Patient safety culture in Polish Primary Healthcare Centers.

OBJECTIVE: To examine patient safety culture in primary healthcare centers in Poland. DESIGN: A cross-sectional survey conducted in 2017 using the questionnaire based on the 'Medical Office Survey on Patient Safety Culture' from Agency for Healthcare Research and Quality (AHRQ). SETTING: Three hundred thirty-seventy primary healthcare centers in Poland. PARTICIPANTS: Family physician practices in Poland selected from the population of 5400 using systematic random sampling. The response rate was 62%. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The survey includes 38 items that measured 10 dimensions of patient safety culture and questions referring to information exchange with other settings, quality issues and overall ratings on quality and safety. Mean percent positive scores on all items in each composite were calculated according to user's guide. RESULTS: Individual domains of patient safety culture had better scores among younger respondents and respondents with job seniority at their clinic under 10 years. Patient safety culture scores correlated with size and location (urban or rural) of studied centers, as well as with respondents' gender. The most highly ranked domains were: organizational learning (87.05% of positive scores), teamwork (84.91%), overall perception of patient safety and quality (84.77%) and leadership support for patient safety (84.30%) while the lowest ranked ones were: patient care tracking and follow-up (65.11%), work pressure and pace (57.77%). Other domains such as communication openness (80.96%), staff training (78.90%), office processes and standardization (71.92%) and communication about error (69.80%) ranked between. CONCLUSIONS: Patient safety culture in primary healthcare centers in Poland was evaluated positively.

Serum Lipid, Vitamin D Levels, and Obesity in Perimenopausal and Postmenopausal Women in Non-Manual Employment.

BACKGROUND Increasing age, increased body mass index (BMI), and abnormal lipid profiles contribute to an increased risk of vitamin D deficiency. Women who have a perimenopausal and postmenopausal reduction in estrogen levels are a high-risk group for vitamin D deficiency. The aims of this study were to compare the serum vitamin D levels, lipid profile, and BMI between perimenopausal and postmenopausal women in non-manual employment, and to determine whether there were any interdependent factors. MATERIAL AND METHODS Three hundred women in non-manual employment, aged between 44-66 years, were divided into three groups: early perimenopausal; late perimenopausal; and postmenopausal. Laboratory tests included measurement of serum lipid profiles and vitamin D levels, the BMI, waist-hip ratio (WHR) and body fat were measured. Statistical analysis included F-test analysis of variance and the least significance difference (LSD) test was used for multiple comparisons. RESULTS For the 300 women who were in non-manual employment, and in the early and late perimenopausal and postmenopausal periods, serum vitamin D levels were reduced (mean 16.8±8.7 ng/mL); 29% of women had abdominal obesity; 41% had excessive body fat accumulation; and 56% had an increased body mass index (BMI) (>25 kg/m²) with raised total cholesterol, low-density lipoprotein (LDL) cholesterol, LDL/high-density lipoprotein (HDL), and total cholesterol/HDL ratios (p<0.05). CONCLUSIONS The findings of this study showed that in perimenopausal and postmenopausal women in non-manual employment, serum vitamin D levels were associated with serum lipid profile and degrees of obesity.

Cognitive functions and serum cortisol concentration in perimenopausal and postmenopausal women working non-manually.

OBJECTIVES: To asses a possible relationship between serum cortisol concentration and cognitive function in peri- and postmenopausal women engaging in non-manual work. METHODS: The Montreal Cognitive Assessment (MoCA) was used to screen women for the study and the Computerized Neurocognitive-assessment Software (CNS) Vital Signs to diagnose cognitive functions. RESULTS: Cognitive functions and serum cortisol concentration did not differ between women in early and late perimenopause and postmenopause. The women in the study obtained lower reaction time compared to other cognitive functions studied. Cognitive functions correlated negatively with age and educational level, but not BMI. Serum cortisol concentration correlated negatively to NCI, motor speed, psychomotor speed and reaction time in postmenopausal women, but positively to complex memory in early perimenopausal women and to processing speed in early and late perimenopasal women. CONCLUSION: Higher serum cortisol concentration may negatively effect cognitive functions in women post menopause.

Relationship between adipokines and lipid profile in postmenopausal women with different apolipoprotein E genotypes.

The aim of the authors of this study was to clarify the relationships among apolipoprotein E (ApoE) genotype, blood pressure, lipid profile, serum leptin, and adiponectin in healthy postmenopausal women. The study was conducted between March 2011 and December 2012 on 266 participants aged 50-65 years from the Institute of Rural Health in Lublin, Poland. Results showed that women had four combinations of genotypes: ɛ2/ɛ3, ɛ3/ɛ3, ɛ3/ɛ4, and ɛ4/ɛ4. Carriers of different genotypes did not differ in terms of age, body mass index (BMI), blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, and adiponectin levels. Mean low-density lipoprotein (LDL) cholesterol levels were higher in ε4 carriers compared to non-carriers. Fasting serum leptin concentrations were higher in homozygotes ɛ4/ɛ4. Leptin correlated positively with BMI in all study groups and with LDL in ɛ2/ɛ3, ɛ3/ɛ3, and ɛ3/ɛ4. Adiponectin correlated negatively with triglycerides in ɛ2/ɛ3, ɛ3/ɛ3, and ɛ3/ɛ4 and positively with HDL in ɛ2/ɛ3 carriers. Adipokines were not associated with blood pressure. Multiple regression analyses demonstrated associations among leptin, ApoE ɛ4/ɛ4, BMI, and LDL, and among adiponectin, BMI, and triglycerides. In healthy postmenopausal women ɛ4/ɛ4 genotype was associated with lower leptin levels. Homozygosity ɛ4/ɛ4 was associated with a more atherogenic lipid profile and possibly dysregulation of leptin and adiponectin signaling in lipid metabolism.

Cognitive Functions, Concentration of Endogenous Estradiol, Estrogen Receptor α (ERα) Polymorphism in Postmenopausal Women.

BACKGROUND The goal of this study was to investigate the relationship between cognitive functions and the level of endogenous estradiol in postmenopausal women, according to which estrogen receptor α (ERα) polymorphism the woman carries. MATERIAL AND METHODS The study group consisted of 210 women. The inclusion criteria were: minimum 2 years after the last menstruation, FSH concentration 30 U/ml, and no dementia signs on Montreal Cognitive Assessment (MoCA). A computerized battery of Central Nervous System Vital Signs (CNS VS) test was used to diagnose cognitive functions. Genotyping of the ERa polymorphism was performed using a polymerase chain reaction and restriction enzymes (PCR-RFLP). Blood plasma was tested for FSH and estradiol (E2). Statistical analysis was performed using STATISTICA software. RESULTS A relationship was confirmed between standard scores for 3 cognitive functions: general memory, verbal memory, and processing speed, and the XbaI polymorphism in the women in the study. In the group of women with genotype TT PvuII, significant positive relationships were observed between the concentration of E2 and the standard scores of 3 cognitive functions: general memory, verbal memory, and processing speed. In the group of women with genotype TC PvuII, significant negative correlations were found between the concentration of E2 and the standard scores of 4 cognitive functions: NCI, general memory, verbal memory, and processing speed. CONCLUSIONS ERα polymorphism exerted an effect on the interaction between the concentration of estradiol and the results for cognitive functions. The concentration of estradiol did not depend on Xba1 and PvuII polymorphisms. The results for cognitive functions depended on which Xba1 polymorphism the woman carried.

State of Health and Quality of Life of Women at Advanced Age.

BACKGROUND Evaluation of the state of health, quality of life, and relationship between the level of the quality of life and health status in a group of women at advanced age (90 and more years) in Poland. MATERIAL AND METHODS The study was conducted in 2014 in an all-Polish sample of 870 women aged 90 and over. The research instruments were: the author's questionnaire, and standardized tests: Katz index of independence in Activities of Daily Living (ADL), Abbreviated Mental Test Score (AMTS), The World Health Organization Quality of Life (WHOQOL) - BREF. The results of the study were statistically analyzed using significant t test for mean and regression analysis. RESULTS The majority of women at advanced age suffered from chronic pain (76%) and such major geriatric problems as hypoacusis (81%), visual disturbances (69%) and urinary incontinence (60%), the minority - fall and fainting (39%) as well as stool incontinence (17%), severe functional and cognitive impairment (24% and 10% respectively). Women at advanced age assessed positively for overall quality of life (mean 3.3 on 1-5 scale), social relationships (3.5) and environment (3.2), but negatively - general, physical and psychological health (2.7, 2.7 and 2.8 respectively). The presence of chronic pain and major geriatric problems: urinary and stool incontinences, falls and fainting, visual disturbances and hypoacusis significantly decreases overall quality of life, general, physical and psychological health, social relationships and environment of women at advanced age. Overall quality of life, general, physical and psychological health, social relationships and environment correlate to functional and cognitive impairments of women at advanced age. CONCLUSIONS Quality of life of women at advanced age decreased if chronic pain, major geriatric problems as well as functional and cognitive impairments occur.

Functional status of thyroid and cognitive functions after menopause.

BACKGROUND: Thyroid activity plays a role in cognition. However, the relation between the functional state of thyroid and neuropsychiatric changes proceeding with age among people without clinical symptoms of thyroid dysfunction is still unknown. The aim of this study was analysis of cognitive function levels in reference to thyroid examination: thyroid-stimulating hormone (TSH), total thyroxin (TT4), triiodothyronine (TT3), free thyroxin (FT4), free triiodothyronine (FT3), thyroperoxidase antibodies (TPO-AB), and thyroglobulin antibodies (Tg-AB), TSH receptor antibodies (AB-TSHR) in women after menopause. MATERIAL AND METHODS: A group of 383 women was recruited for the study. The inclusion criteria were: minimum two years after the last menstruation and no dementia signs on Montreal Cognitive Assessment (MoCA). Computerized battery of Central Nervous System Vital Signs (CNS VS) test was used to diagnostic cognitive functions. The blood plasma values were determined: TSH, FT3, FT4, TT3, TT4, TPO-AB, Tg-AB, and AB-TSHR. Statistical analysis was performed using Pearson's correlation coefficient and analysis of variance in STATISTICA software. RESULTS: In women after menopause, TSH was negatively correlated with NCI results, executive functions, complex attention, and cognitive flexibility. FT4 was positively correlated with results of psychomotor speed. TT3 and TT4 were negatively correlated with results of memory and verbal memory. Furthermore, TT4 was negatively correlated with NCI, executive functions, and cognitive flexibility. TPO-AB was negatively correlated with results of memory, verbal memory, and psychomotor speed. Tg-AB was positively correlated with results of reaction time. AB-TSHR was negatively correlated with NCI results, memory, executive functions, psychomotor speed, complex attention, and cognitive flexibility. CONCLUSIONS: Our study supports the importance of thyroid functionality in cognitive functioning in a group of women after menopause. The values of TSH, TT3, TT4, TPO-AB, and AB-TSHR were higher and FT4 was lower in examined women. The results were poorer in examination of cognitive functions measured with a battery of CNS-VS tests.

Homocysteine and cognitive disorders of postmenopausal women measured by a battery of computer tests--central nervous system vital signs.

The purpose of the study was the analysis of cognitive functions in postmenopausal women having different status of homocysteine levels by a battery of computer tests-central nervous system vital signs (CNS-VS). We examined whether homocysteine increases the risk of cognitive decline and which cognitive domains are more affected. We showed that the considerably better neurocognitive index was obtained by women with low homocysteine levels in comparison with those with hyperhomocysteinemia (p = 0.0017). Similarly, results were obtained in the field of executive functioning (p = 0.0011), complex attention (p = 0.0106), cognitive flexibility (p = 0.0016), and memory (p = 0.0145). Verbal memory and visual memory did not differ considerably among the studied groups. Also, we demonstrated that ε4/ε4 genotype was the most common (15.5 %) in women with hyperhomocysteinemia than in groups of patients with low (0 %) or normal (1.9 %) homocysteine levels. In summary, hyperhomocysteinemia was related with increased risk of decline in executive functioning, complex attention, cognitive flexibility, and memory in postmenopausal women.

[Correlation between intensity of menopausal symptoms and cognitive domain assessed with CNS-VS tests]. / Nasilenie objawów menopauzalnych a funkcje poznawcze oceniane bateria testów CNS-VS.

INTRODUCTION: Numerous publications suggest that many cognitive domains deteriorate with age. As far as postmenopausal women are concerned, the question remains whether the process is caused only by an ageing brain or also by the menopause. The objective of this research was to analyze a possible correlation between intensity and duration of menopausal symptoms and the level of cognitive domains measured with CNS-VS tests among post-menopausal women. METHODOLOGY: The group under examination included 383 postmenopausal women (at least 2 years after their last menstruation) from South-Eastern Poland. The following inclusion criteria were used: age 50-65, good overall health status, at least primary level of education, and FSH>30 mlU/ml. Cognitive domains were assessed using the CNS - VitalSigns diagnostic device. The intensity of menopausal symptoms was measured with the Kupperman Index and the Greene Scale. The statistical analysis was conducted with the use of the Statistica software. RESULTS: There were no significant relations between age at last menstruation and cognitive domains. BMI was oositively correlated with the Neurocognitive index (NCI) and memory visual memory processing speed, and executive functions. The intensity of menopausal symptoms measured with the Greene Scale was negatively correlated with NCI and most of the cognitive domains, whereas symptoms measured with the Kupperman Index were negatively correlated with NCI and visual memory CONCLUSIONS: Our findings suggest a correlation of the intensity and duration of menopausal symptoms with the revel of cognitive domain among menopausal women. The most significant consequences resulting from changes in the cognitive domains included psychological and vasomotor symptoms, as well as - to a lesser extent - somatic symptoms.

[The effect of prolactin and apolipoprotein E gene polymorphism on cognitive functions of menopausal women]. / Poziom prolaktyny i polimorfizm genu apolipoproteiny E a funkcje poznawcze kobiet po menopauzie.

OBJECTIVE: The objective of the study was to analyze a possible association between cognitive functions and level of prolactin in menopausal women with different polymorphisms of apolipoprotein E gene (APOE). The examined population included women from the south-eastern part of Poland; aged 50-65 years; at least 2 years after their last menstruation; in good health; with at least primary education, FSH > 30 mIU/ml. The MoCA test (Montreal Cognitive Assessment Test) allowed us to exclude women with signs of dementia. The cognitive functions assessment was conducted with the CNS-VitalSigns diagnostic equipment (Polish version). The prolactin designations were conducted by SYNEVO--an accredited laboratory. The examination of APOE polymorphism was performed using the multiplex-PCR method. The results were statistically analyzed. RESULTS AND CONCLUSION: Higher level of prolactin turned out to be associated with better test results in the following areas: NCI, memory verbal memory psychomotor speed and concentration. Women with higher level of prolactin had better results in NCI, psychomotor speed and verbal memory tests. The test results of other cognitive function were not unequivocally related to higher levels of prolactin. Thus, it was not possible to conclude that the presence of APOE polymorphism is related to the effect of prolactin on cognitive functions of the examined menopausal women.

Polymorphisms of apolipoprotein E gene and cognitive functions of postmenopausal women, measured by battery of computer tests - Central Nervous System Vital Signs.

OBJECTIVES: Apolipoprotein E (APOE) gene belongs to the group of genes increasing the risk of the Alzheimer's disease (AD) development. The purpose of the study was the analysis of cognitive functions in postmenopausal women having different polymorphisms of APOE gene; battery of computer tests - Central Nervous System Vital Signs (CNS-VS) were employed. METHODS: The women were qualified into the examined group on the grounds of clinical symptoms (minimum 2 years after the last menstruation), as well as on the basis of FSH concentration. At the qualification stage, a short test - Montreal Scale of Cognitive Function Assessment (MoCA) was conducted. The assessment of cognitive functions was made with the use of diagnostic CNS-Vital Signs equipment. Genomic DNA isolation was extracted from human whole blood. Multiplex PCR reactions have been performed in a single reaction tube with six (6) primers, consisting of 2 common primers and 4 specific primers [2 - for each of 2 single nucleotide polymorphism (SNP) sites]. RESULTS AND CONCLUSIONS: About half of the examined postmenopausal women were placed below average in the majority of the examined cognitive functions. The biggest impairments occurred in the field of processing speed, and the smallest - in the field of verbal and visual memory. Polymorphisms of APOE gene were considerably linked with the level of results of the majority of cognitive functions among postmenopausal women, as measured by battery of computer tests - CNS-VS. The presence of ε2/ε3 polymorphism of APOE gene impacted positively the obtained results of cognitive functions, whereas the presence of ε3/ε4, or ε4/ε4 polymorphisms worsened the obtained results.

Association between myostatin serum concentration and body fat level in peri- and postmenopausal women.

Introduction: Every year over 25 million women worldwide experience menopause symptoms. Menopause leads to the occurrence and intensification of many psychological and somatic disorders including body composition change. Myostatin may play a crucial role in the remodeling of muscle and fat tissue. The aim of the study was to determine the relationship between the level of body fat and the concentration of myostatin protein in serum of peri- or postmenopausal women. Material and methods: The study included 300 Caucasian women (in perimenopause or postmenopause). Detailed data were collected at a single time point from all enrolled women. The data included: age, body mass index, hormone replacement therapy and body fat. Measurements of adipose tissue were performed using electronic skinfold calipers. Serum levels of myostatin were determined using a Human Myostatin ELISA Kit. Results: The mean myostatin concentration in blood serum was 6.58 ±3.59 ng/ml. The mean percentage of body fat was 32.7 ±6.3 (range: 16.1-50.7). The percentages of women in particular groups of body fat level (I, II, III, IV and V) were 1.7%, 11%, 35.3%, 30.7% and 21.3% respectively. Myostatin level in blood serum was significantly lower (median concentrations: 5.5 vs. 7.0 ng/ml, p = 0.0269) in subjects with higher body fat (groups IV and V) compared to those classified as having a normal or low level of body fat (groups I-III). Myostatin was an independent predictive factor of the occurrence of high body fat (p = 0.0463). Conclusions: Decreased level of myostatin is related to higher level of body fat in peri- and postmenopausal women.

Oestrogen receptor α gene polymorphisms, insomnia, and cognitive functions in perimenopausal and postmenopausal women in non-manual employment.

Introduction: A potential way to explain the relationships between sleep disorders and cognitive disorders during menopausal transition is the identification of genetic markers related to changes in cognitive functions, as well as changes in quality of sleep during menopause. The objective was an analysis of the relationship between sleep disorders and cognitive disorders, according to the possessed oestrogen receptor α gene polymorphism (ESR1) in perimenopausal and postmenopausal women. Material and methods: The study included 300 women aged 44-66 years, employed as non-manual workers. A computerised battery of the Central Nervous System Vital Signs (CNS VS) test was used to diagnose cognitive functions. ESR1 polymorphisms were genotyped using PCR-RFLP methods. The Athens Insomnia Scale was used to diagnose sleep disorders. Results: More severe insomnia was related to worse complex memory, visual memory, and simple attention in the total group of examined women. More severe insomnia was related to worse simple attention in women with genotypes AG Xba I or TC Pvu II ESR1, in perimenopausal women with genotypes AG Xba I or TC Pvu II ESR1. During the postmenopausal period, the severity of insomnia negatively correlated with visual memory in carriers of Pvu II TT, and with reaction time in carriers of Xba I AA. Conclusions: The results indicate an important role of oestrogen receptor α gene polymorphism in the modulation of the effect of insomnia on cognitive functions in peri- and postmenopausal women.

Effect of interactions between APOE and ESR1 polymorphisms on cognitive functions in postmenopausal women.

INTRODUCTION: During menopause the level of estrogens is decreased, which may lead to cognitive impairment or dementia. Some forms of genetic polymorphism were found to be related to cognitive functions, including APOE and ESR1 (PvuII and XbaI) polymorphisms. In the present study we aimed to analyze the impact of interactions between APOE and ESR1 polymorphisms on cognitive functions in the group of postmenopausal women. MATERIAL AND METHODS: The study group consisted of 266 postmenopausal women aged 50-65 years without symptoms of dementia. A computerized battery of the Central Nervous System Vital Signs (CNS VS) test was used to diagnose cognitive functions. APOE and ESR1 polymorphisms were genotyped using multiplex PCR and PCR-RFLP methods, respectively. Statistical analysis was performed using two-way analysis of variance in Statistica software. RESULTS: The best memory, visual memory, processing and psychomotor speeds were found in women carrying the C allele of the PvuII polymorphism (TC + CC genotypes) in the presence of the APOE ε2/ε3 genotype, while a lower outcome was noted in women with ε3/ε3, and the lowest if they had the ε4 allele. In the case of women with TT genotype of the PvuII polymorphism, cognitive functioning did not decrease in women with the ε4 allele. A similar effect on cognitive functions was observed for AG + GG genotypes of the XbaI and APOE polymorphisms. Women who simultaneously carried CC PvuII and GG XbaI genotypes had the lowest cognitive functions. CONCLUSIONS: Interactions of polymorphic variants of APOE and ESR1 genes influenced cognitive functions in postmenopausal women.

Metabolic syndrome in peri - and postmenopausal women performing intellectual work.

INTRODUCTION: Metabolic Syndrome is a set of interrelated risk factors for the emergence and progression of cardiovascular disease and diabetes, such as central obesity (abdominal), elevated blood pressure and disorders of carbohydrate and lipid metabolism. Peri- and postmenopausal women are particularly at risk of developing MS, by aging and the loss of protective effect of estrogen on the body, additionally by intellectual work associated with a sedentary lifestyle and job stress. The aim of our study was to analyze the frequency of MS and its criteria in perimenopausal and postmenopausal women doing intellectual work, as well as selected factors on which metabolic syndrome depend. MATERIAL AND METHODS: The study group consist of 300 women aged 44-66 working intellectually. Research methods used: metabolic syndrome's criteria, Greene Climacteric Scale, body fat accumulation, medical interview. Statistical methods used: logistic regression analysis, analysis of variance, χ2 test of stochastic independence. RESULTS: The MS was diagnosed in about » of the women in perimenopausal and postmenopausal period working intelectually, in most of them abdominal obesity ( ¾ ), in more than a half hypertension, in every sixth hypertriglyceridemia, in every seventh hyperglycemia and in every tenth low HDL-C. Prevalence of MS and its criteria was correlated with BMI, body fat accumulation and parity. Prevalence of arterial hypertension was associated with the severity of menopausal symptoms and lack of physical activity. CONCLUSIONS: Prevalence of MS and some of its criteria depended on BMI, body fat accumulation, parity, severity of menopausal symptoms and lack of physical activity, whereas did not depend on: age between 44-66, educational level, marital status or HRT taking.

Telemedical assessment of the level of energy expenditure in overweight and obese individuals.

INTRODUCTION: Increasing the energy expenditure above the elementary level of metabolism by undertaking regular physical activity causes body mass reduction and its maintenance at a healthy level. AIM: To remote assessment of the level of physical activity in a group of overweight and obese individuals. MATERIAL AND METHODS: The research was conducted in the Department of Rehabilitation at the Institute of Rural Health, Lublin, Poland, and included a group of 514 volunteers of both genders (38 ±12 years). The examined group was divided into three subgroups depending on the body mass index (BMI) level (I - normal, II - overweight, III - obese). The level of physical activity at home was assessed based of the short version of the International Physical Activity Questionnaire (IPAQ), conducted by means of a mobile application, and was compared with data registered by the accelerometer of a smartphone. RESULTS: The IPAQ-assessed level of the physical activity expressed in MET-min/week amounted to the following values: group I: 5190.38 ±6629.84, group II: 5099.53 ±6380.97, group III: 3939.31 ±4000.73; and the caloric cost (cal × week-1) amounted to: group I: 5825.47 ±7512.99, group II: 7204.09 ±9187.96), and group III: 7002.10 ±7296.22. Registered levels of physical activity (MET-min/week) were lower than IPAQ-assessed: in group I (3741.24 ±3958.29), in group II (2447.72 ±2156.44) and in group III (1927.42 ±1790.85) (p < 0.05). CONCLUSIONS: The average values of energy expenditure showed a declining tendency, together with an increase in the BMI. On the other hand, the total weekly caloric cost showed the lowest average values in the group with normal body mass.

Pain involving the motor system and serum vitamin D concentration in postmenopausal women working in agriculture.

INTRODUCTION AND OBJECTIVE: Since the role of vitamin D is essential in numerous biological processes its deficiency was suggested to be a risk factor for e.g. osteoporosis, musculoskeletal pain and spine pain. The purpose of the study was to analyse whether serum vitamin D concentration is related to pain involving the motor system in Polish postmenopausal women working in agriculture. MATERIAL AND METHODS: The study group consisted of 1,751 post-menopausal women, aged 45-65, at least 12 months from the last menstrual period, living in rural areas and working in agriculture. The research method was self-assessment of pain involving the motor system using VAS, laboratory test of serum vitamin D concentration and a medical interview. Statistical methods included generalized linear models, analysis of variance, t test for two means in two independents, χ2 test of stochastic independence. RESULTS: Postmenopausal women working in agriculture and suffering from pain in at least one part of the motor system were younger and lower educated, they also had higher abdominal obesity and lower serum vitamin D, compared to those without pain in any part of the motor system. Decreased serum vitamin D concentration in postmenopausal women working in agriculture is important from the aspect of a higher prevalence of pain in the thoracic spine and more severe pain in the neck spine, but not for severity of pain in the lumbar spine; higher occurrence of pain in both hands or wrists; higher prevalence and more severe pain in at least one knee; and no prevalence or severity of pain in the shoulders and elbows. CONCLUSION: Serum vitamin D concentration is important for the prevalence and severity of pain in the neck and thoracic spine, knees and hands or wrists, but not for the lumbar spine, shoulders and elbows.

Cardiovascular diseases, metabolic syndrome and health behaviours of postmenopausal women working in agriculture.

INTRODUCTION: The objective of the study was to examine the impact of occurrence of cardiovascular diseases (CVDs) and metabolic syndrome (MS) diagnoses on the frequency of health behaviours in postmenopausal women working in agriculture. MATERIAL AND METHODS: Eight hundred and ten postmenopausal women living in rural areas and working in agriculture, aged 46-70 and at least 12 months from the last menstrual period, were examined. Analysis of variance with multiple comparison tests was used to compare the Inventory of Health Behaviours among the women with and without CVDs and MS. RESULTS: The frequency of some health behaviours, mainly health practices, is higher in postmenopausal women working in agriculture with CVDs or MS than in those without CVDs or MS (p = 0.045). Women with such disorders more often limit their physical effort (p = 0.029), try to be less overworked (p < 0.001) and to take more rest (p = 0.027), more often limit consumption of animal fat and sugar (p = 0.024), more regularly visit physicians (p = 0.003) and more often take seriously recommendations concerning their health. However, an insufficient frequency of health behaviours was observed among both the healthy women and those with metabolic disorders and CVDs. One third of all the examined women had a high frequency of health behaviours, one third had an average frequency and one third had a low frequency; hence actions should be taken to improve the situation. CONCLUSIONS: Postmenopausal women working in agriculture more often perform beneficial health behaviours if they have MS and CVDs diagnosed in comparison to healthy women.

Does genetic testing for ERα gene polymorphisms provide new possibilities of treatment for cognitive function disorders in postmenopausal women?

It is commonly considered that cognitive abilities decrease with age, especially with respect to processing and psychomotor speed. It is an interesting issue whether, apart from the ageing process, the undergoing of menopause itself deteriorates cognitive functions, compared to women at reproductive age. Hopes for improvement of cognitive functions were pinned on the use of menopausal hormone therapy. However, the results of studies concerning the effect of hormone replacement therapy on cognition proved to be contradictory. It seems that the essence of the problem is more complicated than only estrogen deficiency. It is suggested that estrogen receptor α (ERα) polymorphism may be responsible for the differences in the effect of estrogens on cognitive processes. The article presents current knowledge concerning the effect of estrogens on the central nervous system, especially the role of ERα polymorphism, with respect to foreseeing benefits from the use of exogenous estrogens for cognitive functions. At the present stage of research, ERα appears to be poorly specific; nevertheless, it may be an important instrument for the classification of peri- and post-menopausal patients in the group where therapy with the use of estrogens may bring about benefits in terms of prevention and treatment of cognitive disorders. It also seems necessary to conduct prophylactic, screening examination of cognitive functions in post-menopausal women, in order to identify those at risk of the development of dementia.

Models of cognitive functions with respect to selected parameters of functional state of the thyroid gland in post-menopausal women.

INTRODUCTION: The objective of the study was the development of models of cognitive functions in a group of post-menopausal women, according to the concentration of the selected laboratory parameters evaluating the functional state of the thyroid gland. MATERIAL AND METHODS: The study was conducted during 2012-2014, and covered women aged 50-65 years, minimum two years after the last menstruation, without chronic diseases, cancerous diseases, mental disorders, addiction to drugs or alcohol, and who did not use hormone replacement therapy. At the stage of qualification, a brief MoCA test was performed; 383 women were qualified for the study. Blood was collected for the determination of such parameters as: TSH, TT4, fT4, anti-TPO, anti-Tg, and AB-TSHR. Assessment of cognitive functions was performed using the diagnostic instrument Central Nervous System - Vital Signs (CNS-VS) (Polish version). The results were statistically analysed. RESULTS: The mean age of the women in the study was 56.4 ± 3.4; the mean TSH was 1.91 ± 1.35 mU/L, fT4 14.76 ± 2.34 pmol/L, and TT4 99.12 ± 16.98 nmol/L. Mean values were: 64.74 IU/L for anti-TPO, 100.69 IU/L for anti-Tg, and 1.40 IU/L for AB-TSHR. The examined women obtained the neurocognitive index (NCI) on the level of 84.4 scores, on average. The lowest results were obtained in tests assessing cognitive flexibility (mean 78.64 scores), processing speed (mean 79.25 scores), and executive functions (mean 79.75 scores). In the tests evaluating complex attention, the mean values were 82.24 scores, psychomotor speed - mean 83.42 scores, and reaction time - mean 86.87 scores. The women examined obtained the best results in tests assessing memory (mean 90.15 scores), including verbal (mean 91.22 scores), and visual (mean 93.37 scores). The NCI and cognitive function models were assessed from the aspect of thyroid gland examinations in post-menopausal women. Based on the analyses performed, the following conclusions were drawn: The developed models of cognitive functions indicate a considerable effect of TSH, fT4, AB-TSHR, and anti-TPO, as well as TT4 and anti-Tg, on the level of cognitive functions after menopause in the group examined. The conducted study suggests the need for examination of the functional state of the thyroid gland in post-menopausal women who show cognitive function disorders.