Higher Educated Patients Research Articles

Inequities in Unexpected Cost-Sharing for Preventive Care in the United States

Unexpected out-of-pocket (OOP) costs for preventive care reduce future uptake. Because adherence to service guidelines differs by patient populations, understanding the role of patient demographics and social determinants of health (SDOH) in the incidence and size of unexpected cost-sharing is necessary to address these disparities. This study examined the associations between patient demographics and cost-sharing for common preventive services. This cross-sectional study used a national sample of insurance claims for recommended preventive services provided to privately insured adult patients between 2017 and 2020. The relationships between patient demographics and OOP costs were adjusted for service type, insurance type, geographic location, and time trends using regression analysis. Analyses were conducted in 2024. The sample included 1,736,063 unique preventive care encounters of 1,078,010 individuals. Among preventive encounters, 40.3% resulted in OOP costs. Lower-educated patients had 9.4% (OR=1.094; 95% CI=1.082, 1.106) higher odds of incurring OOP costs than patients with college degrees. Low-income patients (annual household income of $49,999 or less) had 10.7% (OR=0.893; 95% CI=0.880, 0.906) lower odds of incurring OOP costs than high-income patients. Conditional on incurring costs, lower educated patients paid $15.07 (95% CI= -$15.24, -$14.91) less than higher educated patients, and low-income patients paid $11.76 (95% CI=$11.58, $11.95) more than high-income patients. Significant differences across racial and ethnic groups were observed. The likelihood and size of OOP costs for preventive care varied considerably by patient demographics; this may contribute to inequitable access to high-value care.

T1 colorectal cancer patients' perspective on information provision and therapeutic decision-making after local resection.

Decision-making after local resection of T1 colorectal cancer (T1CRC) is often complex and calls for optimal information provision as well as active patient involvement. The aim was to evaluate the perceptions of patients with T1CRC on information provision and therapeutic decision-making. This multicenter cross-sectional study included patients who underwent endoscopic or local surgical resection as initial treatment. Information provision was assessed using the EORTC QLQ-INFO25 questionnaire. In patients with high-risk T1CRC, we evaluated decisional involvement and satisfaction regarding the choice as to whether to undergo additional treatment after local resection, and the level of decisional conflict using the Decisional Conflict Scale. Ninety-eight patients with T1CRC were included (72% response rate; 79/98 endoscopic and 19/98 local surgical resection; 45/98 high-risk T1CRC). Median time since local resection was 28months (IQR 18); none had developed recurrence. Unmet information needs were reported by 29 patients (30%; 18 low-risk, 11 high-risk), mostly on post-treatment related topics (follow-up visits, recovery time, recurrence prevention). After local resection, 24 of the 45 high-risk patients (53%) underwent additional treatment, while others were subjected to surveillance. Higher-educated patients were more often actively involved in decision-making (93% vs. 43%, p=0.002) and more frequently underwent additional treatment (79% vs. 40%, p=0.02). Decisional conflict (p=0.19) and satisfaction (p=0.78) were comparable between higher- and lower-educated high-risk patients. Greater attention should be given to the post-treatment course during consultations following local T1CRC resection. The differences in decisional involvement and selected management strategies between higher- and lower-educated high-risk patients warrant further investigation.

Association Between Years of Education and Amyloid Burden in Patients With Subjective Cognitive Decline, MCI, and Alzheimer Disease.

Higher-educated patients with Alzheimer disease (AD) can harbor greater neuropathologic burden than those with less education despite similar symptom severity. In this study, we assessed whether this observation is also present in potential preclinical AD stages, namely in individuals with subjective cognitive decline and clinical features increasing AD likelihood (SCD+). Amyloid-PET information ([18F]Flutemetamol or [18F]Florbetaben) of individuals with SCD+, mild cognitive impairment (MCI), and AD were retrieved from the AMYPAD-DPMS cohort, a multicenter randomized controlled study. Group classification was based on the recommendations by the SCD-I and NIA-AA working groups. Amyloid PET images were acquired within 8 months after initial screening and processed with AMYPYPE. Amyloid load was based on global Centiloid (CL) values. Educational level was indexed by formal schooling and subsequent higher education in years. Using linear regression analysis, the main effect of education on CL values was tested across the entire cohort, followed by the assessment of an education-by-diagnostic-group interaction (covariates: age, sex, and recruiting memory clinic). To account for influences of non-AD pathology and comorbidities concerning the tested amyloid-education association, we compared white matter hyperintensity (WMH) severity, cardiovascular events, depression, and anxiety history between lower-educated and higher-educated groups within each diagnostic category using the Fisher exact test or χ2 test. Education groups were defined using a median split on education (Md = 13 years) in a subsample of the initial cohort, for whom this information was available. Across the cohort of 212 individuals with SCD+ (M(Age) = 69.17 years, F 42.45%), 258 individuals with MCI (M(Age) = 72.93, F 43.80%), and 195 individuals with dementia (M(Age) = 74.07, F 48.72%), no main effect of education (ß = 0.52, 95% CI -0.30 to 1.58), but a significant education-by-group interaction on CL values, was found (p = 0.024) using linear regression modeling. This interaction was driven by a negative association of education and CL values in the SCD+ group (ß = -0.11, 95% CI -4.85 to -0.21) and a positive association in the MCI group (ß = 0.15, 95% CI 0.79-5.22). No education-dependent differences in terms of WMH severity and comorbidities were found in the subsample (100 cases with SCD+, 97 cases with MCI, 72 cases with dementia). Education may represent a factor oppositely modulating subjective awareness in preclinical stages and objective severity of ongoing neuropathologic processes in clinical stages.

A scenario-based web app to facilitate patient education in lung tumor patients undergoing video-assisted thoracoscopic surgery: Development and usability testing.

Patient education (PE) is essential for improving patients' knowledge, anxiety, and satisfaction, and supporting their postoperative recovery. However, the advantages of video-assisted thoracoscopic surgery (VATS)-smaller incisions and faster recovery-can result in shorter hospital stays, making PE more challenging to implement effectively. Multimedia PE can potentially enhance PE, but its effectiveness for patients undergoing VATS is unclear. This study developed a scenario-based PE web app for lung tumor patients undergoing VATS (SPE-VATS) to facilitate the PE process and evaluated its usability through a clinical trial. The SPE-VATS provided the experimental group (EG: 32 participants) with interactive scenario, query guidance, diagnostic analysis, experience sharing, and active reminder, while the control group (CG: 32 participants) used pamphlets and videos. The usability of SPE-VATS in terms of postoperative anxiety reduction and patient satisfaction with the app was evaluated using self-reported questionnaires based on the state-trait anxiety inventory, technology acceptance model, system usability scale, and task load index. There was no statistically significant difference in postoperative anxiety reduction between the EG and CG, possibly because 90% of the participants underwent a low-risk surgical type, and VATS is known to be advantageous in alleviating surgical anxiety. However, females and higher educated EG participants showed a non-significant but favorable reduction than their CG counterparts. Moreover, the EG was highly satisfied with the app (rated 4.2 to 4.4 out of 5.0), with no significant gender and education level difference. They particularly valued the interactive scenario, experience sharing, and diagnostic analysis features of SPE-VATS. The SPE-VATS demonstrated its usability and high patient satisfaction, particularly for female and higher educated patients. Low-risk patient predominance and VATS's advantages may explain non-significant postoperative anxiety reduction, warranting further studies on high-risk patients to evaluate the impact of SPE-VATS on clinical practice.

First contact with the health system: a survey study in northern Portugal

ObjectiveThe objective of this study is to characterise the self-reported first contact with the health system and the reasons stated for each choice, testing associations with population characteristics.DesignCross-sectional survey.SettingPrimary care...

Patient's knowledge regarding radiation exposure from various imaging modalities: a pilot study.

To determine patients' knowledge about ionising radiation used in diagnostic imaging and whether they were adequately informed about the procedure they were referred to. A cross-sectional study was conducted at the University Hospital Merkur, Zagreb, Croatia during 2019-20. A questionnaire with 14 questions was given to patients in waiting rooms for imaging examinations. Statistical analysis was conducted using the standard software package. Chi-square with Yates correction was used to determine differences in patients' answers between those who received the explanation about the procedure and those who did not. The differences depending on the educational level were also evaluated. The survey was completed by 374 participants (200 women, 174 men) with a mean age of 55.45±15.92y. Of all patients, 8.63% had no formal education or only finished elementary school, 52.83% had finished high school and 38.55% had a college or a higher degree. The referring physicians informed 63.66% of participants about the radiological exam they were being referred to, and 226 thought that the given explanation was sufficient. Most patients knew that some radiological procedures use ionising radiation. Only 47.37% of respondents correctly identified MRI as a non-ionising method, whereas 37.40% of participants recognised chest X-ray as the modality with the lowest radiation dose. Higher-educated patients had better knowledge of radiological procedures and the potential risks. The study demonstrated suboptimal patients' knowledge about ionising radiation, and additional efforts in their education are needed.

Examining the adequacy of preoperative informed consent in a developing country: Challenges in the era of surgical specialisation.

Preoperative informed consent is a legal and ethical requirement that ensures patients understand a procedure, its associated risks and benefits, alternative treatment options, and potential complications to make an informed decision about their care. This cross-sectional study evaluated the informed consent process for major orthopaedic surgeries at a tertiary hospital in Nigeria. A self-administered questionnaire was used to collect data from 120 adult participants. Results showed that many patients do not read the consent form before signing it, and surgeons do not adequately explain the alternatives to surgery, potential risks, and available anaesthetic options. Higher-educated patients are more likely to read the consent form. Surgeons performed well in explaining the nature of the condition and prognosis, the procedure's potential benefits, and answering patients' questions. The study emphasises the need to improve the informed consent process to ensure patients understand and can make rational decisions about their healthcare.

Exploring the occurrence and the risk factors of the desire for hastened death and depression in people with early-stage dementia in Greece.

To assess the factors associated with desire for hastened death and depression in early-stage dementia as well as the association between them. Also, to explore the mediator and moderator role of age in the relationship between depression and desire for hasten death. A prospective cross-sectional study including 100 patients diagnosed with early-stage dementia from a rehabilitation center between December 2018 and July 2019. Measurement tools used were the Mini-Mental State Examination, the Greek Montreal Cognitive Assessment, the Greek Schedule of Attitudes toward Hastened Death, and the Geriatric Depression Scale-15 item. Patients diagnosed with dementia as a result of Stroke history were excluded. Factors of multifactorial analysis significantly associated with desire for hastened death were as follows: age (p=0.009), marital status (p=0.001), and depression (p<0.001). The factor significantly associated with depression was age (p=0.001). Also, a mediation/moderation analysis has shown that depression and age are significant predictors of desire for hasten death. The desire for hastened death and depression in people diagnosed with early-stage dementia includes many components. Younger patients, men, higher educated patients, single, childless, and those with higher depression scores had higher desire for hastened death, while men and older patients had higher scores of desire for depression. Our study provides important information about the desire for hastened death and depression in early-stage dementia, their risk factors, and their association.

Disease pattern and satisfaction about health care services among patients attending a selected geriatric hospital in Dhaka city

Background: The proportion of elderly people is increasing at an unprecedented rate globally as well as in Bangladesh. Exploring the current situation it terms of magnitude and pattern of diseases suffered by elderly people would be a good resource for the policy makers in considering health care services and other supports for the elderly.&#x0D; Methods: A cross sectional descriptive study was done during January 2021 to December 2021 among elderly patients aged 60 years and above. A total of among 203 Patients form both indoor and outdoor department were included. A pretested questionnaire was used to collect the data collection. SPSS V23 software program were using analyzed data.&#x0D; Results: Among them 98 (48.25%) patients were suffering from communicable disease of which the most common (38.9%) was tuberculosis. On the other hands 201 patients were suffering from non- communicable disease of which the most common was Hypertension (HTN) (73.4%) followed by diabetes mellitus (DM) (36.5%), peptic ulcer (33%) and COPD (31%). The higher educated patients were significantly more dissatisfied compared to lower educated patients about drug dispensing (77.9% vs. 59.6%). Similarly, higher educated patients were significantly more dissatisfied compared to lower educated patients about nursing care (41.3% vs. 26.3%). The patients from urban area were significantly more dissatisfied compared to that of rural area about drug dispensing (76.7% vs. 58.6%).&#x0D; Conclusions: The study findings reveal that non-communicable diseases are the major bulk of diseases in elderly population in comparison to communicable diseases and HTN, DM, peptic ulcer, COPD were the common non-communicable diseases.

Do members of cancer peer support groups know more about cancer than non-members? Results from a cross-sectional study in Germany

PurposeThis study aims to assess whether cancer-specific knowledge (CSK) is associated with membership in a cancer peer support group (PSG) and other factors.MethodsA cross-sectional study investigated the CSK of 1121 cancer patients of various entities across Germany. CSK was measured with the BCKS-14, a 14-item knowledge instrument which was previously participatory developed with patient representatives and oncologists. Associations between CSK and PSG membership, sociodemographic factors, internet use, and preferences in medical decision-making were analysed with t-tests and multiple linear regressions.ResultsThe t-test showed a statistically significant difference in CSK between members and non-members of PSGs. Knowledge for PSG members was on average 0.97 points higher (p < 0.001) and varied between 2 and 14 points compared to 0–14 points for non-members. Regression analysis revealed age, gender, time since diagnosis, education, internet use, and PSG activity to be statistically significant predictors. Younger (β = − 0.15; p < 0.001), female (β = 0.10; p = 0.001), higher educated patients (β = 0.27; p < 0.001) with and a diagnosis longer ago (β = 0.10; p = 0.002) who use the internet frequently for information seeking (β = 0.20; p ≤ 0.001) and members of cancer PSGs (β = 0.18; p ≤ 0.001) showed a higher CSK.ConclusionOverall, CSK of the participants shows a high degree of variance. CSK should be promoted for all patients and especially for older, newly diagnosed patients with low educational levels and PSGs introduced early on as they contribute to improving CSK among other benefits.

The guided use of an e-health tool to strengthen health literacy. A pilot study in a multicultural diabetes population in a primary care clinic in Brussels.

We aimed to investigate whether the use of an e-health tool, guided by a healthcare provider, can improve health literacy (HL) in primary care. We set up a longitudinal prospective cohort study in a primary care clinic in Brussels. Diabetes patients were invited to participate in two study consultations with a trained healthcare provider, in which an e-health tool was introduced. The Health Literacy Questionnaire (HLQ) was used to evaluate HL before (n = 59) and after intervention (n = 41). The data were analysed within SPSS, Version 26. Additionally, impressions and experiences of both patients and healthcare providers were collected throughout the different phases of the study. Patients feel significantly stronger in finding good health information after intervention (p = 0.041), with relatively stronger progress for the subgroup with weaker digital skills (p = 0.029). Participants also declare understanding health information better after intervention (p = 0.050). Specifically, the lower educated participants feel reinforced to correctly evaluate and assess health information and come closer to the skill level of the higher educated patients after intervention. The relationship with the healthcare provider was also more markedly enhanced within the group of the lower educated (p = 0.008; difference between higher and lower educated), which could strengthen self-management in the long run. The guided use of an e-health tool in primary care strengthens various patient HL skills. Most particularly the skills "the ability to find good health information" and "understand health information well enough to know what to do" are reinforced. Moreover, patient populations with lower HL, such as the lower educated and lower digitally skilled, show a greater learning potential. Our results offer further proof for the learnable and flexible nature of HL, and show that even a small e-health intervention, in a very diverse patient population, can produce significant, positive effects on HL. These results need to be considered as promising, and a motivation for further investments in more widely accessible e-health tools to further improve HL at population level and to bridge health differences.

Assessment of diabetes mellitus related knowledge and its association with glycemic control level among adult diabetic patients attending Ministry of Health Primary Health Care Centers in Makkah Al Mukarramah, Saudi Arabia

Backgroundː Diabetes mellitus (DM) has a high prevalence rate in Saudi Arabia. Patients must have sufficient knowledge about DM to improve their self-management skills and prevent complications. This research was conducted to estimate the knowledge level among diabetic patients attending primary care centers about DM and its impact on their health. Methodsː A cross-sectional study was conducted on a sample of type II diabetic patients in Makkah city. Self-administered validated Arabic questionnaire was used to collect sociodemographic data, knowledge about the disease, and the level of control. Resultsː The study included 293 patients, 50.2% were females and 85.3% were Saudis. Mean age was 50 years (ranged 31 -77). Blood glucose was uncontrolled in 90.4% of patients. The overall knowledge regarding DM score mean 8.3±2.5 SD (ranged 3 -16) out of 20 and a median (Interquartile range) of 8 (7-10). Higher educated patients (p=0.043) and those who practiced physical activities (p=0.007) were more knowledgeable than their counterparts. None of the diabetes-related variables was significantly related with participants` information. Score of knowledge was not significantly related with level of glycemic control. Conclusionsː Patients with type II DM in Makkah had insufficient knowledge about their disease, its complications, and treatment.

The Potential of E-Health in Patients after Allogeneic Stem Cell Transplantation

Introduction Modern information and communication technologies (ICT) have become increasingly important in daily life as well as in patient-physician interaction, health monitoring and health related information (E-Health). Progress in allogeneic stem cell transplantation (allo-SCT) has led to improved survival and increasing numbers of patients. However, with a multitude of potential complications, follow-up of allo-SCT patients remains complex requiring close monitoring, support and treatment with a plethora of medical fields involved. Early studies have shown that E-Health can benefit caretaking of these patients. So far, only little information is known about the patients’ current use of E-Health and their perspective on its potential. Yet, this knowledge is of particular importance for re-structurization of follow-up after allo-SCT including the standardized use of E-Health and its comprehensive acceptance. This multicenter study aims to close this knowledge gap by investigating the patients’ view towards E-Health and use of telemedicine after allo-SCT. The results will help to facilitate the implementation of E-Health in standard follow-up after allo-SCT and other cellular therapies with a focus on patients’ perspective. Methods and Results Between May 2021 and June 2022, 237 patients after allo-SCT were asked to answer a structured questionnaire at the university hospitals Aachen, Bonn, Cologne and Duesseldorf (Center for Integrated Oncology, CIO ABCD) in Germany. Overall, 219 patients returned the questionnaire leading to a response rate of 92%. Of these, 34% were female and 66% were male with a median age of 59 years (range 18-81). In our patient cohort, the current distribution of internet-enabled computers/smartphones is over 90% and the electronic devices are mainly used for daily life activities. Nevertheless, the use of ICT in medical monitoring and patient-physician interaction is still limited. Only a minority of patients have digitized medication plans, use digital monitoring of health data/fitness-apps or own wearables for health monitoring such as smartwatches. In contrast, the majority of patients favors additional online patient-physician interaction such as scheduling and transmission of medical reports and 65% of the patients support real-time transmission of health data through wearables to the physician for a limited time period. Of note, 40-50% of patients have concerns regarding data safety, even more when using messenger services (67%). The majority of patients considers online chats or video calls with their physician to be beneficial and expects an improvement of the treatment quality through increased use of E-Health. Additionally, most patients favor local treatment with online correspondence between their local practitioner and a specialized center, especially if the patients are present during the online communication or with intermittent personal patient contact to the center. Subgroup analyses revealed that in most areas there is no gender difference in use and perspective on E-Health. However, male patients consider online chats more beneficial and expect an improved patient-physician interaction through increased use of ICT compared to females. Age and educational attainment are very significant factors in patients’ view on E-Health. Younger (<60 years) as well as higher educated patients favor increased use of online communication, applications and devices in almost all regards and expect benefits of patient-physician interaction and treatment quality, which is in significant contrast to the views of older or less educated patients. Hometown size or distance to a specialized center does not show a relevant impact on the view on E-Health. This is also true for time after allo-SCT or frequency of outpatient visits at the time of questioning. Conclusions Dissemination of internet-enabled devices is wide and the potential of E-Health is high in patients after allo-SCT. The majority of patients favors further standardized implementation of E-Health technologies and telemedically supported caretaking post allo-SCT and potentially other cellular therapies to improve patient-physician interaction and cross-sectoral care. Future research should focus on patients’ needs in the context of data safety and exchange of medical information in interdisciplinary care processes to successfully integrate new E-Health technologies.

Assessment of diabetes mellitus related knowledge and its association with glycemic control level among adult diabetic patients attending ministry of health primary health care centers in Makkah al Mukarramah, Saudi Arabia

Backgroundː Diabetes mellitus (DM) has a high prevalence rate in Saudi Arabia. Patients must have sufficient knowledge about DM to improve their self-management skills and prevent complications. This research was conducted to estimate the knowledge level among diabetic patients attending primary care centers about DM and its impact on their health. Methods A cross-sectional study was conducted on a sample of type II diabetic patients in Makkah city. Self-administered validated Arabic questionnaire was used to collect sociodemographic data, knowledge about the disease, and the level of control. Results The study included 293 patients, 50.2% were females and 85.3% were Saudis. Mean age was 50 years (ranged 31 -77). Blood glucose was uncontrolled in 90.4% of patients. The overall knowledge regarding DM score mean 8.3±2.5 SD (ranged 3 -16) out of 20 and a median (Interquartile range) of 8 (7-10). Higher educated patients (p=0.043) and those who practiced physical activities (p=0.007) were more knowledgeable than their counterparts. None of the diabetes-related variables was significantly related with participants` information. Score of knowledge was not significantly related with level of glycemic control.

An observational and cross-sectional study on prevalence of cognitive impairment and short-term changes in cognitive function after ischemic stroke in a tertiary care hospital

Background: Stroke is a leading cause physical and cognitive disability. Aims and Objectives: The aims of this study were to investigate the prevalence and pattern of cognitive impairment (CI) after first-ever ischemic stroke. Materials and Methods: Sixty subjects with first-ever ischemic strokes, confirmed by magnetic resonance imaging (MRI), were selected. Their clinic-diagnostic and comorbidity data were collected. Mini mental state examination (MMSE) was done after 3–7 days on each patient. MRI was used to ascertain the side, vascular territory, extent, and neural tissues (cortical/subcortical) involved. CIs were categorized as normal, mild, and moderate-to-severe according to MMSE scores ≥ 24, 18–23, and 0–17, respectively. Data were summarized as mean±standard deviation (SD) for numerical variables and counts and percentages for categorical variables. Results: (1) Elderly (61–70 years), male and higher educated patients were more prevalent, hypertension (HTN) was the most common comorbidity. (2) Subcortical, middle cerebral artery (MCA), and anterior cerebral artery (ACA) lesions and non-dominant side involvement were common. (3) 80% patients had CI (65% mild and 15% moderate-to-severe). (4) CI was the most common in patients aged 71–80 years, of lower educational status and having both diabetes and HTN. MCA territory strokes and non-dominant side involvement resulted in more moderate/severe CI. (5) Registration followed by recall was least affected whereas language and praxis were more affected domains. Conclusion: Post-stroke cognitive decline is more common in elderly population and patients with lower education. CI is more in people with HTN and DM and in people with MCA territory infarct. Language and praxis were the most affected domain of all.

Isfahan COVID cohort study: Rationale, methodology, and initial results.

The Isfahan COVID Cohort (ICC) study was designed to investigate the short- and long-term consequences of patients with COVID-19 in Iran. This report presents the rationale, methodology, and initial results of ICC. ICC is a 5-year multicentric prospective cohort study that is ongoing on two groups including 5000 patients hospitalized with moderate or severe and 800 nonhospitalized patients with mild or asymptomatic COVID-19 in Isfahan. The ICC endpoints are morbidity, mortality, incident cases, or worsening of underlying noncommunicable diseases (NCDs) and their risk factors. In the current analysis, we examined the persistent symptoms and incident NCDs or risk factors in 819 previously hospitalized patients who completed 1-year follow-up. The two most common symptoms were joint pain/myalgia (19.7%) and dry cough/dyspnea (18.7%). Around 60% of patients had at least one symptom which was more common among women than men and in middle aged than younger or older patients. Female (odds ratio [OR] =1.88, 95% confidence interval [CI]: 1.39-2.55) and highly-educated patients (OR = 2.18, 95% CI: 1.56-3.04) had higher risk of having any symptom in 1-year follow-up. New cases of hypertension followed by diabetes then coronary heart disease (CHD) were the most common incident NCDs. During 1-year follow-up after hospital discharge, about 60% of patients experienced persistent symptoms. Incident hypertension, diabetes, and CHD were the most common events seen. Close monitoring and extensive health services with integrative approaches are needed to improve the health status of these patients.

Insomnia in Post-Hematopoietic Stem-Cell Transplant Patients in Jordan: Prevalence and Associated Factors

Background and Objective Insomnia is a common symptom that is experienced by the patients post hematopoietic stem cell transplant that interfere with recovery outcomes and patients’ quality of life. Little is known about insomnia among post hematopoietic stem cell transplant in Jordan and in other Arab countries. The purpose of the current study was to identify the levels of insomnia and the related factors in post hematopoietic stem cell transplant.Methods A descriptive cross-sectional correlational design was used to guide this study. Data was collected from 163 patients by the Arabic version of the Insomnia Severity Index (ISI).Results The participant’s average ISI was 14.06 ± 7.71 indicating sub-threshold insomnia. Regarding the insomnia levels, 23.9% of the participants reported no insomnia, 27.6% had subthreshold insomnia, 31.3% had moderate clinical insomnia, and 17.2% had severe clinical insomnia. A significant difference in insomnia levels in some related factors was reported including the higher educated patients (t = 2.40, p = 0.018), patients who received allogeneic transplants (t = -2.932, p = 0.004), and patients within a 30 days’ post-transplant (F (160, 2) = 61.03, p &lt; 0.001).Conclusions In conclusion, the overall prevalence of insomnia among post HSCT patients was 48.5% (n = 79) that suggested clinical insomnia, and it was affected by several clinical variables. Further studies are needed to provide appropriate interventions to decrease insomnia levels among patients.

Factors influencing atrophy progression in primary progressive aphasia

AbstractBackgroundPrimary progressive aphasia (PPA) is a rare primarily language‐related neurodegenerative disorder that subdivides into the non‐fluent (nfvPPA) and the semantic variant (svPPA). Atrophy progression shows variant‐specific patterns, however, its extent seems highly individual and thus difficult to predict.MethodWe investigated volumetric changes in patients with nfvPPA (n=18) and svPPA (n=15) with an MRI scan (3D T1 MPRAGE sequence, 3T) at baseline and 2‐years follow‐up that were recruited from the prospective German FTLD‐consortium study. According to the LONI Probabilistic Brain Atlas (Shattuck et al., 2009), 56 brain regions were assessed with automated atlas‐based volumetry (Huppertz et al., 2010). Longitudinal volumetric changes were analyzed by means of the R software (www.r‐project.org). A possible impact of group, adjusted for age and sex, had been investigated using a linear mixed effect model. Atrophy progression for each region over two years was correlated (Pearson or Kendall rank correlation; 95% BCa bootstrap CI with 1000 replicates) with age at symptom onset, years of education, and disease duration to review a possible relation.ResultVolume change within 2‐years revealed parts of the left frontal lobe (up to ‐10%) and subcortical regions in nfvPPA and parts of the left temporal lobe (up to ‐15%) and the hippocampus/amygdala complex in svPPA as most progressive.A correlation analysis with age at symptom onset rendered no relevant results. Higher educated patients showed more atrophy in the right parahippocampal gyrus in nfvPPA and less atrophy in white matter portions of the left superior frontal, the bilateral middle and inferior frontal, the right middle and bilateral lateral orbitofrontal and the bilateral cingulate gyrus in svPPA. Shorter disease duration correlated with higher atrophy in the caudate and putamen in nfvPPA, and in the left middle and inferior temporal gyrus, the right superior and bilateral middle occipital gyrus, the left cuneus, and left angular gyrus in svPPA.ConclusionAge at symptom onset showed no interrelation with atrophy progression in PPA. Higher education levels seem to slow white matter decrease of frontal areas in svPPA. Shorter disease duration is related to increased volume loss in some primarily affected regions in both nfvPPA and svPPA.

Patients with rheumatic diseases are ready to use social media in clinical practice; what about rheumatologists? A cross-sectional survey.

Social media can be an innovative communication method between patients and physicians that help to overcome time limitation in outpatient clinics. In this study, we investigated how patients with rheumatic diseases (RD) and physicians use and are willing to use social media platforms to communicate with each other. We used a face-to-face survey that provides information on current social media habits and communication methods of rheumatology patients and physicians. We studied 399 (135 M/262 F) patients with RD with a median age of 45 (IQR: 34) years. We also studied 55 (30 M/25F) rheumatologists with a median age of 37 (IQR:34–44) years. Among patients with RD, 288 (72%) used at least one social media site within the previous month. Facebook was the most preferred social media platform, whereas Twitter and Instagram were favored by males and higher educated patients. While 17% of the patients with RD could communicate with their physicians outside of the hospital, 94% expressed that they would like to. Most patients (74%) defined social media as a reliable source for health-related information, yet 90% declared that they would like to obtain information about their disease using face-to-face communication. Forty-two (83%) rheumatologists were using social media and reported that they already communicate or would like to communicate with their patients outside of the hospital. Internet-based mobile applications and social media platforms are promising communication and educational tools for rheumatology patients.

Does Health Literacy Reinforce Disease Knowledge Gain? A Prospective Observational Study of Hungarian COPD Patients.

We set out to measure the health literacy (HL) of COPD patients using the Short Test of Functional Health Literacy (S-TOFHLA), perception-based screening questions (BHLS), and a specific disease knowledge test (COPD-Q). Our main focus is the relationship between functional HL and patients’ disease-knowledge, which contributes to the clarification of the relationship between the different kinds of HL. In two prospective observational studies, 151 COPD patients (80 males, mean age: 62 ± 9 years) completed a questionnaire containing HL measurements, psychological tests (e.g., the Self-Control and Self-Management Scale), and questions regarding subjective health status. Medical data of the patients from the MedSole system were added. The HL scores of the COPD patients were compared to a representative sample using a t-test. Furthermore, correlations of HL with demographic, psychological, and medical variables were calculated within the patient group. The relations among the different HL measurements were tested by chi-square trials. COPD patients had significantly lower HL, as measured by S-TOFHLA. Younger and higher educated patients possessed higher S-TOFHLA scores. Unlike the demographic variables, general self-management showed significant correlations with both BHLS and with COPD-Q. Out of the medical variables, objective health status was associated with BHLS and COPD-Q. Neither BHLS nor S-TOFHLA had a correlation with COPD-Q, but they correlated with each other. We found S-TOFHLA to be a better tool in the medical context. There is a clear gap between self-perceived/functional HL and the necessary disease knowledge. Rehabilitation care for patients with lower HL was more advantageous.