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.

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.

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.

Determinants of occupational burnout among employees of the Emergency Medical Services in Poland.

INTRODUCTION: Occupational burnout is a multifaceted phenomenon and a problem often encountered among medical personnel. An example of such a group are workers of the Emergency Medical Services (EMS). The aim of the present study was to make an attempt to assess the level of job burnout among professionally active employees of the EMS and to compare the different occupational groups (paramedics, nurses of the system, doctors of the system) according to four analyzed factors. MATERIAL AND METHODS: A cross-sectional study was performed using an on-line questionnaire. Four factors impacting the level of burnout were analyzed: 1) attitude to work; 2) workload; 3) contact with the patient; 4) attitude to stress). The minimum possible result on the scale is 36 points and the maximum - 252. Data were analysed by means of the Cronbach's alpha coefficient, the Spearman correlation, the Ramsey RESET test, the Chow test, VIF statistics. RESULTS: The average score for occupational burnout was 131.0 points (SD ± 31.47). The tool's reliability measured by means of Cronbach's alpha was 0.910). Both nurses and doctors obtained higher results throughout the scale (ßstand.0.147 and 0.215). Significant differences were shown between the group working only in the Helicopter Emergency Medical Service (HEMS) teams and the other services (land EMS, emergency rooms, etc.) at the level of p < 0.000. CONCLUSIONS: EMS employees encounter varying degrees of threat by occupational burnout. Doctors working in the system are shown to have the highest level of burnout, while paramedics the lowest. Among all the jobs analyzed, the lowest level of occupational burnout has been demonstrated by employees of HEMS.

The state of the health of the oral cavity and health behaviors.

OBJECTIVE: The aim: To compare the patients' self-evaluations of oral hygiene and oral health with the results of the clinical examination expressed using both the DMFT index (DT, MT, FT) and the API index; and to evaluate the relationship between the patients' general health behaviors and their oral health status. PATIENTS AND METHODS: Material and Methods: 78 first-time dental patients (40 females, 38 males; Mage=40,7, SD=14.4) participated in the study. Prior to the initial dental visit, a questionnaire consisting of statements measuring self-rated oral health, hygiene and the patient's knowledge about the oral cavity and the Health Behaviour Questionnaire (HBI) was administered. DMFT index, dental treatment index (DTI), and Approximal Plaque Index (API) were assessed upon intraoral examination. RESULTS: Results: The analyses revealed that the self-declared level of knowledge about the oral cavity was significantly related to the API (p=0.004), to the number of DT (p<0.001) and to the number of FT (p<0.001). There was a correlation between the patients' declared state of the oral cavity and number of DT (p<0.001) and FT (p<0.001). The total HBI score correlated positively with FT (p=0.049). Health behaviours were related to the self-evaluation of oral care (p≤0.19), oral condition (p≤0.001), and knowledge of the oral cavity (p≤0.008). CONCLUSION: Conclusions: There is a significant relationship between the self-declared condition of the patients' oral cavity and their oral care and DMFT index. The higher the level of a patient's declared health behaviours, the better both the self-evaluated, and objectively assessed, state of the oral cavity.

[ANALIZA EMOCJI ZWIAZANYCH Z LECZENIEM STOMATOLOGICZNYM ANALYSIS OF EMOTIONS RELATED TO DENTAL TREATMENT].

OBJECTIVE: Introduction: Experiencing emotions is complicated process often related to dental treatment. Based on research conducted in different countries, the occurrence of dental anxiety is estimated at around 20% and 5% of the general population of patients is characterized by high level of anxiety , including dental phobia. Research indicates that many dentists have problems with identification of the symptoms of dental phobia and implementing appropriate and effective treatment. The aim: The goal of the article is to analyze emotions associated with a dental visit and their symptomatology and patient management. RESULTS: Results: The occurrence of stress is determined by the current individual perception of the situation that evokes emotions and is not connected with the objective features of the situation. The dentist can assess the patient's emotional condition basing on the observation of physiological symptoms related to stimulation of the autonomic nervous system, behavior and reported psychosomatic symptoms. The source of valuable tips is also the analysis of the style of the coping with emotions. CONCLUSION: Conclusions: The dentists ability to recognize the patient's style of coping with emotions makes dental treatment more effective and benefits in increase of patient satisfaction and comfort.

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.

[Burnout syndrome among physiotherapists].

BACKGROUND: Burnout is a syndrome of emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment. Symptoms of burnout include mental and physical exhaustion, accompanied by psychosomatic disorders and emotional problems. Burnout occurs most often in people employed in occupations requiring working with people (human services) as a result of coping with stress and experience numerous failures at work. The aim of the research is the analysis of burnout among physiotherapists and demographic factors and conditions that may contribute to the burnout. MATERIAL AND METHODS: 212 (137 woman and 75 man) physiotherapists completed an anonymous questionnaire to assess burnout created by Owczarek and Olczyk. The age of respondents ranged between 20 to 56 years, with work experience from several months to more than 30 years. RESULTS: Total score of burnout was 115,66 (SD 21,78). On the scale of attitude to work 36,82 was achieved, workload - 34,76, contact with the patient - 27,54, and an attitude towards stress - 16,54, which means that the result obtained fit in the lower zone including average results concerning the level of burnout. Women had a higher level of professional burnout than men. Respondents who reported that their working conditions are not conducive to achieving therapeutic success (quality of equipment, size of treatment rooms, treatment technologies), exhibited a higher level of burnout. The average result of the level of burnout among physiotherapists is lower than all the results obtained in other occupational groups of health care workers, lead with the same diagnostic tool. CONCLUSIONS: Burnout syndrome among practicing physiotherapists require further study, taking into account the type and quality of jobs, but also the level of referral among professional physiotherapists.

Quality of life and severity of skin changes in the dynamics of psoriasis.

INTRODUCTION: Psoriasis is a chronic skin disease with periods of recurrence and remission. The skin changes which are typical of this disease can have a considerable effect on the patient's psychological state, self-esteem and body image. It can also affect the patient's functioning in all areas of life and quality of life. AIM: The present study characterized the patient needs to improve the quality of life in specified areas in patients depending on the severity of psoriatic changes. MATERIAL AND METHODS: The study was conducted in two stages on 100 patients aged from 18 to 66. A dermatological examination was conducted in stage one. Patients' dermatological condition was assessed with the Psoriasis Area and Severity Index (PASI). Clinical and socio-economic information was collected in stage two using a questionnaire, a medical interview and a standardized questionnaire measuring quality of life, the WHOQOL-BREF. RESULTS: The following factors had the greatest effect on the general quality of life and quality of health ratings in the studied sample: severity of psoriatic changes, duration of the most recent recurrence and sex. Severity of psoriatic changes had a negative effect on the patient's somatic, psychological, environmental and social functioning. Duration of the most recent recurrence had a negative effect on social functioning. Practical implications of this study allow dermatologists to determine the appropriate therapeutic intervention which improves the quality of life of these patients on the one hand, and will increase patient's involvement in the process of treatment on the other hand. CONCLUSIONS: Quality of life is more impaired by more severe chronic skin disease.

Employment in people with epilepsy from the perspectives of patients, neurologists, and the general population.

OBJECTIVE: Finding and continuing employment are among the most important issues for patients with epilepsy (PWE). Earlier studies indicated overrepresentation of PWE in manual unskilled or semiskilled positions. METHODS: The questionnaire-based study was carried out throughout Poland between February and March 2009. 995 PWE (18-65 yrs), 179 neurologists, and a representative sample of the Polish population over 15 yrs of age (1042) were included. RESULTS: 49% of PWE were employed. Patients with epilepsy most commonly work as service and sales workers, office workers, professionals, and technicians. 56% of Poles, 25% of patients, and 28% of neurologists believed that all PWE could work. CONCLUSIONS: Almost 3/4 of PWE held non-manual positions. This contradicts the stereotype of unskilled professions being more suitable for PWE. Generally, Poles have a positive attitude towards employment of PWE, but the lack of knowledge about the condition makes them less prudent than neurologists and the PWE themselves.

Treating epilepsy: a review of Polish historical sources.

The first surviving Polish publications on epilepsy were written in the 16th and 17th centuries. Many causes of epileptic seizures are quoted and they are divided into two categories: internal and external. Internal causes (causa interna) include imbalance in the basic bodily humors, that is, yellow bile, black bile, phlegm, and blood. According to medieval writers, the principal cause of epilepsy was vapor, a damp, cold volatile substance originating in the excessive production of one of the basic organismic liquids. Vapor allegedly stuck to the openings leading to the cerebral ventricles or blocked them entirely, resulting in convulsions. External causes (causa externa) include overeating and excessive drinking, teething, spoiled milk, poisons, badly treated spots and fever, cold air, moonlight, and wearing donkey hide. Medical treatments for epilepsy included surgical interventions (bloodletting) and pharmacological interventions. The latter included laxatives, sea onion (scilla maritima, urginea maritima), and ground human skull, all of which were supposed to protect the body from vapors. Medical practitioners of that time also advised that the factors and circumstances conducive to epileptic seizures be observed and identified so that patients could be isolated from these alleged causal factors and their seizures reduced or ended.

Falls in Parkinson's disease. Causes and impact on patients' quality of life.

The aim of this study was to investigate the prevalence of the different causes of falling in Parkinson's disease (PD) and to evaluate the influence of falls on patients' quality of life (QoL). We recruited 60 PD patients (31 with falls, 29 without falls). We found that falls were caused by: unstable posture (29.0%), freezing or festination (25.8%), sudden loss of postural reflexes (toppling falls) (25.8%), co-existing neurological disorders (6.5%), cardiological disorders (6.5%), and symptomatic orthostatic hypotension (3.2%). Duration of the disease was longer, its stage more advanced, daily levodopa dosage higher, and the proportion of patients with abnormalities in the EEG apparently greater in the group with falls. The presence of falls was found to be a factor contributing to a multidirectional negative impact on patients' QoL. QoL also depended on impairment of cognitive function, daily dosage of levodopa, disease duration, disease progression, and sex. The results of this study underline the need to diagnose the causes of falls in order to institute appropriate treatment and to improve patients' QoL.

Somatisation indexes as differential factors in psychogenic pseudoepileptic and epileptic seizures.

One of the postulated factors responsible for psychogenic epileptic seizures is somatisation. The purpose of this study was to analyse differences in the levels of somatisation manifested in the Minnesota Multiphasic Personality Inventory (MMPI) somatisation scales. Subjects were divided into three groups on the basis of a neurological examination and long-term video-monitoring. Group One (N=66, 55F; 11M) had only psychogenic pseudoepileptic seizures. Group Two (N=42, 32F; 10M) had both epileptic and psychogenic pseudoepileptic seizures. Group Three (N=36, 28F; 8M) had only epileptic seizures and served as the control group. Patients in all three groups were given the MMPI. Somatisation indexes in the three groups were compared. Significant between-group differences were obtained for the following somatisation indexes (mean scores): Hypochondriasis (P<0.001), Somatic Complaints (P<0.001), Organic Symptoms (P<0.015) and Poor Health (P<0.05). No significant differences were found for Physical-Somatic Complaints. Psychological evaluation of the differences in the levels of somatisation in these groups may help us to gain a better understanding of, and discrimination between, patients with psychogenic epileptic seizures, mixed seizures and epileptic seizures only.

Anxiety as a differential factor in epileptic versus psychogenic pseudoepileptic seizures.

Anxiety may be a hypothetical factor responsible for psychogenic pseudoepileptic seizures. The purpose of this study was to analyse anxiety indexes manifested in the Minnesota Multiphasic Personality Inventory. Patients were divided into three groups on the basis of a neurological examination and long-term video-monitoring. Group One (N=70; 58 F, 12 M) had only psychogenic pseudoepileptic seizures. Group Two (N=40; 31 F, 9 M) had both epileptic seizures and psychogenic pseudoepileptic seizures. Group Three (N=42; 30 F, 12 M) had only epileptic seizures and served as the control group. Patients with psychogenic pseudoepileptic seizures, alone or in combination with epileptic seizures scored significantly higher than the epileptic group on the following anxiety measures: Anxiety Sign (Gough) - AxS - (P<0.001), Expressive-repressive Index (Sandford, Webster and Freedman) - ERI (P<0.001), and the Neurotic score (Ruesch and Bowman) - NS (P<0.001). Difference between all three groups were found for the Triad Elevation Index (Lovell)-TI (P<0.001) and the Frustration Tolerance Index (Beall and Panton) - FT (P<0.005). These findings suggest that the existence of psychogenic pseudoepileptic seizures or the predisposition to such seizures is reflected in the anxiety dimensions of the personality profile. Psychological evaluation of anxiety may help us to gain a better understanding of, and discrimination between, patients with psychogenic pseudoepileptic seizures, mixed seizures and epileptic seizures.