Holistic Long-Term Care Over Elderly Kidney Transplant Recipients

Kidney transplantation is an optimal method of renal replacement therapy in patients with phase V chronic kidney disease. Elderly patients (older than 60 years) with a kidney transplant create a significant and constantly growing pool of patients with this type of organ transplantation. In this group of patients, long-term care should be particularly stringent and vigilant. Apart from typical conditions associated with chronic kidney disease and possible post-transplant complications as well as side effects of immunosuppressive treatment, the patient also experiences changes and limitations associated with the progress of age and diseases typical for old age, characterized by a higher risk of infection, and changed pharmacokinetics/pharmacodynamics. Undoubtedly, patients should remain under the medical care of qualified transplantologists, but constant cooperation with a general practitioner and geriatrician would be of added value. Study results show that although most of the elderly kidney recipients have constant contact with their general practitioners, and almost half of them use private care, contribution of the geriatrician to the transplant care system is unsatisfactory, and elderly kidney recipients would expect more extensive outpatient care.

[The relationship between selected biochemical parameters, clinical factors and bone mineral density in postmenopausal women with osteoporosis]

Bone loss in women occurs mainly due to postmenopausal estrogen deficiency and impaired balance between bone resorption by osteoclasts and bone formation by osteoblasts.

OBJECTIVE

The aim of this study was to determine the relationship between selected biochemical parameters, bone turnover markers, clinical parameters and bone mineral density (BMD) in postmenopausal women with osteoporosis.

MATERIAL AND METHODS

The study group consisted of 85 women treated at the Menopause and Osteoporosis Clinic of the Obstetrics and Gynecological Hospital in Poznań. The average age of the women was 59.9 +/- 5.20 years. Quantitative assessment of bone mass at the lumber spine and proximal femoral epiphysis was performed using DEXA technique. The study included women with BMD expressed as T-score < or = (-2.5) SD. A multifactorial regression analysis was used to determine the correlation between selected biochemical parameters, clinical factors and BMD.

RESULTS

As far as biochemical parameters were concerned, the concentration of estradiol correlated with BMD. The assessed bone turnover markers did not show a correlation with BMD. The following clinical parameters correlated with BMD: age, body mass index - BMI, family history of fractures, bisphosphonates treatment, transdermal hormone replacement therapy use, and intensity of physical activity

CONCLUSION

It is important to identify risk factors for osteoporosis in women, especially when planning prevention of bone loss in postmenopausal women.

[Knowlege about breast feeding advantages among primiparas]

Breastfeeding is the only way to nourish newborns and toddlers and it enables them to have an optimal health condition and growth. Both a child and a mother draw a lot of profits from breastfeeding. Woman's milk is perfectly balanced as far as quantity and quality is concerned. It has specific generic nourishment that ensures optimal psychological emotional and physical development of a child. Breastfeeding also protects infants from immunological problems and infections. Having the skills and knowledge about breastfeeding is the main factor that enables a smooth process of lactation. All the medical staff and midwives especially are obliged to promote breastfeeding and they should provide information as well as emotional and technical support for mums through the whole period of lactation. The aim of this thesis was to examine the level of knowledge about breastfeeding among first-time mothers.

MATERIAL AND METHOD

The research was carried out from August till October 2011 in birthing rooms of Obstetrics and Gynecology Clinic Hospital for Medical University by the name of K. Marcinkowskiego in Poznań and Obstetrician Wing in Provincial Complex Hospital in Leszno. 101 randomly chosen pregnant women in labor were questioned. An anonymous survey was used as an analytic tool. The survey was specifically created for this research and it contained 30 questions. Majority of responders (98%) declared a will for breastfeeding. Also majority of women (94%) knew that their milk contains all the needed ingredients for proper development of their young. According to the pregnant women in labor (98%) breastfeeding is a key element in establishing an emotional connection with the child. Most of the responders knew the influence of breastfeeding on child's health. Minority of the questioned women (14%) attended birthing courses.

CONCLUSIONS

The responders were equipped in knowledge on various levels. It proves the necessity of sys- tematic and planned education for women. The system of lactation counseling should be an integral part of post-labor care in obstetrician clinics.

[Psycho-social context of health self-esteem in elderly ex-smokers]

Tobacco smoking remains still as dominating and essential risk factor of morbidity and mortality of cancer, especially in elderly people. Advanced age presents difficulties, because of changes in social status level of physical fitness, and decreased problem-solving abilities. The aim of the study was to self-evaluation of health in elderly ex-smokers post hospitalization. The study was conducted on 48 elderly ex-smokers (37 women, 11 men), using a general version of FACT-G questionnaire from USA. The analysis of the results was accomplished through Mann-Whitney and Spearman tests. Statistical differences were observed in tested subjects, with relativity level of 0,05, which related to states of physical fitness and social functions. Decreased physical and psychological abilities associated with process of aging, create a need for monitoring the finding of the study to life style, in order to achieve independence and effective smoking cessation among elderly patients.

[Degree of independence of patients after surgical treatment femoral neck fractures]

The main aim of the research was to define the degree of independence among patients after operative treatment femoral neck fractures in the first day after the operation and on day previous to the release from hospital. Attempt was made to determine the degree of independence in the ten activities of life, functional status and emotional state of patients. Efforts have also tried to assess the impact of functional status and emotional autonomy to the degree subjects. The study was conducted in Hospital in Poznan and Hospital in Chodziez, in the period from August 2006 March 2007. The research concerned 30 patients after operative treatment femoral neck fractures. To assess functional status, 100-point scale Barthel, to assess the emotional state HADS scale was used. Degree of independence was assessed Scale of Deficit Self-Care. The lack of independence was bigger among older patients in life activities like: moving, feed, drinking, expelling, personal sanitation and dressing. These patients required increasingly bigger medical care. Functional condition introduces considerably worst in older patients equal in research I and research II. Emotional status does not affect the degree of independence of patients, but in the first day after surgery, patients showing symptoms of depression had demanded a bigger range of assistance from medical personnel. Hip fracture have a negative impact on many areas of life activity of the patient, therefore, these patients require particularly caring therapeutic and rehabilitation activities.

[Degree of independence of patients after surgical treatment femoral neck fractures]

The main aim of the research was to define the degree of independence among patients after operative treatment femoral neck fractures in the first day after the operation and on day previous to the release from hospital. Attempt was made to determine the degree of independence in the ten activities of life, functional status and emotional state of patients. Efforts have also tried to assess the impact of functional status and emotional autonomy to the degree subjects. The study was conducted in Hospital in Poznan and Hospital in Chodziez, in the period from August 2006 March 2007. The research concerned 30 patients after operative treatment femoral neck fractures. To assess functional status, 100-point scale Barthel, to assess the emotional state HADS scale was used. Degree of independence was assessed Scale of Deficit Self-Care. The lack of independence was bigger among older patients in life activities like: moving, feed, drinking, expelling, personal sanitation and dressing. These patients required increasingly bigger medical care. Functional condition introduces considerably worst in older patients equal in research I and research II. Emotional status does not affect the degree of independence of patients, but in the first day after surgery, patients showing symptoms of depression had demanded a bigger range of assistance from medical personnel. Hip fracture have a negative impact on many areas of life activity of the patient, therefore, these patients require particularly caring therapeutic and rehabilitation activities.

[Evaluation of the functioning of women with osteoporosis with vertebral fractures and without vertebral fractures using the Polish version of Qualeffo-41]

Osteoporosis is a very frequent bone illness and fractures not giving any symptoms in the form of pain are its typical complication and a common diagnostic sign. For a many years the diagnosis of osteoporosis was made only after recognizing a fracture. The objective of this research is to evaluate the influence of osteoporosis on functioning of women with vertebral fractures and without vertebral fractures, treated in Menopause and Osteoporosis Outpatient and Orthopedic Outpatient in Poznan. According to the World Health Organization, definition, subjects were classified as having osteoporosis if they had a T-score < -2.5 SD, osteopenic if -2.5 < T-score < -1.0 SD, and normal BMD if--score was > -1.0 SD in at least one of the measured areas (either lumbar spine, or femoral, or both). The Polish version of the Qualeffo was administered to all subjects. The analysis of the results shows that the evaluation of functioning oscillates between mean values of: 40.80 +/- 3.82 for osteoporosis group, 37.79 +/- 337 for osteopenic group and 37.43 +/- 2.80 for control group. Between groups I, II and III a statistically important difference was discovered with p < 0.001. In evaluating the functioning of women with osteoporosis and osteopenic in accordance to age, three domains were especially important: physical functioning (p < 0.001), social functioning (p < 0.001) and general health perception (p < 0.01). Comparing the groups of woman with and without fractures of the stem of the vertebrae, the functioning was evaluated as definitely worse by patients that had diagnosed osteoporotic fractures. Those patients received a lower score in all domains of the instrument.

[Elderly smokers and their health status in FANLTC study]

Epidemiological research proves that the number of the disabled, in the incidences of physical functions, carrying out of day-to-day activities, tackling psychological tasks and taking on social roles, increases along with ageing. Thus, there arises a need for new solutions in the area of positive ageing deprived of disability or functional distress. Smoking tobacco by the disabled elderly persons is a serious health and social disorders as a consequences may restrict their heath efficiency. Demographic and epidemiological data confirms increasing numbers of elderly, as well as the fact that aging is a continuous and unavoidable process, posing a major challenge for a society. Systematic growth of elderly populations leads to a need for analysis of the social and health issues facing them. Comprehension of the aging process strongly relates to the concept of health and its essence, which lies in a complete physical, psychological and social well-being. The goal of the study conducted among smoking disabled elderly persons was to generate information about their health, which was accomplished through a subjective evaluation of selected physical and psychological factors. The study was conducted among 54 patients without any recognized psychological problems (16 males, 38 females), ages 65-87 in a nursing/rehabilitation facility. During study, the FANLTC (version from North-Western Health Care-Illinois) was utilized, after an agreement authorizing its use. The questionnaire consisted of four subscales relating to: physical, social, emotional and functional states. In aspect of social functioning among patients, the study showed statistical relevance variable p = 0.05. The situation of the study subjects relating to their family and social life was unfavorable, because of lacking comfort and support from loved ones (family members and friends) in time of illness. Low estimation of health, suggesting the need for research, which should be further researched in expended studies, in order to verify the health of smoking disabled geriatric patients in nursing/rehabilitation facility.

Quality of life of women with osteoporosis - review of literature

Osteoporosis is a systemic skeletal disease characterized by low bone mass and architectural derangements leading to an increased fracture risk. Evaluation of the quality of life of patients with osteoporosis concerns the physical, emotional, social and pain QoL domains. Quality of life can be measured to compare the effect of different treatments of osteoporosis. The assessment of quality of life is also useful in epidemiological studies to estimate the burden of disease and to evaluate the effectiveness of different treatments. The principal goals of health care for these patients are to maintain independence and preserve good quality of life.

Comparison functioning and quality of life of patients with osteoarthritis and rheumatoid arthritis

PURPOSE

The aim of this study was to assess the quality of life of the osteoarthritis (OA) and rheumatoid arthritis (RA) patients of Outpatient Clinic Rehabilitation in Poznań.

MATERIAL AND METHODS

The study consisted of 97 OA patients, including 86 women and 11 men. Almost 123 patients with RA included of 102 women and 21 men. The mean age of the treated patients with OA was 11.50 and 11.10 years for RA patients. The Polish version of the Arthritis Impact Measurement Scales-2 (AIMS-2) was used to assess the quality of life. AIMS-2 scores range from 0-10, with 0 representing good quality of life, 10 representing poor quality of life.

RESULTS

It was showed that the mean score on the AIMS-2 for OA patients was: physical--3.53, affect--4.42, symptom--6.74, social interaction--3.33, role--4.20. Mean score on the AIMS-2 for RA patients was: physical--3.73, affect--4.48, symptom--7.09, social interaction--3.45, role--3.63. The quality of life depended on the sex of these patients. Women of OA and RA patients scored significantly higher in the physical state and symptom then men. Younger patients and suffering shorter than 5 years demonstrated higher evaluation of quality of life in the physical state. The assessment in most of the subscales of the AIMS-2 correlated significantly with Pain, Morning Stiffness and Grip Strength for OA and RA patients.

CONCLUSION

This study showed that quality of life of OA and RA depends on gender, age and clinical variables.

Quality of life in Polish respondents: psychometric properties of the Polish WHOQOL-Bref

The aim of this study was to examine the validity and reliability of the Polish WHOQOL - Bref in a sample of 908 respondents. The Bref is a generic quality of life (QoL) instrument designed for cross - cultural use. Correlational and multivariate analyses confirmed the relevancy of individual items and domains supporting the construct validity of the scale. Multiple regression analyses of the domain scores with two overall questions (dependent variable) showed that all four domains made a significant contribution in explaining the variance in overall QoL. The psychological domain made the strongest contribution (unstandardized B coefficient = 0.10, r2 = 0.41), followed by the social, environmental and physical domains. When overall health satisfaction was considered as the dependent variable, the physical domain contributed most strongly (unstandardized B coefficient = 0.21, r2= 0.43) followed by the psychological and environmental domains. Exploratory factor analyses resulted in a four factors solution with 24 items explaining 49.6% of the cumulative variance. Confirmatory factor analyses lended marginal support for the goodness of fit of the four-domain model. The physical domain was found to be strongest in differentiating between unhealthy and healthy subjects, followed by psychological and social domains. Acceptable internal consistency was shown with Cronbach's alpha coefficients being greater than 0.70 for all domains with the exception of the social domain. Further exploration of the scales validity and conceptual clarity need further testing in Polish and international samples.

[The phenomenon of spreading smoking cigarettes among the first year course students in the Medical Academy]

The World Health Organization declared the addiction of tobacco smoking as a separate disease unit requiring adequate recognition and treatment. In the International Classification of Diseases, it has been registered with F17 as mental and behavioral disorders caused by tobacco smoking. As some research shows, an estimated 4 million people die every year (about 11 thousand a day), because of smoking-related illnesses and the number has been expected to rise until 10 million in 2030. The health service workers such as nurses and midwives play a huge part in establishing pro-health attitudes. They are expected to participate in campaigns promoting a tobacco-free lifestyle. It is important that the persons mentioned were non-smokers, otherwise the information regarding the negative effects will be unconvincing. The main goal of the study was to estimate the phenomenon of spreading smoking cigarettes among the first year course students in the Medical Academy, and accomplishing their knowledge and awareness about threats resulting from tobacco smoking. All information was collected from the poll questionnaire, which was filled in by each person independently. The group (n = 100) consisted of 50 interviewed females (n = 50) and 50 interviewed males (n = 50) at the age between 18 and 20. The poll questions were carried among the first year course students in the Medical Academy, in May and June 2006. They were guaranteed anonymity. The results subdued to statistic analysis showed no statistic dependence between the gender of the interviewed and tobacco smoking. The basic study questions referred to the number of young people who have already experienced smoking, and to the intensity degree of the experience. The study aimed also in identifying factors influencing the popularity of the phenomenon in question. The research touched such questions as conviction about damage caused by smoking, the source of information, causes and effects of smoking, about the environment of the interviewed people (family members, friends--whether they are smokers or non-smokers). Other questions concerned the time of the first experience with smoking- whether it was childhood, puberty or adolescence time, the interviewee's smoking preventive activities in their future work place and their opinion about themselves as non-smokers. All the questions were subdued to quantitative measurement due to estimation of all interviewed population.

The evaluation of the functioning and of the quality of life of patients with rheumatoid arthritis

PURPOSE

It has been reported that Rheumatoid Arthritis (RA) affects 0.5-1% of the adult population in Poland. The condition is two or three times more common among women than among men. The majority of the onsets of disease occur between the ages of 40 and 60. The aim of this study was to assess the functioning and quality of life of patients with Rheumatoid Arthritis treated in Rheumatoid Special Clinic in Poznań, Poland. The specific question was: does the functioning and the quality of life of RA patients depend on demographic variables (gender and age) and duration of the disease?

MATERIAL AND METHODS

The study sample consisted of 168 RA patients, including 123 women (73.2%) and 45 men (26.8%). To assess the functioning and the quality of life the Polish version of the Arthritis Impact Measurement Scales 2 (AIMS 2) was applied. The Arthritis Impact Measurement Scales 2 was translated into Polish according to standardized approach (internal consistency reliability for the global score, alpha = 0.78). AIMS 2 scores range from 0-10, with 0 representing high functioning and quality of life, 10 representing poor functioning and quality of life.

RESULTS

The results showed that the mean scores on the AIMS 2 for physical state and mobility was 3.53, which is within the medium section of the average measurement of the quality of life. The quality of life depended on the sex of the patients. Women scored significantly lower in the emotional area than men. Youngest patients demonstrated higher evaluation of quality of life in the area of bending and walking (4.4). Life satisfaction of people with RA is higher among the patients suffering longer than 5 years.