Assessment of anxiety and depression and selected psychosocial variables in cancer patients. / Ocena zwiazku leku i depresji oraz wybranych zmiennych psychospolecznych u pacjentów onkologicznych.

OBJECTIVES: Assessment of anxiety-depressive disorders in an oncologically ill patient may help in the treatment process and planning psycho-oncological care. The aim of the study was to assess the level of anxiety and depression and selected psychosocial variables in cancer patients. METHODS: The study group consisted of cancer patients eligible for causal treatment for at least 6 weeks. The HADS questionnaire was used to examine 537 patients aged 19 to 91 (average age: 53.5). RESULTS: Both during the first oncological treatment and in the relapse of the disease, patients more often show symptoms of anxiety than depression. These conditions occur with greater intensity in women than in men (p=0.000), moreover, the risk of depressive disorders increases with the patient's age (p=0.015). The highest intensity of symptoms of depression was observed in patients living in the countryside and in people on disability or retirement pension, and the lowest in small and medium-sized towns and in people who were economically active or on short sick leave. On the other hand, the simultaneous occurrence of anxiety and depression was distinctive for the patients with breast and reproductive organs cancers, which were least frequently reported by patients with urinary tract cancers. CONCLUSIONS: Tools for screening the risk of depression and anxiety disorders should be used routinely during regular medical consultations in a patient with cancer. This will allow for early detection of symptoms and initiation of therapeutic measures.

The Opinions of Specialists in Obstetrics and Gynecology on the Indications for Pregnancy Termination in Poland-A Preliminary Cross-Sectional Study.

The physician's decision concerning pregnancy termination is influenced by a number of factors. The study aimed at obtaining the opinions of obstetricians and gynecologists with regard to the indications for pregnancy termination, the readiness to perform the procedure personally and the assessment of the determinants thereof. The survey study was conducted between 1 January 2020 and 31 December 2021 among physicians who performed diagnostic prenatal ultrasonography. A considerable majority of physicians participating in the study did not approve of termination without medical indications (62.5%). A marked majority of them considered the following cases as indications for pregnancy termination: severe fetal defects (90%), lethal defects (91.5%) and a disease threatening maternal life (91.5%). A small group of physicians declared that they were ready to perform a termination without medical indications (12.5%). However, they were ready to perform a pregnancy termination personally in cases of threat to maternal life (77.5%), severe fetal defects (75%), lethal fetal defects (75%) and a pregnancy being a result of rape (75%). No statistical significance was observed with regard to the influence of the respondents' sex, the fact of having children or the workplace on the issue of indications for pregnancy termination. It seems justified to develop case-centered counseling concerning abortion, based on specialists in perinatology, law and ethics, especially in countries with more restrictive abortion law or strongly religious societies.

Work-related problems faced by coordinators of organ, cell, and tissue transplantations in Poland and possible ways of ameliorating them.

In recent years in Poland, the numbers of reported potential cadaveric donors of organs, tissues, and cells, and the numbers of transplantations being carried out seem to be low in the context of the size of the country population and the presumed consent legal principle which rules transplantations. This research project was carried out on 109 Polish transplant coordinators by means of a questionnaire created specifically for this study. The goal of the project was to detect problems specific to transplant coordinators working in Poland which, when properly addressed, might improve the efficacy of transplantation network within the Polish health care system. The results suggest that Polish transplant coordinators face a variety of issues in their work. It appears that the most important interventions which could improve working conditions for in this population and-as a result-also improve the efficacy of transplantation network in Poland could include: (1) a variety of training programs for transplant coordinators; (2) a social campaign promoting transplantations and spreading awareness of the transplantation-related legislation; and (3) introduction of changes in the regulations pertaining to medical professions in Poland.

The Quality of Life in Patients with Epilepsy in the Context of Sleep Problems and Sexual Satisfaction.

Epilepsy influences the quality of patient functioning in almost all aspects of life. This study aimed to assess the quality of difficulties with sleep initiation and those concerning sexual function, and to assess whether sleep disorders are associated with selected aspects of sexual function and quality of life. The study involved completing a quality-of-life questionnaire for persons with epilepsy: a QOLIE-31 questionnaire, and the present authors' questionnaire, including 20 questions. A total of 170 questionnaires were completed by 89 men and 81 women. Sleep problems of various frequency were reported by 98 participants (57.6%). Only 41% of patients were definitely satisfied with their sex life. The respondents who declared dissatisfaction with their sex life more often reported difficulties with sleep initiation (χ2 = 10.20; p ≤ 0.001). Moreover, those who claimed that epilepsy might contribute to sex life problems more commonly declared dissatisfaction with their sex life (χ2 = 20.01; p ≤ 0.001) and more frequently, reported difficulties with sleep initiation (χ2 = 6.30; p ≤ 0.012). The issues should constitute the constant element of medical history taking, as improvement in these areas of functioning may promote better quality of life in patients with epilepsy.

The Influence of Abortion Law on the Frequency of Pregnancy Terminations-A Retrospective Comparative Study.

Abortion law is one of the main factors influencing the number of abortions performed in a country. The study aimed to assess the influence of abortion law on the number of performed terminations with particular attention paid to pregnancy terminations due to fetal defects. The retrospective comparative analysis of statistical data included on the governmental websites of Poland and the UK was performed. The average of 190,733.1 terminations were performed in the United Kingdom in the years 2009-2018 with the average of 2820.9 due to fetal defects. At the same time the average of 858.6 terminations were performed in Poland with 820.7 due to fetal defects. Population size is the only significant predictor of the number of terminations in the United Kingdom. The increase in the number of deliveries and population in Poland was not linked to the increase in the overall number of terminations or terminations due to fetal defects. It might be due to the unavailability of pregnancy terminations in many places. The radicalization of abortion law exerts no influence on the decrease in the number of terminations due to fetal indications. The liberalization of abortion law promotes the increase in the number of terminations due to social indications.

Adaptive capacity of midwives participating in pregnancy termination procedures: Polish experience.

A cross-sectional study was conducted in 181 midwives working in hospitals in Poland. The midwives completed professional psychological tests (CISS questionnaire, EPQ-R questionnaire, OLBI questionnaire) and a questionnaire developed for this study. Midwives participating in pregnancy termination procedures most commonly used the task-oriented coping style. The emotion-oriented coping style was positively related to burnout in the group which performed pregnancy terminations. The analysis showed that the higher the indices of neuroticism, the greater the severity of burnout in both groups. The results indicate the need to conduct an initial assessment of personality resources when employing midwives to the wards.

Peripartum Predictors of the Risk of Postpartum Depressive Disorder: Results of a Case-Control Study.

BACKGROUND: The study aimed at the identification of the risk factors present during delivery, which might be present in prophylactic programs concerning postpartum mood disorders. MATERIAL AND METHOD: This was a retrospective comparative study. The study material included data retrieved from the medical records of patients hospitalized in the Teaching Department of Gynecology and Obstetrics of Professor Orlowski Hospital in Warsaw, in the years 2010-2017. The EPDS data of 604 patients were analyzed. The study group included 75 women who obtained at least 12 points in the EPDS and the control group was made up of 75 women who obtained no more than 5 points in the EPDS. RESULTS: The women in whom we noted an increased risk of developing mood disorders had blood loss >1000 mL and had a significantly longer stage II and III of labor than the control group. Other risk factors were cesarean section, vaginal delivery with the curettage of the uterine cavity, slightly lower APGAR scores (0.4 pts), and lower birth weight (approximately 350 g) of the child. Women at a low risk of postpartum mood disorders more commonly underwent episiotomy during delivery (76%). CONCLUSIONS: Increased supervision and support should be offered to women who experienced the above-mentioned risk factors.

Perinatal Predictors of Postpartum Depression: Results of a Retrospective Comparative Study.

Postpartum mood disorders occur in a considerable number of women with the most common postpartum disorder being baby blues. The study aimed at the identification of the risk factors present before delivery, which may be comprised in prophylactic programs concerning postpartum mood disorders. The research material includes data retrieved from the medical record of patients delivering in Warsaw in the years 2010-2017 who routinely completed Edinburgh Postnatal Depression Scale (EPDS) after delivery. Data of 604 patients were analyzed. The study group included 75 women who obtained at least 12 points in EPDS, which constituted 12.4% of the whole group (mean = 14.92, SD = 3.05). The control group was made up of 75 women who obtained no more than 5 points in EPDS. A significant correlation was reported between the parity and their order vs. the risk of developing postpartum mood disorders. Women with an increased risk delivered at about 37 gestational weeks, while women in whom the risk of such disorders was low delivered at about 39 gestational weeks. No increased risk was noted in women with premature rupture of membranes. Primigravidas and women who delivered prematurely were the most predisposed to developing postpartum depression and should undergo screening tests in the perinatal period.

Emotional Complications in Midwives Participating in Pregnancy Termination Procedures-Polish Experience.

Background: Ethically controversial medical procedures, such as the termination of pregnancy, are frequently associated with a discrepancy between personal attitude and values versus requirements related to a professional situation. The study aimed to assess emotional complications in midwives participating in pregnancy termination procedures. Methods: The study included 181 midwives working in state-governed healthcare facilities in central and eastern Poland. The Oldenburg Burnout Inventory (OLBI) and the present authors' own questionnaire were used in the study. The results indicating the level of occupational burnout were presented in two scales: the exhaustion scale and the disengagement scale. Results: The study revealed that 48% of midwives had never participated in pregnancy termination procedures due to fetal defects. The level of occupational burnout described with the exhaustion factor (t = 2.06; p < 0.041) and disengagement factor (t = 2.96; p < 0.003) was significantly higher in the group of midwives participating in pregnancy termination procedures due to fetal defects than in the group of midwives who did not participate in pregnancy terminations. The most common factors contributing to burnout reported by midwives who participated in pregnancy terminations were: moral dilemmas (68%), seeing the aborted fetus (65%), anticipating the child's death in case it was born with signs of life (59%) and the lack of professional psychological support for medical personnel (56%). Conclusions: Importantly, pregnancy termination should be performed by persons who find such procedures acceptable from the viewpoint of their value system. It is a protective factor in regards to work with women who undergo terminations. Moreover, developing a system of informational and psychological support for midwives participating in pregnancy termination procedures is also a significant aspect.

Features of personality and professional burnout syndrome of physicians - analysis based on questionnaires studies.

INTRODUCTION: This observational study was ordered by the Medical Practitioners' Chamber in Warsaw. THE OBJECTIVE: of the study was to evaluate the problem of professional burnout of physicians correlation between professional burnout and features of personality. MATERIAL AND METHODS: Professional burnout was considered relative to different features of personality. This study was initially carried out from 2005-2008, but further analysis of burnout and personality was carried out from 2017-2018. The research tools were anonymous, validated questionnaires. The sample size was based on the size of the population- the registry of the Regional Chamber of Medical Practitioners and literature on burnout prevalence. The respondents' work places were randomly selected from the Mazovian District register. RESULTS: The test on burnout was completed by 378 respondents, while 62 subjects completed a personality test. Results showed that burnout syndrome was an occupational problem for healthcare workers. Professional burnout affected as many as 42% of respondents (n = 158). It affected two age groups in particular: physicians up to 31 years old and individuals aged 41-50. Moreover, neuroticism was found to be significantly related to burnout syndrome. CONCLUSION: burnout syndrome is common among professionally active medical practitioners, and neuroticism may be correlated with burnout syndrome.

Risk factors for shivering during caesarean section under spinal anaesthesia. A prospective observational study.

BACKGROUND: Shivering during caesarean section (CS) under spinal anaesthesia is a common phenomenon. It could not only alter patient's physiology by increasing oxygen consumption but also affect the parturient's experience of childbirth. Shivering is thought to be associated with intraoperative hypothermia, but the risk factors and exact mechanism remain unclear. METHODS: We conducted a prospective, observational study to examine the potential risk factors for intraoperative shivering, including anxiety levels. Two hundred patients undergoing elective CS under spinal anaesthesia were recruited. Parturient anxiety levels were evaluated using the State-Trait Anxiety Inventory (STAI) questionnaire. Age, weight, height, BMI, anxiety level, number of previous deliveries, sensory block level, level of education, temperature difference during surgery and American Society of Anesthesiologists score were investigated as potential risk factors. Stepwise logistic regression was used to assess the predictors for shivering. RESULTS: Data from 155 parturients were analysed. Shivering incidence was 21.9% (34 parturients). The statistical model predicted 8.5% of a shivering incidence variability (R-square Nagelkerke = 0.085). Out of all measured variables, only the number of previous deliveries [(W) = 4.295 Exp(B) = 0.562 P < .05] and STAI-X1 [(W) = 4.127 Exp(B) = 1.052 P < .05] were significant. In our model, the risk of shivering decreased by 44% with every previous delivery and increased by 5.2% with each 1-point increase in STAI-X1. CONCLUSION: We failed to prove a strong correlation between the measured variables and shivering. Our findings, however, support the hypothesis, that to a limited extent, anxiety promotes shivering during CS.

Professional burnout and its correlates in Polish donor transplant coordinators.

Job demands-resources (JD-R) model of professional burnout states that job demands predict the feeling of exhaustion, and lack of job resources-disengagement from work. This research project investigated professional burnout and it correlates, including sex, death anxiety, and relationship status in 108 Polish donor transplant coordinators involved in organ, tissue, and cell transplantations. This study employed the Polish version of the Oldenburg Burnout Inventory which follows the JD-R model, the Psychosocial Working Conditions Questionnaire-a Polish instrument based on the model of job stress proposed by Karasek-and the Polish version of the Fear of Death and Dying Questionnaire. The results were suggestive of average levels of job stress and burnout in the studied population, with men being more disengaged than women. Participants who were in relationship had significantly higher levels of exhaustion than those who were single. Exhaustion was positively correlated with years of working as a transplant coordinator but not with participants' age. Multiple negative correlations were detected between exhaustion/disengagement and different aspects of job control, social support, and well-being. Moreover, positive correlations between different components of fear of death and dying and exhaustion were detected. Our findings, linking fear of death and dying with some aspects of professional burnout in transplant coordinators, suggest that a pre-employment screening for the level of death anxiety in candidates for transplant coordinators could be useful as this job provides chronic exposure to mortality cues.

Correlates of professional burnout in a sample of employees of cell and tissue banks in Poland.

Job Demands-Resources model proposes that the development of burnout follows excessive job demands and lack of job resources. Job demands are predictive of feeling of exhaustion, and lack of job resources-disengagement from work. This pilot study investigated professional burnout and its correlates in employees of Polish cell and tissue banks, many of whom were involved in procurement and processing of tissues from deceased donors, as it was hypothesized that job burnout in this population might influence the effectiveness of cell and tissue transplantation network in our country. This study utilized the Polish version of the Oldenburg Burnout Inventory (OLBI), which measures the two dimensions of burnout (exhaustion and disengagement), and the Psychosocial Working Conditions Questionnaire (PWC), a Polish instrument used for monitoring psychosocial stress at work. The study sample consisted of 31 participants. Their average time of working in a cell and tissue bank was 13.20 years. Majority of the PWC scales and subscales scores fell in the Average range, and the OLBI results for the Disengagement and the Exhaustion scales were in the Average range. A number of correlations between the Exhaustion or Disengagement and the PWC scales and subscales were detected, majority of which fell in the Moderate range. In spite of the limited number of participants, the results of this pilot study are consistent with the burnout literature reports. Among the detected correlates of professional burnout, it is job-related support which seems to be the most important factor which may influence the efficacy of transplantation network in Poland.

Quality of life before and after laparoscopic fundoplication. Does quality of life depend on psychological factors? Preliminary report.

UNLABELLED: Gastroesophageal reflux disease (GERD) is the most common benign foregut disorder. In many cases multiple factors contribute to the development of esophagitis and result in GERD symptoms. GERD has a definite negative impact on patients' quality of life. The aim of this study was to assess the postoperative results and compare pre- and postoperative quality of life after laparoscopic Nissen or Toupet fundoplication and also to determine if psychological factors have an influence on the quality of life and surgical outcome. MATERIAL AND METHODS: Fifty patients with a proven GERD and hiatal esophageal hernia (HHE) were included in a prospective study. After routine examinations, assessment of quality of life (Gastrointestinal Quality of Life Index--GIQLI) and psychological investigation (Minnesota Multiphasic Personality Inventory--MMPI) the patients underwent laparoscopic fundoplication. Three months after operation all of the patients had quality of life assessment again. RESULTS: Patients were divided into two groups depending on the result of MMPI test. Patients with conversion disorder (CD) preoperatively had significantly lower mean overall score in GIQLI (84.3 +/- 16.3) in comparison to patients without CD (93.0 +/- 19.4). The mean score increased significantly in both groups 3 month after surgery (to 100.6 +/- 21.2 in patients with CD and to 106.7 +/- 18.1 in patients without CD). CONCLUSION: Quality of life in GERD patients is significantly impaired. It shows general improvement after surgery. There are findings in the literature and in our research project showing that comorbidities or psychological factors are able to affect the subjective outcome without any fundamental explanations or basis. Thus, psychological intervention can decrease the spectrum of symptoms and improve the subjective outcome of fundoplication in selected patients.