Work-related problems faced by coordinators of organ, cell, and tissue transplantations in Poland and possible ways of ameliorating them.

In recent years in Poland, the numbers of reported potential cadaveric donors of organs, tissues, and cells, and the numbers of transplantations being carried out seem to be low in the context of the size of the country population and the presumed consent legal principle which rules transplantations. This research project was carried out on 109 Polish transplant coordinators by means of a questionnaire created specifically for this study. The goal of the project was to detect problems specific to transplant coordinators working in Poland which, when properly addressed, might improve the efficacy of transplantation network within the Polish health care system. The results suggest that Polish transplant coordinators face a variety of issues in their work. It appears that the most important interventions which could improve working conditions for in this population and-as a result-also improve the efficacy of transplantation network in Poland could include: (1) a variety of training programs for transplant coordinators; (2) a social campaign promoting transplantations and spreading awareness of the transplantation-related legislation; and (3) introduction of changes in the regulations pertaining to medical professions in Poland.

Risk factors for shivering during caesarean section under spinal anaesthesia. A prospective observational study.

BACKGROUND: Shivering during caesarean section (CS) under spinal anaesthesia is a common phenomenon. It could not only alter patient's physiology by increasing oxygen consumption but also affect the parturient's experience of childbirth. Shivering is thought to be associated with intraoperative hypothermia, but the risk factors and exact mechanism remain unclear. METHODS: We conducted a prospective, observational study to examine the potential risk factors for intraoperative shivering, including anxiety levels. Two hundred patients undergoing elective CS under spinal anaesthesia were recruited. Parturient anxiety levels were evaluated using the State-Trait Anxiety Inventory (STAI) questionnaire. Age, weight, height, BMI, anxiety level, number of previous deliveries, sensory block level, level of education, temperature difference during surgery and American Society of Anesthesiologists score were investigated as potential risk factors. Stepwise logistic regression was used to assess the predictors for shivering. RESULTS: Data from 155 parturients were analysed. Shivering incidence was 21.9% (34 parturients). The statistical model predicted 8.5% of a shivering incidence variability (R-square Nagelkerke = 0.085). Out of all measured variables, only the number of previous deliveries [(W) = 4.295 Exp(B) = 0.562 P < .05] and STAI-X1 [(W) = 4.127 Exp(B) = 1.052 P < .05] were significant. In our model, the risk of shivering decreased by 44% with every previous delivery and increased by 5.2% with each 1-point increase in STAI-X1. CONCLUSION: We failed to prove a strong correlation between the measured variables and shivering. Our findings, however, support the hypothesis, that to a limited extent, anxiety promotes shivering during CS.

Professional burnout and its correlates in Polish donor transplant coordinators.

Job demands-resources (JD-R) model of professional burnout states that job demands predict the feeling of exhaustion, and lack of job resources-disengagement from work. This research project investigated professional burnout and it correlates, including sex, death anxiety, and relationship status in 108 Polish donor transplant coordinators involved in organ, tissue, and cell transplantations. This study employed the Polish version of the Oldenburg Burnout Inventory which follows the JD-R model, the Psychosocial Working Conditions Questionnaire-a Polish instrument based on the model of job stress proposed by Karasek-and the Polish version of the Fear of Death and Dying Questionnaire. The results were suggestive of average levels of job stress and burnout in the studied population, with men being more disengaged than women. Participants who were in relationship had significantly higher levels of exhaustion than those who were single. Exhaustion was positively correlated with years of working as a transplant coordinator but not with participants' age. Multiple negative correlations were detected between exhaustion/disengagement and different aspects of job control, social support, and well-being. Moreover, positive correlations between different components of fear of death and dying and exhaustion were detected. Our findings, linking fear of death and dying with some aspects of professional burnout in transplant coordinators, suggest that a pre-employment screening for the level of death anxiety in candidates for transplant coordinators could be useful as this job provides chronic exposure to mortality cues.

Correlates of professional burnout in a sample of employees of cell and tissue banks in Poland.

Job Demands-Resources model proposes that the development of burnout follows excessive job demands and lack of job resources. Job demands are predictive of feeling of exhaustion, and lack of job resources-disengagement from work. This pilot study investigated professional burnout and its correlates in employees of Polish cell and tissue banks, many of whom were involved in procurement and processing of tissues from deceased donors, as it was hypothesized that job burnout in this population might influence the effectiveness of cell and tissue transplantation network in our country. This study utilized the Polish version of the Oldenburg Burnout Inventory (OLBI), which measures the two dimensions of burnout (exhaustion and disengagement), and the Psychosocial Working Conditions Questionnaire (PWC), a Polish instrument used for monitoring psychosocial stress at work. The study sample consisted of 31 participants. Their average time of working in a cell and tissue bank was 13.20 years. Majority of the PWC scales and subscales scores fell in the Average range, and the OLBI results for the Disengagement and the Exhaustion scales were in the Average range. A number of correlations between the Exhaustion or Disengagement and the PWC scales and subscales were detected, majority of which fell in the Moderate range. In spite of the limited number of participants, the results of this pilot study are consistent with the burnout literature reports. Among the detected correlates of professional burnout, it is job-related support which seems to be the most important factor which may influence the efficacy of transplantation network in Poland.

[Burnout syndrome among physiotherapists].

BACKGROUND: Burnout is a syndrome of emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment. Symptoms of burnout include mental and physical exhaustion, accompanied by psychosomatic disorders and emotional problems. Burnout occurs most often in people employed in occupations requiring working with people (human services) as a result of coping with stress and experience numerous failures at work. The aim of the research is the analysis of burnout among physiotherapists and demographic factors and conditions that may contribute to the burnout. MATERIAL AND METHODS: 212 (137 woman and 75 man) physiotherapists completed an anonymous questionnaire to assess burnout created by Owczarek and Olczyk. The age of respondents ranged between 20 to 56 years, with work experience from several months to more than 30 years. RESULTS: Total score of burnout was 115,66 (SD 21,78). On the scale of attitude to work 36,82 was achieved, workload - 34,76, contact with the patient - 27,54, and an attitude towards stress - 16,54, which means that the result obtained fit in the lower zone including average results concerning the level of burnout. Women had a higher level of professional burnout than men. Respondents who reported that their working conditions are not conducive to achieving therapeutic success (quality of equipment, size of treatment rooms, treatment technologies), exhibited a higher level of burnout. The average result of the level of burnout among physiotherapists is lower than all the results obtained in other occupational groups of health care workers, lead with the same diagnostic tool. CONCLUSIONS: Burnout syndrome among practicing physiotherapists require further study, taking into account the type and quality of jobs, but also the level of referral among professional physiotherapists.

[Self-esteem of boys with attention deficit hyperactivity disorder - pilot study]. / Samoocena chlopców z zespolem nadpobudliwosci psychoruchowej i zaburzen koncentracji uwagi - doniesienie wstepne.

AIM: To compare the self concept of boys with ADHD and health subjects; to determine which symptoms ofADHD, oppositional defiant disorder (ODD) or conduct disorder (CD) have the greatest impact on self-concept. METHOD: Polish version of The Harter Self-Esteem Questionnaire (HSEQ) was filled by boys with ADHD and control group. In addition, a diagnosis of ODD and CD was made in ADHD group. RESULTS: A significant difference was observed between boys with ADHD and control group on the following scales of HSEQ: Global Self-Esteem Subscale, Social Acceptance Subscale and Scholastic Performance Subscale. No significant influence of the quantity and intensity of ADHD and ODD symptoms on self-esteem was found. A significant correlation was indicated between all scales of HSEQ and quantity and intensity of symptoms ofADHD. CONCLUSIONS: Boys with ADHD have lower self-esteem than their healthy peers and their global self-esteem, social acceptance and school skills are most affected. The presence of conduct disorder (CD) had the greatest impact on the decrease of self esteem in ADHD group.

The Opinions of Specialists in Obstetrics and Gynecology on the Indications for Pregnancy Termination in Poland-A Preliminary Cross-Sectional Study.

The physician's decision concerning pregnancy termination is influenced by a number of factors. The study aimed at obtaining the opinions of obstetricians and gynecologists with regard to the indications for pregnancy termination, the readiness to perform the procedure personally and the assessment of the determinants thereof. The survey study was conducted between 1 January 2020 and 31 December 2021 among physicians who performed diagnostic prenatal ultrasonography. A considerable majority of physicians participating in the study did not approve of termination without medical indications (62.5%). A marked majority of them considered the following cases as indications for pregnancy termination: severe fetal defects (90%), lethal defects (91.5%) and a disease threatening maternal life (91.5%). A small group of physicians declared that they were ready to perform a termination without medical indications (12.5%). However, they were ready to perform a pregnancy termination personally in cases of threat to maternal life (77.5%), severe fetal defects (75%), lethal fetal defects (75%) and a pregnancy being a result of rape (75%). No statistical significance was observed with regard to the influence of the respondents' sex, the fact of having children or the workplace on the issue of indications for pregnancy termination. It seems justified to develop case-centered counseling concerning abortion, based on specialists in perinatology, law and ethics, especially in countries with more restrictive abortion law or strongly religious societies.

The Influence of Abortion Law on the Frequency of Pregnancy Terminations-A Retrospective Comparative Study.

Abortion law is one of the main factors influencing the number of abortions performed in a country. The study aimed to assess the influence of abortion law on the number of performed terminations with particular attention paid to pregnancy terminations due to fetal defects. The retrospective comparative analysis of statistical data included on the governmental websites of Poland and the UK was performed. The average of 190,733.1 terminations were performed in the United Kingdom in the years 2009-2018 with the average of 2820.9 due to fetal defects. At the same time the average of 858.6 terminations were performed in Poland with 820.7 due to fetal defects. Population size is the only significant predictor of the number of terminations in the United Kingdom. The increase in the number of deliveries and population in Poland was not linked to the increase in the overall number of terminations or terminations due to fetal defects. It might be due to the unavailability of pregnancy terminations in many places. The radicalization of abortion law exerts no influence on the decrease in the number of terminations due to fetal indications. The liberalization of abortion law promotes the increase in the number of terminations due to social indications.

The Quality of Life in Patients with Epilepsy in the Context of Sleep Problems and Sexual Satisfaction.

Epilepsy influences the quality of patient functioning in almost all aspects of life. This study aimed to assess the quality of difficulties with sleep initiation and those concerning sexual function, and to assess whether sleep disorders are associated with selected aspects of sexual function and quality of life. The study involved completing a quality-of-life questionnaire for persons with epilepsy: a QOLIE-31 questionnaire, and the present authors' questionnaire, including 20 questions. A total of 170 questionnaires were completed by 89 men and 81 women. Sleep problems of various frequency were reported by 98 participants (57.6%). Only 41% of patients were definitely satisfied with their sex life. The respondents who declared dissatisfaction with their sex life more often reported difficulties with sleep initiation (χ2 = 10.20; p ≤ 0.001). Moreover, those who claimed that epilepsy might contribute to sex life problems more commonly declared dissatisfaction with their sex life (χ2 = 20.01; p ≤ 0.001) and more frequently, reported difficulties with sleep initiation (χ2 = 6.30; p ≤ 0.012). The issues should constitute the constant element of medical history taking, as improvement in these areas of functioning may promote better quality of life in patients with epilepsy.

Peripartum Predictors of the Risk of Postpartum Depressive Disorder: Results of a Case-Control Study.

BACKGROUND: The study aimed at the identification of the risk factors present during delivery, which might be present in prophylactic programs concerning postpartum mood disorders. MATERIAL AND METHOD: This was a retrospective comparative study. The study material included data retrieved from the medical records of patients hospitalized in the Teaching Department of Gynecology and Obstetrics of Professor Orlowski Hospital in Warsaw, in the years 2010-2017. The EPDS data of 604 patients were analyzed. The study group included 75 women who obtained at least 12 points in the EPDS and the control group was made up of 75 women who obtained no more than 5 points in the EPDS. RESULTS: The women in whom we noted an increased risk of developing mood disorders had blood loss >1000 mL and had a significantly longer stage II and III of labor than the control group. Other risk factors were cesarean section, vaginal delivery with the curettage of the uterine cavity, slightly lower APGAR scores (0.4 pts), and lower birth weight (approximately 350 g) of the child. Women at a low risk of postpartum mood disorders more commonly underwent episiotomy during delivery (76%). CONCLUSIONS: Increased supervision and support should be offered to women who experienced the above-mentioned risk factors.

The change in the intensity of symptoms in children and adolescents with attention deficit hyperactivity disorder after "Workshops for Parents of Hyperactive Children". / Zmiana nasilenia objawów zespolu nadpobudliwosci psychoruchowej po zastosowaniu programu "Warsztatów dla rodziców dzieci nadpobudliwych".

OBJECTIVES: To evaluate changes in the intensity of ADHD symptoms and size effects after the completion of the twelve-week "Workshops for Parents of Hyperactive Children". METHODS: Intervention group included parents (N = 199) of children and adolescents diagnosed with ADHD, who completed the twelve-week parental training. The reference group included parents (N = 24) of children and adolescents diagnosed with ADHD, who received 1-2 standard psychiatric visits within twelve weeks (treatment-as-usual). The following questionnaires were completed by the participants at the beginning and at the end of the training: CBCLand Conners-IOWA-10 (parent's assessment of the child), TRF and Conners-RCTRS-28 (assessment of the child by the teacher/educator), and YSR (in children of 11 years and over). The same diagnostic regime was used in the reference group - the patients were assessed during the first visit and after twelve weeks. RESULTS: The majority of attendees were parents of boys diagnosed with: ADHD mixed type with or without ODD and ADHD predominantly inattentive type. The intervention resulted in significant reduction of inattentive-impulsive-hyperactive and oppositional-defiant symptoms in Conners-IOWA-10 and significant reduction of symptoms in the following CBCL scales: "Social problems", "Attention problems", "Aggressive behavior", "Externalizing behavior", as well as the overall score, as rated by mothers. The improvement was age, diagnosis and pharmacotherapy independent. CONCLUSIONS: The therapeutic program used in our study resulted in small to moderate reduction of symptoms in children and adolescents with attention deficit hyperactivity disorder irrespective of subtype, comorbid disorders or pharmacotherapy (if implemented).

Perinatal Predictors of Postpartum Depression: Results of a Retrospective Comparative Study.

Postpartum mood disorders occur in a considerable number of women with the most common postpartum disorder being baby blues. The study aimed at the identification of the risk factors present before delivery, which may be comprised in prophylactic programs concerning postpartum mood disorders. The research material includes data retrieved from the medical record of patients delivering in Warsaw in the years 2010-2017 who routinely completed Edinburgh Postnatal Depression Scale (EPDS) after delivery. Data of 604 patients were analyzed. The study group included 75 women who obtained at least 12 points in EPDS, which constituted 12.4% of the whole group (mean = 14.92, SD = 3.05). The control group was made up of 75 women who obtained no more than 5 points in EPDS. A significant correlation was reported between the parity and their order vs. the risk of developing postpartum mood disorders. Women with an increased risk delivered at about 37 gestational weeks, while women in whom the risk of such disorders was low delivered at about 39 gestational weeks. No increased risk was noted in women with premature rupture of membranes. Primigravidas and women who delivered prematurely were the most predisposed to developing postpartum depression and should undergo screening tests in the perinatal period.

General health, sense of coherence and coping styles in parents participating in Workshops for Parents of Hyperactive Children. / Ogólny stan zdrowia, poczucie koherencji oraz style radzenia sobie ze stresem rodziców uczestniczacych w "Warsztatach dla rodziców dzieci nadpobudliwych".

OBJECTIVES: The assessment of changes in the general health, sense of coherence and stress coping styles in parents of children and adolescents with ADHD, participating in 12-week Workshops for Parents of Hyperactive Children. METHODS: The experimental group included 186 mothers and 139 fathers (parents of 199 children); the reference group included 23 mothers and 19 fathers (parents of 24 children), attending 1-2 standard medical visits within a 12-week period (treatment as usual). Parents from both groups were assessed twice using (1) the General Health Questionnaire (GHQ), (2) the Life Orientation Questionnaire (SOC-29), and (3) the Coping Inventory for Stressful Situations (CISS). RESULTS: (1) The experimental group showed a significant improvement in the severity of somatic symptoms and anxiety/insomnia in mothers and the general well-being of mothers and fathers. We observed the influence of workshops on manageability and reduction of the emotion-oriented coping in mothers; (2) the participation in the workshops was associated with a statistically significant effect (mostly moderate) in relation to general health of mothers, while TAU was mostly associated with a low or insignificant effect. CONCLUSIONS: The assessed form of interventions improves the functioning of parents of children with ADHD.

Initial experience with endoscopic sleeve gastroplasty in Poland.

INTRODUCTION: Obesity is becoming one of the major public health problems. Bariatric procedures are considered the most effective methods of treating this condition but they are costly and entail a high risk of complications. Thus, there is a need to look for better bariatric treatment solutions. One of the newest, highly promising bariatric methods is endoscopic sleeve gastroplasty (ESG), which is comparably effective to other bariatric procedures in terms of weight loss but at the same time it is much less invasive. MATERIALS AND METHODS: Eight obese patients underwent ESG. Under general anaesthesia, an endoscope was inserted into the stomach, where a row of 4-5 running stitches was placed (from the pyloric part towards the GE junction). Each of the stitches was cinched tight, which resulted in gastric lumen reduction comparable to that achieved with laparoscopic sleeve gastrectomy. RESULTS: The procedures were performed without any severe peri-operative complications. The only adverse event was a minor haemorrhage in one of the patients, which did not require any surgical intervention. After the surgery, the patients reported a substantial weight loss. Mean %TBWL was 8.6%, 15.4% and 19.6% at 1, 2 and 3 months, respectively. CONCLUSIONS: Minimally invasive and highly effective in body weight reduction, endoscopic sleeve gastroplasty is a promising method of treating obesity. The procedure requires appropriate tools and equipment. The method guarantees gastric volume reduction comparable to that achieved with sleeve resection. The initial results confirm that the effectiveness of the surgery in terms of body weight loss is similar to that seen in other forms of bariatric treatment. DISCUSSION: Compared to laparoscopic sleeve gastrectomy, endoscopic sleeve gastroplasty is substantially less invasive. Also, it requires shorter procedure time and shorter hospital stay. Data from other medical centres demonstrate somewhat lower dynamics of total body weight loss but these results need to be verified in a long-term follow-up.

Initial experience with endoscopic sleeve gastroplasty in Poland.

INTRODUCTION: Obesity is becoming one of the major public health problems. Bariatric procedures are considered the most effective methods of treating this condition but they are costly and entail a high risk of complications. Thus, there is a need to look for better bariatric treatment solutions. One of the newest, highly promising bariatric methods is endoscopic sleeve gastroplasty (ESG), which is comparably effective to other bariatric procedures in terms of weight loss but at the same time it is much less invasive. MATERIALS AND METHODS: Eight obese patients underwent ESG. Under general anaesthesia, an endoscope was inserted into the stomach, where a row of 4-5 running stitches was placed (from the pyloric part towards the GE junction). Each of the stitches was cinched tight, which resulted in gastric lumen reduction comparable to that achieved with laparoscopic sleeve gastrectomy. RESULTS: The procedures were performed without any severe peri-operative complications. The only adverse event was a minor haemorrhage in one of the patients, which did not require any surgical intervention. After the surgery, the patients reported a substantial weight loss. Mean %TBWL was 8.6%, 15.4% and 19.6% at 1, 2 and 3 months, respectively. CONCLUSIONS: Minimally invasive and highly effective in body weight reduction, endoscopic sleeve gastroplasty is a promising method of treating obesity. The procedure requires appropriate tools and equipment. The method guarantees gastric volume reduction comparable to that achieved with sleeve resection. The initial results confirm that the effectiveness of the surgery in terms of body weight loss is similar to that seen in other forms of bariatric treatment. DISCUSSION: Compared to laparoscopic sleeve gastrectomy, endoscopic sleeve gastroplasty is substantially less invasive. Also, it requires shorter procedure time and shorter hospital stay. Data from other medical centres demonstrate somewhat lower dynamics of total body weight loss but these results need to be verified in a long-term follow-up.

[Motivational factors in psychotherapy of eating disorders]. / Czynniki motywacyjne w psychoterapii zaburzen odzywiania sie.

AIM: We examined changes in general psychopathology during psychotherapy of patients with eating disorders. We were also interested in distinguishing motivational characteristics of completers and dropouts with anorexia and bulimia nervosa. METHOD: All subjects completed two self-descriptive measures: Motivational Inventory and Hopkins Symptoms Checklist (HSCL-72). Questionnaires were completed three times: during the qualification visit, at admission and two weeks before discharge. RESULTS: It was observed that general psychopathology among patients with anorexia nervosa and bulimia nervosa decreased. Comparing to completers with bulimia nervosa completers with anorexia nervosa had a higher level of activity factor before the treatment. Dropouts with anorexia nervosa differed from completers in decreased level of threat factor and activity factor. Completers with bulimia contrasted markedly with statistically meaningful decrease of the Body Mass Index. CONCLUSIONS: The efficacy of cognitive-behavioural-social psychotherapy of patients with eating disorders seems to be confirmed by large decrease of general psychopathology. Dropouts with anorexia seem to have poorer insight concerned with lower need of health activity.