\r\n\tRadiation monitoring deals with the sampling and measurement of different products found in different radiation pathways from the environment ending with consumption in humans. Gamma-spectroscopy is the main tool for measurement of these radiations.
\r\n
\r\n\tThe aim of this book is to investigate the radionuclide concentrations in the most consumable food products, air, water and soil. Particularly, it is essential to investigate the radiations level in the surroundings of a nuclear facility.
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\n
1. Introduction
\n
In the last few years, the applications of the magnetic resonance techniques, particularly nuclear magnetic resonance (NMR) and electron paramagnetic resonance (EPR), in food chemistry have enormously increased [1, 2, 3, 4, 5].
\n
EPR spectroscopy is a sensitive and versatile technique for analyzing molecules that contain unpaired electrons, such as paramagnetic metal ions and organic radicals. The formation of organic radicals in foods is an indication of food degradation occurring mainly due to oxidation reactions. Metal ions present in foods are able to catalyze oxidation of the food components by activating O2 to produce reactive oxygen species (ROS). In addition to the analysis of the paramagnetic species in foods, EPR can be used for the evaluation of the food stability and shelf-life. In order to perform such studies, acceleration of the radical production and degradation in food is needed. Several methods have been applied for the production of radicals in foods, including irradiation with microwave, UV, or γ-radiation, heating, and addition of oxidants. Stable organic radicals, such as tyrosyl and semiquinone radicals, can be detected directly by EPR. However, for the detection of transient radicals, spin traps are employed in order to be measured by EPR spectroscopy. The life of the short-lived radicals can also be extended by rapid freezing of the samples after their generation. In addition, time-resolved EPR can be used for the detection of short-lived radicals. Valuable information is acquired for the mechanisms involved in these reactions by measuring the EPR signal vs time.
\n
The main objective of this chapter is the discussion of methods for food analysis by cw X-band EPR, including the observation of endogenous unpaired electronic spin species and the initiation and detection of free radicals in foods.
\n
\n
\n
2. Endogenous unpaired electronic spin species in foods
\n
\n
2.1. Metal ions in food
\n
Foods contain metal ions originated either from the raw starting materials or from contamination with metals from metallic containers or from contamination with metals during food processing [6, 7, 8, 9]. EPR spectroscopy is particularly sensitive in detection of FeIII, MnII, and CuII metal ions, which can be found in food materials, because of their relative long relaxation times. FeIII gives at X-band EPR a singlet at ∼160 mT, MnII a six-line hyperfine pattern due to the coupling of the unpaired electrons with 55Mn nucleus (spin I = 5/2) at 300–350 mT, while CuII gives quartet hyperfine splitting after coupling with 59Cu nucleus (spin I = 3/2) for the isotropic spectra at room temperature at 250–320 mT. The axial anisotropic EPR spectra of CuII nucleus consist of four peaks for the magnetic field aligned along the z axis and one peak for the magnetic field aligned along xy plane. One example was provided by Drew et al. who employed cw X-band EPR to explore the origin of the metal ions in Scotch whiskies [7].
\n
The EPR spectrum of a frozen whiskey, depicted in Figure 1, shows the presence of all three metal ions.
\n
Figure 1.
Cw X-band EPR spectra of a 2008 distillate and as-bottled aged whiskies from 1960 to 1970. After the permission of Prof. SC Drew.
\n
The EPR spectra of MnII is of particular interest because MnII is present at almost all the foods of plant origin [10]. The signal of the frozen solutions of the symmetric [MnII(H2O)6]2+ consists of six narrow lines with additional small peaks between the six main components due to forbidden transitions. However, the EPR signal of MnII is significantly different from [MnII(H2O)6]2+ when MnII is coordinated to small ligands or large biomolecules mainly because of changes in zero field splitting (ZFS) parameters [11, 12]. These EPR data can be obtained from the simulations of the experimental spectra and they can be used for investigating the coordination environment around MnII in foods. However, foods are complicated biosystems and metal ions might interact with several molecules creating around them various environments [13] of different symmetry. Thus, the MnII EPR signal is complicated and fitting of the signal by considering one MnII species is not possible in most of the cases. In order to analyze the multicomponent EPR signals, researchers combine EPR and separation techniques and analyze the EPR signals of simpler-paramagnetic fractions [14].
\n
Trials to fit the MnII EPR signal of two Cypriot wines using Easyspin 5.2.8 [15] (Figure 2) did not result in a perfect match with the experimental spectra revealing multiple MnII species in the wines.
\n
Figure 2.
Experimental (black continues lines) and simulated (red dashed lines) cw X-band EPR spectra of two Cypriot wines from the grapes varieties Lefkada (L) and Maratheftiko (M) at 110 K. For the simulations were used the following parameters: (L) g = 1.999, A = 258 MHz, D = 530 MHz, and E = 192 MHz; (M) g = 1.999, A = 257 MHz, D = 564 MHz, and E = 210 MHz.
\n
These EPR spectra features of the metal ions, which are originated from the various environments occurring for metal ions in foods, might be used for the food classification such as geographical or botanical discrimination. An example of the use of MnII X-band EPR spectroscopy for the discrimination of Cypriot wines from various grape varieties is shown in Figure 3 (unpublished results). In addition to the characteristic shape of the spectrum, the quantity of MnII in each wine can be measured from the double-integrated spectra in the presence of standard [14, 16] information that can be additionally used as a variable for the wine discrimination.
\n
Figure 3.
Cw X-band EPR spectra of various Cypriot wines from the grape varieties Xynisteri (X), Lefkada (L), Shiraz (S), and Maratheftiko (M) at 110 K.
\n
The MnII cw X-band EPR spectra are also useful for analyzing the degradation of the food [10, 17]. An example of the alternation of the MnII signal in the wines up to exposure to air is shown in Figure 4. After the exposure, a new signal is appeared at g = 2.000 and A ∼ 185 MHz. Such signals have been assigned to multinuclear manganese clusters of higher oxidation states than MnII as previously reported for studies in solutions of model MnII compounds after their exposure to O2 [18, 19]; therefore, similar clusters might be formed also in wines.
\n
Figure 4.
Cw X-band EPR spectra of two fresh samples and one sample exposed to atmospheric oxygen for 1 day of the Cypriot wine from the grape variety Maratheftiko (M) at 110 K.
\n
The presence of free ions, such as FeIII and CuII, might accelerate degradation of foods, through Fenton reactions, leading to undesirable taste, color, or food spoilage [20, 21, 22, 23, 24, 25, 26]. Sometimes the removal of excessive free ions from foods is required in order to preserve their quality [8]. Metal chelators have found to inhibit the oxidation and increase the stability of model wines [27]. On the other hand, addition of metal ions in foods emerges reactive radical species that can be detected by EPR and used further for food characterization.
\n
\n
\n
2.2. Organic radicals
\n
In addition to metallic radicals, foods might contain persistent organic radicals formed by the exposure of food in atmospheric oxygen or the food preparation processes. Metal ions might play an important catalytic role in the formation of organic radicals. For example, although X-band EPR spectrum of fresh tea leaves gives at g = 2.000 only the sextet of MnII, the ground tea from tea bags gives a sharp peak due to the stable semiquinone radical, in addition to the MnII peak (Figure 5).
\n
Figure 5.
Cw X-band EPR spectra of ground tea from tea bags at room temperature.
\n
An extensive EPR study of dry tea leaves from various origins has shown that except the semiquinone radicals, stable carbohydrate radical can also be detected [28]. The same study showed that the type of radical is depended on the content of flavan-3-ols in tea. The teas owned the highest content of flavan-3-ols (unfermented teas) form carbohydrate radicals, whereas fermented teas have high quantities of semiquinone radicals.
\n
Troup et al. have investigated the organic radicals formed in roasted coffee beans and the brewed coffee solutions by EPR spectroscopy [14]. They have assigned the radicals to high-molecular-weight phenolic compounds present in the coffee brew and melanoidin compounds generated in the course of the Maillard reaction from reducing sugars and amino acids.
\n
Phenolics are also the compounds which form radicals in red wines [29]. In addition, stable radicals were detected directly in the extracts of carrot root, celery stalk, cress shoots, cucumber, parsley, and cabbage leaf appeared upon maceration. The EPR signal is a double peak in the EPR spectrum, attributed to the monodehydroascorbyl radical formed in the aqueous solution. A wide single peak overlays the above signals in some samples and is attributed to the stressed biotic or abiotic conditions [30].
\n
In general, fresh foods, protected from the oxidation, do not form organic radicals. However, such radicals might be induced and used for the characterization of food shelf-stability.
\n
\n
\n
\n
3. Induction and monitoring of radicals in foods
\n
\n
3.1. Methods for induction of radicals
\n
Several methods have been used for the induction of free radicals in foods, including irradiation with UV, microwaves, or γ-radiation, heating, addition of ozone, metal ions, or other oxidants. The EPR signal of stable radicals formed in food could be monitored directly, whereas unstable radicals can be measured indirectly with the addition of spin traps.
\n
The use of EPR spectroscopy to monitor radicals in γ-radiated foods is a common practice which is very well documented in the literature [31, 32, 33, 34, 35, 36, 37, 38, 39]. The most of the studies were focused on consumer safety due to the use of this method in some countries for food product sterilization.
\n
Microwave irradiation also causes formation of radicals in foods which can be monitored by EPR spectroscopy [40]. X-band EPR studies of the effect of microwave radiation on rice flour and rice starch [41, 42, 43] have shown the formation of tyrosyl and semiquinone radicals, after food irradiation, localized in the starch and the protein fraction of rice flour. These radicals exist in the native rice flour; however, their intensity increases exponentially by increasing microwave power and radiation time. The authors have proposed that transition metal redox process might be associated with the formation of the radicals [42, 43]. On the other hand, the rate of radical generation in flour starch is not related to the microwave power and irradiation time but increases rapidly at about 100°C [41].
\n
UV-irradiation is a very popular technique for the generation of radicals measured by EPR [44, 45, 46]. Foods are directly irradiated with UV-light [47, 48, 49] or after the addition of a photosensitive radical initiator in foods [50, 51]. The radicals, produced from UV-irradiation, usually are trapped by spin traps before being measured by EPR. However, there are examples of direct measurement of stable radicals formed in food. For example, UV-irradiation of grains resulted in the formation of reactive oxygen species and stable semiquinone and phenoxyl radicals [49]. In addition to the formation of organic radicals, the MnII and the FeIII EPR signals alternate, pointing to a disturbance of the biomolecules’ structures.
\n
The thermal stability of foods, in particular, edible oils, is a property associated with the storage life of food staff explored through various spectroscopic methods and rancimat analysis [52, 53, 54, 55, 56, 57]. The thermal process of foods generates radicals that can be detected by EPR spectroscopy. An example of heating-induced radical formation is the coffee beans roasting with formed radicals to be monitored in real time [14, 58, 59]. Goodman et al. have shown that the organic radicals produced from the heating of coffee beans are dependent on the variety of the bean, but the experimental data were not enough to support an explanation. In addition, they noticed that the quantity of radicals is higher at the presence of O2, and the oxidation rate of beans is considerably higher during the cooling process [58]. The radicals produced from the heating of edible oils are trapped with radical traps such as N-tert-butyl-α-phenylnitrone (PBN). Monitoring the signal of the PBN spin adducts by EPR consists a promising method for the determination of the lipid oxidation lag phase but not suitable for the lag phase of hydroperoxides and thus oil shelf-life [60]. The formation of free radicals in edible oils is catalyzed by unsaturated lipids, and in this autoxidation mechanism, there is a direct involvement of β-carotene and chlorophyll [61]. The EPR spectra of the heated oils showed also the formation of α-tocopheryl radical, suggesting that the α-tocopheryl radical might be used as an alternative marker for studying the oxidation state of edible oils [61, 62]. The EPR spectra of edible oils heated at 180 °C in contact with metals suggested that iron and aluminum do not significantly affect the oils. On the other hand, heating the oil with copper resulted in the dissolution of large quantities of CuII in the oil promoting the decomposition of primary oxidation products, while increasing the buildup of secondary oxidation products [63].
\n
Ozone is a nonthermal technology with promising application in food processing. It is primarily used as a disinfectant and antimicrobial agent for food safety applications and for food preservation [64, 65, 66]. However, processing of foods with ozone results in the formation of radicals that can be detected with EPR [67, 68]. The ozonation of grains was found to be safe for the consumers; however, the application of ozone directly on food products containing crushed grains, for instance, meal, might pose a threat to consumers.
\n
The initiation of radicals with addition of metal ions or with the addition of metal ions with H2O2 (Fenton-like reagents) is also a usual strategy for the characterization of foods. The formation of radicals with the Fenton reagents is based in the reactions (1) and (2).
However, in addition to Fenton reagent, other reagents [69], reacting like the Fenton reagent, such as CoII/H2O2, CuI/H2O2 [70], and K2S2O8 [71], might be used. Usually, the radicals formed from the reaction with the Fenton reagents are trapped by spin traps and monitored by various spectroscopies including EPR. This methodology has been applied on several types of foods including plant extracts [72], strawberry fruit [73], sugar and other molecules found in foods [74], edible oils [48, 75], tea [76], wines [27], etc. Investigation of the reactivity of FeII complexes with quinolinic acid as Fenton reagent has shown that Fe(II)-Quin produces more hydroxyl radicals and is more stable than Fe(II) alone [72]. In addition, metal ions being in the form of salts are insoluble in lipids; thus, in order to be used as radical initiators in lipids, they require their solubility to be increased by the addition of emulsifiers [77, 78, 79]. Recently, Drouza et al. have synthesized lipophilic metal complexes soluble in oils that initiate radicals in the presence of oxygen [3], whereas α-tocopherol is used as a marker for the investigation of the olive oils’ stability.
\n
\n
\n
3.2. Addition of radicals
\n
A common use of EPR spectroscopy is the addition of reactive organic radicals, usually DPPH•, galvanoxyl radical, ABTS+•, TEMPO, TEMPOL, or Fremy’s salt for the determination of the antioxidant activity of foods [80, 81, 82, 83, 84]. The EPR signal is reduced after the addition of radicals in oil because of the reduction of the radicals from the antioxidant food components, and the antioxidant activity can be calculated from Eq. (3) or more complicate mathematical equations [85, 86, 87, 88, 89].
where A0 and A are the double integrals of the signal of the control and the sample after the addition of the antioxidant, respectively.
\n
Stable radicals can also be added as probes. The EPR signal of the radical is dependent on the environment around the radical, thus structural information can be acquired. The radical probes could be organic [90, 91, 92, 93, 94] or inorganic [13]. The X-band EPR spectra of aqueous solutions containing extracts of green or black tea and CuII showed the formation of six complexes, probably of CuII with amino acids. The interactions of CuII with teas are pH dependent. At high pH, the CuII ions form complexes with polyphenols [13].
\n
\n
\n
3.3. Lipophilic metal initiators
\n
Although metal ions have been used as insoluble salts to induce free radicals in edible oil samples, a novel approach has been presented by the utilization of lipophilic metal complexes as radical initiators for the oxidation of lipids in olive oils, targeting the activation of α-tocopheryl radical naturally contained in edible oils [3].
\n
The new metal initiators consist the VV and VIV complexes, 1 and 2 (Figure 6), containing a lipophilic tail enabling them to perfectly dissolve in the oil matrix. This has been presented as an advantage of the new method because it allows the retaining of the chemical environment neighboring the polar phenols as it is in the bulk pure oil. Thus, phenols are allowed to participate in the free radical interplay between the redox species unaffected by any phase change discontinuation as it occurred in the case of the emulsions. In this method, the evolution of the phenol scavenging activity is recorded versus time revealing information for all the time framework of the food exposure to radicals (Figures 7 and 8).
\n
Figure 6.
Vanadium (IV/V) complexes 1 and 2.
\n
Figure 7.
X-band EPR spectrum of virgin olive oil (0.500 g) vs time after addition of 1 (100 μL, 7.00 mM) at RT. The time period between two adjacent spectra is 6.5 min.
\n
Figure 8.
First integral X-band EPR spectrum of virgin olive oil (0.500 g) vs time after addition of 1 (100 μL, 7.00 mM) at RT. The time period between two adjacent spectra is 6.5 min.
\n
The particular metal ion, vanadium, was selected because it participates in redox reactions, producing radicals and stabilizing semiquinone radicals [95, 96, 97], and activate molecular dioxygen [98, 99]. Cw X-band variable temperature (VT)-EPR spectroscopy reveals strong interactions between complex 2 and phenols suggesting that such interactions in the presence of O2 might promote the initiation of the radicals.
\n
The effect of the polar phenols naturally contained in the edible oils on the dioxygen activation and the free radical production was explored by a key experiment based on the monitoring of the intensity of the EPR α-tocopheryl signal in the presence and/or the absence of the polar phenols. The subtraction of the polar phenols resulted in (i) the reduction of maximum intensity of the EPR signal of α-tocopheryl radical and (ii) the decrease of the time needed for the occurrence of maximum intensity, tm, for the same edible oil. This new method has been applied for evaluating the age of olive oil or the storage period associated with the amounts of the polar phenols, which are decomposed by the increase of the storage time, using the abovementioned two spectral characteristics as evaluating parameters. The mechanism of the radical initiation by 1 and 2 complexes was further investigated by spin trap experiments.
\n
\n
\n
3.4. Radical traps
\n
The life time of organic free radicals is usually very short because they undergo bimolecular self-reaction. Spin trap technique has been developed since 1968 for the detection and identification of the transient free radicals. Spin traps are diamagnetic molecules exerting a particular high affinity for reactive radicals, to which reactive radicals rapidly add to form persistent spin adducts, detectable in the EPR spectroscopy. Typically, there are two types of molecules serving as spin traps, the C-nitroso compounds and the nitrones; some of them are shown in Table 1.
\n
Table 1.
Spin traps commonly used for detection and identification of free radicals.
\n
The first one, the C-nitroso compounds are organic nitroxides which upon reaction form the spin adduct through addition of organic part of the radical directly on the nitrogen atom [100, 101]. This proximity to the unpaired electron occupying the p* orbital of N atom of the functional group generates additional hyperfine coupling because of the presence of the neighboring magnetic nuclei of the added free radical. These hyperfine coupling parameters can provide structural information for the identification of added radical. The spin adducts of C-nitroso compounds in general have longer life times but bound less types of radicals, usually the C-centered ones, than nitrones [102]. The second type of spin traps, nitrones are organic molecules reacting with free radicals very fast, close to the diffusion-controlled limit, forming spin adducts by the bound of the added radical to the unsaturated C atom next to the N atom of the functional group [101, 102, 103]. It appears that this type of traps is widely used because they can form spin adducts with a wide range of radical species, such as peroxy (HOO•), alkoperoxy (ROO•), alkoxy (RO•), hydroxy (HO•), acyloxy radicals, as well as with other heteroatom-centered radical, including halogen atoms. The prime drawback for this type of traps is the poor information provided by their EPR spectra: the unpaired electron gives hyperfine coupling in the very best cases only from nitrogen nuclei of the function group and the β-proton, but not from the added radical. Thus, identification of the free radical goes through comparison of the under examination EPR spectra with undoubtfully characterized spectra obtained from the spin adducts of the prototype radicals.
\n
An example of the use of DMPO for the detection of the alkoperoxyl and the alkoxyl lipid radicals is shown in Figure 9. The spectrum was acquired 5 min after the addition of DMPO, and the vanadium complex 1 in olive oil. Deconvolution of the spectra fits to the alkoperoxyl lipid radical adduct of DMPO (DMPO-OOR) (AN = 1.37 and AH = 1.06 mT) in 33%, and the alkoxyl lipid radical adduct of DMPO (DMPO-OR) of (AN = 1.31, AHβ = 0.65, and AHγ = 0.17 mT) in 77%, and a minor unknown carbon adduct of DMPO (DMPO-CRR′R″).
\n
Figure 9.
(A) X-band EPR spectra of a solution of 200 μL 1 (7.0 mM, in CH2Cl2) 0.5 g pomace olive oil and 100 μL DMPO (30.0 mM DMPO in CH3OH) at 5 min, (B, C) simulated spectra of the two components of the experimental spectra (AN = 1.37 and AH = 1.06 mT (DMPO-OOR) and with AN = 1.31, AHβ = 0.65, and AHγ = 0.17 mT (DMPO-OR)).
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4. Conclusions
\n
In this chapter, we have reviewed the main cw X-band EPR methodologies used for the study of foods, by observing endogenous unpaired electronic spin species and by the initiation and detection of radicals in foods. The use of EPR for analysis of foods is growing up rapidly. New methodologies in initiation and detection of radicals have resulted in the better understanding of the mechanisms involved in food oxidation processes. The high sensitivity and versatility of EPR makes this technique a valuable tool in food science, and further applications are expected to emerge in the future.
\n
The cw EPR methods used for the characterization of foods are based on the recording of endogenous metal ion or organic radical preexisting in food or the initiation of radicals that can be detected directly or by the addition of radical traps. This chapter is an overview of these methods focusing to the research of the last 15 years.
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Acknowledgments
\n
Supported by Research Promotional Foundation of Cyprus and the European Structural Funds ΑΝΑΒΑΘΜΙΣΗ/ΠΑΓΙΟ/0308/32.
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Notes/Thanks/Other declarations
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The cw X-band EPR spectra in this review were acquired on an ELEXSYS E500 Bruker spectrometer at resonance frequency ∼9.5 GHz and modulation frequency 100 MHz. Figures were produced by the software MultiSpecEPR (the software has been developed by Prof. AD Keramidas).
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\n',keywords:"EPR, free radicals, food, antioxidants, spin traps, time-dependent EPR",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/62793.pdf",chapterXML:"https://mts.intechopen.com/source/xml/62793.xml",downloadPdfUrl:"/chapter/pdf-download/62793",previewPdfUrl:"/chapter/pdf-preview/62793",totalDownloads:1509,totalViews:381,totalCrossrefCites:3,totalDimensionsCites:3,totalAltmetricsMentions:0,impactScore:1,impactScorePercentile:52,impactScoreQuartile:3,hasAltmetrics:0,dateSubmitted:"February 27th 2018",dateReviewed:"June 29th 2018",datePrePublished:"November 5th 2018",datePublished:"February 13th 2019",dateFinished:"July 24th 2018",readingETA:"0",abstract:"An overview of the different methodologies developed so far for the investigation of paramagnetic species in foods is presented. Electron paramagnetic resonance spectroscopy (EPR), also known as electron spin resonance spectroscopy (ESR), is the primary technique toward the development of methods for the exploration of EPR-sensitive species, such as free radicals, reactive oxygen species (ROS), nitrogen reactive species (NRS), and C-centered radicals and metal ions. These methods aim for: (a) quantification of radical species, (b) exploration of redox chemical reaction mechanisms in foods, (c) assessment of the antioxidant capacity of food, and (d) food quality, stability, and food shelf life. For these purposes, different radical initiations and detections have been used in foods depending on both the chemistry of the target system and the kind of information required, listed in: the induction of radicals by (a) microwave, UV, or γ-radiation; (b) heating; (c) addition of metals; and (d) use of oxidants.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/62793",risUrl:"/chapter/ris/62793",book:{id:"7330",slug:"topics-from-epr-research"},signatures:"Chryssoula Drouza, Smaragda Spanou and Anastasios D. Keramidas",authors:null,sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Endogenous unpaired electronic spin species in foods",level:"1"},{id:"sec_2_2",title:"2.1. Metal ions in food",level:"2"},{id:"sec_3_2",title:"2.2. Organic radicals",level:"2"},{id:"sec_5",title:"3. Induction and monitoring of radicals in foods",level:"1"},{id:"sec_5_2",title:"3.1. Methods for induction of radicals",level:"2"},{id:"sec_6_2",title:"3.2. Addition of radicals",level:"2"},{id:"sec_7_2",title:"3.3. Lipophilic metal initiators",level:"2"},{id:"sec_8_2",title:"3.4. Radical traps",level:"2"},{id:"sec_10",title:"4. Conclusions",level:"1"},{id:"sec_11",title:"Acknowledgments",level:"1"},{id:"sec_11",title:"Notes/Thanks/Other declarations",level:"1"}],chapterReferences:[{id:"B1",body:'Gómez-Caravaca AM, Maggio RM, Cerretani L. Chemometric applications to assess quality and critical parameters of virgin and extra-virgin olive oil. A review. Analytica Chimica Acta. 2016;913:1-21\n'},{id:"B2",body:'Siddiqui AJ, Musharraf SG, Choudhary MI, Rahman AU. Application of analytical methods in authentication and adulteration of honey. Food Chemistry. 2017;217:687-698\n'},{id:"B3",body:'Drouza C, Dieronitou A, Hadjiadamou I, Stylianou M. Investigation of phenols activity in early stage oxidation of edible oils by electron paramagnetic resonance and 19F NMR spectroscopies using novel lipid vanadium complexes as radical initiators. 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Food Chemistry. 2013;141:3042-3049\n'},{id:"B87",body:'Košťálova Z, Hromádková Z, Ebringerová A, Polovka M, Michaelsen TE, Paulsen BS. Polysaccharides from the Styrian oil-pumpkin with antioxidant and complement-fixing activity. Industrial Crops and Products. 2013;41:127-133\n'},{id:"B88",body:'Bartoszek M, Polak J, Chorążewski M. Comparison of antioxidant capacities of different types of tea using the spectroscopy methods and semi-empirical mathematical model. European Food Research and Technology. 2018;244:595-601\n'},{id:"B89",body:'Polak J, Bartoszek M. The study of antioxidant capacity of varieties of Nalewka, a traditional Polish fruit liqueur, using EPR, NMR and UV-vis spectroscopy. Journal of Food Composition and Analysis. 2015;40:114-119\n'},{id:"B90",body:'Aliaga C, López de Arbina A, Rezende MC. “Cut-off” effect of antioxidants and/or probes of variable lipophilicity in microheterogeneous media. Food Chemistry. 2016;206:119-123\n'},{id:"B91",body:'Balanč BD, Ota A, Djordjević VB, Šentjurc M, Nedović VA, Bugarski BM, Ulrih NP. Resveratrol-loaded liposomes: Interaction of resveratrol with phospholipids. European Journal of Lipid Science and Technology. 2015;117:1615-1626\n'},{id:"B92",body:'Chatzidaki MD, Arik N, Monteil J, Papadimitriou V, Leal-Calderon F, Xenakis A. Microemulsion versus emulsion as effective carrier of hydroxytyrosol. Colloids and Surfaces B: Biointerfaces. 2016;137:146-151\n'},{id:"B93",body:'Chatzidaki MD, Mitsou E, Yaghmur A, Xenakis A, Papadimitriou V. Formulation and characterization of food-grade microemulsions as carriers of natural phenolic antioxidants. Colloids and Surfaces A: Physicochemical and Engineering Aspects. 2015;483:130-136\n'},{id:"B94",body:'Rübe A, Klein S, Mäder K. Monitoring of in vitro fat digestion by electron paramagnetic resonance spectroscopy. Pharmaceutical Research. 2006;23:2024-2029\n'},{id:"B95",body:'Drouza C, Keramidas AD. Solid state and aqueous solution characterization of rectangular tetranuclear VIV/V-p-semiquinonate/hydroquinonate complexes exhibiting a proton induced electron transfer. Inorganic Chemistry. 2008;47:7211-7224\n'},{id:"B96",body:'Drouza C, Vlasiou M, Keramidas AD. Vanadium(iv/v)-p-dioxolene temperature induced electron transfer associated with ligation/deligation of solvent molecules. Dalton Transactions. 2013;42:11831-11840\n'},{id:"B97",body:'Kundu S, Maity S, Weyhermüller T, Ghosh P. Oxidovanadium catechol complexes: Radical versus non-radical states and redox series. Inorganic Chemistry. 2013;52:7417-7430\n'},{id:"B98",body:'Stylianou M, Drouza C, Giapintzakis J, Athanasopoulos GI, Keramidas AD. Aerial oxidation of a VIV-iminopyridine hydroquinonate complex: A trap for the VIV-semiquinonate radical intermediate. Inorganic Chemistry. 2015;54:7218-7229\n'},{id:"B99",body:'Adao P, Maurya MR, Kumar U, Avecilla F, Henriques RT, Kusnetsov ML, Pessoa CJ, Correia I. Vanadium-salen and -salan complexes: Characterization and application in oxygen transfer reactions. Pure and Applied Chemistry. 2009;81:1279-1296\n'},{id:"B100",body:'McCormick ML, Gaut JP, Lin T-S, Britigan BE, Buettner GR, Heinecke JW. Electron paramagnetic resonance detection of free tyrosyl radical generated by myeloperoxidase, lactoperoxidase, and horseradish peroxidase. The Journal of Biological Chemistry. 1998;273:32030-32037\n'},{id:"B101",body:'Hawkins CL, Davies MJ. Direct detection and identification of radicals generated during the hydroxyl radical-induced degradation of hyaluronic acid and related materials. Free Radical Biology & Medicine. 1996;21:275-290\n'},{id:"B102",body:'Perkins MJ. Spin trapping. Advances in Physical Organic Chemistry. 1980;17:1-64\n'},{id:"B103",body:'Venkataraman S, Schafer FQ, Buettner GR. Detection of lipid radicals using EPR. Antioxidants & Redox Signaling. 2004;6:631-638\n'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Chryssoula Drouza",address:"chryssoula.drouza@cut.ac.cy",affiliation:'
Department of Agricultural Sciences, Biotechnology and Food Science, Cyprus University of Technology, Cyprus
Department of Agricultural Sciences, Biotechnology and Food Science, Cyprus University of Technology, Cyprus
'},{corresp:null,contributorFullName:"Anastasios D. Keramidas",address:null,affiliation:'
Department of Chemistry, University of Cyprus, Cyprus
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1. Background
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Over the last decade, there have been many studies on a variety of interventions to decrease mortality by improving the health of patients through literacy. Some researchers such as [1] have addressed direct literacy related barriers primarily by testing interventions to make health education materials easier to understand. While other researchers like [2] have focused on indirect barriers by providing more general supportive interventions.
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According to the [3] individuals with low to moderate health care, literacy skills face implications that may include the incompetence to carry out positive self-management, it also means higher medical costs due to more medication and treatment errors, more frequent hospitalizations, longer hospital stays, more visits to their health care provider, and a lack of necessary skills to obtain needed services.
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Notwithstanding the colossal implications of low health literacy, there remains a significant amount of misunderstanding surrounding the concept and its implications for healthcare professionals and facilities in Jamaica [4]. Health literacy is not a new concept to the Jamaican healthcare community, however, it has not been a concept that is practiced on a daily basis in our facilities [4]. In other countries, it has caught the attention of researchers, policy makers, and healthcare professionals due to its prevalent impact on health and well-being.
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The purpose of this chapter is to outline health literacy as a concept and explore some appropriate interventions that can assist researchers and healthcare professionals to reduce its negative impact on health outcomes such as mortality. The chapter will also address issues concerning low health literacy in developed and developing countries. Firstly, the major definitions of health literacy are presented in the introduction. Then, the description of interventions, how they have been applied, the challenges and outcomes, the discussion of resources required for implementation, the authors’ unique perspective on the issue and proposed a framework for the implementation and evaluation of health literacy interventions, including culturally appropriate programming and the multi-disciplinary team approach.
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2. Introduction
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The term health literacy was introduced in 1974 in a paper calling for minimum health education standards for all grade-school levels in the United States (US) [5]. The World Health Organization (WHO) later defined health literacy as “the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health” [6].
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Kirsch et al. [7] explained that the inability to read, write, and use numbers effectively, is common and is associated with a wide range of adverse health outcomes in the Caribbean and the Americas. There are five health outcomes of low health literacy, which are health knowledge, health behaviors, use of health care resources, intermediate markers of disease status, and measures of morbidity or mortality. However, this chapter will only focus on health knowledge and health behaviors because research indicates that knowledge affects behavioral outcomes [7]. Additionally, in order to reduce hospital mortality rates, individuals must have the knowledge base to obtain, process, and understand basic health information and services needed to make appropriate health decisions [8].
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Health knowledge, or health education, refers to the knowledge and understanding people have about health-related issues [9]. It is important that people understand the causes of ill-health and recognize the extent to which they are vulnerable to, or at risk from, a health threat. The World Health Organization’s (WHO) definition of health was expanded in 1996 as a state of complete physical, mental and social well-being and now includes a social dimension. Additionally, some social scientist of that era, believed that WHO expansion of the health, must include a spiritual dimension [10].
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According to the aforementioned [11] definition of health, it summarized complete health as the development of the social, physical, mental and spiritual dimension of a person. These four aspects of health were highlighted in the Bible, by Jesus Christ, when he said in Luke 2 verse 52 “he (Jesus) increased in wisdom (mental health) and stature (physical health) in favor with God (spiritual health) and man (social health),” [12]. Therefore, in order for a person to experience complete health, there must be growth in these four dimensions. Individuals in this twenty-first century must know that impairment in any one of these dimensions will affect the proper function of the other dimensions. These four components of health knowledge, spiritual, mental, social and physical will be defined and discussed below.
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2.1 Spiritual health
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The term “spiritual intelligence” was coined by Danah Zohar in 1997. Additionally, Ken O’Donnell in 1997 who is an Australian author and consultant living in Brazil, also introduced the term “spiritual intelligence” and Michal Levin in 2000 use this “spiritual intelligence” in his book to draw attention to the concept of linking the spiritual and the material reality of life that is eventually concerned with the well-being of the universe and those who coexist in it [13, 14, 15].
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It appears challenging to outwardly define spiritual health or spiritual intelligence without comprehending that the perception of spirituality is divergent from religiosity [16]. Fogel [17] opines that, for a very long time “spiritual” was, considered to be separate from “religious” and our secular societies prefers to steer as far as possible away from discussions on religion, for fear of kindling dormant conflicts or intruding on a taboo subject.
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However, some researchers have tried to coin some functional definitions. For instance, [18] “spiritual intelligence is concerned with the inner life of mind and spirit and its relationship to being in the world.” On the other hand, [19] defines spiritual intelligence as “the ability to act with wisdom and compassion, while maintaining inner and outer peace, regardless of the circumstances.”
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Research conducted by medical ethicists has reminded us that religion and spirituality form the basis of meaning and purpose for many people [20]. It is important to note that patients in health care institution, not only have the pain of physical ailment to confront with but the mental and spiritual pain that is associated with their sickness.
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2.2 Mental health
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According to [21], mental health literacy (knowledge) is defined as “knowledge and beliefs about mental disorders which aid their recognition, management or prevention.” According to [22], there are key areas that help to equip persons with mental health knowledge. This will assist them with overcoming cultural and societal obstacles by challenging the fear of stigmatization. These areas include, but are not limited to; (a) the ability to recognize specific mental health problems, (b) knowledge and beliefs about risk factors, self-management approaches and the professional help available, (c) knowledge and beliefs about self-help interventions, (d) attitudes which facilitate recognition and appropriate help-seeking behaviors and (e) knowledge of how to seek and access mental health information.
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The economic impacts of mental illness include its effects on personal income. These effects can only be quantified based on the ability of the persons with mental disorders or their caregivers to gauge the measurable economic burden of mental illness [23]. Bloom et al. [24] on the World Economic Forum (WEF) described three different approaches used to quantify economic disease burden, which do not only acknowledge the “hidden costs” of diseases, but also their impact on economic growth at a macroeconomic level (Figure 1).
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Figure 1.
Different approaches used to estimate economic costs of mental disorders [25].
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Mental health is now getting a great deal of scrutiny around the world, it is an area of health that developing countries are seeking to end stigmatization and discrimination through literacy [26]. In a study conducted by [27] opines that the most commonly expressed emotional response to the mentally ill and mental illness was fear, often specifically a fear of “dangerousness.” While the study reported some positive and empathetic responses, the most prominent emotional response was fear. Mental health literacy is the one of the most effective ways that fear towards the mentally challenged can be mitigated [28].
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The possible recommendation could be that, to be effective and relevant, mental health educators must seek to improve individual literacy and numeracy skills. Furthermore, mental health information needs to be written clearly and the information must be accessible to those who need it. This type of information must be useful in improving practical social skills and the communicative elements should aid these persons to access and maintain health [29].
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2.3 Social health
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The idea of social health is less recognizable to that of physical or mental health, but nonetheless, it’s one of the four pillars (spiritual, mental and physical) that forms the WHO definitions of health. According to [30] accentuates that “a society is healthy when there is equal opportunity for all and access by all to the goods and services essential to full functioning as a citizen.” Therefore, the success of a healthy society is influenced by the rule of law, equality in wealth distribution, public involvement in the decision-making process and a level of social capital.
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In developing countries like Jamaica, there are many determinants of social health that affects the livelihood of many such as inequality, poverty, exploitation, violence and injustice, these are at the root of ill-health and the deaths of poor and marginalized people [31]. According to [32] mentioned that a determinant is any factor that contributes to person current state of health. Based on researchers, it is believed that social determinants of health are the situations in which people are born, grow, live, work and age. These conditions are molded base on the supply of money, power and resources at the global, national and local levels [33].
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Julianne et al. [34] postulated that the quality of life and social relationship are closely related to mental health and the mortality rate. Furthermore, their opinion is that this modern way of life limits individual’s social interactions, which results in people living insolation from extended families in developing countries. It is clear, that people of all different ages around the world are living alone, and loneliness on this crowded planet is becoming common [35].
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2.4 Physical health
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According to [36], physical health literacy is the ability to move with competence and confidence in a wide variety of physical activities in multiple environments that benefit the healthy development of the whole person. Moreover, it is supported by researchers that physical literacy is an essential and valuable human competency that can be described as a disposition learnt by human individuals surrounding that enthusiasm, confidence, physical competence, knowledge and understanding that establishes physical quests as an important part of their lifestyle [37].
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In her research, [38] gave a summary of the key features of physical literacy:
Everyone can be physically literate as it is appropriate to each individual’s endowment,
Everyone’s physical literacy journey is unique, physical literacy is relevant and valuable at all stages and ages of life,
The concept embraces much more than physical competence,
At the heart of the concept is the motivation and commitment to be active, the disposition is evidenced by a love of being active, born out of the pleasure and satisfaction individuals experience in participation,
A physically literate individual values and takes responsibility for maintaining purposeful physical pursuits throughout the life course and charting of progress of an individual’s personal journey must be judged against previous achievements and not against any form of national benchmarks.
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2.5 Health behaviors
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There are several definitions for health behavior, one such researcher, [39] defined health behavior as the activity undertaken by people for the purpose of maintaining or enhancing their health, preventing health problems, or achieving a positive body image. Conner and Norman [40] added that any activity that is undertaken for the purpose of preventing or detecting disease or for improving health and wellbeing is defined as a health behavior. In the Handbook of Health Behavior Research, [41] defines health behavior as behavior patterns, actions and habits that relate to health maintenance, to health restoration and to health improvement’ (Vol. 1, p. 3). Behaviors within this definition include medical service usage (e.g., physician visits, vaccination, screening), compliance with medical regimens (e.g., dietary, diabetic, antihypertensive regimens), and self-directed health behaviors (e.g., diet, exercise, smoking, alcohol consumption and illegal drug use).
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It is common to differentiate health enhancing from health impairing behaviors. Institute of Medicine (US) Committee on Health and Behavior Research, Practice, and Policy [42] explained that health impairing behaviors have harmful effects on health or otherwise predispose individuals to diseases and even mortality. Such behaviors include smoking, excessive alcohol consumption, illegal drug misuse and high dietary fat and sugar consumption [42]. In contrast, [43] stated that engagement in health enhancing behaviors conveys health benefits or otherwise protect individuals from disease. Such behaviors include exercise, fruit and vegetable consumption, consumption of water instead of juice, limited alcohol consumption, no usage of illegal drugs and condom use in response to the threat of sexually transmitted diseases [43].
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3. Methodology
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This chapter utilized a multiple method approach to understand health literacy as an intervention to improve health outcomes. A meta-analysis, design was employed using three key phrase search and six keywords search resulting from the analysis of 43 articles. A breakdown of the methodologies using the two of the three key phrases is tabulated below (Tables 1 and 2).
Over 19,000 adults from 38 states and the district of Columbia participated in the national and state-level assessments to create data for the NAAL.
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The 2003 National Assessment of Adult Literacy (NAAL) which is a nationally representative assessment of English health literacy was distributed to American adults age 16 and older.
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Table 1.
Showing key phrase: the relationship between health literacy and health outcomes.
The demographic sample was 25 elderly and health illiterate persons using a mixed method and a convenience sampling approach.
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The instrumentations used were verbal questioning (perception of drug visual aide assistance) and a written questionnaire on how prescription medication instructions should be written currently and in the future; since the sample was compiled of both literate and illiterate people, questions were asked verbally and the questionnaire was administered. The methods used were paper & pencil recording of the types of prescriptions each individual tool, what they should have taken and if they felt comfortable taking their current prescriptions.
There were 15 studies dating from 1997 to 2006, a review confined to complex intervention study design was used and a sample range of 40-2046 participants.
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A systematic review of randomized and quasi-randomized controlled trials with a narrative synthesis. The search strategy included searching eight databases from start date to 2007, reference checking and contacting expert informants. After the initial screen, two reviewers independently assessed eligibility, extracted data and evaluated study quality.
There were 20 studies dating from 1992 to 2002, a controlled or uncontrolled experimental design was used and a sample range from 28 to 1744 participants.
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The 20 studies were of three types: randomized controlled trials (n = 9), nonrandomized controlled trials (in which subjects were assigned to intervention or control groups by the day or the week or some other nonrandom fashion; n = 8), and uncontrolled, single-group trials (n = 3). The number of participants enrolled ranged from 28 to 1744; most studies had between 100 and 500 participants. All but 2 studies were conducted in the United States. Most interventions and outcome assessments were administered in single sessions. Interventions to improve dietary behavior and one other study delivered multisession interventions and/or followed participants longitudinally to assess changes in outcomes.
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Table 2.
Showing key phrase: health literacy interventions to reduce mortality.
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4. The relationship between health literacy and health outcomes
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U.S. Department of Health and Human Services [8] explained in their research that low health literacy has been correlated with negative health outcomes, including reduced use of preventive health services, poor disease-specific outcomes for certain chronic conditions, and increased risk of hospitalization and mortality. Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association [48] agreed in their publication that health literacy is assumed to be a stronger predictor of health outcomes than social and economic status, education, gender, and age. With that being said, [49] stated that individuals with low health literacy have poorer health outcomes regardless of the illness they are diagnosed with. They went on to explain that low health literacy is more prevalent among vulnerable populations, such as the elderly, minorities, persons with lower education, and persons with chronic disease.
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Several researches have shown that low literacy can have a direct and negative effect on health. Berkman et al. [50] explained that they expect this effect to be predominantly important for conditions that require substantial and complex self-care on the part of the patient because of the barriers to accessing and using health information, particularly written and calculated information. DeWalt et al. [2] agreed with [51, 48] by adding that low literacy can also be a marker for other conditions, such as poverty and lack of access to health care, that lead to poor health outcomes especially outcomes such as mortality.
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The National Assessment of Adult Literacy report [44] explained that only 14% of adults have attained proficient health literacy, so in other words, nearly nine out of 10 adults may lack the skills needed to manage their health and prevent diseases. Additionally, it was reported that 16% of adults (50 million people) in having below basic health literacy and these adults were more likely to report their health as poorer (42%) than adults with proficient health literacy. Low literacy has been linked to poor health outcomes such as higher rates of hospitalization, less frequent use of preventive services and even hospital mortality [44].
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4.1 Health literacy interventions to reduce mortality
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4.1.1 The Jamaican context
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In a study conducted by [45], a health literacy intervention was carried out in the cities of Black River, Balaclava, and Parottee, Jamaica by creating prescription drug visual aids that will assist the elderly health illiterate population with their medication adherence and to promote health literacy.
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The results from the questionnaire used in the research showed that 80% of the overall sample were below the sixth-grade education literacy level, with 64% below the third-grade level and 16% between the fourth and sixth-grade levels. Additionally, 12% of respondents specifically from the city of Black River reported the ability to read but not to write. From the verbal questioning, 60% of the 64% of respondents who were below the third-grade education literacy level believed that visual aids would make medications easier to take. Furthermore, 8% of the 16% of respondents who were between the fourth and sixth grade education literacy levels believe that visual medication aides will benefit them. The results also displayed that a health literacy problem does exist in the areas in St. Elizabeth, Jamaica.
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The findings indicated that the health literacy of the elderly population in rural Jamaica is a national health concern [45]. If these persons are incapable of understanding what type of medications they are taking and why, they are less likely to take them regularly and as scheduled/prescribed. However, many of these same persons understand and acknowledge that they also need help in terms of understanding and taking their medications and illnesses. The outcome of this study stated that rural elderly Jamaicans believe visual medication aides will benefit them and the results indicated that a health literacy problem does exist in the area, and visual aides are needed due to the literacy level and health literacy level of the region.
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The main limitation stated for this intervention was that the sample size used was relatively small (25) and it might have played a role in respondents indicating their receptiveness to visual aids. Future implications of this research suggested that there is a need to conduct further research on the public health disparity between individuals in urban versus rural areas and that research might reveal disparities in the health outcomes.
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4.1.2 The international context
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Another study conducted by [46] in the United States of America, to evaluate the published literature of the effects of complex interventions intended to improve the health-related outcomes of individuals with limited literacy or numeracy. The focus of the 15 studies aforementioned in the methodology was on: health professionals (n = 2), literacy education (n = 1), and health education/management interventions (n = 12). In most of these studies (9 out 15), outcomes were measured in the intervention session or immediately afterwards. One study did not specify its follow-up period. The other five studies reported follow-up periods ranging from 1 week to 10.5 months with a median 5.5 months.
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The primary results showed that there were statistically significant in 13/15 trials, though 8/13 had mixed results across primary outcomes. Two trials showed no significant positive finding in primary outcomes: one failed to show a significant improvement in health knowledge and the other failed to show significant changes in cholesterol and blood pressure changes. It was recommended that health related improvements were reported across all four intervention types, however, all interventions were complex interventions and it is not known which components of each initiative were effective. This, combined with the fact that some of the interventions were resource intensive, demands that future initiatives are carefully designed and based on sound theoretical and pragmatic reinforcements. The wider empowerment and community participation aspect of some of the interventions represent a welcome, broader approach to health literacy.
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It was concluded that a variety of interventions for adults with limited literacy can be beneficial in improving some health outcomes especially mortality. The classes of outcome most likely to improve based on the study such as knowledge and self-efficacy. The implications suggested that more research was needed on the mechanisms of interventions that are most effective for improved health outcomes (specifically mortality). Additionally, there was limited evidence on interventions that targeted health professionals and their aptitude to deliver care optimally to patients with limited health literacy and to improve mortality rates especially in a hospital setting.
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Pignone et al. [47] reported on a systematic review of interventions designed to improve health outcomes for persons with low health literacy in developed countries defined as United States, Canada, Western Europe, Japan, Australia and New Zealand. The focus of the studies were easy-to-read printed materials (n = 4), video/audio tapes (n = 4), computer-based programs (n = 3) and individual or group instructions (n = 9). The primary results displayed that the diversity of outcomes limits conclusions about the effectiveness, though effectiveness “appeared mixed”. There were limitations in research quality that also hindered the drawing of conclusions. The five articles which dealt with the interaction between literacy level and the effect of the intervention stated mixed results. It is therefore recommended that research is needed to establish whether the correlation between low literacy and poor health outcomes is direct or indirect so as to most efficiently direct interventions.
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The results of the interventions should be stratified by literacy level and future studies should focus on intermediate to longer term outcomes rather than short-term knowledge outcomes or health behaviors. There is no research which has considered how interventions may impact on health disparities or care costs based on race, ethnicity, culture or age. Multi-component interventions should be analyzed to establish efficacy and effectiveness.
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It was concluded that several interventions based on the study have been developed to improve health for individual with low health literacy. There were limitations in the interventions tested and outcomes assessed make drawing deductions about effectiveness very difficult. Finally, advanced research is required to have a better understanding of the types of interventions that are most effective and efficient for overcoming health literacy-related barriers to good health and to improve health outcomes such as mortality.
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World Health Organization Regional Office for South-East Asia [51] stated in their Health Literacy Toolkit for Low- and Middle-Income Countries that the Optimizing Health Literacy and Access to health information and services (Ophelia) approach is an effective system that supports the documentation of community health literacy needs, and the advancement and testing of possible solutions to reduce mortality. Each Ophelia project seeks to improve health and equity by increasing the availability and accessibility of health information and services in locally appropriate ways [51].
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Projects have been carried out in Lavender Hill, an informal settlement, Cape Town: Ophelia South Africa under the title, “Identifying health literacy needs and developing local responses to health emergencies”; in Thailand under the title, “Optimizing health literacy needs of people” in Thailand and in New Zealand under the title, “Health literacy and Whanau Ora Outcomes: Ophelia New Zealand.” The outcomes generated new data and tools that were used to inform practice and policy and aid practitioners at both the patient and organization levels to comprehend and meet the needs of the community, targeting those with low health literacy [52]. Batterham et al. [52] stated that the Ophelia approach is innovative as it recognizes that health literacy is multidimensional and different people may have different health literacy needs and that it took a systematic and grounded approach to intervention development.
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4.2 Health literacy issues affecting developed and developing countries
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In both developed and developing countries, a significant portion of the population has challenges in understanding health information which affect how they traverse the health care system. Decades of investigation show that there is a strong correlation between limited literacy in dealing with challenges in the health care and lower health knowledge intertwine with misinterpretation of prescriptions and lower receipt of preventive care [53].
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In both developed and developing countries for the population to benefit from better health care, they must be knowledgeable about the various aspects of health care. Mayagah and Wayne [54] identified six general themes that help determine why health literacy is important for population health, firstly, large numbers of people affected because some developed countries have high adult literacy rates, while in developing countries approximately half have rates below the global developing country average of 79%. Research indicated that in developing countries literacy rates are lower among women than men, which is affecting how these persons respond to health information [55]. Additionally, difficulties with health literacy affect all people, but the elderly and chronically ill are most at-risk, and also have the greatest health care needs and expenses [56]. People with low health literacy are overwhelmed by health care because their skills and abilities are challenged by the demands and complexity required [57].
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Secondly, poor health outcomes, findings indicated that there is a clear correlation between inadequate health literacy as measured by reading fluency and increased mortality rates. Report on the Council of Scientific Affairs [58] suggested that poor health literacy is “a stronger predictor of a person’s health than age, income, employment status, education level, and race.” Moreover, UNICEF, reported that hundreds of millions of people around the globe are living in extreme poverty. Both poverty and poor health are linked and can be the result of social, political, and economic injustices. The linkage is a vicious, self-perpetuating cycle where poverty causes poor health and poor health keeps communities in poverty. Research cited that people who are economically deprived and living in poor environments are faced with many health risk factors in their everyday life [59].
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Thirdly, increasing rates of chronic disease are estimated to account for almost half (47%) of the total burden of disease. Likewise, chronic diseases often occur with co-morbidities (concomitant but unrelated diseases) and co-morbidity further increases the demand for health care. For example, individuals with diabetes and very high co-morbidity are expected to use 10 times the healthcare resources of the population average [60]. Research done on the Canadian Health Care System that indicated help is provided to people with chronic conditions such as diabetes, asthma, congestive heart failure, renal failure and chronic obstructive pulmonary disease. A large proportion of the available healthcare resources are devoted to treating chronic conditions and, in Canada, 67% of all health care costs are incurred as a result of caring for those with chronic conditions. More than half of Canadians aged 12 or older report at least one chronic condition and at age 65, 77% of men and 85% of women have at least one chronic condition [61]. Health literacy plays a crucial role in chronic disease self-management. In order to systematically manage chronic conditions on a daily basis, individuals must be able to assess, understand, evaluate, and use health information [62]. According to the Adult Literacy and Life Skills Survey, more than half (55%) of working-age Canadians do not have adequate levels of health literacy and only one in eight adults (12%) over age 65 has adequate health-literacy skills [63]. Also, [1] specified that populations most likely to experience low-literacy levels are among those being asked to manage their condition such as older adults, ethnic minorities, people with low levels of educational attainment, people with low income levels, nonnative speakers of English, and people with compromised health [64].
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Also, those with low literacy skills are not likely to attend voluntary peer-led self-management programs even if they are aware, they exist. In 2003, the Institute of Medicine in its priority areas for national action, identified self-management/health literacy as an area that cut across many health problems [64]. Schloman [65] opines that “improved health literacy was put forward as a condition necessary to enable active self-management of patients for most conditions.”
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Fourthly, health care costs; the additional costs of limited health literacy range from 3 to 5% of the total health care cost per year. Research has indicated that, insufficient health literacy has been associated with an increased need for disease management, higher medical service utilization among older, racial, ethnic minorities, and with low educational attainment [1]. Research conducted by the [66] in managing care, suggested that individuals with low health literacy have higher medical costs and are less efficient when using services than those individuals with adequate health literacy. Their findings estimated the costs associated with inadequate health literacy among adults at the national level to be $73 billion annually.
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Fifthly, health information demand has created discrepancies between the reading levels of health-related materials and the reading skills of the intended audience. Often, the use of jargon and technical language made many health-related resources unnecessarily difficult to use [54]. The populations in both developing and developed countries are challenged with the increasing demands to understand and utilize health information, which are some of the complexities that are facing modern health care systems [67]. Additionally, the increasing proportion of people living with chronic conditions, competencies for proactive self-management of health and participation in collaborative care have become key public health agendas. The ability to take active part in shared decision making with healthcare providers is important for adherence to treatment, self-management of chronic diseases [68].
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Lastly, equity is a factor that suggests that low levels of health literacy often means that a person is unable to manage their own health effectively, access health services effectively, and understand the information available to them and thus make informed healthy decisions [54]. Researchers over the past two decades, have been investigating the importance of health literacy and have examined over 1600 related research articles such as the field of “health care disparities” [69]. Improving the health literacy of those with the worst health outcomes is an important tool in reducing health inequalities [54].
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It’s evident that the challenges with [70] equity may still exist today. Many countries have failed to document data about the population that will make inferences about the disparities that have contributed to the lower quality of care. Due to the limited data about these disparities, situations that affects individuals with low literary skills are often times overlooked and efforts to address inequities in health care are rendered as ineffective. Furthermore, health care researchers are of the view that data to properly assess these disparities can be collected. However, health care organizations are lacking in the measurement tools to assess patient literacy in populations served by operating health care systems [70]. Isham [70] further lamented that quality measures for improving health literacy are lacking. Therefore, the current problems of low health literacy should perhaps be viewed less as a patient problem and more as a challenge to health care providers and health systems to reach out and more effectively communicate with patients. The United Nations Educational, Scientific and Cultural Organization (UNESCO) Institute of Statistics (UIS) projected that over 776 million adults, which is about 16% of the world’s adult population lacking basic literacy skills [71]. These figures appear to be alarmed by the strides that the human race has made in development of education. Additionally, a recent survey of health literacy among 2000 adults in the United Kingdom found that one in five people had difficulty with the basic skills required for understanding simple information that could lead to better health [72].
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It seems that quality health care is advancing in the developed countries due to the developments in technology [73], while on the other hand, the population in developing countries is affected by low literacy levels due to the limited advancement of technology [74]. However, research has indicated that 60% of adult Canadians (ages 16 and older) lack the capacity to obtain, understand and act on health information and services, and also the ability to make appropriate health decisions on their own. In addition, the proportion of adults with low levels of health literacy is significantly higher among certain groups. These findings raise questions of equity [54].
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Findings from comparable studies done in Europe, Australia, Latin America and other countries have correlated literacy levels with access to education, ethnicity and age as determinants to better health care [75]. Other studies have indicated that having limited literacy or numeracy skills also acts as an independent risk factor for poor health, which lead to medication errors and insufficient understanding of diseases and treatments [76]. Additionally, [49] from their review determined that there is a relationship between literacy and health outcomes that was directly corresponding to several adverse health-related factors, such as, knowledge about health and health care, hospitalization, global measures of health, and some chronic diseases.
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In exploring the link between literacy and mortality, Baker and colleagues suggest that there is a strong correlation between inadequate health literacy—as measured by reading fluency—and increased mortality rates [77]. Neuroscience and Behavioral Health specialists opine that health literacy is essential to overall patient care. It’s very important for every citizen in both developed and developing countries to understand basic health information. This understanding will empower people to make better decision as it relates to self-care and medical decisions. Educating the population of any country about health is crucial in mitigating inequalities that exist in health care systems. It is evident that individuals with low health literacy have poorer health status and higher rates of hospital admission, are less likely to adhere to prescribed treatments and care plans, experience more drug and treatment errors, and make less use of preventive services [78].
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Poor health literacy with limited access to education may result in a deficiency in patient self-management. According to [79] believes that lack of understanding of procedures of basic health information, will interfere with their ability to take better care of themselves and make health related informed decisions. Therefore, it’s evident that patients who are involved self-management will mostly experience positive health outcomes and place fewer demands on the healthcare system.
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The role of healthcare facilities and health care professionals is to assist patients in becoming better in self-management and limit the patients’ dependency on the health care system. It’s important to understand that health literacy is pivotal in the management of chronic medical conditions. Patients need to learn and understand self-management by having access to health information which will enable them to better cope with daily challenges (includes a complex medical regimen, plan and make lifestyle adjustment) that comes with chronic illness [80].
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Another major issue that affects both developed and developing countries is the cost that is attached to health care. Research has concluded that is difficult to correctly evaluate the real economic cost that is associated with low health literacy. Factors such as what constitutes health literacy and insufficient data collection on the frequency of low literacy help to compound the challenge of economic cost. Researchers believe that despite these challenges in evaluating the impact of limited health literacy studies that are available underscore the importance of addressing limited health literacy from a financial perspective [81].
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Vernon et al. [82] revealed that the findings of a health literacy cost study that was based on an analysis of US National data revealed that the cost of low health literacy to the U.S. economy is in the range of $106–$238 billion annually. Additionally, he stated, “when one accounts for the future costs of low health literacy that result from current actions (or lack of action), the real present-day cost of low health literacy is closer in range to $1.6–$3.6 trillion” [82].
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It is clear that tracking the economic cost associated with low health literacy will strongly depend on the strength of the economic status of the developed and developing countries. Rootman and Ronson [83] stated that inequality is another major factor that affects the citizens of all countries. They postulate that “a person’s literacy level is influenced by many factors and conditions; these determinants of literacy are similar to the determinants of health commonly referred to in the health promotion literature.” Studies have indicated that factors like education, personal ability, early childhood development, aging, living and working conditions, gender and culture and language help to influence literacy rates in countries around the world [83].
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Research in the United Kingdom indicated [84] that low health literacy is emphatically connected with more unfortunate health outcomes, and every dynamic increment towards higher health literacy is related to a more prominent probability of participating in a solid and healthier way of life, explicitly eating at least five servings of fruits and vegetables and being a non-smoker. Likewise, [83] expressed that low levels of health literacy frequently imply that an individual cannot deal with their own wellbeing adequately, access health services viably, or comprehend the data accessible to them and therefore settle on educated and sound health choices. Enhancing the health literacy of those with the poor, negative health outcomes is a critical device in diminishing health inequalities [83].
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It’s important for developing countries to comprehend that health literacy entails development of individual level of knowledge, personal skills and the confidence to take action to improve self-management and community health by encouraging changes in the personal lifestyle and living conditions. Therefore, health literacy is more than people reading pamphlets and making appointments but is the overall improvement in the individual’s ability to access health data and their capacity to effectively use that information [85].
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In both developed and developing countries but mostly in developing nations, health care systems need to address the needs of communities and breaking down the barriers that exist through health literacy, such as, lack of compliance medication regime. Lack of health educators working with vulnerable citizens in communities like women, those living rural areas and immigrants. Other barriers like language, socio-political, economic and cultural barriers and time constraints pose challenges to health care providers and health literacy advancement. Research has shown that these vulnerable people have significantly worse outcomes which is associated with high mortality and morbidity rates due to the lack health literacy levels. Therefore, developing countries like the Caribbean in tackling the economic cost of low literacy must apply a comprehensive, and integrated health approach to the services that are important in transforming in the model of care [79].
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Pan American Health Organization [79] reported that regardless of the improvements has been achieved in health literacy, poverty and inequities remain a challenge in the Region. Recent data suggest that Latin America and the Caribbean (LAC) remains the most inequitable region in the world, with 29% of the population below the poverty line and the poorest 40% of the population receiving less than 15% of total income. Such inequities are reflected in health outcomes: for example, the Region of the Americas did not achieve the Millennium Development Goal (MDG) target for the reduction of maternal mortality by 2015, and despite significant reductions in infant mortality, very sharp differences exist between countries. Without specific interventions to transform health systems, economic growth is not sufficient to reduce inequities.
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As a developing country, Jamaica is confronted with many health issues. Specifically, there are concerns with an ever-aging population, which continues to grow in size at an astounding rate of 11.3% each year [86]. Coverson [45] asked these impertinent questions, “who will take care of this aging population, what services will be available, and how the elderly will maintain a reasonable quality of life are all questions that are facing Jamaica in the near future. People are living longer and with this increase in life-years come other concerns such as the cost of care, who will administer the care, and access to care as travel becomes more difficult with increased age.”
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Paul and Bourne [87] suggested that this vulnerable group in the population that are affected by reading difficulties have greater challenges in understanding the high level of grammar associated with health care instruments, diagnostic tests, directions and medications. This lack of comprehension can result in patients experiencing confusion in navigating the healthcare system, and are significantly handicapped in the task of self-management or caring for their family members.
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4.3 Cultural issues affecting health literacy in developed and developing countries
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Baker [88] concurring with other researchers agree that culturally, health care is multifaceted idea. National Center for Cultural Competence [89], culture has been defined as the “integrated pattern of human behavior that includes thoughts, communications, actions, customs, beliefs, values and institutions of a racial, ethnic, religious or social group.”
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State of illness is viewed through a cultural lens in countries around the world. With these cultural lens people summarize health and sickness and based on their perception will respond to the health message. It’s important to note that culture will help people determine what treatment options are best (by going to the medical doctor or the herbalist), and it helps people interpret symptoms [90]. It is important to recognize that based on these cultural health beliefs that an individual has, will greatly impact how they think and feel about their health and health challenges. It also affects the kind of people that they seek care from and how they respond to recommendations to make changes to their lifestyle and how they accept health intervention messages [91].
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Due the complex nature of health literacy and cultural practices, health literacy cannot have one “sprang” approach in reaching the populace. Health literacy is not determined solely by an individual’s capacity to read, understand, process, and act on health information. However, it’s dependent on the request that individuals make for health information and their ability to decode, interpret, and understand the information presented. Furthermore, health literacy is not constant, but is a dynamic state that may change with the situation [88]. Researchers have agreed that in order to effectively deal with low health literacy in the health care system, there needs to be an aggressive research agenda that will in cooperate evidence base tools that will provide relevant data in order to address these challenges [92].
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Cultures also vary in their styles of communication, in the meaning of words and gestures, and even in what can be discussed regarding the body, health, and illness. Health literacy requires communication and mutual understanding between patients and their families and healthcare providers and staff. Culture and health literacy, both influences the content and outcomes of health care encounters [29]. Cooper and Roter [93] review the relationship that exists between the relationship between culture, patient-provider interaction, and quality of care and have concluded that culture gives significance to health information and messages. The awareness that people have about the definitions of health and illness, preferences, language and cultural barriers, and stereotypes are strongly influenced by the individual’s culture which can greatly sway health literacy and health outcomes. Furthermore, others challenges are developed due to the different educational backgrounds among patients and providers and those responsible to create health information can lead to cultural challenges based on the wording used to share the information [93].
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Research done on the importance of culture and health literacy in European-American cultural groups indicated that the use of language differs in discussing symptoms such as pain [94, 95]. Base on the cultural, linguistic differences were linked with changes in diagnoses, regardless of symptomology. African-American patients frequently experience shorter physician-patient interactions and less patient-centered visits than Caucasian patients [93, 96].
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With the ever increasing melting pot of ethnicity in countries around the world, health care systems are forced to recognize these different ethnic groups with cultural diversity in order to be inclusive [93]. Therefore, cultural, social, and family norms have transformed the attitudes and beliefs which will significantly impact the levels of health literacy (native language, socioeconomic status, gender, race, and ethnicity are considered as influencers that limits person’s control which affects his or her ability to participate fully in a health-literate society [97]. It behooves the health care providers to properly utilize the various modes of communication such as news publishing, advertising, marketing, and the plethora of health information sources available through electronic channels are also integral to the social-cultural landscape of health literacy when communicating with cultural masses [29].
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By incorporating a greater focus on health literacy, health care professionals will move closer toward a patient-centered health care system (Figures 1 and 2).
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Figure 2.
The intersection of health literacy with health care improvement [98].
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Governments around the world must understand that need to develop a health care system that works is not the burden of health care consumer. The need to improve health literacy must be seen as a partnership between public and private organizations whose primary focus is to help citizens become health literate. This cohesive partnership will help both developed and developing nation’s realized improvements in health literacy will play a major role in improving health care systems and the holistic health for their citizens [73].
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Since health literacy is not constant, but dynamic, governments must observe health literacy as fundamental to health, and essential for improving quality of patient care. Low levels of health literacy present a formidable challenge to the widespread and effective use of patient self-management [99]. However, these challenges can be met. Although, health literacy continues to get more attention at the national level and economic cost becomes visible, improving health literacy will be crucial in reducing adverse outcomes that are connected with low health literacy [73]. Within the twenty-first century there is no universal solution, but by gathering relevant data and implementing best practices can be strategies that can be steadily used to improve health literacy for populations around the world. By simplifying health literacy information which will increase the usability of this information must be the priority focus. When patients can relate health information in plain language in both the written and spoken formats will help in improving the decision-making capacity of the client [92]. The method of assessing and responding to health literacy at the governmental level has been a progression in the focus of health literacy as a responsibility of the patient. However, organizations and systems are accountable for designing service delivery that challenges the health literacy needs of the clients of health care providers [99].
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5. Recommendations
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Governments, policy makers, organizations, health practitioners and community members must work in partnership to address health literacy issues contributing to poor health outcomes such as mortality and morbidity. We are therefore recommending the following:
Implementing the Ophelia (Optimizing Health Literacy and Access to health information and services) Australian approach in our health care system and in extent in all developing countries. This approach involves the collaboration of a wide range of healthcare professionals, government leaders or representatives, community health center or hospital patients and leaders to develop health literacy interventions that are based on needs identified within a hospital or community.
Develop and implement policies that promote documentation of health literacy issues and the implementation of targeted responses.
Develop and implement policies that promote equitable access to health information and services for all citizens.
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6. Conclusions
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This visualization for health literacy as an intervention to reduce hospital mortality and morbidity rates can be effective as the data presented shows the importance of meeting the needs of patients with low health literacy in Jamaica. Healthcare professionals have an important role to play, but the responsibility for achieving real progress for patients facing challenges related to health literacy must extend to greater government involvement by creating health literacy policies and programs in both rural and urban areas.
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Greater emphasis needs to be placed where the hard-to-reach or disadvantaged or vulnerable groups which include the elderly, children and patients with disability (mental/physical/intellectual). In Jamaica, we are still stuck at the developmental stage of understanding the scope of health literacy and the challenges patients face and developing cultural relevant interventions to address them. The relationship between health literacy and health outcomes such as mortality and morbidity needs to be explored through further research. The interventions identified in this chapter are stepping stones which need significantly greater support, resources for research and implementation of interventions.
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\n\n',keywords:"health literacy, health promotion, health behavior, health knowledge, health outcomes",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/67091.pdf",chapterXML:"https://mts.intechopen.com/source/xml/67091.xml",downloadPdfUrl:"/chapter/pdf-download/67091",previewPdfUrl:"/chapter/pdf-preview/67091",totalDownloads:1809,totalViews:0,totalCrossrefCites:2,dateSubmitted:"September 21st 2018",dateReviewed:"April 10th 2019",datePrePublished:"September 10th 2019",datePublished:"September 25th 2019",dateFinished:"May 13th 2019",readingETA:"0",abstract:"WHO has defined health literacy as the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make basic health decisions for themselves and their loved ones. The purpose of this article is to outline the scope of low health literacy as a concept and explore some appropriate interventions that researchers and healthcare professionals may use to reduce its negative impact on health outcomes such as mortality. The authors conclude by identifying areas of research that are needed to advance the conceptualization of health literacy in reducing hospital mortality and morbidity.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/67091",risUrl:"/chapter/ris/67091",signatures:"Monique Ann-Marie Lynch and Geovanni Vinceroy Franklin",book:{id:"7158",type:"book",title:"Strategies to Reduce Hospital Mortality in Lower and Middle Income Countries (LMICs) and Resource-Limited Settings",subtitle:null,fullTitle:"Strategies to Reduce Hospital Mortality in Lower and Middle Income Countries (LMICs) and Resource-Limited Settings",slug:"strategies-to-reduce-hospital-mortality-in-lower-and-middle-income-countries-lmics-and-resource-limited-settings",publishedDate:"September 25th 2019",bookSignature:"Jasneth Mullings, Camille-Ann Thoms-Rodriguez, Affette M. McCaw-Binns and Tomlin Paul",coverURL:"https://cdn.intechopen.com/books/images_new/7158.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83962-225-0",printIsbn:"978-1-83880-933-1",pdfIsbn:"978-1-83962-226-7",isAvailableForWebshopOrdering:!0,editors:[{id:"248594",title:"Ph.D.",name:"Jasneth",middleName:null,surname:"Mullings",slug:"jasneth-mullings",fullName:"Jasneth Mullings"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"276834",title:"Dr.",name:"Monique",middleName:"Ann-Marie",surname:"Lynch",fullName:"Monique Lynch",slug:"monique-lynch",email:"monique.a.lynch@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"289629",title:"MSc.",name:"Geovanni",middleName:null,surname:"Franklin",fullName:"Geovanni Franklin",slug:"geovanni-franklin",email:"geovannifranklin29@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Background",level:"1"},{id:"sec_2",title:"2. Introduction",level:"1"},{id:"sec_2_2",title:"2.1 Spiritual health",level:"2"},{id:"sec_3_2",title:"2.2 Mental health",level:"2"},{id:"sec_4_2",title:"2.3 Social health",level:"2"},{id:"sec_5_2",title:"2.4 Physical health",level:"2"},{id:"sec_6_2",title:"2.5 Health behaviors",level:"2"},{id:"sec_8",title:"3. Methodology",level:"1"},{id:"sec_9",title:"4. The relationship between health literacy and health outcomes",level:"1"},{id:"sec_9_2",title:"4.1 Health literacy interventions to reduce mortality",level:"2"},{id:"sec_9_3",title:"4.1.1 The Jamaican context",level:"3"},{id:"sec_10_3",title:"4.1.2 The international context",level:"3"},{id:"sec_12_2",title:"4.2 Health literacy issues affecting developed and developing countries",level:"2"},{id:"sec_13_2",title:"4.3 Cultural issues affecting health literacy in developed and developing countries",level:"2"},{id:"sec_15",title:"5. Recommendations",level:"1"},{id:"sec_16",title:"6. 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Available from: https://www.ncbi.nlm.nih.gov/books/NBK248431/\n\n'},{id:"B98",body:'DeWalt DA, Malone RM, Bryant ME, Kosnar MC, Corr KE, Rothman RL. A heart failure self-management program for patients of all literacy levels: A randomised, control trial. BMC Health Services Research. 2006;6(30):1-10\n'},{id:"B99",body:'Rothman R, De Walt D, Malone R, Bryant B, Shintqani A, Crigler B, et al. Influence of patient literacy on the effectiveness of a primary care-based diabetes management program. Journal of the American Medical Association. 2004;292(14):1711-1716\n'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Monique Ann-Marie Lynch",address:"monique.a.lynch@gmail.com",affiliation:'
World Federation for Mental Health, University of the West Indies, Mona
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He completed his post doctorate in 2008, funded by the Higher Education Commission of Pakistan from the Institute of Plant Protection in the Chinese Academy of Agricultural Sciences, Beijing, China. He has several hundred published papers to his credit and is recipient of the Shield award, letters of appreciation, and certificates of performance from faculty members of the Chinese Academy of Agricultural Sciences, Beijing, China. In 2010, the Zoological Society of Pakistan presented him with the Prof. Dr. Mirza Azhar Beg Gold Medal. In 2011, the Pakistan Council for Science and Technology awarded him a Research Productivity Award.\n\nHis research activities focus on integrated pest management for rice, cotton, chickpea, and Brassica crops; predatory mites, ladybird beetles, Chrysoperla, Trichogramma, and parasitoids of fruit flies culturing as bio-control agents; integrated management of fruit flies and mosquitos; and other arthropod pest control methodologies. He has also researched vertebrate pest control, especially controls of rodents in field crops and storage. He was the first to explore thirty-six new species of stored grain mites belonging to eight genera, including Forcellinia, Lackerbaueria, Acotyledon, Caloglyphus, and Troupeauia in the Acaridae family; and Capronomoia, Histiostoma, and Glyphanoetus in the Histiostomatidae family. He also planned and designed research trials on the integrated management of cotton leaf curl virus (CLCV), pest scouting, pest monitoring, and forecasting. He conducted training of progressive farmers and field staff, and provided advisory services to the farmers regarding plant protection practices. He also trained pesticide dealers on the proper handling, distribution, and storing of pesticides.\n\nUnder a coordinated research program, Dr. Sarwar collaborated with other institutes to trace resistance sources for cotton, rice, gram, rapeseed, mustard plants, and stored cereals and pulses. 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His is a lifetime member of the Zoological Society of Pakistan.",institutionString:"National Institute for Biotechnology & Genetic Engineering",institution:null},{id:"416492",title:"M.D.",name:"Bastian",surname:"lubis",slug:"bastian-lubis",fullName:"Bastian lubis",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"418849",title:"Dr.",name:"Hilal",surname:"H. Al-Shekaili",slug:"hilal-h.-al-shekaili",fullName:"Hilal H. 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Definition of Terms:
\n\n
Book - collection of Works distributed in a book format, whose selection, coordination, preparation, and arrangement has been performed and published by IntechOpen, and in which the Work is included in its entirety in an unmodified form along with one or more other contributions, each constituting separate and independent sections, but together assembled into a collective whole.
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Work - a book Chapter (as well as Conference Papers), including any and all content, graphics, images and/or other materials forming part of, or accompanying, the Chapter/Conference Paper.
\\n\\n
Attribution – appropriate credit for the used Work or book.
\\n\\n
Creative Commons licenses – enable licensors to retain copyright while allowing others to use their Works in an appropriate way.
\\n\\n
Rules of Attribution for Works Published by IntechOpen
\\n\\n
With the purpose of protecting Authors' copyright and the transparent reuse of OA (Open Access) content, IntechOpen has developed Rules of Attribution of Works licensed under Creative Commons licenses.
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\\n\\t
All Chapters published in IntechOpen books prior to October 2011 are licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported license (CC BY-NC-SA 3.0);
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All Chapters published in IntechOpen books after October 2011 are licensed under the Creative Commons Attribution 3.0 Unported license (CC BY 3.0);
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\\n\\n
In case you reuse or republish any of the Works licensed under CC licenses, you must abide by the guidelines outlined below:
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1. Rules for reusing of books in their entirety or significant parts of books
\\n\\n
All rights to Books and other compilations published on the IntechOpen platform and in print are reserved by IntechOpen. The Copyright to Books and other compilations is subject to a separate Copyright from any that exists in the included Works.
\\n\\n
A Book in its entirety or a significant part of a Book cannot be translated freely without specific written consent by the publisher. Further information can be obtained at permissions@intechopen.com.
\\n\\n
In instances where permission is obtained from the publisher for reusing or republishing the Book, or significant parts of the Book, all of the following conditions apply:
\\n\\n
\\n\\t
Information about the first publisher must be provided – please note the fact that the material was originally published by IntechOpen as an OA (Open Access) publication must be acknowledged;
\\n\\t
All original Academic Editor(s) must be credited;
\\n\\t
Since you are reusing content that someone else created and allowed you to use freely, you must credit all Authors involved;
\\n\\t
The type of license that is available for the Works must be indicated, as well as a link to the license provided, so that others can investigate the terms of the license. You will be aware that the material can be used for free in consequence of the CC license attribution, so you must acknowledge that fact. It is not sufficient that the material is Creative Commons, because that says nothing about how the material can actually be used. There are different CC licenses and you have to identify the specific license that is being used;
\\n\\t
Any original Copyright Notices associated, with the Works which constitute the Book must be kept intact;
\\n\\t
Provision of the original title of the Book, as well as the original titles of any individual Works;
\\n\\t
Provision of the URL where the Book is hosted, with a notice to the effect that the Book is an OA (Open Access) publication;
\\n\\t
Provision of the URL to every individual Work which constitutes the Book with a notice that the Work is an OA (Open Access) publication. As the material has been accessed for free, it is incumbent upon you to provide the source so that others can also access it for free.
\\n
\\n\\n
Every single Work that is used has to be attributed in the way described. If you are unsure about proper attribution, please write to permissions@intechopen.com.
\\n\\n
2. Rules of attribution for works published by IntechOpen
\\n\\n
Individual Works originally published in IntechOpen books are licensed under Creative Commons licenses and can be freely used under terms of the respective CC license, if properly attributed. In order to properly attribute the Work you must respect all the conditions outlined below:
\\n\\n
\\n\\t
Credit all Authors – since you are reusing contents that someone created and allowed you to use freely, you have to acknowledge authorship;
\\n\\t
Indicate the type of license under which the Work is available and provide the URL to the license so others can find out the license terms. Preferably keep intact any original Copyright Notice associated with the Chapter (if any). You will be aware that the material can be used for free in consequence of the CC license attribution, so you must acknowledge that fact. It is not sufficient that the material is Creative Commons, because that says nothing about how the material can actually be used. There are different CC licenses and you have to identify the specific license that is being used;
\\n\\t
Provide the URL where the Work is hosted, preferably providing the original title of the Work, as well as the original title of the Book with a notification that the Work is an OA (Open Access) publication. As the material has been accessed for free, it is incumbent upon you to provide the source so that others can also access it for free;
\\n\\t
Provide information about the first publisher – please note the fact that the material was originally published by IntechOpen as an OA (Open Access) Work must be acknowledged.
\\n
\\n\\n
Every single Work that is used has to be attributed in the way as described. If you are unsure about proper attribution, please contact Us at permissions@intechopen.com.
\\n\\n
In the event that you use more than one of IntechOpen's Works published in one or more books (but not a significant part of the book that is under separate Copyright), each of these have to be properly attributed in the way described.
\\n\\n
IntechOpen does not have any claims on newly created copyrighted Works, but the Works originally published by IntechOpen must be properly attributed.
\\n\\n
All these rules apply to BOTH online and offline use.
\\n\\n
Parts of the Rules of Attribution are based on Work Attributing Creative Commons Materials published by the Australian Research Council Centre of Excellence for Creative Industries and Innovation, in partnership with Creative Commons Australia, which can be found at creativecommons.org.au licensed under Creative Commons Attribution 2.5 Australia license, and Best practices for attribution published by Creative Commons, which can be found at wiki.creativecommons.org under the Creative Commons Attribution 4.0 license.
\\n\\n
All the above rules are subject to change, IntechOpen reserves the right to take appropriate action if any of the conditions outlined above are not met.
Work - a book Chapter (as well as Conference Papers), including any and all content, graphics, images and/or other materials forming part of, or accompanying, the Chapter/Conference Paper.
\n\n
Attribution – appropriate credit for the used Work or book.
\n\n
Creative Commons licenses – enable licensors to retain copyright while allowing others to use their Works in an appropriate way.
\n\n
Rules of Attribution for Works Published by IntechOpen
\n\n
With the purpose of protecting Authors' copyright and the transparent reuse of OA (Open Access) content, IntechOpen has developed Rules of Attribution of Works licensed under Creative Commons licenses.
\n\n
\n\t
All Chapters published in IntechOpen books prior to October 2011 are licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported license (CC BY-NC-SA 3.0);
\n\t
All Chapters published in IntechOpen books after October 2011 are licensed under the Creative Commons Attribution 3.0 Unported license (CC BY 3.0);
\n
\n\n
In case you reuse or republish any of the Works licensed under CC licenses, you must abide by the guidelines outlined below:
\n\n
1. Rules for reusing of books in their entirety or significant parts of books
\n\n
All rights to Books and other compilations published on the IntechOpen platform and in print are reserved by IntechOpen. The Copyright to Books and other compilations is subject to a separate Copyright from any that exists in the included Works.
\n\n
A Book in its entirety or a significant part of a Book cannot be translated freely without specific written consent by the publisher. Further information can be obtained at permissions@intechopen.com.
\n\n
In instances where permission is obtained from the publisher for reusing or republishing the Book, or significant parts of the Book, all of the following conditions apply:
\n\n
\n\t
Information about the first publisher must be provided – please note the fact that the material was originally published by IntechOpen as an OA (Open Access) publication must be acknowledged;
\n\t
All original Academic Editor(s) must be credited;
\n\t
Since you are reusing content that someone else created and allowed you to use freely, you must credit all Authors involved;
\n\t
The type of license that is available for the Works must be indicated, as well as a link to the license provided, so that others can investigate the terms of the license. You will be aware that the material can be used for free in consequence of the CC license attribution, so you must acknowledge that fact. It is not sufficient that the material is Creative Commons, because that says nothing about how the material can actually be used. There are different CC licenses and you have to identify the specific license that is being used;
\n\t
Any original Copyright Notices associated, with the Works which constitute the Book must be kept intact;
\n\t
Provision of the original title of the Book, as well as the original titles of any individual Works;
\n\t
Provision of the URL where the Book is hosted, with a notice to the effect that the Book is an OA (Open Access) publication;
\n\t
Provision of the URL to every individual Work which constitutes the Book with a notice that the Work is an OA (Open Access) publication. As the material has been accessed for free, it is incumbent upon you to provide the source so that others can also access it for free.
\n
\n\n
Every single Work that is used has to be attributed in the way described. If you are unsure about proper attribution, please write to permissions@intechopen.com.
\n\n
2. Rules of attribution for works published by IntechOpen
\n\n
Individual Works originally published in IntechOpen books are licensed under Creative Commons licenses and can be freely used under terms of the respective CC license, if properly attributed. In order to properly attribute the Work you must respect all the conditions outlined below:
\n\n
\n\t
Credit all Authors – since you are reusing contents that someone created and allowed you to use freely, you have to acknowledge authorship;
\n\t
Indicate the type of license under which the Work is available and provide the URL to the license so others can find out the license terms. Preferably keep intact any original Copyright Notice associated with the Chapter (if any). You will be aware that the material can be used for free in consequence of the CC license attribution, so you must acknowledge that fact. It is not sufficient that the material is Creative Commons, because that says nothing about how the material can actually be used. There are different CC licenses and you have to identify the specific license that is being used;
\n\t
Provide the URL where the Work is hosted, preferably providing the original title of the Work, as well as the original title of the Book with a notification that the Work is an OA (Open Access) publication. As the material has been accessed for free, it is incumbent upon you to provide the source so that others can also access it for free;
\n\t
Provide information about the first publisher – please note the fact that the material was originally published by IntechOpen as an OA (Open Access) Work must be acknowledged.
\n
\n\n
Every single Work that is used has to be attributed in the way as described. If you are unsure about proper attribution, please contact Us at permissions@intechopen.com.
\n\n
In the event that you use more than one of IntechOpen's Works published in one or more books (but not a significant part of the book that is under separate Copyright), each of these have to be properly attributed in the way described.
\n\n
IntechOpen does not have any claims on newly created copyrighted Works, but the Works originally published by IntechOpen must be properly attributed.
\n\n
All these rules apply to BOTH online and offline use.
\n\n
Parts of the Rules of Attribution are based on Work Attributing Creative Commons Materials published by the Australian Research Council Centre of Excellence for Creative Industries and Innovation, in partnership with Creative Commons Australia, which can be found at creativecommons.org.au licensed under Creative Commons Attribution 2.5 Australia license, and Best practices for attribution published by Creative Commons, which can be found at wiki.creativecommons.org under the Creative Commons Attribution 4.0 license.
\n\n
All the above rules are subject to change, IntechOpen reserves the right to take appropriate action if any of the conditions outlined above are not met.
\n\n
Policy last updated: 2016-06-09
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Both degrees were in electrical engineering. His current research interests include signal processing and photonics. Currently he is affiliated with the Department of Electrical Engineering, University of Malaya, Malaysia.",institutionString:null,institution:{name:"University of Malaya",country:{name:"Malaysia"}}},{id:"41989",title:"Prof.",name:"He",middleName:null,surname:"Tian",slug:"he-tian",fullName:"He Tian",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"East China University of Science and Technology",country:{name:"China"}}},{id:"33351",title:null,name:"Hendra",middleName:null,surname:"Hermawan",slug:"hendra-hermawan",fullName:"Hendra Hermawan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/33351/images/168_n.jpg",biography:null,institutionString:null,institution:{name:"Institut Teknologi Bandung",country:{name:"Indonesia"}}},{id:"11981",title:"Prof.",name:"Hiroshi",middleName:null,surname:"Ishiguro",slug:"hiroshi-ishiguro",fullName:"Hiroshi Ishiguro",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRglaQAC/Profile_Picture_1626411846553",biography:"Hiroshi Ishiguro is an award-winning roboticist and innovator. 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Despite rich genetic diversity, manipulation of the cultivars through alternative techniques such as mutation breeding becomes important. Radiation is proven as an effective method as a unique method to increase the genetic variability of the species. Gamma radiation is the most preferred physical mutagen by plant breeders. Several mutant varieties have been successfully introduced into commercial production by this method. Combinational use of in vitro tissue culture and mutation breeding methods makes a significant contribution to improve new crops. Large populations and the target mutations can be easily screened and identified by new methods. 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These reactions occur through a regular radical chain causing growth of polymer by three steps, namely, initiation, propagation, and termination. To understand ionizing radiation-induced polymerization, the water radiolysis must be taken into consideration. This chapter explores the mechanism of water molecules radiolysis paying especial attention to the basic regularities of solvent radicals’ interaction with the polymer molecules for forming the crosslinked polymer. Water radiolysis is the main engine of the polymerization processes, especially the “free-radical polymerization.” The mechanisms of the free-radical polymerization and crosslinking will be discussed in detail later. Since different polymers respond differently to radiation, it is useful to quantify the response, namely in terms of crosslinking and chain scission. A parameter called the G-value is frequently used for this purpose. It represents the chemical yield of crosslinks, scissions and double bonds, etc. For the crosslinked polymer, the crosslinking density increases with increasing the radiation dose, this is reflected by the swelling degree of the polymer while being immersed in a compatible solvent. If crosslinking predominates, the crosslinking density increases and the extent of swelling decreases. If chain scission predominates, the opposite occurs. A further detailed discussion of these aspects is presented throughout this chapter.",book:{id:"6149",slug:"ionizing-radiation-effects-and-applications",title:"Ionizing Radiation Effects and Applications",fullTitle:"Ionizing Radiation Effects and Applications"},signatures:"Mohamed Mohamady Ghobashy",authors:[{id:"212371",title:"Dr.",name:"Mohamed",middleName:null,surname:"Mohamady Ghobashy",slug:"mohamed-mohamady-ghobashy",fullName:"Mohamed Mohamady Ghobashy"}]},{id:"53780",title:"Gamma-Ray Spectrometry and the Investigation of Environmental and Food Samples",slug:"gamma-ray-spectrometry-and-the-investigation-of-environmental-and-food-samples",totalDownloads:2476,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Gamma radiation consists of high‐energy photons and penetrates matter. This is an advantage for the detection of gamma rays, as gamma spectrometry does not need the elimination of the matrix. The disadvantage is the need of shielding to protect against this radiation. Gamma rays are everywhere: in the atmosphere; gamma nuclides are produced by radiation of the sun; in the Earth, the primordial radioactive nuclides thorium and uranium are sources for gamma and other radiation. The technical enrichment and use of radioisotopes led to the unscrupulously use of radioactive material and to the Cold War, with over 900 bomb tests from 1945 to 1990, combined with global fallout over the northern hemisphere. The friendly use of radiation in medicine and for the production of energy at nuclear power plants (NPPs) has caused further expositions with ionising radiation. This chapter describes in a practical manner the instrumentation for the detection of gamma radiation and some results of the use of these techniques in environmental and food investigations.",book:{id:"5451",slug:"new-insights-on-gamma-rays",title:"New Insights on Gamma Rays",fullTitle:"New Insights on Gamma Rays"},signatures:"Markus R. Zehringer",authors:[{id:"311750",title:"Dr.",name:"Markus R.",middleName:null,surname:"Zehringer",slug:"markus-r.-zehringer",fullName:"Markus R. Zehringer"}]},{id:"54118",title:"Gamma Rays from Space",slug:"gamma-rays-from-space",totalDownloads:2005,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"An overview of gamma rays from space is presented. We highlight the most powerful astrophysical explosions, known as gamma-ray bursts. The main features observed in detectors onboard satellites are indicated. In addition, we also highlight a chronological description of the efforts made to observe their high energy counterpart at ground level. Some candidates of the GeV counterpart of gamma-ray bursts, observed by Tupi telescopes, are also presented.",book:{id:"5451",slug:"new-insights-on-gamma-rays",title:"New Insights on Gamma Rays",fullTitle:"New Insights on Gamma Rays"},signatures:"Carlos Navia and Marcel Nogueira de Oliveira",authors:[{id:"189908",title:"Dr.",name:"Carlos",middleName:null,surname:"Navia",slug:"carlos-navia",fullName:"Carlos Navia"},{id:"243084",title:"MSc.",name:"Marcel",middleName:null,surname:"De Oliveira",slug:"marcel-de-oliveira",fullName:"Marcel De Oliveira"}]}],onlineFirstChaptersFilter:{topicId:"227",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:8,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:98,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:286,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:106,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:9,numberOfPublishedChapters:101,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:11,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}},{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}}]},series:{item:{id:"24",title:"Sustainable Development",doi:"10.5772/intechopen.100361",issn:null,scope:"
\r\n\tTransforming our World: the 2030 Agenda for Sustainable Development endorsed by United Nations and 193 Member States, came into effect on Jan 1, 2016, to guide decision making and actions to the year 2030 and beyond. Central to this Agenda are 17 Goals, 169 associated targets and over 230 indicators that are reviewed annually. The vision envisaged in the implementation of the SDGs is centered on the five Ps: People, Planet, Prosperity, Peace and Partnership. This call for renewed focused efforts ensure we have a safe and healthy planet for current and future generations.
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\r\n\tThis Series focuses on covering research and applied research involving the five Ps through the following topics:
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\r\n\t1. Sustainable Economy and Fair Society that relates to SDG 1 on No Poverty, SDG 2 on Zero Hunger, SDG 8 on Decent Work and Economic Growth, SDG 10 on Reduced Inequalities, SDG 12 on Responsible Consumption and Production, and SDG 17 Partnership for the Goals
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\r\n\t2. Health and Wellbeing focusing on SDG 3 on Good Health and Wellbeing and SDG 6 on Clean Water and Sanitation
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\r\n\t3. Inclusivity and Social Equality involving SDG 4 on Quality Education, SDG 5 on Gender Equality, and SDG 16 on Peace, Justice and Strong Institutions
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\r\n\t4. Climate Change and Environmental Sustainability comprising SDG 13 on Climate Action, SDG 14 on Life Below Water, and SDG 15 on Life on Land
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\r\n\t5. Urban Planning and Environmental Management embracing SDG 7 on Affordable Clean Energy, SDG 9 on Industry, Innovation and Infrastructure, and SDG 11 on Sustainable Cities and Communities.
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\r\n\tThe series also seeks to support the use of cross cutting SDGs, as many of the goals listed above, targets and indicators are all interconnected to impact our lives and the decisions we make on a daily basis, making them impossible to tie to a single topic.
",coverUrl:"https://cdn.intechopen.com/series/covers/24.jpg",latestPublicationDate:"April 24th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:0,editor:{id:"262440",title:"Prof.",name:"Usha",middleName:null,surname:"Iyer-Raniga",slug:"usha-iyer-raniga",fullName:"Usha Iyer-Raniga",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRYSXQA4/Profile_Picture_2022-02-28T13:55:36.jpeg",biography:"Usha Iyer-Raniga is a professor in the School of Property and Construction Management at RMIT University. Usha co-leads the One Planet Network’s Sustainable Buildings and Construction Programme (SBC), a United Nations 10 Year Framework of Programmes on Sustainable Consumption and Production (UN 10FYP SCP) aligned with Sustainable Development Goal 12. The work also directly impacts SDG 11 on Sustainable Cities and Communities. She completed her undergraduate degree as an architect before obtaining her Masters degree from Canada and her Doctorate in Australia. Usha has been a keynote speaker as well as an invited speaker at national and international conferences, seminars and workshops. Her teaching experience includes teaching in Asian countries. She has advised Austrade, APEC, national, state and local governments. She serves as a reviewer and a member of the scientific committee for national and international refereed journals and refereed conferences. She is on the editorial board for refereed journals and has worked on Special Issues. Usha has served and continues to serve on the Boards of several not-for-profit organisations and she has also served as panel judge for a number of awards including the Premiers Sustainability Award in Victoria and the International Green Gown Awards. Usha has published over 100 publications, including research and consulting reports. Her publications cover a wide range of scientific and technical research publications that include edited books, book chapters, refereed journals, refereed conference papers and reports for local, state and federal government clients. She has also produced podcasts for various organisations and participated in media interviews. She has received state, national and international funding worth over USD $25 million. Usha has been awarded the Quarterly Franklin Membership by London Journals Press (UK). Her biography has been included in the Marquis Who's Who in the World® 2018, 2016 (33rd Edition), along with approximately 55,000 of the most accomplished men and women from around the world, including luminaries as U.N. Secretary-General Ban Ki-moon. In 2017, Usha was awarded the Marquis Who’s Who Lifetime Achiever Award.",institutionString:null,institution:{name:"RMIT University",institutionURL:null,country:{name:"Australia"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. Dr. Ekinci serves as the Editor in Chief of four international books and is involved in the Editorial Board of several international journals.",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null},{id:"17",title:"Metabolism",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",isOpenForSubmission:!0,editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",isOpenForSubmission:!0,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. He is a Consultant Reviewer for several journals, including the Journal of Chromatography A, Journal of Chromatography B, Plos ONE, Proteomes, International Journal of Molecular Science, Biotech, Electrophoresis, and others. He is also Associate Editor of Biotech.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",slug:"simona-viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",biography:"Simona Viglio is an Associate Professor of Biochemistry at the Department of Molecular Medicine at the University of Pavia. She has been working since 1995 on the determination of proteolytic enzymes involved in the degradation process of connective tissue matrix and on the identification of biological markers of lung diseases. She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. She is an author of about 90 publications (According to Scopus: H-Index: 23; According to WOS: H-Index: 20) on peer-reviewed journals, a member of the “Società Italiana di Biochimica e Biologia Molecolare,“ and a Consultant Reviewer for International Journal of Molecular Science, Journal of Chromatography A, COPD, Plos ONE and Nutritional Neuroscience.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null}]},overviewPageOFChapters:{paginationCount:49,paginationItems:[{id:"80495",title:"Iron in Cell Metabolism and Disease",doi:"10.5772/intechopen.101908",signatures:"Eeka Prabhakar",slug:"iron-in-cell-metabolism-and-disease",totalDownloads:0,totalCrossrefCites:null,totalDimensionsCites:null,authors:null,book:{title:"Iron Metabolism - Iron a Double‐Edged Sword",coverURL:"https://cdn.intechopen.com/books/images_new/10842.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"81799",title:"Cross Talk of Purinergic and Immune Signaling: Implication in Inflammatory and Pathogenic Diseases",doi:"10.5772/intechopen.104978",signatures:"Richa Rai",slug:"cross-talk-of-purinergic-and-immune-signaling-implication-in-inflammatory-and-pathogenic-diseases",totalDownloads:7,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Purinergic System",coverURL:"https://cdn.intechopen.com/books/images_new/10801.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"81764",title:"Involvement of the Purinergic System in Cell Death in Models of Retinopathies",doi:"10.5772/intechopen.103935",signatures:"Douglas Penaforte Cruz, Marinna Garcia Repossi and Lucianne Fragel Madeira",slug:"involvement-of-the-purinergic-system-in-cell-death-in-models-of-retinopathies",totalDownloads:4,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Purinergic System",coverURL:"https://cdn.intechopen.com/books/images_new/10801.jpg",subseries:{id:"17",title:"Metabolism"}}},{id:"81756",title:"Alteration of Cytokines Level and Oxidative Stress Parameters in COVID-19",doi:"10.5772/intechopen.104950",signatures:"Marija Petrusevska, Emilija Atanasovska, Dragica Zendelovska, Aleksandar Eftimov and Katerina Spasovska",slug:"alteration-of-cytokines-level-and-oxidative-stress-parameters-in-covid-19",totalDownloads:8,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Chemokines Updates",coverURL:"https://cdn.intechopen.com/books/images_new/11672.jpg",subseries:{id:"18",title:"Proteomics"}}}]},overviewPagePublishedBooks:{paginationCount:27,paginationItems:[{type:"book",id:"7006",title:"Biochemistry and Health Benefits of Fatty Acids",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7006.jpg",slug:"biochemistry-and-health-benefits-of-fatty-acids",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Viduranga Waisundara",hash:"c93a00abd68b5eba67e5e719f67fd20b",volumeInSeries:1,fullTitle:"Biochemistry and Health Benefits of Fatty Acids",editors:[{id:"194281",title:"Dr.",name:"Viduranga Y.",middleName:null,surname:"Waisundara",slug:"viduranga-y.-waisundara",fullName:"Viduranga Y. Waisundara",profilePictureURL:"https://mts.intechopen.com/storage/users/194281/images/system/194281.jpg",biography:"Dr. Viduranga Waisundara obtained her Ph.D. in Food Science and Technology from the Department of Chemistry, National University of Singapore, in 2010. She was a lecturer at Temasek Polytechnic, Singapore from July 2009 to March 2013. She relocated to her motherland of Sri Lanka and spearheaded the Functional Food Product Development Project at the National Institute of Fundamental Studies from April 2013 to October 2016. She was a senior lecturer on a temporary basis at the Department of Food Technology, Faculty of Technology, Rajarata University of Sri Lanka. She is currently Deputy Principal of the Australian College of Business and Technology – Kandy Campus, Sri Lanka. She is also the Global Harmonization Initiative (GHI) Ambassador to Sri Lanka.",institutionString:"Australian College of Business & Technology",institution:null}]},{type:"book",id:"6820",title:"Keratin",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/6820.jpg",slug:"keratin",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Miroslav Blumenberg",hash:"6def75cd4b6b5324a02b6dc0359896d0",volumeInSeries:2,fullTitle:"Keratin",editors:[{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. 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The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. 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