***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We determined the factors associated with exacerbation of heart failure , using a cohort ( n = 192 ) nested within a r and omized trial at a university‐affiliated ambulatory practice . Factors associated with emergency or hospital care included left ventricular ejection fraction , hematocrit and serum sodium levels , refill adherence , and the ability to read a prescription label . Refill adherence of < 40 % was associated with a threefold higher incidence of hospitalization for heart failure than a refill adherence of ≥80 % ( P = 0.002 ) . In multivariable analysis , prescription label reading skills were associated with a lower incidence of heart failure – specific emergency care ( incidence rate ratio , 0.76 ; 95 % confidence interval ( CI ) , 0.19–0.69 ) , and participants with adequate health literacy had a lower risk of hospitalization for heart failure ( incidence rate ratio , 0.34 ; 95 % CI , 0.15–0.76 ) . We conclude that inadequate treatment adherence and health literacy skills are key factors in the exacerbation of heart failure . These findings emphasize the need for careful instruction of patients about their medications Abstract BACKGROUND : Patients ’ ability to manage medications is critical to chronic disease control . Also known as medication management capacity ( MMC ) , it includes the ability to correctly identify medications and describe how they should be taken . OBJECTIVE : To evaluate the effects of low literacy , medication regimen complexity , and sociodemographic characteristics on MMC . DESIGN : Cross-sectional analysis of enrollment data from participants in a r and omized trial . PARTICIPANTS : Patients with coronary heart disease in an inner-city clinic . MEASUREMENTS : Medication management capacity was measured with the  Drug Regimen Unassisted Grading Scale ( DRUGS )  , which scores subjects ’ ability to identify , open , describe the dose , and describe the timing of their medications . DRUGS overall and component scores were compared by literacy .  Mini Mental State Exam score , regimen complexity ( number of prescription medications )  , and sociodemographic characteristics . RESULTS : Most of the 152 participants were elderly ( mean age 65.4 years ) , women ( 54.6 % ) , and African American ( 94.1 % ) . Approximately half ( 50.7 % ) had inadequate literacy skills , and 28.9 % had marginal skills . In univariate analysis , MMC was significantly associated with literacy ( P<.001 ) , and this effect was driven by the ability to identify medications . In multivariable models , patients with inadequate literacy skills had 10 to 18 times the odds of being unable to identify all of their medications , compared with those with adequate literacy skills ( P<.05 ) . CONCLUSIONS : Adults with inadequate literacy skills have less ability to identify their medications . Techniques are needed to better educate low-literacy patients about their medications , as a potential strategy to enhance adherence PURPOSE This study evaluated the effect of oral health literacy ( OHL ) on the retention of health information in pregnant women . MATERIAL S AND METHODS A total of 175 pregnant women were r and omly assigned to st and ard oral ( spoken ) , written and control intervention groups . With the exception of the control group , the interventions investigated the eating habits and oral hygiene among children under 2 years of age . The participants ' answers before the interventions ( pre-test ) , 15 min after the interventions ( post-test ) and 4 weeks after the interventions ( follow-up test ) were used to estimate the knowledge score ( KS ) . Information acquisition was determined by comparing pre-test and post-test results , while retention of information was based comparing pre-test and follow-up test results . OHL was analysed by BREALD-30 . The data were assessed by nonparametric tests and Poisson regression models with robust variance ( α = 0.05 ) . RESULTS By the end of the follow-up period , 162 pregnant women had been assessed . The BREALD-30 mean was 22.3 ( SD = 4.80 ) . Regardless of the type of intervention , pregnant women with low OHL had lower knowledge scores in the three assessment s. Participants with low OHL showed higher acquisition and retention of information in the st and ard oral health intervention . Multiple regression models demonstrated that OHL was independently associated with KS , age , socioeconomic status and type of intervention . CONCLUSION The results suggest a negative effect of low OHL on retention of information . Only the st and ard , spoken oral health intervention could address the differences in literacy levels Caregivers ’ health literacy has emerged as an important determinant of young children ’s health care and outcomes . We examined the hypothesis that caregivers ’ health literacy influences children ’s  oral-health-care – related expenditures . This was a prospect i ve cohort study of 1,132 child/caregiver dyads ( children ’s mean age = 19 months ) , participating in the Carolina Oral Health Literacy Project .  Health literacy was measured by the REALD-30 ( word recognition based ) and NVS ( comprehension based ) instruments . Follow-up data included child Medicaid cl aims for CY2008 - 10 . We quantified expenditures using annualized 2010 fee-adjusted Medicaid-paid dollars for oral-health – related visits involving preventive , restorative , and emergency care . We used descriptive , bivariate , and multivariate statistical methods based on generalized gamma models . Mean oral-health – related annual expenditures totaled $ 203 : preventive—$81 , restorative—$99 , and emergency care—$22 . Among children who received services , mean expenditures were : emergency hospital-based—$1282 , preventive—$106 , and restorative care—$343 . Caregivers ’ low literacy in the oral health context was associated with a statistically non-significant increase in total expenditures ( average annual difference = $ 40 ; 95 % confidence interval , -32 , 111 ) . Nevertheless , with both instruments , emergency dental care expenditures were consistently elevated among children of low-literacy caregivers . These findings provide initial support for health literacy as an important determinant of the meaningful use and cost of oral health care PURPOSE To examine the relationship between oral health literacy and oral health by adapting a valid oral health literacy instrument . MATERIAL S AND METHODS A r and om sample of 715 students from 9 institutes was included in the study .  Oral health literacy ( OHL ) was assessed by making the students pronounce a list of 40 words from REALD-99 . Oral health status  ( OHL ) was assessed using a modified WHO ( 1997 ) proforma . A stepwise logistic regression analysis was performed to assess the impact of independent factors on oral health literacy . RESULTS The response rate was 97.9 % ; 15 students refused to participate , leaving 700 participants in the final sample . The mean age of the participants was 20.35±1.66 years . A statistically significant difference was observed in OHL according to the clinical parameters . Caries prevalence was higher among subjects with low OHL with a mean DMFT score of 2.69±1.53 , compared with high-OHL students having a mean DMFT of 0.22±0.4 . Similarly , oral hygiene status was poor among subjects with low OHL ( 1.53±0.6 ) . Community periodontal index ( CPI ) scores were lower ( 1.06±0.8 ) in subjects with high OHL than in those with low literacy ( CPI : 1.6±0.6 ) . CONCLUSION The present study revealed a negative correlation between oral health literacy and clinical parameters measured , that is , higher oral health literacy was associated with better oral health 
    Output:
    
Most studies regarding tooth brushing frequency found no association with OHL .
Most studies regarding oral health knowledge related outcomes reported an association with higher OHL .
The literature was inconclusive regarding the association between OHL and dental treatment outcomes , oral health behaviors , and oral health perception .
The current scientific evidence suggests that no association exists between OHL and any of the outcomes investigated .