Antibiotic use, knowledge and health literacy among the general population in Berlin, Germany and its surrounding rural areas.

Knowledge concerning antibiotic use in the general population is insufficient. The way health literacy is related to antibiotic use aside from knowledge needs further investigation. Our aim was to compare the levels of knowledge of antibiotics and health literacy in individuals who had taken antibiotics in recent years compared with those who not had taken antibiotics.A population-based cross-sectional survey of 2,000 individuals aged 35 and older from Berlin, Germany and its surrounding rural and suburban areas (response rate 59%) with strata urban/rural, sex, age, and education. Computer-assisted personal interviews were conducted by external, trained interviewers during home visits. Knowledge, health literacy, and antibiotic use were assessed using standardized questionnaires.In all, 33.3% (666/2,000) of the participants indicated having had an antimicrobial therapy during the previous 12 months. Adjusting for sex, age, educational level and health literacy, individuals with four correct answers regarding antibiotics were 1.70 times and those with three correct answers 1.94 more likely to have had a history of recent antibiotic use than those who did not have any correct answers. Individuals with sufficient health literacy were 0.57 times less likely to have had a recent history of antibiotic use than individuals with insufficient health literacy.Patients who have used antibiotics might have more knowledge as a result of their recent involvement with the topic of antibiotic use; health literacy may be a preventive mechanism to use antibiotics more critically. Besides improving the health knowledge of the general population and of vulnerable groups such as patients with low levels of health literacy, intervention strategies should focus on providers as well

Preventing adverse events of chemotherapy by educating patients about the nocebo effect (RENNO study) – study protocol of a randomized controlled trial with gastrointestinal cancer patients

Abstract Background Patients undergoing chemotherapy are highly burdened by side effects. These may be caused by the pharmacodynamics of the drug or be driven by psychological factors such as negative expectations or pre-conditioning, which reflect nocebo effects. As such, negative pre-treatment expectations or prior experiences might exacerbate the burden of chemotherapy side effects. Educating patients about this nocebo effect has been put forward as a potential strategy to optimize patients’ pre-treatment expectations. In this study, we evaluate whether a briefing about the nocebo effect is efficacious in reducing side effects. Methods In this exploratory study, a total number of n = 100 outpatients with newly diagnosed gastrointestinal cancers are randomized 1:1 to an information session about the nocebo effect (nocebo-education) or an attention control group (ACG) with matching interaction time. Assessments take place before the intervention (T1 pre), post-intervention (T1 post), and 10 days (T2) and 12 weeks (T3) after the initial chemotherapy. The primary outcomes are the patient-rated number and intensity of side effects at 10-days and at 12-weeks follow-up. Secondary outcomes include coping with side effects, tendency to misattribute symptoms, compliance intention, attitude towards the chemotherapy, co-medication to treat side effects and the clinician-rated severity of toxicity. Further analyses are conducted to investigate whether a potential beneficial effect is mediated by a change of expectations before and after the intervention. Discussion Informing patients about the nocebo effect might be an innovative and feasible intervention to reduce the burden of side effects and strengthen patients’ perceived control over adverse symptoms. Trial registration The trial is registered at the German Clinical Trials Register (ID: DRKS00009501; retrospectively registered on March 27, 2018). The first patient was enrolled on September 29, 2015

Main reasons for having antimicrobial therapy.

<p>Cross-sectional survey of a population-based sample of 2,000 individuals from Berlin and its surrounding rural and suburban areas. Note. UTI, urinary tract infection; SSI, surgical site infection. 12.8% noted for other reasons and 7.9% I don´t know.</p

Multivariate associations with history of antibiotics.

<p>A cross-sectional survey of a population-based sample of 2,000 individuals from Berlin and its surrounding rural and suburban areas.</p

Causal pathways between health literacy and antibiotic use.

<p>Figure adapted from Paasche-Orlow and Wolf, 2007 [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0193336#pone.0193336.ref020" target="_blank">20</a>].</p

Questionnaire statements.

<p>A cross-sectional survey of a population-based sample of 2,000 individuals from Berlin and its surrounding rural and suburban areas.</p

Health literacy and the use of antibiotics within the previous 12 months.

<p>Cross-sectional survey of a population-based sample of 2,000 individuals from Berlin and its surrounding rural and suburban areas.</p