Validation of the Fibromyalgia Rapid Screening Tool in patients with axial spondyloarthritis: Polish version adaptation and value in clinical practice.

INTRODUCTION: Fibromyalgia frequently co­occurs with axial spondyloarthritis. The Fibromyalgia Rapid Screening Tool (FiRST) is a well­recognized screening tool for fibromyalgia and has been translated into multiple languages. Yet, it has not been adapted into Polish, nor has it been validated in the context of axial spondyloarthritis. OBJECTIVES: This study aimed to create a Polish version of the FiRST, evaluate its psychometric properties, and conduct its validation among patients with axial spondyloarthritis. PATIENTS AND METHODS: We translated and performed a cross­cultural adaptation of the FiRST into Polish, followed by its validation in a cohort of 174 patients with axial spondyloarthritis. For criterion validity, we employed the 2016 American College of Rheumatology fibromyalgia diagnostic criteria as the gold standard for fibromyalgia diagnosis. RESULTS: The Polish version of the FiRST demonstrated marginally acceptable internal consistency with the Cronbach α coefficient of 0.644, but exhibited high test­retest reliability, with a global score correlation coefficient of 0.75 (P <0.001). Receiver operating characteristic analysis indicated a good performance of the translated questionnaire (area under the curve of 0.803). The accuracy of the derived cutoff value for the global score (5+ points, consistent with the original instrument) was 75.3%, featuring higher specificity (82.6%) than sensitivity (63.1%), and a fair level of diagnostic agreement, as indicated by the Cohen κ coefficient of 0.46. CONCLUSIONS: Our study provided a validated Polish version of the FiRST. Although it may not be an ideal tool for screening in axial spondyloarthritis cases and should be used cautiously in research, it proves to be a useful instrument in daily clinical settings.

Gender and the Relationship Between Knowledge, Self-Efficacy, and Behaviors for Cardiovascular Health Among Adults - The Effects of Conditional Process Modeling.

Background: Cardiovascular diseases are the main causes of morbidity and premature mortality among men and women in most industrialized and many developing countries. Cardiovascular health (CVH) is a relatively new term that focuses on maintaining good health not only on the prevention of cardiovascular diseases. Purpose: To demonstrate gender differences in selected elements regarding CVH, such as cardio-protection knowledge, behaviors for CVH, and self-efficacy and in the relationships between them. Methods: In this cross-sectional study, a convenience sample of 157 respondents (70% women) aged 20-60 was included. The research tool consisted of four parts: the List of Health Behaviors - CVH version, the Test of Cardio-protection Knowledge, the Generalized Self-Efficacy Scale (GSES), and a sociomedical survey. To estimate the direct and indirect effects between the variables, a bootstrapping procedure was adopted, as recommended for small- and medium-sized samples. Results: There were no gender differences in cardio-protection knowledge, but the groups differed in the levels of behaviors for CVH and self-efficacy. Women generally declared a higher level of healthy behaviors, whereas men demonstrated a higher level of self-efficacy. Women reported more healthy activities related to diet. Men more frequently practiced resistance exercise. The relationships between cardio-protection knowledge, self-efficacy, and behaviors for CVH were different in men and women. Conclusion: Further research should focus more on gender differences in mechanisms underlying health behaviors. Health-promoting programs should give more attention than before to how to differentiate the messages sent to men and women.

The prevalence and determinants of PTSD, anxiety, and depression in Ukrainian civilian physicians and paramedics in wartime-An observational cross-sectional study six months after outbreak.

Russia's invasion of Ukraine is the largest European land offensive since World War II. Individuals affected by conflicts such as war are at an increased risk of mental disorders, which result from frequent exposure to traumatic events and the breakdown of supportive social networks. The aim of the study was to assess the prevalence and determinants of PTSD, anxiety, and depression in Ukrainian civilian physicians and paramedics six months after the Russian invasion of Ukraine. A cross-sectional study was conducted using validated questionnaires: The Life Events Checklist, PTSD Checklist for DSM-5, The International Trauma Questionnaire (ICD-11), The Generalized Anxiety Disorder-7, The Patient Health Questionnaire-9, The World Health Organization Disability Assessment Schedule 2.0. The study showed that 61.1 % of participants indicated combat or exposure to a war zone as the most bothersome event in their experience. Physicians and paramedics did not differ in the prevalence of PTSD according to the DSM-5 diagnostic rule and of depression (criteria met by 14.5 % and 9 % of participants, respectively). However, more physicians than paramedics met the criteria of PTSD according to the ICD-11 diagnostic rule (5.1 % vs. 1.2 %) and of anxiety (16.5 % vs. 10.0 %). The risk factors for the mental health problems included personal combat experience, total trauma exposure, parenthood, and economic situation. Despite the differences found in the prevalence of PTSD depending on the criteria used, the severity of mental problems and disability in this group is significant. It is advisable to monitor the mental state and need for help among Ukrainian civilian medical personnel.

Cardiovascular disease threat and perceived efficacy of selected preventive behaviors among Polish men: an analysis based on the extended parallel process model.

Considering the low rate of preventive behaviors (5%), it is important to increase the effectiveness of actions that motivate the public to engage in health-promoting behaviors. The purpose of this study was to assess the way in which Polish men perceive the threat of cardiovascular diseases (CVDs) and the effectiveness of five preventive behaviors in the context of CVDs. We aimed to identify groups of recipients, based on the extended parallel process model (EPPM), for five preventive behaviors and to compare the identified groups in terms of selected characteristics. We conducted the survey in November 2022, using the computer-assisted web interviewing technique, on a representative sample of 1,000 men aged 18-65 years. Polish men showed relatively low levels of perceived susceptibility to CVDs (15.1%), but at the same time tended to perceive the consequences of CVDs as severe (54.2%). Segmentation of audiences according to the EPPM showed that regardless of the type of preventive behavior, the most numerous groups are responsive (31-37%) and indifferent (29-31%). This study revealed the need to increase awareness of the importance of a healthy diet to prevent CVDs among male population. Less than half of the men indicated that they would be able to implement effective stress management (49.8%) and smoking avoidance (39.4%), indicating the need to implement measures to increase self-efficacy in the areas.

Decision Tree Analyses for Prediction of QoL over a One-Year Period in Breast Cancer Patients: An Added Value of Patient-Reported Outcomes.

Despite the current shift in medicine towards patient-centered care, clinicians rarely utilize patient-reported outcomes (PROs) in everyday practice. We examined the predictors of quality- of-life (QoL) trajectories in breast cancer (BC) patients during the first year after primary treatment. A total of 185 BC patients referred for postoperative radiotherapy (RT) filled in the EORTC QLQ-C30 Questionnaire assessing global QoL, functioning and cancer-related symptoms before starting RT; directly after RT; and 3, 6 and 12 months after RT. We used decision tree analyses to examine which baseline factors best allowed for predicting the one-year trajectory of the global QoL after BC treatment. We tested two models: 'basic', including medical and sociodemographic characteristics, and 'enriched', additionally including PROs. We recognized three distinct trajectories of global QoL: 'high', 'U-shape' and 'low'. Of the two compared models, the 'enriched' model allowed for a more accurate prediction of a given QoL trajectory, with all indicators of model validation being better. In this model, baseline global QoL and functioning measures were the key discriminators of QoL trajectory. Taking PROs into account increases the accuracy of the prediction model. Collecting this information in the clinical interview is recommended, especially for patients with lower QoL.

Gender-Specificity of Fatigue and Concerns Related to the COVID-19 Pandemic-A Report on the Polish Population.

BACKGROUND: The COVID-19 pandemic, which is now going on its third year, and its consequences experienced in almost every sphere of life may eventually lead to pandemic fatigue. Previous research indicates that one of the important determinants of the negative consequences of the pandemic is gender. Based on the WHO's definition of pandemic fatigue, a study was undertaken to determine the level of pandemic fatigue and concerns expressed in relation to the pandemic in Poland. METHODS: A survey among 1064 respondents was conducted using the CATI technique during the fourth wave of the COVID-19 pandemic in Poland. Questionnaires adopted: the Polish adaptation of the Pandemic Fatigue Scale (PFS), Subjective Fatigue Symptoms (SFS), and the COVID-19 Concerns Checklist (CCC) and sociodemographic questions. The following statistical methods were employed: ANOVA analysis of variance, Mann-Whitney U test or Kruskal-Wallis test, and Chi-square test. RESULTS: The analysis showed that women received higher overall PFS, information PFS, SFS, and pandemic-related concerns scores. Other factors that were associated with pandemic fatigue were age, treatment for chronic diseases, receipt of the COVID-19 vaccine, and COVID-19 survivor status. CONCLUSIONS: Women in Poland are experiencing pandemic fatigue, subjective fatigue symptoms, and concerns associated with the COVID-19 pandemic at a higher rate than men. Along with implementing interventions focused on public health safety, it seems reasonable to put in place strategies to assist people who are less capable of coping with prolonged stressful situations.

Medics as a Positive Deviant in Influenza Vaccination: The Role of Vaccine Beliefs, Self-Efficacy and Contextual Variables.

The influenza vaccination rate remains unsatisfactorily low, especially in the healthy adult population. The positive deviant approach was used to identify key psychosocial factors explaining the intention of influenza vaccination in medics and compare them with those in non-medics. METHODS: There were 709 participants, as follows: 301 medics and 408 non-medics. We conducted a cross-sectional study in which a multi-module self-administered questionnaire examining vaccination beliefs, risk perception, outcome expectations (gains or losses), facilitators' relevance, vaccination self-efficacy and vaccination intention was adopted. We also gathered information on access to vaccination, the strength of the vaccination habit and sociodemographic variables. RESULTS: We used SEM and were able to explain 78% of the variance in intention in medics and 56% in non-medics. We identified both direct and indirect effects between the studied variables. In both groups, the intention was related to vaccination self-efficacy, stronger habits and previous season vaccination, but access to vaccines was significant only in non-medics. CONCLUSIONS: Applying the positive deviance approach and considering medics as positive deviants in vaccination performance extended the perspective on what factors to focus on in the non-medical population. Vaccination promotion shortly before the flu season should target non- or low-intenders and also intenders by the delivery of balanced information affecting key vaccination cognitions. General pro-vaccine beliefs, which may act as implicit attitudes, should be created in advance to build proper grounds for specific outcome expectations and facilitators' recognition. It should not be limited only to risk perception. Some level of evidence-based critical beliefs about vaccination can be beneficial.

The Brave Patient after 80-Satisfaction with Visit and Individual Determinants of Proactive Patient Attitude among the Oldest General Practice Users.

BACKGROUND: A patient's adherence to a course of treatment depends on the individual's activation, the quality of patient-clinician relations, attitudes, self-efficacy, or positive emotions. Patient proactive attitude (PAA) is seldom researched among the oldest healthcare users. This study was designed to identify predictors of PAA toward health and treatment among community-dwelling general practice patients aged 80+, and was based on a PRACTA (PRomoting ACTive Aging) project. METHODS: Patients (n = 658), aged 80+ visiting a general practitioner (GP) filled in the PRACTA attitude toward treatment and health scale and the PRACTA self-efficacy scale questionnaires. Sociodemographic factors, self-reported health status, and satisfaction with the visit were analyzed as independent factors. RESULTS: Attitudes toward treatment and health scores were predicted by marital status, living alone or not alone, hospitalization the prior year, level of impairment, and satisfaction with visit. However, some differences were observed depending on the device's subscale. Self-efficacy score was determined by marital status, living alone or not alone, prior hospitalization, and satisfaction with visit. We did not find an effect of age or gender on PAA. Patient satisfaction with visit was the strongest predictor of all PAA dimensions. CONCLUSION: Higher visit satisfaction helps to retain a PAA among seniors 80+. Screening questions about living situation, marital and functional status, emotional state, and recent history of hospitalization might help GPs additionally anticipate PAA level and adjust their actions accordingly.

Profiles of Health-Related Patient Activation and Their Determinants: The Results of a Cluster Analysis of Older Adults-Conclusions for Patient Counselling.

Health-related proactivity in older adults may significantly increase medication handling, adherence and patient safety. Deficiencies in training in critical characteristics and diversity of older patients may lead to medical errors in diagnosis and drug administration. This study investigated the profiles of health proactivity in older adults and the factors differentiating them, like sociodemographic factors, health status, visit characteristics, and patients' visit-related expectations, actual experiences, and satisfaction with the visit. Before and after visits, 3391 patients aged 65-95 filled in two sets of questionnaires, that allowed to measure aforementioned factors. Three distinct proactivity profiles emerged from a cluster analysis: high (43%), medium (25%), and low proactivity (32%). Highly proactive patients had the highest expectations, but their visits provided better opportunities to meet them than in other groups. Higher proactivity was related to a longer attendance time, frequent contact with and easier access to the doctor, or a longer time spent with a patient. The findings highlight the need to detect and respond to patients' expectations regarding psychosocial aspects of care, as well as to improve organizational aspects of care, in order to enhance health proactivity in older adults. The resulting good practice recommendations may significantly improve healthcare workers' effectiveness in both primary and secondary care.

Mature Adults at the GP: Length of Visit and Patient Satisfaction-Associations with Patient, Doctor, and Facility Characteristics.

Background and objectives: The consultation time for more mature adults is often perceived as longer, increasing with the patient's age and boosting their satisfaction with the visit. However, factors determining patient satisfaction (PS) or the consultation time (CT) in the population aged 50+ are not clearly identified. A cross-sectional design was used to identify factors specific to the facility (e.g., size, staff turnover), doctor (e.g., seniority, workload), and patient (e.g., self-rated health, impairment of activities) that are related to PS and the CT. Our secondary focus was on the relation of PS to the CT along with the role of the patient's age and gender for both. Materials and Methods: Doctors (n = 178) and their 1708 patients (aged 50-97) from 77 primary care facilities participated in the study. The Patient Satisfaction with Visit Scale score and the CT were the outcome measures. Results: We identified associations with the CT in terms of the facility-related factors (number of GPs, time scheduling); doctors' workload and health; and patients' education, time attending GP, and impairments. PS was additionally governed by doctors' perceived rate of patients aged 65+, as well as the patients' hospitalization in the prior year, frequency of visits, and impairments. For adults aged 50+ the CT was unrelated to PS and both remained independent of patients' age. Conclusions: Specific factors in terms of the facility, GP, and patient were identified as related to PS and the CT for participating adults in primary care. During visits of patients aged 50+ at their GP, there is scope for both time-savings and patient satisfaction improvements, when paying attention, e.g., to the time scheduled per visit, the number of doctors employed, and the patients' impairments.

How gender-specific are predictors of post-MI HRQoL? A longitudinal study.

PURPOSE: Extant research shows that health-related quality of life (HRQoL) differs between female and male survivors of myocardial infarction (MI), but the reasons for this are not fully understood. We aimed to examine the predictors of HRQoL in female and male survivors during the first year after MI. METHODS: At timepoints 1 and 2, the sample comprised 222 MI survivors (59 women and 163 men; mean age 53.84 years, range 24-65) referred for in-patient cardiac rehabilitation. This number dropped to 140 participants (42 women and 98 men) at the third timepoint, approximately one year after the MI. We examined the gender differences in various predictors of physical and mental HRQoL: demographic factors (e.g., age, education, marital status), disease-related factors (pre- and post-MI), personality and coping with stress. RESULTS: Initially, both physical and mental HRQoL were lower in women than men, but the differences disappeared at timepoint 3. Stepwise regressions performed separately for men and women revealed that the factors shaping HRQoL were different in both genders; they also changed over time. Substantially fewer factors predicted physical HRQoL in women than in men. Trait anxiety seems to play a similarly negative role in both genders. CONCLUSIONS: The psychosocial resources that influence HRQoL were different for women and men. There were also differences concerning predictors of HRQoL dimensions. Further studies with a different or broader range of predictors are needed, especially among women.

Teaching general practitioners to activate older patients: The intervening role of changes in perceived communication skills.

OBJECTIVE: This report examined whether a change in the perceived communication behaviour (PeCoBe) of general practitioners (GPs) influenced the effect of the Promoting Active Aging (PRACTA) intervention on activation of older patients as perceived by GPs. METHODS: Pre- and post-intervention questionnaires were filled out by 225 GPs, who were assigned to three groups, e-learning, pdf-article, and control. GPs self-reported their communication behaviour and their perceptions of the attitudes of older patients toward treatment and health. RESULTS: Participation in the e-learning intervention showed an increase in the PeCoBe of GPs, while reading the pdf-article resulted in a decrease of such behaviours. An increase in the PeCoBe of GPs was positively related to an increase in their perception of an active attitude among older patients. The indirect effects observed for e-learning and pdf-article interventions had opposite directions. CONCLUSION: Both types of PRACTA intervention exerted an impact on GPs' perception of the attitudes of older patients, and change in PeCoBe of GPs could be considered as a mechanism driving this effect. PRACTICAL IMPLICATIONS: The methods based on a combination of knowledge delivery and modelling of communication skills are strongly recommended forms of teaching for GPs on how to communicate with and activate seniors.

Diversity in changes of HRQoL over a 1-year period after radiotherapy in Norwegian breast cancer patients: results of cluster analyses.

PURPOSE: The diversity in long-term changes in health-related quality of life (HRQoL) among breast cancer (BC) survivors is poorly understood. The aim of this study was to identify clusters of trajectories (subgroups of patients with similar patterns of changes) of selected HRQoL domains over a 1-year period after radiotherapy (RT) in BC patients. METHODS: The group consisted of 250 BC patients referred for postoperative RT. Global quality of life (QoL), functions, and cancer-specific symptoms were assessed using the European Organisation for Research and Treatment of Cancer (EORTC) core Quality of Life Questionnaire (QLQ-C30) before starting RT, at completion of RT and 3, 6, and 12 months after RT. A hierarchical cluster analysis was used to identify possible trajectories of HRQoL domains. RESULTS: Three distinct types of clusters of trajectories were identified for all outcome variables: Type 1 clusters encompassing the rather time-stable high-global QoL cluster, high-functioning clusters, and low-symptom clusters (44-98% of patients), Type 2 clusters with medium levels of HRQoL domains (8-49%), Type 3 clusters encompassing low-global QoL, low-functioning, and high-symptoms clusters (2-51%). CONCLUSIONS: Our results demonstrated a noticeable heterogeneity of changes in HRQoL domains after BC treatment. The findings support the importance of an accurate patient-reported HRQoL assessment as a routine element of BC survivors' care. The pre-RT assessment of HRQoL alone allows to predict the course of HRQoL changes over the 1-year period after RT and the risk of "falling into" low functioning clusters.

Testing a New Tool Assessing Attitude Towards Treatment and Health in Primary Health Care Setting: Senior Patients and Doctors Perspectives.

AIMS: Patients' attitude towards treatment and health (ATH) is crucial for compliance at all stages of treatment. This study examined the psychometric properties of the developed PRACTA Attitude Towards Treatment and Health questionnaire, designed to measure ATH as perceived by seniors (PRACTA-ATH) and doctors (PRACTA-ATH-D) in primary health care. METHODS: The data were collected in two waves of the Polish-Norwegian PRACTA project. Exploratory factor analyses (EFAs) were conducted on wave 1 data from senior patients ( n = 3392) and their general practitioners ( n = 491). Confirmatory factor analyses (CFAs) were conducted on wave 2 data. This was a new sample of senior patients ( n = 2765) and a follow-up sample of doctors ( n = 393). RESULTS: The EFAs showed that the 16-item four-factor solution is the best solution reflecting the structure of both seniors and doctors' ATH questionnaires. The CFAs conducted to establish the best unified model for PRACTA-ATH and PRACTA-ATH-D indicated three comparatively good solutions: the 16-item four-factor solution, the 12-item four-factor solution and the 12-item five-factor solution. CONCLUSIONS: The questionnaire is found appropriate for use among patients and doctors, and can be used as a good tool to monitor older patients' ATH and concordance between doctors and patients' perspectives.

The role of gender in the active attitude toward treatment and health among older patients in primary health care-self-assessed health status and sociodemographic factors as moderators.

BACKGROUND: Active attitude toward treatment and health (ATH) leads to improved cooperation and better health outcomes in patients. Supporting it in the population of older adults is a growing need in primary care. Recognising the role of gender, health and other sociodemographic factors can help to distinguish patients who need the most assistance in activation from general practitioners (GPs). The objective of the study was to investigate gender differences in ATH as well as the moderating role of self-assessed health (SAH) and selected sociodemographic factors (age, education, financial status, marital status). METHODS: A cross-sectional, multicentre study among 4936 primary care older patients (aged 50+) was conducted. The PRACTA-Attitude toward Treatment and Health questionnaire (PRACTA-ATH) was used to measure the cognitive, emotional (positive and negative affect), and motivational dimensions of ATH. Patients were approached before and after their visits in the primary health-care facilities randomly selected in Central Poland. RESULTS: Generalised linear models (GENLIN) revealed the main effects of gender, SAH, and sociodemographic characteristics, such as financial status, marital status and education. Interaction effects of gender and age (Wald's χ2 = 24.767, p < 0.001 for ATH Global), as well as gender and SAH (Wald's χ2 = 16.712, p < 0.002 for ATH Global) on ATH were found. The most assistance in regard to ATH was required by men aged 50-74 and men declaring good self-assessed health. Generally, women declared a more active attitude than men, showing more knowledge (M = 5.40, SD = 0.07 and M = 5.21, SD = 0.07, for women and men, respectively, p = 0.046), positive emotion (M = 5.55, SD = 0.06 and M = 5.33, SD =0.06, for women and men, respectively, p = 0.015) and motivation to be involved in their health issues (M = 5.71, SD = 0.07 and M = 5.39, SD = 0.07, for women and men, respectively, p = 0.001). The level of negative emotions related to health was not significantly different between genders (p = 0.971). CONCLUSIONS: The need to create health promoting programmes taking account of particular gender differences in older adults emerges. In regard to clinical practice, building a sense of efficacy and individual responsibility for health, providing information about the means of health promotion and prevention, and recognising health-related cognitions, is recommended especially for men who feel well and are less advanced in age (50-74).

Activation of older patients through PRACTA intervention for primary healthcare doctors: does the method matter?

Background: Activating older adults in medical practice can benefit patients' health and quality of life, as well as the economy and burden of the healthcare system. Placing general practice in the public healthcare system gives the elderly population easy access to the promotion of active attitudes toward health, provided that the doctors have and use relevant activating tools. The aim of this study was to verify the possibility of activating senior patients through an educational intervention for doctors. Methods: Two waves of data collection from primary care patients and their doctors were separated by an intervention for doctors. The intervention took the form of an e-learning programme or article and was developed so as to improve general practitioners' (GP) communication and activation skills, especially when working with older adults. The outcome variable was the change between the waves in patients' scores on the PRACTA Attitude Toward Treatment and Health (ATH) Scale and PRACTA Self-efficacy Scale. Data from patients aged 50 + (n = 2175; 55.6% women; age: M = 69.56, SD = 9.10) appointed at the primary care facilities were analysed. Results: The analysis revealed the effect of doctors' e-learning and, to a lesser extent, the effect of article reading on patients' attitudes toward treatment and health as well as on their self-efficacy. In facilities in which the intervention was implemented, patients' attitudes were more active on follow-up than at baseline when compared with facilities without the intervention. Conclusions: Educational intervention among doctors can result in patients' ATH becoming more active. The form of intervention might diversify the impact.

Primary care patients' expectations regarding medical appointments and their experiences during a visit: does age matter?

INTRODUCTION: There is evidence that meeting patients' expectations toward health care correlates with involvement in the treatment they receive. The most important patient expectations concern certain types of information: explanation of disease and treatment, health promotion, and improvement in quality of life. Other demands include proper rapport and emotional support. The aim of this paper was to examine different patient groups over the age of 50 years and their expectations toward medical visits, evaluated before a visit and after the visit. PATIENTS AND METHODS: The study group consisted of 4,921 primary health-care patients. The patients received self-administered questionnaires that they filled in before and after the appointment with the doctor. Interviews with patients were conducted individually by specially trained interviewers. The PRACTA Patient Expectations Scale was used to measure the appointment-related expectations of the patients. RESULTS: We observed differences related to age in patients' expectations before medical visits regarding the following factors: disease explanation, treatment explanation, quality of life, rapport, and emotional support. The same differences were not observed on health promotion. Evaluation of patients' appointment-related experiences after the visit showed that there were significant differences between the age-groups regarding all types of expectations included in the study. Differences between previsit and postvisit measurements were statistically significant in all age-groups. Patients who received less than they expected from doctors outnumbered those who received what they expected or more in all the groups. CONCLUSION: Patients' expectations toward medical visits are conditioned by age. Therefore, doctors should pay more attention to requirements related to age in their effort to identify and satisfy expectations. This is particularly important in light of the discrepancy between previsit expectations and the actual experiences of patients evaluated after the visit.

Enhancing Doctors' Competencies in Communication With and Activation of Older Patients: The Promoting Active Aging (PRACTA) Computer-Based Intervention Study.

BACKGROUND: Demographic changes over the past decades call for the promotion of health and disease prevention for older patients, as well as strategies to enhance their independence, productivity, and quality of life. OBJECTIVE: Our objective was to examine the effects of a computer-based educational intervention designed for general practitioners (GPs) to promote active aging. METHODS: The Promoting Active Aging (PRACTA) study consisted of a baseline questionnaire, implementation of an intervention, and a follow-up questionnaire that was administered 1 month after the intervention. A total of 151 primary care facilities (response rate 151/767, 19.7%) and 503 GPs (response rate 503/996, 50.5%) agreed to participate in the baseline assessment. At the follow-up, 393 GPs filled in the questionnaires (response rate, 393/503, 78.1%), but not all of them took part in the intervention. The final study group of 225 GPs participated in 3 study conditions: e-learning (knowledge plus skills modelling, n=42), a pdf article (knowledge only, n=89), and control (no intervention, n=94). We measured the outcome as scores on the Patients Expectations Scale, Communication Scale, Attitude Toward Treatment and Health Scale, and Self-Efficacy Scale. RESULTS: GPs participating in e-learning demonstrated a significant rise in their perception of older patients' expectations for disease explanation (Wald χ2=19.7, P<.001) and in perception of motivational aspect of older patients' attitude toward treatment and health (Wald χ2=8.9, P=.03) in comparison with both the control and pdf article groups. We observed additional between-group differences at the level of statistical trend. GPs participating in the pdf article intervention demonstrated a decline in self-assessed communication, both at the level of global scoring (Wald χ2=34.5, P<.001) and at the level of 20 of 26 specific behaviors (all P<.05). Factors moderating the effects of the intervention were the number of patients per GP and the facility's organizational structure. CONCLUSIONS: Both methods were suitable, but in different areas and under different conditions. The key benefit of the pdf article intervention was raising doctors' reflection on limitations in their communication skills, whereas e-learning was more effective in changing their perception of older patients' proactive attitude, especially among GPs working in privately owned facilities and having a greater number of assigned patients. Although we did not achieve all expected effects of the PRACTA intervention, both its forms seem promising in terms of enhancing the competencies of doctors in communication with and activation of older patients.

Optimism and hope as predictors of subjective health in post-myocardial infarction patients: A comparison of the role of coping strategies.

This study explored the effects intervening in the linkages of optimism and hope with subjective health in the short term after myocardial infarction. A two-wave study design was used. The sample consisted of 222 myocardial infarction survivors. When adopting a cross-sectional design, optimism and hope predicted subjective health at Time 1 and Time 2. After controlling for baseline subjective health, they were no longer significant predictors of subjective health at Time 2. Parallel indirect effects of seeking social support and problem solving were significant for both optimism and hope. After controlling for the shared variance between optimism and hope, these effects remained significant only for optimism.

[Gender and quality of life and coping over one year after myocardial infarction: do men really have the upper hand?]. / Plec a jakosc zycia i radzenie sobie w okresie roku po zawale serca: czy rzeczywiscie mezczyzni góra?

BACKGROUND: Multiple reports have confirmed that quality of life (QoL) in women after myocardial infarction (MI) is worse compared to men of the same age but some variation depending on QoL dimension was also reported. A less studied issue is coping after MI. AIM: The present study examined whether gender affected the level and dynamics of QoL and coping over 1 year after MI. METHODS: This questionnaire-based study included 3 stages, at the beginning and the end of a rehabilitation programme (n = 222, 163 [73%] men) and 1 year later (n = 140, 98 [70%] men). The MacNew questionnaire was used for evaluating cardiac patient-specific QoL in 3 dimensions: physical, emotional and social. Coping was examined using a modified COPE scale that allows assessment of seven coping strategies. RESULTS: Compared to women, men had higher levels of emotional and physical QoL at the first and second stage of the study. At the third stage, men and women did not differ in any QoL aspect. Significant gender-time interactions were found for physical QoL (F(2.137) = 8.66; p = 0.001, eta2 = 0.07) and for 2 of 7 coping strategies: sense of humour (F(2.137) = 4.10; p = 0.02, eta2 = 0.06) and turning to religion (F(2.137) = 3.55; p = 0.03, eta2 = 0.05). CONCLUSIONS: Men demonstrated higher levels of physical and emotional QoL during inpatient rehabilitation but no gender-related differences in any QoL dimension were seen at 1 year. The dynamics of physical QoL changes was related to gender, with improvement seen in women and deterioration seen in men. There were also gender-related differences in the dynamics and levels of certain coping strategies. The observed changes in QoL and coping suggest that some of the beneficial effects of rehabilitation could not be maintained over 1 year. These unfavourable changes are more frequent in men.