Low health literacy in older Americans is linked to poorer health status and a higher risk of death, according to a new evidence report by the HHS Agency for Healthcare Research and Quality. More than 75 million English-speaking adults in the United States have limited health literacy, making it difficult for them to understand and use basic health information.

The report, "Heath Literacy Interventions and Outcomes: An Update of the Literacy and Health Outcomes Systematic Review of the Literature" an update of a 2004 literature review featuring findings from more than 100 new studies, also found an association between low health literacy in all adults, regardless of age, and more frequent use of hospital emergency departments and inpatient care.

The report's authors also found a link between low health literacy and a lower likelihood of getting flu shots and of understanding medical labels and instructions, and a greater likelihood of taking medicines incorrectly compared with adults with higher health literacy. They also found evidence linking poor health literacy among adult women and underuse of mammograms.

Furthermore, evidence from a small but growing body of studies suggests that differences in health literacy levels are related to racial and ethnic disparities. For example, the rates of seniors receiving flu shots, children being enrolled in health insurance programs and patients taking medications as instructed by a health care professional are lower among minorities.

"Ensuring that people understand health care information is critical to a high-quality, safe health care system," said AHRQ Director Carolyn M. Clancy, M.D. "Improving health literacy will be a major step in the nation's efforts to enhance health care quality and safety."

In May 2010, Health & Human Services launched the National Action Plan to Improve Health Literacy to engage organizations, professionals, policymakers, communities, individuals and families in a linked, multi-sector effort to improve health literacy.

The plan calls for improving the jargon-filled language, dense writing and complex explanations that often fill patient handouts, medical forms, health websites and recommendations to the public. Other objectives are to promote changes in the health care system that improve health care information; to improve patient-provider communication; to help individuals with low health literacy make health care decisions based on evidence; and to provide access to health care.

For more information on AHRQ funding, studies, tools and other resources related to health literacy and cultural competency, visit its website.

Electronic Faucets Unsafe for Use in High-Risk Patient Hospital Settings

Researchers have determined that electronic faucets are more likely to become contaminated with unacceptably high levels of bacteria, including Legionella spp., compared with traditional manually operated faucets. The study was presented April 3 at the annual meeting of the Society for Healthcare Epidemiology of America.

Electronic-eye sensors in faucets have been utilized increasingly in health care settings to lower water consumption and in an attempt to reduce recontamination of the hands of health care personnel. Emily Sydnor, M.D., infectious disease fellow at The Johns Hopkins University School of Medicine, and colleagues, working in conjunction with the facilities and engineering departments at Johns Hopkins Hospital, examined bacterial growth from faucets of two clinical wards within the hospital from December 2008 through January 2009. The study included 20 manual faucets and 20 electronic faucets, all receiving water from the same source, and showed that 50 percent of water cultures from electronic faucets grew Legionella spp. compared with 15 percent of water cultures from manual faucets.

Additionally, following a flush of the water system using chlorine dioxide, the disparity between electronic and manual faucets persisted. After the cleaning, 29 percent of electronic faucet cultures still were contaminated with bacteria compared with seven percent of manual faucet cultures. Sydnor speculated that the increased bacterial growth in electronic faucets may be due to contamination of the numerous parts and valves that make up the faucet. During the course of collecting water samples, researchers discovered that all of the electronic faucet parts grew Legionella spp.

She explained that the study's findings should not create cause for concern over the use of electronic faucets by the general public. "The levels of bacterial growth in the electronic faucets, particularly the Legionella spp., were of concern because they were beyond the tolerable thresholds determined by the hospital. Exposure to Legionella spp. is dangerous for chronically ill or immune-compromised patients because it may cause pneumonia in these vulnerable patients. The levels we found of both Legionella spp. and bacterial burden on HPC [heterotrophic plate count cultures] were still within the level that is well-tolerated by healthy individuals," said Sydnor. Following the study, Johns Hopkins Hospital is replacing electronic faucets in clinical areas with manual faucets, and has decided not to install electronic faucets in clinical areas of another hospital building, which is under construction.

"As infectious disease experts, our job is to remain vigilant about protecting patients from potential exposure to infection-causing agents. This means that no matter how innovative the technology, the benefits must always be weighed against patient protection," said Steven Gordon, M.D., president of SHEA.

Regardless of faucet type, Gordon noted that the importance of proper hand-hygiene practices by health care personnel to help reduce transmission of pathogens in health care settings should not be marginalized. "Proper hand-hygiene practices are a basic and evidence-based element of helping to prevent HAIs [health care-associated infections]."

To read more online, visit The Johns Hospital University Gazette.

Large NIH-funded rehabilitation study looks at getting stroke patients back on their feet

In the largest stroke rehabilitation study ever conducted in the United States, stroke patients who received physical therapy at home improved their ability to walk just as well as those who were treated in a training program that requires the use of a body-weight supported treadmill device followed by walking practice.

The study also found that patients continued to improve up to one year after a stroke, defying conventional wisdom that recovery occurs early and tops out at six months. In fact, even patients who started rehabilitation as late as six months after a stroke were able to improve their walking.

The results of the study were announced at the American Stroke Association's International Stroke Conference in February. Primary funding for the study was provided by NIH's National Institute of Neurological Disorders and Stroke , with additional support by the National Center for Medical Rehabilitation Research.

"More than four million stroke survivors experience difficulty walking. Rigorously comparing available physical therapy treatments is essential to determine which is best," said Walter Koroshetz, M.D., NINDS deputy director. "The results of this study show that the more expensive, high-tech therapy was not superior to intensive strength and balance training at home, but both were better than lower-intensity physical therapy."

The walking program involves having a patient walk on a treadmill in a harness that provides partial body-weight support. This form of rehabilitation, which is known as locomotor training, has become increasingly popular. After patients complete their training on a treadmill, they practice walking.

Previous studies suggested that weight-supported treadmills, also called commercial lifts or robot-assisted treadmill steppers, are an effective intervention in helping stroke patients walk. But this walking program had not been tested on a large scale or examined in terms of the most appropriate timing for therapy.

The investigators of the Locomotor Experience Applied Post-Stroke trial set out to compare the effectiveness of the body-weight supported treadmill training with walking practice started at two different stages—two months post-stroke (early locomotor training) and six months post-stroke (late locomotor training). The locomotor training also was compared with a home-exercise program managed by a physical therapist, aimed at enhancing patients' flexibility, range of motion, strength and balance as a way to improve their walking. The primary measure was each group's improvement in walking one year after the stroke.

Investigators had hypothesized that the body-weight supported treadmill and walking program, especially early locomotor training, would be superior to a home-exercise program. However, they found that all groups did equally well, achieving similar gains in walking speed, motor recovery, balance, social participation and quality of life.

At the end of one year, 52 percent of all participants had made significant improvements in walking, but no differences were found in the proportion of patients who improved walking with the early vs. late treadmill-training program, nor did the severity of the stroke affect their ability to make progress by the end of one year.

The patients' improvement was measured by how well they were able to walk independently by the end of the study period. For example, severely impaired stroke patients were considered improved when they could walk around inside the house; whereas, patients who already were mobile at home were considered improved when they could walk independently in the community. All groups achieved similar gains in their walking speed and distance, physical mobility, motor recovery and social participation, resulting in an improved quality of life.

All participants started out with usual care, which involved a variable number of physical therapy sessions of about an hour each, before they were assigned to one of the study groups. The study found that earlier is better when it comes to rehabilitation therapy. Patients who were not assigned to a study group until six months after their stroke recovered only about half as much as those who received one of the two therapy programs at two months. This finding suggests that either the treadmill-training program or the at-home sessions are effective forms of physical therapy, and both are superior to usual care.

Patients in the body-weight supported treadmill and walking program group that started at six months made significant improvements in walking speed, despite widely held assumptions and reports that most functional improvements after stroke are complete by six months. Researchers said this suggests that recovery beyond six months can be influenced by further therapy.

Individuals in the locomotor-training groups were more likely to feel faint and dizzy during the exercise, and those who received early locomotor training experienced more falls. Fifty-seven percent of participants experienced one fall, 34 percent had multiple falls and 6 percent had a fall resulting in injury. Falls are a common problem among stroke survivors, and investigators say this study builds on evidence that additional research is needed to prevent falls.

The at-home group was the most likely to stick with the program; only 3 percent dropped out of this arm of the study compared with 13 percent of the locomotor-training groups. The authors noted that the physical therapy training programs in the study were progressive, intensive and repetitive, and highly effective in improving functional status and levels of walking ability, and quality of life at one year post-stroke.

"We were pleased to see that stroke patients who had a home physical therapy-exercise program improved just as well as those who did the locomotor training," said Pamela W. Duncan, Ph.D., principal investigator of LEAPS, and professor at Duke University School of Medicine in Durham, N.C. "The home physical therapy program is more convenient and pragmatic. Usual care should incorporate more intensive exercise programs that are easily accessible to patients to improve walking, function and quality of life."

The home-exercise programs require less expensive equipment, less training for the therapists and fewer clinical staff members. The authors suggest that this intervention may help keep stroke survivors active in their own homes and community environments.

More than 400 patients randomly were assigned into the three study groups and participated in 36 90-minute sessions over 12 to 16 weeks. They had either severe or moderate walking impairments. The average age of the patients was 62 years. Fifty-four percent were men and 22 percent were black. The trial took place at six inpatient rehabilitation centers including Brooks Rehabilitation Hospital in Jacksonville, Fla; Florida Hospital in Orlando; Long Beach (CA) Memorial Hospital; and Sharp Rehabilitation Center in San Diego.

Read the full text of the study online in the BMC Neurology journal.