Background: Low health literacy is associated with decreased patient compliance and worse outcomes - with clinicians increasingly relying on printed materials to lower such risks. Yet, many of these documents exceed recommended comprehension levels. Furthermore, patients look increasingly to social media (SoMe) to answer healthcare questions. The character limits built into Twitter encourage users to publish small quantities of text, which are more accessible to patients with low health literacy. The present authors hypothesize that SoMe posts are written at lower grade levels than traditional medical sources, improving patient health literacy. Methods: The data sample consisted of the first 100 original tweets from three trending medical hashtags, leading to a total of 300 tweets. The Flesch-Kincaid Readability Formula (FKRF) was used to derive grade level of the tweets. Data was analyzed via descriptive and inferential statistics. Results: The readability scores for the data sample had a mean grade level of 9.45. A notable 47.6% of tweets were above ninth grade reading level. An independent-sample t-test comparing FKRF mean scores of different hashtags found differences between the means of the following: #hearthealth versus #diabetes (t = 3.15, p = 0.002); #hearthealth versus #migraine (t = 0.09, p = 0.9); and #diabetes versus #migraine (t = 3.4, p = 0.001). Conclusions: Tweets from this data sample were written at a mean grade level of 9.45, signifying a level between the ninth and tenth grades. This is higher than desired, yet still better than traditional sources, which have been previously analyzed. Ultimately, those responsible for health care SoMe posts must continue to improve efforts to reach the recommended reading level (between the sixth and eighth grade), so as to ensure optimal comprehension of patients.

Background: Breaking bad news (BBN) is a routine yet distressing task for physicians and patients. Patients suffer considerable discomfort when bad news such as disease recurrence, spread or treatment failure is disclosed to them. Their physicians, therefore, should acquire effective communication skills to help them overcome these feelings. Objectives: To assess the physicians' awareness and practice of breaking bad news to patients. Methods: A crosssectional study was carried out in a rural Family Health Center (FHC), Menoufia, Egypt. A semi-structured questionnaire based on the 6-step SPIKES protocol for BBN was administered to 170 physicians working and training in the FHC to assess their awareness of the process. The practice of these physicians was assessed against a checklist. Results: About 68% of the physicians had good awareness of the components of the 6-step SPIKES protocol, while 58% implemented the protocol at a fair level. There was a statistically significant difference among physicians' results based on specialties where family physicians and general practitioners had higher awareness and practice scores. As regards their qualifications, physicians with Ph.D. degrees or fellowships had statistically significant better awareness and practice scores. The physicians who received training on breaking bad news had higher awareness and practice scores. There was a statistically significant positive correlation between participants' years of experience and their awareness and practice. Conclusion: Physicians' BBN awareness is good; however, their technique of practicing is fair. It is a neglected issue in physicians' education and training, particularly in the case of novice physicians.

Background: Patient-doctor relationship and patient satisfaction are important engines that improve patient compliance and hence the health outcome. There are widely used instruments to measure patient-doctor relationship and patient satisfaction for primary health care purposes. Researchers lack a validated Arabic instrument that is tailored to the Arab population. So, it is important to translate and validate Patient-Doctor Relationship (PDRQ9) and patient satisfaction (PSQ 18) questionnaires into the Arabic language. Objectives: Is therefore to develop, evaluate, and validate a self-reported measure of Patient-Doctor Relationship (PDRQ9) and patient satisfaction (PSQ 18). Subject and Method: The Arabic version of PDRQ-9 and the PSQ-18 was translated from the English one with back to back translation. They were pilot tested statistically to ensure the psychometric properties (reliability and validity) and the appropriateness for the adult participants in the Arab countries. The Arabic questionnaires were administered to 434 adult participant attending primary health care facilities and hospitals in Suez Governorate, Egypt. Results: Exploratory factor analysis suggested two factors, comprising of 27 items in total. Good model fit was demonstrated through confirmatory factor analysis, with measurement invariance analyses demonstrating equivalent factor structures across. Internal consistency for the PDRQ-9 ranged between (α= 0.981-0.975) for the total scores and that for PSQ-18 ranged between (α = 0.986-0.984). Conclusion: Initial testing of the Arabic versions of the PDRQ-9 and PSQ-18 suggests that these questionnaires have satisfactory psychometric properties.

Background: COVID-19 has been declared as a pandemic that has compelled health systems to operate around the clock. The increased workload has developed psychiatric problems among frontline physicians where they reached burnout due to the high stress they face. Hence, their ability to work effectively decreased. Objectives: Assess the prevalence of anxiety and depression among working physicians during the pandemic, analyze their influencing factors, and evaluate their effect on the productivity of physicians` work. Method: A cross-sectional study was carried out among working physicians in Egypt inquiring about their socioeconomic status, anxiety, depression, expected influencing factors, and work productivity. The questionnaire was administered to 400 physicians in contact with the disease. Results: A total of 40% of the participating physicians suffered from anxiety and about 35% suffer from depression. Lack of support at work, fear of depletion of certain drugs and PPE during work in hospitals, having higher qualifications, increased workload, and being married were the most influencing factors for developing anxiety. Lack of support at work followed by increased workload, fear of PPE depletion, and working in hospitals were the most influencing factors for developing depression. A significant positive correlation was found between the impaired work productivity, anxiety, and depression. Conclusion: Anxiety and depression are prevalent among physicians during COVID-19 pandemic. Socioeconomic and work-related factors significantly affect the development of these diseases which evidently affect their work productivity.

Background: Modern technology has made a radical change in our life. The internet is one form of that technology that invades our life with its applications. Variant social media has become an essential part of our daily routine. Objectives: This study aims to map social media usage among medical students and describe the relationship between social networking sites and social and academic behavior. Method: A Cohort prospective study using a predesigned paper-based, pilot-tested, and selfadministered questionnaire. The study was conducted in the academic year 2018-2019 on the fourthyear medical students in the faculty of medicine at Menoufia University. A total of 211 fourth grade medical students were randomly selected. Results: The average time spent on the internet is 4 -6 hours daily mainly for communication. There was a high statistically significant relation between internet browsing generally and Social media specifically and the score of the behavior changes. There were high scores of students` behavior accompanying the high use (P <0.001). Conclusion: Social channels are widely used, and they influence the behavior of their users. So, we recommend further studies to determine the type of affected behavior.