Association of the MTHFR C677T and A1298C polymorphisms with methotrexate toxicity in rheumatoid arthritis: a meta-analysis

The aim of this study was to explore whether the C677T and A1298C polymorphisms of methylenetetrahydrofolate reductase (MTHFR) play a role in methotrexate (MTX) toxicity in rheumatoid arthritis (RA). MEDLINE and EMBASE database searches and subsequent manual searches were utilized to identify articles in which C677T and A1298C MTHFR polymorphisms were evaluated in RA patients taking MTX. A meta-analysis was conducted to identify associations between MTHFR polymorphisms and MTX toxicity. Twelve studies comprising a total of 2,288 RA patients were included in our meta-analysis. Meta-analysis revealed an association between the overall toxicity of MTX and the MTHFR 677TT genotype (odds ratio [OR]?=?1.615, 95 % confidence interval [CI]?=?1.185–2.200, p?=?0.002). Stratification by ethnicity indicated an association between the MTHFR 677TT genotype and the overall toxicity of MTX in East Asians (OR?=?1.583, 95 % CI?=?1.075–2.331, p?=?0.020). The toxicity of MTX also was found to be associated with the TT genotype in patients taking folate (OR?=?1.893, 95 % CI?=?1.283–2.793, p?=?0.001). Stratification by toxicity type indicated an association between the MTHFR 677TT genotype and any adverse effects (OR?=?1.716, 95 % CI?=?1.127–2.612, p?=?0.012). Meta-analysis stratified by toxicity type indicated an association between the MTHFR 1298CC genotype and any adverse effects (OR?=?0.501, 95 % CI?=?0.284–0.886, p?=?0.017). The results of our meta-analysis suggest that the MTHFR C677T and A1298C polymorphisms are associated with MTX toxicity in RA patients.     

Health care in systemic lupus erythematosus (SLE): the patient’s perspective

In order to provide more patient-centered care for patients suffering from systemic lupus erythematosus (SLE), we studied their current satisfaction and preferences regarding future health care delivery. We sent questionnaires to all SLE patients visiting the rheumatology outpatient clinic in Leiden, the Netherlands. The questionnaire comprised three topics: (a) health care needs using a modified version of SLE Needs Questionnaire (range 0–38), (b) satisfaction with care per provider (visual analogue scale, range 0 (not at all)–100 (very satisfied)), and (c) preferences for future healthcare (four items). One hundred and two patients (63 % response) reported an average of 16 (±6) health care needs, with all patients reporting a need in the physical domain. More needs were significantly associated with worse physical functioning and a higher educational level. The average satisfaction score was 73 (±19) with a lower overall satisfaction score being associated with younger age and an educational level higher or lower than average. Regarding preferences for future health care delivery, 75 % of patients showed interest in a yearly standardized medical assessment, 57 % in regular, specialized nurse contacts using internet, 50 % in a yearly inventory on the need for self-management support, and 36 % in an education course. The association of age, education level and physical functioning with health care needs, and/or satisfaction suggest that the delivery of care should be better tailored to the needs of subgroups of patients.     

Development and evaluation of a school-based asthma educational program

Objectives: To develop, implement, and evaluate the effects of a school-based asthma educational program on Saudi primary school teachers' asthma awareness and competence in delivering asthma-related first aid interventions. Methods: An asthma educational intervention program entitled “School Asthma Action Program” (SAAP) was designed based on pedagogical principles and implemented among teachers randomly selected from girls' primary schools in Riyadh, Saudi Arabia. This pilot study employed a pre-test/post-test experimental design. A previously tested asthma awareness questionnaire and a custom-designed asthma competence score sheet were used to evaluate the effects of the educational intervention program on teacher's asthma awareness and competence in providing asthma-related first aid interventions at schools. Results: Forty-seven teachers from five different primary schools participated in the program. Of the 47 teachers, 39 completed both the pre- and post-program questionnaires. The SAAP improved teachers' awareness of asthma (teachers' median pre-program score was 11 (range 5–18) and their post-program score was 15 (range 7–18), p < 0.001) and their attitudes toward asthma management at schools (teachers' median pre-program score was 74 (range 15–75) and their post-program score was 75 (range 15–75), p = 0.043). Further, it improved teachers' competence in providing asthma-related first aid interventions (teachers' mean pre-program score was 1.4 ± 2.3 and their mean post-program score was 9.8 ± 0.5, p < 0.001). After completing the SAAP, a high proportion of teachers reported increased confidence in providing care to children with asthma at school. Conclusion: School-based asthma educational programs can significantly improve teachers' knowledge of asthma and their competence in providing asthma-related first aid interventions during emergencies.     

The effect of methotrexate and anti-tumor necrosis factor therapy on the risk of lymphoma in rheumatoid arthritis in 19,562 patients during 89,710 person-years of observation

OBJECTIVE: To ascertain the relationship between anti-tumor necrosis factor (anti-TNF) therapy, methotrexate (MTX), and the risk of lymphoma in patients with rheumatoid arthritis (RA). This report updates our previous report during 29,314 person-years of followup. METHODS: Participants in the National Data Bank for Rheumatic Diseases (NDB) longitudinal study of long-term outcomes of RA completed semiannual questionnaires from 1998 through 2005, during 89,710 person-years of followup. Lymphoma reports were validated by medical records. The association between lymphoma and treatment was investigated using conditional logistic regression, adjusted for severity and demographic covariates. RESULTS: Of the 19,591 participants, 55.3% received biologic agents and 68.0% received MTX while enrolled in the NDB. The lymphoma incidence rate was 105.9 (95% confidence interval [95% CI] 86.6-129.5) per 100,000 person-years of exposure. Compared with the SEER (Surveillance, Epidemiology, and End-Results) lymphoma database, the standardized incidence ratio was 1.8 (95% CI 1.5-2.2). The odds ratio (OR) for lymphoma in patients who received anti-TNF therapy compared with patients who did not receive anti-TNF therapy was 1.0 (95% CI 0.6-1.8 [P = 0.875]). The OR for lymphoma in patients who received anti-TNF plus MTX therapy compared with patients who received MTX treatment alone was 1.1 (95% CI 0.6-2.0 [P = 0.710]). Infliximab and etanercept considered individually also were not associated with a risk of lymphoma. CONCLUSION: In a study of lymphoma in 19,591 RA patients over 89,710 person-years of followup, which included exposure to anti-TNF therapy in 10,815 patients, we did not observe evidence for an increase in the incidence of lymphoma among patients who received anti-TNF therapy.     

Merging Veterans Affairs rheumatoid arthritis registry and pharmacy data to assess methotrexate adherence and disease activity in clinical practice

Objective

The Veterans Affairs (VA) Rheumatoid Arthritis (VARA) registry and the VA Pharmacy Benefits Management database were linked to determine the association of methotrexate (MTX) adherence with rheumatoid arthritis (RA) disease activity.

Methods

For each patient, the medication possession ratio (MPR) was calculated for the first episode of MTX exposure of a duration of ≥12 weeks for both new and established MTX users. High MTX adherence was defined as an MPR ≥0.80 and low MTX adherence was defined as an MPR <0.80. For each patient, the mean Disease Activity Score with 28 joints (DAS28) score, erythrocyte sedimentation rate (ESR), and C‐reaction protein (CRP) level observed during registry followup were compared in high‐ versus low‐adherence groups.

Results

In 455 RA patients, the prescribed doses of MTX (mean ± SD 16 ± 4 mg versus 16 ± 4 mg; P = 0.6) were similar in high‐adherence patients (n = 370) in comparison to low‐adherence patients (n = 85). However, the actual observed MTX doses taken by patients were significantly higher in the high‐adherence group (mean ± SD 16 ± 5 mg versus 11 ± 3 mg; P < 0.001). DAS28 (mean ± SD 3.6 ± 1.2 versus 3.9 ± 1.5; P < 0.02), ESR (mean ± SD 24 ± 18 versus 29 ± 24 mm/hour; P = 0.05), and CRP level (mean ± SD 1.2 ± 1.3 versus 1.6 ± 1.5 mg/dl; P < 0.03) were lower in the high‐adherence group compared to those with low MTX adherence. These variances were not explained by differences in baseline demographic features, concurrent treatments, or whether MTX was initiated before or after VARA enrollment.

Conclusion

High MTX adherence was associated with improved clinical outcomes in RA patients treated with MTX. Adjustment for potential confounders did not alter the estimated effect of adherence. These results demonstrate the advantages of being able to merge clinical observations with pharmacy databases to evaluate antirheumatic drugs in clinical practice.     

Tele‐Health Followup Strategy for Tight Control of Disease Activity in Rheumatoid Arthritis: Results of a Randomized Controlled Trial

Objective

To test the effect of patient‐reported outcome (PRO)–based tele‐health followup for tight control of disease activity in patients with rheumatoid arthritis (RA), and the differences between tele‐health followup performed by rheumatologists or rheumatology nurses.

Methods

A total of 294 patients were randomized (1:1:1) to either PRO‐based tele‐health followup carried out by a nurse (PRO‐TN) or a rheumatologist (PRO‐TR), or conventional outpatient followup by physicians. The primary outcome was a change in the Disease Activity Score in 28 joints (DAS28) after week 52. Secondary outcomes were physical function, quality of life, and self‐efficacy. The noninferiority margin was a DAS28 score change of 0.6. Mean differences were estimated following per protocol, intent‐to‐treat (ITT), and multivariate imputation analysis.

Results

Overall, patients had low disease activity at baseline and end followup. Demographics and baseline characteristics were similar between groups. Noninferiority was established for the DAS28. In the ITT analysis, mean differences in the DAS28 score between PRO‐TR versus control were ?0.10 (90% confidence interval [90% CI] ?0.30, 0.13) and ?0.19 (90% CI ?0.41, 0.02) between PRO‐TN versus control. When including 1 yearly visit to the outpatient clinic, patients in PRO‐TN had mean ± SD 1.72 ± 1.03 visits/year, PRO‐TR had 1.75 ± 1.03 visits/year, and controls had 4.15 ± 1.0 visits/year. This included extra visits due to inflammatory flare.

Conclusion

Among RA patients with low disease activity or remission, a PRO‐based tele‐health followup for tight control of disease activity in RA can achieve similar disease control as conventional outpatient followup. The degree of disease control did not differ between patients seen by rheumatologists or rheumatology nurses.

     

Patient self-injection of methotrexate for inflammatory arthritis: a study evaluating the introduction of a new type of syringe and exploring patients' sense of empowerment

Objectives: To evaluate the introduction of a new type of syringe for patients on a self‐injection of methotrexate (MTX) programme and explore patients' sense of empowerment relating to the self‐injection of MTX. Methods: Data were collected using a postal questionnaire, which yielded quantitative and qualitative data. The questionnaire was sent to all eligible patients in the primary care setting who self‐injected MTX (n = 24). Results: The response rate was 88% (n = 21). Patients' responses illustrated numerous disadvantages of using the syringe, particularly difficulties with the syringe stopper, syringe handling and leakage potential of the mildly cytotoxic drug MTX. The advantages included the ease of syringe storage and longer use by date. Difficulties in using the syringe, and the amount of support and training from hospital staff were among the factors affecting patients' sense of empowerment. Conclusions: Although a small study, this work indicates that there may be benefits in a collaboration between hospital staff and the syringe manufacturer, to modify the new syringe to address the problems noted. The potential of cytotoxic MTX spillage being minimized is recognized, making the new syringe more suitable for use by patients with inflammatory arthritis. Patient training may help to alleviate difficulties in using a new syringe, which, in turn, may also increase patients' sense of empowerment. Copyright © 2007 John Wiley & Sons, Ltd.     

某海外企业员工疟疾防治健康教育效果评价

目的 评价健康教育改善海外企业员工疟疾防治相关知识、态度与行为（knowledge-attitude-practice,KAP）的效果。方法 2019年9月,对刚果民主共和国某中资矿产企业全体中方员工开展实地疟疾防治健康教育。在问卷星网站创建疟疾防治KAP调查问卷,分别于干预前和干预后14个月对干预对象开展两次问卷调查。回收问卷后,根据调查对象是否接受健康教育干预及参与前后两次问卷调查,将有效问卷分为基线组（接受干预且参与两次问卷调查的应答者干预前填写的问卷）、失访组（接受干预但仅参与干预前问卷调查的应答者填写的问卷）、复测组（接受干预且参与两次问卷调查的应答者干预后填写的问卷）、新增组（未接收干预、仅参与干预后问卷调查的应答者填写的问卷）4组。对基线组与失访组、基线组与复测组、复测组与新增组疟疾防治知识正确率、态度认可率、行为依从率进行比较。结果 两次问卷调查分别回收有效问卷110份和142份,有效回收率分别为90.9%和70.3%。基线组、失访组、复测组、新增组分别包含77、77、33、65份有效问卷。基线组与失访组应答者性别、年龄、学历构成差异均无统计学意义（P均> 0.0...     

Influenza vaccination. Knowledge, attitudes, and behavior among high-risk outpatients.

The Minneapolis and Pittsburgh Veterans Affairs Medical Centers conduct virtually identical institution-wide influenza vaccination programs that include annual educational and publicity mailings to all outpatients. Despite these efforts, 40% to 50% of high-risk outpatients at both centers fail to receive influenza vaccine each year. To assess differences between high-risk vaccine recipients and nonrecipients, a self-administered questionnaire was mailed to 500 randomly selected outpatients from each site. The questionnaire asked about risk factors, vaccination status, and knowledge and attitudes regarding influenza and "flu shots." Patient risk characteristics and vaccination rates in Minneapolis and Pittsburgh were similar with 75.6% and 76.3% reporting high-risk conditions and 65.6% and 56.1% of high-risk respondents reporting influenza vaccination, respectively. High-risk vaccine recipients and nonrecipients had similar knowledge but different attitudes about influenza and "flu shots." Using stepwise logistic regression, factors positively associated with vaccination behavior were: intention to follow physician or nurse recommendations for "flu shots" (odds ratio [OR] = 7.09); previous vaccination behavior (OR = 6.36); and physician or nurse recommendations for a "flu shot" (OR = 4.29). Factors negatively associated with vaccination behavior were difficulty in coming to the medical center (OR = 0.42) and previous side effects from the vaccine (OR = 0.19). These findings suggest areas in need of additional emphasis if influenza vaccination rates are to be improved.     

Validation of the patient-completed asthma knowledge questionnaire (PAKQ)

Background: Asthma is often suboptimally controlled, in part due to patients' disease knowledge. Understanding patients' knowledge, prior to education may help in individualizing content. However, there are no well validated or internationally relevant patient asthma knowledge questionnaires available. Objective: To translate and validate the rigorously validated Questionnaire de connaissances sur l'asthme destiné aux patients adultes (QCA-PA) based on key points related to asthma knowledge and self-management accordingly to the Global Initiative for Asthma report. Methods: Based on Vallerand's methodology, a preliminary version of the “Patient-completed Asthma Knowledge Questionnaire” (PAKQ) was back-translated and evaluated by an expert committee. A sample of 20 individuals with asthma pretested the questionnaire, after which 62 adults were recruited. Sociodemographic data were collected and the PAKQ together with a comparator questionnaire (Consumer Questionnaire (CQ)) were completed. Fourteen days after the first visit, participants returned to recomplete both questionnaires; half were randomly selected to receive a one-on-one asthma education session and again completed both questionnaires immediately after education, and at 10 days follow-up. Results: The PAKQ showed good internal consistency (KR-20 = 0.77). Moderate correlation with CQ (r = 0.596, p = 0.01) attested to its concurrent validity. Confirmatory factor analyses confirmed a single factor structure. A repeated measures ANOVA showed its reproducibility (n = 21:F₍₁₎ = 3.578, p = 0.07, η_p² = 0.152) and responsiveness (n = 21:F₍₁₎ = 26.041, P < 0.05, η_p² = 0.566). Conclusion: The PAKQ is a valid asthma knowledge questionnaire which is based on international asthma recommendations and could help healthcare professionals in individualizing educational interventions for people with asthma.     

支气管镜下冷冻联合局部注药治疗支气管结核所致气道梗阻的临床分析

目的 探讨电子支气管镜下冷冻治疗联合局部注药治疗支气管结核的疗效.方法 选择2013年1月至2016年12月在咸阳市中心医院呼吸内科及咸阳市中心医院东郊分院(传染病院)经病理确诊的支气管结核210例,分为单纯冷冻治疗组及冷冻联合局部注药治疗组,两组患者均给予全身抗结核化疗;单纯冷冻治疗治疗组在患者服用抗结核药物治疗2周后开始支气管镜下冷冻治疗,联合组在冷冻治疗的基础上给予局部注射异烟肼、利福平治疗.治疗结束后观察两组患者总有效率、气促评分、FEV1、气道狭窄改善情况,以及对比两组患者之间的镜下治疗次数及病程长短.结果 两组患者治疗总有效率均为100％,但联合局部注药治疗组的显效率(83.1％)高于单纯冷冻治疗组(72.8％);两组患者治疗前在气促评分、FEV1、气道内径差异无统计学意义(2.51±0.88,2.63±0.51,P=0.359;1.96±0.82,1.17±0.77,P=0.590;2.45±1.21,3.01±1.15,P=0.542),治疗后两组患者的气促评分、FEV1、气道内镜均明显得到改善,但两组之间差异仍无统计学意义(0.93±0.62,0.81±0.43,P=0.700;3.53±0.77,3.66±0.53,P=0.339;5.84±0.81,6.01±0.49,P=0.616);两组患者在治疗次数上,联合用药组明显少许单纯冷冻治疗组,差异有统计学意义(P=0.012),且联合用药组病程亦短于单纯冷冻治疗组.结论 电子支气管镜冷冻联合局部用药能够提高支气管结核的治疗效果,缩短患者病程,并且是安全、可靠的,值得临床推广.     

A Training Program for Certified Asthma Educators: Assessing Performance

Background. Evidence-based asthma guidelines identify asthma education as an essential element of care. In Canada, a process for certifying asthma educators was established to help provide asthma education to patients. A critical component to certifying asthma educators is their training and evaluation. The purpose of the study was to identify an approach to evaluate participants and to determine if specific characteristics influenced participants' success. Methods. Participants completed a questionnaire that collected demographic, practice, and learner characteristics. Assessment strategies and criteria used to determine the level of success included 1) a written asthma knowledge score; 2) a written educational theory score, and 3) a practice teaching skill score based on three encounters with standardized patients. Standardized patient encounters were scored by using a standard checklist of essential teaching functions. Results. Participants (n = 73) represented a broad range of health professions (respiratory therapists, nurses, pharmacists, and physiotherapists). The average score for written asthma knowledge, educational theory, and practice skill assessment was 82.0 ± 8.0%, 68.6 ± 16.2%, and 80.3 ± 9.7%, respectively. Moderate interrelationships were observed between the practice teaching skills score and years of practice in asthma (r = 0.35; p< 0.01) and percentage of workdays dedicated to asthma care (r = 0.30; p< 0.05). Moderately strong relationships were observed among the three standardized patient encounters. However, there were no associations between participant scores on the written asthma or educational theory examination and the practice skill assessment scores. Conclusions. Participants of an asthma educator training program represent a wide range of disciplines, practice settings, and experience. It is important that asthma educator training programs assess both written knowledge and practice assessments to evaluate participants.     

Health‐related quality of life of patients with juvenile dermatomyositis: Results from the paediatric rheumatology international trials organisation multinational quality of life cohort study

Objective

To investigate the health‐related quality of life (HRQOL) change over time, as measured by the Child Health Questionnaire (CHQ), and its determinants in patients with active juvenile dermatomyositis (DM).

Methods

We assessed patients with juvenile DM at both baseline and 6 months of followup, and healthy children age ≤18 years. Potential determinants of poor HRQOL included demographic data, physician's and parent's global assessments, muscle strength, functional ability as measured by the Childhood Health Assessment Questionnaire (C‐HAQ), global disease activity assessments, and laboratory markers.

Results

A total of 272 children with juvenile DM and 2,288 healthy children were enrolled from 37 countries. The mean ± SD CHQ physical and psychosocial summary scores were significantly lower in children with juvenile DM (33.7 ± 11.7 versus 54.6 ± 4.1) than in healthy children (45.1 ± 9.0 versus 52 ± 7.2), with physical well‐being domains being the most impaired. HRQOL improved over time in responders to treatment and remained unchanged or worsened in nonresponders. Both physical and psychosocial summary scores decreased with increasing levels of disease activity, muscle strength, and parent's evaluation of the child's overall well‐being. A C‐HAQ score >1.6 (odds ratio [OR] 5.06, 95% confidence interval [95% CI] 2.03–12.59), child's overall well‐being score >6.2 (OR 5.24, 95% CI 2.27–12.10), and to a lesser extent muscle strength and alanine aminotransferase level were the strongest determinants of poor physical well‐being at baseline. Baseline disability and longer disease duration were the major determinants for poor physical well‐being at followup.

Conclusion

We found that patients with juvenile DM have a significant impairment in their HRQOL compared with healthy peers, particularly in the physical domain. Physical well‐being was mostly affected by the level of functional impairment.     

Assessment of clinical nurse specialists in rheumatology using an OSCE

Objective: To introduce a new method of assessment; an observed structured clinical examination (OSCE) into a postgraduate course for rheumatology clinical nurse specialists. Method: The OSCE was introduced into a physical assessment module, which focused on the nurses' ability to perform an examination of patients' shoulders, knees and hands. A modified blueprinting exercise was used to ensure adequate sampling of the different components of the syllabus. This resulted in five active stations and one rest station. The active stations included history-taking, physical examination of the shoulder, knee and hand complexes and multidisciplinary management plans. To enhance authenticity real, rather than simulated, patients were used where practical. Results: All 11 students passed all stations, the lowest score related to history-taking and the highest score related to devising a management plan. All 11 students rated the OSCE a worthwhile experience reflecting the learning outcomes of the module and recommended that the OSCE should be used to assess the next cohort of students. Eight students found the OSCE too ‘anxiety-provoking’ and did not want this method of assessment to be used in other modules. All examiners felt this mode of assessment was more valid than the previous assessment format of a viva on a single patient. Conclusion: This was the first time an OSCE was used in a postgraduate course to assess the physical examination skills of rheumatology nurse specialists. The course faculty, examiners and students found it was a reliable and valid means of assessment. Copyright © 2007 John Wiley & Sons, Ltd.     

A multimedia intervention on cardiopulmonary resuscitation and advance directives

OBJECTIVE: To assess the effects of a multimedia educational intervention about advance directives (ADs) and cardiopulmonary resuscitation (CPR) on the knowledge, attitude and activity toward ADs and life-sustaining treatments of elderly veterans. DESIGN: Prospective randomized controlled, single blind study of educational interventions. SETTING: General medicine clinic of a university-affiliated Veterans Affairs Medical Center (VAMC). PARTICIPANTS: One hundred seventeen Veterans, 70 years of age or older, deemed able to make medical care decisions. INTERVENTION: The control group (n = 55) received a handout about ADs in use at the VAMC. The experimental group (n = 62) received the same handout, with an additional handout describing procedural aspects and outcomes of CPR, and they watched a videotape about ADs. MEASUREMENTS AND MAIN RESULTS: Patients' attitudes and actions toward ADs, CPR and life-sustaining treatments were recorded before the intervention, after it, and 2 to 4 weeks after the intervention through self-administered questionnaires. Only 27.8% of subjects stated that they knew what an AD is in the preintervention questionnaire. This proportion improved in both the experimental and control (87.2% experimental, 52.5% control) subject groups, but stated knowledge of what an AD is was higher in the experimental group (odds ratio = 6.18, p <.001) and this effect, although diminished, persisted in the follow-up questionnaire (OR = 3.92, p =. 003). Prior to any intervention, 15% of subjects correctly estimated the likelihood of survival after CPR. This improved after the intervention in the experimental group (OR = 4.27, p =.004), but did not persist at follow-up. In the postintervention questionnaire, few subjects in either group stated that they discussed CPR or ADs with their physician on that day (OR = 0.97, p = NS). CONCLUSION: We developed a convenient means of educating elderly male patients regarding CPR and advance directives that improved short-term knowledge but did not stimulate advance care planning.     

Construction and Validation of a Questionnaire about Heart Failure Patients' Knowledge of Their Disease

Background

The lack of tools to measure heart failure patients'' knowledge about their syndrome when participating in rehabilitation programs demonstrates the need for specific recommendations regarding the amount or content of information required.

Objectives

To develop and validate a questionnaire to assess heart failure patients'' knowledge about their syndrome when participating in cardiac rehabilitation programs.

Methods

The tool was developed based on the Coronary Artery Disease Education Questionnaire and applied to 96 patients with heart failure, with a mean age of 60.22 ± 11.6 years, 64% being men. Reproducibility was obtained via the intraclass correlation coefficient, using the test-retest method. Internal consistency was assessed by use of Cronbach''s alpha, and construct validity, by use of exploratory factor analysis.

Results

The final version of the tool had 19 questions arranged in ten areas of importance for patient education. The proposed questionnaire had a clarity index of 8.94 ± 0.83. The intraclass correlation coefficient was 0.856, and Cronbach''s alpha, 0.749. Factor analysis revealed five factors associated with the knowledge areas. Comparing the final scores with the characteristics of the population evidenced that low educational level and low income are significantly associated with low levels of knowledge.

Conclusion

The instrument has satisfactory clarity and validity indices, and can be used to assess the heart failure patients'' knowledge about their syndrome when participating in cardiac rehabilitation programs.     

Questionnaire survey evaluating disease-related knowledge for 149 primary gout patients and 184 doctors in South China

This study aims to investigate the disease-related knowledge of gout patients and doctors in south China and to identify the important targets of education for patients and doctors. A cross-section survey of 154 primary gout patients and 185 doctors who may see gout patients was conducted with a modified questionnaire with ten items of gout-related knowledge. The participants were considered to have gout-related knowledge if he or she correctly answered seven or more items. One hundred and forty-nine valid questionnaires from patients, 33 from rheumatology physicians, and 151 from non-rheumatology doctors were collected for statistical analysis. The mean correctly answered items of three groups were 6.6?±?2.2, 9.6?±?0.53, and 8.0?±?1.4, with rate of being considered to have knowledge about gout 51.7, 100, and 90.1 %, respectively (P?<?0.05). The correct answer rate for each particular item was over 80 % in the rheumatology physician group. Patients or non-rheumatology doctors knew the optimal serum uric acid (sUA) level (48.3 vs 55.6 %), the need to take lifelong urate-lowering drugs (29.5 vs 43.6 %), that allopurinol is a urate-lowering drug (55.7 vs 76.0 %), and how to prevent attacks induced by urate-lowering therapy (ULT) (60.4 vs 74.0 %). Logistic regression showed that higher education predicted which patients had gout-related knowledge. Both the gout patients and non-rheumatology doctors in south China had poor knowledge on ULT. Since many gout patients do not see rheumatologists, our data suggest that further education should focus on patients and non-rheumatologists and emphasize the use of urate-lowering drugs, treatment duration, the target sUA level, and prophylaxis against acute attacks.     

Long‐standing nonulcerative bladder pain syndrome: Impact of Thiele massage on bladder and sexual domains

Purpose : To assess the efficacy of Thiele massage (TM) as monotherapy for nonulcerative interstitial cystitis/bladder pain syndrome (IC/BPS). Methods : A prospective evaluation of 40 women with IC/BPS who underwent TM was conducted. TM was initially administrated by a physiotherapist and then self‐administrated at home twice weekly for 16 weeks. Patients were assessed every 4 weeks on an outpatient basis. Assessment tools included 3‐day voiding diaries, the Likert visual analog scale (VAS) for pain, and the Interstitial Cystitis Symptom Index (ICSI) and the Interstitial Cystitis Problem Index (ICPI) of the O'Leary‐Sant questionnaire. Sexual function was assessed using the Female Sexual Function Index (FSFI). Results : Thirty‐six patients completed the study with a mean age ± SD 41.31 ± 9.93 (range 21‐60 years). The mean duration of illness ± SD was 81.29 ± 34.55 (range 12‐300 months). Perception of pain was higher than at basal level according to Likert VAS (9.2 ± 1.5 vs 9.8 ± 0.5, P = .018). The ICSI and ICPI questionnaires were deteriorated (16.83 ± 2.57 vs 12.89 ± 3.50, P = .015 and 15.75 ± 0.94 vs 14.31 ± 2.55, P < .001, respectively). TM had no significant impact on the total score of FSFI (P = .119); however, there was a negative impact on the lubrication domain with more dryness (0.045). Conclusions : TM is not an effective option as monotreatment modality for nonulcerative IC/BPS. An attempt of physiotherapy should be integrated in a multidisciplinary treatment.