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Sarbaz M, Mousavi Baigi SF, Darroudi A, Kimiafar K. Occupational exposure to blood and body fluids among prehospital emergency medical services workers in Mashhad, Northeast of Iran. Am J Infect Control 2023; 51:1004-1010. [PMID: 36842711 DOI: 10.1016/j.ajic.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND This study aimed to assess occupational exposure to blood and body fluids (BBFs) and the use of protective equipment among prehospital emergency medical services (EMS) workers in Mashhad, Iran. METHODS This cross-sectional questionnaire survey-based study was conducted from July 2020 to March 2021 in Mashhad. All prehospital EMS workers of Mashhad were invited to participate in the study using the census technique. The questionnaire was about occupational exposure to BBFs, infection control, protective measures, health program, and demographic information. RESULTS In total, 442 participants answered the questionnaire (response rate: 82.77%). Based on the findings, 420 (95.2%) and 402 (91.2%) participants had been exposed to BBFs as prehospital EMS workers. Moreover, 31.5% and 38.5% of these exposures were caused by contaminated needles and lancets, respectively. The BBFs incidents have occurred despite 98% of the EMS workers reporting there is a needle safety disposable box in the ambulance. The relationship between awareness of precaution measures after exposure to BBFs and training course completion was significant (P < .0001). CONCLUSION This study demonstrated the high prevalence of occupational exposures to BBFs among prehospital EMS workers. Considering the significant relationship between the completion of standard precautions courses and awareness of BBFs' postexposure measures, it is recommended to consider multi-faceted strategies for continuous monitoring, training, and follow-up of prehospital EMS workers.
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Affiliation(s)
- Masoumeh Sarbaz
- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyyedeh Fatemeh Mousavi Baigi
- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Darroudi
- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Khalil Kimiafar
- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
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Russell A, Jenkins JL, Zhang A, Wilson LM, Bass EB, Hsu EB. A review of infectious disease epidemiology in emergency medical service clinicians. Am J Infect Control 2022:S0196-6553(22)00846-X. [PMID: 36509183 DOI: 10.1016/j.ajic.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/02/2022] [Accepted: 12/03/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The emergency medical service (EMS) workforce is at high risk of occupationally-acquired infections. This review synthesized existing literature on the prevalence, incidence, and severity of infections in the EMS workforce. METHODS We searched PubMed, Embase, CINAHL, and SCOPUS from January 1, 2006 to March 15, 2022 for studies in the US that involved EMS clinician or firefighter populations and reported 1 or more health outcomes related to occupationally-acquired infections. RESULTS Of the 25 studies that met the inclusion criteria, most focused on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with prevalence rates ranging from 1.1% to 36.2% (median 6.7%). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in 4 studies ranged from 1.9% to 6.4%, and the prevalence of Hepatitis C in 1 study was 1.3%. Few studies reported incidence rates. The prevalence or incidence of these infections generally did not differ by age or gender, but 4 studies reported differences by race or ethnicity. In the 4 studies that compared infection rates between EMS clinicians and firefighters, EMS clinicians had a higher chance of hospitalization or death from SAR-CoV-2 (odds ratio 4.23), a higher prevalence of Hepatitis C in another study (odds ratio 1.74), and no significant difference in MRSA colonization in a separate study. CONCLUSIONS More research is needed to better characterize the incidence and severity of occupationally-acquired infections in the EMS workforce.
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Affiliation(s)
- Anna Russell
- Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - J Lee Jenkins
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allen Zhang
- Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Lisa M Wilson
- Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
| | - Eric B Bass
- Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Edbert B Hsu
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
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Pre-hospital peripheral intravenous catheter insertion practice: An integrative review. Australas Emerg Care 2022:S2588-994X(22)00067-7. [DOI: 10.1016/j.auec.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/21/2022] [Indexed: 11/15/2022]
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Gormley MA, Nolan MS, Heo M, Litwin AH, Alier A, Daguise V. Differences in Motivating Factors for SARS-CoV-2 Vaccination and Perceptions of Infection Risk among Healthcare and EMS Personnel in South Carolina. South Med J 2022; 115:381-387. [PMID: 35649524 PMCID: PMC9154078 DOI: 10.14423/smj.0000000000001406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Although medical workers were prioritized to receive the coronavirus disease 2019 (COVID-19) vaccination, many have declined. Even though studies have investigated differences in COVID-19-related attitudes and vaccination for workers in hospitals and long-term care facilities, none have included emergency medical services (EMS) personnel. We investigated the association between type of medical worker (EMS vs healthcare worker [HCW]) and COVID-19 vaccination, vaccine beliefs, vaccine motivators, personal protection behaviors, and risk perceptions. METHODS The data for self-identified HCWs came from surveys distributed to randomly selected residents of South Carolina and EMS personnel recruited at a targeted surveillance testing event during the South Carolina EMS Symposium. Pearson χ2 and Fisher exact tests analyzed differences in the distribution of demographic characteristics and self-reported COVID-19 vaccination attitudes by medical workers. Multivariable logistic regression assessed the association between COVID-19 vaccination and type of medical worker, adjusting for age, sex, race, and frontline status, and assessed the associations among vaccine beliefs, vaccine motivators, personal protection behaviors, and risk perceptions by type of medical worker, adjusting for age, sex, race, frontline status, and vaccination status. RESULTS Of the 126 respondents 57.9% were EMS, 42.1% were HCWs, and 73.6% of the cohort were self-reported frontline medical workers. Approximately two-thirds of respondents received a vaccine for COVID-19, with no significant differences between EMS and HCWs; however, EMS workers were significantly less likely to receive the vaccination out of concern about exposures at work/school (adjusted odds ratio [aOR] 0.22, 95% confidence interval [CI] 0.08-0.57), concern about exposures within the community (aOR 0.18, 95% CI 0.07-0.48), or to do their part to control the pandemic (aOR 0.20, 95% CI 0.06-0.69). EMS workers also were significantly less likely to wear a mask all/most of the time when outside the home (aOR 0.04, 95% CI 0.0-0.21) and less concerned about the spread of COVID-19 in their community as compared with HCWs (aOR 0.19, 95% CI 0.06-0.56). CONCLUSIONS EMS personnel were significantly less concerned about the spread of COVID-19 in their community and significantly less likely to wear a mask all/most of the time while outside the home as compared with HCWs. Differences in the COVID-19-related attitudes and personal protection behaviors of EMS personnel should be used to develop targeted interventions to increase vaccine motivation and adherence to personal protection protocols.
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Baru A, Sultan M, Beza L. The status of prehospital care delivery for COVID-19 patients in Addis Ababa, Ethiopia: The study emphasizing adverse events occurring in prehospital transport and associated factors. PLoS One 2022; 17:e0263278. [PMID: 35104287 PMCID: PMC8806066 DOI: 10.1371/journal.pone.0263278] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 01/16/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND COVID-19 patients may require emergency medical services for emergent treatment and/or transport to a hospital for further treatment. However, it is common for the patients to experience adverse events during transport, even the shortest transport may cause life-threatening conditions. Most of the studies that have been done on prehospital care of COVID-19 patients were conducted in developed countries. Differences in population demographics and economy may limit the generalizability of available studies. So, this study was aimed at investigating the status of prehospital care delivery for COVID-19 patients in Addis Ababa focusing on adverse events that occurred during transport and associated factors. METHODS A total of 233 patients consecutively transported to Saint Paul's Hospital Millennium Medical College from November 6 to December 31, 2020, were included in the study. A team of physicians and nurses collected the data using a structured questionnaire. Descriptive statistics were used to summarize data, and ordinal logistic regression was carried out to assess the association between explanatory variables and the outcome variable. Results are presented using frequency, percentage, chi-square, crude and adjusted odds ratios (OR) with 95% confidence intervals. RESULTS The overall level of adverse events in prehospital setting was 44.2%. Having history of at least one chronic medical illness, [AOR3.2 (95%; CI; 1.11-9.53)]; distance traveled to reach destination facility, [AOR 0.11(95%; CI; 0.02-0.54)]; failure to recognize and administer oxygen to the patient in need of oxygen, [AOR 15.0(95%; CI; 4.0-55.7)]; absent or malfunctioned suctioning device, [AOR 4.0(95%; CI; 1.2-13.0)]; patients handling mishaps, [AOR 12.7(95%; CI; 2.9-56.8)] were the factors associated with adverse events in prehospital transport of COVID-19 patients. CONCLUSIONS There were a significant proportion of adverse events in prehospital care among COVID-19 patients. Most of the adverse events were preventable. There is an urgent need to strengthen prehospital emergency care in Ethiopia by equipping the ambulances with essential and properly functioning equipment and trained manpower. Awareness creation and training of transport staff in identifying potential hazards, at-risk patients, adequate documentation, and patient handling during transport could help to prevent or minimize adverse events in prehospital care.
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Affiliation(s)
- Ararso Baru
- College of Medicine and Health Sciences, Arbaminch University, Arbaminch, Ethiopia
- Slum and Rural Health Initiative-Ethiopia, Addis Ababa, Ethiopia
| | - Menbeu Sultan
- Department of Emergency Medicine and Critical Care, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Lemlem Beza
- Department of Emergency Medicine and Critical Care, Addis Ababa University, Addis Ababa, Ethiopia
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Barr KL, Sturdivant RX, Williams DN, Harris D. Bacteria Associated with Healthcare-Associated Infections on Environmental Samples Obtained from Two Fire Departments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211885. [PMID: 34831638 PMCID: PMC8621870 DOI: 10.3390/ijerph182211885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 12/14/2022]
Abstract
(1) Background: Firefighters spend about 64% of their time responding to medical emergencies and providing medical care without a patient history, which can render them vulnerable to healthcare-associated infections (HAI). Infection prevention, control, and surveillance systems have been instituted at hospitals. However, the prevalence of firefighters’ exposure to HAI is unknown. The objective of this study was to document evidence of HAI on surfaces in fire stations and engines to inform disinfection procedures and identify which pathogens might contribute to occupational exposures. (2) Methods: High-touch or high-use surfaces of two fire departments were sampled during five separate occasions. One fire station from one fire department was sampled over a 4-week period, whereas four fire stations were sampled from a different fire department only once. Sampled surfaces included: entryway floor, washing machine, medical bag, back seat of engine, keyboard of reporting computer, engine console, and uniform pants. (3) Results: Multiple statistical models determined that bacterial contamination was similar between the two fire departments and their stations. Keyboards were the most contaminated surface for all fire stations and departments, E. coli was the most common bacteria detected, and C. difficile was the least detected bacteria. Adjustments for rates of contamination found that contamination rates varied between fire stations. (4) Conclusions: Comprehensive environmental sampling and clinical studies are needed to better understand occupational exposures of firefighters to HAI.
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Affiliation(s)
- Kelli L. Barr
- Center for Global Health Infectious Disease Research, College of Public Health, University of South Florida, Tampa, FL 10921, USA;
| | | | - Denise N. Williams
- Department of Human Sciences and Design, College of Health and Human Science, Baylor University, Waco, TX 76798, USA;
| | - Debra Harris
- Department of Human Sciences and Design, College of Health and Human Science, Baylor University, Waco, TX 76798, USA;
- Correspondence: ; Tel.: +1-254-710-7255
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Amini R, Mohamadkhani M, Khodaveisi M, Karami M. Effect of Health Belief Model-Based Education on Infection Control Standard Precautions in Prehospital Emergency Staff: A Clinical Trial Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:515-520. [PMID: 34900650 PMCID: PMC8607898 DOI: 10.4103/ijnmr.ijnmr_377_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/17/2021] [Accepted: 08/10/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Standard precautions are a basic strategy to prevent occupational exposure in prehospital emergency staff. The Health Belief Model (HBM)-based education can be used to promote and educate health behavior. The aim of this study was to investigate the effect of the HBM-based education on infection control standard precautions in prehospital emergency technicians. MATERIALS AND METHODS This clinical trial study was conducted on 84 prehospital emergency staff of Hamadan who were randomly assigned to two groups: Experimental (n: 42) and control (n: 42) using a cluster method. The data were collected by a researcher-developed questionnaire. Before education, the questionnaires were completed by both groups, and then three educational sessions were held for the experimental group within one month. Two months after the intervention, the two groups completed the questionnaire and the data were analyzed by SPSS 21 software. RESULTS Before education, there was no significant difference in the mean scores on HBM constructs and performance between the two groups (p > 0.05). The results of the Analysis of Covariance (ANCOVA) after educational intervention showed there was a significant difference in the mean scores of all constructs and performance between the two groups (p < 0.05). CONCLUSIONS HBM-based educational intervention could affect the scores of the model's constructs and improve the use of standard precautions in emergency medical technicians. In-service training is recommended to be developed for the staff based on HBM.
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Affiliation(s)
- Roya Amini
- Department of Community Health Nursing, Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahnaz Mohamadkhani
- Department of Community Health Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Masoud Khodaveisi
- Department of Community Health Nursing, Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran,Address for correspondence: Dr. Masoud Khodaveisi, Department of Community Health Nursing, Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran. E-mail:
| | - Manoochehr Karami
- Department of Epidemiology, Hamadan University of Medical Sciences, Hamadan, Iran
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Nohl A, Afflerbach C, Lurz C, Zeiger S, Weichert V, Brade M, Brune B, Dudda M. [COVID-19: acceptance and compliance of PPE (personal protective equipment) and rules for hygiene and reducing contacts in German emergency medical services-a nationwide survey]. Notf Rett Med 2021; 26:1-8. [PMID: 34305447 PMCID: PMC8284034 DOI: 10.1007/s10049-021-00925-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has also significantly burdened and challenged the German emergency medical services (EMS). In this regard, the personal protective equipment (PPE) and rules like wear a mask, stay 6 feet away from others, avoid crowds and poorly ventilated spaces, wash your hands often (called AHA‑L rules in Germany) play an important role in reducing the spread of COVID-19 infections. OBJECTIVE The aim of this study is to evaluate the acceptance and compliance of PPE and protective measures among rescue service personnel in Germany during pandemic periods. METHOD More than 270 medical directors of EMS were contacted. They were asked to forward a web-based online survey to the rescue stations. Participants were asked about acceptance and compliance in everyday life, in the rescue station, during missions without COVID-19, during missions with COVID-19. RESULTS There were n = 1295 participants. Overall acceptance and compliance of PPE and protective measures is high. The lowest acceptance and compliance is found in the questions acceptance (mean = 4.16; ±1.01) and compliance (mean = 4.26; ±0.89) in the rescue station. CONCLUSION We recommend targeted training regarding PPE in pandemics and the provision of appropriate premises for conflict-free compliance with AHA‑L rules.
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Affiliation(s)
- André Nohl
- Ärztliche Leitung Rettungsdienst, Stabsstelle Rettungsdienst, Berufsfeuerwehr Oberhausen, Brücktorstraße 30, 46047 Oberhausen, Deutschland
- Zentrum für Notfallmedizin, BG Klinikum Duisburg, Duisburg, Deutschland
- Luftrettungszentrum Christoph 9, Duisburg, Deutschland
| | - Christian Afflerbach
- Ärztliche Leitung Rettungsdienst, Stabsstelle Rettungsdienst, Berufsfeuerwehr Oberhausen, Brücktorstraße 30, 46047 Oberhausen, Deutschland
- Klinik für Anästhesiologie und Intensivmedizin, Evangelisches Krankenhaus Oberhausen, Oberhausen, Deutschland
| | - Christian Lurz
- Ärztliche Leitung Rettungsdienst, Stabsstelle Rettungsdienst, Berufsfeuerwehr Oberhausen, Brücktorstraße 30, 46047 Oberhausen, Deutschland
| | - Sascha Zeiger
- Zentrum für Notfallmedizin, BG Klinikum Duisburg, Duisburg, Deutschland
- Ärztliche Leitung Rettungsdienst, Berufsfeuerwehr Duisburg, Duisburg, Deutschland
- Luftrettungszentrum Christoph 9, Duisburg, Deutschland
| | - Veronika Weichert
- Luftrettungszentrum Christoph 9, Duisburg, Deutschland
- Klinik für Orthopädie und Unfallchirurgie, BG Klinikum Duisburg, Duisburg, Deutschland
| | - Marko Brade
- Luftrettungszentrum Christoph 9, Duisburg, Deutschland
- Klinik für Anästhesiologie und Intensivmedizin, BG Klinikum Duisburg, Duisburg, Deutschland
| | - Bastian Brune
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, Deutschland
- Ärztliche Leitung Rettungsdienst, Berufsfeuerwehr Essen, Essen, Deutschland
| | - Marcel Dudda
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, Deutschland
- Ärztliche Leitung Rettungsdienst, Berufsfeuerwehr Essen, Essen, Deutschland
- Luftrettungszentrum Christoph 9, Duisburg, Deutschland
- Klinik für Orthopädie und Unfallchirurgie, BG Klinikum Duisburg, Duisburg, Deutschland
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Ganczak M, Topczewska K, Biesiada D, Korzeń M. Frequency of Occupational Bloodborne Infections and Sharps Injuries among Polish Paramedics from Selected Ambulance Stations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010060. [PMID: 33374768 PMCID: PMC7796263 DOI: 10.3390/ijerph18010060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/19/2020] [Accepted: 12/20/2020] [Indexed: 11/22/2022]
Abstract
To evaluate the prevalence of bloodborne infections (BBIs) and assess the incidence and selected risk factors for sharps injuries (SIs), a cross-sectional serosurvey was performed between December 2018 and October 2019 among 286 paramedics (76.5% males; mean age, 37 years) from 17 randomly selected ambulance stations in the West Pomeranian region of Poland. An ELISA system was used to detect anti-HBc, anti-HCV, and anti-HIV. HBV vaccination uptake was 95.6%; 7.3% (95% CI: 4.6–11.0%) paramedics were anti-HBc positive, and anti-HCV/anti-HIV seropositivity was not reported. Almost one-fourth of paramedics reported having had ≥1 SI during the preceding year (Me = 6.0, range 1–100). Most recent exposures primarily took place during an emergency procedure (76.7%), in an ambulance (45.2%), caused by hollow-bore needles (73.8%), and were not reported (50.0%). Additionally, 52.2% of paramedics reported needle recapping, and 52.6% did not use safety engineered devices (SEDs) at work. Mean knowledge score was low (2.6 ± 1.7); 3.4% had never participated in infection-control (IC) training, and those not trained were more likely to suffer a SI (odds ratio (OR) 4.64; p = 0.03). Due to frequent SIs, of which half are unreported, paramedics remain at risk of acquiring occupational BBIs. SI risk could be reduced by providing training on IC procedures, ensuring better compliance with safe work practices, and supplying more SEDs.
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Affiliation(s)
- Maria Ganczak
- Department of Infectious Diseases, Institute of Medical Sciences, University of Zielona Góra, Zyty 28, 65-046 Zielona Góra, Poland
- Correspondence:
| | - Katarzyna Topczewska
- Department of Epidemiology and Management, Faculty of Health Sciences, Pomeranian Medical University, Rybacka 1, 70-214 Szczecin, Poland;
| | - Daniel Biesiada
- General Practitioner Office, Non-Public Healthcare Management Unit, Szkolna 9, 73-240 Bierzwnik, Poland;
| | - Marcin Korzeń
- Department of Methods of Artificial Intelligence and Applied Mathematics, West Pomeranian University of Technology, Zolnierska 46, 71-210 Szczecin, Poland;
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