Assessment of Awareness and Knowledge about Osteoporosis in Relation to Health Prevention among Patients Treated in Osteoporosis Clinics.

The increasing incidence of osteoporosis indicates that the disease is a serious public health problem, with about 200 million people being affected worldwide. The aims of this research are to assess the awareness and knowledge about osteoporosis in relation to risk factors, health condition, supplementation used, socio-demographic factors and other variables among osteoporosis patients. The study was conducted in 2016-2018 in osteoporosis clinics in Poland. The study involved 312 patients with a diagnosis of osteoporosis. In the diagnostic survey method, the authors' own questionnaire was used. The results indicate that the more frequent the symptoms associated with the disease, the lower the general self-assessment of the health condition of the respondents (rho = -0.682, p < 0.001). In addition, almost half of the respondents stated that their knowledge of osteoporosis is negligible. Moreover, the use of dietary supplements significantly differentiated respondents in terms of health self-assessed (p < 0.001), and it is noteworthy that users of dietary supplements assessed their health significantly better. We also saw a statistically significant relationship between the self-assessment of knowledge about osteoporosis and the use of dietary supplements (p < 0.001). Accordingly, significantly more respondents rating their knowledge as good or very good used dietary supplements. The conducted study demonstrates the need to educate patients and implement educational programs at central and provincial levels to improve patient knowledge concerning the disease. Supporting adaptation to chronic diseases and appropriate therapeutic management may contribute to improved osteoporosis treatment and enhanced patient quality of life.

The Relationship between Searches for COVID-19 Vaccines and Dynamics of Vaccinated People in Poland: An Infodemiological Study.

BACKGROUND: Google Trends has turned out to be an appropriate tool for evaluating correlations and prognostic modelling regarding infectious diseases. The possibility of selecting a vaccine against COVID-19 has increased social interest in particular vaccines. The objective of this study was to show dependencies between the frequency of searches for COVID-19 vaccinations and the number of vaccinated people in Poland, along with epidemiological data. METHODS: Data were collected regarding Google searches for COVID-19 vaccines, the number of people in Poland vaccinated against COVID-19, the number of new cases, and the number of deaths due to COVID-19. Data were filtered from 27 December 2020 to 1 September 2021. RESULTS: The number of new vaccinations smoothed per million correlated most strongly with searches for the word 'Pfizer' in Google Trends (Kendall's tau = 0.46, p < 0.001). The number of new deaths correlated most strongly with the search phrase 'AstraZeneca' (Kendall's tau = 0.46, p < 0.001). The number of new cases per million correlated most strongly with searches for 'AstraZeneca' (Kendall's tau = 0.49, p < 0.001). The maximum daily number of searches ranged between 110 and 130. A significant interest in COVID-19 vaccines was observed from February to June 2021, i.e., in the period of a considerable increase in the number of new cases and new deaths due to COVID-19. CONCLUSIONS: A significant increase in interest in COVID-19 vaccines was observed from February to June 2021, i.e., in the period of gradually extended access to vaccinations, as well as a considerable increase in the number of new cases and new deaths due to COVID-19. The use of Google Trends with relevant keywords and a comparison with the course of the COVID-19 pandemic facilitates evaluation of the relationship between the frequency and types of searches for COVID-19 vaccines and epidemiological data.

The Role of Soy Isoflavones in the Prevention of Bone Loss in Postmenopausal Women: A Systematic Review with Meta-Analysis of Randomized Controlled Trials.

The aim of the report was to determine the effects of soy isoflavones on lumbar spine, femoral neck, and total hip bone mineral density (BMD) in menopausal women. MEDLINE (PubMed), EMBASE, and Cochrane Library databases were searched for articles published in English during 1995-2019. Studies were identified and reviewed for inclusion and exclusion eligibility. Weighted mean differences (WMD) were calculated for each study and were pooled by using the random effects model. Eighteen randomized controlled trials were selected for meta-analysis. Different types of soy phytoestrogens, i.e., genistein extracts, soy isoflavones extracts, soy protein isolate, and foods containing diverse amounts of isoflavones were used in the studies. The analysis showed that daily intake of 106 (range, 40-300) mg of isoflavones for 6-24 months moderately but statistically significantly positively affects BMD, compared with controls: lumbar spine WMD = 1.63 (95% CI: 0.51 to 2.75)%, p = 0004; femoral neck WMD = 1.87 (95% CI: 0.14 to 3.60)%, p = 0.034; and total hip WMD = 0.39 (95% CI: 0.08 to 0.69)%, p = 0.013. Subgroups analyses indicated that the varying effects of isoflavones on BMD across the trials might be associated with intervention duration, racial diversity (Caucasian, Asian), time after menopause, form of supplements (especially genistein), and dose of isoflavones. Our review and meta-analysis suggest that soy isoflavones are effective in slowing down bone loss after menopause.

Recent Trends in Health Literacy Research, Health Status of the Population and Disease Prevention: An Editorial.

One challenge for the development of healthcare systems worldwide is to shape society's health literacy [...].

Assessment of the Level of Satisfaction with Medical Care of Patients Treated in Osteoporosis Clinics as an Indicator of the Quality of Medical Care.

The aims of this research are to assess the level of satisfaction with medical care among patients treated in osteoporosis clinics and to determine the relationship among the frequency of visits to the doctor, the duration of treatment, socio-demographic factors, and patient satisfaction with the medical care they receive. The study was conducted from August 2016 to July 2018 at osteoporosis clinics in eastern Poland. The study participants were 312 patients treated for osteopenia or osteoporosis. The authors utilized two research instruments: the PASAT POZ questionnaire and their own questionnaire. The results indicate that the duration of osteoporosis treatment is a factor that significantly influences the level of satisfaction with medical care: the longer the treatment time, the poorer the assessment of the clinic, and therefore, the lower the patient degree of satisfaction. Our analysis shows that women assess clinics more positively overall. Additionally, the higher the study participants' age, the lower the general assessment of the clinic. A further analysis showed that respondents in better financial situations and with higher levels of education tended to assess clinics more favorably. The Pareto-Lorenz analysis indicated that the key element in general assessments of specialist clinics is the doctor. It is advisable for health service providers to monitor the quality of health care they are providing and make improvements. Therefore, further research is needed, especially in relation to chronic diseases such as osteoporosis.

Coping Strategies Preferred by Patients Treated for Osteoporosis and Analysis of the Difficulties Resulting from the Disease.

Osteoporosis has been recognized as a civilization disease. This chronic condition needs a long-term management plan with a holistic approach to patients. The specificity of the patient's response to the disease and coping strategies are very important in the treatment process. The aim of this research was to analyze the strategies of coping with disease preferred by patients treated for osteoporosis, and to determine the relationship between the self-assessment of patients' health, time of treatment, sociodemographic variables, and strategies of coping with a chronic disease such as osteoporosis. The study was conducted from August 2016 to July 2018 at an osteoporosis clinic in eastern Poland. Coping Orientations to Problems Experienced (COPE) by C.S. Carver, M. F. Scheier, and J. K. Weintraub in the Polish adaptation and our own questionnaire were used. The study participants were 312 patients treated for osteoporosis. The respondents treated in the osteoporosis clinic used the strategies of seeking support and focusing on emotions to the greatest extent, and avoidance strategies the least. Sociodemographic features and self-assessment of health condition significantly differentiate the strategies of coping with the disease. The analysis showed that the higher the assessment of the individual perception of one's own health, the more often the respondents used active coping strategies.

Online Information of COVID-19: Visibility and Characterization of Highest Positioned Websites by Google between March and April 2020-A Cross-Country Analysis.

BACKGROUND: The WHO has used the term "infodemic" to describe the vast amount of false and true information that was making it difficult for people to find reliable information when they needed it. The infodemic spreads faster than COVID-19 itself. The main objective of the study was to characterize and analyze content about COVID-19 returned by Google during the pandemic and compare it between countries. METHODS: The study was conducted between 30 March and 27 April 2020. The information was searched through local Google websites using the "COVID-19", "Coronavirus", "SARS-CoV-2" and "fake news" keywords. The search was conducted in Australia, France, Germany, Italy, Poland, Singapore, Spain, UK and the USA. The total number of the analyzed webpages was 685. RESULTS: The most frequent types were News websites 47% (324/685) and Governmental 19% (131/685) while the least were Health portals 2% (17/685) and Scientific journals 5% (35/635), p < 0.001. United States and Australia had the highest share of Governmental websites. There was a positive correlation between the amount of preventive information and a number of SARS-CoV-2 infections in countries. The higher the number of tests performed, the higher was the amount of information about prevention available online. CONCLUSIONS: Online information is usually available on news and government websites and refers to prevention. There were differences between countries in types of information available online. The highest positioned (the first 20) websites for COVID-19, Coronavirus and SARS-CoV-2 keywords returned by Google include true information.

Pain Control: Normalization of the BPCQ Questionnaire on a Group of Patients Diagnosed with Malignant Cancer.

The purpose of this article is to examine the applicability of the Beliefs about Pain Control Questionnaire (BPCQ) among cancer patients and develop norms that allow differentiation of patients with diagnosed cancer in terms of beliefs about pain control. Normalization aims to establish the value of test results in the study population. The study involved 1187 patients diagnosed with cancer in outpatient care Maria Sklodowska-Curie Cancer Center and Institute of Oncology, in Warsaw. The applied tool was the Beliefs about Pain Control Questionnaire developed by S. Skevington. The results are most strongly differentiated in each dimension of pain control by education, income, and professional status. Sten norms were developed to determine the level of beliefs about pain control in low, average, and high categories. The BPCQ assessment applies to cancer patients, and the assessment of the location of pain control in patients will allow for the identification of patients whose standard therapy should be supplemented with psychotherapeutic support.

Impact of continuous glucose monitoring on improving emotional well­being among adults with type 1 diabetes mellitus: a systematic review and meta­analysis.

INTRODUCTION: Real-time continuous glucose monitoring (CGM) has changed the way people with type 1 diabetes mellitus (T1DM) and health care providers perceive diabetes management and glucose control. OBJECTIVES: The purpose of this meta-analysis was to compare the emotional well-being of adults with T1DM who used CGM and those using conventional self-monitoring of blood glucose (SMBG). PATIENTS AND METHODS: The MEDLINE/PubMed, Cochrane Library / Embase, CINAHL, Scopus, Web of Science, and ProQuest databases were searched for relevant publications. Primary outcome measures were health-related quality of life, glycemic control, and fear of hypoglycemia. Randomized controlled trials and survey studies focused on the quality of life and fear of hypoglycemia among adult patients using CGM and SMBG were included in the analysis. RESULTS: The meta-analysis included 11 studies involving a total of 1228 patients with T1DM. Analysis of the Worry subscale of the Hypoglycemia Fear Survey indicated a reduction of hypoglycemia fear in CGM users compared with SMBG users (Cohen d = ­0.24; 95% CI, ­0.41 to ­0.07; mean difference, ­3.15; 95% CI, ­5.48 to ­0.82). Outcome analysis of studies including the Diabetes Treatment Satisfaction Questionnaire showed Cohen d of 0.23 (95% CI, ­0.18 to 0.63). The overall value of Cohen d equaled ­0.24 (95% CI, ­0.57 to 0.09), indicating a lack of effect of CGM use on improving HbA1c levels; however, after one of the studies was excluded from calculations, the reduction of HbA1c levels was significantly higher in CGM users (Cohen d = ­0.33; 95% CI, ­0.66 to 0.00; P = 0.047). CONCLUSIONS: This is the first quantitative meta-analysis of studies involving adult patients exclusively with T1DM, providing further evidence for the ability of CGM systems to reduce fear of hypoglycemia and improve quality of life. Continuous glucose monitoring systems have advantage over SMBG in adults with T1DM and improve HbA1c levels.

Building age, type of indoor heating and the occurrence of allergic rhinitis and asthma.

INTRODUCTION: Structural materials and interior appliances are frequently mentioned as elements of modern buildings which may have an impact on the natural history of allergic diseases. AIM: We hypothesized that the building age, the type of the heating system and the use of various indoor appliances can influence the occurrence of allergic rhinitis (AR) and asthma. MATERIAL AND METHODS: The study group comprised 18,617 individuals. The tool used in the study was the European Community Respiratory Health Survey (ECRHS) and the International Study of Asthma and Allergies in Childhood (ISAAC) study questionnaire, adapted to European conditions (Middle and Eastern Europe) and used as part of the study called "Implementation of a System for the Prevention and Early Detection of Allergic Diseases in Poland". RESULTS: Questionnaire results indicated that people living in homes built in the years 1971-1990 had higher rates of allergic rhinitis (OR = 1.15025), which was correlated with clinical findings of increased occurrence of seasonal allergic rhinitis (OR = 1.60543). The leading factor contributing to the intensification of AR symptoms was the central heating (OR = 1.45358). As opposed to AR, people living in buildings with central heating less often declared asthma (OR = 0.8407). A clinical examination confirmed that central heating reduced the symptoms of moderate asthma (OR = 0.3524). CONCLUSIONS: Increasing building age and certain indoor heating methods are important risk factors for the occurrence of allergic rhinitis and asthma.

The indirect costs of allergic diseases.

It is estimated that every third person living in Europe suffers from allergic diseases. Allergies are a growing health problem in Poland where 40% of the population have allergy symptoms, including 12% afflicted with asthma. The actual cost of allergic diseases is difficult to estimate due to the lack or incompleteness of the relevant data. The aim of this review is to present estimates of the indirect costs of allergic diseases in Poland and globally, using asthma, allergic rhinitis and atopic dermatitis as examples. The analysis also includes the impact of allergic diseases on the costs to the social welfare system and employers. The literature review of the indirect costs of allergic diseases shows that the indirect costs of a disease, which substantially exceed the direct costs, increase with the disease activity and severity. Interestingly, some studies have found that the indirect costs of lost productivity due to hours missed from work to take care of a sick child could be threefold higher than those of absence due to a worker's own illness. The indirect costs of a disease can be significantly reduced by early diagnosis and appropriate treatment. Int J Occup Med Environ Health. 2019;32(3):281-90.

Dietary supplements: a great menace of our time or golden remedy? A cross-sectional study amongschool-aged children.

INTRODUCTION: Dietary supplements (DS) are commonly used as a remedy for various health issues as they are widely advertised and available. AIM: This study aimed to evaluate the prevalence of DS use among school-aged children in Warsaw, the capital city of Poland. Additionally, we evaluated the parents' motivations for DS administration, the frequency of the use of specific compounds and the influence of child's history of allergy on DS use. MATERIAL AND METHODS: Children aged 6-7 years who attended the first grade of primary schools in Warsaw were included into the study. Forty-two out of 170 primary schools in Warsaw were randomly selected of which 38 agreed to participate. The research tool was a self-administered questionnaire. RESULTS: Half of the studied children received DS in the previous 6 months. Fatty acids were the most commonly administered DS (49.8%). The most common reason for administering DS was prevention of diseases (69.1%). The total household income correlated positively with the DS use. History of food allergy was one of the factors which increased the risk of DS use, whereas diagnosis of asthma did not correlate with a higher frequency of DS use. CONCLUSIONS: This study shows the need to educate patients about medical indications for DS use and expected benefits in the specific indications.

Epidemiology and direct costs of atopic dermatitis in Poland based on the National Health Fund register (2008-2017).

INTRODUCTION: Epidemiological data indicate significant differences in atopic dermatitis (AD) prevalence between countries. AIM: The purpose of this study is to (i) analyse the recorded prevalence of atopic dermatitis (diagnoses of AD reported to the Polish National Health Fund (NHF)) and to (ii) estimate direct costs of medical care for AD incurred by the NHF. MATERIAL AND METHODS: The analysis was based on data reported to the database of the public payer (NHF). The prevalence rates were calculated using the NHF data and population estimates were obtained from the Central Statistical Office of Poland (GUS). RESULTS: In 2017, the annual prevalence rate of AD in the Polish population was 32.5 per 10,000 inhabitants (34.7/10,000 for women and 30.1/10,000 for men). The highest prevalence was observed in the youngest age groups (300/10,000 in children up to 4 years of age and 141/10,000 in 5-9-year-olds). The prevalence rate decreased with age and AD was the least prevalent in patients over 85 years of age (4/10,000). In 2008-2017, NHF expenditure on AD treatment varied between PLN 19.9 million (EUR 5.6 million) in 2008 and PLN 28.4 million (EUR 6.5 million) in 2016. CONCLUSIONS: The prevalence rates of AD in Poland estimated on the basis of NHF data are significantly lower than those reported in previous epidemiological studies conducted in Poland and worldwide. This may indicate that the prevalence of AD in the Polish population is underestimated or that there are no adequate disease control measures in patients with a confirmed diagnosis.

The prevalence of depression and insomnia symptoms among patients with rheumatoid arthritis and osteoarthritis in Poland: a case control study.

The objective of the study was to assess the prevalence of symptoms of depression and insomnia among patients with rheumatoid arthritis and osteoarthritis in comparison with individuals without chronic diseases. The study was carried out at National Institute of Geriatrics, Rheumatology and Rehabilitation, included 229 persons. The participants were divided into the following groups: group I - 120 patients with rheumatoid arthritis, group II - 58 patients with osteoarthritis, group III - 51 healthy individuals no confirmed depression (control group). Symptoms of depression were confirmed by a multiple-choice self-reported Beck Depression Inventory questionnaire. Symptoms of depression confirmed with depression inventory≥ 10 occurred as follows: patients with rheumatoid arthritis - 75.83%, patients with osteoarthritis - 50%, control group - 23.53% (p<0.0001), with the prevalence of insomnia (AIS≥6) at: 71%, 32% and 33%, respectively (p<0.001). In group I mean values of FIRST and AIS were 23.06 and 8.36 respectively, with group II: 21.71 and 7.84, respectively. In all subjects with AIS≥6, the depression inventory was statistically significantly (p<0.005) higher than in the subjects with AIS<6 (respectively: 17.02 vs 12.13; 15.6 vs 8.05; 5.45 vs 1.81). Patients with rheumatoid arthritis find it difficult to cope with stress. Insomnia as a reaction to stress occurs more often in this group.

Effect of indoor air quality on the natural history of asthma in an urban population in Poland.

Background: Indoor air pollution may have an impact on asthma. Objective: To evaluate the influence of indoor air pollution on the natural history of asthma. Methods: Data collection by using the European Community Respiratory Health Survey and International Study of Asthma and Allergies in Childhood standardized questionnaire (N = 18,617) and medical examinations (N = 4783) in selected Polish regions was used. Statistical analysis was performed by using the χ² test. A value of p < 0.05 was considered statistically significant. Results: Questionnaire results demonstrated that people who used the central heating system were less likely to declare the occurrence of asthma (odds ratio [OR] 0.84) and were corroborated with clinical findings of moderate asthma (OR 0.35). Symptomatic asthma occurred more frequently in people who used a solid-fuel heating device (OR 1.36) and electric heaters (OR 1.54). The use of cooking appliances with municipal natural gas (OR 1.77) and gas storage tanks (OR 2.03) was correlated with more frequent declarations of asthma. Symptomatic asthma was more common among people who smoked for at least 1 year (OR 2.26) and those who smoked over the course of the preceding month (OR 1.60). Passive exposure to tobacco smoke provided for a 1.5-fold increase in the incidence of symptomatic asthma (OR 1.53), regardless of the time of exposure. Conclusion: Both active and passive tobacco smoke exposure as well as the use of certain types of heating and cooking appliances have a significant impact on the incidence of asthma and the intensification of its symptoms in rooms with limited air exchange. Highlights of the study included the following: (1) central heating had an amelioratory effect on asthma, (2) heating technologies used at home had a significant impact on the incidence of asthma, and (3) devices used for cooking (municipal and cylinder gas stoves) played an important role in the intensification of asthma symptoms.

Factors of depression among patients with rheumatoid arthritis.

OBJECTIVES: The aim of this study was to assess the correlation between symptoms of depression and the course and clinical picture of rheumatoid arthritis (RA). MATERIAL AND METHODS: 120 patients with RA were included in the study: 104 (87%) female patients and 16 (13%) male patients. All studied patients completed the following questionnaires: Beck Depression Inventory (BDI), Ford Insomnia Response to Stress Test (FIRST), Athens Insomnia Scale (AIS) and Health Assessment Questionnaire (HAQ). The serum levels of IL-1ß, TNF-α, and IL-6 were measured using standard ELISA assays at the time of the first questionnaire assessment. RESULTS: Symptoms of depression were found in 91 patients (76%), including 79 (87%) women and 12 (13%) men. There were no significant differences between the prevalence of depression in women and men (p = 0.93). Symptoms of depression occurred more often in patients who were professionally inactive, compared with the professionally active patients (p = 0.04). Significant correlations was demonstrated between the value of BDI and the patient's pain assessed by the visual analogue scale (VAS) value (r = 0.36), the disease activity assessed by the patient and the physician evaluated in millimetres on the VAS scale (r = 0.38 and r = 0.30, respectively), the number of painful and swollen joints (r = 0.22 and r = 0.26, respectively), DAS28 (r = 0.31) as well as the Health Assessment Questionnaire (HAQ) value (r = 0.46). Longer duration of the disease was observed in patients with symptoms of depression (p = 0.02). Also a significant difference in the assessment of BDI between patients treated with biological drugs and those receiving no such treatment was observed (p = 0.042). CONCLUSIONS: Professional inactivity and longer disease duration are important factors influencing symptoms of depression in patients with RA. Higher values of HAQ increase the probability of the occurrence of depression symptoms. The use of biological drugs that reduce the level of proinflammatory cytokines may have a positive effect on reducing the severity of depressive symptoms.

The impact of nutrition and generally available products such as nicotine and alcohol on rheumatoid arthritis - review of the literature.

Nutrition habits and diet may influence disease development and course. There are no specific recommendations related to rheumatic diseases for a diet that would facilitate treatment. However, some research results suggest that various nutrients may affect the health of patients, especially in the case of inflammatory rheumatic disease such as rheumatoid arthritis (RA). Scientists have been trying to find a relation between inflammatory rheumatic diseases and diet but have never come up with any firm conclusions that would help in determining the model of a diet for such patients. Nevertheless, there are some consistent results that refer to the influence of nutritional behaviours on symptoms of RA. The article presents a review of the research showing that certain nutrients may be beneficial for the course of disease among some RA patients.

Epidemiology of urticaria in Poland - nationally representative survey results.

INTRODUCTION: The prevalence of urticaria is 15-20%. Women are twice as likely to be affected. AIM: To present the epidemiology of urticaria and angioedema in Poland. MATERIAL AND METHODS: A questionnaire-based survey was conducted on a representative group of 4,897 individuals, aged 15-74 years. RESULTS: A total of 11.2% of respondents reported at least one episode of urticaria symptoms in their life, and the frequency was higher in females (OR = 1.46; p < 0.001). Single episodes accounted for 34.8%, while repeated episodes accounted for 65.2%. Acute urticaria was observed in 10.6% (more frequent in females; OR = 1.41; p < 0.001), chronic in 0.6%. Median age of the first episode was 15 years. Angioedema was observed in 3.2%. The last episode of urticaria symptoms and/or angioedema occurred within the previous week in 0.7% of subjects, the last month in 1%, and the last year in 2.2%. 8.8% had experienced urticaria symptoms or angioedema over 1 year prior to the survey. The impact of urticaria symptoms on patients' daily activities was rated with 3.8 points on a scale of 0-10. In addition, chronic urticaria was rated 6.5, and acute urticaria 3.6. Angioedema and urticaria had a negative impact of 5.7 points. CONCLUSIONS: Urticaria and angioedema are serious health problems in Poland, although their prevalence is below the mean rate for the global population. Females are more likely to suffer from these diseases. People affected by urticaria most frequently report contact with plants and substances, insect bites/stings, and food as the provoking factors.

Diagnostic delays in rheumatic diseases with associated arthritis.

OBJECTIVE: The objective of this study was to determine the length of delay in diagnosis of inflammatory rheumatic diseases, and to indicate the main factors responsible for such delays. MATERIAL AND METHODS: A retrospective multi-centre questionnaire survey carried out among 197 patients with diagnosed inflammatory rheumatic diseases or undergoing the diagnostic process. RESULTS: The most common early symptoms of inflammatory rheumatic disease included joint pain (94%), joint swelling (78%), morning joint stiffness (77%), fatigue (76%), and sleep disturbed by joint pain (74%). When asked about the reasons for seeking medical help, most patients indicated intensification of the symptoms (89%) and the fact that the symptoms made them unable to perform daily activities or work (86%). Limited access to specialists (70%) and the conviction that the symptoms will resolve spontaneously (57%) had the biggest impact on delaying a visit to a doctor. Before visiting a rheumatologist, the patients consulted their symptoms with their general practitioners (GPs, 95%), orthopaedicians (43%), and neurologists (29%). Almost half of the patients (48%) consulted their symptoms with at least 2 non-rheumatologists, whereas as many as 21% of patients visited 4 or more specialists. After the onset of symptoms of rheumatic disease, 28% of patients delayed seeing any doctor for 4 months or longer. 36% of patients waited 4 months or longer for a referral to a rheumatologist. The great majority of the patients (85%) made an appointment with a rheumatologist within a month of receiving a referral. 25% of patients waited 4 months or longer to see a rheumatologist. CONCLUSIONS: Diagnostic delays result from both the level of patients' awareness (ignoring early symptoms) and improper functioning of the health care system. In the case of the health care system, the source of delays is not only "queues to rheumatologists", but also referring patients to non-rheumatologists.