[Employment of patients with multiple sclerosis among the population of Lódz]. / Zatrudnienie chorych na stwardnienie rozsiane w populacji Lodzi.

The studied material comprised multiple sclerosis patients aged 46 years or less, not staying in welfare institutions, with at least 5 years of the disease, recorded as cases of this disease 5-6 years previously during one year (Oct 1 1973 to Nov 31 1974) in neurological outpatient clinics or hospital departments of neurology or neurosurgery. The percent of those working in gainful occupations was 26%, and in the subgroup of cases with least pronounced disease it was 43%, while only 10% of all patients were outworkers. Only 4 patients were studying in schools. In the subgroup of patients who were unable to use municipal transport means, even with assistance of other persons, none was working. Only half those patients, who were not working despite full of nearly full motor fitness, declared their willingness to work, among them were 5 out of 6 men only 11 out of 26 women. Eight patients tried to get jobs without success. These facts indicate a negative attitude towards occupational work in a fairly large part of the patients and their families, and also failing organization of employment of disabled persons.

[Utilization of ambulatory health services by patients with disseminated sclerosis among the population of Lódz]. / Korzystanie z ambulatoryjnej opieki zdrowotnej przez chorych na stwardnienie rozsiane w populacji Lodzi.

The reported study included patients with multiple sclerosis with a history of at least 5 years of the disease and aged 46 years or less, living in a big city. On the ground of history data obtained from the patients it was estimated that in the calendar year preceding the study one patient obtained about 11 medical services (in the office of a physician or in the patient's home) and about 10 of these services were given by the doctors of the public health service. The main role in the care of the patients was played by neurologists from the public health service, but the number of house visits provided by physicians of the basic health service was slightly higher than that provided by neurologists. Among the physicians working in medical cooperative or in private practice only the dentists had a more important role in providing of health services to the patients. Thirty percent of patients had no medical visits in outpatient clinics of social health service within a year preceding the study, despite a need for them, and 9% of them had no house visits of physicians. The percent of patients informed about the usefulness of motor rehabilitation treatment was at least half the proportion of patients with walking disturbances. The results indicate inadequate availability of health services for this group of outpatients, similarly as outpatient rehabilitation treatment and treatment in sanatorium, despite the index of employed medical personnel per population which is higher in this city than the average index for the whole country. These results suggest a necessity of undertaking of actions for improving the care of these patients.

[Family and economic situations and social needs of patients with multiple sclerosis among the population of Lódz]. / Sytuacja rodzinna i materialna oraz potrzeby socjalne chorych na stwardnienie rozsiane w populacji Lodzi.

The reported analysis covered patients aged 46 or less living in a large industrial city, not inmates of homes for the disabled, who had a history of at least 5 years of multiple sclerosis and who had been registered 5-6 years earlier during 1 year (from Oct 1 1973 to Sept 30 1974) in neurological outpatient clinics or neurological or neurosurgical inpatient institutions. About 1/5 of the patients required full nursing care or considerable nursing in the basic everyday activities, and another 2/5 patients regarded themselves as at least slightly dependent on the help of other persons in several basic activities. An overwhelming majority of patients were living with their families and received help only from their family members. At least 30% of these patients required help and interventions of civic workers in view of economic and living difficulties. A particularly troublesome shortcoming (and one which could be helped most easily) was lack of telephones in about 4/5 of cases. Most patients (83%) received disability pensions, and half of them (52%) had received it for at least 2 years. Among women there were more patients receiving this pension than among men, and the proportion of women taking this pension since 8 years or longer was also higher (F-54%, M-45%). These results confirm the current observation that the social needs of patients with multiple sclerosis are far from being adequately met, and they may serve as a basis for elaboration of programme of comprehensive care of this group of patients.

[Patients with multiple sclerosis among the Lódz population. I. Verification of the diagnosis and clinical characteristics]. / Chorzy na stwardnienie rozsiane w populacji Lodzi. I. Weryfikacja rozpoznania i charakterystyka kliniczna.

Home-treated patients with multiple sclerosis who 5-6 years earlier had sought medical advice in neurological health service institutions were examined. Their age was to 46 years; they came from the population of the City Lódz. Slightly over half of them (53%) were patients whose disease had begun at the age of 20-29 years. In 18% of cases the duration of the disease exceeded 14 years. In 60% of cases the disease had a remitting course, in 83% of them multifocal involvement of the nervous system was present. In nearly all cases (97%) pyramidal tract involvement was present, and in 59% the optic nerves were involved. Females prevailed in this group (75%); the proportion of patients aged 40-46 years was higher among the females. In males the onset of the disease before the age of 30 years was significantly more frequent, while in females the proportion of cases beginning at the age of 30-39 years was significantly greater. Among patients aged up to 40 years registered within one year by the neurologists as certain or suspected cases of multiple sclerosis (independently of the duration of the disease) about 7% patients died in a period of 5.7 years on average (10.5% males and 5.3% females). These observations suggest a different onset or course of the disease in both sexes in this population.

[Patients with multiple sclerosis among the Lódz population. II. Clinical course of the disease and patient fitness]. / Chorzy na stwardnienie rozsiane w populacji Lodzi. II. Przebieg choroby i sprawnosc pacjentów.

The motor fitness was assessed in multiple sclerosis patients remaining in their homes in the City of Lódz. The age of the patients was up to 46 years; 5-6 years earlier they had been registered within one year in neurological health service institutions after variously long periods of the disease. The proportion of those with severe motor impairment was 14%, and it was highest (17%) in the groups with disease duration 10-14 years. Nearly half of the group, independently of the age, sex and disease duration, were patients who could move about and perform household works. The proportion of fully fit and nearly fully fit was highest (83%) among those whose disease began under the age of 20 years, and it was lowest (42%) in those with disease onset at the age of 20-29 years. A tendency was observed for a different development of motor function impairment in both sexes depending on the age, age at disease onset and disease duration. In the light of the obtained results it is estimated that in the population of cities in Poland in the whole group of multiple sclerosis patients or subjects with suspected multiple sclerosis registered within one year after variously long disease duration about 40-50% remain after 5-6 years still completely or nearly completely fit.

[The care of patients with cerebral circulatory disorders in the catchment area of one of Warsaw's neurological hospital departments. II. Indications for active ambulatory care of patients discharged from the hospital]. / Opieka nad chorymi z zaburzeniami krazenia mózgowego w obszarze dzialania jednego z warszawskich oddzialów neurologicznych. II. Wskazania do ambulatoryjnej opieki czynnej chorych wypisanych ze szpitala.

In a continuation of the analysis of patients hospitalized for cerebrovascular disease their status upon discharge from the hospital was estimated. It was thought that at least 18% of the admitted patients and about 31% of the discharged patients aged below 80 years were suitable for outpatient rehabilitation treatment after discharge because of motor or speech disturbances, and about 9% of the discharged patients required speech reeducation due to aphasia. Among patients after cerebrovascular episodes qualified after discharge for ambulatory active care because of persistent motor deficit or speech disturbances those with past ischaemic stroke prevailed, they were aged mostly 70-79 years. It may be estimated that at least 7% of patients discharged home after stroke (and about 4% of all admitted cases) require special care and nursing because of coexistence of other serious diseases or previously suffered disability. They are potential candidates for care in welfare homes, and when they remain in their homes they depend on the help and care, in different grades, on the assistance of a nurse or at least an unqualified welfare worker.

[Care of patients with cerebrovascular disorders in the health service area of one of Warsaw's neurological hospital departments. I. Hospital admissions]. / Opieka nad chorymi z zaburzeniami krazenia mózgowego w obszarze dzialania jednego z warszawskich oddzialów neurologicznych. I. Przyjecia do szpitala.

A group of patients hospitalized in the period from Oct 1 1978 to March 31 1980 for cerebrovascular disease was analysed in a Warsaw neurological hospital department. It was estimated that in this time period the annual number of patients admitted with acute and subacute episodes of cerebral circulatory failure was 90 per 100 thousand of the population in the catchment area of the hospital. About one-fifth of all admissions were due to haemorrhagic strokes, in 40% of cases ischaemic stroke was diagnosed, in 16% the character of stroke was unrecognized, 9% had transient brain ischaemia, and 15% had other vascular syndromes. The mean duration of hospital stay of the admitted patients was about 29 days, and that of the discharged patients was 38 days. The mortality was 40%. Differences were found in the index of admissions, pattern of diagnoses and mortality between patients from the catchment area and those from a more distant area, which may suggest a bias in the admissions of cerebrovascular disease cases indicating that the availability of the services of the hospital department depends on organizational factors such as distance of the place of residence from the hospital and connections between inpatient and outpatient health services. It may be estimated that in that time period the department admitted not more than 50-60% of stroke cases from its catchment area, including 60-80% from the city district near the hospital and 30% from a more distant districts.