Determinants of Professional Activity After Kidney and Liver Transplantation: Questionnaire Development and Validation.

BACKGROUND: Organ transplantation is currently the treatment of choice in end-stage organ failure. Organ replacement therapy compensates for most of organ function loss and offers recipients the potential for an independent life; nevertheless, the employment rate after kidney or liver transplant is low vs the general population. The purpose of this study was to create a questionnaire for kidney and liver transplant patients that comprehensively assesses factors affecting employment among these people including demographic, physical, and psychosocial variables. MATERIAL AND METHODS: The study was based on a self-prepared questionnaire developed by a team of specialists in the field of medicine, rehabilitation, psychology, and employment. The questionnaire contained 5 parts: demographic data, professional factors, medical factors, physical factors, and psychological factors. The normalization sample consisted of 64 individuals (women and men) aged between 18 to 45 years 1 to 5 years after kidney or liver transplant. The Determinants of Professional Activity after Kidney and Liver Transplantation Questionnaire (DPATQ) was developed based on descriptive statistics, Spearman ρ coefficient, principal component analysis, Cronbach α, and item response theory analysis. RESULTS: The Cronbach α reliability coefficient for the psychological part reached 0.88. CONCLUSION: The DPATQ is a new method for measuring post-transplant adaptation and other factors influencing employment status. It offers good psychometric reliability. The DPATQ may be useful in the preparation process of vocational rehabilitation programs or in research studying problems with employment after solid organ transplant.

Effects of Immunosuppressive Drugs on Serum Fatty Acids of Phospholipids Fraction in Renal Transplant Recipients.

BACKGROUND: Immunosuppressive medications often cause posttransplant hyperlipidemia. The effects of cyclosporine (CsA) and tacrolimus (Tac) on lipid profile is well-known; however, there are very few studies related to the effect of these immunosuppressants on fatty acids (FA) of phosholipids fraction (PL) in renal transplant recipients (RTR). We sought to analyze the FA profile in PL fraction of RTR treated with Tac or CsA. METHODS: The study included 65 renal transplant patients on CsA (n = 24, group I) or Tac (n = 41, group II), and 14 healthy controls. Individual serum FA concentrations were measured by gas chromatography. Chemstation software was used to analyze the data. RESULTS: No differences between studied groups and controls were noted for monounsaturated FA, polyunsaturated n-3 FA (PUFA n-3), PUFA n-6, or the ratio of PUFA n-6 to PUFA n-3. The following mean values of FA were significantly higher in the CsA-RTR and Tac-RTR as compared with controls: total FA (P < .01 in both cases), saturated FA (SFA; P < .02 in both cases), C12 (P < .003 in both cases), C18 (P < .003 in both cases), and C18:2 (P < .01 for CsA RTR; P < .02 for Tac RTR). No differences between the measurements in patients on CsA and in patients on Tac were noticed. Significant correlation between SFA and eGFR was observed only in the CsA RTR group (P < .05). A negative relationship between PUFA n-6 and the estimated glomerular filtration rate was seen, but the correlation was not significant. CONCLUSIONS: Immunosuppressive drugs may affect FA metabolism, but the FA profile does not depend on the type of immunosuppressive drug administered.

Effect of immunosuppressive therapy on the serum fatty acids of phospholipids fraction in patients after heart transplantation.

BACKGROUND: The effects of tacrolimus (Tac) and cyclosporine (CsA) on lipid profile is well known; however, little is known about the changes in fatty acids (FA) of phosholipids fraction (PL) in heart transplant patients after treatment with these immunosuppressants. This study aimed to investigate the effect of Tac and CsA on serum FA of PL in heart transplant patients. METHODS: The study included 23 patients after heart transplantation on Tac (n = 14; group II) or CsA (n = 9; group I). Eleven healthy persons served as a control group. Serum FA of PL were extracted, separated on Sep-Pak NH2, methylated, and measured with the use of gas chromatography. Chemstation software was used to analyze the data. RESULTS: No differences between the studied groups and control were noted for saturated FA, monounsaturated FA, polyunsaturated FA (PUFA), total FA, and PUFA n-6. The mean value of PUFA n-3 was significantly higher in the CsA group compared with the Tac group (P < .015) and control (P < .002) as well as in the Tac group compared with control (P < .001). For individual FA, higher mean concentration, compared with control, was found for C24, C20:2, C20:4, and C22:6 (P < .001 in all cases) and lower for C18:2cis (P < .001 in both groups) and for C18:3 in the Tac group. The mean values of PUFA n-6 to PUFA n-3 ratios were lower than in control (both P < .001). CONCLUSIONS: Different pattern of FA of PL may indicate the different FA metabolism in heart transplant patients treated by different immunosuppressants. This should be taken into account when FA supplementation in these patients is considered.

Psychological stress in rheumatoid arthritis patients: a comparative Polish-German study: summary of the current conceptualization of the role of stress in rheumatoid arthritis.

Cultural differences in experiencing individual stress in rheumatoid arthritis (RA) patients might be observed. The aim of the study was to assess quality of life and psychological stress (distress) in RA patients, and to evaluate socio-demographic and disease specific variables predicting stress of patients. The study covered 300 Polish and 137 German RA patients. SF-36v2 scale was used to evaluate the patients' health. Psychological stress was defined as the feeling of "social isolation" and "being a burden" as demanding help in everyday activities. In both countries, the mental and physical health of patients deteriorated and about 50% of patients required support in everyday activities. 95% of Polish and 62% of German patients felt rejected from social activities. For the psychological stress perceived, functional capacity class 3 and male gender were shown to be predictive in Polish patients and living in a small town - in German patients. In the Polish group, the tertiary/bachelor level of education was linked with lower distress level. RA has a serious impact on the mental health owing to a great disease burden. Awareness of impact of the disease on quality of life and psychological stress of patients should be considered in routine clinical practice.

Risk factors for atherosclerosis in healthy employees-a multidisciplinary approach.

BACKGROUND: The aim of the study was to investigate the prevalence of early atherosclerosis in healthy workers and the relationship between classical, psychological, and immunological risk factors and atherosclerosis, as well as their predictive value. METHODS: One hundred healthy managers and 50 office workers aged 35-65 were studied. In all subjects, individual, family, and occupational stress/coping risk factors were evaluated, including plasma levels of biochemical (total cholesterol, LDL, HDL, TG, glucose) and inflammatory-immunological (aCL, anti-beta(2) GPI, oxLDL, HSP, HSCRP) parameters. Carotid artery intima-media thickness (IMT) and atherosclerotic plaques in carotid arteries were assessed with computer analysis of B-mode ultrasound images. RESULTS: In 107 persons (71%) no changes were found in ultrasound images and in 43 individuals (29%) the presence of plaque was shown. The mean IMT value was 0.0618+/-0.013 mm. Cross-domain analysis showed that core predictors for IMT were age, LDL level, smoking, and occupation (being a manager) (beta=0.33, 0.30, 0.23, and 0.20, respectively); the core predictors for plaque were age, total cholesterol level, and an occupational stressor home-work balance (Wald=7, 6.7, and 5.6, respectively). Immunological factors were not independent predictors. CONCLUSIONS: In atherosclerosis, not only traditional risk factors (age, lipid disorders, and lifestyle) but also occupational stress factors may play a role. Immunological factors do not seem to play a role in the development of atherosclerosis in a population of healthy workers. The interplay between occupational stress and atherosclerotic changes requires further investigation.

[Occupational data cards as a source of information for health prevention purposes]. / Karty charakterystyki zawodów jako zródlo informacji dla celów profilaktyki zdrowotnej.

The Polish Labour Code as well as directives of the European Union (EU) commit employers to ensure safety and health protection at work, including the use of all possible measures to reduce or eliminate risk factors occurring in the work environment, and to provide the workers with information about the extent of the risk and possibilities of its reduction. The fulfilment of this commitment is an element of the whole system for the reduction of accidents at work and rates of occupational diseases in the economically active populations. The effectiveness of the measures taken by employers depends on a number of agents, and the identification of occupation-related risk factors plays among them a key role. It is also important to define predisposition to and limitations in performing certain jobs which allows to select a suitable occupation, to direct properly the process of preparing candidates for particular jobs and to monitor health condition during employment. Activities orientated towards so called human factor in labour processes should be linked with the creation of healthy working conditions by adopting technical solutions aimed at eliminating and reducing potential health risks. In this context the establishment of an effective information system able to identify risk factors, possible hazards and/or arduousness in the work environment is of great importance. A lack of sources of comprehensive information about risk factors and hazards related to various occupations, health effects and relevant preventive interventions is a problem faced not only by Poland but also by many other countries. To this end an international team for developing a multi-language set of International Hazard Datasheets on Occupations available in the Internet has been set up on the initiative of the International Labour Organization (ILO). Due to this initiative it will be possible to distribute widely International Hazard Datasheets on Occupations and thus help people in their choice of occupation before employment, and to up-date data according to technological progress and organisational changes. International Hazard Datasheets on Occupations which are now developed the main stress is put on defining hazards with possible traumas, as well as harmful factors, including psychophysical ones. Sheets should also include information about potential, adverse health effects and necessary preventive measures. In the professional literature one may find references with broad description of problems related to different occupations and relevant legal regulations. International Hazard Datasheets on Occupations are developed in individual countries, then translated and verified in view of specific technological processes applied. They will be used by the Labour Inspection, work safety and hygiene inspectors, sanitary and epidemiological stations, those responsible for qualification of candidates who apply for admission to vocational schools, occupational medicine physicians and general practitioners. They will also be used to produce various instructions, guidebooks and recommendations on safety at work and preventive measures.

Characteristic of Muscular Load in Computer Data Entry Workers Assessed by EMG and Postural Angles.

The goal of this study was to characterize the muscular load in computer data entry workers. EMG parameters of trapezius muscle and postural angles of head, arm, and back were chosen as indicators of musculoskeletal load. The examination was done according to the methods and protocol of international MEPS studies (the "Musculoskeletal, Visual, and Psychosocial Load in VDT Operators in Optimized Environment" international program). The musculoskeletal load during routine VDT data entry work performed by a group of 36 women was assessed on the basis of one-hour physiometer recordings. Results show that the musculoskeletal load associated with data entry is relatively high comparing to other VDT operators' tasks described in the literature. An analysis of the measured parameters shows that most of the time women worked with muscular load higher than optimal. It is postulated that the main reason for the heavy musculoskeletal load was improper posture compelled by unergonomic spatial configuration of work stands.