Multifactorial interventions are crucial to arrest the threat posed by infectious diseases. Public involvement requires adequate information, but determinants such as health literacy can impact on the effective use of such knowledge. The influence of health literacy on infectious diseases is examined in this paper. Databases were searched from January 1999 through July 2015 seeking studies reporting on health literacy and infections such tuberculosis, malaria, and influenza, and infection-related behaviours such as vaccination and hand hygiene. HIV was excluded, as comprehensive reviews have already been published. Studies were found on antibiotic knowledge and use, the adoption of influenza and MMR immunizations, and screening for sexually transmitted and viral hepatitis infections. There was a lack of investigations on areas such as tuberculosis, malaria, hand hygiene, and diarrhoeal diseases. Limited or insufficient health literacy was associated with reduced adoption of protective behaviours such as immunization, and an inadequate understanding of antibiotics, although the relationship was not consistent. Large gaps remain in relation to infectious diseases with a high clinical and societal impact, such as tuberculosis and malaria.

Objective: This study aims to assess the relationship that frailty has with nutritional status and functional risk factors in community-dwelling older adults. Methods: Cross-sectional study in community-dwelling older people, independent for walking and without impaired cognition. Frailty was assessed by Fried criteria. Nutritional status was analyzed by the Mini Nutritional Assessment Short Form (MNA-SF), biochemical markers (albumin, total proteins, cholesterol, lymphocytes, and hemoglobin); and anthropometric parameters (body mass index [BMI], body fat percentage, handgrip, and perimeters). A comprehensive geriatric assessment analyzed other risk factors: functionality, cognition, falls, comorbidity, polypharmacy, physical activity, and quality of life (QoL). Results: We included 564 elderly people with a mean age of 76.05 (standard deviation 3.97) years; 63.1% (n = 356) were women, and 83.9% (n = 473) were prefrail, and frail. The sample presented high functionality and a nutritional status with a predominance of overweight and obesity. Factors associated with frailty (R² = 0.43) were age over 75 years (odds ratio [OR] 3.31, 95% confidence interval [CI] 1.76, 6.21; p < 0.001), female gender (OR 2.37, 95% CI 1.24, 4.52; p = 0.009), anemia (OR 2.45, 95% CI 1.19, 5.02; p = 0.015), falls (OR 1.94, 95% CI 1.12, 3.25; p = 0.016) and the fear of falling (OR 4.01: 95% CI 1.76, 9.16; p = 0.001). Performing more than 3 weekly hours of physical activity was found to be a protective factor (OR 0.23, 95% CI 0.15, 0.35; p < 0.001). Conclusions: The relationship between frailty and malnutrition in functionally independent community-dwelling older people is unclear. More studies are needed to know what nutritional markers are related to frailty, cognition, and functionality in order to discriminate the risk factors for community-dwelling older people at risk of malnutrition and dependency.

Breastfeeding has been shown to result in extensive physical and psychological benefits for both the mother and the newborn. However, the rate and duration of exclusive breastfeeding (EBF) remains low worldwide. Mother–infant skin-to-skin contact (SSC) immediately after birth has demonstrated results that support the argument for breastfeeding continuation. This study aimed to investigate the prevalence of EBF 3 months postpartum and the effect of early SSC in maintaining optimal EBF practices for mothers and their healthy newborns. We conducted an observational, retrospective study in Spain from 2013 to 2015. Pregnant women were interviewed immediately postpartum and again at 3 months postpartum regarding variables associated with breastfeeding initiation and continuation. There were 1,071 women recruited. Early SSC was performed in 92% of vaginal births but only 57% of urgent cesarean births. Of women breastfeeding at discharge, 69.5% performed SSC with their newborn. We found that 68.6% of women were exclusively breastfeeding by discharge and 46.7% by 3 months postpartum. Type of feeding at discharge, country of origin, and parity were found to be associated with each other (p = .003, p = .001, respectively). Early SSC was also significantly associated with type of feeding at discharge, 1 month, 2 months, and 3 months postpartum (p < .001). Hypogalactia (19.8%) was the most frequently reported factor for breastfeeding discontinuation. Breastfeeding promotion interventions are likely to improve breastfeeding rates at 3 months postpartum. Social and economic factors should be taken into account when such programs are planned to be implemented.

Objectives: Immunisations against influenza andBordetella pertussisinfection are recommended to pregnant women in Valencia (Spain), yet vaccination rates remain low. Health literacy (HL) appears as a crucial factor in vaccination decision-making. We explored the relation between HL of pregnant women and decisions to receive influenza and pertussis immunisations.Setting: University hospital in Valencia (Spain).Participants: 119 women who gave birth at a hospital in Valencia (Spain) between November 2015 and May 2016. Women in the immediate postpartum period (more than 27 weeks of gestation), between November 2015 and May 2016 were included in the study. Women with impairments, language barriers or illiteracy which prevented completion of the questionnaires, or those who were under 18 years were excluded from enrolment.Primary and secondary outcome measures: HL level; influenza and pertussis immunisation rate; reasons for rejection of vaccination.Results: 119 participants were included (mean age 32.3±5.5 years, 52% primiparous, 95% full-term deliveries). A higher education level was associated with Short Assessment of Health Literacy for Spanish Adults _50 (adjusted R²=0.22, p=0.014) and Newest Vital Sign (adjusted R²=0.258, p=0.001) scores. Depending on the scale, 56%–85% of participants had adequate HL. 52% (62/119) and 94% (112/119) of women received influenza and pertussis immunisation, respectively. Women rejecting influenza vaccine had a higher HL level (measured by SALHSA_50 tool) than those accepting it (Kruskal-Wallis test p=0.022). 24% of women who declined influenza vaccination felt the vaccine was unnecessary, and 23% claimed to have insufficient information.Conclusions: Influenza vaccination rate was suboptimal in our study. Women with high HL were more likely to decline immunisation. Information from professionals needs to match patients' HL levels to reduce negative perceptions of vaccination.

Background: The WHO recommends the use of the Robson ten-group classification system (RTGCS) as an effective monitoring and analysis tool to assess the use of caesarean sections (CS). The present study aimed to conduct an analysis of births using the RTGCS in La Ribera University Hospital over nine years and to assess the levels and trends of CS births. Methods: Retrospective study between January 1, 2010, and December 31, 2018. All eligible women were allocated in RTGCS to determine the absolute and relative contribution made by each group to the overall CS rate; linear regression and weighted least squares regression analysis were used to analyze trends over time. The risk of CS of women with induced versus spontaneous onset of labor was calculated with an odds ratio (OR) with a 95% CI. Results: 16,506 women gave birth during the study period, 19% of them by CS. Overall, 20.4% of women were in group 1 (nulliparous, singleton cephalic, term, spontaneous labor), 29.4% in group 2 (nulliparous, singleton cephalic, term, induced labor or caesarean before labor), and 12.8% in group 4 (multiparous, singleton cephalic, term, induced or caesarean delivery before labor) made the most significant contributions to the overall rate of CS; Conclusions: In our study, Robson Groups 1, 2, and 4, were identified as the main contributors to the hospital’s overall CS rate. The RTGCS provides an easy way of collecting information about the CS rate, is a valuable clinical method that allows standardized comparison of data, and time point, and identifies the groups driving changes in CS rates.