Neurodevelopmental disorders and family quality of life: emerging trends and future research directions.

Autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) are the most prevalent neurodevelopmental disorders. There is a growing body of literature investigating factors affecting quality of life in families (FQoL) with a child with these disorders. However, there are no studies that trace their knowledge anatomy. Thus, we conducted a scientometric analysis to describe this literature, detect certain variables that could be related to FQoL, and identify tendencies and open questions for future research. A literature search in the Web of Science, PubMed, and Scopus was run and identified 3281 publications published between 1975 and 2022. The results suggest an increase in the quantity of publications on FQoL in ASD and ADHD over the last few years (14% and 12%, respectively). For both research fields, the USA published the highest number of documents, showing that the production related to ADHD and FQoL is concentrated in just a few countries. Thematic analysis revealed several clusters, considering quality of life and children as core themes that are still setting trend lines. Moreover, it would be worthwhile to describe and analyze FQoL not only during the childhood of children with ASD and ADHD but also during their adolescence. IMPACT: Although the relationship between family quality of life and neurodevelopmental disorders could be considered novel, there is a growing interest from an interdisciplinary perspective. Family quality of life should be monitored not only during the childhood of children with ASD and ADHD, but also during their adolescence and adulthood. The analysis of the family quality of life in first-degree relatives and its relationship with protective factors (e.g., resilience and social support) should be explored in future studies.

Sex Moderates the Relationship Between Social Support and Cardiovascular Prevention Behaviors in Middle-aged and Older Adults.

BACKGROUND: Most risk factors for cardiovascular disease (CVD) are modifiable, suggesting that the burden of CVD could be substantially reduced through cardiovascular screening and healthier lifestyle. People who have social support are more likely to adhere to cardiovascular prevention recommendations, but it is not clear whether the benefit of social support is equal for men and women. PURPOSE: We investigated whether sex moderates the relationship between social support and adherence to cardiovascular prevention recommendations in a nationally representative sample. METHODS: Participants were 17,287 adults (n = 10,264 middle-aged adults 40-64 years old and n = 7,023 older adults ≥ 65 years old) who participated in the National Health Survey of Spain in 2017. Social support was measured with the Functional Social Support Questionnaire of Duke-UNC. Adherence to cardiovascular screening recommendations was assessed based on self-reported testing of cholesterol, blood pressure, and blood sugar by a health professional in the past 12 months. Adherence to recommended health-related behaviors was assessed based on the guidelines of the European Society of Cardiology regarding diet, alcohol consumption, smoking, and physical activity. RESULTS: Multiple regression models adjusted for socio-demographic and cardiovascular history and risk variables showed that social support was more strongly associated with adherence to cardiovascular prevention recommendations in men than in women. In particular, low social support levels were especially detrimental for both middle-aged men (screening: B = 0.13, 95% CI [0.06-0.20], p < .001; behaviors: B = 0.33 [0.26-0.41], p < .001) and older men (screening: B = 0.10 [0.04-0.17], p = .001; behaviors: B = 0.16 [0.08-0.25], p < .001), whereas older women had comparatively high adherence, which was unrelated to social support (screening: B = 0.02 [-0.03 to 0.08], p = .433; behaviors: B = 0.03 [-0.03 to 0.10], p = .342). CONCLUSIONS: Social support is more strongly associated with cardiovascular prevention in men than in women, such that men who lack social support have the lowest adherence to cardiovascular screening and lifestyle recommendations.

To help prevent cardiovascular disease, experts recommend screening for cardiovascular risk factors and leading a healthy lifestyle. Previous research has found that people who have social support are more likely to adhere to such cardiovascular prevention recommendations. In this study, using data form a nationally representative survey, we investigated whether the relationship between social support and adherence to cardiovascular prevention recommendations is different for men and women. Participants were 17,287 adults from the National Health Survey of Spain, who reported their cardiovascular screening history (i.e., whether they had their cholesterol, blood pressure, and blood sugar levels tested by a health professional in the past 12 months) and their lifestyle habits regarding diet, alcohol consumption, smoking, and physical activity. Social support was more strongly associated with cardiovascular prevention in men than in women, such that men who lacked social support had the lowest adherence to cardiovascular screening and lifestyle recommendations.

Measuring feelings about choices and risks: The Berlin Emotional Responses to Risk Instrument (BERRI).

We introduce a brief instrument specifically validated for measuring positive and negative feelings about risks-the Berlin Emotional Responses to Risk Instrument (BERRI). Based on seven studies involving diverse adults from three countries (n = 2120), the BERRI was found to robustly estimate anticipatory affective reactions derived from subjective evaluations of positive (i.e., assured, hopeful, and relieved) and negative emotions (i.e., anxious, afraid, and worried). The brief BERRI outperformed a 14-item assessment, uniquely tracking costs/benefits associated with cancer screening among men and women (Studies 1 and 2). Predictive validity was further documented in paradigmatic risky choice studies wherein options varied over probabilities and severities across six contexts (health, social, financial, technological, ethical, and environmental; Study 3). Studies 4-6, conducted during the Ebola epidemic and COVID-19 pandemic, indicated BERRI responses were sensitive to subtle effects caused by emotion-related framing manipulations presented in different cultures and languages (the United States, Spain, and Poland). Study 7 indicated BERRI responses remained stable for 2 weeks. Although the BERRI can provide an estimate of overall affect, choices were generally better explained by the unique influences of positive and negative affect. Overall, results suggest the novel, brief instrument can be an efficient tool for high-stakes research on decision making and risk communication.

Physical comorbidities as a marker for high risk of psychological distress in cancer patients.

AIMS: Physical and psychiatric comorbidities are common in cancer patients and could impact their treatment and prognosis. However, the evidence base regarding the influence of comorbidities in the management and health service use of patients is still scant. In this research we investigated how physical comorbidities are related to the mental health and help-seeking of cancer patients. METHODS: Data were obtained from the representative National Health Survey of Spain (2017). Participants were respondents who reported a cancer diagnosis (n = 484). These were also matched with controls without cancer history (n = 484) based on age, gender, and region. Four alternative physical comorbidities indices were created based on information regarding 28 chronic conditions. Outcomes of interest were psychological distress and having consulted a mental healthcare professional in the year before the survey. RESULTS: Thirty percent of cancer patients reported significant psychological distress but only 10% had consulted a professional. After adjusting for sociodemographic variables, among cancer patients each additional comorbidity was associated with 9% higher odds of reporting high psychological distress (odds ratio [OR] = 1.09, 95% confidence interval [CI]: 1.01-1.16) and 21% higher odds of having consulted a mental healthcare professional (OR = 1.21, 95% CI: 1.09-1.34). The effects of comorbidities depended on the type of index and were different in controls without cancer history. CONCLUSION: Physical comorbidities in cancer patients are associated with higher risk of psychological distress and higher demand for mental health services. We encourage further research on this issue as it could improve mental health screening and management in oncologic care.

Siblings of children with autism spectrum disorders: social support and family quality of life.

PURPOSE: Autism spectrum disorder (ASD) often has a significant impact on all family members, including parents and siblings of the person who suffers the disorder. This case-control study explores potential factors that help explain the impact of having an older sibling with ASD on several developmental domains, and to test whether these factors could explain their satisfaction on family quality of life (FQoL). METHODS: A total of 78 unaffected siblings of children with ASD (Sibs-ASD) and siblings of children with typical development (Sibs-TD) from 6 to 12 years old were evaluated. RESULTS: Our analyses show significant differences between groups in motor skills, severity of autistic traits, satisfaction on FQoL, and social support (ps < .05). Moreover, social support acts as positive factor protecting from the negative effect of having a sibling with ASD on satisfaction of FQoL (R2 = .32). CONCLUSIONS: Our findings highlight the variability in the developmental abilities of the unaffected school-age children with familiar risk factors and emphasize the need for supervising development of all Sibs-ASD over different time points. Social support may be a critical aspect to consider in interventions for improving the satisfaction on FQoL.

Effectiveness of a psychological intervention focused on stress management for women prior to IVF.

Objective: To evaluate the effectiveness of a psychological intervention focused on stress management in women who are candidates for in vitro fertilisation (IVF).Method: Pre-post study with two groups (n = 26). The psychological intervention group (IG) received a 90-minute session that included psychoeducation, relaxation training and coping skills. The control group (CG) did not receive any psychological intervention. All participants later underwent IVF. In the initial and final evaluations, state anxiety, emotional imbalance, adaptive resources and quality of life were measured. In the initial evaluation, demographic and clinical variables were also measured.Results: In the IG, the final evaluation reflected: (1) decreased levels of anxiety and emotional imbalance; (2) the perception of enhanced quality of life. Moreover, among the participants who received the psychological intervention and later achieved a successful IVF, the level of anxiety appeared to have decreased more strongly.Conclusions: A brief intervention focused on stress management can benefit the psychological adjustment of women who are candidates for IVF, reducing the anxiety they may experience in this regard. However, our conclusions are based on a small sample, and so should be considered with caution. Nevertheless, these results are promising and highlight the advisability of further research.

The experience-based format of probability improves probability estimates: The moderating role of individual differences in numeracy.

People with low statistical numeracy have difficulties understanding numerical information. For instance, they often misunderstand the probability of experiencing side effects, which could reduce adherence to medical treatments. We investigated whether presenting information about probability using a method based on the direct experience of events influences the accuracy of probability estimates compared to viewing a static numerical description of the same information. Participants completed a numeracy test and were randomly assigned to one of two conditions. In the description-based probability condition, participants were presented with 24 binomial distributions consisting of a target stimulus "X" and a distractor stimulus "·" in the form of odds (the distribution "7 × 13 ·" is an example of a 35% probability: here the target [distractor] stimulus was present 7[13] times in a 20-stimulus distribution). In the experience-based probability condition, participants observed the same information but the stimuli were randomly arranged and displayed sequentially. Participants in both conditions estimated the probability of the target stimulus in each trial. In the experience-based format participants with low numeracy made more accurate probability estimates in comparison to the description-based format. In contrast, accuracy in participants with high numeracy was similar in the two formats.

Social support buffers the negative effects of stress in cardiac patients: a cross-sectional study with acute coronary syndrome patients.

Cardiac patients who have social support generally have better prognosis than patients who lack social support. Several theoretical mechanisms have been proposed to explain this protective effect, including the capacity of social support to buffer the negative effects of stress. We tested this buffering effect in a study of patients hospitalized for acute coronary syndrome (ACS) in Spain. Several days after the cardiac event patients answered a questionnaire measuring stressful events during their lifetime, perceived social support around the time of the cardiac event, and depression symptoms in the past week. Results showed that stressful life events were related to depressive symptoms and worse renal function post-ACS only among patients with low perceived social support. Among patients who reported enough social support, lifetime stress was not related to depressive symptoms. No similar effects were observed on other prognostic indicators such as troponin levels or the number of obstructed arteries. These results suggest that social support can buffer the negative effects of stress on the mental and physical well-being of cardiac patients.

Graphical and numerical skills in pre- and postgraduate medical students from a private university. / Habilidad gráfica y numérica en estudiantes de medicina de pre y posgrado de una universidad privada.

Introduction: Physicians and medical students need to understand numerical and graphical health data in order to provide patients with correct information. Objective: The graphical and numerical skills of medical students and residents from a private university in Lima, Peru, were determined in this investigation. Method: Cross-sectional, descriptive study. The Objective Numeracy, Subjective Numeracy and Graph Literacy Scales were applied to medical students at their two final years of medical school and to medical residents. Results: Of 169 participants, 52.07% were sixth-year and 18.34% were seventh-year students and 29.58% were residents. Mean objective numeracy score was 7.34, mean subjective numeracy was 34.12 and mean graph literacy was 10.35. A multiple linear regression analysis showed that Subjective and Objective Numeracy Scales highest means were associated with the male gender and training on research methodology (p < 0.05). Graph Literacy Scale highest means were associated with the male gender and younger age (p-value < 0.05). Conclusion: Numeracy and Graph Literacy Scales mean scores were high in medical students.

Introducción: Los médicos y estudiantes de medicina necesitan comprender los datos numéricos y gráficos sobre salud para proveer información correcta a los pacientes. Objetivo: Determinar las habilidades gráficas y numéricas en estudiantes y residentes de medicina de una universidad privada de Lima, Perú. Método: Estudio descriptivo, transversal. Se aplicaron las escalas de Habilidad Numérica Objetiva, de Habilidad Numérica Subjetiva y de Habilidad Gráfica a estudiantes de medicina de los dos últimos años de la carrera de medicina y a residentes de medicina. Resultados: De 169 participantes, 52.07 % fueron estudiantes de sexto año, 18.34 % de séptimo y 29.58 % residentes. La media en la habilidad numérica objetiva fue de 7.34, en la subjetiva de 34.12 y en la habilidad gráfica de 10.35. De la regresión lineal múltiple se obtuvo que las medias más altas en las escalas de Habilidad Numérica Subjetiva y Objetiva estuvieron asociadas con el sexo masculino y la capacitación sobre metodología en investigación (p < 0.05). En la Escala de Habilidad Gráfica, las medias más altas estuvieron asociadas con el sexo masculino y menor edad (p < 0.05). Conclusión: Las medias de las escalas de Habilidad Gráfica y Habilidad Numérica en estudiantes de medicina fueron altas.

Numeracy Predicts Risk of Pre-Hospital Decision Delay: a Retrospective Study of Acute Coronary Syndrome Survival.

BACKGROUND: Many patients delay seeking medical attention during acute coronary syndromes (ACS), profoundly increasing their risk for death and major disability. Although research has identified several risk factors, efforts to improve patient decision making have generally been unsuccessful, prompting a call for more research into psychological factors. PURPOSE: The purpose of this study is to estimate the relationship between ACS decision delay and numeracy, a factor closely related to general decision making skill and risk literacy. METHODS: About 5 days after experiencing ACS, 102 survivors (mean age = 58, 32-74) completed a questionnaire including measures of numeracy, decision delay, and other relevant factors (e.g., anxiety, depression, symptom severity, knowledge, demographics). RESULTS: Low patient numeracy was related to longer decision delay, OR = 0.64 [95 % confidence interval (CI) 0.44, 0.92], which was in turn related to higher odds of positive troponin on arrival at the hospital, OR = 1.37 [95 % CI 1.01, 2.01]. Independent of the influence of all other assessed factors, a patient with high (vs. low) numeracy was about four times more likely to seek medical attention within the critical first hour after symptom onset (i.e., ORhigh-low = 3.84 [1.127, 11.65]). CONCLUSIONS: Numeracy may be one of the largest decision delay risk factors identified to date. Results accord with theories emphasizing potentially pivotal roles of patient deliberation, denial, and outcome understanding during decision making. Findings suggest that brief numeracy assessments may predict which patients are at greater risk for life-threatening decision delay and may also facilitate the design of risk communications that are appropriate for diverse patients who vary in risk literacy.

A multidisciplinary approach to designing and evaluating Electronic Medical Record portal messages that support patient self-care.

We describe a project intended to improve the use of Electronic Medical Record (EMR) patient portal information by older adults with diverse numeracy and literacy abilities, so that portals can better support patient-centered care. Patient portals are intended to bridge patients and providers by ensuring patients have continuous access to their health information and services. However, they are underutilized, especially by older adults with low health literacy, because they often function more as information repositories than as tools to engage patients. We outline an interdisciplinary approach to designing and evaluating portal-based messages that convey clinical test results so as to support patient-centered care. We first describe a theory-based framework for designing effective messages for patients. This involves analyzing shortcomings of the standard portal message format (presenting numerical test results with little context to guide comprehension) and developing verbally, graphically, video- and computer agent-based formats that enhance context. The framework encompasses theories from cognitive and behavioral science (health literacy, fuzzy trace memory, behavior change) as well as computational/engineering approaches (e.g., image and speech processing models). We then describe an approach to evaluating whether the formats improve comprehension of and responses to the messages about test results, focusing on our methods. The approach combines quantitative (e.g., response accuracy, Likert scale responses) and qualitative (interview) measures, as well as experimental and individual difference methods in order to investigate which formats are more effective, and whether some formats benefit some types of patients more than others. We also report the results of two pilot studies conducted as part of developing the message formats.

Designing Visual Aids That Promote Risk Literacy: A Systematic Review of Health Research and Evidence-Based Design Heuristics.

Background Effective risk communication is essential for informed decision making. Unfortunately, many people struggle to understand typical risk communications because they lack essential decision-making skills. Objective The aim of this study was to review the literature on the effect of numeracy on risk literacy, decision making, and health outcomes, and to evaluate the benefits of visual aids in risk communication. Method We present a conceptual framework describing the influence of numeracy on risk literacy, decision making, and health outcomes, followed by a systematic review of the benefits of visual aids in risk communication for people with different levels of numeracy and graph literacy. The systematic review covers scientific research published between January 1995 and April 2016, drawn from the following databases: Web of Science, PubMed, PsycINFO, ERIC, Medline, and Google Scholar. Inclusion criteria were investigation of the effect of numeracy and/or graph literacy, and investigation of the effect of visual aids or comparison of their effect with that of numerical information. Thirty-six publications met the criteria, providing data on 27,885 diverse participants from 60 countries. Results Transparent visual aids robustly improved risk understanding in diverse individuals by encouraging thorough deliberation, enhancing cognitive self-assessment, and reducing conceptual biases in memory. Improvements in risk understanding consistently produced beneficial changes in attitudes, behavioral intentions, trust, and healthy behaviors. Visual aids were found to be particularly beneficial for vulnerable and less skilled individuals. Conclusion Well-designed visual aids tend to be highly effective tools for improving informed decision making among diverse decision makers. We identify five categories of practical, evidence-based guidelines for heuristic evaluation and design of effective visual aids.

The moderating role of objective and subjective numeracy in attribute framing.

Previous research has found that objective numeracy moderates framing effects: People who are less numerate were found to be more susceptible to goal-framing and attribute-framing effects than people who are highly numerate. This study examined the possibility that subjective numeracy likewise moderates attribute framing in contexts where participants are presented with percentages of success or failure. The results show that compared with highly numerate participants, less numerate participants were more susceptible to the effect of attribute framing. Interestingly, this moderating effect was revealed only when using objective numeracy measures, and not when subjective numeracy measures were used. Future research is suggested to replicate these findings, to establish the generalizability of numeracy as a moderator of other cognitive biases, and to examine several possible theoretical explanations for the differential moderation of attribute-framing bias.

Neural mechanisms underlying urgent and evaluative behaviors: An fMRI study on the interaction of automatic and controlled processes.

Dual-process theories have dominated the study of risk perception and risk-taking over the last two decades. However, there is a lack of objective brain-level evidence supporting the two systems of processing in every-day risky behavior. To address this issue, we propose the dissociation between evaluative and urgent behaviors as evidence of dual processing in risky driving situations. Our findings show a dissociation of evaluative and urgent behavior both at the behavioral and neural level. fMRI data showed an increase of activation in areas implicated in motor programming, emotional processing, and visuomotor integration in urgent behavior compared to evaluative behavior. These results support a more automatic processing of risk in urgent tasks, relying mainly on heuristics and experiential appraisal. The urgent task, which is characterized by strong time pressure and the possibility for negative consequences among others factors, creates a suitable context for the experiential-affective system to guide the decision-making process. Moreover, we observed greater frontal activation in the urgent task, suggesting the participation of cognitive control in safe behaviors. The findings of this research are relevant for the study of the neural mechanisms underlying dual process models in risky perception and decision-making, especially because of their proximity to everyday activities.

Lonely hearts don't get checked: On the role of social support in screening for cardiovascular risk.

OBJECTIVE: Regular cardiovascular risk screening can prevent cardiovascular disease through timely implementation of lifestyle changes or medication. However, few studies have investigated what factors promote regular screening for risk factors like hypertension and high blood cholesterol. The aim of this study was to investigate the relationship between social support and adherence to cardiovascular risk screening. METHODS: We analyzed data from the Spanish National Health Survey-a cross-sectional representative survey conducted by the Spanish Ministry of Health in 2012 (N=21,007). Participants reported whether they had their blood pressure and cholesterol levels measured by a health professional in the previous 12 months. Social support (i.e., the perception that emotional and practical support was available when needed) was measured with a validated scale. Multiple logistic regressions were conducted adjusted for demographic and health-related factors. RESULTS: Compared to individuals who reported a lack of social support, individuals who perceived sufficient social support were on average twice more likely to report participation in blood pressure screening, OR=2.06, 95% CI [1.60, 2.66] and cholesterol screening, OR=2.85, 95% CI [1.99, 4.09]. These effects were uniform across different demographics and were replicated in a previous wave of the survey. Factors associated with worse screening adherence were low social class, being single or widowed, smoking, alcohol consumption, and no history of cardiovascular risk. DISCUSSION: Perceptions of social support are positively related to cardiovascular risk screening adherence. Future research should investigate what type of social support most effectively increases screening participation among high risk populations.

On defensive decision making: how doctors make decisions for their patients.

BACKGROUND: In the past decade, the number of lawsuits for medical malpractice has risen significantly. This could affect the way doctors make decisions for their patients. OBJECTIVE: To investigate whether and why doctors practice defensive medicine with their patients. DESIGN: A questionnaire study was conducted in general practice departments of eight metropolitan hospitals in Spain, between January and February 2010. SETTING AND PARTICIPANTS: Eighty general practitioners (48% men; mean age 52 years) with an average of 15.3 years of experience and their 80 adult patients (42% men; mean age 56 years) participated in the study. MAIN OUTCOME MEASUREMENTS: Participants completed a self-administered questionnaire involving choices between a risky and a conservative treatment. One group of doctors made decisions for their patients. Another group of doctors predicted what their patients would decide for themselves. Finally, all doctors and patients made decisions for themselves and described the factors they thought influenced their decisions. RESULTS: Doctors selected much more conservative medical treatments for their patients than for themselves. Most notably, they did so even when they accurately predicted that the patients would select riskier treatments. When asked about the reasons for their decisions, most doctors (93%) reported fear of legal consequences. DISCUSSION AND CONCLUSIONS: Doctors' decisions for their patients are strongly influenced by concerns of possible legal consequences. Patients therefore cannot blindly follow their doctor's advice. Our study, however, suggests a plausible method that patients could use to get around this problem: They could simply ask their doctor what he or she would do in the patient's situation.

Young women's constructions of the HPV vaccine: a cross-cultural, qualitative study in Scotland, Spain, Serbia and Bulgaria.

BACKGROUND: Following international trends, the HPV (human papilloma virus) vaccine was introduced in Europe for protection against infection from common strands of the HPV virus which can lead to cervical cancer. Young women aged 18-26 years are at greatest risk of infection by the HPV virus yet have been neglected in research, policy, and practice. PURPOSE: To explore young women's constructions of the HPV vaccine in four European countries with different implementation policies ranging from national school-based programmes, regarded as the gold standard, to regional on-demand and private provision. METHOD: Qualitative methods comprising 11 focus group discussions with 54 young women aged 18-26, in Scotland (n = 10), Spain (n = 25), Serbia (n = 9) and Bulgaria (n = 10). A discursive analysis was conducted, following an initial thematic analysis. RESULTS: Two competing discursive constructions were considered: the 'responsible young woman' discourse was constructed as someone with individual rights to health, choice and discretion along with responsibilities to protect health and make rational decisions. In 'the HPV vaccine: a discourse of exclusion', access to the vaccine, wider health promotion and knowledge was controlled by others which had the potential to undermine the young woman's health. We consider how young women managed this tension through recourse to being health vigilant. CONCLUSION: Qualitative, cross-cultural research highlighted common concerns amongst young European women towards being responsible citizens in the face of their health and highlighted socio-cultural constraints to knowledge and resources. We highlight cross-cultural implications particularly between Western and Eastern European contexts.

Uncertainty about paternity: a study on deliberate ignorance.

Deliberate ignorance is the willful choice not to know the answer to a question of personal relevance. The question of whether a man is the biological father of his child is a sensitive issue in many cultures and can lead to litigation, divorce, and disinheritance. Thanks to DNA tests, men are easily able to resolve the uncertainty. Psychological theories that picture humans as informavores who are averse to ambiguity suggest men would do a DNA test, as does evolutionary theory, which considers investing in raising a rival's offspring a mistake. We conducted two representative studies using computer-based face-to-face interviews in Germany (n = 969) and Spain (n = 1,002) to investigate whether men actually want to know and how women would react to this desire. As a base line, Germans (Spanish) estimated that 10% (20%) of fathers mistakenly believe that they are the biological father of their child. Nevertheless, in both countries, only 4% of fathers reported that they had performed a DNA paternity test, while 96% said they had not. In contrast, among men without children, 38% (33%) of Germans (Spanish) stated they would do a DNA test if they had children, mostly without telling their partners. Spanish women with children would more often disapprove of a paternity test or threaten their husbands with divorce (25%) than would German women (13%). We find that a simple test of risk aversion, measured also by the purchase of non-mandatory insurances, is correlated with not wanting to know.

Anticipated prehospital decision delay in response to different symptom clusters in acute coronary syndrome: Results from the Spanish Cardiobarometer study.

BACKGROUND AND OBJECTIVE: Reducing patient decision delay - the time elapsed between symptom onset and the moment the patient decides to seek medical attention - can help improve acute coronary syndrome survival. Patient decision delay is typically investigated in retrospective studies of acute coronary syndrome survivors that are prone to several biases. To offer an alternative approach, the goal of this research was to investigate anticipated patient decision delay in the general population in response to different symptom clusters. METHODS: We developed scenarios representing four commonly experienced symptom clusters: classic (chest symptoms only), heavy (a large number of very intense symptoms including chest pain), diffuse (mild symptoms including chest pain), and weary (mild symptoms without clear chest involvement). The scenarios were administered in random order in a representative survey of 1002 adults ≥55 years old from the non-institutionalized general population in Spain. We measured help-seeking intentions, anticipated patient decision delay (waiting >30 min to seek help), and symptom attribution. RESULTS: Patient decision delay was most common in the diffuse scenario (55%), followed by the weary (34%), classic (22%), and heavy (11%) scenarios. Attributing the symptoms to a cardiovascular cause and intentions to call emergency services were least frequent in the weary and diffuse scenarios. Women were less likely to intend to seek help than men in the classic (OR = 0.48, [0.27, 0.85], diffuse (OR = 0.67, [0.48, 0.92]), and weary (OR = 0.66, [0.44, 0.98]) scenarios, despite being more likely to attribute symptoms to cardiovascular causes. Participants with traditional cardiovascular risk factors (e.g., diabetes, hypercholesterolemia, hypertension) reported faster help-seeking, whereas participants with obesity and history of depression were more likely to delay. DISCUSSION: The diverse manifestations of acute coronary syndrome generate fundamentally different appraisals. Anticipated patient decision delay varies as a function of socio-demographic characteristics and medical history, supporting findings from studies with patients who experienced ACS. Measuring anticipated patient decision delay in the general population can help reveal potential barriers to help-seeking and capture effects of population interventions.

Health literacy, numeracy, and graphical literacy among veterans in primary care and their effect on shared decision making and trust in physicians.

Studies reveal high levels of inadequate health literacy and numeracy in African Americans and older veterans. The authors aimed to investigate the distribution of health literacy, numeracy, and graph literacy in these populations. They conducted a cross-sectional survey of veterans receiving outpatient care and measured health literacy, numeracy, graph literacy, shared decision making, and trust in physicians. In addition, the authors compared subgroups of veterans using analyses of covariance. Participants were 502 veterans (22-82 years). Low, marginal, and adequate health literacy were found in, respectively, 29%, 26%, and 45% of the veterans. The authors found a significant main effect of race qualified by an age and race interaction. Inadequate health literacy was more common in African Americans than in Whites. Younger African Americans had lower health literacy (p <.001), graph literacy (p <.001), and numeracy (p <.001) than did Whites, even after the authors adjusted for covariates. Older and younger participants did not differ in health literacy, objective numeracy, or graph literacy after adjustment. The authors found no health literacy or age-related differences regarding preferences for shared decision making. African Americans expressed dissatisfaction with their current role in decision making (p =.03). Older participants trusted their physicians more than younger participants (p =.01). In conclusion, African Americans may be at a disadvantage when reviewing patient education materials, potentially affecting health care outcomes.