Adherence to therapy among liver transplant patients as related to depression, anxiety, acceptance of the disease, and social support

OBJECTIVE

This study aimed to assess the patients' adherence to therapeutic regimens after liver transplantation, taking into account the levels of depression and anxiety, acceptance of the disease, and social support.

PATIENTS AND METHODS

The study group included N = 112 patients selected from 669 patients after liver transplantation. The Delphi method was used to develop a tool to assess the level of adherence to treatment regimens. The sources of data for this study were recommendations and the work of an expert panel. The next method used in the study was a diagnostic survey based on the following standardized research instruments: Inventory of Socially Supportive Behaviors (ISSB), Acceptance of Illness Scale (AIS), Beck Depression Inventory-II (BDI-II) and State-Trait Anxiety Inventory (STAI).

RESULTS

The study group showed a medium level of adherence to therapeutic recommendations (6.8 ± 1.85). We observed a statistically significant positive correlation between acceptance of the disease and adherence to therapeutic recommendations (r = -0.20, t = -2.040, p = 0.044). Among the factors analyzed, six predictors were identified that significantly affect the level of adherence to therapeutic recommendations in a group of liver transplant patients.

CONCLUSIONS

1. Patients who accept their disease are a group of people who significantly worse adhere to therapeutic recommendations. 2. The main positive predictors of treatment adherence in the group of transplant patients are the search for various sources of information and declarative adherence to treatment recommendations. Negative predictors include the duration of the disease, side effects of the applied treatment, and comorbidities. 3. The patients who were informed that results depend on regular medication intake significantly more often followed therapeutic recommendations.

Diagnostic markers of insulin resistance to discriminate between prediabetes and diabetes in menopausal women

OBJECTIVE

Menopause is an important transition period in a woman's reproductive life during which hormonal changes occur, resulting in an increased risk of cardiovascular disease and type 2 diabetes. In this study, we assessed the possibility of using surrogate measures of insulin resistance (IR) to predict the risk of insulin resistance in perimenopausal women.

PATIENTS AND METHODS

The study involved 252 perimenopausal women living in the West Pomeranian Voivodeship. The methods employed in this study were diagnostic survey based on the original questionnaire, anthropometric measurement, and laboratory tests performed to determine the levels of selected biochemical parameters.

RESULTS

In the entire study population, the highest area under the curve was found for the homeostasis model assessment-insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI). Triglyceride-glucose index (TyG index) showed a higher diagnostic value as a distinction tool between prediabetes and diabetes in perimenopausal women than the other markers. HOMA-IR significantly positively correlated with fasting blood glucose (r = 0.72; p = 0.001), glycated hemoglobin (HbA1C, r = 0.74; p = 0.001), triglycerides (TG, r = 0.18; p < 0.005), and systolic blood pressure (SBP, r = 0.15; p= 0.021), and negatively with high-density lipoprotein (HDL, r = -0.28; p = 0.001). QUICKI negatively correlated with fasting blood (r = -0.051; p = 0.001), HbA1C (r = -0.51; p = 0.001), TG (r = -0.25; p = 0.001), low-density lipoprotein (LDL, r = -0.13; p= 0.045), and SBP (r = -0.16; p = 0.011), and positively with HDL (r = 0.39; p = 0.001).

CONCLUSIONS

Anthropometric and cardiometabolic parameters were found to significantly correlate with IR markers. HOMA-beta, the McAuley index (McA), visceral adiposity index (VAI), and lipid accumulation product (LAP) may be useful as predictors of pre-diabetes and diabetes in postmenopausal women.

Analysis of the laboratory results of the patients enrolled in the Nutritional Therapy Program

OBJECTIVE

Nutritional treatment is an integral part of patient management, as meeting nutritional needs significantly contributes to improving treatment outcomes and reducing complications and length of hospitalization. The aim of this study was to analyze the laboratory results of the patients enrolled in the Nutritional Therapy Program.

PATIENTS AND METHODS

This study involved 103 subjects, aged 18-88. It was based on analysis of medical documentation of patients under the care of the Enteral Nutrition Clinic. Nutritional status was assessed by biochemical tests (urea, creatinine, AST, ALT, ALP, CRP, total cholesterol, triglycerides, INR, Na, K, Cl, Mg, Ca, P, Fe, total protein, albumin, and fasting glucose).

RESULTS

After six and twelve months, the groups with malnutrition and neurological diseases had higher levels of erythrocytes and albumin, and significantly lower CRP. The mean glucose level after six months was significantly lower compared to the first measurement, and a downward trend was observed. Calcium showed an upward trend. In cancer patients, a decline in erythrocytes was observed after six months compared to the initial measurement.

CONCLUSIONS

There were significant differences in the results of laboratory tests between patients with cancer and those with malnutrition and neurological diseases. These were mainly lower levels of lymphocytes and glucose, and higher levels of platelets and CRP. Furthermore, the greatest effect of nutritional treatment was observed in patients with malnutrition and neurological diseases.

Psychosocial contributors to Internet and social media addiction among adult women

Introduction

When speaking of behavioral addictions (especially to the Internet and social media), it is emphasized that it is not the environment that is the main contributor to addiction, but rather certain behaviors and personality traits.

Objectives

The aim of this study was to assess the level of Internet and social media addiction on the example of Facebook with regard to psychological and social factors.

Methods

This survey-based study involved a group of women representing the female population in the West Pomeranian Voivodeship, Poland (N = 556). Research instruments were a self-developed questionnaire concerning sociodemographic data, the De Jong Gierveld Loneliness Scale, the Beck Depression Inventory, the Internet Addiction Test, and the Bergen Facebook Addiction Scale.

Results

Age, depressive symptoms, loneliness were the variable contributing to Internet and Facebook addiction among the studied. Available studies confirm the results of their own research. Employed n = 496 Unemployed n = 60 p BDI 4.0(1.0 – 10.0) 6.5 (1.5 – 12.5) 0.20 DJGLS 34.1 ± 3.7 33.0 ± 5.0 0.09 IAT 32.0 (24.0 – 44.0) 24.5 (20.0 – 32.0) < 0.001 BFAS 8.0 (6.0 – 12.0) 6.0 (6.0 – 7.5) < 0.001

Conclusions

Depressive symptoms and dependence on the Internet and Facebook were more common among single women. In the employed women, we only observed higher levels of Internet and Facebook addiction. The level of dependence on the Internet and Facebook was higher among younger women. Loneliness correlated with Internet and Facebook addiction, and more severe depressive symptoms entailed higher levels of Internet and Facebook addiction.

Disclosure

No significant relationships.

Prevalence and socio-demographic correlates of psychological health problems in inhabitants of the West Pomeranian Voivodeship during the COVID-19 outbreak

Introduction

Psychological health problems, especially emotional disorders, have become an important topic of considerations for many scientists, because the epidemiology of these disorders is strongly influenced by stressful events, such as the SARS-CoV-2 coronavirus pandemic.

Objectives

The aim of this study was to evaluate selected parameters of psychosocial functioning as well as socio-demographic correlates of depression, anxiety, sleep disorders and perceived stress among the residents of the West Pomeranian Voivodeship.

Methods

An online questionnaire was completed by 323 participants, in whom the parameters of psychosocial functioning were assessed: symptoms of depression (PHQ-9), anxiety (GAD-7), severity of sleep disorders (AIS) and perceived stress (Perceived Stress Scale).

Results

The majority of the respondents (75.2%) scored high on the Perceived Stress Scale, almost half of the respondents (47.1%) had sleep disorders and 26% of the participants had no depressive symptoms. Age statistically significantly correlated with the severity of depressive symptoms and sleep disorders. Parental status statistically significantly correlated with the severity of depressive symptoms. There was a strong correlation between the severity of depression and anxiety and a strong correlation between depression and sleep disorders.

Conclusions

Age and parental status contributed to the severity of depressive symptoms and the occurrence of sleep disorders among the residents of the West Pomeranian Voivodeship during the SARS-CoV-2 pandemic. Some of the residents of the West Pomeranian Voivodeship showed high levels of stress or insomnia. The severity of depressive symptoms significantly influenced the levels of anxiety and perceived stress, as well as the occurrence of sleep disorders.

Disclosure

No significant relationships.

The effect of vitamin D levels on lipid, glucose profiles and depression in perimenopausal women

OBJECTIVE

Vitamin D deficiency is a significant problem that affects the population living in most countries. This issue is independent by place of residence, sex, age or skin color. It is mainly influenced by the environment we live in and by an unhealthy lifestyle, including bad eating habits. The aim of this study was to evaluate lipid profile, glucose levels, and vitamin D levels, considering sociodemographic variables, smoking and alcohol consumption in perimenopausal women. Depressive mood was also assessed considering sociodemographic variables and vitamin D levels.

PATIENTS AND METHODS

The study was conducted on a group of 191 women and performed in two stages. The first of them was carried out using a diagnostic survey with the use of a technique questionnaire. The applied research instruments were the author's questionnaire (concerning sociodemographic and selected medical data), and the Beck Depression Inventory. The second stage of the study involved the collection of peripheral blood from each respondent, in order to determine lipid profile, glycemia and serum vitamin D levels.

RESULTS

The age of the female respondents ranged from 45 to 65 years, mean age was 53.1 ± 5.37 years, median 53 years. Vitamin D levels were below normal in 78%; 77% had elevated total cholesterol levels; 91.6% of the respondents had high density lipoprotein (HDL) cholesterol levels within the normal range; 64.4% was characterized by too high (low-density lipoprotein) LDL cholesterol, and 84.8% of the women showed normal triglyceride levels. Among the respondents, 91.1% had normal glycemic levels. Analysis of the collected data showed a weak negative correlation between serum vitamin D levels and the levels of total cholesterol (rho=-0.14; p=0.05), LDL cholesterol (rho=-0.16; p=0.026), and triglycerides (rho=-0.22; p=0.002). Only in the case of HDL cholesterol (p=0.067), there was no statistically significant correlation. There were also no statistically significant correlations between serum vitamin D levels and glycemia or severity of depression.

CONCLUSIONS

1. The majority of the women did not manifest depressive disorders. Of all factors analyzed, only education was associated with the severity of depressiveness. 2. Smoking adversely affected serum vitamin D levels in the studied women. 3. The cessation of menstruation affected carbohydrate metabolism and vitamin D levels. Blood glucose levels increased with the age of the studied women. 4. Relationships were found between the levels of vitamin D and the levels of total cholesterol, LDL cholesterol, and triglycerides. Therefore, it is important to maintain normal vitamin D levels.

Self-efficacy and fatigue perceived by nursing students in Poland, Spain and Slovakia during the COVID-19 pandemic

OBJECTIVE

The two-year long epidemic situation around the world has resulted in an increasing number of people experiencing "pandemic fatigue". The aim of this study was to examine the correlation between a sense of self-efficacy and fatigue experienced in everyday life by nursing students in Poland, Spain and Slovakia during the COVID-19 pandemic.

PATIENTS AND METHODS

The study was conducted by the diagnostic survey method on a group of 756 nursing students of the first-cycle degree program, from 20 March to 15 May 2021, in the University of Warmia and Mazury in Olsztyn, Pomeranian Medical University in Szczecin (Poland), as well as in Murcia University (Spain) and in the Catholic University in Ružomberok (Slovakia).

RESULTS

The sense of self-efficacy was significantly lower among the students in Poland than in those in Spain (p < 0.0001) and in Slovakia (p < 0.0001). Students in Slovakia showed symptoms of general, physical, cognitive and psychosocial fatigue much less frequently than those in Poland (p < 0.001) and Spain (p < 0.001). Especially students in Spain acutely felt physical health issues as a result of COVID-19 pandemic-imposed restrictions.

CONCLUSIONS

A high level of a generalized sense of self-efficacy among the nursing students participating in the study was identified. However, it was significantly differentiated with respect to the country of residence. The fatigue severity experienced by the students during the COVID-19 pandemic was determined by a sense of self-efficacy.

The relationship between women's personality traits and addiction to social networking sites on the example of Facebook

OBJECTIVE

The purpose of this study was to generally assess the degree of women's dependence on social networking sites on the example of Facebook, taking into account personality traits according to the five-factor model of personality, the so-called Big Five.

PATIENTS AND METHODS

The study included 556 women. This survey-based study was carried out using the questionnaire technique. The following research tools were used to analyze behavioral addictions in adult women: the Bergen Facebook Addiction Scale (BFAS), the NEO Five-Factor Inventory (NEO FFI) and the author's questionnaire.

RESULTS

Among the surveyed women, 69.6% were average Facebook users, of whom 16.4% had scores indicating possible Facebook addiction, and 14.0% had scores indicating addiction. The higher the neuroticism, the more serious the Facebook addiction. A weak negative correlation was obtained for the agreeableness subscale. A weak negative correlation was also obtained for the subscale of conscientiousness. There was no statistically significant correlation between the log10 score obtained on the BFAS and the score on the NEO-FFI subscales of extraversion and openness to experience.

CONCLUSIONS

The personality types of the studied women indicated relationships in terms of behavioral addictions. Women characterized by neuroticism showed stronger addiction to Facebook. Women characterized by high conscientiousness were at lower risk of behavioral addictions, while agreeableness as a personality trait significantly protected the surveyed women against Facebook addiction.

A comparison of psychosocial functioning as well as the quality of life between young adult patients after orthognathic surgeries and healthy youth

OBJECTIVE

The aim of this study was to compare psychosocial functioning as well as the quality of life of young adults after orthognathic procedures and healthy individuals.

MATERIALS AND METHODS

The study included 124 respondents aged between 16 and 25 years, 65 of whom had undergone orthognathic surgeries, and 59 healthy individuals. The study was carried out using a diagnostic poll method with both standardized tools and the author's own questionnaires: Authors own questionnaire, 'How do you cope?' Questionnaire, Emotional Intelligence INTE Questionnaire, The List of Personal Values (LOPV), The Satisfaction with Life Scale (SWLS), and The Short Form Health Survey (SF-36 v2).

RESULTS

Patients after orthognathic procedures more frequently actively dealt with problems and sought social support rather than concentrating on emotions in terms of dispositional ways of coping with difficult situations. A statistically significant difference was established in the concentration on emotions subscale (CoE) for which lower average value was observed in the study group. Study and control groups differed in terms of the ability to recognise, understand, and control their own and other's emotions.

CONCLUSIONS

Respondents from both groups similarly perceived personal values pointing to love and friendship, health, intelligence as well as happiness as the most important ones. Both patients after orthognathic procedures and healthy ones assessed their life satisfaction on an average level. A link between the choice of the strategy of coping with difficult situations and the fact of having undergone an orthognathic procedure exists. Patients after surgical procedures, in comparison with healthy individuals, less frequently opted for the concentration on emotions (CoE) strategy.

Seeking relationships between Internet addiction and depressiveness, daytime sleepiness, as well as perceived social support in young adults

OBJECTIVE

An assessment of the scale of Internet addiction among young adults and seeking relationships between Internet addiction and chosen sociodemographic variables, perceived social support, prevalence of depressiveness, and excessive daytime sleepiness.

PATIENTS AND METHODS

The study was carried out using a diagnostic poll method with author's own questionnaire as well as standardized diagnostic tools: The Internet Addiction Test (IAT), the Beck Depression Inventory (BDI), The Epworth Sleepiness Scale (ESS), as well as The Multidimensional Scale of Perceived Social Support (MSPSS).

RESULTS

The study was conducted on 567 individuals. Pathological Internet use was identified in 1.41% of the surveyed. Perceived social support was significantly lower in the group of respondents who pathologically used Internet in comparison with ones who used Internet in the proper way. Severity of depressiveness symptoms and daytime sleepiness was significantly higher in respondents who were addicted to Internet in comparison with not addicted individuals.

CONCLUSIONS

The scale of pathological Internet use among surveyed was low. Problematic Internet use refers to women and men to the same degree, as well as to single people and individuals in relationships. Persons who work and do not study as well as residents of large and medium cities more frequently use Internet in a more pathological way than individuals who study and live-in small cities and in the countryside. Internet addiction creates a significant relationship with the prevalence of more severe symptoms of depressiveness and excessive daytime sleepiness, whereas pathological pattern of Internet use more often concerns individuals whose perception of social support is low.

Quality of life of young adult patients after orthognathic surgery

OBJECTIVE

Craniofacial defects are functional imbalances of their structures. Impaired speech and facial deformities hinder adolescents' ability to fulfill social roles. The optimal age for a patient to be qualified for orthognathic surgery is between 16 and 30 years.

PATIENTS AND METHODS

The study sample consisted of 65 patients after bimaxillary orthognathic surgery performed in the Head and Neck Surgery Department with Craniofacial Surgery Subdivision in Provincial Specialist Children's Hospital in Olsztyn. The research tools used in the study were: the author's questionnaire concerning sociodemographic data, and the following standardized questionnaires: the 'How Do You Cope?' questionnaire, the Emotional Intelligence Questionnaire (INTE), the List of Personal Values (LOPV), the Short Form Health Survey (SF-36), the Satisfaction With Life Scale (SWLS).

RESULTS

The study demonstrated a positive correlation between the levels of QoL and general life satisfaction according to the SWLS. A negative relationship was observed between QoL and dispositional coping according to the 'How do you cope?' questionnaire. The emotion-focused coping strategy in the category of dispositional coping negatively correlated with eight of the SF-36 domains.

CONCLUSIONS

Young adults after bimaxillary orthognathic procedures show a high level of QoL. The level of QoL depends, among others, on the level of emotional intelligence. Better ability to recognize emotions is associated with higher QoL in the domain of general health.

Elevated serum fluoride levels in perimenopausal women are related to the components of metabolic syndrome

OBJECTIVE

Increased fluoride levels can lead to numerous complications, including skeletal effects, cardiotoxicity, endocrine dysfunction, neurotoxicity, hepatotoxicity and nephrotoxicity. The aim of this study was to analyze the relationship between serum fluoride levels and MetS or its individual components, and to assess the diagnostic usefulness of fluoride as a factor contributing to MetS.

PATIENTS AND METHODS

The study included a group of 475 women (mean age of 52.9 years), living in the West Pomeranian Voivodeship in Poland. The study involved data collection and biochemical analysis.

RESULTS

Analysis of the relationship between the levels of fluoride and the presence of MetS or its components showed that the mean fluoride level was statistically significantly higher in patients with hypertriglyceridemia (dCohen = 0.39; 95% CI; confidence limits: 0.13, 0.63) and hypertension (dCohen = 0.25; 95% CI; confidence limits: 0.07, 0.44). Moreover, the mean fluoride level was significantly higher in women who met the diagnostic criteria for MetS than in the remaining subjects (dCohen = 0.40; 95% CI; confidence limits: 0.17, 0.64).

CONCLUSIONS

Elevated serum fluoride levels may be associated with an increased incidence of MetS among perimenopasal women, although its diagnostic value as a marker of MetS is limited.

Can personality traits affect the quality of life of women with the BRCA1/BRCA2 mutations before and after prophylactic adnexectomy?

OBJECTIVE

Ovarian, fallopian tube, and peritoneal carcinomas are the most common hereditary gynecological cancers associated with the BRCA1 and BRCA2 mutations. It is recommended to radicalize management, using RRSO. Personality traits are regarded as significant contributors to human QoL and adaptability to the changed conditions of functioning. The aim of this study was to demonstrate the effect of personality on the QoL of women with the BRCA1 and BRCA2 mutations before and after RRSO.

PATIENTS AND METHODS

The study involved 62 patients with the BRCA1 and BRCA2 mutations referred to hospital for RRSO. The research instruments were the WHQ, NEO-FFI, and self-developed sociodemographic data collection tool.

RESULTS

Highly neurotic patients with the BRCA1 and BRCA2 mutations had lower QoL, especially in the domains of depressed mood, anxiety/fears, and sleep problems. At the same time, higher levels of conscientiousness, openness to experience, extroversion, and agreeableness were associated with better QoL outcomes.

CONCLUSIONS

(1) Personality traits can contribute to the QoL of women with the BRCA1 and BRCA2 mutations before and after RRSO. (2) Identification of personality traits may be an important prognostic factor indicating potential changes in the QoL of patients after RRSO.

The effect of human sperm chromatin maturity on ICSI outcomes

Because sperm chromatin may play a key role in reproductive success, we verify the associations between sperm chromatin abnormalities, embryo development and the ability to achieve pregnancy. The evaluation of sperm chromatin maturity using aniline blue (AB), chromomycin A3 (CMA3) and toluidine blue (TB) staining were carried out in group of males from infertile couples that underwent ICSI. Low levels of sperm chromatin abnormalities (< 16%) were found in most subjects (> 50%). A higher percentage of TB-positive sperm cells were discovered in the men from couples who achieved ≤ 50% fertilized oocytes compared to men who achieved > 50%. No significant differences were discovered by the applied tests between the men from couples who achieved ≤ 50% and those who achieved > 50% high-quality embryos on the 3rd or 5th day after fertilization, nor between the men from couples who achieved pregnancy and those who failed. The sperm chromatin maturity did not correlate with the ICSI results. However, the ROC analysis revealed a significant predictive value of TB-positive spermatozoa only for fertilization. Therefore, the TB assay can be considered as a useful test for the prediction of fertilization. Our findings suggest that the level of sperm chromatin abnormalities of the examined men was not clinically significant. No found associations between sperm chromatin maturity and embryo development and the ability to achieve pregnancy. We could not exclude the effects of the repairing processes in the fertilized oocyte. The use of complementary tests that verify the status of the sperm chromatin seems justified.

Occurrence of climacteric symptoms in postmenopausal women after prophylactic bilateral ovariectomy

PURPOSE OF INVESTIGATION

To analyse the quality of life in postmenopausal women after prophylactic bilateral ovariectomy depending on the time from menopause.

MATERIALS AND METHODS

The study involved 252 postmenopausal women grouped according to the time from last menstruation: one to five years (group A), five to ten years (group B), and > ten years (group C). All women were ovariectomized during laparotomy performed for benign diseases of the uterus. Climacteric symptoms were measured with the Kupperman Index one day before and three months after surgery.

RESULTS

Highly significant age differences and no substantial BMI differences were demonstrated among the study groups. Before and after surgery climacteric symptoms were reported by 17.06% and 57.8% of women, respectively. After surgery, group A women significantly more often had hot flushes, sweating, nervousness, and sleep disorders, the women in group B significantly more often reported sleep disorders, nervousness, and sweating, and the women in group C significantly more often complained of nervousness.

CONCLUSION

In postmenopausal women, ovaries play the most important role during the first ten years from the last menstruation.

Effects of substances on serum zinc levels in postmenopausal women

INTRODUCTION

Demographic facts and forecasts about lengthening life expectancy motivate to systematize the knowledge of health problems experienced by women at the age of 50 and older. It refers to the whole health policy including health economics. Longer female life spans cause that an increasing number of women suffer from health problems associated with the perimenopausal period, and become health care recipients. Also a shift of retirement age is the reason to take interdisciplinary actions for women's health and quality of life. This study describes a decline in the levels of many bioelements in hair, urine and blood serum, which progresses with age. It not only correlates with a decrease in the synthesis and secretion of estrogen, but also environmental pollution, unhealthy lifestyle and the use of substances.

AIM OF THE STUDY

The aim of this study was to determine the correlation between serum zinc levels in postmenopausal women and such variables as the use of substances (cigarettes, alcohol) and menopausal hormone therapy (MHT). Material and method: The study was conducted among 152 healthy women being 1-16 years after menopause. The women were divided into study group (MHT users) and control group (MHT non-users). A sub-division criterion was the use of substances (cigarettes, alcohol). Serum zinc levels were determined in all women. Results: The use of substances significantly contributed to the lowering of serum zinc levels in postmenopausal women. MHT users had statistically higher average zinc levels in blood serum, which referred both to smokers and consumers of alcohol and those who did not use these substances.

CONCLUSIONS

(1) The use-of substances (cigarettes, alcohol) contributes to the lowering of zinc levels in blood serum. (2) MHT positively affects serum zinc levels in postmenopausal women regardless of whether they use substances (cigarettes, alcohol) or not.

The severity of depressive symptoms vs. serum Mg and Zn levels in postmenopausal women

The aim of this study was to assess the severity of depressive symptoms in postmenopausal women, depending on serum Mg and Zn levels. The study involved 171 postmenopausal women from Poland, who were not using menopausal hormone therapy (MHT). The intensity of depressive symptoms was evaluated using a standard research technique, the Beck Depression Inventory (BDI). The plasma Mg and Zn concentrations were measured. Depressive symptoms of different severity levels were diagnosed in 36.8 % of the women. The mean serum Mg level was 1.53 ± 0.28 mg/dL, and Zn level was 72 ±14 μg/dL. The women with higher serum Mg and Zn levels had less depressive symptoms, and this observation is a precious information which can be used when planning depressive disorder prevention programmes.

[The influence of antipsychotic therapy on the cognitive functions of schizophrenic patients]

AIM

The aim of the present study was twofold: 1. to compare the efficacy of three antipsychotics (ziprasidone, olanzapine and perazine) in schizophrenia 2. to compare the improvement in cognitive functioning between groups treated with the three different neuroleptics.

METHOD

A total of 58 Caucasian patients diagnosed with paranoid schizophrenia were recruited into the study group. We used the Polish version of the CIDI (Composite International Diagnostic Interview) to obtain ICD-10 diagnoses. The intensity of psychopathological symptoms was examined using the PANSS. The patients were randomly assigned to treatment with perazine, olanzapine or ziprasidone administered as monotherapy for 3 months. The treatment efficacy was measured as a change in the PANSS (Positive and Negative Syndrome Scale) total score from baseline (T0) to 3 months (T1). The WCST (The Wisconsin Card Sorting Test) was used to measure working memory and executive functions in the evaluated patients. Wilcoxon's and Kruskal-Wallis tests were applied to compare changes in the PANSS scores between the treatment groups. To analyze the cognitive functions, Kruskal-Wallis test for the WCST parameters was used.

RESULTS

The three antipsychotics similarly reduced the total PANSS score. The WCST parameters in the 3 groups of examined patients using the Kruskal-Wallis test revealed some differences between the three administered antipsychotics.

CONCLUSIONS

Results suggest that the short-term efficacy of the atypical (olanzapine, ziprasidone) and typical (perazine) antipsychotic drugs did not differ. Based on the analysis, a conclusion can be drawn that the three neuroleptics provided similar improvements in cognitive functioning.

[Psychosexual functioning of women after breast cancer therapy]

AIM

The study was to assess psychosexual functioning of women after breast cancer treatment, since this problem is very rarely discussed in Polish professional literature.

METHODS

Our study involved 103 women after breast cancer treatment. The questionnaire was based on the Likert scale, the Beck Depression Inventory, and the authors' own questions.

RESULTS

Some 52% of respondents were operated in 2002-2008; 93% had a radical mastectomy or a breast-sparing operation without reconstruction. About 71% accepted themselves before falling ill, and 65% regarded themselves as pretty. After surgery 57% felt attractive as sexual partners, 48.5% found it difficult to look at themselves naked, and 37.9% were embarrassed in their partners' presence. Some 26.21% of the women had a very good and 42.71% had a satisfactory sexual life before the disease. Following surgery, 54% did not notice any changes in their partners' behaviour, 14% avoided intimate situations, and 11% have not had sexual intercourse since the operation.

CONCLUSIONS

In the relationships where sex was important, the quality of sexual intercourse improved. A factor which contributes to successful sexual life of a woman is her acceptance of her body and her feeling of attractiveness.

[The effects of lead level in the blood on social functioning in children with developmental disabilities]

AIM

The aim of the study was to assess the relationship between lead levels in children's blood and the development of social disorders.

METHOD

Lead levels were measured in every child's blood test and following on from that the influence of this toxin on children's behaviour was assessed. Manfred Cierpka questionnaire was used as the assessment tool examining children's family relationships and Children's Health Questionnaire Parent Form-28 was used to assess the subjects' health profile.

RESULTS

The statistical analysis revealed a statistically significant relationship between lead concentration in the child's blood and whether or not the child was able to meet social expectations (p = 0.018), form affective relationships (p = 0.046), its nervousness (p = 0.024) and a generally lower assessment of his/her behavior in comparison with the peer group (p = 0.024).

CONCLUSIONS

Neurotoxic influence of lead on the developing child's organism results in developmental disabilities in its behaviour. These dysfunctions can lead to disorders in the child's social development and they can hinder its functioning. An increased concentration of metal toxins in the child's blood can be responsible for difficulties in meeting social expectation, which in turn is connected with increased nervousness and disorders in forming relationships. Children facing these problems often receive negative marks for their behaviour in comparison with the peer group. Such difficulties can lead to the child's social exclusion and predispose it to making antisocial or criminal decisions in the future.

[Research on associations between selected polymorphisms of genes DRD2, 5HTT, GRIK3, ADH4 and alcohol dependence syndrome]

Alcohol abuse is a complex multifactorial disease. It is believed that alcohol dependence is mostly caused by genetic (40-50%) and environmental (50-60%) factors.

AIM

The aim of this study was to assess the relation between the alcohol dependence syndrome (ADS) and the polymorphism of the selected genes (GRIK3, 5HTT, ANKK1, ADH4).

METHODS

The study was conducted in the Department and Clinic of Psychiatry, the Pomeranian Medical University in Szczecin in the years 2006-2008. It involved 100 patients hospitalised with Alcohol Dependence Syndrome (ADS). DNA polymorphisms were detected using the polymerase chain reaction (PCR). Statistical calculations were done with SPSS version 9.0. The chi-square test was applied to calculate the differences in the frequency of allelic forms.

RESULTS

Comparison between the patients with ADS and the patients from the control group demonstrated statistically significant association of ADH4 (rs1800759) with the alcohol dependence syndrome. Both the A/A genotype and the A allele were more common in patients with ADS. Also, analysis of the association of the ANKK1 gene revealed statistically significant differences (p = 0.004) between the ADS group and the control group. No statistically significant differences considering other associations were found.

CONCLUSION

Our results suggest that the analysed polymorphisms ofANKK1 and ADH4 can play an important part in the pathogenesis of alcohol abuse. The greater study group would increase the statistical power of the study and help to isolate homogeneous sub-groups of patients.

Functional polymorphism of matrix metalloproteinase-9 (MMP-9) gene in alcohol dependence: family and case control study

AIM

Matrix metalloproteinases (MMP) are extracellularly acting endopeptidases, whose substrates are extracellular matrix and adhesion proteins. In the gene polymorphism studies MMP-9 has been suggested to be involved in the pathogenesis of heart disease, cancer, bipolar disorder, and schizophrenia. In animal models MMP-9 has been shown to play a key role in a variety of neuronal plasticity phenomena, including learning and memory as well as drug addiction.

METHOD

We studied 139 families, Caucasians, with no history of psychiatric disorder of ICD-10 other than alcohol or nicotine dependence. The control subjects were 136 unrelated individuals, matched for ethnicity and gender, with no mental disorder. Alcohol and family history of alcoholism were assessed by means of a structured interview, based on the Polish version of SSAGA (Semi-Structured Assessment on Genetics in Alcoholism).

RESULTS

We found a statistically significant preferential transmission of the T allele (known to produce higher gene transcriptional activity) from parents to alcoholics (59%, p=0.046). In a case-control study genotype TT and T alleles were significantly more frequent in the alcoholics than in the controls (OR=2.6).

CONCLUSION

Our results suggest that the MMP-9 gene may play a role in the pathogenesis of alcohol dependence.

Reasons for giving up breastfeeding and support during problems with lactation in the north-western part of Poland

INTRODUCTION

Breastfeeding is the optimal way of feeding for neonates and infants. Its duration is of vital importance for the child's development and health. The World Health Organization recommends exclusive breastfeeding until the end of the sixth month of life. Many mothers give up breastfeeding earlier than recommended. Professional and non-professional support plays a great role in motivation to start and continue breastfeeding. The aim of this study was to determine how long infants from Szczecin, the capital city of the North-Western region of Poland, are breastfed, what are the reasons for giving up breastfeeding, and whether mothers obtain support in case of problems with lactation.

METHODS

One hundred randomly chosen mothers with children aged 12-18 months, living in Szczecin, were examined. A questionnaire was administered to the mothers during a direct interview. Prior to the interview, consent of the mothers to participate in the study was obtained.

RESULTS

More than 8% of the mothers gave up breastfeeding during the first month after delivery, 68% were breastfeeding till the end of the third month, 31.5% were breastfeeding till the end of the sixth month, and only 2% continued to breastfeed for one year or longer. The most frequent reasons for giving up breastfeeding were: return to work (43.4%), small volume of milk (29.3%) and child's reluctance to suck (18.5%). 62% of breastfeeding women benefited from support during lactation problems but only 6% visited an outpatient breastfeeding service or joined a breastfeeding mothers support group. Support was obtained from the family midwife (37%), pediatrician (32%), and midwife at an outpatient clinic (25.8%). Most women (74.2%) were satisfied with the support.

CONCLUSIONS

(1) It is necessary to promote breastfeeding so that all women could decide to start breastfeeding after childbirth. 2. As the percentage of women who continue breastfeeding after the sixth month of the infant's life is unsatisfactory, mothers should be encouraged to breastfeed longer. (3) A system of professional lactation support for breastfeeding mothers should be developed.

[Assessment of the impact of some sociodemographic factors on the quality of life of patients with multiple sclerosis]

INTRODUCTION

Multiple sclerosis is the most common cause of disability among young people, affecting the emotional and intellectual condition of the patient. Assessment of the quality of life enables long-term planning of the strategy of support and thus should constitute a permanent part of care for multiple sclerosis patients. The aim of this study was to assess the impact of gender, age, duration of the disease, and economic status of multiple sclerosis patients on the quality of life in separate domains.

MATERIAL AND METHODS

A diagnostic survey was conducted in 64 patients with multiple sclerosis. We administered a questionnaire developed by us with questions referring to sociodemographic data of the patients. We also used the standard SF-36 questionnaire with eight scales.

RESULTS

No significant differences between male and female SM patients were noted as regards the quality of life in each scale. Wealthy patients experienced a higher quality of life as regards the general health and physical functioning in comparison to patients with a middle economic status. There was no effect of the place of residence on the quality of life. Elderly patients and patients with long-term multiple sclerosis had a poorer quality of life in the physical functioning, general health, vitality, and role-emotional domains.

CONCLUSIONS

1. Gender and place of residence of multiple sclerosis patients has no effect on any of the scales of the quality of life. 2. High economic status favors a higher quality of life in the physical functioning and general health scales. 3. Age and long duration of multiple sclerosis are important factors decreasing the quality of life in most scales.

[Self-care and demand for social support in women with infertility]

INTRODUCTION

The prevalence of infertility among married couples is growing. It is estimated that every fifth married couple in Poland is infertile. Infertility is often a source of significant stress for the spouses. It is therefore important to provide professional support, demonstrate interest, listen to the problem, and be present in difficult moments. Social support considerably reduces the feeling of abandonment, fosters self-care, accelerates recovery, strengthens coping, and helps modify views and habits or attitudes towards treatment. The aim of this study was to assess self-care in women with infertility and to identify the most common sources of social support.

MATERIAL AND METHODS

The study group consisted of 100 women diagnosed or treated for infertility at the Department of Reproduction and Gynecology, Pomeranian Medical University in Szczecin. The diagnostic poll was done with the aid of a standardised research tool--the Social Support Scale Questionnaire by Danuta Zarzycka. The study protocol was approved by the Bioethics Committee of the Pomeranian Medical University. The study was performed between July 2005 and March 2007.

CONCLUSIONS

(1) Self-care in women with infertility is adequate. (2) Women with infertility usually expect professional support from a physician; the role of the nurse is undervalued. Thus, the role of the nurse and midwife needs further promotion.

Comparative analysis of informative support in lactation in lying-in women hospitalized in rooming-in system

PURPOSE

The aim of the study was to assess the expected and received informative support in lactation in hospitalized lying-in women. Such variables as the number of deliveries and participation in antenatal classes were taken into consideration.

MATERIAL AND METHODS

The research was conducted from May to September 2005, and involved 202 lying-in women staying in maternity wards in Chair and Clinic of Obstetrics and Perinatology, Pomeranian Medical University (PAM) in Szczecin, and Obstetrics and Gyneacology Unit in Independent Public Specialistic Health Care Centre Zdroje Szczecin. The diagnostic survey was carried out; it was based on the questionnaire of author's design.

RESULTS

The obtained results suggest that primiparas significantly more frequently than multiparas show demand for all elements of informative support in lactation (p < 0.001), while women who did not attend antenatal classes considerably more often need information on the half of elements of informative support connected with lactation. Informative support that lying-in women receive does not satisfy the demand for it.

CONCLUSIONS

1. Professional support provided by midwives/nurses should be particularly directed on primiparas and women who did not attend antenatal classes. 2. Participation of future parents in antenatal classes causes them to be better prepared to breastfeeding, and be less needing the mentioned information while their stay in a mother-baby ward. 3. It is necessary that midwives/nurses constantly perfect their professional skills in order to improve the quality of obstetrical care.

Clinical forms of infections in neonates hospitalized in clinic of obstetrics and perinatology within the space of one year

Because of their specificity, infections in neonatal units form one of the main clinical problems. Our research involved all neonates (1019) hospitalized in Clinic of Obstetrics and Perinatology within the space of one year. Clinically manifested infections were diagnosed in the total number of 47 (4.6%) newborns, including 23 (2.4%) neonates from the neonatal unit (NU) and 24 (46.2%)--from the Neonatal Intensive Care Unit (NICU). In both units, the most commonly observed were general infections (59.6%) and pneumonias (21.3%); cerebrospinal meningitis and necrotic enteritis were diagnosed in a few cases. Urinary system infections were only found in neonates hospitalized in the NU (30.5%). The course of infection was mild in most cases.

Estimation of the declared knowledge of anaesthesiology nurses concerning some chosen procedures and actions being within the scope of professional competence

Together with introducing legal regulations as well as modem standards of postgraduate education, the professional position of a nurse has strengthened and also her responsibility for professional activity has increased. Performing the profession of an anaesthesiology nurse involves necessity of possessing some adequate professional qualifications. The aim of the study was an attempt to answer the question on how the knowledge of an anaesthesiology nurse concerning the activities being within her professional qualifications shapes. The research was carried out in 2005 among 123 anaesthesiology nurses working in some Polish hospitals chosen at random. Method of diagnostic opinion poll was applied and a questionnaire of own authorship was a research tool. Analysing the obtained results the following conclusions have been drawn: 1. The level of knowledge of an anaesthesiology nurses on the activities being within their qualifications is unsatisfactory; 2. Obtaining competence in anaesthesiology nursing involves the necessity of continual raising of qualifications by nurses, especially being on specialization level; 3. A necessity of differentiation between particular competence levels of anaesthesiology nurses during different forms of education should be underlined; 4. Possibility of realization of their competences on a particular level by anaesthesiology nurses is connected with the necessity of improving whole therapeutic team work.

Clinical and microbiological characteristics of hospital infections in the neonatal intensive care unit

Neonates hospitalized in intensive care units, are exposed to a higher risk of infectious complications. The research involved 52 neonates hospitalized in the Neonatal Intensive Care Unit (NICU), Chair and Clinic of Obstetrics and Perinatology over a span of one year. The incidence of hospital infections as well as etiological factors were analyzed. Clinically manifested hospital infections were diagnosed in 38.5% of babies with very low or extremely low birth weight, in boys twice as often as in girls. Generalised invasive infections prevailed; in most cases they were caused by Gram-negative rods, mainly Klebsiella spp.

Information support concerning care of a baby provided for lying-in women during their stay in maternity ward in rooming-in system

The aim of the study was to estimate the need for information support concerned with care of a baby and evaluation of lying-in women expectations referred to sources of support, methods and devices used during presentation. The research included 200 lying-in women hospitalized in Clinic of Obstetrics and Perinatology, Pomeranian Medical University in Szczecin; there were separated the study group which consisted of primiparas (n=100) and reference group - multiparas (n=100). The applied method was medical history of a patient, and a research tool was author's questionnaire. The results show that primiparas noticeably more often than multiparas need information support related to care of umbilical stump (p < 0.001), bathing (p < 0.001), care of skin and mucous membranes (p < 0.001), management of regurgitation, management of colic (p < 0.001), signs of neonatal transient states, and checking for concern-raising signs (p < 0.001). Lying-in women much more often indicate a nurse/midwife and a doctor working in maternity ward as a source of information support, and considerably more often expect information to be provided in the form of training and chatty lecture with the use of brochures.

CONCLUSIONS

(1) Primiparas require greater involvement of health professionals in providing information support and especially giving information on baby care. (2) A nurse/midwife and a doctor are these people in maternity ward who are particularly expected to provide information support for both primiparas and multiparas. (3) Different methods (training, chatty lecture) may be applied when information support is provided and the choice should correspond with patients' needs, goals and organizational possibilities. (4) Lying-in women expect various devices used for providing information support, but in most cases they are brochures with information on particular topics.

Influence of education at The Childbirth School on Breast Feeding

Breast feeding is the only proper way to feed a newborn and a baby during the first several months of his life. The most professional way of preparation for natural feeding is The Childbirth School. Education ought to be continued in maternity wards. The aim of this study is to prove that women who participated in The Childbirth Courses are better motivated and prepared for breast feeding. Material and methodology. The research comprised 294 lying-in women hospitalized in maternity ward in Clinic of Obstetrics and Perinatology, Pomeranian Medical University in Szczecin from June 2001 to December 2002. The examined women were divided into two groups: Group I--"study group"--comprised 129 lying-in women who attended the childbirth school courses during at least one pregnancy, but no earlier than 2 years ago. Group II--"control group" (reference group)--included 165 lying-in women who did not participate in any organized forms of prenatal education. Every woman who agreed to participate in the research was accepted. There was applied analysis of lying-in woman's documentation and author's questionnaire which was also used for further research. As a result of the research it was found that The Childbirth School increases motivation for natural feeding and prepares women for this activity. It also showed that more emphasis should be given to childbirth education for puerperal women in maternity wards; it refers in special to those women who did not attend The Childbirth School.

[Analysis of some pro-health behaviors of pregnant women after a childbirth education class]

Nowadays the school of childbirth is one of the most important forms of antenatal education. The aim of the study was to compare some pro-health behaviours of women after courses at school of childbirth with pro-health behaviours of women without such education. A group of 129 women after courses at schools of childbirth who were hospitalized in the Chair and Department of Obstetrics and Perinatology of Pomeranian Medical University in Szczecin were introduced into the study. The control group contained 165 women who did not take part in any antenatal education. The questionnaire was a research tool; it was completed 2-5 days after childbirth and also patients' documentation was analyzed. The test results were statistically analyzed. Investigations showed that woman attending classes at school of childbirth were highly aware of pro-health behaviours during pregnancy; they often changed their lifestyle during pregnancy, they smoked less frequently, they had more appointments with their obstetricians and they earlier had their first medical visit. It seems necessary to intensify the classes of nourishing during pregnancy at schools of the childbirth, because no statistically significant differences in the increase of body mass were showed. Moreover, it is necessary to educate every pregnant woman of the hygiene, nourishing and stimulant abuse during pregnancy not only at schools of the childbirth, but also during obstetric consultation.

[Assessment of social and professional support offered to patients during their stay in a rooming-in at a maternity ward]

The improvement of quality of care on maternity wards concerns not only the medical activities. Professional activities minimalizing the occurrence of difficult situations of woman in puerperal period are of great importance as well. The aims of the study were: 1) to evaluate the accessible social support and the need of professional support in women during their staying on maternity ward in rooming-in system; 2) to establish the correlation between accessible social support the need of professional one. Studies were conducted at one of maternity wards in Szczecin working in rooming-in system. Studied group were primiparas (n = 100), reference group consisted of multiparous females (n = 100). The following tools were introduced into the study: Modified Social Support Scale and Author's questionnaire on Demand for Support in maternity ward in rooming-in system. The results of investigations show, that the need of professional support was more often expressed in the study group (p < 0.001). It reached an average--high level. There was no significant difference concerning an accessible social support in both groups. No correlation was showed between accessible social and professional support.

CONCLUSIONS

1. Primiparas require special puerperal care and professional support as well. 2. High, accessible social support has no influence on need of professional support in women during their stay on maternity ward in rooming-in system.

[Nursing support at a rooming-in maternity ward]

The international congress called "Birth Quality-Life Quality" has been a key scientific event in Poland resulting in great changes in perinatal care. Improvements in the quality of care at maternity wards were not limited to purely medical issues. Attention became increasingly focused on psycho-social problems of women after parturition. Emphasis is now directed to support by the doctors and nurses and efforts to acquaint young mothers with the benefits of natural feeding, as well as to prepare them for taking good care of their child. Social support is seen as an important tool in the improvement of care over the mother and child. The present study has classified social support according to J. House as informational, emotional, instrumental and worthing. Informational support consists of methods to cope with specific problems that require delivery of information and teaching of new skills. Emotional support focuses on demonstrating care, winning trust and showing empathy. Instrumental support is reflected by delivery of goods or services to persons in need. Finally, worthing support aims at promoting self-esteem. The aim of this study was (1) to analyze the determinants of informational, emotional, instrumental and worthing support and to compare the needs for different types of support among primiparas and multiparas at an obstetrics ward with the rooming-in system; (2) to study correlations between availability and demand for social support; (3) to determine the expectations of patients as to sources of informational, emotional, instrumental and worthing support and as to methods and means used during delivery of informational support. The study was done in a group of 200 women giving birth at the Department of Obstetrics and Perinatology, Pomeranian Medical University in Szczecin. A special questionnaire was developed to determine the needs for support. A modified Social Support Score was also used. It was found that the demand for all determinants of informational support was greater among primiparas than multiparas. In the lactation part, significant differences were noted for 25 determinants (Tab. 1). Similarly, significant differences were noted for 13 determinants of neonatal care and nursing (Tab. 2) and for 9 determinants of postpartum self-care (Tab. 3). A large demand for most determinants of emotional support was noted in the study and reference groups. Statistically significant differences (p < 0.05) were revealed as to 3 determinants representing feeling of safety by the woman during hospitalization (Tab. 4). It was found that the demand for all determinants of instrumental support was greater among primiparas than multiparas (Tab. 5). There were no significant differences in worthing support needs (Tab. 6). Primiparas significantly more often expected informational and instrumental (p < 0.001), as well as emotional support (p < 0.05) (Tab. 7) in comparison to multiparas. The need for social support at a maternity ward was found to be independent of the available support (Tab. 8). The most frequently expected source of informational support is the nurse/midwife at the maternity ward, as well as the doctor at the ward and the outpatient unit. Worthing and instrumental support is usually expected of the husband and the family. The usual methods of delivering support include discussions, training, and demonstration. Brochures remain the preferred vehicle for delivering support (Tab. 9).