and upper extremity transplantation programs exceeded the sixth grade reading level recommended by the National Institutes of Health and the American Medical Association. The average reading grade level of online resources by these programs was also significantly higher than those of SOT with both exceeding the recommended reading level (13.95 ± 1.55 vs 12.60 ± 1.65; P = 0.003). Conclusions Future efforts in face and upper extremity transplantation should be directed toward developing standardized, comprehensive, and intelligible resources with high-quality content and simple language.

Purpose: The objective of this study was to compare the symptoms of cluttering among school-age children who do and do not clutter in the contexts of monologue, conversation and expository discourse.Method: A matched pairs design was used to compare cluttering symptoms according to the Lowest Common Denominator (LCD) definition of cluttering, a definition representing the core speech and fluency characteristics of cluttering agreed upon among experts. Cluttering symptoms (over-coarticulated words, normal disfluencies, abnormal pauses) in eight school-aged males with cluttering were compared to eight controls matched by sex and grade level in school. Symptoms were compared in the speech contexts of conversation, monologue and expository discourse.Result: Regardless of the speaking context, significantly more over-coarticulated words were found in children with cluttering (CWC) as compared to controls. Significantly more normal disfluencies were produced by CWC during monologue only.Conclusion: Study findings confirm increased over-coarticulation and normal disfluencies in specific speaking contexts in CWC when compared to controls. These findings provide the premise for clinical implications for cluttering assessment and diagnosis. Findings also provide the basis for further investigation of the validity of the LCD's symptom of abnormal pausing for accurate diagnosis of people who clutter.

Background Little is known about the readability and utility of patient education materials for stereotactic radiosurgery (SRS). Therefore, the goal of this investigation was to evaluate such materials from high-performing neurosurgery hospitals and professional societies through an analysis of readability and educational content. Methods In this cross-cross sectional study, 61 websites associated with the top 50 neurosurgery and neurology hospitals according to U.S. News & World Report (USNWR) and 11 predetermined professional medical societies were queried. Identified SRS education materials were analyzed by 6 readability indices. Educational content was assessed by 10 criteria based on surveys of patients’ perspectives about SRS. Results Fifty-four materials were identified from the target population (45 from USNWR hospital websites and 9 from professional society websites). Mean readability of materials ranged from 11.7 to 15.3 grade level, far more difficult than national recommendations of sixth and eighth grade. Materials were found to have deficiencies in educational content. Compared with high-performing hospitals, materials from websites of professional societies were longer (P = .002), and more likely to discuss risks and benefits specific to SRS (P = .008), alternative treatment options (P = .05) and expected outcomes or postprocedure descriptions (P = .004). Hospital materials were also more likely to favor brand-specific terminology (eg, GammaKnife) over generic terminology (eg, radiosurgery; P = .019). Conclusion Publicly available online patient educational materials for SRS are written at reading levels above national recommendations. Furthermore, many lack information identified as important by patients. Reevaluation and improvement of online SRS educational materials on a national scale are warranted.

Purpose: The average United States adult reads at an eighth-grade reading level. In an effort to ensure that patients understand written medical information, the National Institutes of Health and American Medical Association suggest that patient-directed material be written at a sixth- to eighth-grade reading level. We hypothesized that the mean reading level of surgical consent forms for hand surgery is not at or below an eighth-grade reading level (the suggested maximum from the National Institutes of Health). Methods: We conducted a retrospective review of consecutive consent forms used for hand surgery patients from 7 hand surgeons at our institution from June, 2017 to October, 2017. Consent forms were reviewed to collect the hand-written portion describing the procedure. We also assessed our institution’s consent form template. This text was assessed for readability and reading level with the following tools: Flesch-Kincaid Grade Level and Flesch Reading Ease. We categorized the procedures written on each consent form by procedure type and then created simplified language for the same procedure below an eighth-grade reading level. Results: Mean Flesch-Kincaid grade level of all consent forms was 10.5 (SD, 5.8) and mean Flesch readability was 33.6 (SD, 38.8), or difficult to read. A total of 78% and 58% of forms were written above the sixth- and eighth-grade reading levels, respectively. Readability was remarkedly poor; 94% and 88% of consent forms were written above sixth- and eighth-grade readability, respectively. The grade level of the consent form template was 17.1. Conclusions: Most consent forms were written above a sixth- to eighth-grade reading level and may not have been well-understood by patients. It is possible for physicians to write on surgical consent forms at a reading level that patients are more likely to understand by opting for less specialty-specific words and writing in shorter sentences. Improving the readability of patient-directed materials is an approach to improving patient-centered care. Type of study/level of evidence: Prognostic IV. Key words: hand surgery, readability, reading level, surgical consent form, upper-limb surgery

Amaç: Diş Hekimliği Fakültesi’nde okuyan öğrencilerin kendi ağız ve diş sağlıklarının değerlendirilmesi bu çalışmanın amacıdır. Bunun sonucunda toplum ağız ve diş sağlığını etkileyecek olan geleceğin diş hekimlerine, kişisel sağlıklarını korumaları için etkili eğitim yöntemlerini geliştirecek fikirler üretilecektir.Materyal ve Metot: İnönü Üniversitesi Diş Hekimliği Fakültesi’nde eğitim gören 200 öğrenciye sosyodemografik, ağız diş sağlığı, beslenme düzeniyle ilişkili sorular içeren anket verilmiş, ardından her öğrencinin oral muayenesi yapılarak değerlendirilmiştir.Bulgular: Öğrencilerin sınıf dereceleri arttıkça genel olarak ağız ve diş sağlığına ve beslenmeye önem verdikleri ortaya çıkmıştır. Eğitime başladıkları zamandan itibaren restoratif tedavi yaptırma oranı artmış, diş çürüğü sayısı azalmıştır.Sonuçlar: Diş hekimliği öğrencilerinin toplumu eğitecek ve etkileyecek bireyler olduğu düşünüldüğünde kişisel sağlık ve bakımlarına daha fazla dikkat etmeleri gerekmektedir. Dolayısıyla öğrencilere edindirilen doğru ağız ve diş sağlığı alışkanlığı tüm toplumun sağlığını etkileyecektir., Objective:The aim of this study is to evaluate the oral and dental health of studentsstudying at the Faculty of Dentistry. As a result, the ideas to improveeffective training methods for future dentists who will have impact on oral anddental health of the society will be developed.Methods:A survey including sociodemographic, oral and dental health-associatedquestions was conducted with 200 students who were studying at Faculty ofDentistry of Inonu University and subsequently, dental examination of eachstudent was performed and evaluated.Results:It has been noted that students generally give importance to oral and dentalhealth and nutrition as their grade level increases. It is observed that sincethe beginning of their education, the rate of restorative treatment increased,and the number of tooth cavity is decreased.Conclusions:Considering that dentistry students are individuals who will educate andinfluence the society, they need to pay more attention to their personal healthand care. Therefore, the right oral and dental health practice acquired as ahabit by students will affect the health of the entire society.

To evaluate current online parent education resources for children returning to school after a cancer diagnosis. Online search was conducted using 3 search engines and terms recommended by affected families. Sites were evaluated by 3 reviewers for understandability and actionability (scored 0-100%) using the Patient Education Materials Assessment Tool (PEMAT). Readability was assessed using Flesch-Kincaid (grade K-12) and content comprehensiveness by a clinical expert review for 5 late effect domains (scored 0-100%). A total of 56 unique online resources were evaluated. Mean understandability and actionability scores were 54% (range 17-83) and 36% (range 0-83) respectively. The mean Flesch-Kincaid grade level was 10th grade (mode 12th). Comprehensiveness of domain coverage was 34% (mode 20%). Some high-quality materials for this topic are available, but generally low scores on the PEMAT scales and high reading level estimates on Flesch-Kincaid indicate parents may have difficulty understanding and using the information. The low scores for comprehensiveness of information indicate parents will likely need to access multiple sources for complete information. A table provides the names, website (URL), and scoring for the 24 top-rated sites and can be used to make recommendations to parents with improved confidence in quality.

Purpose To evaluate grade-level readability of dense breast notification letters (DBNs) and popular websites. Methods HIPAA-compliant, institutional review board–exempt study. As of April 2018, letter characteristics and grade-level readability were evaluated from states with mandated text using five readability metrics, one of which was the Flesch-Kincaid Grade Level. For states that had mandated DBNs in 2016, the 2016 data were compared with 2018. Readability was also assessed for common websites about dense breasts. Results Thirty states had mandated text for DBNs. All were written above a Flesch-Kincaid sixth-grade level. Eight state DBNs were around or below a Flesch-Kincaid eighth-grade level. Connecticut was the highest (19.4) and Alabama and New York lowest (both at 7.2). For all states, the mean readability score using the five metrics exceeded an eighth-grade level. Of states that had updated DBNs since 2016, only one state significantly improved readability (Missouri 13.1 to 8.5). All DBNs discussed that breast density may mask cancer on a mammogram, 20 discussed the association with increased risk of breast cancer, and 23 discussed supplemental screening. For websites, the range of Flesch-Kincaid grade-level readability was 6 to 11.3. The lowest was the American Cancer Society dense breast website (6.0) followed by ACR dense breast patient pamphlet (7.2). Conclusion As of 2018, the mean readability score using five metrics for all state-mandated DBNs exceeded an eighth-grade reading level. Compared with 2016, only one state significantly decreased DBN grade-level readability. Publicly available websites performed relatively better.

Learning mathematics is a complex process that requires the development of multiple domain-general and domain-specific skills. It is therefore not unexpected that many children struggle to stay at grade level, and this becomes especially difficult when several abilities from both domains are impaired, as in the case of mathematical learning disabilities (MLD). Surprisingly, although MLD is one of the most common neurodevelopmental disorders affecting schoolchildren, most of the diagnostic instruments available do not include assessment of domain-general and domain-specific skills. Furthermore, very few are computerized. To the best of our knowledge, there is no tool with these features for Spanish-speaking children. The purpose of this study was to describe the protocol for the diagnosis of Spanish MLD children using the BM-PROMA multimedia battery. BM-PROMA facilitates the evaluation of both skill domains, and the 12 tasks included for this purpose are empirically evidence-based. The strong internal consistency of BM-PROMA and its multidimensional internal structure are demonstrated. BM-PROMA proves to be an appropriate tool for diagnosing children with MLD during primary education. It provides a broad cognitive profile for the child, which will be relevant not only for diagnosis but also for individualized instructional planning.

The purpose of this study was to determine the amount of time elementary and middle-school students spend away from the classroom and clinic time required to administer vaccines in school-located vaccination (SLV) clinics. We conducted a time study and estimated average time away from class and time to administer vaccine by health department (HD), student grade level, vaccine type, and vaccination process for SLV clinics during the 2012–2013 school year. Average time away from classroom was 10 min (sample: 688 students, 15 schools, three participating HD districts). Overall, time to administer intranasally administered influenza vaccine was nearly half the time to administer injected vaccine (52.5 vs. 101.7 s) (sample: 330 students, two HDs). SLV administration requires minimal time outside of class for elementary and middle-school students. SLV clinics may be an efficient way to administer catch-up vaccines to children who missed routine vaccinations during the coronavirus disease-2019 pandemic.

Objective The effects of shared clinical notes on patients, care partners, and clinicians (“open notes”) were first studied as a demonstration project in 2010. Since then, multiple studies have shown clinicians agree shared progress notes are beneficial to patients, and patients and care partners report benefits from reading notes. To determine if implementing open notes at a hematology/oncology practice changed providers’ documentation style, we assessed the length and readability of clinicians’ notes before and after open notes implementation at an academic medical center in Boston, MA, USA. Materials and Methods We analyzed 143 888 notes from 60 hematology/oncology clinicians before and after the open notes debut at Beth Israel Deaconess Medical Center, from January 1, 2012 to September 1, 2016. We measured the providers’ (medical doctor/nurse practitioner) documentation styles by analyzing character length, the number of addenda, note entry mode (dictated vs typed), and note readability. Measurements used 5 different readability formulas and were assessed on notes written before and after the introduction of open notes on November 25, 2013. Results After the introduction of open notes, the mean length of progress notes increased from 6174 characters to 6648 characters (P Conclusions After the implementation of open notes, progress notes and A&P sections became both longer and easier to read. This suggests clinician documenters may be responding to the perceived pressures of a transparent medical records environment.