Chiaramente, ogni formato ha i propri vantaggi e svantaggi comprare amoxil senza ricetta per effettuare un acquisto, non è necessario fornire la prescrizione medica.
Health Literacy FEATURE
When most people think of literacy they think of reading and writing skills.
However, in Ireland, the National Adult Literacy Agency (NALA) is
working with a broader understanding and definition of adult literacy. Here,
Communications Officer with NALA, Jennifer Lynch details NALA's role in
the area of health literacy and explains the implications for Irish society.
iteracy involves listening and speaking, reading, writing, formulation in the adult literacy sector in Ireland. Since 2001
numeracy and using everyday technology to communicate
NALA has developed HSE funded initiatives to address
and handle information. It includes more than the technical
health literacy issues. The Health Promotion Strategy 2000-
skills of communication: it also has personal, social and economic 2005 (DOHC) acknowledged literacy as a barrier to accessing dimensions. Literacy increases the opportunity for individuals
health information and work in this area has been driven by the
to reflect on their situation and initiate change. This definition
Population Health Unit.
acknowledges that the literacy demands of society are constantly
Currently health literacy is getting attention internationally
changing. In our day to day lives we are being asked to use
in terms of research and strategies. In April 2009, helped by a
more paperwork and embrace technology for more and more
National Lottery contribution from the Department of Health
things, such as checking in our luggage or using our bank.
and Children, Ireland agreed to participate in the first European
Evidence shows that healthcare systems in industrial nations are
Health Literacy Survey. The EU Health Literacy survey will
also getting more complex and therefore more demanding for
collect data on health literacy using standard methodology and
patients (OECD 2005).
provide a comparative assessment of health literacy in the general public. NALA hopes that the results from this survey will
The National Adult literacy Agency (NAlA)
stimulate policy and research.
The National Adult Literacy Agency (NALA) is a non-profit
As part of its Health Literacy Policy, NALA seeks to make
membership organisation concerned with training and policy
the Irish health service literacy friendly where both the skills of
October 09 THE CONSULTANT 51
"Health literacy emerges when the expectations, preferences
and skills of individuals seeking health information and services meet the expectations, preferences and skills of those providing information and services." (IOM, 2004)
This definition calls for a more balanced approach to analysing
health literacy. It acknowledges that service providers contribute to the problem of health literacy and therefore have a part to play in making information and services more accessible.
People who do not experience literacy difficulties in other areas
of life might easily run into trouble in healthcare settings because they are not used to the setting or indeed the vocabulary used. They can struggle to make sense of health-related materials with unfamiliar concepts. Emotions can also play a part. When people feel vulnerable and scared their ability to understand information is inhibited. People sometimes have to make decisions in unfamiliar circumstances, where studies indicate that the dialogue is often fast and patients have limited speaking turns.
literacy in Ireland The first Irish literacy survey took place in 1995 with results published in 1997. It is called the International Adult Literacy Survey (IALS) and was sponsored by the Organisation for Economic Co-operation and Development (OECD). It took place across a number of international countries thus allowing for international comparisons. It used everyday reading material such as train timetables and instructions on a packet of Aspirin. It used a 5 Level scale with Level 3 considered the minimum level needed to actively engage in Irish society.
Results showed that 25 per cent of the Irish population, or at
PICTURED: Alice Leahy, Director of Trust and overall winner of the Crystal
least 500,000 adults, scored at the lowest level, Level 1. This
Clear Health Literacy Awards. Also pictured are Mr Neil Boyle, Managing
means that a large percentage of the population experience
Director of MSD Ireland and Jennifer Lynch of NALA.
difficulty with everyday reading material. People at this level
}As part of its Health Literacy Policy, NALA seeks to make the
Irish health service literacy friendly where both the skills of
individuals and the literacy demands of the health
service are analysed."
individuals and the literacy demands of the health service are
for example were not able to follow instructions on an everyday
analysed. It wants to see a health service where literacy is not a
health medicine, i.e. on a packet of Aspirin. People were asked
barrier to treatment. It will work to influence the health service
to look at the directions on this bottle to find "the maximum
in every context: promotion, protection, prevention, access to
number of days a person should take this medicine". A total of
care and maintenance.
23 per cent of Irish adults (24 per cent male and 21 per cent female) could not answer this correctly.
What is health literacy? Health literacy is a relatively new term. The USA Institute of
Medicine (IOM) and the Department of Health and Human
Risk, probability, likelihood, norm are difficult mathematical
Services offers the most relevant definition in emphasising a dual
concepts and yet are commonly used in everyday communication,
responsibility for health literacy:
particularly in the healthcare context. Many of these concepts
52 THE CONSULTANT October 09
Health Literacy FEATURE
are abstract and so people can have problems picturing and
the body the "Cardiology Department" was for
• 10 per cent admitted to taking the wrong dose of medication
Ireland did not score very well when answering the
on one occasion because they could not fully understand
"quantitative literacy" (numeracy) questions in the IALS. Again
25 per cent of people scored Level 1 meaning that they could not answer correctly the simplest of numerical questions with 41
What Can be done?
per cent of these respondents in this group aged 56-65.
NALA would encourage all health organisations to use the HALA/HSE Literacy Audit for healthcare settings along with
hidden Nature of literacy
the eight minute health literacy awareness DVD. Both resources
Many adults with weak literacy skills try to hide it. There is also
were produced so that health practitioners could examine how
the complication that people with weak literacy skills do not
literacy friendly their settings are and begin to develop a health
always realise their limitations. Adults who experience problems
literacy plan. These resources explain good communication
with literacy may:
practice based on international practice and research.
• Appear passive or may act defensively• Pretend to have forgotten their glasses so as to avoid reading
• Pretend to have hurt their hand so as to avoid writing in
public. ( NALA 2002)
NALA's research found that healthcare workers interviewed were not aware of literacy being an issue in Ireland and were not aware of their local literacy provider.
Approx 20 per cent of Irish people do not fully understood information and instructions that appeared on medication packaging."
Irish Research in health literacy In 2007 the first national health literacy questionnaire was undertaken on behalf of Merck Sharp & Dohme Ireland (Human Health) Limited. Members of the general public were questioned about their interactions with medical practitioners and their understanding of medical terminology. The following are some of the key findings from the research:• 20 per cent of Irish people, do not deem themselves to be fully
confident when dealing with medical professionals
• Nearly 50 per cent of those surveyed stated that if they did
not understand something a healthcare professional said to
them they would only sometimes ask for clarification
• Approx 20 per cent of Irish people do not fully understood
information and instructions that appeared on medication
• Nearly 67 per cent of those surveyed admitted to having
difficulty understanding signs and directions in Irish hospitals
at least some of the time, with one in five stating difficulty
most of the time
• 60 per cent of participants were unable to correctly define the
• 20 per cent were not able to correctly identify which part of
October 09 THE CONSULTANT 53
FEATURE Health Literacy
NALA also recommends the use of ‘Ask Me 3' and ‘Teach Back'
initiative to meet with healthcare professionals, politicians and
systems. ‘Ask Me 3' encourages patients to ask three questions of the Minister for Health, Mary Harney. Dr Rudd explained their healthcare provider:
how health literacy has had a positive effect on public health
Life with epilepsy can be much more
than just a gap bet ween seizures*
• What is the main problem?
in other countries. Rudd is a Senior Lecturer on Society,
• What do I need to do?
Human Development and Health at the Harvard School of Public Health and she has been involved in the development
• Why is it important for me to do this?
of health policies for the US Office of Disease Prevention and
In the ‘Teach Back' method, the healthcare provider asks the
Health Promotion, the NIH Oral Health Division, and the
patient to repeat instructions to ensure that the message has
National Institutes of Sciences. Commenting on Ireland she
been relayed accurately. Health workers are advised to place the
noted that there seemed to be a general interest in the area but
responsibility on themselves to make sure they are understood
a literacy champion has yet to emerge – and the topic needs a
e.g. "I want to be sure I explained everything properly because
champion. According to Dr Rudd the US Surgeon-General was
this can be confusing. Can you tell me what changes we decided
a champion of this in the US – you need policy people to step
to make and how you will take your medication now?"
up and say this is important and you need professional societies
In 2008 NALA and MSD organised the first health
to incorporate these presentations, to encourage research and to
literacy awards, the Crystal Clear Awards, to encourage
put in requirements both for education in terms of qualifying
healthcare professionals and organisations to consider how they
degrees and also for continuing education for practitioners. Dr
communicate health matters to the public by acknowledging best
Rudd highlighted the 2007 US Joint Commission White Paper
practice in this area. Efforts such as this develop an awareness
on Health Literacy which stated, "Failure to provide patients with
of health literacy amongst health practitioners and can help to
information about their care in ways that they can understand, will
develop communication standards.
continue to undermine other efforts to improve patient safety."
health literacy in the US
For more information on this subject please contact Jennifer
In February of this year, Dr Rima Rudd was invited to Ireland
Lynch, NALA Project Co-ordinator at email@example.com
by Merck Sharp and Dohme, as part of their MSD/ NALA
Add Vimpat® for the confidence of additional seizure control
u An innovative mode of action1,2
u Improved seizure control, compared to or regardless
of current or prior antiepileptic drug therapy3
u High long-term retention rate4
Licensed for adjunctive therapy in patients
with partial-onset seizures ≥16 years old
Confidence of additional seizure control
ABBREVIATED PRESCRIBING INFORMATION
cipients. Known second- or third-degree atrioventricular block. In addition prolongation may occur. Consult SPC in relation to other side effects.
(Please consult the Summary of Product Characteristics (SmPC) before pre-
, hypersensitivity to peanuts or soya. Precautions:
Pharmaceutical Precautions: Tablets:
Do not store above
has been associated with dizziness. Use with caution in patients with known 30°C. Use within 4 weeks of first opening. Solution for infusion:
VIMPAT 50 mg, 100 mg, 150 mg and 200 mg film-coated tablets, VIMPAT 15
conduction problems, severe cardiac disease or in elderly. Excipients in the store above 25°C. Use immediately.
mg/ml syrup, VIMPAT 10 mg/ml solution for infusion
may cause allergic reactions (possibly delayed), should not be taken
POM. Product Licence Numbers: 50 mg x 14 tabs:
Active Ingredient: Tablets:
lacosamide 50 mg, 100 mg, 150 mg and 200
by those with fructose intolerance and may be harmful to patients with phe-
EU/1/08/470/001; 100 mg x 14 tabs: EU/1/08/470/004; 100 mg
mg film-coated tablets. Syrup:
lacosamide 15 mg/ml. Solution for infusion:
nylketonuria. Monitor patients for signs of suicidal ideation and behaviours. x 56 tabs: EU/1/08/470/005; 150 mg x 14 tabs: EU/1/08/470/007;
lacosamide 10 mg/ml.
Advise patients and carers to seek medical advice should such signs emerge.
150 mg x 56 tabs: EU/1/08/470/008; 200 mg x 56 tabs:
VIMPAT is indicated as adjunctive therapy in the
Prolongations in PR interval with lacosamide have been ob-
EU/1/08/470/011; Syrup (15 mg/ml) x 200 ml: EU/1/08/470/014;
treatment of partial-onset seizures with or without secondary generalisation served in clinical studies. Use with caution in patients treated with products Solution for Infusion (10 mg/ml) x 20 ml: EU/1/08/470/016.
in patients with epilepsy aged 16 years and older. Dosage and Administra-
associated with PR prolongation and those treated with class I antiarrhyth-
Name and Address of PL Holder:
UCB Pharma S.A., Allee de la Recherche
tion: Adults and adolescents from 16 years:
Recommended starting dose
mic drugs. Strong enzyme inducers such as rifampicin or St John's Wort 60, B-1070 Bruxelles, Belgium. Further information is available on request
is 50 mg twice a day which should be increased to an initial therapeutic
may moderately reduce the systemic exposure of lacosamide. No significant
UCB Pharma Ireland Ltd, United Drug House, Magna Drive, Magna
dose of 100 mg twice a day after 1 week. Maximum daily dose of 400 mg effect on plasma concentrations of carbamazepine and valproic acid. La-
Business Park, Citywest Road, Dublin 24.
(in two 200 mg doses). For solution for infusion:
Infused over a period of cosamide plasma concentrations were not affected by carbamazepine and Tel:
01 4637395. Fax:
15 to 60 minutes twice daily. Can be administered i.v. without further dilu-
valproic acid. No clinically relevant interaction with ethinylestradiol and
No dose reduction necessary. Age associated decreased renal
levonorgestrel. No effect on pharmacokinetics of digoxin. Pregnancy and
Date of Revision:
February 2009. VIMPAT is a registered trade name.
clearance with an increase in AUC levels should be considered. Paediatric
Should not be used during pregnancy. For precautionary mea-
1. VIMPAT® Summary of Product Characteristics, June 2008. 2.
Not recommended. Patients with renal impairment:
No dose ad-
sures, breast feeding should be discontinued during treatment with lacos-
Beyreuther BK et al. CNS Drug Rev 2007; 13(1):21-42. 3. UCB data on file.
justment necessary in mild and moderate renal impairment. Dose adjustment amide. Driving etc.:
Patients are advised not to drive a car or operate other 4. Rosenfeld W et al. Poster presented at the 61st Annual American Epilepsy
is recommended in SPC for patients with severe renal impairment and pa-
potentially hazardous machinery until they are familiar with the effects of Society Meeting November 30 – December 4, 2007. Ref *: Ben-Menachem
tients with end-stage renal disease. Dose titration should be performed with VIMPAT on their ability to perform such activities. Adverse Effects: Very com-
et al, Epilepsia, 48(7): 1308-1317,
caution. Patients with hepatic impairment:
No dose adjustment needed in
Dizziness, headache, diplopia, nausea. Common (between
mild to moderate impairment. In accordance with current clinical practice, 1%-10%):
Depression, balance disorder, abnormal coordination, memory
if VIMPAT has to be discontinued, it is recommended this be done gradually impairment, cognitive disorder, somnolence, tremor, nystagmus, blurred vi-
Date of preparation:
(e.g. taper the daily dose by 200 mg/week). Contraindications, Warnings
sion, vertigo, vomiting, constipation, flatulence, pruritus, gait disturbance, 08VIM239
Hypersensitivity to lacosamide or to any of the ex-
asthenia, fatigue, fall, skin laceration. Adverse reactions associated with PR
54 THE CONSULTANT October 09
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