Features of personality and professional burnout syndrome of physicians - analysis based on questionnaires studies.

INTRODUCTION: This observational study was ordered by the Medical Practitioners' Chamber in Warsaw. THE OBJECTIVE: of the study was to evaluate the problem of professional burnout of physicians correlation between professional burnout and features of personality. MATERIAL AND METHODS: Professional burnout was considered relative to different features of personality. This study was initially carried out from 2005-2008, but further analysis of burnout and personality was carried out from 2017-2018. The research tools were anonymous, validated questionnaires. The sample size was based on the size of the population- the registry of the Regional Chamber of Medical Practitioners and literature on burnout prevalence. The respondents' work places were randomly selected from the Mazovian District register. RESULTS: The test on burnout was completed by 378 respondents, while 62 subjects completed a personality test. Results showed that burnout syndrome was an occupational problem for healthcare workers. Professional burnout affected as many as 42% of respondents (n = 158). It affected two age groups in particular: physicians up to 31 years old and individuals aged 41-50. Moreover, neuroticism was found to be significantly related to burnout syndrome. CONCLUSION: burnout syndrome is common among professionally active medical practitioners, and neuroticism may be correlated with burnout syndrome.

Pexophagy in Penicillin G Secretion by Penicillium chrysogenum PQ-96.

Penicillin G oversecretion by Penicillium chrysogenum PQ-96 is associated with a strictly adjusted cellular organization of the mature and senescent mycelial cells. Abundant vacuolar phagy and extended cellular vacuolization combined with vacuolar budding resulting in the formation of vacuolar vesicles that fuse with the cell membrane are the most important characteristic features of those cells. We suggest as follows: if the peroxisomes are integrated into vacuoles, the penicillin G formed in peroxisomes might be transferred to vacuoles and later secreted out of the cells by an exocytosis process. The peroxisomal cells of the mycelium are privileged in penicillin G secretion.

Evaluation of economic effects of population ageing--methodology of estimating indirect costs.

Process of demographic ageing, especially in recent decades, is steadily growing in dynamics and importance due to increasing health-related needs and expectations with regard to a guarantee of social services. Elaboration of the most effective model of care, tailored to Polish conditions, requires an estimation of actual costs of this care, including indirect costs which are greatly related to informal care. The fact that the costs of informal care are omitted, results from a determined approach to analyses. It is discussed only from a perspective of budget for health and does not cover societal aspects. In such situation, however, the costs borne by a receiver of services are neglected. As a consequence, the costs of informal care are underestimated or often excluded from calculations, even if they include indirect costs. Comprehensive methodological approach for estimating the costs of informal care seems to be important for a properly conducted economic evaluation in health care sector.

Compartmentalization in penicillin G biosynthesis by Penicillium chrysogenum PQ-96.

The arrangement of organelles in the sub-apical productive non-growing vacuolated hyphal cells of the high- and the low-penicillin-pro- ducing strains Penicillium chrysogenum was compared using transmission electron microscopy. In the productive cells of the high-yielding strain the endoplasmic reticulum and the polyribosomes with associated peroxisomes are frequently arranged at the periphery of the cytoplasm and around the vacuoles. At the high activity of penicillin G biosynthesis the immuno-label of the cytosolic isopenicillin N synthase is concentrated at the polyribosomes arranged in the peripheral cytoplasm and along the tonoplast as well as around the peroxisomes. On the basis of the obtained results the compartmentalization of the pathway of penicillin G biosymthesis is discussed. The obtained results support the phenylacetic acid detoxification hypothesis of penicillin G biosynthesis.

Determining the use of health care services by obese inhabitants of Warsaw. A preliminary study.

BACKGROUND: The excessive use of health care services by obese people constitutes a serious financial burden to all highly developed countries. As yet however, this has not been recognised to be a problem in Poland. OBJECTIVE: To provide a preliminary analysis of Warsaw inhabitants in their use of and quality of received health care by comparing obese subjects with those of normal weight. MATERIALS AND METHODS: Study subjects were fifty three obese (BMI > 30) and one hundred eighty one normal weight (18.5 < BMI < 25) inhabitants of Warsaw, who had taken part in a study on social participation in health care reforms. The use of health care services covered: visits to public health care physicians, hospitalisation and visiting private physicians. Assessing health care quality was by evaluating overall the health care system and the family doctor as well as out-of-pocket treatment expenses and any difficulties in accessing physicians. RESULTS: Obese subjects perceived their health to be significantly worse than those of normal weight and significantly more of them never attended private practice. Consultation with public health physicians was also frequently, but not significantly, higher in the former whilst hospital admissions were the same in both groups. Obese subjects gave considerably lower general assessments of the quality of the health care system and more often perceived their medical expenses as being very high, nevertheless, both these differences were statistically insignificant. CONCLUSIONS: The obtained findings have allowed us to formulate new recommendations for future research. These will examine various uses of health care services by the obese, i.e. family doctors and other specialists of public primary health care, out-patient clinic physicians and private physicians (according to their defined specialisations), hospitals according to location and rehabilitation centres. Account will be taken of visiting frequency, admission waiting time for physicians, length of visits, amounts of prescribed medication, out-of-pocket payment for treatment and medication, frequency of surgical interventions, satisfaction with given treatments and physician attitudes towards obese patients. Moreover, the socioeconomic status of the obese will be investigated as a potential obstacle to using health care services.

The risk of overweight and obesity in chronic diseases among Warsaw inhabitants measured by self-reported method.

BACKGROUND: Obesity is well known cause of various diseases. However, there are only a few studies which enable to compare directly the magnitude of risk in different groups of chronic diseases. OBJECTIVES: The aim of presented paper was to identify a magnitude of the risk of chronic diseases attributable to overweight and obesity on the basis of data on weight and height self-reported by respondents. MATERIAL AND METHODS: The survey was conducted among 402 Warsaw inhabitants selected by non-random method. Overweight and obesity was measured by Body Mass Index (BMI) on the basis of the data of weight and height reported by respondents. According to WHO criteria the normal weight is defined as BMI 18.5 - 24.9 kg/m2, overweight as BMI 25.0 - 29.9 kg/m2, and obesity as BMI 30 kg/m2 or more. The following groups of chronic diseases were included: cancer, diabetes and other endocrine diseases, mental disorders, cardiovascular diseases, respiratory diseases, digestive diseases, arthritis and allergy disorder. RESULTS: Obesity measured by self-reported method was recognised as significant risk factor for diabetes (OR=9.6, CI: 2.0-152.8), respiratory diseases (OR=10.6, CI: 3,0-333,7), cardiovascular diseases (OR=5.2, CI: 1.9-108.3), arthritis (OR=6.3, CI: 2.4-266.7), digestive diseases (OR=3,8, CI: 1.3-83.6) and mental disorders (OR=5.8, CI: 1.5-29.1), while overweight significantly increased the risk of diabetes (OR=4.4, CI: 1.2-10.8), respiratory diseases (OR=3.2, CI: 1.4-22.2), cardiovascular diseases (OR=2.9, CI: 1.2-6.4) and arthritis (OR=3.0, CI: 1.1-9.6) CONCLUSIONS: Our findings showed that data on weight and height collected by survey method provide some information about the magnitude of the risk regarding particular groups of diseases attributable to overweight and obesity, nevertheless, underestimation of BMI calculated in this way should be taken into account.

[Willingness of Warsaw inhabitants to cooperate with health service. I. Opinions on health reforms]. / Gotowosc mieszkaniców Warszawy do wspólpracy ze sluzba zdrowia. I. Opinie o reformie zdrowia.

Social participation in undertaking public decisions is one of the main determinants of good governance. Recognizing to what extent people are ready to participate in the process of reforming health care as an active partners seems to be necessary. Therefore, in Health Promotion and Postgraduate Education Department of NIPH-NIH the study aimed at examining citizen's willingness to cooperate with health staff and gathering their opinions on health reform was carried out. The not-addressed questionnaires were conveyed to 1700 households in Warsaw and 402 correct completed were received. Our findings indicate that one of four Warsaw citizens was ready to participate jointly with health workers in health reform. The willingness was higher in women, older people, higher educated and pensioners. From perspective of their own health, respondents perceived the following issues as requiring a change in the time of health reform: easier access to specialist treatment (60,9%), changing the health insurance system (17,3%), reduction in medicines price (14,8%), improving the quality of medical services (14,0%), easier access to diagnostic tests (13,6%) and to primary care physicians (10,7%), improving the health and social security of old people (9,0%), easier access and wider range of preventive examinations (7,4%), facilitate the sanatorium treatment (4,1%) and rehabilitation (3,7%).

[Willingness of Warsaw inhabitants to cooperate with health service. II. Evaluation of health and retirement security]. / Gotowosc mieszkankców Warszawy do wspólpracy ze sluzba zdrowia. II. Ocena bezpieczenstwa zdrowotnego i emerytalnego.

Providing citizens with health security is one of the main challenges for health policy. For the effective modifying the health an social care system it is very important to recognize how citizens themselves perceived their health and retirement assurance. The article presents the analysis of assessment of health care system, out-of-pocket payments for treatment, and retirement system by Warsaw inhabitants in relation to demographic characteristics and health indicators. Data were collected using not-addressed questionnaire. Our findings indicated that women, people aged 30-64 years, those having vocational education and unemployed, the others out of work as well as employed more negatively assessed health care system in comparison to the other demographic groups. The youngest and oldest people, those having elementary education and those who were economically inactive relatively frequently declared bearing very high expenses for treatment. The retirement system was more negatively assessed by women, people under 45 years, unemployed and the others out of work. The analysis of the relationship between perceived health and out-of-pocket payments for treatment and selected health indicators showed that people, who positively assessed existing health care and declared low expenses for treatment, higher evaluated their health, less frequently stayed at home because of ill-health, less frequently were in contact with physician and rarely were treated in hospital. Such differences were not noted (except one) for retirement security.

[Willingness of Warsaw inhabitants to cooperate with health service. III. Use of different types of treatment]. / Gotowosc mieszkanców Warszawy do wspólpracy ze sluzba zdrowia. III. Korzystanie z róznych rodzajów leczenia.

BACKGROUND: The global economic crisis led to the need to reduce the public expenditure, including health care. In a situation of reduction of the publicly guaranteed benefits, some services may be available only in private physicians for particular patients. Therefore, there is a need to examine factors determining the use of both types of health care. OBJECTIVES: The aim of the study was to assess the association between the use of free treatment of general practitioner and the use of private physician services on one hand, and health and its disorders, assessment of physician, and expenditure on treatment of the Warsaw inhabitants on other hand. MATERIAL AND METHODS: The data were collected from 402 Warsaw inhabitants by not-addressed questionnaire elaborated in Health Promotion and Postgraduate Education Department of the National Institute of Public Health-National Institute of Hygiene. RESULTS: Our findings showed that the majority of respondents used the both types of health care. Males, people from the youngest and the oldest group, those having elementary education, students and unemployed were more likely to use only free treatment from general practitioner, whereas people aged 30-44 years, higher educated, employed and those depending on other people were more often treated only by private physicians. The beneficiaries of only private physician services higher evaluated their health, physically felt better, perceived stronger social support and rarely remained at home due to illness. Private physicians were evaluated more positively in comparison with general practitioner practicing in public health care, nevertheless, the difference was not large. With respect to their own financial situation, the people using private physician services did not find higher medical expenses than those using only the general practitioner of public health care. CONCLUSIONS. Our research indicates that uncontrolled development of private medical services market may increase inequality in access to health care, if not protected by appropriate access to public health care.

Determinants of self-rated health of Warsaw inhabitants.

BACKGROUND: Self-rated health is a one-point measure commonly used for recognising subjectively perceived health and covering a wide range of individual's health aspects. OBJECTIVE: The aim of our study was to examine the extent to which self-rated health reflects the differences due to demographic characteristics, physical, psychical and social well-being, health disorders, occurrence of chronic disease and negative life events in Polish social and cultural conditions. MATERIAL AND METHOD: Data were collected by non-addressed questionnaire methods from 402 Warsaw inhabitants. The questionnaire contained the questions concerning self-rated health, physical, psychical and social well-being, the use of health care services, occurrence of chronic disease and contact with negative life events. RESULTS: The analysis showed that worse self-rated health increased exponentially with age and less sharply with lower level of education. Pensioners were more likely to assess their own health worse then employed or students. Such difference was not found for unemployed. Compared to married, the self-rated health of divorced or widowed respondents was lower. Gender does not differentiate self-rated health. In regard to well-being, self-rated health linearly decreased for physical well-being, for social and, especially, for psychical well-being the differences were significant, but more complicated. Hospitalisation, especially repeated, strongly determined worse self-rated health. In contrast, relationship between self-rated health and sickness absence or frequency of contact with physician were lower. Chronic diseases substantially increased the risk of poorer self-rated health, and their co-morbidity increased the risk exponentially. The patients with cancer were the group, in which the risk several times exceeded that reported for the patients of other diseases. Regarding negative life events, only experience with violence and financial difficulties were resulted in worse self-rated health. CONCLUSIONS: Our findings confirmed the usefulness of self-rated health for public health research.

Amateur Athlete with Sinus Arrest and Severe Bradycardia Diagnosed through a Heart Rate Monitor: A Six-Year Observation-The Necessity of Shared Decision-Making in Heart Rhythm Therapy Management.

Heart rate monitors (HRMs) are used by millions of athletes worldwide to monitor exercise intensity and heart rate (HR) during training. This case report presents a 34-year-old male amateur soccer player with severe bradycardia who accidentally identified numerous pauses of over 4 s (maximum length: 7.3 s) during sleep on his own HRM with a heart rate variability (HRV) function. Simultaneous HRM and Holter ECG recordings were performed in an outpatient clinic, finding consistent 6.3 s sinus arrests (SA) with bradycardia of 33 beats/min. During the patient's hospitalization for a transient ischemic attack, the longest pauses on the Holter ECG were recorded, and he was suggested to undergo pacemaker implantation. He then reduced the volume/intensity of exercise for 4 years. Afterward, he spent 2 years without any regular training due to depression. After these 6 years, another Holter ECG test was performed in our center, not confirming the aforementioned disturbances and showing a tendency to tachycardia. The significant SA was resolved after a period of detraining. The case indicates that considering invasive therapy was unreasonable, and patient-centered care and shared decision-making play a key role in cardiac pacing therapy. In addition, some sports HRM with an HRV function can help diagnose bradyarrhythmia, both in professional and amateur athletes.

Character of abuse towards the elderly through history.

Abuse, neglect and other forms of discrimination towards the elderly have always been present in history. There has been a model of "old person" in every culture, according to which older people are treated. The more idealized the model is, the less tolerant and more demanding society is towards the elderly. Presented results lead to the conclusion that significant number of older people feel mistreated because of their age in many aspects of daily life. Various forms of abuse may be difficult to thoroughly analyze, for they are so persistent in our collective consciousness. Unfortunately, material civilization progress is not sufficient to eliminate abuse. Thus, monitoring and relevant assistance to people exposed to abuse and violence, particularly those with compromised defense abilities, is crucial.

[Depression, overweight and perceived body image among adolescents living in suburban areas]. / Depresja a nadwaga i postrzegany wyglad ciala wsród mlodziezy mieszkajacej na terenach podmiejskich.

The aim of the article is to explore the association between depression and overweight among adolescents living in suburban areas and to verify to what extend the acceptance of body image may be a mediating factor. The study was conducted on the sample of 322 students (girls--51.2%, boys--48.8%) aged 16 - 19 years attending two senior high schools in Radzymin. Overweight was measured by Body Mass Index (BMI) and according to WHO recommendations the following categories were established: BMI < 20--underweight, 20 < BMI < 25--normal weight, BMI > 25--overweight or obese. A question about the acceptance of body image contained four possible answers: I'm okay/I do not weight properly, but I accept myself/I do not accept myself, I'm too thin/I do not accept myself, I'm to thick. Beck Depression Inventory (BDI) was used for measure the level of depression. Unexpectedly, our investigations found association between depression and overweight only for boys. In turn, the girls, as expected, lower accepted their body image than boys. Moreover a considerable percents of girls whose weight was normal, and even those with underweight, perceived themselves as thick. The association between acceptance of body image and depression was confirmed only for girls. Our study suggests that the lack of acceptance of body image, especially by girls, to greater extend causes the appearance of depression than real overweight.

The risk of blood-borne infections in Poland - opportunities and threats to public health, nationwide qualitative research.

INTRODUCTION: The article presents the diagnosis of the problem of blood-borne infections in Poland from perspectives of experts' opinions at the voivodship level. The evaluation became the basis for subsequent analysis, aimed at creating assumptions for the proposed strategies to prevent blood-borne infections in Poland. MATERIAL AND METHODS: Diagnosis was based on the expertise of practitioners in epidemiology and service providers. Analysis covered assessment of service safety, examples, recommended practices, forms and scope of education. Also covered is information for the general public from different aspects: points of view of recipients and service providers, legislation, system organization, and finances. The SWOT method was used in analysis. The opportunities and threats concerning the risk of blood-borne diseases for the service sector are presented, as well as data gathered from 42 representative experts from across Poland. RESULTS: Databases on health indicators, covered by the reporting obligation of all diagnosed cases, are a crucial element of the surveillance system in public health (e.g. sentinel). Additional information on health care management (risk management) is not a common and routine approach. The study fills a gap in knowledge about risk management in the medical and non-medical services sector. The information also enriches education programmes (e.g. http://www.hcv.pzh.gov.pl/). CONCLUSIONS: Currently, the evidence-based approaches in medicine and in public health are standard. Experts emphasize that the opportunities for the prevention of infection risk are linked to technological advances and innovations, while threats are seen in both financial and organizational constraints, and the non-normalized, dynamically developing service market.

Disposal of Waste from Tattoo and Beauty Parlors in Poland: A Survey-Based Analysis on Epidemiological Safety.

Appropriate waste management is increasingly relevant due to environmental and infectious disease transmission concerns. An anonymous observational cross-sectional study was conducted from 2013-2017 of 262 tattooists and 824 beauticians throughout Poland. Knowledge, attitudes, behavior, and compliance with blood-borne infection controls and correct waste disposal were assessed. Tattooists correctly addressed hazardous waste significantly more often than did beauticians (83.3% vs. 44.8%). Medical waste was collected by a specialist company in 90.1% of tattoo parlors and 63.3%of beauty parlors. Tattooists correctly used and disposed of sharps more frequently than beauticians (93.1% vs. 68.9%); however, 46.4% of beauticians and 12.4% of tattooists discarded waste into municipal trash, including sharps (27.1% and 2.6%, respectively). Incorrect collection and labeling of biological waste present occupational risk to waste disposal personnel. Education and instructional controls could improve health safety in this industry. Biological waste management processes are restrictive for medical services and liberal for beauty services, an industry for which they should also be applied more comprehensively.

Assessment of Epidemiological Safety in the Cosmetic Service Industry in Poland: A Cross-Sectional Questionnaire Study.

The variety of current cosmetic procedures has increased the potential risks of adverse events and infections. In a nationwide cross-sectional study (2013-2015), we assessed the aspects of infection risk in cosmetic services. An anonymous voluntary questionnaire survey was conducted among 813 employees of cosmetic establishments in Poland. The establishments were selected from a register of service providers. The survey was conducted by employees of the State Sanitary Inspectorate during an audit, and the results showed that cosmetic providers were not fully prepared for risk assessment in terms of occupational exposure or infection transmission. The majority of the respondents (84%) reportedly washed the salon tools. Some establishments did not perform any decontamination (2%) or sterilization (~13%) procedures. Occupational punctures or lacerations occurred from needles, ampoules-syringes, or razors. Most respondents had attended professional training or studied medical textbooks. Approximately 1.7% of the respondents had not updated their knowledge, and 5% gained knowledge from unauthorized sources.The project's results impacted a variety of innovations and improvements in the field of public health. The results were used to update the national education program (2012-2017); more attention has been directed toward effective education in infection prevention, general hygiene, and post-exposure procedures. Moreover, the study's results were grounds for the introduction of legislative modifications in the field of epidemiological safety standards for cosmetic services in Poland.

To Be a Champion of the 24-h Ultramarathon Race. If Not the Heart ... Mosaic Theory?

This comprehensive case analysis aimed to identify the features enabling a runner to achieve championship in 24-h ultramarathon (UM) races. A 36-year-old, multiple medalist of the World Championships in 24-h running, was assessed before, one and 10 days after a 24-h run. Results of his extensive laboratory and cardiological diagnostics with transthoracic echocardiography (TTE) and a one-time cardiopulmonary exercise test (CPET) were analyzed. After 12 h of running (approximately 130 km), the athlete experienced an increasing pain in the right knee. His baseline clinical data were within the normal range. High physical efficiency in CPET (VO2max 63 mL/kg/min) was similar to the average achieved by other ultramarathoners who had significantly worse results. Thus, we also performed genetic tests and assessed his psychological profile, body composition, and markers of physical and mental stress (serotonin, cortisol, epinephrine, prolactin, testosterone, and luteinizing hormone). The athlete had a mtDNA haplogroup H (HV0a1 subgroup, belonging to the HV cluster), characteristic of athletes with the highest endurance. Psychological studies have shown high and very high intensity of the properties of individual scales of the tools used mental resilience (62-100% depending on the scale), openness to experience (10th sten), coherence (10th sten), positive perfectionism (100%) and overall hope for success score (10th sten). The athlete himself considers the commitment and mental support of his team to be a significant factor of his success. Body composition assessment (%fat 13.9) and the level of stress markers were unremarkable. The tested athlete showed a number of features of the champions of ultramarathon runs, such as: inborn predispositions, mental traits, level of training, and resistance to pain. However, none of these features are reserved exclusively for "champions". Team support's participation cannot be underestimated. The factors that guarantee the success of this elite 24-h UM runner go far beyond physiological and psychological explanations. Further studies are needed to identify individual elements of the putative "mosaic theory of being a champion".

Bridging the Gap between Theory, Practice, and Policy: A Decision-Making Process Based on Public Health Evidence Feasible in Multi-Stage Research on Biological Risk Factors in Poland.

Stakeholder input into the decision-making process when developing public health programs and policies is crucial. This article presents an innovative approach, involving online participation with a wide group of stakeholders located in different geographic locations for policy consensus. The results of the project have been used to propose assumptions regarding a strategy for preventing blood-borne diseases in Poland. The research was conducted iteratively using a multi-stage qualitative methodology to explore risk assessment involving blood-borne infections. The final output of the study is a list of key problems/challenges and potential solutions associated with medical and nonmedical services that are connected to the breakage of tissue continuity. Qualitative research is rare in risk assessment, as priority is generally given to statistical data and endpoints. In addition to policy preparation for blood-borne illnesses, the methodology employed in the study can also be used to successfully explore other areas of public health.

Strengths and Weaknesses in the Risk Management of Blood-Borne Infections: Qualitative Research in Public Health.

This article presents the research from the first phase of our study on blood-borne risk management, wherein we solicited epidemiologists' and healthcare practitioners' expert opinions on a blood-borne infection risk assessment in Poland. Forty-two experts were recommended by epidemiology consultants and recruited from all districts in Poland. We used the SWOT (Strengths, Weaknesses, Opportunities, Threats) method in the evaluation. Experts' opinions showed that there is room for improvement in the prevention of blood-borne infections. Commonly reported weaknesses in the risk assessment included gaps in knowledge and inappropriate procedures, which are largely caused by financial constraints and practitioners' lack of awareness of developments in their trade. Strengths included legal regulations for medical services and procedures, surveillance, and increasing awareness on the part of medical staff. When paired with the existing statistical data, these results provide a comprehensive view of the problem of blood-borne infections in Poland. The analysis supported the development of a strategy proposal to prevent blood-borne infections and enhance existing risk assessment procedures.

Assessing Infection Risks among Clients and Staff Who Use Tattooing Services in Poland: An Observational Study.

Across cultures and generations, people have tattooed their bodies. Although blood-borne infections from tattooing have been reduced, certain service aspects remain improperly managed. We assessed the infection risks associated with tattooing by conducting a cross-sectional study (2013-2014) in Poland using an anonymous questionnaire survey. Scoring procedures for blood-borne infection risks for tattooists and their clients were used. Overall, 255 tattooists were interviewed. A quasi-random selection of tattoo parlors was based on a service register. Knowledge, attitudes, and behavior regarding blood-borne infection risks were assessed using a questionnaire. Simultaneously, tattoo centers were audited. Tattooing had a higher infection risk for tattooists than for clients. Approximately 50% of respondents underwent training on postexposure procedures, which constituted almost one in five of the reported needlestick/cut injuries sustained while working. Furthermore, 25.8% had no knowledge regarding risk from reliable sources, and 2.1% had not broadened their knowledge. Tattooists and their clients are at a risk of infection, and knowledge concerning infection risks remains an underestimated preventative factor. Service quality surveillance and creation of a register for tattoo-related complications may help assess the scale of this public health issue. However, a lack of these records implies the challenges in developing effective organizational and legal protections.