Prevalence and factors associated with professional burnout in Polish oncologists-results of a nationwide survey.

BACKGROUND: High rates of burnout are observed among health care professionals worldwide, which could have negative consequences on personal and organizational levels. We aimed to evaluate the burnout prevalence and factors associated with burnout among oncologists in Poland. MATERIALS AND METHODS: An online survey was conducted using the validated Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and additional work/lifestyle questions. Descriptive statistics, parametric and nonparametric tests, and multivariate logistic regression were used to identify factors associated with burnout. RESULTS: A total of 228 physicians participated in the survey, including 168 medical oncologists, 43 radiation oncologists, and 17 from other specialties. Data collected from 211 medical and radiation oncologists were included in the final analyses. Most participants were female (71.6%) and ≤40 years of age (70.1%). A self-reported feeling of burnout was present in 65.9% of participants. Based on the MBI-HSS, 74.9% showed evidence of burnout with burnout subdomains as follows: depersonalization 37.0%; emotional exhaustion 64.5%; low accomplishment 43.1%. There were no differences in burnout rates based on specialization (oncology/haematology-75.6%, radiotherapy-72.1%), career stage, gender, or age groups. Lack of work-life balance was the only significant factor associated with the risk of burnout in the logistic regression (relative risk 2.6, 95% confidence interval 1.3-5.4). Only 20.9% of physicians had access to psychological support in their workplace; however, 70.1% desired such support. Three main factors impacting burnout in cancer care workers were: bureaucracy and administrative duties overload, admissions of many patients, and poor work culture. CONCLUSIONS: Burnout is common among medical and radiation oncologists in Poland. There is a high demand for psychological support and organizational changes in the workplace to reduce risk and mitigate the adverse effects of burnout among health care professionals.

Nurses as new heroes of modern times.

BACKGROUND: Difficult times of epidemics, wars and an ageing population have made humanity aware of the important role to be played by those who, at the risk of their own health and lives, help and care for others, are the new superheroes of modern reality. Nurses are the foundation of any healthcare system. Today, many of them are on the front line in the fight against COVID-19. Without nurses and other health professionals, the world will not win the fight against epidemics or pandemics or achieve the health potential of populations. AIM: The main purpose of this article is to draw attention to the heroic work of nurses and the role they have to fulfil in society. Their daily work, hardship and courage can be called heroism, especially when in times of epidemics or pandemics they risk their own lives to care for and support those most in need. CONCLUSION: The greatest heroes of today are health professionals, among whom nurses play a key role. The new superheroes can be a symbol of hope, tenacity, courage and persistence of humanity, no matter how difficult a challenge fate presents. Implications for nursing, and Social Policy.

Effect of age and stage of lactation on whey protein content in milk of cows of different breeds.

The aim of the study was to determine the effect of age of cows, i.e. subsequent lactation and stage of lactation, on bioactive whey protein content in milk of dairy cows of six primary breeds kept in Poland. In all cases the significant correlations between lactoferrin concentration in milk and stage of lactation was stated. Its content gradually increased with the course of lactation but the changes in the content of this protein were highly dependent on breed of cows, what was indicated also by high interactions between breed and stage of lactation.

Changes of protein content and its fractions in bovine milk from different breeds subject to somatic cell count.

Global milk production is undeniably dominated by 2 dairy breeds recognized worldwide: Holstein-Friesian and Jersey. A third breed, Simmental, serves as a dual-purpose breed. The objective of the present research was to establish potential changes in the fractional components of bovine milk protein (mainly whey) in relation to the health status of a dairy cow's mammary glands, which is closely determined by somatic cell count (SCC). The milk of 3 breeds was studied: Polish Holstein-Friesian (Black and Red-White varieties), Simmental, and Jersey. The cows were housed in freestall barns and fed according to the total mixed ration feeding system for both winter and summer periods. Milk samples were collected individually from each cow twice a year, in the winter and summer seasons. A total of 1,822 milk samples were evaluated (946 in winter and 876 in summer). The milk was examined for SCC, crude protein, casein, and whey fraction proteins (α-lactalbumin, ß-lactoglobulin, lactoferrin, BSA, and lysozyme). The research material for each breed was split into 4 groups based on SCC (group I: ≤100,000 cells/mL; group II: 101,000 to 400,000 cells/mL; group III: 401,000 to 500,000 cells/mL; and group IV: 501,000 to 1,000,000 cells/mL). It was found that an increase of SCC promulgated a progressive decline in the daily yield of milk, which was significantly true for the Polish Holstein-Friesian. The level of crude protein decreased slightly as SCC increased, and casein concentration (r=-0.591) also followed this trend of decline. Elevation of SCC produced a decrease of major albumins (i.e., α-lactalbumin and ß-lactoglobulin). However, SCC increase induced an increase in the immunoactive proteins (lactoferrin and lysozyme) as well as BSA. The interactions of a breed with increased SCC, which can be measured based on the BSA content of the milk, has indicated various levels of susceptibility to the increase in different breeds. This is confirmed by different values of correlation coefficients for these relationships: 0.71 in the Holstein-Friesian, 0.58 in Simmental, and 0.47 in the Jersey cows. Holstein-Friesian cows are more sensitive to mammary gland infections causing a greater decline of their daily milk yields, which, in turn, is reflected in an increase of the negative value of the correlation coefficients between SCC and milk efficiency (-0.24). In the other 2 breeds, the correlations were also negative, but substantially lower (-0.12 and -0.15).

Lactoferrin, lysozyme and immunoglobulin G content in milk of four breeds of cows managed under intensive production system.

The aim of the study was to analyze chosen antibacterial protein content, i.e. immunoglobulin G, lactoferrin and lysozyme in bovine milk obtained from cows of four breeds raised and maintained under intensive production technology, that is in the free stall system, and fed total mixed ration diet (TMR system). The studies were conducted on milk from four breeds of dairy cows maintained in Poland, i.e. Polish Holstein-Friesian Black-White and Red-White variety, Jersey and Simental. Milk samples were collected solely from healthy cows, having performed the TOK test with Mastirapid. Further analyses were made only on the milk samples with SCC determined under 2.0 x 10(5) cells/ml, i.e. 423 samples. Each sample was examined for lactoferrin and lysozyme determination using reversed-phase high-performance liquid chromatography (RP-HPLC) with UV-VIS detector. The immunoglobulin G (IgG) levels were established by the aid of radial immunodiffusion technique with Bovine IgG LL tests (The Binding Site, Birmingham, UK). It should be stated that a breed of cow had a significant effect on a content of the antimicrobial proteins analyzed in bovine milk evaluated. Milk obtained from Simental and Jersey cows prove to be their excellent source, i.e. lactoferrin (116.74 and 103.48 mg/l), lysozyme (9.84 and 13.02 microg/l) and immunoglobulin G (579.9 and 508.6 mg/l). The highest content of these protein was stated in milk of multiparous cows at the late stage of lactation.

Relationship of somatic cell count to daily yield and technological usefulness of milk from different breeds of cows.

The aim of the present study was to determine a relationship between the somatic cell count in milk and daily yield, chemical content as well milk technological usefulness in different breeds cows. The examinations included a total of 1867 milk samples collected from cows of four breeds: Polish Holstein-Friesian, Black-White variety--712 and Red-White variety--356, Simental--587 and Whitebacks--212 samples. Each sample was examined to determine somatic cells count (SCC), basic chemical composition, thermostability and rennet milk coagulation time. Based on the SCC score, within each cow breed, the milk samples were classified into one of four groups, i.e., I--up to 200,000 cells/ml, II--200,001-400,000 cells/ml, III--400,001-1,000,000 cells/ml and IV above 1,000,000 cells/ml. The increase in SCC was associated with the reduction in daily milk yield of the high-yielding dairy cows. As far as milk composition is concerned, an increased SCC level was connected with raise in a total crude protein content and a distinct reduction in lactose level (P < or = 0.01) as well as with a small (P < or = 0.05) increase in fat and casein content, and elevation in protein to fat ratio. The time of milk enzymatic coagulation also was lengthened (P < or = 0.01) but it did not influence its thermostability. The significant relationship (breed x SCC) for the protein, casein and lactose content, protein to fat ratio as well as rennet milk coagulation time has been revealed.

On the holistic approach in cancer biology: tumor necrosis factor, colon cancer cells, chaos theory and complexity.

TNFalpha plays a role in the pathogenesis of septic shock, inflammatory diseases, autoimmune diseases, graft rejection reaction, acute, and chronic respiratory inefficiency among others. Its activity depends on the type of target cells and different regulating factors, but the effect of biological activity is conditioned by specific receptors such as p55 (type I, TNF R55) and p75 (type II, TNF R75). The aim of the study was to answer the following questions: 1) Is it possible to apply elements of non-linear dynamics to assess the level of expression of TNF, TNFRI, TNFRII genes in tumor cells, pathologically unchanged tissue and metastatically changed lymph nodes? 2) Is theoretically anticipated variability of cytokine and its receptors in colorectal carcinoma cells and the immediate vicinity justified in the developed mathematical model? The research material--specimens taken from tumor, unchanged tissue and metastatic lymph nodes--were histopathologically and molecularly analysed. Results of the molecular research were used to develop a mathematical model using the basic studies on the theory of chaos and biological system modelling.

Disturbances of mental image processing in post-stroke patients with left and right hemisphere damage.

BACKGROUND: The purpose of this article is to point out significant differences in how mental images are processed by post-stroke patients with left and right hemisphere damage. The issues involved are of theoretical importance because of the light shed on the modularity of cerebral functions, especially the imagination, and of clinical importance due to the better understanding of the underlying pathomechanism. MATERIAL AND METHODS: The research involved 82 right-handed patients with a lesion in the left hemisphere (Group L), 82 right-handed patients with a lesion in the right hemisphere (Group R), and, as a control group, 82 patients with musculo-skeletal disorders not affecting the central nervous system (Group C), matched by age and sex. Image processing of complex notions was examined by using selected items from the Simple Neurolinguistic Test. RESULTS: In the control group, the majority of the patients responded to most of the prompts with polymodal associations of various types. In Group L, responses were dominated by isolated elements of the complex situation, while in Group R the associations were mostly verbal (lexical) and highly restricted in scope. CONCLUSIONS: The results indicate that the loss of LH functions interferes with the ability to assemble pieces of polymodal image information into sensible strings, while the loss of RH functions leaves strings to which little information is attached.

[Evaluation of quality of life in patients with advanced colorectal cancer treated with topotecan]. / Ocena jakosci zycia chorych z zaawansowanym rakiem jelita grubego leczonych topotekanem.

UNLABELLED: During last years a few new directions appeared in therapy of advanced colorectal cancer. Topotecan, a camptothecin analog, seems to be one of the promising novel drug in these cases. Its unique mechanism of action is connected with inhibition of the nuclear enzyme topoizomerase I. Assessing therapeutic effects of new cytotoxic drugs we should consider their impact on survival time and quality of life as well. The aim of our study was the attempt to assess the quality of life of patients with advanced colorectal cancer (IV stage in TNM scale), treated by topotecan. Clinical trial was performed in the group of 10 patients. Topotecan was administered intravenously at 1.5 mg/m2/day for 5 days and repeated every 21 days. Quality of life assessment was performed at special time points using Rotterdam Symptom Checklist. We observed improvement in quality of life in six out ten patients having advanced colorectal cancer. Two patients did not show any change in quality of life and two patients with progression of disease demonstrated lower quality of life during topotecan treatment. CONCLUSION: Topotecan has a positive influence on quality of life of patients with advanced colorectal cancer. Further study are needed to confirm this observation.

Neurophysiology of the mental image.

Apart from perceptions, mental images are the most frequent experiences of the conscious mind. Mentation can be understood as a process which consists in the manipulation of recalled or imagined mental images. The scientific literature related to this process is relatively scant. This article reviews the relevant original and recent neurophysiological data in such a way as to enable the presentation of a synthetic theory of the neuronal mechanisms that form mental images. Recurrent axons and some reproductive efferent connections constitute the neural circuitry essential for imagery. These connections enable the reverberating, circular arousal of the upper levels of the hierarchical structure active during previous perceptions. The recalling of a mental image evokes an accompanying electromagnetic field. The investigation of its functional role is a challenge for contemporary neural scientists.

Dynamics of circadian fluctuations in serum concentration of cortisol and TNF-alpha soluble receptors in gastrointestinal cancer patients.

The objective of the study was to investigate the dynamic changes of cortisol and soluble TNF-alpha p-55 and p-75 receptors in serum of advanced cancer patients during 24 h. The examined group consisted of 42 patients suffering from advanced gastrointestinal neoplasms (colorectal, gastric and pancreatic cancer). Serum levels of cortisol, TNF-alpha and both receptors in cancer patients were measured using ELISA type kits 6 times a day (8.00 a.m., 2.00 p.m., 6.00 p.m., 10.00 p.m., 2.00 a.m. and again 8.00 a.m.) as well as in healthy controls. The levels of cortisol, TNF-alpha and its soluble receptors were substantially increased in examined group and displayed statistically significant circadian fluctuations. Cortisol peak was found typically at 8.08 a.m., the minimum value appeared at 6 p.m. The presence of circadian rhythm of the cytokine was proved (acrophase -00.36 a.m.), however no diurnal rhythm of soluble TNF receptors was observed. The concentration of p-55 receptor was distinctly lower then p-75. The peak p-55 value appeared at 10.00 p. m. while the p-75 reached its minimum level at the same time. Although there was no statistical correlation between the receptor concentrations the shapes of both curves remained in inversely proportional manner to each other. The present results may suggest the presence of complex self-regulation mechanisms in advanced gastrointestinal cancer patients. There was no correlation observed between cortisol and TNF-alpha soluble receptor concentration.

Dynamics of diurnal changes in serum concentration of TNF-alpha soluble receptors in gastrointestinal cancer patients.

The objective of the study was to investigate the dynamic changes in soluble TNFalpha p-55 and p-75 receptors in serum of advanced cancer patients during 24 hours. The group examined consisted of 42 patients suffering from advanced gastrointestinal neoplasms (colorectal, gastric and pancreatic cancer). Serum levels of the cytokine and both receptors in cancer patients were measured using ELISA type kits 6 times a day (8.00 a.m., 2.00 p.m., 6.00 p.m., 10.00 p.m., 2.00 a.m. and again 8.00 a.m.) as well as in healthy controls. The levels of TNFalpha and its soluble receptors were substantially increased in the examined group and displayed statistically significant circadian fluctuations. The presence of circadian rhythm of the cytokine was proved (acrophase - 00.36 a.m.), however no diurnal rhythm of soluble TNF receptors was observed. The concentration of p-55 receptor was distinctly lower then p-75. The peak p-55 value appeared at 10.00 p.m. while the p-75 reached its minimum level at the same time. Although there was no statistical correlation between the receptor concentrations the shapes of both curves remained inversely proportional. The present results may suggest the presence of complex self-regulation mechanisms in advanced gastrointestinal cancer patients.

[Soluble tumor necrosis factor receptors--their properties and role in diagnosis and therapy of acute and chronic diseases]. / Rozpuszczalne receptory czynnika martwicy nowotworów--ich wlasciwosci i znaczenie w diagnostyce i terapii schorzen o przebiegu ostrym i przewleklym.

The review presents the properties and significance of soluble forms of tumor necrosis factor-alpha receptors in physiology and pathology of human organism. Special attention was turned to the possibility of practical application of those forms of the receptors in the therapy of diseases caused by excessive activity of TNF-alpha. The significance of the soluble receptors as prognostic factors of disease progression and outcome was stressed.

Central single and chronic administration of morphine stimulates corticosterone and interleukin (IL)-6 in adjuvant-induced arthritis.

Adjuvant-induced arthritis (AA) in the rat is a chronic inflammatory stress in which circulating corticosterone and interleukin (IL)-6 levels are elevated. In addition, there are profound neuroendocrine changes associated with the development of hind-paw inflammation which have major implications for the ability of the rat to respond to stress. Central injection of morphine is able to increase plasma corticosterone and circulating IL-6 concentration in control animals. In present study we have determined the effects of a single and repeated injection of morphine into the lateral ventricle of control and AA animals on plasma corticosterone, circulating IL-6 levels and course of hind-paw inflammation in AA rats. In the present study we found a sustained increase in plasma corticosterone both after single and repeated injection of morphine in control and AA rats and an increase of the level of circulating IL-6 in AA rats after repeated injection of morphine. These data suggest that alternative systems distinct from Athose activated in response to acute stress are activated by morphine in the AA animals. The similarity with the sustained increase in corticosterone following LPS injection suggest that central opiates may be involved in mediating HPA axis and cytokines response to inflammatory stress.

[The influence of early childhood experiences on depression among medical students. Preliminary study]. / Wplyw negatywnych doswiadczen z okresu dziecinstwa na wystepowanie depresji u studentów medycyny--doniesienie wstepne.

The aim of this study was an attempt to estimate depression prevalence in medical students. Simultaneously we tried to asses the impact of early negative experiences on the level of depression in that population. We examined 92 third year medical students of the Silesian Academy of Medicine (54 women and 38 men) at the age from 20 to 24. Frequency and intensification of depression were assessed by using Beck Depression Inventory. Early experiences including negative and positive ones were estimated with the use of a self prepared repertory test called "biographical path", based on Personal Construct Theory of George Kelly. The obtained results indicated that 25% of examined students had depression symptoms. These students were exposed more frequently to early negative experiences than students without depression. In childhood depressive students were under pressure of their environment to score successes. If they did not realise these expectations they were exposed to discontent and frustration of their parents. Depressive students came less frequently into contact with other people and acquired independence later than non depressive students.

[Beautiful literature and audiovisual media provide a change to stimulate human creativity]. / Literatura piekna i srodki audiowizualne szansa na pobudzenie ludzkiej kreatywnosci.

The aim of this study was the attempt to determine which films and books had an influence on the mental resources of medical students. We used a special form, created in accordance with the group thinking theory called "brain storm on a paper". We examined 111 six year medical students taking part in the workshops. Each group of students consists of 9-12 persons. It was impossible to describe and analyze in that paper all novels which made the impression on the examined students. The obtained outcomes indicated that the progress of young people mentality was limited by simple and traditional ground basis. That basis was consisted of obligatory set books and actually popular films. There were only a few items which were to teach an optimism or to promote an active and creative attitude to the life. In our opinion that findings should be very important to every person who cares for a mental condition of young people.

Breast self-examination: attitudes and practices among young women in Europe.

Breast self examination (BSE) is recommended for the early detection of breast cancer in the European Code against Cancer. Evidence from North America suggests that there is reasonable public awareness of its importance, but compliance with regular BSE is reported by only a minority of young women. Attitudes to and practice of BSE has rarely been studied outside North America. In the present study, attitudes to BSE were evaluated by questionnaire in a sample of 16,486 students aged 17-30 from 20 European countries. Frequency of BSE practice was reported by the 9,181 women in the sample. Information on public recommendations concerning BSE was obtained from cancer organizations in each country. The data were collected as part of the European Health Behaviour Survey, an international study on health beliefs and health behaviour. The results showed that BSE was recommended in 16 countries and 'breast awareness' in two, while two countries did not recommend self-examination. 54% of women reported as never having practiced BSE. Regular practice (monthly) was reported by only 8% of the sample, with another 36% reporting occasional BSE. Significant differences emerged between centres in different countries ranging from 6% to 15% reporting regular BSE. Attitude towards BSE was a significant predictor of BSE practice within each centre and across all centres combined. Attitudes towards BSE were significantly less positive in the two centres from countries without BSE recommendations than in the others, but levels of practice were similar.(ABSTRACT TRUNCATED AT 250 WORDS)

[Is the integration of brain sciences necessary?--or how to avoid new battles with dissenters?]. / Czy integrowanie nauk o mózgu jest nam potrzebne?--czyli jak uniknac nowych wojen z innowiercami?

The author point out the possibility of joint consideration of different psychological theories, neurophysiology and computer science to grasp better understanding of the brain. He propose the scheme supporting the trail of the synthesis. The synthesis indicates remedial measures against the hate causing war by ideological reasons.