From Husserl to van Manen. A review of different phenomenological approaches.

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.

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Health literacy interventions and outcomes: an updated systematic review.

Osteoporosis constitutes a major public health problem through its association with age-related fractures, most notably those of the proximal femur. Substantial geographic variation has been noted in the incidence of hip fracture throughout the world, and estimates of recent incidence trends have varied widely. Studies in the published literature have reported an increase, plateau, and decrease in age-adjusted incidence rates for hip fracture among both men and women. Accurate characterisation of these temporal trends is important in predicting the health care burden attributable to hip fracture in future decades. We therefore conducted a review of studies worldwide, addressing secular trends in the incidence of hip and other fractures. Studies in western populations, whether in North America, Europe or Oceania, have generally reported increases in hip fracture incidence through the second half of the last century, but those continuing to follow trends over the last two decades have found that rates stabilise with age-adjusted decreases being observed in certain centres. In contrast, some studies suggest that the rate is rising in Asia. This synthesis of temporal trends in the published literature will provide an important resource for preventing fractures. Understanding the reasons for the recent declines in rates of hip fracture may help understand ways to reduce rates of hip fracture worldwide.

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Secular trends in the incidence of hip and other osteoporotic fractures

Osteoporosis is a major health problem, especially in elderly populations, and is associated with fragility fractures at the hip, spine, and wrist. Hip fracture contributes to both morbidity and mortality in the elderly. The demographics of world populations are set to change, with more elderly living in developing countries, and it has been estimated that by 2050 half of hip fractures will occur in Asia. This review conducted using the PubMed database describes the incidence of hip fracture in different regions of the world and discusses the possible causes of this wide geographic variation. The analysis of data from different studies show a wide geographic variation across the world, with higher hip fracture incidence reported from industrialized countries as compared to developing countries. The highest hip fracture rates are seen in North Europe and the US and lowest in Latin America and Africa. Asian countries such as Kuwait, Iran, China, and Hong Kong show intermediate hip fracture rates. There is also a north-south gradient seen in European studies, and more fractures are seen in the north of the US than in the south. The factors responsible of this variation are population demographics (with more elderly living in countries with higher incidence rates) and the influence of ethnicity, latitude, and environmental factors. The understanding of this changing geographic variation will help policy makers to develop strategies to reduce the burden of hip fractures in developing countries such as India, which will face the brunt of this problem over the coming decades.

Epidemiology of hip fracture: Worldwide geographic variation.

Background
Highly crosslinked polyethylene (HXLPE) was introduced to reduce wear and osteolysis in total joint arthroplasty. While many studies report wear and osteolysis associated with HXLPE, analytical techniques, clinical study design and followup, HXLPE formulation and implant design characteristics, and patient populations differ substantially among investigations, complicating a unified perspective.

History and Systematic Review of Wear and Osteolysis Outcomes for First-generation Highly Crosslinked Polyethylene

Background:  Ankle fractures form a high proportion of the total number of fractures treated in New Zealand. International studies show that there are mixed functional outcomes with differing fracture types and subsequently differing lifestyle outcomes.

Methods:  Fracture clinic records and orthopaedic admissions books for Wellington Public Hospital, Capital Coast Health, ­Wellington, were retrospectively reviewed to gain a population of patients who sustained ankle fractures for the period January−­December 1998. These patients were asked to fill in postal questionnaires detailing their current ankle function and lifestyle, two years after fracturing their ankle. The patients’ radiographs were reviewed to classify the types of ankle fractures sustained.

Results:  Of 141 patients that sustained ankle fractures, 74 were followed up 2 years after their ankle fracture. All fracture types averaged Olerud-Molander ankle scores of 71.1. Weber A fractures averaged ankle function scores of 90, Weber B fractures 80, and Weber C fractures 78. Four patients (5%) achieved ‘poor’ results, 12 (16%) patients achieved a ‘fair’ result, 30 (41%) patients gained a ‘good’ result, 27 (36%) patients attained ‘excellent’ results. Lifestyle outcomes were reflected in the patient’s ankle function outcomes (P < 0.05).

Conclusion:  Patients who sustain ankle fractures can be expected to be still experiencing functional difficulties two years post-treatment.

Ankle fractures: Functional and lifestyle outcomes at 2 years

This prospective cohort study of 153 patients aimed to determine the economic and health costs of waiting for total hip arthroplasty (THA). Health-related quality of life, using self-completed WOMAC and EQ-5D questionnaires, was assessed monthly from enrolment preoperatively to 6 months postsurgery. Monthly cost diaries were used to record costs. The mean waiting time was 5.1 months and mean total cost of waiting for surgery was NZ 4305 dollars(US 2876 dollars) per person (pp) (NZ 1 dollar = US 0.668 dollar). Waiting more than 6 months was associated with a higher total mean cost (NZ 4278 dollars/US 2858 dollars pp) than waiting less than 6 months (NZ 2828 dollars/US 1889 dollars pp; P < .01). Improvements from preoperative to postoperative WOMAC and EQ-5D scores were identified (P < or = .01). Waiting longer led to poorer physical function preoperatively (P < or = .01). Those with poor initial health status showed greater improvement in WOMAC (P = .0001) and EQ-5D (P = .003) measures by 6 months after surgery. Longer waits for total hip arthroplasty incur greater economic costs and deterioration in physical function while waiting.

Waiting for hip arthroplasty: economic costs and health outcomes.

Using Heidegger's hermeneutic phenomenology informed by van Manen's and Benner's work, this research is an exploration and interpretation of the lived experiences of family members since they lost a close family member to suicidal death. Data from in-depth interviews with six participants, the researcher's journal entries and published literature were analysed. Findings gave rise to a grief model where suicide survivors moved through four modes of being-in-the-world characterized by 13 lifeworlds or themes. Surviving suicide was a transformative process that in time enabled survivors to discover new ways of understanding and relating to the world. The findings have implications for nurses and counsellors working in the area of suicide bereavement.

Grief as a transformative experience: Weaving through different lifeworlds after a loved one has completed suicide

Highly cross-linked polyethylene was developed to reduce articular bearing wear in total hip arthroplasty. In vitro studies have shown reduced wear in comparison with conventional polyethylene. A double-blind, prospective, randomized trial was performed comparing highly cross-linked and conventional polyethylene in 119 patients. The primary outcome variables were linear, 3-dimensional, and volumetric wear as determined by analysis of digitized radiographs using validated wear measurement software. Linear, 3-dimensional, and volumetric wear rates were significantly less in the highly cross-linked polyethylene group between 6 months and 4 years postoperatively (P < .05). The data presented here show that highly cross-linked polyethylene reduces short-term polyethylene wear. The intermediate and long-term clinical results of highly cross-linked polyethylene remain unknown pending further follow-up.

A Double-Blind, Prospective, Randomized Controlled Trial Comparing Highly Cross-Linked and Conventional Polyethylene in Primary Total Hip Arthroplasty

Patients with osteoarthritis commonly complain of sleep disturbance that may be due to pain. Osteoarthritic hip pain is commonly alleviated by total hip arthroplasty (THA). Forty-eight patients waiting for THA completed a sleep questionnaire and were monitored using actigraphy and sleep diaries for 4 to 5 nights, 1 month before and 3 months after surgery. For the group as a whole, significant improvements were seen in subjective and objective measures of sleep after THA. In this study, 75% of participants reported that their sleep was never or rarely disturbed by hip pain after surgery. Actigraphy indicated significant reductions in time in bed and activity during sleep, more efficient sleep and less fragmented (restless) sleep. Differences between patients aged

Jann Fielden

Papers

Ankle fractures: Functional and lifestyle outcomes at 2 years

Waiting for hip arthroplasty: economic costs and health outcomes.

Grief as a transformative experience: Weaving through different lifeworlds after a loved one has completed suicide

A Double-Blind, Prospective, Randomized Controlled Trial Comparing Highly Cross-Linked and Conventional Polyethylene in Primary Total Hip Arthroplasty

An assessment of sleep disturbance in patients before and after total hip arthroplasty.