Impact of gastroesophageal reflux disease on the quality of life of Polish patients.

BACKGROUND: Gastro-esophageal reflux disease (GERD) is a serious health and social problem leading to a considerable decrease in the quality of life of patients. Among the risk factors associated with reflux symptoms and that decrease the quality of life are stress, overweight and an increase in body weight. The concept of health-related quality of life (HRQL) covers an expanded effect of the disease on a patient's wellbeing and daily activities and is one of the measures of widely understood quality of life. HRQL is commonly measured using a self-administered, disease-specific questionnaires. AIM: To determine the effect of reflux symptoms, stress and body mass index (BMI) on the quality of life. METHODS: The study included 118 patients diagnosed with reflux disease who reported to an outpatient department of gastroenterology or a specialist hospital ward for planned diagnostic tests. Assessment of the level of reflux was based on the frequency of 5 typical of GERD symptoms. HRQL was measured by a 36-item Short Form Health Survey (SF-36) and level of stress using the 10-item Perceived Stress Scale. Multi-variable relationships were analyzed using multiple regression. RESULTS: Eleven models of analysis were performed in which the scale of the SF-36 was included as an explained variable. In all models, the same set of explanatory variables: Gender, age, reflux symptoms, stress and BMI, were included. The frequency of GERD symptoms resulted in a decrease in patients' results according to 6 out of 8 SF-36 scales- except for mental health and vitality scales. Stress resulted in a decrease in patient function in all domains measured using the SF-36. Age resulted in a decrease in physical function and in overall assessment of self-reported state of health. An increasing BMI exerted a negative effect on physical fitness and limitations in functioning resulting from this decrease. CONCLUSION: In GERD patients, HRQL is negatively determined by the frequency of reflux symptoms and by stress, furthermore an increasing BMI and age decreases the level of physical function.

Protein separation in carousel multicolumn setup. Performance analysis and experimental validation.

To overcome limitations of periodic separations of proteins in batch chromatographic columns Carousel Multi-Column Setup (CMS) has been recently suggested and theoretically analyzed in a previous study (R. Bochenek, W. Marek, W. Piatkowski, D. Antos, J. Chromatogr. A, 1301 (2013) 60-72). In this system, feed and mobile phase streams are subsequently delivered through parallel columns to mimic their countercurrent movement with respect to the fluid flow. All fluxes in the system are synchronized to ensure continuous feed delivery, which however causes reduction in the size of the operating window compared to batchwise-operating systems. In this study to improve the performance of CMS, additional process variables have been considered, such as the flow rate gradient and feed concentration. Though altering both variables allowed improving the separation selectivity and extending the operating window, the feed concentration appeared to be the most influential parameter affecting the process performance. Moreover, a procedure for practical realization of protein separations in CMS has been developed, including hints about the process design, configuration of columns and detectors, and use of pumps. As the case study, the separation of a ternary mixture of proteins, i.e., cytochrome C, lysozyme and immunoglobulin G, on hydrophobic interaction columns was used. A target product was a protein with intermediate adsorption strength that was isolated out of a more and less strongly adsorbed compound.

Meeting needs for rehabilitation equipment and home adjustments among the disabled in their life environment.

INTRODUCTION: The elimination of functional barriers resulting from disability through the provision of adequate orthopaedic and rehabilitation equipment, and homes adjusted for disability is the precondition for an efficient and independent functioning, and high quality of life of the disabled. The objective of the study was recognition of the needs of the disabled declared by them, and the degree of satisfaction with these needs. METHODS: The study covered 478 disabled from the Lublin Region. The research instrument was the 'Questionnaire for the Disabled' designed by the authors. RESULTS: Considering the needs expressed by the respondents concerning the provision of orthopaedic and rehabilitation equipment and meeting these needs, four groups were distinguished: No Needs - 30.1%, Needs Partially Met - 22.4%, Needs Fully Met - 37.7%, Needs Not Met - 9.8%. The group Needs Not Met was characterized by younger age, in the group Needs Partially Met worse indicators of the state of health were noted, more frequent independent living, loneliness and low material standard. Considering the expressed needs for home adjustments adequate to disability and meeting these needs, three groups were distinguished: No Needs - 59.6%, Needs Not Met - 15.9%, and Needs Met - 24.7%. The group Needs Not Met more rarely covered respondents living in residential homes, compared to those living independently in rural or urban areas. The group Needs Met more rarely included rural inhabitants, while more frequently including the disabled who had a high material standard. CONCLUSIONS: Both the provision of orthopaedic equipment and adjustment of the home to disability are insufficient with respect to the needs. The meeting of these needs is significantly conditioned by high or very high material standard. The lack or incomplete satisfaction with the needs for rehabilitation equipment is associated with a relatively younger age, independent, single residence and low material standard. Living in an residential home means better adjustment of the living environment, and better provision with orthopaedic and rehabilitation equipment.

Psychological aspects of pain.

INTRODUCTION: Pain is defined "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage". Pain is a sensation of the body, and is always an unpleasant emotional experience. The role of psychology is auxiliary and supplemental to medicine. This is an aid addressed to the patient, physician and patient's caregivers: professional caregivers, family members and significant others. At each stage of the diagnostic and therapeutic process, psychology offers help, both from the cognitive and practical aspects. OBJECTIVE: The objective of the article is to present important psychological aspects of studies concerning pain, and the psychological methods and techniques of pain treatment. STATE OF KNOWLEDGE: Pain is the leading reason for patients seeking medical care and is one of the most disabling, burdensome, and costly conditions. Pain accompanies many diseases, each one of which generates unique/separate diagnostic, therapeutic and research problems. DEPRESSION AND RELATED PSYCHICAL DISORDERS: There is a significant relationship between depression and pain symptoms, as well as between pain and suicidal thoughts. Patients with a long history of pain disorders also have increased depression and anxiety symptoms, as well as suicidal thoughts. Patients with more severe depression and anxiety symptoms also have an increase in pain problems. The intensity of pain correlates with the intensity of psychopathological symptoms - both with mood lowering and with anxiety symptoms and worry. Active pain coping strategies strive to function in spite of pain, or to distract oneself from pain, are associated with adaptive functioning. Passive strategies involve withdrawal or relinquishing control to an external force or agent and are related to greater pain and depression. Pain catastrophizing is a negatively distorted perception of pain as awful, horrible and unbearable. Catastrophizing is strongly associated with depression and pain. Studies in which functional magnetic resonance imaging (fMRI) was used showed that pain catastrophizing, independent of the influence of depression, was significantly associated with increased activity in brain areas related to anticipation of pain, attention to pain, emotional aspects of pain and motor control. Pain behaviour is a conditioned pain. Care and concern on the part of others, secondarily enhance a patient's pain behaviours, which lead to an increase in the intensity of the pain experienced. A history of early life adversity (ELA) - rejection, neglect, physical or sexual abuse is related to the development of irritable bowel syndrome (IBS) in adulthood. Ovarian hormones have been shown to modulate pain sensitivity. IMAGING OF THE HUMAN BRAIN IN CHRONIC PAIN: Acute pain and chronic pain are encoded in different regions of the brain. Chronic pain can be considered a driving force that carves cortical anatomy and physiology, creating the chronic pain brain/ mind state. Cognitive-behavioural methods of pain treatment in domains of pain experience, cognitive coping and appraisal (positive coping measures), and reduced pain experience are effective in reducing pain in patients.

Selected social and health problems in functioning of disabled rural and urban inhabitants in the Lublin Region--similarities and differences.

The objective of the study was determination of the frequency of occurrence of selected difficulties associated with disability and social problems which disturb the functioning of the disabled in rural and urban areas in the Lublin Region. The study was conducted by trained surveyors with the use of a standardized questionnaire which covered: 1) Demographic data: age, gender, education level and marital status; 2) Information concerning biological and legal disability, degree of disability, its causes, functional limitations due to disability; 3) Information pertaining to difficulties and barriers in daily living of the disabled population. The study covered 403 disabled selected by the method of targeted sampling--147 rural and 256 urban inhabitants. Log-linear model was applied for data analysis. Unfavourable demographic characteristics of the population of the disabled in the study: mean age 63; high percentage of never-married males and females; respondents possessing elementary education level; dominant number of those occupationally inactive. The most frequent limitations associated with disability: limitations in performing household jobs (70.9%), walking difficulties (68.1%). High intensity of material difficulties, in association with low education level and high percentage of those occupationally inactive, are the evidence of socio-economic deprivation of the population examined. Differences between rural and urban inhabitants was found: in the rural environment, compared to urban areas, the following were more frequently reported: lack of possibilities of rehabilitation in the place of residence, difficulties with access to medical specialist; alcohol abuse in the family, and family disagreements. Urban population more often than rural inhabitants perceived loneliness and isolation from the closest family.

Causes and consequences of head injuries among rural population hospitalized in the Ward for Multi-Organ Injuries. I. Demographic and social structure.

The main objective of the study was the analysis of types, causes and consequences of head injuries among patients treated in the Ward for Multi-Organ Injuries during the period 1999-2002. The study aimed at the recognition of the health situation and selected demographic traits of people who had sustained head injuries. The authors' research tool - a Scientific-Research Protocol - was applied in the study. The survey covered 265 people, including 204 males (77.0%) and 61 females (23.0%) hospitalized due to head injuries; 90 people, i.e. 34% of the total population examined, were rural inhabitants 82.2% were males and 17.8% females. Thus, among the population examined the percentage of males was considerably higher than that of females, both in the sub-populations of urban and rural inhabitants. The percentage of people aged 65 and over was higher among the rural population, compared to urban inhabitants (21.1% and 8.0%, respectively), while the percentage of patients aged under 35 was lower (30.0% and 48.0%, respectively). A significantly higher percentage of patients living in rural areas, compared to urban inhabitants, had an elementary school or elementary vocational education level (77.8% and 46.3%, respectively). The number of patients who were never married was smaller among the rural than urban population (22.2% and 35.4%, respectively), whereas the percentage of those widowed was higher (13.3% and 2.9%, respectively). In the group of patients living in rural areas the percentages of people maintaining themselves on nonagricultural and agricultural work were similar (27.7% and 25.6%, respectively).

Causes and consequences of head injuries among rural inhabitants hospitalised in a Multi-organ Injury Ward. II. Circumstances, types and consequences of head injuries.

The scope of problems concerning head injuries was investigated among rural patients, compared to urban population, from the aspect of their incidence in both populations, as well as an attempt to perform a multi-variable analysis of socio-demographic and geographical risk factors for each of the analysed traits concerning the injury. The study group were patients treated in the Multi-Organ Injury Ward, at Cardinal Stefan Wyszynski Regional Hospital in Lublin during the period 1999-2002. The study covered 265 patients. The group of rural inhabitants covered 34% of the total population in the study. The most frequent circumstances of the injury sustained, both among rural and urban patients, was a road accident with the patient either as a passenger or a pedestrian, observed in 30.6% of the total number of people in the study. Female gender was an injury risk factor. The second position among circumstances of injuries was occupied in both sub-populations by road accident with the patient as the driver - this concerned 23% of the total number of patients in the study, and the risk factors were: male gender, place of residence in rural area and better educational status. The majority of patients sustained an injury in the street, with similar frequency among rural and urban inhabitants. Rural patients, significantly more often than urban inhabitants, sustained injuries at home and in the courtyard. The most frequent type of an injury sustained was cerebral concussion, which was noted twice as frequently among urban (59.9%) than rural inhabitants (31.1%). The risk factors of cerebral concussion were: urban place of residence, female gender, and younger age of a patient. Injuries of mesencephalon were placed in the second position with respect to the frequency of occurrence, and more often concerned rural (46.7%) than urban (24.6%) patients. The risk factors for this injury were: living in a rural area, and older age in males. Concomitant injuries were observed in 50% of rural patients and in 57.1% of urban inhabitants. The consequences of injuries in various forms were observed in 87.8% of rural inhabitants, and in a similar percentage of urban patients. Age turned out to be the risk factor for the appearance of the negative consequences of the injury. This was also the risk factor of death during treatment, and in balance disorders.