Higher Educated Patients Research Articles

Alfabetización en salud y resultados de salud en pacientes muy ancianos con insuficiencia cardiaca

Introduction and objectivesHealth literacy (HL) has been associated with lower mortality in heart failure (HF). However, the results of previous studies may not be generalizable because the research was conducted in relatively young and highly-educated patients in United States settings. This study assessed the association of HL with disease knowledge, self-care, and all-cause mortality among very old patients, with a very low educational level. MethodsThis prospective study was performed in 556 patients (mean age, 85 years), with high comorbidity, admitted for HF to the geriatric acute-care unit of 6 hospitals in Spain. About 74% of patients had less than primary education and 71% had preserved systolic function. Health literacy was assessed with the Short Assessment of Health Literacy for Spanish-speaking Adults questionnaire, knowledge of HF with the DeWalt questionnaire, and HF self-care with the European Heart Failure Self-Care Behaviour Scale. ResultsDisease knowledge progressively increased with HL; compared with being in the lowest (worse) tertile of HL, the multivariable beta coefficient (95%CI) of the HF knowledge score was 0.60 (0.01-1.19) in the second tertile and 0.87 (0.24-1.50) in the highest tertile, P-trend = .008. However, no association was found between HL and HF self-care. During the 12 months of follow-up, there were 189 deaths. Compared with being in the lowest tertile of HL, the multivariable HR (95%CI) of mortality was 0.84 (0.56-1.27) in the second tertile and 0.99 (0.65-1.51) in the highest tertile, P-trend = .969. ConclusionsNo association was found between HL and 12-month mortality. This could be partly due to the lack of a link between HL and self-care.Full English text available from: www.revespcardiol.org/en

The intertwined relationship between patient education, hospital waiting times and hospital utilization.

Background Hospital waiting times are established instruments to ration healthcare when resources are scarce. However, higher educated patients may be better able to influence access to, and exit from, hospital care when waiting times are long. Methods Based on a representative sample of 11 European countries from the Survey of Health, Ageing and Retirement in Europe (SHARE) collected in 2004/2005, this paper investigates whether the relationship between individual educational background and hospital utilization depends on the prevalent hospital waiting times in a country. Logistic regression with interaction effects between individual education and average waiting times per country are conducted. Results Primary education is significantly associated with a lower probability of visiting a hospital overnight (OR = 0.88) compared to secondary and tertiary education. Patients in countries with long waiting times had shorter stays (OR = 0.92), and the significant interaction effect indicates that lower educated patients have longer hospital stays than higher educated patients in countries where waiting times tend to be long (OR = 1.06). Conclusions While the findings imply that educational differences exist with regard to hospital care, future research should investigate potential underlying mechanisms, i.e. patients' perceived access barriers and the perceived quality of hospital treatment.

Health Literacy and Health Outcomes in Very Old Patients With Heart Failure

Introduction and objectivesHealth literacy (HL) has been associated with lower mortality in heart failure (HF). However, the results of previous studies may not be generalizable because the research was conducted in relatively young and highly-educated patients in United States settings. This study assessed the association of HL with disease knowledge, self-care, and all-cause mortality among very old patients, with a very low educational level. MethodsThis prospective study was performed in 556 patients (mean age, 85 years), with high comorbidity, admitted for HF to the geriatric acute-care unit of 6 hospitals in Spain. About 74% of patients had less than primary education and 71% had preserved systolic function. Health literacy was assessed with the Short Assessment of Health Literacy for Spanish-speaking Adults questionnaire, knowledge of HF with the DeWalt questionnaire, and HF self-care with the European Heart Failure Self-Care Behaviour Scale. ResultsDisease knowledge progressively increased with HL; compared with being in the lowest (worse) tertile of HL, the multivariable beta coefficient (95%CI) of the HF knowledge score was 0.60 (0.01-1.19) in the second tertile and 0.87 (0.24-1.50) in the highest tertile, P-trend = .008. However, no association was found between HL and HF self-care. During the 12 months of follow-up, there were 189 deaths. Compared with being in the lowest tertile of HL, the multivariable HR (95%CI) of mortality was 0.84 (0.56-1.27) in the second tertile and 0.99 (0.65-1.51) in the highest tertile, P-trend = .969. ConclusionsNo association was found between HL and 12-month mortality. This could be partly due to the lack of a link between HL and self-care.

Influence of education on cognitive performance and dopamine transporter binding in dementia with Lewy bodies

ObjectivesDementia with Lewy bodies (DLB) and Alzheimer’s disease (AD) are the two most common forms of dementia. These two diseases share some clinical and pathological similarities, yet the loss of dopaminergic neurons confirmed by 123-I-Ioflupane Single Photon Emission Computed Tomography (SPECT) is a suggestive feature of DLB. Current evidence suggests that higher education has a protective effect on the risk of developing clinical AD. However, how education influences cognitive performance and the presynaptic dopamine transporter marker in DLB is unknown. Materials and methodsWe reviewed 56 consecutive patients with DLB who underwent a 123-I-Ioflupane SPECT from January 2009 to August 2013 at the University Hospital of Caen. We collected clinical and neuropsychological data from medical files and 123-I-Ioflupane SPECT data for all patients. ResultsThere was no correlation between education and global cognitive performance in patients with DLB. However, there was a positive correlation between education and tests exploring visuoconstructive functions (Rey complex figure copy and recall) and verbal retrieval strategies (Grober and Buschke free recall test). There was also a positive correlation between education and dopamine transporter binding. Higher educated patients had higher binding in the striatum, putamen and caudate nucleus (p=0.001 for each regions of interest). Dopamine transporter binding in the striatum, putamen and caudate nucleus was lower in the subgroup of patients with REM sleep behavior disorder, but was not associated with other DLB symptoms. ConclusionHigher education may have a protective effect on visuoconstructive performance and verbal retrieval strategies and may influence dopaminergic nigrostriatal neurodegeneration in patients with DLB.

Primary care-led survivorship care for patients with colon cancer and the use of eHealth: a qualitative study on perspectives of general practitioners

ObjectivesThe aim of this study was to explore the perspectives of general practitioners (GPs) regarding their current and future role in survivorship care of patients with colon cancer, and to...

妇科癌症患者化疗后与认知功能障碍相关的研究

目的：1) 分析妇科癌症患者化疗后的认知功能状态。2) 分析化疗后认知功能障碍差异程度的相关因素。方法：2009年至2011年，妇科病房53名妇科癌症患者(Group A)入选本研究，年龄为18岁至66岁，其中患宫颈癌22例，卵巢癌24例，及其他妇科癌症7例。其中接受TP方案辅助化疗47例，接受其他方案化疗6例。化疗病人分组,根据他们的年龄(pre-perimenopausal <45岁和post-perimenopausal期 ≥45岁)，教育水平(低教育不到9年的教育和高等教育超过9年的教育)，类型的癌症(宫颈癌、卵巢癌、其他癌症)，类型的化疗方案(TP方案,其他方案)。对照组分为两组，非化学疗法的患者(B组)和健康对照组(C组)。根据患者的化疗情况分成5个研究组，对照组分为2组。采用2个主观问卷调查(Everyday Memory Questionnaires及CAMDEX)和1个客观问题测试(Random Number Test)，根据问题答案对错计分，判断受试对象的认知功能受损情况。问题测试在患者未接受任何治疗前(T1)和患者接受两次或者以上化疗疗程后3~4周后(T2)进行测试。患者的测试结果与对照组进行比较。结果：1) 资料显示化疗患者比非化疗患者和健康对照组出现更多的认知问题。2) 在化疗前后自身对照研究中发现，化疗后认知功能障碍与化疗前的有统计学差异(p = 0.039)。3) 妇科癌症患者化疗后认知功能障碍，在围绝经前组和围绝经后组间，有统计学差异(p = 0.031)。4) 妇科癌症患者化疗后认知功能障碍，在文化程度高组和文化程度低组间，有统计学差异(p = 0.010)。5) 妇科癌症患者化疗后认知功能障碍，在宫颈癌组和卵巢癌组间，没有统计学差异(p = 0.304)。结论：1) 妇科癌症患者化疗后认知功能障碍与健康人组、非化疗病人组有统计学差异。2) 在化疗前后自身对照研究中发现，化疗后患者认知功能障碍与化疗前的有统计学差异。3) 妇科癌症患者化疗后认知功能障碍，在围绝经前组和围绝经后组间有统计学差异。4) 妇科癌症患者化疗后认知功能障碍，在文化程度高组和文化程度低组间有统计学差异。5) 妇科癌症患者TP方案化疗后认知功能障碍，在宫颈癌组和卵巢癌组间没有统计学差异。 Objectives: 1) To evaluate post-chemotherapy cognitive functions in gynecology oncology patients; 2) To analyze the factors that influence memory impairment in those patients. Methods: The expe-rimental group (Group A) consisted of 53 patients admitted between year 2009-2011, with age ranging from 18 - 66 years old, suffering from cervical cancer (n = 22), ovarian cancer (n = 24), and other gynecologic cancer types grouped together (n = 7), treated with adjuvant TP regimen chemotherapy (n = 47) or other regimen chemotherapy grouped together (n = 6). The chemothe-rapy patients are grouped according to their age (pre-perimenopausal <45 years old and post-pe- rimenopausal period ≥45 years old), education level (lower educated of less than 9 years of edu-cation and higher educated of more than 9 years of education), types of cancer (cervical cancer, ovarian cancer, other cancer), types of chemotherapy regimen received (TP regimen, other regi-men). The control group is divided into 2 groups, non-chemotherapy patients (Group B) and heal- thy controls (Group C). According to patients’ chemotherapy is divided into five group, control group is divided into 2 groups. Using two subjective questionnaires (Everyday Memory Questionnaires and CAMDEX) and 1 objective problems Test (Random Number Test), right and wrong points according to the problem, determine subjects of cognitive function damage. Problems before test in patients who did not receive any treatment (T1) and patients received two or more than 3 to 4 weeks after chemotherapy regimen (T2) after the test. The patient test results comparing with control group. Results: 1) The data show that chemotherapy patients have more cognitive problems than chemotherapy patients and healthy controls. 2) Found in its own control study before and after chemotherapy, the cognitive dysfunction after chemotherapy and before chemotherapy is statistically significant (p = 0.039). 3) Gynecological cancer after chemotherapy in patients with cognitive dysfunction, and in the scarf premenopausal and postmenopausal group, has statistical difference (p = 0.031). 4) Gynecological cancer after chemotherapy in patients with cognitive dys-function, and in the cultural level between high and low degree of cultural groups, is statistically significant (p = 0.010). 5) Gynecological cancer after chemotherapy in patients with cognitive dys-function, between cervical cancer and ovarian cancer group, has no statistical difference (p = 0.304). Conclusions: 1) There was a statistically significant difference of cognitive impairment prevalence between chemotherapy patients and non-chemotherapy control groups. 2) Among chemotherapy patients participated in baseline cognitive assessment, there was a statistically significant difference in cognitive impairment prevalence between pre- and post-chemotherapy assessment. 3) Among chemotherapy patients, there was a statistically significant difference in cognitive impairment prevalence between pre-perimenopausal patients and post-perimenopausal patients. 4) Among chemotherapy patients, there was a statistically significant difference in cognitive impairment prevalence between lower educated patients and higher educated patients. 5) Among TP regimen chemotherapy patients, there was no statistically significant difference in cognitive impairment prevalence between ovarian cancer patients and cervical cancer patients.

A Cognitive Behavioural Illness Management Program for Severe Depression: Predictors of Treatment Response

Background: Although combined pharmacotherapy and teaching illness management are the standard in the treatment of depressed inpatients, few studies have been reported of the effects of these programs. The purpose of this study was to determine the applicability and preliminary effectiveness of a brief, group-based cognitivebehavioural illness management program for depression, and to explore whether patient socio demographic and clinical characteristics predicted differential treatment response.Methods: 97 inpatients with a major depression participated in a 6-week treatment program providing psycho education and skills to cope with the illness. Psychopathology, global functioning, knowledge about depression, selfesteem covering areas of problem solving, assertiveness and social competence were assessed as dependent variables.Results: Overall, patients improved over the treatment period on most dimensions of psychopathology, knowledge about depression, and self-esteem. There was little evidence of differential treatment response as a function of either socio demographic or clinical variables. However, level of education was related to changes in psychopathology from pre- to post-treatment with higher educated patients benefiting most. Patients who were rapidly discharged from the hospital benefited more than inpatients in symptoms and problem solving skills. At twoand six year follow-ups, characteristics such as age and duration of illness were the only significant predictors for relapses.Limitations: The absence of a control group limits the conclusions that can be drawn from this study.Conclusion: These results suggest that this illness management program may be a useful approach to treating patients with severe depression, and that it warrants further investigation in a controlled study.

Predictive factors for disease progression in patients with early-onset Alzheimer's disease.

Only a few studies have investigated disease progression in patients with early-onset Alzheimer's disease (EOAD). Therefore, the aim of this study was to investigate disease progression in patients with EOAD and the influence of various factors, such as gender, education, and apolipoprotein E (APOE) genotype on disease progression. A total of 288 EOAD patients were enrolled in the study. Linear mixed models were used to investigate the rate of cognitive and functional decline in terms of age at onset, gender, education, follow-up period, and APOE genotype. EOAD patients showed an annual decline of -1.54 points/years in the Korean version mini-mental examination score, an annual increase of 3.46 points/year in the Seoul instrumental activities of daily living (SIADL) score, and an annual increase of 1.15 points/year in the clinical dementia rating scale-sum of boxes score. After stratification, higher educated patients showed faster disease progression in all three parameters, and female patients demonstrated faster disease progression as assessed by the SIADL score. Age at onset and APOE genotype had no influence on disease progression. We confirmed the rate of disease progression in Korean patients with EOAD in real-life hospital-based clinical practice. The results of this study suggest that education and female gender, not APOE genotype, may be important as independent strong predictive factors for disease progression in patients with EOAD.

Relevance of graph literacy in the development of patient-centered communication tools

ObjectiveTo determine the literacy skill sets of patients in the context of graphical interpretation of interactive dashboards. MethodsWe assessed literacy characteristics of prostate cancer patients and assessed comprehension of quality of life dashboards. Health literacy, numeracy and graph literacy were assessed with validated tools. We divided patients into low vs. high numeracy and graph literacy. We report descriptive statistics on literacy, dashboard comprehension, and relationships between groups. We used correlation and multiple linear regressions to examine factors associated with dashboard comprehension. ResultsDespite high health literacy in educated patients (78% college educated), there was variation in numeracy and graph literacy. Numeracy and graph literacy scores were correlated (r=0.37). In those with low literacy, graph literacy scores most strongly correlated with dashboard comprehension (r=0.59–0.90). On multivariate analysis, graph literacy was independently associated with dashboard comprehension, adjusting for age, education, and numeracy level. ConclusionsEven among higher educated patients; variation in the ability to comprehend graphs exists. Practice implicationsClinicians must be aware of these differential proficiencies when counseling patients. Tools for patient-centered communication that employ visual displays need to account for literacy capabilities to ensure that patients can effectively engage these resources.

All eyes on the patient: the influence of oncologists' nonverbal communication on breast cancer patients' trust.

Trust in the oncologist is crucial for breast cancer patients. It reduces worry, enhances decision making, and stimulates adherence. Optimal nonverbal communication by the oncologist, particularly eye contact, body posture, and smiling, presumably benefits patients’ trust. We were the first to experimentally examine (1) how the oncologist’s nonverbal behavior influences trust, and (2) individual differences in breast cancer patients’ trust. Analogue patients (APs) viewed one out of eight versions of a video vignette displaying a consultation about chemotherapy treatment. All eight versions varied only in the oncologist’s amount of eye contact (consistent vs. inconsistent), body posture (forward leaning vs. varying), and smiling (occasional smiling vs. no smiling). Primary outcome was trust in the observed oncologist (Trust in Oncologist Scale). 214 APs participated. Consistent eye contact led to stronger trust (β = −.13, p = .04). This effect was largely explained by lower educated patients, for whom the effect of consistent eye contact was stronger than for higher educated patients (β = .18, p = .01). A forward leaning body posture did not influence trust, nor did smiling. However, if the oncologist smiled more, he was perceived as more friendly (r s = .31, p < .001) and caring (r s = .18, p = .01). Older (β = .17, p = .01) and lower educated APs (β = −.25, p < .001) were more trusting. Trust was weaker for more avoidantly attached APs (β = −.16, p = .03). We experimentally demonstrated the importance of maintaining consistent eye contact for breast cancer patients’ trust, especially among lower educated patients. These findings need to be translated into training for oncologists in how to optimize their nonverbal communication with breast cancer patients while simultaneously managing increased time pressure and computer use during the consultation.Electronic supplementary materialThe online version of this article (doi:10.1007/s10549-015-3486-0) contains supplementary material, which is available to authorized users.

Exclusive olive oil consumption and 10-year (2004-2014) acute coronary syndrome incidence among cardiac patients: the GREECS observational study.

The present study evaluated the association between long-term, exclusive olive oil consumption, in cooking preparation or as a dressing, and the 10-year (2004-2014) incidence of acute coronary syndrome (ACS) among cardiac patients. From October 2003 to September 2004, a sample of 2172 ACS consecutive patients from six major Greek hospitals were enrolled. During 2013-2014, the 10-year follow-up was performed in 1918 patients (88% participation rate). The development of fatal or nonfatal ACS was recorded through medical records or hospital registries. Among other dietary components, added fats (i.e. olive oil, butter, margarine and seed oils) consumption at baseline examination was assessed using a semi-quantitative food frequency questionnaire. Non-exclusive olive oil consumption on a daily basis was associated with an adverse effect on the ACS incidence after taking into account various potential confounders [odds ratio (OR) = 1.40, 95% confidence interval (CI) = 1.05-1.86, P = 0.024]. However, significant interactions between olive oil consumption and body mass index (BMI) (P = 0.082) and educational level (P = 0.054) led to further stratified analysis. Using BMI as strata (i.e. ≤29.9 versus >29.9 kg m(-2)), the above association remained significant only in obese patients (OR = 1.80, 95% CI = 1.03-3.12, P = 0.038), whereas, on examining the education status (i.e. ≤9 versus >9 years of school), a significant association was observed only among the higher educated patients (OR = 1.83, 95% CI = 1.01-3.32, P = 0.047). Exclusive use of olive oil, either as a salad dressing or in cooking, should be promoted through the dietary management of ACS patients, with the aim of reducing the likelihood of recurrent cardiac episodes.

Satisfaction with Nursing Care from the Inpatients' Perspective in Prince Salman Armed Forced Hospital Tabuk , Saudi Arabia

Background: Patient satisfaction with nursing care is important for any health care agency because nurses comprise the majority of health care providers and they provide care for patients 24 hours a day. Objectives: To assess nursing care from patients` perspective as well as to study the difference in the level of patients` satisfaction and their perspectives in relation to demographic background of patients and hospital characteristics. Subjects and Methods: This cross-sectional study included a representative sample of inpatients in Prince Salman Armed Forces hospital, Tabuk, KSA from all main departments (medical, surgical, nephrology, orthopedic and obstetrics & gynecology departments). Arabic version of Newcastle Satisfaction with Nursing scale (NSNS) was used for data collection. Results: Out of 420 patients invited to participate in the study, 414 filled in the questionnaires giving a response rate of 98.6%. The study included 414 admitted patients. Their age ranged between 18 and 74 with a mean of 38.5 (SD=14.2) years. Males represent 59.4% of them. 44.9% of patients reported below good, while 55.1% of them reported good experience of nursing care score. None of the participants reported above good (>80%) experience of nursing care score. The participants were mostly experienced with team work between Doctors and nurses and collaboration between nurses of different shifts. 73.9% of patients reported low ( 80%) satisfaction with nursing care score. Male, higher educated patients, those admitted to obstetrics and gynecology and stayed for 2-3 weeks in hospitals were more likely to express higher experience of nursing care and satisfaction with nursing care scores. Conclusions: Patient satisfaction with nursing care is generally low in the recent study. The findings provide nurses with information about aspects that enhance or hinder patient satisfaction.

Reproducibility of self-reported melanoma risk factors in melanoma patients.

As melanoma researchers continue to investigate environmental and lifestyle-related risk factors, questionnaire data remain important. The reproducibility of a questionnaire on melanoma risk factors was investigated using a test-retest approach in 389 Dutch melanoma patients. In 2011, 389 melanoma patients filled out a questionnaire on melanoma risk factors twice. Test-retest reproducibility was assessed by calculating kappas (κ), weighted kappas (κw), and intraclass correlation coefficients (ICCs) for categorical, ordinal, and continuous variables, respectively. Stratified analyses were carried out by sex, age group, education level, and time since diagnosis. The median time between the questionnaires was 31 days. The reproducibility was substantial for questions on phenotypic characteristics (κ/κw/ICC=0.62-0.77), fair-to-substantial for sun exposure and sun protection behavior (κ/κw/ICC=0.38-0.79), and moderate for sunburn history (κ/κw=0.42-0.51). No clear differences were observed between men and women. Younger patients showed a better reproducibility in nine of the 29 questions compared with older patients and higher educated patients showed a better reproducibility in four of the 29 questions. Patients with a diagnosis shorter than 1.5 years ago had a better reproducibility in four out of 29 items compared with patients with a diagnosis 1.5-3.0 years ago. Our study showed that self-reported information on melanoma risk factors is fairly well reproducible. Although this does not guarantee validity, this type of questionnaire seems to be useful in research settings. The reproducibility is slightly better in young patients and patients with a higher education level, which can be taken into account when interpreting results from epidemiological studies.

Danish cancer patients’ perspective on health care: results from a national survey

Patient's experiences and patient surveys are increasingly being used for the evaluation of the quality of health care. Patient information is valuable input when we aim to improve healthcare services. The aim of this study was to assess Danish cancer patients' experiences and assessment of the health care they have received, in regard to access to diagnostics, coordination and continuity of care, information and communication and involvement of patients and relatives. Questions and the opportunity to comment in free text were distributed to 6,720 newly diagnosed cancer patients in the summer 2010. A total of 4,346 patients (64.7 %) returned a questionnaire and were finally included in the study. The results exposed patient experienced problems with regard to easier access to diagnostics, GP's responsiveness to patients' worries, better coordination between different healthcare units and better involvement of patient and relatives. The study indicates that women, younger and higher educated patients tend to be less satisfied with the health care they received. This study shows that even though the majority of patients are satisfied with the quality of health care, there is room for improvements with regard to better access to diagnostics, healthcare professionals' responsiveness to patients, improved coordination and involvement of patient and relatives. There is a need to focus more on individual needs and patient-centered care.

Free and Cued Selective Reminding Test is superior to the Wechsler Memory Scale in discriminating mild cognitive impairment from Alzheimer's disease

The Logical Memory (LM) and the Verbal Paired Associative Learning (VPAL) are subtests from the Wechsler Memory Scale commonly used to characterize the memory deficit of amnestic mild cognitive impairment (aMCI) and Alzheimer's disease (AD). The Free and Cued Selective Reminding Test (FCSRT) was suggested to assess the memory impairment of AD spectrum patients by the International Working Group on AD. In the present study, we compared the properties of the tests and their accuracy in classifying aMCI and AD. A group of aMCI patients (n = 85) and AD patients (n = 43) were included. The reliability and the validity of the three tests were analyzed. AD patients showed a significant pattern of worse impairment on all tests than aMCI. The FCSRT was able to classify more patients as having memory impairment in the aMCI group rather than the WMS subtests. The FCSRT proved to be good in discriminating the two groups in both lower and higher educational levels, whereas the LM was more useful in higher educated patients. Although the instruments had good results, the FCSRT was more accurate in discriminating MCI from AD, and less influenced by the educational level.

Technological preferences of aging cancer patients for delivery services and devices to solve drug-related problems in oncology.

To identify the technological preferences of aging cancer patients with regard to the delivery services and devices for preventing/solving three common drug-related problems (DRPs): medication nonadherence, lack of knowledge in medications, and side effects management. A survey was conducted at a cancer center from May to August 2011. Delivery services included in the interviewer-administered questionnaire included voice-activated dispensing, voice reminders, electronic messages, helplines, and mobile phone applications, among others. Three devices were proposed-watches, bracelets, and mobile phones. Descriptive statistics and chi-square tests were performed. A total of 361 surveys were analyzed. Median age of respondents was 61 years. The majority of respondents were female (57.3 %), Chinese (88.9 %), and 65 years and younger (73.4 %). More than half (59.0-63.2 %) were receptive to the use of the delivery services. Patients preferred voice reminder alerts (28.0 %) and electronic messages (17.7 %) to help with their medication nonadherence, and helplines for medications (52.6 %) and side effects management (47.4 %). Higher educated patients were more likely to want delivery services to improve their medication adherence (p = 0.045) and knowledge in medications management (p = 0.050). Middle age patients (age 50-65) were also more likely to want delivery services for the latter DRP (p = 0.009). Among those who wanted delivery services, most preferred mobile phones. Middle age and elderly cancer patients are accepting of delivery services to help them with their DRPs. With middle aged patients being more receptive of the delivery services, technology can potentially play an important role in minimizing DRPs.

Is educational attainment related to end-of-life decision-making? A large post-mortem survey in Belgium

BackgroundEducational attainment has been shown to influence access to and quality of health care. However, the influence of educational attainment on decision-making at the end of life with possible or certain life-shortening effect (ELDs ie intensified pain and symptom alleviation, non-treatment decisions, euthanasia/physician-assisted suicide, and life-ending acts without explicit request) is scarcely studied. This paper examines differences between educational groups pertaining to prevalence of ELDs, the decision-making process and end-of-life treatment characteristics.MethodWe performed a retrospective survey among physicians certifying a large representative sample of Belgian deaths in 2007. Differences between educational groups were adjusted for relevant confounders (age, sex, cause of death and marital status).ResultsIntensified pain and symptom alleviation and non-treatment decisions are more likely to occur in higher educated than in lower educated patients. These decisions were less likely to be discussed with either patient or family, or with colleague physicians, in lower educated patients. A positive association between education and prevalence of euthanasia/assisted suicide (acts as well as requests) disappeared when adjusting for cause of death. No differences between educational groups were found in the treatment goal in the last week, but higher educated patients were more likely to receive opioids in the last day of life.ConclusionThere are some important differences and possible inequities between educational groups in end-of-life decision-making in Belgium. Future research should investigate whether the found differences reflect differences in knowledge of and adherence to patient preferences, and indicate a discrepancy in quality of the end of life.

Match and mismatch between objective and subjective improvements in upper limb function after stroke

Purpose: To identify stroke patients showing a match between an objectively meaningful improvement in upper-limb motor capacity and subjectively meaningful improvement in upper-limb performance after stroke, as well as determinants of matching and non-matching. Methods: Changes in upper-limb capacity in 39 stroke patients were measured over 17 weeks using the Action Research Arm Test (ARAT). Subjective change was measured with the Stroke Impact Scale Hand domain (SIS-Hand) and the Motor Activity Log (MAL). Patients showing a match between objective and subjective improvements (matchers) and patients showing a mismatch (non-matchers) were identified. Subsequently, determinants for the matchers were modeled using a logistic regression analysis. Results: A significant association was found between improvements on the ARAT and MAL (p = 0.011), but not for improvements on the ARAT and SIS-Hand. For the ARAT and SIS-Hand level of education and mood significantly improved the model. The probability of a match between objective and subjective outcomes in lower-educated patients with a positive mood was estimated to be 0.83, whereas in higher-educated patients with a negative mood it was estimated to be 0.07. Conclusions: Mismatches between objective and subjective outcomes are relevant for practitioners evaluating rehabilitation goals, and for defining outcome variables in future upper limb rehabilitation trials.Implications for RehabilitationIn upper limb rehabilitation after stroke, a match between capacity and self-perception outcome measures is not self-evident.Regarding these potential mismatches, practitioners and patients should consider carefully which goals to set, and how to evaluate upper limb rehabilitation after stroke; preferably with capacity measures and self-perception measures combined.

Do patients and physicians agree on diabetes management? A study conducted in Public Healthcare Centres in Brazil

ObjectiveTo explore to what extent patients with diabetes agree with their physicians on diabetes management and whether the agreement varies according to patients’ socio-demographic characteristics. MethodsA cross-sectional study was conducted among patients with diabetes and their Family Health physicians in 108 healthcare centres in Belo Horizonte, Brazil. Patients and physicians were interviewed face-to-face using standard questionnaires. Physicians were unaware of which of their patients would be interviewed. Their responses were compared using descriptive statistics and Cohen's weighted kappa. Results282 patient–physician pairs were included. Kappa coefficients were often low, the highest was found for presence of diabetic foot and the lowest for kidney disease. Physicians tended to overestimate patients’ risk of diabetes complications and underestimate patients’ adherence to all diabetes self-management activities as well as diabetes control. Moreover, the agreement rate regarding adherence to diet, foot care and medicine prescriptions was significantly higher among male, younger and higher educated patients. ConclusionResults indicate that physicians’ recommendations are generally poorly apprehended by their patients, especially by the lower educated, compromising the goal of patient-centred care. Practice implicationsEducational programmes need to incorporate strategies to improve the comprehension and effectiveness of physician–patient communication, especially with the most socially vulnerable groups.

Impact of socio-demographic factors on quality of life of primary chronic daily headache patients

Primary chronic daily headaches (CDHs) have a considerable negative impact on patients. It leads to poor quality of life (QOL) and diminished ability to function in day-to-day life, in spite of this sufficient work has not been done in this area in India. The purpose of this study was to determine influence of sociodemographic variables on QOL of primary daily headache patients. A prospective study was carried out on 50 consecutive primary CDH patients attending psychiatry and neurology outpatient unit, diagnosed as per IHC 2003 criteria. They were evaluated using a specially designed proforma and QOL was evaluated using the WHOQOL-Brief (Hindi) instrument. Statistical analysis was done on SPSS version 10. Results revealed that old age patients had poor QOL in environmental domain. Female patients had poorer QOL in social relationship and environmental domains. Married patients had poorer QOL in physical, environmental domain, and their total QOL was also poor. There was a significant positive correlation with education status of patients, that is, higher educated patients had better QOL in environmental domain and negative correlation with family size, that is, more the number of family members poorer was the QOL in social relationship domain. Thus, to conclude many sociodemographic factors in the patients suffering from primary CDH have significant negative impact on QOL of patients. Among sociodemographic variables age, gender, marital status, and family size were the important factors that influence QOL of patients.