bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health Literacy and Health Service Use in Germany
Authors: Berens Eva-Maria , Vogt Dominique , Ganahl Kristin , Weishaar Heide , Pelikan Jürgen , Schaeffer Doris 
Published: June 2018

Background:
Health literacy (HL) is defined as the ability to process health-related information to make decisions to maintain health and improve quality of life. A growing number of studies demonstrate that people with lower HL are less likely to use preventive services but more likely to use curative, emergency, or hospital care.

Objective:
This study investigated the relationship between HL and the use of different types of health services in a sample of the general German population, as we expected that the effect of HL on the frequency of use differs by type of health service.

Methods:
A nationally representative sample of 2,000 people in Germany was interviewed in person in 2014. Analyses of the data included frequencies of contacts with doctors, other health professionals, hospitals, and emergency services. Analysis also included a HL measure (European Health Literacy Survey Questionnaire), as well as sociodemographic and health status indicators. To test whether and how HL is related to the frequency of use of the different types of curative health services, regression analyses were performed.

Key Results:
Respondents with lower HL scores reported more frequent use of all four included types of curative health services. Although multiple regression analysis showed a direct significant effect of HL only on doctor (β = −.066) and other health professionals visits (β = −.103), no significant direct effect of HL on hospital and emergency services use was found when sociodemographic and health-related factors were controlled for.

Conclusions:
Health professionals should be aware that their patients are likely to have difficulties in understanding and processing health-related information. Interventions to strengthen HL should aim at improving health care literacy and, moreover, not only address individuals but also consider demands related to the health care system and health professionals' communication skills.

Plain Language Summary:

This study investigates the relationship between health literacy and health service use in Germany. The results show that health services are used more often by individuals with low health literacy. Thus, health professionals need to take low health literacy into account in their communication with patients.

[
HLRP: Health Literacy Research and Practice.
2018;2(2):e115–e122.]
Health Literacy Estimation of English and Spanish Language Caregivers
Authors: Cooper Michael , Blucker Ryan , Thompson David , Griffeth Elaine , Grassi Michael , Damron Kelsey , Parrish Colleen , Gillaspy Stephen , Dunlap Marianne 
Published: June 2018

Background:
Provider ability to estimate caregiver health literacy (HL) in English-speaking caregivers has been shown to be poor, but estimation of HL in Spanish-speaking caregivers by physicians and staff has yet to be studied. Linguistic differences can further hinder communication in medical care.

Objective:
This study evaluated how well pediatric providers and staff predict caregiver HL as measured by two HL tools in a bilingual (English/Spanish) population.

Method:
For this study, we obtained a convenience sample of caregivers, evaluating one group with the Newest Vital Sign (NVS) and the second group with the Short Assessment of Health Literacy (SAHL). Physicians/nurse practitioners (NPs), and medical assistants (MAs) estimated caregiver scores for each tool. We dichotomized estimated and actual scores for each tool using published standards. We used McNemar's test and Cohen's Kappa to evaluate agreement between dichotomized predicted and actual scores. We used log binomial regression to examine how caregiver's language affected agreement between dichotomized caregiver scores and provider estimates. All physicians/NPs were native English speakers only and all MAs were native bilingual English/Spanish speakers. Physicians/NPs used interpretation services when appropriate.

Key Results:
Fifty caregivers were evaluated using the NVS and 50 using the SAHL. There was no overall association between dichotomized physician/NP or MA estimation and caregiver score for either tool. However, providers' estimates were less likely to match caregiver scores when the caregiver's language was Spanish (NVS: relative risk [RR] = 0.57 [95% CI 0.37, 0.87], SAHL: RR = 0.37 [95% CI 0.23,0.6]).

Conclusion:

Physician/NP and MA ability to estimate caregiver HL in English proficient and limited English proficiency caregivers is poor. The physician/NP group was less likely to estimate HL correctly if the caregivers spoke Spanish. Providers must use additional caution when providing cross-language care.

[
HLRP: Health Literacy Research and Practice
. 2018;2(2):e107–e114.]

Plain Language Summary:
This study examined estimation of health literacy of English- and Spanish-speaking caregivers by pediatric providers and medical assistants. We found that both providers and staff estimate caregiver health literacy poorly, and that primary language discordance may be a factor. The results support the institution of universal health literacy precautions for all caregivers of pediatric patients.
The Christian faith and evolution: An evolving, unresolved debate
Authors: Conradie Ernst M. 
Published: June 2018

This article sketches how the debate on Christian faith and evolution has evolved. Seven challenges are identified and described in the debate, namely, regarding a recognition of deep (geological) time (challenging the historicity of the biblical creation narratives), understanding the role of chance in natural selection (posing questions about the nature of divine action, e.g., providence), human descent (challenging presumed human distinctiveness), a recognition of natural suffering (challenging the benevolence of the Creator), identifying the evolutionary roots of evil (challenging Christian views on the fall of humanity), a recognition of natural disselection (challenging notions of divine election) and, finally, evolutionary explanations of the emergence of morality and of religion (reiterating the challenge of atheism). It is argued that with each of these challenges, some of the underlying problems were provisionally resolved, only to reappear later in an even more challenging form.Intradisciplinary and/or interdisciplinary implications: The contribution describes shifts in Christian discourse on evolution and challenges the tacit assumption that any one aspect of the debate has been fully resolved by articulating some of the questions that have been resolved and others that remain unresolved.
Student Mobility and Employability: The Ethiopian Experience
Authors: Tamrat Wondwosen , Teferra Damtew 
Published: June 2018

This article reports the findings of a larger study conducted on international students from Ethiopia to gauge their views on the impact of their training on employability. For those who can afford or have the chance, international studies are perceived as mechanisms of improving one’s employability due to the various advantages they can offer. This has become one of the major pull factors in student mobility.
The Vanishing Public Monopoly
Authors: Levy Daniel C. 
Published: June 2018

A significant aspect of the massive growth of private higher education is the near disappearance of public monopoly. Almost all countries now have both public and private sectors of higher education. The decline of public monopoly has been notable for decades, the demise of Communism providing the most impactfulmoment. The remaining monopoly presence is mostly in small systems, often with rather left-leaning political regimes. In several of these countries, activity to end public monopoly is already underway.
Reconsidering Private Higher Education in Brazil
Authors: De Araújo Filho Targino 
Published: June 2018

This article discusses the role of the for-profit private sector in the Brazilian Higher Education System. Emphasizing its hegemony, we consider that the adoption of mercantilist logic has implications for the quality of supply and is leading the sector to be characterized as an oligopoly. Although the National Education Plan predicts an increase in public sector enrollment as massification continues, current economic and political conditions may prevent this expansion, leaving the country in a very delicate situation.
Sexual Harassment at African Higher Education Institutions
Authors: Dranzoa Christine 
Published: June 2018

In most African states, joining higher education institutions (HEIs) is, for students, an investment in their own economic progress. Yet, HEIs are sites where sexual harassment and gender-based violence (GBV) occur, increasing the vulnerability of newly enrolled female students and of women in general. A strong gender policy environment, a clear stand by senior management at HEIs, and the empowerment ofmen with respect to gender equity issues are remedies to help achieve the Sustainable Development Goals (SDGs), especially goal 3 (Good Health and Well-being), goal 4 (Quality Education), goal 5 (Gender Equality), and goal 10 (Reduced Inequality).
The #MeToo Movement as a Global Learning Moment
Authors: Regulska Joanna 
Published: June 2018

This article places the #MeToo movement within the context of global learning. Given the global nature of sexual harassment, sexual assault, and violence against women, it asks what responsibilities we have as international educators. It raises numerous questions that can be utilized as teaching tools—and it proposes that institutions rethink internationalization strategies and seize this moment of opportunity to create aninclusive and diverse environment conducive to advancing intercultural and intracultural understanding.
Medical Students’ Knowledge, Attitudes, and Behaviors With Regard to Skin Cancer and Sun-Protective Behaviors
Authors: Ivanov Nedyalko N. , Swan Aili , Guseman Emily Hill , Whipps Jonathon , Jensen Laura L. , Beverly Elizabeth A. 
Published: June 2018

Abstract

Background
Skin cancer is the most prevalent cancer in the United States. Training medical students about the importance of sun-protective behaviors is critical to reducing skin cancer rates. However, minimal research has explored osteopathic medical students’ knowledge and behaviors with regard to the sun's effect on skin health.

Objective
To assess first-year osteopathic medical students’ knowledge about skin cancer and UV radiation, attitudes toward tanning, and sun-protective behaviors to establish baseline values.

Methods
Using a descriptive, cross-sectional study design, the authors evaluated students’ knowledge, attitudes, and behaviors through a quiz.

Results
A total of 121 first-year osteopathic medical students completed the quiz. The mean (SD) score was 74.6% (11.5%). Two-thirds of participants (n=82) correctly identified basal cell carcinoma as the most common skin cancer, and the majority identified the ABCDs (asymmetry, border irregularity, color, and diameter) of melanoma detection (96 [79.3%], 106 [87.6%], 108 [89.3%], and 94 [77.7%], respectively). Most participants were aware that cloud cover and swimming underwater do not provide UV ray protection (121 [100%] and 109 [90.1%], respectively), a fact that is often misconceived. Forty participants (33.1%) usually or always used some form of sun protection when outdoors. Forty-seven participants (38.8%) believed that a tan makes one look healthy, and 43 participants (35.6%) sunbathed with the intention of tanning.

Conclusion
Physicians are uniquely positioned to counsel patients regarding sun-protective behaviors. Thus, a medical school curriculum that includes education about the sun's effect on health is needed for the prevention and early recognition of skin cancer in future patients.
Diversity and abundance of conspicuous macrocrustaceans on coral reefs differing in level of degradation
Authors: González-Gómez Roberto , Briones-Fourzán Patricia , Álvarez-Filip Lorenzo , Lozano-Álvarez Enrique 
Published: June 2018

Coral reefs sustain abundant and diverse macrocrustaceans that perform multiple ecological roles, but coral reefs are undergoing massive degradation that may be driving changes in the species composition and abundance of reef-associated macrocrustaceans. To provide insight into this issue, we used non-destructive visual census techniques to compare the diversity and abundance of conspicuous macrocrustaceans (i.e., those >1 cm and visible without disturbance) between two shallow Caribbean coral reefs similar in size (∼1.5 km in length) and close to each other, but one (“Limones”) characterized by extensive stands of the branching coral Acropora palmata, and the other (“Bonanza”) dominated by macroalgae and relic coral skeletons and rubble (i.e., degraded). We also assessed the structural complexity of each reef and the percent cover of various benthic community components. Given the type of growth of A. palmata, we expected to find a greater structural complexity, a higher cover of live coral, and a lower cover of macroalgae on Limones, and hence a more diverse and abundant macrocrustacean community on this reef compared with Bonanza. Overall, we identified 63 macrocrustacean species (61 Decapoda and two Stomatopoda). Contrary to our expectations, structural complexity did not differ significantly between the back-reef zones of these reefs but varied more broadly on Limones, and the diversity and abundance of macrocrustaceans were higher on Bonanza than on Limones despite live coral cover being higher on Limones and macroalgal cover higher on Bonanza. However, the use of various types of microhabitats by macrocrustaceans differed substantially between reefs. On both reefs, the dominant species were the clinging crab Mithraculus coryphe and the hermit crab Calcinus tibicen, but the former was more abundant on Bonanza and the latter on Limones. M. coryphe occupied a diverse array of microhabitats but mostly coral rubble and relic skeletons, whereas C. tibicen was often, but not always, found associated with colonies of Millepora spp. A small commensal crab of A. palmata, Domecia acanthophora, was far more abundant on Limones, emerging as the main discriminant species between reefs. Our results suggest that local diversity and abundance of reef-associated macrocrustaceans are partially modulated by habitat degradation, the diversity of microhabitat types, and the establishment of different commensal associations rather than by structural complexity alone.
Risk of Incident Osteoarthritis of the Hand in Statin Initiators: A Sequential Cohort Study
Authors: Burkard Theresa , Hügle Thomas , Layton J. Bradley , Glynn Robert J. , Bloechliger Marlene , Frey Noel , Jick Susan S. , Meier Christoph R. , Spoendlin Julia 
Published: June 2018

ObjectiveTo investigate the association between statin therapy initiation and incident hand osteoarthritis (OA).MethodsWe performed a propensity score–matched cohort study using data from the UK‐based Clinical Practice Research Datalink. Statin initiators had ≥1 statin prescription between 1996 and 2015 and were matched 1:1 on their propensity score to noninitiators within 10 sequential 2‐year cohort entry blocks. After a 180‐day run‐in period, patients were followed in an as‐treated approach until a recorded diagnosis of hand OA or until censoring (change in exposure status, development of an exclusion criterion, or maximum follow‐up of 5.5 years). We applied Cox proportional hazard regression to calculate hazard ratios (HRs) with 95% confidence intervals (95% CIs) overall and in subgroups of sex, age, statin dose, statin agent, preexisting dyslipidemia, and treatment duration. To compare results, we ran all analyses with negative and positive control outcomes and assessed generalized OA as a secondary outcome. We further performed the overall analysis with an active comparator (topical glaucoma therapy initiators).ResultsAmong 233,608 statin initiators and the same number of noninitiators, we observed an overall HR for hand OA of 0.98 (95% CI 0.88–1.09). The observed null result remained unchanged in all subgroups. Results were highly similar for generalized OA and negative control outcomes. In addition, the active comparator analysis showed a null result with an HR for hand OA of 0.85 (95% CI 0.56–1.29). Previously known associations with positive control outcomes were observed.ConclusionThere was no association between statin initiation and incident hand OA in this study.
Responsiveness of Patient‐Reported Outcomes Measurement Information System Measures in Rheumatoid Arthritis Patients Starting or Switching a Disease‐Modifying Antirheumatic Drug
Authors: Wohlfahrt Alyssa , Bingham Clifton O. , Marder Wendy , Phillips Kristine , Bolster Marcy B. , Moreland Larry W. , Zhang Zhi , Neogi Tuhina , Lee Yvonne C. 
Published: June 2018

ObjectiveThe Patient‐Reported Outcomes Measurement Information System (PROMIS) is a calibrated item bank used to assess patient‐reported outcomes across multiple domains. The purpose of this study was to describe the performance of selected PROMIS measures in patients with rheumatoid arthritis (RA) with active disease who were initiating a disease‐modifying antirheumatic drug (DMARD).MethodsParticipants in an ongoing prospective observational study completed 8 PROMIS measures before and after DMARD initiation. Linear regression models were performed to identify cross‐sectional associations between baseline PROMIS measures and disease activity, measured using the Clinical Disease Activity Index (CDAI). Paired t‐tests were performed to evaluate responsiveness after 12 weeks of DMARD treatment. Associations between changes in PROMIS measures and changes in the CDAI score were assessed using linear regression.ResultsAmong the 156 participants who completed the first study visit, the mean ± SD baseline CDAI score was 25.5 ± 14.0. Baseline scores for PROMIS measures of physical health, pain, and sleep were associated with the baseline CDAI score (P ≤ 0.05). Among the 106 participants with 12‐week data, all PROMIS scores improved after DMARD initiation (P ≤ 0.05). With the exception of depression, changes in all assessed PROMIS measures were correlated with changes in the CDAI score (standardized βs from |0.23| to |0.38|).ConclusionThese data provide support for the utility of PROMIS measures for the assessment of physical and mental health in individuals with active RA. All PROMIS measures improved significantly after DMARD initiation, with the magnitudes of association between changes in PROMIS measures and changes in the CDAI score in the low‐to‐moderate range.
Patient‐Reported Outcomes Are More Important Than Objective Inflammatory Markers for Sick Leave in Biologics‐Treated Patients With Rheumatoid Arthritis
Authors: Olofsson Tor , Söderling Jonas K. , Gülfe Anders , Kristensen Lars‐Erik , Wallman Johan K. 
Published: June 2018

ObjectiveTo study the impact of common noncomposite disease activity measures on sick leave in biologics‐treated patients with rheumatoid arthritis (RA).MethodsData from study visits by biologics‐treated RA patients of working age (<65 years) in the observational South Swedish Arthritis Treatment Group Register between 2005 and 2011, were included (5,118 visits by 941 patients). We performed association analyses between various noncomposite disease activity measures at each visit and the number of days of sick leave during the subsequent month; this information was retrieved from the Social Insurance Agency. Adjusted separate generalized estimating equation regression models were used, and analyses were stratified according to sick leave status for the month preceding each visit (no, partial, or full sick leave). Results are presented as standardized beta coefficients for comparability.ResultsAmong modifiable noncomposite disease activity measures, patient's assessment of pain and disease activity scored on a visual analog scale (VAS) were most strongly associated with subsequent sick leave, irrespective of baseline sick leave status. Generally, measures that were more objective (swollen joint count, erythrocyte sedimentation rate, and C‐reactive protein) had less impact on sick leave compared with variables that were more subjective (patient's pain and global scores on a VAS, evaluator's global assessment of disease activity on a 5‐grade Likert scale, and tender joint count).ConclusionMeasures of disease activity that are more subjective have a greater impact on sick leave in biologics‐treated patients with RA compared with variables that are more objective, suggesting a stronger focus on subjective measures when targeting work loss or intervening to reduce it.
Invasiveness of Cells Leads to Changes in Their Interaction Behavior with the Glycocalyx
Authors: Broda Ellen , Torrano Adriano A. , Löbbert Laura , Möckl Leonhard , Bräuchle Christoph , Engelke Hanna 
Published: June 2018

AbstractTransendothelial migration is a crucial step during metastasis. Before circulating tumor cells enter the endothelium, they face the glycocalyx. While invasive migration of cancer cells is well studied, few investigations exist regarding their interaction with the glycocalyx. Here, the interaction of three breast cell lines with an endothelial glycocalyx is studied. Benign MCF‐10A, noninvasive malign MCF‐7, and invasive MDA‐MB‐231 cells penetrate the glycocalyx, just adhere to it or approach without even attaching to it. Remarkable fluctuations in these interaction modes are detected by time‐resolved interaction profiles. Adhesion, migration, and invasion characteristics as well as combinations of interaction modes, cell shapes, and cell extensions are studied. The motility and penetration depth into the glycocalyx are analyzed. The invasive cells are the most flexible, penetrating the glycocalyx mostly with a round shape and feet‐like membrane extensions. Noninvasive cancer cells penetrate the glycocalyx the deepest over time and benign cells integrate more likely into the endothelial cell layer underneath the glycocalyx.
Dual Intratumoral Redox/Enzyme‐Responsive NO‐Releasing Nanomedicine for the Specific, High‐Efficacy, and Low‐Toxic Cancer Therapy
Authors: Jia Xiaobo , Zhang Yihua , Zou Yu , Wang Yao , Niu Dechao , He Qianjun , Huang Zhangjian , Zhu Weihong , Tian He , Shi Jianlin , Li Yongsheng 
Published: June 2018

AbstractChemotherapy suffers numbers of limitations including poor drug solubility, nonspecific biodistribution, and inevitable adverse effects on normal tissues. Tumor‐targeted delivery and intratumoral stimuli‐responsive release of drugs by nanomedicines are considered to be highly promising in solving these problems. Compared with traditional chemotherapeutic drugs, high concentration of nitric oxide (NO) exhibits unique anticancer effects. The development of tumor‐targeting and intratumoral microenvironment‐responsive NO‐releasing nanomedicines is highly desired. Here a novel kind of organic–inorganic composite nanomedicine (QM‐NPQ@PDHNs) is presented by encapsulating a glutathione S‐transferases π (GSTπ)‐responsive drug O2‐(2,4‐dinitro‐5‐{[2‐(β‐d‐galactopyranosyl olean‐12‐en‐28‐oate‐3‐yl)‐oxy‐2‐oxoethyl] piperazine‐1‐yl} phenyl) 1‐(methylethanolamino)diazen‐1‐ium‐1,2‐dilate (NPQ) as NO donor and an aggregation‐induced‐emission (AIE) red fluorogen QM‐2 into the cores of the hybrid nanomicelles (PEGylated disulfide‐doped hybrid nanocarriers (PDHNs)) with glutathione (GSH)‐responsive shells. The QM‐NPQ@PDHN nanomedicine is able to respond to the intratumoral over‐expressed GSH and GSTπ, resulting in the responsive biodegradation of the protective organosilica shell and NPQ release, and subsequent NO release within the tumor, respectively, and thus normal organs remain unaffected. This work demonstrates a paradigm of dual intratumoral redox/enzyme‐responsive NO‐release nanomedicine for tumor‐specific and high‐efficacy cancer therapy.