How to measure ego-resiliency in the face of various life-changing crises: Measurement invariance, convergent and discriminant validity and reliability of the Polish version of the Revised Ego-Resiliency Scale (ER89-R12).

This study examines the generalizability of the latent structure of the Polish version of the Ego-Resiliency Scale (ER89-R12), a brief self-report scale that measures ego-resiliency. We investigated the measurement invariance, validity, and reliability of ER89-R12 among three groups of individuals who were facing various major, long-term, life-changing crises (N = 512): parents of children with Down's syndrome, women with breast cancer, and individuals after divorce. The analysis of the measurement invariance confirmed the two-factor structure of the questionnaire and the high reliability of this measure in those studied groups. A multigroup confirmatory factor analysis provided evidence of configural, metric, scalar, and residual invariance across the three groups. Moreover, the correlation patterns were similar across the groups. Ego-resiliency was strongly and consistently positively correlated with mental health: psychological well-being, perceived social support, self-esteem, and post-traumatic growth, and negatively correlated with perceived stress. The presented results indicate the potential usefulness of the ER89-R12 tool in studies on people experiencing various crises in their lives.

Health-Related Quality-of-Life among Pregnant Women after First, Second, and Multiple Cesarean Sections in the Perinatal Period: A Short-Term Longitudinal Study.

The primary objective of this study was to compare assessments of health-related quality-of-life (HRQoL) in women who had a medical qualification for cesarean section (CS), depending on the number of CSs in their medical history. A short longitudinal study was conducted among 115 women on the day before a planned cesarean section (CS)-T1, and on the third day after CS-T2. They were divided into three groups. G1: no CS (n = 17); G2: one CS (n = 34); G3: two or more CSs (n = 64). Participants completed a set of questionnaires concerning sociodemographic aspects and psychological outcomes: the HRQoL questionnaire (EQ-5D-3L). A chi-square test, McNemar's test, and repeated measures ANOVA were used to compare the three groups in T1 and T2. Regardless of the number of CSs, before a CS, women mainly experience health problems with pain and anxiety/depression, and after a CS, mostly problems with pain, usual activity, and mobility. All participants experienced an increase in the amount of health problems with mobility and pain after a CS. Women who have had two or more CSs also had problems with self-care and usual activities. Women who have had one or two CSs experienced a decrease in the general assessment of the HRQoL, which is not observed in the group of women with multiple CSs. However, the HRQoL of women in the group with multiple CSs was lower before the CS than in the other groups. The results indicated the significance of the number of CSs, not only in postoperative, but also in preoperative HRQoL.

Common model of stress, anxiety, and depressive symptoms in pregnant women from seven high-income Western countries at the COVID-19 pandemic onset.

OBJECTIVE: Increases in stress, anxiety, and depression among women pregnant during the COVID-19 pandemic have been reported internationally. Yet rigorous comparison of the prevalence of maternal mental health problems across countries is lacking. Moreover, whether stress is a common predictor of maternal mental health during the pandemic across countries is unknown. METHODS: 8148 pregnant women from Germany, Israel, Italy, Poland, Spain, Switzerland, and the United States were enrolled in the International COVID-19 Pregnancy Experiences (I-COPE) Study between April 17 and May 31, 2020. Sociodemographic characteristics, pandemic-related stress, pregnancy-specific stress, anxiety, and depression were assessed with well-validated instruments. The magnitude of stress and mood disturbances was compared across countries. A path model predicting clinically significant levels of anxiety and depression from maternal characteristics and stress was tested for all study participants and then examined separately in each country with >200 participants. RESULTS: Countries differed significantly in magnitude of pandemic-related pregnancy stress and pandemic-unrelated pregnancy-specific stress, and in prevalence of clinically significant anxiety and depression levels. A well-fitting common path model for the entire sample indicated that mood and anxiety disturbances were strongly predicted by pandemic-related and pregnancy-specific stress after accounting for maternal characteristics. The model was replicated in individual countries. CONCLUSIONS: Although pregnant women in high-income Western countries experienced different levels of stress resulting from the COVID-19 pandemic, stress is a strong, common predictor of anxiety and depressive symptoms in these individuals. The common model can be used to inform research and clinical interventions to protect against adverse consequences of prenatal maternal stress, anxiety, and depression for mothers and infants.

Anxiety among pregnant women during the first wave of the COVID-19 pandemic in Poland.

Although anxiety is common because of the transitional nature of the perinatal period, particularly high levels of anxiety have been observed in some studies of pregnant women during the pandemic. The purpose of this study was to evaluate the severity of anxiety among pregnant women during the first wave of the COVID-19 pandemic in Poland, and factors associated with it. Cross-sectional study with a total of 1050 pregnant women recruited via social media in Poland during the first wave of the COVID-19 pandemic, from March 1 until June 1, 2020. The survey included validated psychological measures: the GAD-7 (anxiety), the PREPS (pandemic stress), with two subscales: preparedness and infection stress, and obstetric, sociodemographic and COVID-19 related variables. T-tests, ANOVAs, and hierarchical binary logistic regression for dichotomized GAD-7 scores (minimal or mild vs. moderate or severe) were used. Over a third of respondents experienced moderate or severe levels of anxiety. Predictors of moderate or severe anxiety were non-pandemic related factors like unplanned pregnancy and emotional and psychiatric problems, as well as pandemic related pregnancy stress. Levels of anxiety among pregnant women during the first wave of the COVID-19 pandemic in Poland exceeded pre-pandemic norms. Findings suggest that prior psychiatric conditions, unplanned pregnancy, and elevated pandemic-related pregnancy stress due to concerns about infection or poor preparation for birth contributed to the risk of high anxiety in Polish pregnant women during the pandemic onset. Given the harmful effects of antenatal anxiety on the health and well-being of mothers and their children, psychotherapeutic interventions, efforts to alleviate pregnant women's stress, and training in adaptive ways to cope with stress are vital to reduce the prevalence of maternal anxiety and its potential consequences during this global crisis.

Sex-Dependent Differences in Predictive Value of the C2HEST Score in Subjects with COVID-19-A Secondary Analysis of the COLOS Study.

Background: Since the outbreak of the COVID-19 pandemic, a growing number of evidence suggests that COVID-19 presents sex-dependent differences in clinical course and outcomes. Nevertheless, there is still an unmet need to stratify the risk for poor outcome at the beginning of hospitalization. Since individual C2HEST components are similar COVID-19 mortality risk factors, we evaluated sex-related predictive value of the score. Material and Methods: A total of 2183 medical records of consecutive patients hospitalized due to confirmed SARS-CoV-2 infections were analyzed. Subjects were assigned to one of two of the study arms (male vs. female) and afterward allocated to different stratum based on the C2HEST score result. The measured outcomes included: in-hospital-mortality, three-month- and six-month-all-cause-mortality and in-hospital non-fatal adverse clinical events. Results: The C2HEST score predicted the mortality with better sensitivity in female population regarding the short- and mid-term. Among secondary outcomes, C2HEST-score revealed predictive value in both genders for pneumonia, myocardial injury, myocardial infarction, acute heart failure, cardiogenic shock, and acute kidney injury. Additionally in the male cohort, the C2HEST value predicted acute liver dysfunction and all-cause bleeding, whereas in the female arm-stroke/TIA and SIRS. Conclusion: In the present study, we demonstrated the better C2HEST-score predictive value for mortality in women and illustrated sex-dependent differences predicting non-fatal secondary outcomes.

Recurrent COVID-19 Polymerase Chain Reaction (PCR) Positivity in 2 Patients During the Current Health Care System Crisis.

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic is becoming challenging for public health crisis management. Effective detection method such as the criterion standard real-time reverse-transcription polymerase chain reaction (rRT-PCR) test is the only reliable option for the Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2). RT-PCR detects the genetic material of the virus but does not distinguish the infectious periods. Other diagnostic methods as serological tests and computed tomography (CT) are less accurate but can provide complementary information, especially in the face of new SARS-CoV-2 variants. Here, we report 2 cases of coronavirus-infected patients with recurrent RT-PCR positivity after recovery, which raised questions about possible reinfection. CASE REPORT A married couple, a 44-year-old woman and a 45-year-old man, after COVID-19 recovery, from April to August 2020 presented dynamic RT-PCR outcomes (oscillating from negative to positive). Anti-SARS-CoV-2 immunoglobulin G (IgG) levels for both patients were 1000 U/ml, indicating seroconversion. As a result of recurrent positivity, the patients were isolated and had limited access to healthcare. In the follow-up period, combining RT-PCR results with serology testing and CT allowed determination of the patients' infectiousness. CONCLUSIONS Due to emerging coronavirus variants, individuals with dynamic PCR results, especially with post-COVID-19 syndrome, are indistinguishable from those who are infectious. Misdiagnosis causes unnecessary quarantines and exacerbates the health care crisis. Patients who had dynamic RT-PCR for SARS-CoV-2 require different diagnostics methods from those used in patients with a first-time positive test result. Combining diagnostic methods and identification of new variants of SARS-CoV-2 allows better estimation of the risk of reinfection.

Investigation of Repeatability of Peak Nasal Inspiratory Flow Rate Measurements Under Baseline Conditions and After Administration of 0.05% Oxymetazoline.

OBJECTIVES: Peak nasal inspiratory flow (PNIF) measurement is an inexpensive and user-friendly method to assess nasal patency. However, the repeatability of PNIF measurements, as well as the threshold value of a change in PNIF, which can be considered significant remain unclear. This study aims to investigate the repeatability of PNIF measurements and the change in PNIF after the administration of 0.05% oxymetazoline. METHODS: Repeated measurements of PNIF (Clement Clarke In-Check nasal inspiratory flow meter; Clement Clarke International, Ltd, Harlow, Essex, UK) were obtained in 333 healthy volunteers (174 women). Based on age, participants were categorized into three groups (6-7 years, 13-14 years, and 20-45 years). We obtained five measurements in each participant. PNIF was remeasured in 294 subjects 30 min after administration of 0.05% oxymetazoline. The variability in PNIF measurements was assessed using the coefficient of variation (CV = standard deviation × 100%/mean). RESULTS: The first four PNIF measurements significantly differed from each other. The difference in PNIF measurements ceased to be statistically significant only between the fourth and fifth measurements (p = 0.19). PNIF repeatability was acceptable; the median CV was 15.5% (0-66), which did not significantly differ between age groups. The administration of 0.05% oxymetazoline led to a statistically significant increase in the PNIF value by 14.3% (-45, 157%) (p = 0.000000). CONCLUSIONS: 1. No statistically significant difference was observed in PNIF values only between the fourth and fifth measurements; therefore, at least three measurements are essential to draw meaningful conclusions. 2. PNIF measurements were satisfactorily characterized by a relatively low CV (15%). 3. The administration of 0.05% oxymetazoline led to an increase in PNIF by approximately 14% over the baseline value.

Pandemic Stress and Its Correlates among Pregnant Women during the Second Wave of COVID-19 in Poland.

Background: The ongoing COVID-19 pandemic has created numerous stressful conditions, especially for vulnerable populations such as pregnant women. Pandemic-related pregnancy stress consists of two dimensions: stress associated with feeling unprepared for birth due to the pandemic (Preparedness Stress), and stress related to fears of perinatal COVID-19 infection (Perinatal Infection Stress). The purpose of our study was to elucidate the association between various factors-sociodemographic, obstetric, pandemic-related, and situational-and pandemic stress in its two dimensions during the second wave of the COVID-19 pandemic in Polish pregnant women. Methods: A cross-sectional study with a total of 1119 pregnant women recruited during the second wave of the COVID-19 pandemic in Poland (between November 2020 and January 2021). Participants were recruited via social media to complete an online study questionnaire that included sociodemographic, obstetric, situational, and COVID-19 pandemic factors, as well as the Pandemic-Related Pregnancy Stress Scale (PREPS). Results: Nearly 38.5% of participants reported high Preparedness Stress; 26% reported high Perinatal Infection Stress. Multivariate analyses indicated that lack of COVID-19 diagnosis, higher compliance with safety rules and restrictions, and limited access to outdoor space were independently associated with moderate to severe levels of Infection Stress. Current emotional or psychiatric problems, nulliparity, limited access to outdoor space, and alterations to obstetric visits were independently associated with moderate to severe Preparedness Stress. Conclusion: Study findings suggest that particular attention should be focused on the groups of pregnant women who are most vulnerable to pandemic-related stress and therefore may be more prone to adverse outcomes associated with prenatal stress.

Factors associated with fear of childbirth among Polish pregnant women.

The purpose of our study was to elucidate the association between obstetric and psychological factors and fear of childbirth (FOC) during the third trimester of pregnancy and to identify women at risk of severe FOC in Poland. An additional goal of the study was to verify the Polish version of the Wijma Delivery Expectancy Questionnaire (W-DEQ) and to establish its psychometric characteristics. Cross-sectional study with a total of 359 women recruited during routine visits to an antenatal clinic in Poland during the third trimester (≥ 27 weeks gestation). The survey included obstetric details (parity, obstetric history and preferred mode of delivery), and standardized psychological measures: the W-DEQ (fear of childbirth) and the EPDS (depressive symptoms). We demonstrated the satisfactory psychometric properties of the Polish version of the W-DEQ. Our findings confirm the one-factor structure found by the authors of the original version of the scale. A greater FOC was reported by women with unplanned pregnancies, women whose preferred mode of delivery was a cesarean section, and women who had previously undergone psychiatric treatment. The risk factors for severe FOC were depression, unplanned pregnancy or parity, and disagreement with the birth plan proposed by the obstetrician. The W-DEQ is a widely used, valid instrument for the assessment of FOC in pregnant women and can be used in Poland. Findings support the key role of obstetric and psychological variables in predicting fear of childbirth.

Pandemic-related pregnancy stress assessment-Psychometric properties of the Polish PREPS and its relationship with childbirth fear.

PURPOSE: The aim of the study was to create and to validate the Polish version of the original English version of the Pandemic-Related Pregnancy Stress Scale (PREPS) developed by Preis and colleagues (2020a; 2020b) We additionally investigated the association of maternal obstetrical and pandemic related factors with the PREPS in order to test its sensitivity. METHODS: A cross-sectional study design with nonrandom sampling was used. The sample consisted of a total of 1148 pregnant women in various trimesters. They were recruited via social media and completed an online study questionnaire in April-May 2020. RESULTS: The results of the present research indicate satisfactory psychometric properties of the Polish version of the PREPS. Our findings confirm the factor structure found by the authors of the original English version of the PREPS. The scale consists of two stress subscales: perinatal infection stress and preparedness stress and one additional positive appraisal scale. Pandemic-related pregnancy stress is significantly associated with fear of childbirth and with non-pandemic pregnancy-specific stress, which bolsters its convergent validity. Higher levels of pandemic-related pregnancy stress are experienced by primiparas, those in their second or third trimester, women who received infertility treatment, and those with a high-risk pregnancy. CONCLUSIONS: The Polish version of the PREPS has sound psychometric properties and replicates the structure of the original English PREPS. This stress scale can be used to investigate additional impacts of the COVID-19 pandemic and to identify women at risk of high stress and those who need intervention.

Influence of optimizing protocol choice on the integral dose value in prostate radiotherapy planning by dynamic techniques - Pilot study.

AIM: The purpose of this study was to compare the values of integral dose, calculated for treatment plans of dynamic radiotherapy techniques prepared with two different optimization protocols. BACKGROUND: Delivering radiation by IMRT, VMAT and also HT techniques has an influence on the low dose deposition of large areas of the patient body. Delivery of low dose can induce injury of healthy cells. In this situation, a good solution would be to reduce the area, which receives a low dose, but with appropriate dose level for the target volume. MATERIALS AND METHODS: To calculate integral dose values of plans structures, we used 90 external beam radiotherapy plans prepared for three techniques (intensity modulated radiotherapy, volumetric modulated arc therapy and helical tomotherapy). One technique includes three different geometry combinations. 45 plans were prepared with classic optimization protocol and 45 with rings optimization protocol which should reduce the low doses in the normal tissue. RESULTS: Differences in values of the integral dose depend on the geometry and technique of irradiation, as well as optimization protocol used in preparing treatment plans. The application of the rings optimization caused the value of normal tissue integral dose (NTID) to decrease. CONCLUSION: It is possible to limit the area of low dose irradiation and reduce NTID in dynamic techniques with the same clinical constraints for OAR and PTV volumes by using an optimization protocol other than the classic one.

Intralymphatic immunotherapy for cat allergy induces tolerance after only 3 injections.

BACKGROUND: Subcutaneous allergen-specific immunotherapy frequently causes allergic side effects and requires 30 to 80 injections over 3 to 5 years. OBJECTIVE: We sought to improve immunotherapy by using intralymphatic allergen administration (intralymphatic immunotherapy [ILIT]) and by targeting allergen to the MHC class II pathway. METHODS: Recombinant major cat dander allergen Fel d 1 was fused to a translocation sequence (TAT) and to part of the human invariant chain, generating a modular antigen transporter (MAT) vaccine (MAT-Fel d 1). In a randomized double-blind trial ILIT with MAT-Fel d 1 in alum was compared with ILIT with placebo (saline in alum) in allergic patients (ClinicalTrials.govNCT00718679). RESULTS: ILIT with MAT-Fel d 1 elicited no adverse events. After 3 placebo injections within 2 months, nasal tolerance increased less than 3-fold, whereas 3 intralymphatic injections with MAT-Fel d 1 increased nasal tolerance 74-fold (P < .001 vs placebo). ILIT with MAT-Fel d 1 stimulated regulatory T-cell responses (P = .026 vs placebo) and increased cat dander-specific IgG(4) levels by 5.66-fold (P = .003). The IgG(4) response positively correlated with IL-10 production (P < .001). CONCLUSION: In a first-in-human clinical study ILIT with MAT-Fel d 1 was safe and induced allergen tolerance after 3 injections.

Timolol 0.5%/dorzolamide 2% fixed combination versus timolol 0.5%/pilocarpine 2% fixed combination in primary open-angle glaucoma or ocular hypertensive patients.

PURPOSE: To establish the efficacy and safety of timolol maleate/dorzolamide fixed combination (TDFC) versus timolol maleate/pilocarpine fixed combination (TPFC), each given twice daily, in primary open-angle glaucoma or ocular hypertensive patients. METHODS: In this prospective, multicentred, double-masked trial, 37 patients were treated twice daily with timolol for 4 weeks. They were then randomized to one of the treatment medications for 6 weeks, after which they were treated with timolol again for 2 weeks before being placed on the opposite treatment medication for 6 weeks. RESULTS: A total of 36 patients completed the trial. Their mean baseline intraocular pressure (IOP) was 22.3 +/- 3.7 mmHg. Following 6 weeks of treatment, the mean trough (08.00 hours) IOP was 18.0 +/- 2.2 mmHg for TDFC and 17.4 +/- 2.0 mmHg for TPFC (p = 0.22). The mean diurnal curve IOP was 18.1 +/- 2.2 mmHg for TDFC and 16.7 +/- 1.9 mmHg for TPFC (p = 0.0007). At the remaining time-points (10.00, 18.00 and 20.00 hours), TPFC IOPs were statistically lower than TDFC IOPs (p < 0.03). There were statistically more unsolicited reports of vision change and ocular pain associated with TPFC (p = 0.04). Six patients were discontinued early from TPFC therapy (17%) versus two from TDFC (6%) (p = 0.13). CONCLUSIONS: This study suggests that TPFC can provide at least a similar efficacious reduction in IOP as TDFC in patients with primary open-angle glaucoma or ocular hypertension.