App-Mohedo®: A mobile app for the management of chronic pelvic pain. A design and development study.

BACKGROUND: Chronic Pelvic Pain (CPP) has been described as a public health priority worldwide, and it is among the most prevalent and costly healthcare problems. Graded motor imagery (GMI) is a therapeutic tool that has been successfully used to improve pain in several chronic conditions. GMI therapy is divided into three stages: laterality training (LRJT, Left Right Judgement Task), imagined movements, and mirror therapy. No tool that allows working with LRJT in pelvic floor has been developed to date. OBJECTIVE: This research aims to describe the process followed for the development of a highly usable, multi-language and multi-platform mobile application using GMI with LRJT to improve the treatment of patients with CPP. In addition, this will require achieving two other goals: firstly, to generate 550 pelvic floor images and, subsequently, to carry out an empirical study to objectively classify them into different difficulty levels of. This will allow the app to properly organize and plan the different therapy sessions to be followed by each patient. METHODOLOGY: For the design, evaluation and development of the app, an open methodology of user-centered design (MPIu + a) was applied. Furthermore, to classify and establish the pelvic floor images of the app in different difficulty levels, an observational, cross-sectional study was conducted with 132 volunteers through non-probabilistic sampling. RESULTS: On one hand, applying MPIu+a, a total of 5 phases were required to generate an easy-to-use mobile application. On the other hand, the 550 pelvic floor images were classified into 3 difficulty levels (based on the percentage of correct answers and response time used by the participants in the classification process of each image): Level 1 (191 images with Accuracy = 100 % and RT = [0-2.5] seconds); Level 2 (208 images with Accuracy = 75-100 % and RT = [2.5-5] seconds); and Level 3 (151 images with Accuracy = 50-75 % and RT > 5 s). CONCLUSION: App-Mohedo® is the first multi-platform, multi-language and easy-to-use mobile application that, through GMI with LRJT, and with an adequate bank of images classified into three levels of difficulty, can be used as a complementary therapeutic tool in the treatment of patients with CPP. This work can also serve as an example, model or guide when applying a user-centered methodology, as MPIu + a, to the development of other apps, especially in the field of health.

Quality of Life in Female Patients with Overactive Bladder after Botulinum Toxin Treatment.

BACKGROUND: Manifestations of OAB can considerably diminish the quality of life. Botulinum toxin has emerged as a valuable treatment option in diseases whose symptoms cannot be controlled adequately with other available therapies. The aim of the present study was to compare the subjective quality of life of patients with OAB before the injection of botulinum toxin and three and six months after the intervention. METHODS: This study was based on a diagnostic survey with three validated questionnaires, ICIQ-OAB, ICIQ-OABqol, and ICIQ-LUTSqol, and an additional questionnaire developed by the authors to collect sociodemographic characteristics and selected medical data. RESULTS: This study demonstrated significant differences between pre-treatment scores and those at three and six months post injection. At three and six months after the intervention, mean scores for all three instruments (ICIQ-OAB, ICIQ-OABqol, ICIQ-LUTSqol) were significantly lower than the respective pre-treatment values, implying a significant attenuation of OAB symptoms and their lower impact on the quality of life. However, the severity of OAB symptoms and their impact on the quality of life at six months post intervention were significantly higher than at three months, except for the social interaction domain. CONCLUSIONS: Botulinum toxin is an effective treatment for OAB.

Connections Between Perceived Social Support and the Body Image in the Group of Women With Diastasis Recti Abdominis.

Background: The psychological features of the body image and the role of perceived social support for women with diastasis recti abdominis (DRAM) is significant for the treatment of this group of patients, but it is difficult to identify research on this topic. We aimed to search for similarities and differences between postpartum women with DRAM in terms of their psychological features of the body image and perceived social support from the partner, family and friends. Methods: Three hundred forty-five Polish women with DRAM were asked to fill the The Multidimensional Body-Self Relations Questionnaire (MBSRQ), The Multidimensional Scale of Perceived Social Support (MSPSS) and The Drawing Self-Assessment Sheet. Data analysis included the stepwise regression analysis and k-cluster analysis. Results: We identified several predictors in the group of women with DRAM. Social support of partner, family, and friends are the predictors of self-assessment of general body appearance. Social support of family is a predictor of self-assessment of the health of the body. Social support of friends is a predictor of self-esteem of weight and fear of gaining weight. Moreover, three clusters of women with DRAM were found. Type 1-women with DRAM with one child and low self-esteem of the general appearance of the body, low self-esteem of health condition of the body, high self-esteem of weight, and fear of weight gain, and low level of social support; Type 2-women with DRAM with three or more children and low self-esteem of the general appearance of the body, low self-esteem of health condition of the body, high self-esteem of weight and fear of weight gain, and high level of social support; and Type 3-women with DRAM with two children and high self-esteem for the general appearance of the body, high level of self-esteem for health of the body, low self-esteem of weight and fear of weight gain, and high levels of social support. Conclusions: Social support is a predictor of body image in women with DRAM, but there are other factors that influence body acceptance more in this group of women. Furthermore the three clusters featured in the study may help in treating women with DRAM.

Evaluation of the Diagnostic Accuracy of the Interview and Physical Examination in the Diagnosis of Endometriosis as the Cause of Chronic Pelvic Pain.

BACKGROUND: Chronic pelvic pain affects approximately 15% of reproductive age women. It is mainly caused by adhesions (20-40%). Despite CPP being the main symptom of endometriosis, the disease is confirmed by laparoscopy only in 12-18% of cases. The aim of this study was to evaluate the results of laparoscopy in women with CCP and to assess the sensitivity and specificity of elements of an interview and clinical examination. MATERIALS AND METHODS: The study included 148 women with CPP. Each patient underwent laparoscopy. In laparoscopy, the presence of endometriosis and/or peritoneal adhesions was confirmed. Then, the sensitivity and specificity and the positive and negative predictive value of endometriosis symptoms or abnormalities in the gynecological examination were statistically calculated. RESULTS: After previous surgery, adhesions were found in almost half (47%) of patients. In patients without a history of surgery, adhesions were diagnosed in 6.34% of patients. Endometriosis without coexisting adhesions was more often diagnosed in women without previous surgery (34.9%), compared to 10.58% in the group with a history of surgery (p < 0.05). CONCLUSIONS: Intraperitoneal adhesions are most common in women after pelvic surgery and with chronic ailments. The best results for sensitivity, specificity, positive predictive value, and negative predictive value in the diagnosis of endometriosis are found in women with irregular menstruations during which the pain increases. Laparoscopy still remains the primary diagnostic and therapeutic method for these women.

The Relationship between the Concentration of Magnesium and the Presence of Depressive Symptoms and Selected Metabolic Disorders among Men over 50 Years of Age.

BACKGROUND: changes in the concentration of magnesium influence numerous processes in the body, such as hormone and lipid metabolism, nerve conduction, a number of biochemical pathways in the brain, and metabolic cycles. As a result, changes in magnesium concentration may contribute to the emergence of such pathologies as depressive and metabolic disorders, including hypertension, diabetes, and dyslipidemia. METHODS: blood samples were taken from 342 men whose mean age was 61.66 ± 6.38 years. The concentrations of magnesium, lipid parameters, and glucose were determined using the spectrophotometric method. Anthropometric measurements were performed to determine each participant's body mass index (BMI). Additionally, all participants completed two questionnaires: the Beck Depression Inventory and the author's questionnaire. RESULTS: abnormal levels of magnesium were found in 78 people. The analysis showed that these subjects more often suffered from metabolic disorders such as diabetes mellitus (p < 0.001), hypertension (p < 0.001), and depressive symptoms (p = 0.002) than participants with normal magnesium levels. CONCLUSION: our research showed that there is a relationship between abnormal levels of magnesium and the presence of self-reported conditions, such as diabetes, hypertension, and depressive symptoms among aging men. These findings may contribute to the improvement of the diagnosis and treatment of patients with these conditions.

The Effect of Selected Exercise Programs on the Quality of Life in Women with Grade 1 Stress Urinary Incontinence and Its Relationship with Various Body Mass Indices: A Randomized Trial.

AIMS: The aim of the study was to analyze the influence gymnastics has on the quality of life (QOL) in women with grade 1 stress urinary incontinence (SUI) and to determine the relationship between the outcome and selected body weight indices: body mass index (BMI) and waist-to-hip ratio (WHR). METHODS: A randomized study of 140 women (45-60 years) with grade 1 SUI. The subjects were randomly assigned to a 3-month training for pelvic floor muscles and a transverse abdominal muscle (PFM + TrA, n = 70) or PFM alone (n = 70). The QOL was determined with the questionnaire International Consultation on Incontinence Modular Questionnaire-Lower Urinary Tract Symptoms Quality of Life (ICIQ LUTS QOL), before and after the program. RESULTS: Women with BMI < 30 kg/m2 benefited more from the PFM + TrA program with respect to physical limitations and embarrassment domains, whereas patients with a gynoid body type (WHR < 0.8) benefited more in terms of physical and social limitations, SUI-evoked emotions, severity measures, and embarrassment domains. CONCLUSIONS: After the PFM + TrA training, women with WHR < 0.8 had a better QOL than those with WHR > 0.8.

Assessment of the Relationship between Selected Factors and Stress-Coping Strategies in Handcyclists-A Preliminary Study.

Background and Objectives: Playing competitive sports is associated with stress, especially during the starting season. Disabled athletes are additionally burdened with physical and/or emotional factors, resulting from the trauma they have experienced. The aim of the work was to assess the relationship between strategies of coping with stress and the level of education, category of disability and its duration of handcyclists before the competition. Materials and Methods: 44 handcyclists with a mean age of 41.8 ± 11.6, from European countries, were divided according to the severity of mobility impairments, education and duration of the disability. The participants were asked to fill in the Mini-COPE Inventory for Measuring Coping with Stress, which provided answers in writing to some sociodemographic questions regarding age, sex, education, type of mobility impairment and duration of the disability. Results: The subjects who had suffered spinal injury at the cervical section obtained the lowest scores regarding their subjective assessment of their active stress management in difficult situations (p = 0.007). They scored the lowest, 1.5 points, when asked about acceptance in difficult circumstances compared to those with university education (p = 0.02). A statistically significant correlation was found to exist between education levels and positive revaluation, acceptance and seeking instrumental support. A negative correlation was observed between education and sustained use of psychoactive substances and denial. Conclusions: Highly educated cyclists with short-lasting disability, damage to the lower spine section or amputations tend to cope better with stress than other study participants.

Association between the Urinary Bladder Volume and the Incidence of "De Novo" Overactive Bladder in Patients with Stress Urinary Incontinence Subjected to Sling Surgeries or Burch Procedure.

Aim. The aim of the study was to compare the incidence of "de novo" overactive bladder (OAB) after sling surgeries and Burch procedure and to analyze the effect of the preoperative bladder volume on the incidence of this condition. Methods. This prospective trial included 290 female patients with stress urinary incontinence (SUI) who were subjected to sling surgeries (TOT or TVT, n=170) or Burch procedure (n=120). Urodynamic testing was performed prior to the surgery and 6 months thereafter. The presence of OAB was diagnosed on the basis of subjective symptoms and urodynamic parameters. Results. The incidence of OAB 3 at 6 months postsurgery was the highest in patients who were subjected to the Burch procedure (14.2% and 17.5%, respectively). The incidence of OAB at 6 months turned out to be significantly higher in patients subjected to the Burch procedure with preoperative bladder volumes greater than 353 ml. We observed the significant postoperative decrease in the bladder volume of women who developed this complication following the Burch procedure. Conclusions. Among surgeries for stress urinary incontinence, Burch procedure is associated with the greatest risk of overactive bladder development. Probably, one reason for the higher incidence of overactive bladder after Burch procedure is the intraoperative reduction of the urinary bladder volume.

The Effect of Pelvic Floor Muscles Exercise on Quality of Life in Women with Stress Urinary Incontinence and Its Relationship with Vaginal Deliveries: A Randomized Trial.

INTRODUCTION: Urinary incontinence (UI) is a health problem affecting the quality of women's lives (QOL) at various life stages. Stress urinary incontinence (SUI) can be caused by previous vaginal deliveries and is especially likely to occur in the perimenopausal period. The most commonly recommended first-choice treatment methods involve exercises for the pelvic floor muscles (PFM). The aim of this study was to assess the impact of isolated PFM exercises and combined training of the PFM and the m.transversus abdominis (TrA) muscle on the QoL of patients with SUI with regard to the number of vaginal deliveries. MATERIAL AND METHODS: 137 women with SUI were qualified for analysis (mean age 53,1 ± 5,5). To assess the effectiveness of PFM training QOL questionnaire was used (ICIQ-LUTS qol). PFM training for groups A (PFM+TrA) and B (PFM) was intended for 12 weeks. Statistica v. 12.0 PL, StatSoft, USA, was used for statistical calculations. RESULTS: The analysis demonstrated that conservative treatment based on the A training program (PFM + TrA) yielded statistically significantly better results than the B program (PFM), with the improvement observed in such QoL domains as the performance of household duties, physical activity and travelling, social limitations, emotions, sleep problems and fatigue, the frequency of changing panty liners, fluid intake control, and embarrassment. CONCLUSION: Both the combined training of the PFM and the synergistic (TrA) muscle and the isolated PFM exercises improve the QoL of women with SUI. Nonetheless, the combined PFM and TrA muscle physiotherapy is more effective. The exercises for the PFM and the synergistic muscle give better results in women who have given birth fewer than three times than isolated PFM exercises.

Filamentous Aggregates of Tau Proteins Fulfil Standard Amyloid Criteria Provided by the Fuzzy Oil Drop (FOD) Model.

Abnormal filamentous aggregates that are formed by tangled tau protein turn out to be classic amyloid fibrils, meeting all the criteria defined under the fuzzy oil drop model in the context of amyloid characterization. The model recognizes amyloids as linear structures where local hydrophobicity minima and maxima propagate in an alternating manner along the fibril's long axis. This distribution of hydrophobicity differs greatly from the classic monocentric hydrophobic core observed in globular proteins. Rather than becoming a globule, the amyloid instead forms a ribbonlike (or cylindrical) structure.

The Relationship between Diabetes Mellitus and Respiratory Function in Patients Eligible for Coronary Artery Bypass Grafting.

Introduction: Spirometry performed prior to surgery provides information on the types of lung disorders in patients. The purpose of this study was to look for a relationship between the prevalence of diabetes and spirometry parameters. Material and Methods: The study was conducted in patients with coronary artery disease who were eligible for an isolated coronary artery bypass graft in 2013. The study group included 367 patients (287 men and 80 women) aged 68.7 ± 8.4 years. They were divided into those with diagnosed diabetes (group I, n = 138, 37.6%) and without diabetes (group II, n = 229, 62.4%). Spirometry tests were performed on the day of admission to the hospital. Results: Patients with diabetes (group I) had a significantly higher body mass index than those without diabetes (group II). Spirometry tests also showed that patients with diabetes had statistically significantly lower forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1.0). Both FVC and FEV1.0 were also statistically significantly lower for overweight and obese individuals in group I than those in group II. Conclusion: Patients with diabetes eligible for coronary artery bypass grafting with concurrent overweight or obesity are more likely to have lower spirometry parameters than those without diabetes.

Quality of Life in Women with Stage 1 Stress Urinary Incontinence after Application of Conservative Treatment-A Randomized Trial.

Stress urinary incontinence (SUI) influences quality of life in female patients. In this study, we used ICIQ LUTS QoL (The International Consultation Incontinence Questionnaire Lower Urinary Tract Symptoms quality of life) to determine the quality of life (QoL) in various domains in patients with stage 1 SUI. The study included 140 perimenopausal women subjected to urodynamic tests at the Department of Gynaecology, Endocrinology and Gynaecologic Oncology, Pomeranian Medical University, Police (Poland) in 2013-2015. The study subjects were divided into two groups, A and B. Each patient completed two questionnaires, an original survey developed by the authors and the validated ICIQ LUTS QoL. Two exercise programs, each lasting for 3 months and consisting of 4 weekly sessions, were recommended to the study subjects. The program for Group A included exercises for pelvic floor muscles (PFM) with simultaneous tension of the transverse abdominal muscle (TrA), and the program for Group B, PFM exercises without TrA tension. After completing the exercise programs, patients with stage 1 SUI, both from Group A and from Group B, showed a significant improvement in most QoL domains measured with ICIQ LUTS QoL. However, more beneficial effects of the training were observed in the group subjected to PFM exercises with TrA tension.

[Kinesiotaping as an interdisciplinary therapeutic method].

Introduction: Kinesiotaping (KT) is one of the newest methods commonly used in many medical sciences: neurology, orthopaedics and traumatology, oncology, gynaecology and obstetrics, and in paediatrics. Due to its special properties, KT can be used depending on individual needs and problems during rehabilitation. Aim: This article presents a systematic review of the clinical effectiveness of using KT in physiotherapy. Conclusions: KT method is widespread in different medical sciences and is a good method supporting rehabilitation and pharmacological treatment. Due to its special properties it can be used in children, adults, and also pregnant women.

[The influence of grade 1 stress urinary incontinence on the physical activity of women depending on nutritional status as defined by the Body Mass Index].

Introduction: Stress urinary incontinence (SUI) and obesity are problems recognized by the World Health Organization as social diseases. The International Continence Society has estimated that about 10­40% of women have problems with urinary incontinence. Overweight states and obesity are among the biggest health problems in perimenopausal women. The aim of the study was to analyze the impact of SUI on the physical activity (PA) of women in relation to their body weight. Material and methods: The study comprised 54 women aged 41­67 years with SUI. Anthropometric measurements were taken. Physical activity was examined by specially designed questionnaires. The statistical significance was calculated in the Statistica 12 software using normality tests, correlation coefficient, nonparametric tests, and a post -hoc test. Results: The mean age of subjects was 55 ±7 years. Body Mass Index (BMI) in subjects was normal (N1) ­ 11 (20.4%), or indicated the state of being overweight (N2) ­ 33 (59.2%) or obese (N3) ­ 11 (20.4%); 94% (51) patients had the android body type and 6% (3) had the gynoidal body type. PA before the onset of problems with SUI was assessed by patients as a sedentary lifestyle ­ 12 (22.2%), active ­ 23 (42.6%) or mixed ­ 19 (35.2%). Subjects, when asked how strong the impact of SUI on their PA was, answered: minor 13 (24.1%), moderate ­ 14 (25.9%), very strong ­ 27 (50%). No statistically signiô€icant differences between PA and SUI were found in N1, N2 and N3 groups. Conclusions: Overweight patients reported the strongest impact of SUI on their PA, but the differences between the analysed groups were not signiô€icant. Most subjects had the android body type, which was assessed by means of WHR.

[Effect of low -level laser therapy and exercise in reducing the symptoms of disease in patients with osteoarthritis of the knee].

Introduction: Osteoarthritis is the most common disease of the joints contributing to the failure of movement. The disease mostly affects the older part of the population, and is associated with suffering and reduced quality of life. Knee osteoarthritis contributes to joint dysfunction of varying severity. These are common causes of chronic ailments limiting physical activity, which may even complicate the performance of activities of daily living. Low-level laser therapy is thought to have an analgesic effect, as well as a biomodulatory effect on the microcirculation. The aim of this study was to evaluate the effectiveness of low- -level laser therapy on pain relief and functional improvement in patients with osteoarthritis of the knee. The effects of laser therapy alone and in combination with exercise were compared. Materials and methods: 40 patients of mean age 65 years with knee osteoarthritis of both sexes were divided into two groups. Laser alone was used in group I (n = 20) and laser combined with kinesistherapy was used in group II (n = 20). All patients received the same dose of laser radiation, which was 3.0 J/cm², 10 Hz, 400 mW. In both groups a series of 10 treatments was performed daily. VAS, ranges of motion in the knee joint, and the strength of the quadriceps and biceps femoris muscles were used as the criteria of pain assessment in both groups. All measurements were taken before and after treatment. Results: Significant pain reduction: I (p = 0.00009, R = 0.68); II (p = 0.00002, R = 0.86), increased range of flexion in the knee: I (p = 0.000001, R = 0.90); II (p = 0.00002, R = 0.85), increased range of extension in the knee: I (p = 0.042, R = 0.87); II (p = 0.0004, R = 0.9) and increased strength of the quadriceps femoris muscle: I (p = 0.03, R = 0.77); II (p = 0.0002, R = 0.9) and the biceps femoris muscle: I (p = 0.04, R = 0.80); II (p = 0.0007, R = 0.91) were found in both groups after treatment. With the exception of flexion of the knee (p = 0.027; r = 0.17), there were no statistically significant differences in other analysed parameters between the use of laser alone and laser therapy combined with exercise. Conclusion: The use of laser in knee osteoarthritis reduces pain and improves the functional status of the patient. Laser therapy combined with kinesistherapy produces better therapeutic effects, and effectively improves the functional status of knee osteoarthritis. Exercise therapy applied in a series of 10 treatments is too short to significantly improve the functional status of the patient.

[Analysis of selected risk factors for cardiovascular diseases in patients scheduled for Coronary Artery Bypass Graft]. / Profil spoleczny i analiza wybranych czynników ryzyka chorób sercowo-naczyniowych u pacjentów zakwalifikowanych do operacji pomostowania aortalno-wiencowego.

INTRODUCTION: Cardiovascular diseases are classified as diseases of civilization, and constitute a major social problem because they are the main cause of death. For this reason, according to the WHO, more than 17.3 million people die every year in developed countries. In the European Union the number of deaths is over 2 million, and represents 42% of total mortality. The aim of the study was analysis of selected risk factors for cardiovascular disease in patients scheduled for surgical revascularization, and an outline of their social profile. MATERIAL AND METHODS: The study was conducted among patients scheduled for surgery in Cardiac Surgery Department SPSK no. 2 in Szczecin. Ninety patients were studied. The research was carried out using proprietary diagnostic surveys and data obtained from medical records. RESULTS: The selected modifiable risk factors for diseases of the cardiovascular system were evaluated. In the study group 15 patients (17%) were current smokers. Most patients (38, 42%) had not smoked for more than 2 years. 33 patients (37%) suffered from diabetes. More than half (47, 52%) of the respondents did not follow a balanced diet. Most of the patients were obese (37, 41%), including 18 diabetics and 19 non-diabetics. 58 patients (64%) suffered from hypertension. CONCLUSION: Diabetes, obesity, and smoking were confirmed as risk factors for coronary heart disease. The educational activity of family doctors should be mainly focused on the prevention of diabetes, stopping smoking, and lifestyle changes in order to prevent diseases of the cardiovascular system, especially among the elderly.