Effectiveness of tuberculosis prophylaxis in patients with HIV/AIDS - retrospective analysis of data from Almaty, Kazakhstan, 2010-2015.

INTRODUCTION: According to data from the National Centre for Prevention and Control of AIDS, in the Republic of Kazakhstan, 45.8% of patients in the symptomatic stages of HIV infection are diagnosed with tuberculosis (TB) which is the cause of death in 36% of patients infected with HIV. OBJECTIVE: The aim of the study was to conduct a retrospective analysis of the effectiveness of tuberculosis (TB) chemoprophylaxis among people living with HIV in the Republic of Kazakhstan (RK) in Central Asia. MATERIAL AND METHODS: Materials and method. A retrospective analysis of patient health status was performed for each of the 648 patients (323 in the study group and 325 in the control group) during 2010-2015. Data from outpatient treatment charts were used concerning each patient infected with HIV observed at AIDS Treatment Centres. From among the 648 patients infected with HIV, 136 were receiving isoniazid in 2010, and 187 in 2011. The control group consisted of 325 people living with HIV (PLW HIV), who did not received isoniazid during observation. RESULTS: Results. The incidence of TB in patients who underwent chemoprophylaxis did not exceed 0.555/ 100,000 population in the first year of observation. Within 5 years, the TB incidence dropped to 0. In the control group, the TB incidence rate during the first year of observation was 3.262/100,000, with a decrease to 0.364 observed in 2015. Cumulated incidence rate in 2011-2015 in the study group accounted for 1.276/100,000. In the control group, the cumulative incidence was 4.3 times higher and accounted for 5.527. A significant difference in the mortality rate due to TB in the study and control groups was observed, the share of deaths due to TB in study group was 21.6% - nearly 3 times lower than in the control group (57.0%). CONCLUSIONS: Conclusions. The effectiveness of chemoprophylaxis for TB depends on biomedical, organizational and cultural factors. The presence of HIV co-infections is a special situation. Opposite to the majority of reports, in own study, no drug-resistant forms of tuberculosis were observed in relation with chemoprophylaxis with isoniazid. In the examined population, TB chemoprophylaxis reduced the incidence and cumulative incidence of TB among PLW HIV by 3.4-4.8 times. Isoniazid chemoprophylaxis decreased 4-fold the annual and cumulative mortality due to TB.

Comparative analysis of the effectiveness of tuberculosis prophylaxis in patients with HIV/AIDS treated with isoniazid.

INTRODUCTION: The epidemic of human immunodeficiency virus has had a tremendous effect on the epidemic of tuberculosis. Together with the spread of HIV, a great increase has been observed in morbidity due to tuberculosis, both in endemic countries and in those where earlier, as a result of treatment, the frequency of occurrence of tuberculosis had decreased. In 2018, the WHO data demonstrated that the EECA region was the only region worldwide where the epidemics of HIV was still rapidly increasing. The EECA region still struggles with a serious epidemic of tuberculosis. MATERIAL AND METHODS: Materials and method. The research method applied was comparative analysis of the results of own study and studies by other researchers, concerning the effectiveness of tuberculosis prophylaxis in patients with HIV/AIDS when treated with isoniazid. RESULTS: Results. In own study, it was found that primary morbidity among patients administered isoniazid significantly decreased within 5 years. Incidence rates of primary morbidity were significantly lower than among patients who had not received isoniazid. Relevant studies conducted worldwide, in many cases differed from own study with respect to both the results and approach to the problem, by country or selection of the type of patients participating in the study. However, in all studies, isoniazid was generally a safe and well-tolerated drug, without special side-effects. CONCLUSIONS: Conclusions. All studies analyzed concerning the effectiveness of tuberculosis prophylaxis in patients with HIV/AIDS treated with isoniazid, confirmed the effectiveness of this drug. In the compared studies, applied isoniazid preventive therapy showed no difference in effectiveness according to its duration. Analyzed studies showed similar effectiveness also with respect to a decrease in mortality among patients with TB/HIV/AIDS.

Risk factors for work-related eczema and urticaria among vocational students of agriculture.

INTRODUCTION AND OBJECTIVE: Farmers are at high risk of occupational skin diseases which may start already during vocational training. This study was aimed at identification of risk factors for work-related skin diseases among vocational students of agriculture. MATERIAL AND METHODS: The study involved 440 students (245 males, 195 females aged 17-21 years) in 11 vocational schools which were at least 100 km from each other. The protocol included a physician-managed questionnaire and medical examination, skin prick tests, patch tests, total IgE and Phadiatop. Logistic regression model was used for the identification of relevant risk factors. RESULTS: Work-related dermatoses were diagnosed in 29 study participants (6.6%, 95%CI: 4.3-8.9%): eczema in 22, urticaria in 14, and co-existence of both in 7 students. Significant risk factors for work-related eczema were: history of respiratory allergy (OR=10.10; p<0.001), history of eczema (itchy rash) provoked by wet work and detergents before entering the school (OR=5.85; p<0.001), as well as history of contact dermatitis to metals, rubber or cosmetics prior to inscription (OR=2.84; p=0.016), and family history of any skin disease (OR=2.99; p=0.013). Significant risk factors for work-related urticaria were: history of allergic rhinitis and asthma prior to inscription (OR=7.29; p=0.006), positive skin prick tests to work place allergens (OR=4.65; p=0.002) and to environmental allergens (OR=3.79; p=0.009), and positive Phadiatop test (OR=3.61; p=0.013). CONCLUSIONS: Work-related skin diseases are common among vocational students of agriculture. Atopy, past history of asthma, allergic rhinitis, and eczema (either atopic, allergic or irritant) are relevant risk factors for work-related eczema and urticaria in young farmers, along with family history of any skin disease. Positive skin prick tests seem relevant, especially in the case of urticaria. Asking simple, aimed questions during health checks while enrolling students into agricultural schools would suffice to identify students at risk for work-related eczema and urticaria, giving them the chance for selecting a safer profession, and hopefully avoiding an occupational disease in the future.

Psychosocial aspect of quality of life among working and unemployed nurses and midwives.

OBJECTIVE: The objective of the study was to explain differences in the subjective evaluation of the psychological and social aspects of quality of life in a group of working and unemployed nurses and midwives. MATERIAL AND METHODS: The survey was conducted in a group of 620 professionally-active and inactive people (315 nurses and 305 midwives), selected by random stratified-systematic sampling. The tool used to gather empirical material was the standardized questionnaire WHOQoL-100. RESULTS: Professionally-active nurses evaluated the mental domain less favourably (M=12.33), compared with unemployed nurses (M=12.73), and the difference between average values was statistically significant (p=.043). It is also worth noting that in the group of midwives there were significant differences in each discussed domain. The unemployed respondents evaluated more positively the overall quality of life (M=14.29; p=.005) and the mental domain (M=12.85; p=.009), while the social domain was evaluated less favourably by the professionally-active midwives (M=12.73; p=.022). CONCLUSIONS: Paradoxically, those who were unemployed made slightly more positive evaluations in comparison with the professionally active. Professional work is not a factor preferably affecting the quality of life and its psychosocial dimension. The higher quality of life of the unemployed respondents may result from the buffering impact of social support.

Evaluation of communication and acceptance of the patients by medical personnel

Background: The low level of patient satisfaction recorded in many studies and, at the same time, the level of frustration and burnout, disclosed by medics in the perception of the patient as a 'problem', incline to look for the causes of inadequate relationship between physician and patient. Objective: The aim of this study was to evaluate the level of acceptance of the patient by the medical personnel. The research problem was the acceptance level which was within the range of the communication skills of the nurses and doctors. Another aim was to discover the factors determining this level of acceptance. Material and Methods: Two methods were used in the research process: 1) a diagnostic survey regarding the medical, professional communication skills; 2) testing of professional self-esteem from the medical aspect. The study population consisted of a total of 1,244 respondents divided into the following groups: registered nurses and doctors (729), students of nursing and medical faculties (515). Results: The results of the research showed that in most cases the acceptance of the patient by the medical staff was 'conditional', which translated into the level of frustration or lack of satisfaction with their profession, and ultimately into the level of burnout. The level of patient acceptance by medical staff (unconditional acceptance), depended primarily on age, followed by their profession. However, the relationship between this acceptance and gender and work experience was statistically insignificant. Conclusions: As the method to improve this situation, the expansion of education in the field of interpersonal communication is proposed, adding issues related with both the conditional and unconditional acceptance of the patient, as well as issues regarding how to deal with the patient from the aspect of disease and the psycho-socio-spiritual area.

Knowledge of osteoporosis prophylaxis and health behaviours of the population of chosen countries of the world.

INTRODUCTION: Osteoporosis is recognized by the World Health Organization as a disease associated with the progress of civilization, also called the 'epidemic of the 21 st century'. OBJECTIVE: An attempt to portray the level of knowledge and health behaviours of societies of selected countries of the world in the prevention of osteoporosis, based on available studies. MATERIALS AND METHOD: Theoretical concepts and reviews of current published studies. RESULTS: Accessible study findings conducted worldwide are not exhaustive and often present the subject in a fragmentary way. Data presented in the presented article shows that knowledge of osteoporosis among the Polish population and the population of selected countries of the world appears insufficient in the issues associated with its prophylaxis and prevention; they also testify to a disregard and lack of application of the principles of a healthier lifestyle in daily life regarding this still little-known illness. Since the number of people threatened with osteoporosis, as well as the number of bone fractures, is constantly rising, versatile action should be undertaken aimed at preventing falling ill and progression of the disease. CONCLUSIONS: After reviewing the literature, it was realized that few researchers have been interested in the issue of osteoporosis. This fact is proved by an insufficient amount of publications dealing with the subject and the problem associated with osteoporosis from the point of view of the public. The findings of presented study show that most often the subject is not portrayed as a whole, but concerns only selected preventive behaviours or learning about some risk factors.

The influence of passive and active moral training on medical university on changes of students' moral competence index - results from randomized single blinded trial.

INTRODUCTION AND OBJECTIVES: Human's life as well as medical professions consist of many moral dilemmas. The aim of our study was to evaluate moral competences of midwifery students during their whole university education (3 year course) based on their moral competences C-index. MATERIAL AND METHOD: We performed randomized single blinded 3-year follow-up trial of 72 midwifery students. Standard Moral Judgment Test (MJT) By Georg Lind was used accompanied by own questionnaire. Moral competences were calculated (C-index) according to Lind's methodology. Subjects were also divided into active and passive ethics training to search for differences. RESULTS: C-index varied during studies insignificant (p=0.14). Randomized groups were equal at the beginning point, no significant differences were noticed. Active ethics teaching did not increase C-index compared to controls in all measuring points (P1-P4, respectively p=0,41 and p=0,38). CONCLUSIONS: During 3 year studies at medical university moral competences measured by C-index varied insignificantly, but simultaneously the change in C-index was dependent on its value at the beginning of the trial. There was not statistically significant influence of active ethic's teaching compared to controls. Among social factors parents have strongest influence on students' morality, but growing role of Medical University in this hierarchy raises hopes for improvement in effectiveness of training in ethics.

Stress, coping styles and personality tendencies of medical students of urban and rural origin.

INTRODUCTION: The problem of high levels of stress among medical students is a real problem and its prevalence and mechanisms have not yet been fully explored. It was found that there are only a few publications concerning the influence of urban and rural settings of the medical students in relation to stress, coping styles and personality tendencies. AIM: Analysis of the coping mechanisms and personality types of medical students of rural and urban origin based on the survey of the students of the Medical University in Lublin (MUL), south-east Poland. MATERIAL AND METHODS: The study was conducted with a group of 570 medical students from MUL, aged 19-35. Average medical student age: 22. Two questionnaires were used: CISS and SCID II for the evaluation of the coping styles and the personality tendency structures. RESULTS: The place of origin significantly influenced tendencies to the occurrence of specific personality types. The schizotypal, borderline and narcissistic personality tendencies mostly presented in big cities, less in small cities, and the least among students of rural origin. Dependent personality tendencies were significantly more common among females. The coping styles based on avoidance and on looking for the social contacts were significantly more common among females than males. CONCLUSIONS: Medical students of urban and rural origin were differentiated in terms of personality structure tendencies, concerning personalities: schizotypal, narcissistic and borderline. The tendencies to the dependent personality were also significantly more common among females than males. Two types of coping styles, based on avoidance and looking for social contacts, were significantly more common among females than males.

Wet age-related macular degeneration (wet AMD) in rural and urban inhabitants in south-eastern Poland.

OBJECTIVE: Evaluation of the demographic profile of patients from south-eastern Poland treated due to wet age-related macular degeneration. MATERIAL AND METHODS: Data concerning 201 patients were analyzed (133 F/ 68 M), aged from 50 -91, (mean age 76 ± 8.6), with the wet form of age-related macular degeneration treated by intravitreal injections of vascular endothelial growth factor inhibiting drugs. The significance of the relationships between variables was investigated by means of chi-square test for independence. The differences between the empirical and theoretical sample distribution was examined by means of chi-square goodness-of-fit test. The significance level was set at p=0.05. RESULTS: Analysis did not show any significant differences in the access to treatment with intravitreal injections of vascular endothelial growth factor inhibitors between the rural and urban patients. Urban males and females living in the rural areas received treatment statistically more often (p=0.05). No significant differences were observed with respect to either the waiting time for a visit in a specialist outpatient department, nor the duration of waiting for treatment. Patients from the rural and urban areas presented a similar degree of visual impairment, evidencing the advancement of the pathological process. CONCLUSIONS: Place of residence has no effect on obtaining treatment by patients. The lack of significant differences in treatment between the rural and urban inhabitants may indicate a sufficient level of ophthalmological care in the area of south-eastern Poland. An improvement in the awareness of hazards resulting from inadequate diet and life style could exert a positive effect on the state of health of rural and urban inhabitants. At the same time, knowledge of the disease and risk of blindness related with this disease would increase alertness among rural and urban inhabitants, and in consequence, accelerate an early diagnosis and implementation of an effective treatment.

Diagnostic methods of TSH in thyroid screening tests.

INTRODUCTION: Reliable and quick thyreologic diagnostics, as well as verification of the effectiveness of the therapy undertaken, is of great importance for the state of health of society. The measurement of plasma TSH is the commonly accepted and most sensitive screening test for primary thyroid disorders, which are the most frequent diseases related to the endocrine glands. At present, the available methods for the determination of TSH are characterized by high sensitivity ≤0.01 µIU/ml and lack of cross-reactivity. However, many drugs and substances, as well as pathological conditions, may affect the TSH level. OBJECTIVE: evaluation of contemporary laboratory methods for the determination of TSH and the principles of interpretation of screening tests. STATE OF KNOWLEDGE: In many countries, the TSH test is the only test performed in the diagnostics of thyroid function; nevertheless, it seems that for genuine and objective assessment of thyroid status the TSH level, together with FT4 level, should be absolutely determined, which allows the differentiation and assessment of the intensity of thyroid function disorders and foresee its consequences. The interpretation of TSH results in screening tests is different in such population groups as: children aged under 14, pregnant women, the elderly, and patients with non-thyroidal illnesses. CONCLUSIONS: From among currently used laboratory methods for determination of TSH levels, third generation non-isotopic methods are most frequently recommended, especially the method of immunochemiluminescence.

New cases of suspected HFRS (Hantavirus infection) in south-eastern Poland.

INTRODUCTION: HFRS--hemorrhagic fever with renal syndrome, found in Europe, is an acute viral zoonosis due to the hantavirus infection. The disease is characterized by the triad of symptoms: sudden, febrile onset, acute renal failure and haemorrhagic diathesis. The range of hantavirus infections in humans has not been yet established on the territory of Poland. The medical literature described 18 cases of seropositive HFRS in Poland--mainly in the district of Sanok, and single cases in the districts of: Brzozów, Debica, Krosno, Lesko, Przemysl and Stalowa Wola. AIM: The aim of the study was to verify the hypothesis, assuming that patients hospitalized in the Department of Nephrology, located in the Regional Hospital in Przemysl were infected with hantavirus and had HFRS. MATERIAL AND METHODS: Due to the fact that patients selected for the study were not tested serologically, verification was based on statistical comparison of the retrospectively selected group of patients suspected of HFRS with the seropositive group described in the study of Nowakowska, Heyman, Knap et al. in 2009, in terms of individual symptoms prevalence in conjunction with the structure of selected clinical and epidemiological parameters. RESULTS: 26 individuals with renal failure and influenza-like episode of several-day fever of unknown origin were indentified on the base of the retrospectively analyzed records of the patients hospitalized in the Department of Nephrology in Przemysl between 2001-2011. The significant differences in age, frequency of selected laboratory parameters (platelet count, serum electrolytes) and oliguria were not found in both compared groups. However, the study group included the higher percentage of men. Additionally, the differences in prevalence of symptoms (cough, diarrhea), which are not considered specific for HFRS were detected. Analogously to the reference group, seasonal morbidity was observed also in the study group, but the peak intensity was delayed for 4 weeks. CONCLUSIONS: The hypothesis cannot be rejected that, the group analyzed in the prestent study, hospitalized in the Department of Nephrology in the Regional Hospital in Przemysl--is the sample of patients with HFRS (similarly to the group described by Nowakowska et al.). The cases described in this study can be considered as suspected of HFRS. It is justifiable to perform serological testing in these individuals.

Risk factors of postural defects in children at school age.

INTRODUCTION AND OBJECTIVE: Postural defects increasingly more often concern children and adolescents at school age. The lack of prophylaxis and neglecting adequate procedures may lead to limitations of physical and motor abilities, back pain, or the development of severe spinal deformities. Recognition of the risk factors conducive to the occurrence of the disorder allows the creation of adequate conditions for the psychomotor development of children, as well as the elaboration and implementation of specified educational schemes directed at schools and parents. The study concerned determination of the risk factors for the development of postural defects in school age children. MATERIAL AND METHODS: The study was conducted by means of a diagnostic survey. The study group covered 380 children aged 14 (175 girls (46.1%) and 205 boys (53.9%))--selected at random from schools in eastern Poland and the Czech Republic. The significance of the relationships between variables was investigated by means of chi-square test for independence. The differences between the empirical and theoretical sample distribution was examined by means of chi-square goodness-of-fit test. The significance level was set at p=0.05. RESULTS: The BMI in the population examined was 20.2, on average (from 14-39). Respondents living in rural areas and small towns constituted 57.63% of the study group, while inhabitants of medium-size and large cities--42.37%. The majority of children in the study had been previously examined for the occurrence of postural defects (74.2%), whereas nearly every tenth child had never undergone such an examination. As many as 16.3% of adolescents did not know whether they had ever participated in a screening test. A defect was detected in 14.7% of children, in 56.6% no asymmetry was detected, while approximately 30% were not aware if their body posture was normal or not. CONCLUSIONS: 1. There is a relationship between physical activity of the child and the occurrence of postural defects. 2. There is a relationship between the economic standard of the family and awareness of own state of health. 3. There is a need for the creation of a system of education for parents and children concerning postural defects and risks resulting from these defects.

Is there the gap in public health literature in Europe?

INTRODUCTION AND OBJECTIVE: The growing expectations for the effectiveness of public health increase the demand for scientific literature, concerning research, reviews and other forms of information. The bibliographic databases are of crucial importance for researchers and policy makers. The objective of this study is to estimate the supply of scientific literature related to public health in selected European countries, which are available to a wide range of users. MATERIALS AND METHODS: Analysis of the number of bibliographic records on topics related to public health was based on searches in Ovid MEDLINE (R) in May and June 2011. According to MeSH terms, 11 keywords and names of 13 European countries were used in the search. Publications from the years 2001-2010 were analyzed. A number of publications indexed under 'public health', and related to selected countries were compared with the size of the population of those countries, GDP, total expenditure on health and burden of disease (DALYS's). RESULTS: The most popular topic was 'health policy', whereas the topics 'occupational health' and 'environmental health' were less prevalent. There were no significant changes in the number of publications in 2001-2010. The number of articles indexed under 'public health' had significant positive correlation with national GDP, expenditure on health and population size, and negative with DALY's. CONCLUSIONS: According to the criteria accepted in this study, the Nordic countries--Finland, Sweden and Norway--were very productive in this respect. Poland and other Central European Countries were less productive.

Professional communication competences of paramedics--practical and educational perspectives.

INTRODUCTION: Dissonance between the high 'technical' competences of medical professionals, including paramedics or emergency medical technicians (EMT), and the relatively low level of patient satisfaction with care received, is a phenomenon observed in many countries. Many studies show that it occurs in the case of an inadequate interpersonal communication between medical professionals and patients. The primary goal of the presented research was evaluation of the level (study of the state) of communication competences of paramedics, and determination of the factors on which this level depends. An additional goal was analysis of the needs and educational possibilities within the existing models of education in the area of interpersonal communication provided by higher medical education institutions. METHODS: The following three methods were used: 1) documentation analysis (standards, plans and educational programmes); 2) diagnostic survey concerning professional communication competences of paramedics; 3) self-reported communication skills in emergency medical services--adjective check list. The last two instruments were subject to standardization from the aspect of reliability and validity. The study group covered a total of 105 respondents in the following subgroups: 1) professional paramedics who, as a rule, were not trained in interpersonal communication (31 respondents); paramedic students covered by a standard educational programme (54 respondents); 3) paramedic students who, in addition to a standard educational programme, attended extra courses in professional interpersonal communications (20 respondents). RESULTS: The results of studies indicate poor efficacy of shaping communication competences of paramedics based on education in the area of general psychology and general interpersonal communication. Communication competences acquired by paramedics during undergraduate education are subject to regression during occupational activity. DISCUSSION: Methods of evaluating communication competences are useful in constructing group and individual programmes focused on specific communication competences, rather than on general communication skills.

Selected aspects of a professional doctor-patient communication--education and practice.

BACKGROUND: In the work of a physician, not only knowledge, and professional skills (technical/hard) are important, but also psychosocial skills (relational/soft). OBJECTIVES: The primary goal of the presented research was evaluation of the level (study of the state) of communication competences of physicians and determination of the factors on which this level depends. An additional goal was analysis of the needs and educational possibilities within the existing models of education in the area of interpersonal communication provided in Medical Universities in Poland. DESIGN, SETTING AND PARTICIPANTS: Information about educational curricula available on the websites of 12 Medical Universities in Poland were compared. The self-designed questionnaire and adjective check list were subject to standardization from the aspect of reliability and validity. The study groups included 1) occupationally-active physicians (185 respondents) employed in outpatient departments and hospitals, who were covered by a pre-graduate standard educational programme and not trained in interpersonal communication skills as part of their continuing education; 2) medical students covered by a standard educational programme (246 respondents). RESULTS: The conducted analysis of the educational curricula showed a very narrow scope of problems concerning professional medical communication. The results indicating the general state of respondents' communication competences within all aspects (motivation, skills, knowledge) were relatively low. That clearly indicated an inadequate educational model (students), and lack of post-graduate training in the area of professional medical communication (physicians). CONCLUSIONS: The education of students of medicine should cover selected classes within the scope of professional communication competences. These classes should be based on the systemically designed training of skills. The patterning by students of the relations attitudes observed in practising physicians is insufficient. It is necessary to apply a methodical evaluation of communication competences, diagnosing educational needs of occupationally active physicians in this respect. This allows the preparation of courses in accordance with the needs in the area of professional communication competences.

Professional communication competences of nurses -- a review of current practice and educational problems.

BACKGROUND: A dissonance between high 'technical' professionalism of nurses and a relatively low level of patient satisfaction with received care is a phenomenon observed in many countries. METHOD: Theoretical concept and review of current published studies. DISCUSSION: Most reviewed studies show that a low level of patient satisfaction occurs in the case of an inadequate interpersonal communication between nurses and patients. Most studies indicate poor effectiveness of shaping communication competences of nurses based on standard education in the area of general psychology and communication knowledge, because this knowledge does not convert itself 'spontaneously' into communication competences during occupational activity. CONCLUSIONS: It is necessary to supplement educational programmes for nurses with practical courses in professional interpersonal communication. International experience exchange concerning the shaping of nurses' communication competences may be limited due to cultural, organizational and systems factors.

Professional communication competences of physiotherapists -- practice and educational perspectives.

BACKGROUND: Dissonance between the high 'technical' competences of medical professionals, including physiotherapists, and the relatively low level of patient satisfaction with care received is a phenomenon observed in many countries. Many studies show that it occurs in the case of an inadequate interpersonal communication between medical professionals and patients. OBJECTIVES: The primary goal of the presented research was evaluation of the level (study of the state) of communication competences of physiotherapists, and determination of the factors on which this level depends. An additional goal was analysis of the needs and educational possibilities within the existing models of education in the area of interpersonal communication provided by higher medical education institutions. DESIGN, SETTING AND PARTICIPANTS: The self-designed questionnaire and adjective check list were subject to standardization from the aspect of reliability and validity. Information available on the websites of 20 educational facilities in Poland were compared. The study group covered a total number of 115 respondents in the following subgroups: 1) occupationally-active physiotherapists who, as a rule, were not trained in interpersonal communication (35 respondents); students of physiotherapy covered by a standard educational programme (60 respondents); 3) students of physiotherapy who, in addition to a standard educational programme, attended extra courses in professional interpersonal communications (20 respondents). RESULTS: The results of studies indicate poor efficacy of shaping communication competences of physiotherapists based on education in the area of general psychology and general interpersonal communication. Communication competences acquired during undergraduate physiotherapy education are subject to regression during occupational activity. CONCLUSIONS: Methods of evaluating communication competences are useful in constructing group and individual programmes focused on specific communication competences, rather than on general communication skills.

[The need of prenatal public health initiatives in Poland]. / Potrzeba dzialan z zakresu prenatalnego zdrowia publicznego w Polsce.

The author emphasizes the achievements of the Polish Gynecological Society in the field of improving the health indicators concerning perinatal mortality among infants during the last two decades in Poland. Attention is paid to the contribution of the members of the Society to organizational change in Polish health care after 1990, which resulted in the improvement of the care of mother and child. It is also underlined that the members of the Society contributed to the creation of early detection system of breast and cervical cancer in Poland. However it is noteworthy that in 'Polish Gynecology' - the publication of the Polish Gynecological Society - the number of reports devoted to risky health behaviors of women during periconceptional period and pregnancy is scarce. The author draws attention to the percentage of women who smoke cigarettes and consume alcohol before and during pregnancy Emphasis is also placed on the problem of nutritional disorders (mainly pathological methods of dieting) among Polish women during the reproductive period and in the first weeks of pregnancy (before the pregnancy is confirmed). These aspects may result in epigenetic changes shaping the phenotype of the offspring. The author refers to the Barker's theory of Developmental Origins of Adult Diseases and warns that the above-mentioned health behaviors of women may bring about negative effects for the offspring and future generations, namely susceptibility to chronic diseases: arterial hypertension, obesity type 2 diabetes and metabolic syndrome. Negative effects for the health of offspring may also result from low level of physical activity of women before and during pregnancy The author concludes that it is necessary to intensify the efforts of the Polish Gynecological Society in the area of prenatal public health.

Diabetes and depression: a combination of civilization and life-style diseases is more than simple problem adding - literature review.

The article presents a review of current medical and psychological literature published between 2000 - 2010, with the use of the PubMed database, concerning the occurrence of anxiety and depression in diabetic patients, with particular consideration of those affected by complications. Anxiety and fear are the most frequent emotional disorders among diabetic patients. Depression occurs in approximately 30% of patients with diabetes. Both diabetes and depression belong to so called 'life style' or 'civilization diseases'. Numerous studies have confirmed that the course of depression in patients with diabetes is more severe, and the relapses of depression episodes are more frequent. The studies show that diabetic patients experience various types of psychosocial and emotional problems due to which the monitoring of own state of health is not the priority in life. In the process of treatment of both sole diabetes and concomitant anxiety and depression it is important to adjust and motivate patients to apply widely understood therapeutic recommendations. The treatment of depression syndrome in the course of diabetes does not have to lead to improvement in glycaemic control. The following factors influencing the therapeutic eff ect should be mentioned: duration of diabetes, presence of complications, and the eff ect of the drugs applied on body weight, or possibly initial diabetes management. It seems, therefore, that the patient education model based on the provision of knowledge concerning diabetes and its complications, methods of treatment, principles of nutrition and health-promoting life style, may be insufficient, at least for patients with depression. The results of a review of reports shows that an optimum treatment of diabetes, in accordance with the current state of knowledge, requires from physicians a special consideration of psychological and psychiatric knowledge for the 2 following reasons: 1) effectiveness of therapy to a high degree depends on the proper behaviour of a patient; 2) considerably more frequent, compared to the total population, occurrence of the symptoms of emotional disorders negatively affect the course of diabetes.