https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(09)60914-4.pdf

Indigenous health part 1: determinants and disease patterns

Objectives To update a 2004 systematic review of health care service use and health outcomes related to differences in health literacy level and interventions designed to improve these outcomes for individuals with low health literacy. Disparities in health outcomes and effectiveness of interventions among different sociodemographic groups were also examined. Data sources We searched MEDLINE®, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, PsychINFO, and the Educational Resources Information Center. For health literacy, we searched using a variety of terms, limited to English and studies published from 2003 to May 25, 2010. For numeracy, we searched from 1966 to May 25, 2010. Review methods We used standard Evidence-based Practice Center methods of dual review of abstracts, full-text articles, abstractions, quality ratings, and strength of evidence grading. We resolved disagreements by consensus. We evaluated whether newer literature was available for answering key questions, so we broadened our definition of health literacy to include numeracy and oral (spoken) health literacy. We excluded intervention studies that did not measure health literacy directly and updated our approach to evaluate individual study risk of bias and to grade strength of evidence. Results We included good- and fair-quality studies: 81 studies addressing health outcomes (reported in 95 articles including 86 measuring health literacy and 16 measuring numeracy, of which 7 measure both) and 42 studies (reported in 45 articles) addressing interventions. Differences in health literacy level were consistently associated with increased hospitalizations, greater emergency care use, lower use of mammography, lower receipt of influenza vaccine, poorer ability to demonstrate taking medications appropriately, poorer ability to interpret labels and health messages, and, among seniors, poorer overall health status and higher mortality. Health literacy level potentially mediates disparities between blacks and whites. The strength of evidence of numeracy studies was insufficient to low, limiting conclusions about the influence of numeracy on health care service use or health outcomes. Two studies suggested numeracy may mediate the effect of disparities on health outcomes. We found no evidence concerning oral health literacy and outcomes. Among intervention studies (27 randomized controlled trials [RCTs], 2 cluster RCTs, and 13 quasi-experimental designs), the strength of evidence for specific design features was low or insufficient. However, several specific features seemed to improve comprehension in one or a few studies. The strength of evidence was moderate for the effect of mixed interventions on health care service use; the effect of intensive self-management inventions on behavior; and the effect of disease-management interventions on disease prevalence/severity. The effects of other mixed interventions on other health outcomes, including knowledge, self-efficacy, adherence, and quality of life, and costs were mixed; thus, the strength of evidence was insufficient. Conclusions The field of health literacy has advanced since the 2004 report. Future research priorities include justifying appropriate cutoffs for health literacy levels prior to conducting studies; developing tools that measure additional related skills, particularly oral (spoken) health literacy; and examining mediators and moderators of the effect of health literacy. Priorities in advancing the design features of interventions include testing novel approaches to increase motivation, techniques for delivering information orally or numerically, "work around" interventions such as patient advocates; determining the effective components of already-tested interventions; determining the cost-effectiveness of programs; and determining the effect of policy and practice interventions.

/pdf/health-literacy-interventions-and-outcomes-an-updated-chswt8nilu.pdf

Health literacy interventions and outcomes: an updated systematic review.

https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(14)70168-7.pdf

Respiratory risks from household air pollution in low and middle income countries

Risk of COPD From Exposure to Biomass Smoke: A Metaanalysis

Rationale: Exposure to biomass smoke has been related to adverse health effects. In Mexico, one household in four still cooks with biomass fuel, but there has been no evaluation of the health impact of reducing indoor air pollution. Objectives: To evaluate the health impact of the introduction of an improved biomassstove (Patsari; Interdisciplinary Groupfor Appro- priate Rural Technology (GIRA), Patzcuaro, Mexico) in Mexican women. Methods:ArandomizedcontrolledtrialwasconductedintheCentral Mexican state of Michoacan. Households were randomized to re- ceive the Patsari stove or keep their traditional open fire. A total of 552 women were followed with monthly visits over 10 months to assessstoveuse,inquireaboutrespiratoryandothersymptoms,and obtain lung function measurements. Statistical analysis was con- ducted using longitudinal models. Measurements and Main Results: Adherence to the intervention was low(50%).WomenwhoreportedusingthePatsaristovemostofthe timecomparedwiththoseusingtheopenfirehadsignificantlylower riskofrespiratorysymptoms(relativerisk(RR),0.77;95%confidence interval(CI),0.62-0.95forcoughandRR,0.29;95%CI,0.11-0.77for wheezing) adjusted for confounders. Similar results were found for otherrespiratorysymptomsas wellas for eyediscomfort, headache, and back pain. Actual use of the Patsari stove was associated with alowerFEV1decline(31ml)comparedwiththeopenfireuse(62ml) over 1 year of follow-up (P 5 0.012) for women 20 years of age and older, adjusting for confounders. Conclusions: The use of the Patsari stove was significantly associated with a reduction of symptoms and of lung function decline compa- rable to smoking cessation.

https://www.atsjournals.org/doi/pdf/10.1164/rccm.200810-1556OC

Improved biomass stove intervention in rural Mexico: impact on the respiratory health of women.

Background: More than two-fifths of the world's population uses solid fuels, mostly biomass, for cooking. The resulting biomass smoke exposure is a major cause of chronic obstructive pulmonary disease (COPD) among women in developing countries. Objective:

/pdf/effects-of-woodsmoke-exposure-on-airway-inflammation-in-1hgbkbnux8.pdf

Effects of Woodsmoke Exposure on Airway Inflammation in Rural Guatemalan Women

Nxwisen, ntzarrin or ntzo’lin? Mapping children’s respiratory symptoms among indigenous populations in Guatemala

Low birth weight in rural guatemala: indoor air pollution as a contributing factor

Indoor air pollution from biomass fuel use and lung health in young guatemalan women: preliminary analysis of a randomised controlled trial

Burns to children in wood fuel using homes in rural guatemala

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