Assessment of physicians' career satisfaction in the Silesian Voivodeship, Poland.

OBJECTIVE: Aim: To assess the career satisfaction of physician's in the Silesian Voivodeship, Poland, in relation to selected factors. PATIENTS AND METHODS: Materials and Methods: The questionnaire survey was conducted among 701 physicians and dentists from the Silesian Voivodeship, Poland, in the period from January to December 2018, using the PAPI (Paper and Pencil Interview) method. Physicians' Career Satisfaction was measured and basic socio-demographic, economic and occupational data, concerning lifestyle and health, and also the level of life satisfaction according to the SWLS (Satisfaction with Life Scale) were collected. Moreover, the occurrence of anxiety and/or depressive symptoms according to the HADS (Hospital Anxiety and Depression Scale) were included in the analyses. RESULTS: Results: The career satisfaction of the surveyed Silesian physicians and dentists was moderate. Wages and combining personal life with work were rated the lowest, while interpersonal opportunities were rated the highest. The predictors: age, economic status and body mass index (BMI) were significant; in addition, in younger age group (25-49 years) - practicing sports and chronic fatigue, and in older age group (50-80 years) - the presence of a chronic disease. A moderate correlation between the level of career satisfaction and life satisfaction was revealed, as well as a lower score in people with the occurrence of anxiety and/or depression symptoms. CONCLUSION: Conclusions: The diversified level of career satisfaction of physicians in separated aspects makes it necessary to verify them both at the level of health care units and at higher levels.

Assessment of Life Satisfaction of the Physicians of the Silesian Province, Poland.

BACKGROUND: The medical profession is associated with a heavy psychological and physical burden. Specific working conditions can negatively affect the assessment of physicians' quality of life. The lack of current studies prompted us to evaluate the life satisfaction of the physicians in the Silesian Province in relation to the selected factors (health status, professional preferences, family and material status). MATERIAL AND METHODS: The study included 701 physicians and dentists from the Silesian Province aged between 25 and 80 years. It was conducted in 2018 using the Paper and Pencil Interview technique by obtaining non-personalized demographic, anthropometric, socioeconomic, occupational, health and lifestyle data. The following measures were used: the Satisfaction with Life Scale (SWLS), Occupational Satisfaction and the Hospital Anxiety and Depression Scale (HADS). Considering the environmental conditions, the total SWLS scores were analysed in terms of the significance of differences in the groups. Moreover, the SWLS scores underwent multivariate analysis of variance and the correlation analysis of job satisfaction and the presence of anxiety and/or depressive symptoms. RESULTS: Life satisfaction among the physicians and dentists from the Silesian Province was at an average level. Significant predictors included age and economic status. Additionally, significant predictors in the younger subjects (25-50 years) included the Body Mass Index and practising sports. In turn, in the older subjects (50-80 years), these predictors were related to hospital work and being on sick leave. The study found a significant moderate association between life satisfaction and professional satisfaction. Additionally, a significantly lower level of life satisfaction was reported in the subjects who presented with anxiety and/or depressive symptoms. CONCLUSIONS: Due to its association with the profession, the mean level of life satisfaction among physicians and dentists prompts verification of crucial spheres related to the physical, emotional, social and material well-being and the activity of the professional group.

Subarachnoid Haemorrhage-Incidence of Hospitalization, Management and Case Fatality Rate-In the Silesian Province, Poland, in the Years 2009-2019.

Little is known about the epidemiology of subarachnoid haemorrhage (SAH) in Poland, and until now no such research has been conducted for Silesia, which is the second largest province with circa 4.5 million inhabitants. Therefore, the current study was done to assess the data on SAH in the Silesian Province, Poland. The study was based on the data obtained from the administrative databases of the only public health insurer in Poland (the National Health Fund, NHF) from 2009 to 2019. The SAH cases were selected based on primary diagnosis coded in ICD-10 as I60. The total number of SAH cases was 2014 (41.8% men, 58.2% women). The number of SAH hospitalizations decreased from 199 in 2009 to 166 cases in 2019; p < 0.05. The median age increased from 58 in 2009 to 62 years in 2019; p < 0.001. Endovascular treatment or clipping of the aneurysm was performed in 866 cases (43%). An increase in in-hospital mortality was observed from 31% in 2009 to 38% in 2019 (p = 0.013). Despite the number of stroke units increasing, in-hospital mortality in SAH patients is high, and the number of vascular interventions seems insufficient. Better organization for care of SAH patients is needed in Poland.

The Assessment of Serum Concentrations of AGEs and Their Soluble Receptor (sRAGE) in Multiple Sclerosis Patients.

BACKGROUND: Advanced glycation end products (AGEs) are involved in the pathogenesis of many diseases, including neurodegenerative diseases such as multiple sclerosis (MS). The aim of the study was to determine serum concentrations of AGEs and their soluble receptor (sRAGE) in MS patients and healthy controls and to investigate their possible influence on disease activity. METHODS: Serum concentrations of AGE and sRAGE in patients with MS and healthy controls were determined by enzyme-linked immunosorbent assay (ELISA). RESULTS: The mean serum AGE concentration in patients with MS was higher than in healthy controls, whereas the mean serum sRAGE concentration was lower than in the control group. However, the differences were not statistically significant. In MS patients, serum AGE and sRAGE concentrations did not differ significantly, depending on the duration of the disease and the Expanded Disability Status Scale (EDSS) score. CONCLUSIONS: Multiple sclerosis may be accompanied by disturbances of the AGE-sRAGE axis. However, further studies are warranted to confirm it. The duration of the disease and the degree of disability do not seem to affect the progression of the glycation process, particularly in the stable phase of the disease.

ASSESSMENT OF ADULT EATING HABITS IN THE NUTRITIONAL PREVENTION OF STROKE.

OBJECTIVE: Introduction: Lifestyle modification, including changing eating habits, plays an essential role in the prevention of stroke. The aim: The study aimed to assess the nutritional prevention of cerebrovascular diseases in adult inhabitants of Poland. PATIENTS AND METHODS: Material and Methods: The study was conducted using the author's questionnaire among 145 women and 76 men, aged 18 - 30 (53.9%) and 50 - 70 (46.1%) years. RESULTS: Results: The following stroke risk factors were found in the examined group: overweight or obesity (46.6%), lack of regular physical activity (48%), smoking (33%), hypertension (22.1%), dyslipidemia (8.6%), diabetes (5.9%), and cardiac arrhythmias (6.3%). The younger subjects compared to older ones more often declared the daily consumption of whole-grain cereal products and vegetables, fish at least once a week, and they preferred vegetable oils. On the other hand, older subjects declared the consumption of sweets, sweet drinks, salt, and fast food less frequently than younger ones. Also, fruits were more often chosen by older people. Both groups declared similar moderate consumption of milk and dairy products with reduced fat content, lean meat, and alcohol. Only 38% of respondents considered their eating habits to be appropriate. CONCLUSION: Conclusions: The eating habits of examined adults only partially met the recommendations regarding the nutritional prevention of stroke. In some elements, younger people were more likely to follow appropriate dietary recommendations, while older people were more appropriate in others. The education regarding the principles of the nutritional prevention of cerebrovascular diseases is still necessary and should be age-appropriate.

The mediterranean diet in the prevention of cardiovascular and nervous system diseases - the assessment of nutritional knowledge.

OBJECTIVE: Introduction: Following a Mediterranean diet significantly reduces the risk of cardiovascular and neurodegenerative diseases. The aim of the study was to assess nutritional knowledge among adult residents of the Silesian Province on the Mediterranean diet in the prevention of cardiovascular and nervous system diseases. PATIENTS AND METHODS: Material and methods: The study was conducted using an anonymous self-made questionnaire. 190 adults from the Silesian Province participated in the study. RESULTS: Results: The respondents had a good or sufficient level of knowledge on the Mediterranean diet. Respondents as the benefits of using the Mediterranean diet more often indicated a reduction in the risk of cardiovascular diseases than prevention of nervous system diseases. CONCLUSION: Conclusions: The inhabitants of Silesian Province have a fairly good level of knowledge on the preventive use of the Mediterranean diet. Public knowledge on the prevention of cardiovascular diseases, as well as knowledge on the principles of the Mediterranean diet, and on the benefits of its use, can reduce the incidence of cardiovascular and nervous system diseases.

Multimodal evoked potentials in patients with multiple sclerosis in assessment of the course of the disease.

INTRODUCTION: Multiple sclerosis (MS) is a chronic inflammatory, demyelinating disease of the central nervous system with a multifocal damage. THE AIM: The assessment of the MS course by multimodal evoked potentials (EP). MATERIAL AND METHODS: We evaluated 95 patients (63 female, 32 male) with relapsing-remitting MS in the average age of 36.4±10.4. The average disease duration was 4.6±7.4 year. Among them, 48 patients (50.5%) were treated with immunomodulatory drugs. All patients underwent neurological examination and EP testing: VEP (visual evoked potentials), SEP (somatosensory evoked potentials), endogenous potential P300. The latencies of following waves were evaluated: P100 (VEP), N4 , N9 , N13, N20, P22 (SEP) and P300, with the reference values of the Neurophysiological Research Laboratory of the Department of Neurology in Zabrze. RESULTS: Abnormal VEP(I) was found in 80 patients (84.2%), SEP(I) in 9 patients (9.5%), P300(I) in 15 patients (15.8%). Abnormal result of the control research VEP (II) was found in 23 patients (82.1%), SEP(II) in 1 patient (3.6%), P300(II) in 4 patients (14.3%). The average values of the waves latencies in the control study were higher, however the statistical significance was not found. The correlation was observed between EDSS, and N20 and P22. No relationship was found between EP and age, disease duration, number of relapses and treatment. CONCLUSIONS: In the era of neuroimaging, usage of EP in the diagnosis and assessment of MS is limited. Electrophysiological studies may be used in addition to the clinical examination to confirm the multifocal damage.

[Psychometric and neurophysiological assessment of cognitive functions in patients with epilepsy].

BACKGROUND: The aim of the study was to assess cognitive functions in patients with epilepsy using the neurophysiological method and psychological tests, and analysis the relationship between clinical features of the disease and test results. MATERIAL AND METHODS: The study included 31 patients with epilepsy aged 37.3±18.4 years. The control group consisted of 40 healthy volunteers aged 33.5±12.2 years. Cognitive functions were assessed using endogenous evoked potential P300 and psychological tests - Mini-Mental State Examination (MMSE), three subtests of Wechsler Adult Intelligence Scale-Revised (WAIS-R), Trail Making Test (TMT), Benton Visual Retention Test (BVRT) and State-Trait Anxiety Inventory (STAI). RESULTS: Epileptic patients achieved significantly lower scores in all, except STAI-1, psychological tests in relation to the controls. A correlation between age and TMT-A (p<0.050) and BVRT (p<0.050) was observed. The disease duration affected results of MMSE (p<0.050), TMT-B (p<0.050) and BVRT (p<0.050). Type of seizures was related to results of MMSE (p=0.005), type of therapy - to results of STAI-1 (p=0.014) and TMT-B (p=0.008). The average latency of P300 was significantly prolonged (p=0.00003) in epileptic patients (348±38ms) in relation to the controls (324±26ms). The relationship between P300 and the duration of seizures (p=0.017) was observed. There was no correlation between P300 and age, sex, frequency and type of seizures and therapy. A correlation between P300 and TMT-B (p<0.050), BVRT-LPO(p<0.050) and STAI-1 (p<0.050) was noticed. CONCLUSION: In epileptic patients cognitive impairment is often found. It is advisable to perform regular neuropsychological testing; P300 can be used only as a preliminary assessment.

The usefulness of accelerometric registration with assessment of tremor parameters and their symmetry in differential diagnosis of parkinsonian, essential and cerebellar tremor.

BACKGROUND AND PURPOSE: The aim of the study was to perform an analysis of the recorded tremor using accelerometry and select those parameters that are the most useful in differentiation of tremor types. MATERIAL AND METHODS: We examined 45 patients with parkinsonian tremor (PT), 39 patients with essential tremor (ET) and 35 patients with cerebellar tremor (CT). The control group consisted of 52 healthy persons. The analysis included tremor intensity, frequency of spectral peaks, centre frequency, standard deviation of the centre frequency, and harmonic index. Parameters of tremor were compared between particular groups of patients with pathological tremor and with the control group. The side-to-side symmetry of these parameters was also analysed. RESULTS: Tremor intensity was significantly higher in patients than in controls. There was a significant side-to-side asymmetry of intensity in all patient groups. Significantly lower peak frequency, centre frequency and standard deviation of centre frequency were found in patients compared to the control group. The frequency was symmetric in ET and in controls, but asymmetric in other subjects. The differences between hands regarding the standard deviation of centre frequency were significantly greater in all patient groups than in controls, who revealed no difference of this parameter between sides. Harmonic index was significantly greater and asymmetric in all groups of patients when compared to the control group. CONCLUSIONS: Standard deviation of centre frequency and harmonic index are the most valuable variables in differentiation of tremor. The assessment of symmetry of tremor parameters is useful in discrimination of various types of pathological tremor.

Essential tremor - assessment of tremor accelerometric parameters' symmetry and the relationship between hand dominance and severity of tremor.

BACKGROUND AND PURPOSE: Essential tremor (ET) is likely the most common movement disorder. The aim of the study was to carry out spectral analysis of the essential tremor recorded by an accelerometer and assess the symmetry of tremor parameters between the two hands. MATERIAL AND METHODS: We examined 39 patients with ET diagnosed clinically using the criteria of the Movement Disorder Society. The control group consisted of 52 healthy persons. A biaxial accelerometer mounted at the dorsal side of the hand was used. Spectral analysis was performed. Tremor intensity, frequency of spectral peaks, centre frequency, standard deviation of the centre frequency, and harmonic index were measured. The side-to-side symmetry of these parameters was analysed. The relationship of hand dominance and severity of tremor was also analysed. RESULTS: There was significant side-to-side asymmetry of intensity in ET. The intensity in the more affected hand was over two times higher than that in the less affected one. The tremor was more severe in the nondominant hand in 62% of patients. In spite of significant difference in tremor intensity between the two sides, tremor frequency was similar in both hands. The standard deviation of centre frequency was significantly lower and the harmonic index was significantly higher in the more trembling hand. CONCLUSIONS: Accelerometric registration revealed that asymmetry of intensity and symmetry of frequency are characteristic features of ET. The remaining two coefficients reflecting the rhythmicity and regularity of tremor also differed considerably between the hands.

Assessment of autonomic nervous system in patients with epilepsy in the interictal state. A pilot study.

BACKGROUND AND PURPOSE: Dysfunction of the autonomic nervous system often accompanies partial and generalized epileptic seizures. In some epileptic patients dysfunction of the autonomic nervous system is also present in the interictal state. Cardiovascular autonomic disturbances are possibly associated with the pathogenesis of sudden unexpected death in people with epilepsy. The aim of the study was to evaluate the autonomic nervous system in patients with epilepsy in the interictal state and to assess the clinical usefulness of applied methods. MATERIAL AND METHODS: The study was done in 21 patients with epilepsy (mean age: 35.9 +/-10.7 years; mean duration of the disease: 16.7 +/-14 years). The evaluation of the autonomic nervous system was made using a questionnaire, cardiovascular reflex tests (Ewing's battery) and neurophysiological method (sympathetic skin response). RESULTS: Abnormal score of the questionnaire was present in 57.1% of patients. Cardiovascular autonomic neuropathy (l 2 abnormal tests of Ewing's battery) was diagnosed only in 1 patient. Abnormal sympathetic skin response was found in 33.3% of patients. Duration of the disease influenced the results of Ewing's battery only. CONCLUSIONS: Autonomic dysfunction revealed by cardio- vascular tests is present uncommonly in patients with epilepsy in the interictal state. The questionnaire is a screening method whose result should be confirmed by other tests. The value of sympathetic skin response in diagnosis of dysautonomia in epilepsy needs further studies.