Stress coping styles in firemen exposed to severe stress. / Styl radzenia sobie ze stresem u strazaków narazonych na ciezki stres.

OBJECTIVES: Emergency service workers such as firemen are exposed to severe stress, which may result in deteriorated functioning and development of posttraumatic stress disorder (PTSD). The aim of the presented study was to assess the stress coping styles of firemen exposed to severe stress, the prevalence of PTSD symptoms, and the correlation between them. METHODS: The study was carried out in a group of 147 Polish firemen. Two questionnaires were used: the Coping Inventory for Stressful Situations (CISS) and the PTSD Interview (PTSD-I) in the Polish language version (K-PTSD). RESULTS: The study was carried out in a group of 147 Polish firemen. Two questionnaires were used: the Coping Inventory for Stressful Situations (CISS) and the PTSD Interview (PTSD-I) in the Polish language version (K-PTSD). CONCLUSIONS: Nearly one third of the investigated group of firemen suffered from symptoms of PTSD, with the stress coping strategy most often observed in that subgroup being style focused on avoidance. Age proved to be a factor associated with the readiness to undertake behavioral measures to cope with stress tension; such behavior tends to be undertaken by older firemen.

Breaking bad news in genetic counseling-problems and communication tools.

Breaking bad news is a common problem for clinical geneticists in their daily work. Just like doctors of other specialties, e.g., oncologists, they can use proven communication tools instead of relying only on professional sense. The latter is, of course, always the most important for experienced doctors, but the use of protocols such as SPIKES and EMPATHY facilitates both the delineation of difficult information and the process of its transmission. The article gives an overview of the best tools of this type available to medical professionals dealing with genetic counseling.

Automated external defibrillator use in public places: a study of acquisition time.

BACKGROUND: Sudden cardiac arrest (SCA) is a frequent cause of death in the developed world. Early defibrillation, preferably within the first minutes of the incident, significantly increases survival rates. Accessible automated external defibrillators (AED) in public areas have been promoted for many years, and several locations are equipped with these devices. AIM: The aim of the study was to assess the real-life availability of AEDs and assess possible sources of delay. METHODS: The study took place in the academic towns of Poznan, Lodz, and Warsaw, Poland. The researchers who were not aware of the exact location of the AED in the selected public locations had to deliver AED therapy in simulated SCA scenarios. For the purpose of the trial, we assumed that the SCA takes place at the main entrance to the public areas equipped with an AED. RESULTS: From approximately 200 locations that have AEDs, 78 sites were analysed. In most places, the AED was located on the ground floor and the median distance from the site of SCA to the nearest AED point was 15 m (interquartile range [IQR] 7-24; range: 2-163 m). The total time required to deliver the device was 96 s (IQR 52-144 s). The average time for discussion with the person responsible for the AED (security officer, staff, etc.) was 16 s (IQR 0-49). The AED was located in open access cabinets for unrestricted collection in 29 locations; in 10 cases an AED was delivered by the personnel, and in 29 cases AED utilisation required continuous personnel assistance. The mode of accessing the AED device was related to the longer discussion time (p < 0.001); however, this did not cause any significant delay in therapy (p = 0.132). The AED was clearly visible in 34 (43.6%) sites. The visibility of AED did not influence the total time of simulated AED implementation. CONCLUSIONS: We conclude that the access to AED is relatively fast in public places. In the majority of assessed locations, it meets the recommended time to early defibrillation of under 3 min from the onset of the cardiac arrest; however, there are several causes for possible delays. The AED signs indicating the location of the device should be larger. AEDs should also be displayed in unrestricted areas for easy access rather than being kept under staff care or in cabinets.

Analysis of the impact of harmful factors in the workplace on functioning of the respiratory system of firefighters.

INTRODUCTION AND OBJECTIVE: Firefighters are considered a healthy and fit group of individuals, well-prepared for taking action in disaster situations. While working, they suffer from exposure to certain toxic agents, especially combustion products generated when a fire takes place. Among them, the most frequent and the most toxic are: carbon monoxide, hydrogen cyanide, ammonia, and those resulting from PVC combustion - hydrochloride, phosgene and chloride. Additionally, fire-extinguisher powder can be inhaled and lead to certain lesion in the airways. The aim of study was to ascertain the influence of toxic agents present at the scene of fire on the lung tissue of firefighters, and also to study this on an animal model. MATERIAL AND METHODS: The study group consisted of firefighters who had a minimum of 10 years service. After completing a questionnaire, their clinical status was ascertained based on a general examination, laboratory tests and lung function tests. RESULTS: Questionnaire analysis showed a high percentage of pathological symptoms in the studied group. The incidence of the symptoms correlated with the duration of occupational exposure to toxic agents. Among other results, obstruction of flow in medium airways in about 30% of the studied individuals represented the most important finding. Experimental tests were next performed on male Wistar rats, aged 3 months. They were insufflated with the solution of powdered fire-extinguisher, after which morphology specimens of lung tissue were studied. Evidence for disseminated fibrosis was obtained, which supported the previous clinical findings in the firefighters. CONCLUSIONS: The above shows correlation between occupational exposure and respiratory system involvement in firefighters. This justifies covering the group of firefighters with special medical care focused on prophilaxis, early detection and therapy of pulmonary diseases.

Privacy and confidentiality measures in genetic testing and counselling: arguing on genetic exceptionalism again?

Medical confidentiality in clinical genetics poses an important question about its scope, which would be in line with professional ethics and simple honesty. It is already known that the maintenance of absolute anonymity, bearing in mind the current progress of genetic techniques, is virtually impossible. On the other hand, our insight into the information contained in the human genome is increasing. This mini-review presents the authors' standpoint regarding this complex and difficult issue.

[Medical simulation as a professional tool which affect the safety of the patient used in the learning process]. / Symulacja medyczna jako profesjonalne narzedzie wplywajace na bezpieczenstwo pacjenta wykorzystywane w procesie nauczania.

Simulation is the methodology of teaching, learning process using educational equipment from simple simulators, designed to study individual tasks, through advanced mannequins called human patient stimulators faithfully mimic the human and its parameters. The medical simulation's main task is education and improvement patients' safety. Advanced human simulators can realistically cough, vomit with artificial chyme and bleed with artificial blood causing a real stress of medical personnel and the need for immediate action. Medical simulation gives the opportunity to prepare medical personnel to the profession more effectively, in less time than traditional education and also clearly affects the patients' safety.

Injuries caused by sharp instruments among healthcare workers--international and Polish perspectives.

Health care workers (HCW) worldwide are especially exposed to injury by sharp instruments in the course of their duty. The most often executed procedures with injury risk are: intramuscular or subcutaneous injection (22%), taking blood samples, or during intravenous cannulation (20%), and repeatedly replacing the cap on an already used needle (30%). Even a minor sharp injury with only a small loss of blood carries the risk of transfer of over 20 pathogens: Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), HIV/AIDS virus, malaria, syphilis, tuberculosis, brucellosis, herpes virus and diphtheria. The World Health Organization (WHO) estimates that more than two million health care workers experience the stressful event of a percutaneous injury with a contaminated sharp object each year (25-90% of them, however, remain unreported). These exposures result in about 16,000 infections with HCV, 66,000 with HBV and about 1,000 (200-5000) with HIV, which lead to about 1,100 deaths or significant disability. Exposures to sharp injuries and their consequences are highly preventable through simple interventions, such as HBV vaccination, education and providing containers for sharp instruments. Specific guidelines, similar to the American Occupational Safety and Health Administration (OSHA) regulations that have lowered by up to 88% of needle stabbing incidents, should be introduced by the European Union (EU) and other countries. The results of a review of reports leads to the following conclusions: 1) elaboration and implementation of new State regulations, especially in EU countries and in countries where such regulations do not exist; 2) the training of health care personnel should always be undertaken for new employees, and periodically for those already employed; 3) periodical control by appointed inspectors of knowledge of procedures for the prevention of injuries by sharp instruments among health care workers; 4) introducing and training in the use of equipment, which can prevent the sharp injuries; 5) an advanced monitoring system of sharp injuries sustained by worker should also be introduced. Successful implementation of these prevention measures will result in progress for public health and HCW's health and safety.

Population biobanking in selected European countries and proposed model for a Polish national DNA bank.

Population biobanks offer new opportunities for public health, are rudimentary for the development of its new branch called Public Health Genomics, and are important for translational research. This article presents organizational models of population biobanks in selected European countries. Review of bibliography and websites of European population biobanks (UK, Spain, Estonia). Some countries establish national genomic biobanks (DNA banks) in order to conduct research on new methods of prevention, diagnosis and treatment of the genetic and lifestyle diseases and on pharmacogenetic research. Individual countries have developed different organizational models of these institutions and specific legal regulations regarding various ways of obtaining genetic data from the inhabitants, donors' rights, organizational and legal aspects. Population biobanks in European countries were funded in different manners. In light of these solutions, the authors discuss prospects of establishing a Polish national genomic biobank for research purpose. They propose the creation of such an institution based on the existing network of blood-donation centres and clinical biobanks in Poland.

Current genetic methodologies in the identification of disaster victims and in forensic analysis.

This review presents the basic problems and currently available molecular techniques used for genetic profiling in disaster victim identification (DVI). The environmental conditions of a mass disaster often result in severe fragmentation, decomposition and intermixing of the remains of victims. In such cases, traditional identification based on the anthropological and physical characteristics of the victims is frequently inconclusive. This is the reason why DNA profiling became the gold standard for victim identification in mass-casualty incidents (MCIs) or any forensic cases where human remains are highly fragmented and/or degraded beyond recognition. The review provides general information about the sources of genetic material for DNA profiling, the genetic markers routinely used during genetic profiling (STR markers, mtDNA and single-nucleotide polymorphisms [SNP]) and the basic statistical approaches used in DNA-based disaster victim identification. Automated technological platforms that allow the simultaneous analysis of a multitude of genetic markers used in genetic identification (oligonucleotide microarray techniques and next-generation sequencing) are also presented. Forensic and population databases containing information on human variability, routinely used for statistical analyses, are discussed. The final part of this review is focused on recent developments, which offer particularly promising tools for forensic applications (mRNA analysis, transcriptome variation in individuals/populations and genetic profiling of specific cells separated from mixtures).

Different effects of pimecrolimus and betamethasone on the skin barrier in patients with atopic dermatitis.

BACKGROUND: Genetic defects leading to skin barrier dysfunction were recognized as risk factors for atopic dermatitis (AD). It is essential that drugs applied to patients with AD restore the impaired epidermal barrier to prevent sensitization by environmental allergens. OBJECTIVES: We investigated the effect of 2 common treatments, a calcineurin inhibitor and a corticosteroid, on the skin barrier. METHODS: In a randomized study 15 patients with AD were treated on one upper limb with pimecrolimus and on the other with betamethasone twice daily for 3 weeks. RESULTS: Stratum corneum hydration and transepidermal water loss, a marker of the inside-outside barrier, improved in both groups. Dye penetration, a marker of the outside-inside barrier, was also reduced in both drugs. Electron microscopic evaluation of barrier structure displayed prevalently ordered stratum corneum lipid layers and regular lamellar body extrusion in pimecrolimus-treated skin but inconsistent extracellular lipid bilayers and only partially filled lamellar bodies after betamethasone treatment. Both drugs normalized epidermal differentiation and reduced epidermal hyperproliferation. Betamethasone was superior in reducing clinical symptoms and epidermal proliferation; however, it led to epidermal thinning. CONCLUSION: The present study demonstrates that both betamethasone and pimecrolimus improve clinical and biophysical parameters and epidermal differentiation. Because pimecrolimus improved the epidermal barrier and did not cause atrophy, it might be more suitable for long-term treatment of AD.

Different effects of pimecrolimus and betamethasone on the skin barrier in patients with atopic dermatitis.

BACKGROUND: Genetic defects leading to skin barrier dysfunction were recognized as risk factors for atopic dermatitis (AD). It is essential that drugs applied to patients with AD restore the impaired epidermal barrier to prevent sensitization by environmental allergens. OBJECTIVES: We investigated the effect of 2 common treatments, a calcineurin inhibitor and a corticosteroid, on the skin barrier. METHODS: In a randomized study 15 patients with AD were treated on one upper limb with pimecrolimus and on the other with betamethasone twice daily for 3 weeks. RESULTS: Stratum corneum hydration and transepidermal water loss, a marker of the inside-outside barrier, improved in both groups. Dye penetration, a marker of the outside-inside barrier, was also reduced in both drugs. Electron microscopic evaluation of barrier structure displayed prevalently ordered stratum corneum lipid layers and regular lamellar body extrusion in pimecrolimus-treated skin but inconsistent extracellular lipid bilayers and only partially filled lamellar bodies after betamethasone treatment. Both drugs normalized epidermal differentiation and reduced epidermal hyperproliferation. Betamethasone was superior in reducing clinical symptoms and epidermal proliferation; however, it led to epidermal thinning. CONCLUSION: The present study demonstrates that both betamethasone and pimecrolimus improve clinical and biophysical parameters and epidermal differentiation. Because pimecrolimus improved the epidermal barrier and did not cause atrophy, it might be more suitable for long-term treatment of AD.

[Can smoking habit be a real risk factor of coronary heart disease in firefighters?]. / Czy rozpowszechnienie palenia tytoniu wsród strazaków stanowic moze realny czynnik ryzyka rozwoju chorób sercowo-naczyniowych?

Active firefighting is strongly associated with exposure to health and live threads (smoke, toxic substances, high temperature) and stress (human suffering, injury, death). Tobacco smoking as a form of stress reduction is an important social and health problem in this group. Smoking as one of the well recognized cardiovascular risk factors may be associated with a risk of death from coronary heart disease in firefighters. The group of 174 active firefighters from wielkopolska region was examined based on Fagerström's and Scheiner's questionnaire. 46% of examined firefighters were active smokers. Mean age of smoking initiation was 16 years, motivation was indicated as an influence of school fellows, curiosity and social situations. Smoking was continued mainly due to professional stress, influence of friends and social situations. 99% considered smoking as harmful and 84% expressed high motivation to quit smoking. It seems to be of special importance to undertake prophylactic measures for oligosymptomatic cardiologic problems and creation of special programs allowing to maintenance of physical fitness among firefighters. Another area of concern should be psychological education on stress-lowering techniques and on general knowledge on a harm of smoking.

[Preliminary analysis of smoking habit in firefighters of Wielkopolska region]. / Wstepna ocena nalogu palenia papierosów u ratowników panstwowej strazy pozarnej w województwie wielkopolskim.

Professional performance of firefighters causes high level of stress. This results in certain activities meant to lower a stress level, some of which are harmful to individuals health per se--smoking is a classical example here. This work was aimed at assessment of prevalence and style of smoking in the group of 69 professional firefighters of Wielkopolska region. Parameters studied were: prevalence, awareness of health-hazard, extent of nicotin addiction, motivation to quit with habit. Motivation to start smoking and further development of smoking habit as well as influence of environment was also studied. Since smoking presents a medical and social problem in this group of professionals, educative measures aimed at reduction of stress level and bad habit fighting should be undertaken.

A hypothesis for GPCR activation.

Growing evidence that rhodopsin (RD) and related G protein-coupled receptors form functional dimers/oligomers, followed by direct proof (using atomic force microscopy) that in the retina disc membrane RD associates into a paracrystalline network of rows of dimers, need models of the RD-transducin (Gt) complex that would envision an optimal RD dimer/oligomer able to satisfy all well-documented interactions with Gt. Of the models proposed so far, only a few refer to RD dimers and only one of them proposes a complex of Gt with an RD oligomer (Filipek S, Krzysko KA, Fotiadis D, Liang Y, Saperstein DA, Engel, A, Palczewski K Photochem Photobiol Sci 3: 628-638, 2004). This paper puts forward a hypothesis on another arrangement of RD monomers into the reported network of rows of dimers. Arguments for the compatibility of this set-up with interactions and activation of RD in the complex with Gt, in particular, with the well-documented movement of transmembrane helix 6 and cytosolic loop 3, which is vital for RD activation, are provided and discussed.

[Fire fighters as a high-risk group of pathological changes in the respiratory tract]. / Ratownicy strazy pozarnej jako grupa wysokiego ryzyka powstawania zmian w drogach oddechowych.

Fire fighters are exposed to a variety of toxic substances in their profession. Additionally, a tobacco smoke leads to a harmful effect on their respiratory tract. The goal of this work was to determine the mutual effect of both agents on respiratory tract of fire fighter. Questionnaire analysis showed differences in the presence of COPD symptoms in the subgroups of smokers and nonsmokers. Results of spirometryc analysis indicated lower values of results in FMF25-75%, parameter, which may be explained by an obstruction of an air-flow in medium and small airways.