Wellbeing and older adults in primary health care in Poland.

INTRODUCTION AND OBJECTIVE: The Polish health service is in need of improvement because of the increasing number of geriatric patients. Identifying the resources available to patients is important for ameliorating deficits. The goal of this research was to measure the health and wellbeing of seniors and to investigate to what extent health services meet their needs. Differences in access and scope of received services between patients from different localities (i.e villages, small towns and big cities) were analysed. MATERIAL AND METHODS: Questionnaires (Satisfaction with Life Scale; VAS Numeric Pain Distress Scale) and a structured interview assessing the quality of healthcare were carried out in 2015 on a sample of 459 seniors. Each candidate gave consent for participation in the study. Statistica 12.5 software was used for analyses. RESULTS: The overall measure of satisfaction with life of the respondents (M=22.34 SD=5.78) was good. Inhabitants of small towns had a significantly lower sense of quality of life than seniors from big cities (Tukey HSD = 0.047, p<.05). Multimorbidity and polypharmacy were present to a limited extent. The issue of discrimination of older individuals by medical personnel affected a fifth of seniors living in villages, and one- third of those living in big cities. Geriatric patients did not have equal opportunities for access to medical services. CONCLUSIONS: State-provided geriatric care is insufficient and does not meet the real needs of patients. A holistic care approach and/or individualized care for older adults are often indicated but are only theoretical constructs in Poland. This inefficient system places the burden of caregiving on the family of the ageing patient. Anxiety among geriatric patients is growing regarding exclusion and lack of care.

Health in old age, and patients' approaches to telemedicine in Poland.

INTRODUCTION: Polish ageing society still experiences health-related problems and the increasing difficulties in receiving medical care. The initiation of telemedicine programmes can change this situation for better. The question arises if telemedicine is a solution that the elderly are willing to accept and take advantage of in order to raise their quality of life. MATERIAL AND METHODS: Questionnaire based research was conducted in 2015 on a sample group of 312 seniors. The respondents completed the Diener Satisfaction with Life Scale (SWLS) and the subscale of Health States from Fragebogen zur Lebenszufriedenheit (FLZ) by Fahrenberg et al. Each participant gave their consent to take part in the research. RESULTS: SWLS presents a relatively stable value in the subsequent decades of being old (60-69 years M=21.93 SD=6.25; 70-79 years M=21.70 SD=5.52; 80+ M=21.38 SD=5.82). The health related quality of life (the FLZ subscale), varied in the analysed subgroups (F=7.783 p=0.000), and was related to comorbidity and polytherapy. A positive attitude towards telemedicine was expressed by 40% of those surveyed. However the seniors' need for telemedical services was more limited and did not exceed the 10%. CONCLUSIONS: In Poland in ageing there still dominates the experience of multiple ailments and polytherapy, something which justifies a search for new, easily accessible, and economically sound solutions for health care. Telemedicine is a promising solution although there is a need for concrete steps to be taken to raise willingness amongst geriatric patients to take advantage of telemedicine.

An evaluation of antisocial behaviour in children after traumatic brain injury: the prospect of improving the quality of life in rehabilitation.

INTRODUCTION AND OBJECTIVE: The aim of the article is to present the consequences of traumatic brain injury in children, associated with general cognition and behavioural disorders, mainly of the antisocial type. MATERIAL AND METHODS: A total of 20 school-age children took part in the study, including six girls and 14 boys. The average age of the children was 13.35 years (standard deviation SD = 1.95). The research instruments included an analysis of documentation, a structured clinical interview, MMSE and Frontal Behavioral Inventory (FBInv) with additional set of five supplementary questions directed for detection of antisocial behavior. The research was conducted from the beginning of January 2009 until the end of May 2009. RESULTS: As hypothesized, the functioning of the children with traumatic brain injury is severely disrupted, because of the presence of cognitive impairment, however, dementia is not manifested. In a significant number of the children with traumatic brain injury we found not only the frontal syndrome, but also the occurrence of antisocial behaviour. The most commonly reported behavioural problems were: disorganization commonly referred to as laziness, hypersensitivity, and anxiety. The most common types of anti-social behaviour were: impulsivity, physical and verbal aggression, and also an outburst of anger. CONCLUSIONS: The children with traumatic brain injury suffer from a cognitive disorders and behavioural problems, especially impulsivity, physical and verbal aggression, increased anxiety, and disorganization. The occurrence of frontal syndrome is related to the development of antisocial behaviour.

Prejudices and elderly patients' personality -- the problem of quality of care and quality of life in geriatric medicine.

BACKGROUND: The article discusses the position of elderly patients in medical intervention context. The phenomenon of greying population has changed the attitude towards the old but common observations prove that quality of geriatric care is still unsatisfactory. In order to improve specialists' understanding of ageing, the comparative study on personality among people at different age was designed. The results are discussed in relation to the elderly patient-centred paradigm and in order to counterbalance still present ageist practices. MATERIAL AND METHODS: The research involved 164 persons in the early and late adulthood stage ages. Among the old there were the young old (aged 65-74) and the older old (aged 75+). All participants were asked to fill the NEO-FFI. RESULTS: The results prove age-related differences in personality. In late adulthood in comparison to early adulthood there is the decline in openness to experiences. Two traits: agreeableness and conscientiousness increase significantly. Age did not differentiate significantly the level of neuroticism and of extraversion. The results of cluster analyses show the further differences in taxonomies of personality traits at different period of life. CONCLUSIONS: The results challenge the stereotypes that present older people as neurotic, and aggressive. The age did not differentiate significantly the level of neuroticism and of extraversion. In general, the obtained results prove that the ageist assumption that the geriatric patients are troublesome is not arguable. This article builds support for effective change in geriatric professional practices and improvement in the elderly patients' quality of life.

Post accessive social policy in the rehabilitation of adolescents following TBI.

BACKGROUND: The aim of this research was to evaluate the effectiveness of the post-accessive Conduct Disorder Therapy Program administered within the "Academy of Life" in the reduction of behavioural disorder in adolescents following traumatic brain injury (TBI). MATERIAL/METHODS: 100 adolescents from Gdansk and adjacent areas, psychiatrically diagnosed with "frontal lobe syndrome" following a TBI, were examined. Group A included 50 participants examined and treated at the Reintegration and Training Center of the Foundation for Persons with Brain Dysfunctions. Group B comprised 50 people matched for age and sex, under treatment at the Gdansk Center for Neuropsychological Studies, Gdansk-Poludnie Non-Public Health Care Center. Group A used the above therapy programme, while group B did not. The studies included an analysis of documentation, neuro-imaging (CT or MRI), clinical interviews, the Mini-Mental State Examination and the Frontal Behavioural Inventory. RESULTS: The therapy program had a significant impact on conduct disorders, the most visible differences being within neurological disorders and the least visible within cognitive disorders. It also influenced the social reintegration of adolescents following TBI, as demonstrated by the greater increase in the percentage of participants from group A returning to school and hobbies practised before the accident. CONCLUSIONS: The results indicate that the evaluated therapy program is effective in reducing behavioral disorders in adolescents following brain injury, and their reintegration into society.

Social reintegration of TBI patients: a solution to provide long-term support.

BACKGROUND: This article evaluates the effectiveness of a workable long-term program to provide social support for TBI patients, based on the "Academy of Life" concept. Disability after TBI causes numerous disruptions of normal life, which affect the patient, the family, and society. The patient needs the particular kind of support the program was designed to provide. MATERIAL/METHODS: The study involved 200 married couples with a TBI spouse previously enrolled in the "Academy of Life." The methods included documentation analysis, clinical interviews, the Family Bonds Scale, the Social Isolation Scale, and the Social Functions subscale from a battery used to evaluate QOL after TBI. The subjects were examined before and after completing the program. RESULTS: In the first examination all types of family bonds were found to be severely weakened; there was deep social isolation, loneliness, sadness, a feeling of being surrounded by hostility, and no purposeful social activity. The most common form of support from significant others was pity and unwanted interference, accompanied by lack of understanding and social ostracism. In the second examination there was selective improvement of all parameters, significantly greater in patients without PTSD symptoms. The best effects were achieved in the reduction of social dysfunctions, the growth of purposeful social activity, and improvement in the type of support received, and a reduction of selected parameters of social isolation. CONCLUSIONS: The program here described is selectively effective for the social reintegration of TBI-patients, especially those without PTSD symptoms.

Physical activities among other types of health-related behaviour in people losing weight.

BACKGROUND: The role of physical activity in a health-seeking life style is increasingly and frequently about the improvement of one's silhouette. This constitutes the problem that we are trying to resolve in this article--are physical activities a part of actions aimed at the reduction of weight in people trying to lose it? MATERIAL/METHODS: We studied a group of adults trying to lose weight (N=398) aged 24-35. The Inventory of Healthy Behaviour (IHB) by Juczynski was applied, together with a questionnaire on physical activity and slimming. The IHB test results are analysed in four aspects: proper nutritional habits, prophylactic behaviour, positive mental attitude, and health-related practice. RESULTS: The more the studied people weigh, the more they would like to lose; this correlation is significantly stronger in women. Women desire a lower weight and height norm; men--a higher. Men are more realistic in their expectations. Both women and men spent 5 hours a week exercising, participating in four different forms of activity. Only a relatively small percentage do not exercise. CONCLUSIONS: Women exercise not for health, but in order to have a better silhouette. A slim beautiful body and, in effect, sexual attractiveness are the most emphasised element in their promotion of health, for which physical activity is paramount.

Rehabilitation of an artist after right-hemisphere stroke.

BACKGROUND: Traditionally, in both medicine and neuropsychology, symptoms are defined as significant deviations in a given parameter from a "physiological" norm largely based on statistical studies of large populations. Thus the goal of rehabilitation is to bring the patient's performance within the bounds of acceptable variation from the norm, and this is what defines a good outcome. Although this model seems reasonable for "average" patients, in the case of "exceptional" patients an "average" outcome may not be acceptable. CASE REPORT: The present study describes the symptoms and successful rehabilitation of a prominent Polish artist, who was referred for rehabilitation after a right hemisphere stroke, and whose chief subjective complaint was the loss of artistic vision. The patient (female, ambidextrous) suffered an RH stroke at the age of 61. In traditional rehabilitation many symptoms resolved and others were well compensated, but the patient continued to complain that she had a "hole" in her brain and could not paint. A special program of rehabilitation was designed for her, based on art therapy, but including many unique elements, using a microgenetic, "bottom-up" approach to energize creativity and bypass obstacles. Ultimately the patient was able to resume her artistic career, thanks to the heuristic, holistic approach to therapy. CONCLUSIONS: The case described here raises a number of theoretical questions about art, imagination, and creativity in the brain, and the goals of rehabilitation in the case of talented and gifted individuals.