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This study used survey data from cross-sectional, university-based samples of young adults in different cultural settings (i.e., the United States and Ghana) to accomplish 2 main objectives: (1) to construct a 4-dimensional police legitimacy scale, and (2) to assess the relationship that police legitimacy and feelings of obligation to obey the police have with 2 outcome measures. The fit statistics for the second-order confirmatory factor models indicated that the 4-dimensional police legitimacy model is reasonably consistent with the data in both samples. Results from the linear regression analyses showed that the police legitimacy scale is related to cooperation with the police, and that the observed association is attenuated when the obligation to obey scale is included in the model specification in both the United States and Ghana data. A similar pattern emerged in the U.S. sample when estimating compliance with the law models. However, although police legitimacy was associated with compliance in the Ghana sample, this relationship along with the test statistic for the sense of obligation to obey estimate were both null in the fully saturated equation. The findings provide support for the Bottoms and Tankebe's (2012) argument that legitimacy is multidimensional, comprising police lawfulness, distributive fairness, procedural fairness, and effectiveness. However, the link between police legitimacy and social order appears to be culturally variable. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the prevalence of low health literacy, and evaluate the impact of low health literacy on outcomes in patients with chronic musculoskeletal conditions. Data Sources: We searched Embase, Pubmed, PsycInfo, and CINAHL in January 2011 for relevant studies, restricted to English-language articles. Study Selection and Data Extraction: Studies were included if they measured health literacy and/or reported on the link between outcomes and health literacy levels in patients with osteoporosis, osteoarthritis, or rheumatoid arthritis. We assessed risk of bias from participant selection, methods of measuring health literacy and functional outcomes, missing data, and potential for confounding. Data Synthesis: We reviewed 1863 citations and judged 8 studies to be relevant. Most were cross-sectional in nature, and five were based in the United States. Diversity in measurements, participant characteristics, and settings meant that results had to be synthesized narratively. Prevalence of low health literacy varied from 7% to 42%. Of the five studies that reported on musculoskeletal outcomes, only one showed an association (unadjusted) between low health literacy and greater pain and limitations in physical functioning. However, other studies, including those with multivariate analyses, found no significant relationship between health literacy and measures of pain or disease specific questionnaires. One clinical trial found short-term improvements in the mental health of patients with musculoskeletal conditions after an intervention to improve health literacy. Limitations: Most of the studies were cross-sectional in nature, which precludes interpretation of a causal relationship. The sample sizes may not have been sufficiently large to enable detection of significant associations. Conclusions: The current evidence does not show a consistent association between low health literacy and poorer functional outcomes in patients with chronic musculoskeletal conditions. In the absence of a definite link, efforts to develop interventions to improve health literacy would not necessarily improve health service or patient-related outcomes. [ABSTRACT FROM AUTHOR]