Publications by authors named "Marcin Mikos"

28 Publications

  • Page 1 of 1

The influence of pre-hospital medication administration in ST-elevation myocardial infarction patients on left ventricular ejection fraction and intra-hospital death.

Postepy Kardiol Interwencyjnej 2021 Mar 27;17(1):39-45. Epub 2021 Mar 27.

Department of Bioinformatics and Public Health, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland.

Introduction: Currently, invasive cardiology techniques are the preferred method of treatment for patients with ST-elevation myocardial infarction (STEMI). Improving the care of patients with STEMI is possible by minimizing the time that elapses from the onset of pain to the start of treatment. As studies indicate, early pharmacotherapy, especially with antiplatelet and anticoagulant medications, allows for their early effectiveness.

Aim: To assess the influence of early administration of antiplatelet (clopidogrel) and anticoagulant medications in the pre-hospital period in patients with ST-elevated myocardial infarction on the frequency of in-hospital deaths and on the left ventricular ejection fraction evaluated at hospital discharge.

Material And Methods: In this study, a retrospective analysis of 573 patients hospitalized due to ST-segment elevation myocardial infarction in one of Krakow's hospitals from January 2011 to December 2015 (excluding the whole of 2013) was used as a research method.

Results: As many as 97% of patients received pre-hospital pharmacotherapy, but only 46.0% of respondents received unfractionated heparin, and 19.2% received clopidogrel. The in-hospital mortality rate was 6.7%, but among patients prehospitally treated with clopidogrel and unfractionated heparin, the in-hospital mortality rate was 1.1%. Prehospital administration of clopidogrel significantly decreased the possibility of reduced left ventricular ejection fraction (OR = 0.27; 95% CI: 0.09-0.90).

Conclusions: Among pre-hospital procedures, only administration of a second antiplatelet drug (clopidogrel) significantly decreased the risk of reduced left ventricular ejection fraction, and administration of clopidogrel or heparin, or a combination of both, significantly decreased the risk of in-hospital death in patients with STEMI.
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http://dx.doi.org/10.5114/aic.2021.104766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039926PMC
March 2021

Link between cardiovascular disease and the risk of falling: a comprehensive review of the evidence.

Pol Arch Intern Med 2021 Apr 25;131(4):369-376. Epub 2021 Feb 25.

Falls are associated with increased morbidity and mortality, rising hospital readmission rates, decreased patient independence, and strained healthcare resources. In aged populations and individuals with multimorbidity, cardiovascular conditions may contribute towards an increased propensity to fall. The prevalence of cardiovascular conditions generally increases with age, and understanding potential fall risk factors may help to minimize the risk of falls and develop preventive interventions. Acting on even one such risk factor or introducing an appropriate intervention may reduce the overall propensity for a patient to fall. Further prevention strategies primed towards cardiovascular ailments should be elucidated and trialed.
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http://dx.doi.org/10.20452/pamw.15849DOI Listing
April 2021

Human bocavirus and metapneumovirus in acute wheezing in children-Is there a link with atopy?

Clin Respir J 2020 Dec 7;14(12):1201-1207. Epub 2020 Sep 7.

Department of Pneumonology, Allergology and Clinical Immunology, Poznań University of Medical Sciences, Poznan, Poland.

Introduction: Viral respiratory tract infections are the leading cause of acute wheezing in children with a significant risk of hospital admission, risk of recurrence and subsequent asthma. Human respiratory syncytial virus (RSV) and human rhinovirus (RV) in childhood wheezing are widely studied; however, accessible PCR assays enabled diagnosis of other pathogens, including bocavirus (hBOV) and metapneumovirus (hMPV).

Objectives: The aim of the study was to evaluate the prevalence of respiratory viruses in children hospitalized for acute wheezing along with demographic and clinical data.

Methods: We enrolled 101 children, n = 50 (49.5%) with wheezy bronchitis, n = 34 (33.7%) with acute bronchiolitis and n = 17 (16.8%) with exacerbation of asthma; (median age 1.41 ± 2.84 years). Multiplex real-time PCR assay was used for virus detection.

Results: One or more viruses were detected in 83.2% subjects: RSV in 44.6%, followed by RV (23.8%), hBOV and hMPV (both 11.9%); other viruses were less frequent (<8%). Viral coinfection was found in 38 (37.6%) of children. ANCOVA analysis revealed significantly higher total IgE concentrations in the hMPV-positive subgroup compared to RSV (34 kU/L vs 12.7 kU/L; P = .009) and RV (13.3 kU/L, P = .022). For both hMPV and hBOV an association with atopic dermatitis (AD) was observed: aOR for hMPV and AD was 5.6 (95%CI: 1.4-22.7; P = .016) and 4.7 for hBOV and AD (95%CI: 1.3-18; P = .024).

Conclusion: Viral detection ratio in wheezy respiratory tract infections in Polish children is high (83.2%), with both hBOV and hMPV at 11.9% The results also suggest possible relationship of hBOV wheezy infection with nonspecific markers of atopy in children.
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http://dx.doi.org/10.1111/crj.13261DOI Listing
December 2020

Occurrence of adverse events in the activity of hospital wards in the opinions of doctors and nursing management staff.

Ann Agric Environ Med 2020 Jun 15;27(2):306-309. Epub 2019 Apr 15.

National Center for Quality Assessment in Health Care, Krakow, Poland.

Introduction: An adverse event is an incident induced while providing health care services or resulting from it, not related to the natural course of a given disease or health condition, which causes or is likely to cause negative consequences for the patient, including their death, a threat to life, the necessity of hospitalisation or its prolongation, permanent or considerable health detriment; or is a foetal disease, congenital defect or the result of foetal damage.

Objective: The aim of this analysis is to explore the problem of the occurrence of adverse events from the perspective of doctors and ward nurses who manage wards.

Material And Methods: The research on the occurrence of adverse events among doctors and nurses (the management staff) was conducted with the use of a postal survey.

Results: It was ascertained that 86.5% of the medical personnel had taken part in an adverse event, of which 20.2% took part in an occurrence associated with pharmacotherapy, 16.2% - in an event related to diagnostics and diagnosis, or an infection - 15.7%. 14.2% of respondents were involved in an occurrence linked to a medical device malfunction, and 14.1% - in an adverse event related to an operation.

Conclusions: The adverse events most often identified in the nursing professional group are occurrences associated with pharmacotherapy, and in the doctors' professional group - occurrences related to diagnostics and diagnosis. The research established that the most frequent reason for not informing patients about the occurrence of an adverse event is fear of their filing a complaint. Medical management staff show high acceptance of an adverse event reporting system as a tool for improving patient safety.
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http://dx.doi.org/10.26444/aaem/106234DOI Listing
June 2020

Evaluation of Risk Factors for Falls in Patients with Rheumatoid Arthritis.

Med Sci Monit 2020 Apr 15;26:e921862. Epub 2020 Apr 15.

Department of Rheumatology, The J. Dietl Specialist Hospital Cracow, Cracow, Poland.

BACKGROUND The aim of our study was to investigate the risk factors for falls in the rheumatoid arthritis (RA) patient population in Poland. This would be a major step towards the development of new fall prevention programs. MATERIAL AND METHODS There were 450 RA patients who met the criteria of the American College of Rheumatology who participated in this study. The average age of patient participants was 54.2 years; the average RA duration was 15.1 years. All patients filled out the study questionnaire regarding falls, medications, and diseases, and they filled out the Polish version of the Health Assessment Questionnaire (HAQ). RESULTS Of the 400 patients, 203 patients (51%) experienced falls. Out of the 268 falls experienced by study patients, 113 falls (42%) were due to an environmental cause, the remainder 155 falls were caused by health conditions. The number of falls positively correlated with HAQ scores (r=0.42, P<0.01) and the duration of RA (r=0.39, P<0.05). For individuals who had fallen 3 or more times, there was a stronger positive correlation between the number of falls and the total HAQ score (r=0.61, P<0.01). The main risk factors for falls in the study group were dizziness (odds ratio [OR]=3.42), the use of hypotensive medication (OR=2.82), foot deformities (OR=4.09), and a high HAQ score (OR=2.59). Other factors such as drug use (e.g., glucocorticoids), pain, and duration of RA were measured using a visual analogue scale, and were found not to have increased the risk for falls and fractures (P>0.05). CONCLUSIONS Knowledge about risk factors can help identify high-risk patients to help decrease their risk of falling, thus preventing fall-related injuries.
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http://dx.doi.org/10.12659/MSM.921862DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7177037PMC
April 2020

Metastatic and non-metastatic sentinel inguinofemoral lymph nodes in vulvar cancer show an increased lymphangiogenesis.

Ann Agric Environ Med 2020 Mar 26;27(1):123-128. Epub 2019 Mar 26.

Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow, Poland.

Introduction And Objective: Lymph node involvement is a strong predictor of disease recurrence and patient survival in vulvar cancer. The aim of the study was to evaluate the feasibility of sentinel lymph node (SLN) screening, the incidence of skip metastases, and lymph node lymphangiogenesis.

Material And Methods: Fifty-five patients participated in this prospective, single centre study. A double SLN screening method was employed using radiocolloid (technetium-99 sulfur colloid) and 1.0% Isosulfan Blue. Immunohistochemistry, using a mouse monoclonal antibody against D2-40, was used to evaluate lymphatic vessel density (LVD). All calculations were performed using STATISTICA software v. 10 (StatSoft, USA, 2011); p < 0.05 was considered significant.

Results: Using both methods of SLN detection, 100% accuracy was achieved, and skip metastases were diagnosed in only one woman (1.82%). Peri-tumour median LVD was significantly increased compared with matched intra-tumour samples (p < 0.001), while median LVD was significantly lower in negative, compared with positive SLN, regardless of whether matched non-SLN were negative (p < 0.001) or positive (p = 0.005). Metastatic SLN exhibited significantly higher median LVD compared with matched negative non-SLN (p = 0.015), while no significant difference in median LVD was detected between positive SLN and matched positive non-SLN. However, negative SLN had a significantly higher median LVD compared with matched negative non-SLN (p = 0.012).

Conclusions: SLN detection is a safe and feasible procedure in vulvar cancer. In patients without nodular involvement, SLN, compared with non-SLN, exhibited significantly higher median LVD, which may be an indication of its preparation to host metastases, and thus requires further investigation.
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http://dx.doi.org/10.26444/aaem/105925DOI Listing
March 2020

Stress at work: The case of municipal police officers.

Work 2020 ;65(1):145-152

Andrzej Frycz Modrzewski Krakow University, Kraków, Poland.

Introduction And Objective: Occupational stress-related factors among working municipal police officers in Poland have not been examined in the literature. The purpose of the paper was to evaluate the impact of selected work-related factors on occupational stress in active municipal police officers in Warsaw by using configural frequency analysis (CFA).

Materials And Methods: A cross-sectional study was conducted among 578 participants, which accounted for 55.1% of all municipal police officers in Warsaw. The majority of study participants were men (72%) (mean age 43 years old). Two groups of workplace-related stress factors were analysed in the study: physical conditions and organisational working conditions causing stress. The study was carried out using the PAPI method (Paper-and-Pencil Interviewing), based on a proprietary questionnaire developed for the study. CFA searches for templates and patterns in contingency tables.

Results: Municipal police officers who claimed that stress did not affect health, took advantage of psychological/psychiatric advice less often than those who thought so (1.7% vs 10.1%; χ2 = 20.152, df = 2, P = 0.000). Those who declared that they often experienced stress at work were also more prone to claiming that one or two factors affected their level of stress: physical abuse, contact with infectious materials, working at uncomfortable temperatures or working in a noisy environment. In the opinion of the study population, there were some factors which contributed to the occurrence of stress at work, and these factors included: working in a hurry, lack of necessary resources, devices and materials at work, the need to be available at all times and the unpredictability of the work. The municipal police officers from the study population combined two or three methods to cope with stress, such as watching TV, surfing the Internet and talking with their families.

Conclusion: Due to the specificity of a municipal police officer's occupation, special attention should be paid to the occupational stress risk factors characteristic for this group of professionals, and measures should be taken to reduce the number of stressors. It is important to organise training events devoted to effective methods of coping with stress. There is need to carry out more in-depth studies of occupational stress among municipal police officers.
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http://dx.doi.org/10.3233/WOR-193067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7029323PMC
August 2020

Causes of delays in breast cancer diagnosis in Poland.

Pol Merkur Lekarski 2019 Sep;47(279):85-90

Department of Cancer Prevention, Medical University of Warsaw, Warsaw, Poland.

Breast cancer is the most common malignant tumor in women. The results of breast cancer treatment to a large extent depend on the time of the primary diagnosis of the disease.

Aim: The aim of this study was to determine the most common causes of the delay and the delay time in the diagnosis of breast cancer in Polish women.

Materials And Methods: The study was performed using a diagnostic survey and analysis of medical documentation from the Subcarpathian Regional Oncology Center, Poland. A total of 231 patients with diagnosed breast cancer were recruited to the study.

Results: Delays in diagnosing of breast cancer were found in 83.1% of all the patients. The average time from the first symptom observation by a woman to the first medical consultation was on average 61.7 days. The most common cause of the delay in medical consultation in the examined group was a fear of diagnosing cancer (31.2%).

Conclusions: The examined women require permanent health education in the field of breast cancer and the importance of early diagnosis of the disease for the effectiveness of treatment and prognosis.
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September 2019

Prevalence and Clinical Implications of the Primitive Trigeminal Artery and its Variants: A Meta-Analysis.

World Neurosurg 2020 Jan 16;133:e401-e411. Epub 2019 Sep 16.

International Evidence-Based Anatomy Working Group, Krakow, Poland; Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland.

Background: The primitive trigeminal artery (PTA) is the most common and the largest persistent carotid-basilar anastomosis. Primitive trigeminal artery variants (PTAVs) are anastomoses between the internal carotid artery and cerebellar arteries. These vessels pose a risk of hemorrhagic or ischemic complications during neurosurgical procedures in the parasellar and intrasellar regions. The aim of this study was to determine the prevalence of both PTA and PTAVs and their clinically important anatomic features.

Methods: Major electronic databases were thoroughly searched for studies on PTA and PTAV. References in the included articles were also evaluated. Data regarding prevalence, laterality, origin, course patterns, and associated anomalies were extracted and pooled into a meta-analysis.

Results: A total of 39 studies (110,866 patients) were included in the meta-analysis. The total pooled prevalence estimate of PTA and PTAVs combined was 0.4% (95% confidence interval [CI], 0.3-0.5). Individually, PTA was present in 0.3% of patients and PTAV in 0.2%. Both arteries most often originated from the C4 internal carotid artery and took a course lateral to the dorsum sellae. The anterior inferior cerebellar artery type was the predominant PTAV (72.1%). Basilar artery hypoplasia was found in 42.5% of patients with a PTA.

Conclusions: PTA and PTAVs are rare vessels, but they are clinically important because they can contribute to trigeminal neuralgia. Knowledge of the potential course of these arteries is essential in neuroradiology and neurosurgery, especially in minimally invasive procedures such as the endoscopic endonasal transsphenoidal approach to the pituitary gland and the percutaneous gasserian ganglion procedure.
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http://dx.doi.org/10.1016/j.wneu.2019.09.042DOI Listing
January 2020

Refusal to Take Sick Leave after Being Diagnosed with a Communicable Disease as an Estimate of the Phenomenon of Presenteeism in Poland.

Med Princ Pract 2020 3;29(2):134-141. Epub 2019 Sep 3.

Medical University of Warsaw, Warsaw, Poland.

Objective: The purpose of this study was to estimate the prevalence of presenteeism in patients with communicable diseases in Poland.

Subject And Methods: This study was based on data from the medical records of 2,529 patients aged 19-64 years. All of the patients were diagnosed with communicable diseases. The inclusion criteria were based on implementing decision concerning communicable diseases made by the Commission of the European Union. Associations between refusal to take sick leave and patients' age, gender, and diagnosis in terms of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) were tested. Linear regression analysis of the data acquired from the patients who agreed to take sick leave was further used to estimate the possible length of sick leave in patients who refused to take it.

Results: The number of patients who refused to take sick leave was 18.1%. The presenteeism rate was related to the age of patients (periods of sick leave were longer in older patients) and the ICD-10 diagnosis (largely in bacterial intestinal infections and measles). The estimated number of days spent on sick leave in patients who refused to take it, assuming that they made a different decision and complied with it, was in the range of 4-6 days.

Conclusion: The prevalence of presenteeism in the case of communicable diseases in Poland is lower than in the general population. However, as the refusals to take sick leave took place in the case of potentially contagious diseases, the negative impact on productivity may be significant.
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http://dx.doi.org/10.1159/000503052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098319PMC
January 2021

The effects of prehospital system delays on the treatment efficacy of STEMI patients.

Scand J Trauma Resusc Emerg Med 2019 Apr 8;27(1):39. Epub 2019 Apr 8.

Department of Emergency Medical Services, Faculty of Medicine and Health Sciences Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzińskiego 1, 30-705, Kraków, Poland.

Background: Cardiovascular disease accounts for nearly half of all deaths in Poland. The aim of this study was to assess both the duration and the delays of prehospital treatment in ST-segment elevation myocardial infarction (STEMI) patients and how it impacts left ventricle ejection fraction (LVEF) measured at the time of discharge and the frequency of in-hospital patient mortality.

Methods: This study retrospectively analyzed medical records from January 2011 to December 2015 (excluding the year 2013) of 573 patients who were transported to a hospital with a diagnosis of STEMI.

Results: The mean time of prehospital system delays was 59 min with a maximum time of 152 min and a minimum time of 23 min. The relationship between reduced LVEF (< 55%) and in-hospital patient mortality and the relationship between length of time from first medical contact (FMC) to hospital admission was analysed in 515 respondents. Extending the time of FMC to hospital admission by 1 min increased the chances of lowering LVEF by 2% (95% CI: 1.004-1.041) and increased the chances of death by 2% (95% CI: 1.002-1.04) in STEMI patients.

Conclusions: This study emphasised how vital it is to minimise time spent with STEMI patients at the scene of their cardiovascular event by performing an ECG as quickly as possible and by immediately transporting the patient to the hospital with the targeted treatment. This may lead to the implementation of additional training in the field of ECG interpretation, increase the prevalence of teletransmission systems, and improve communication between Emergency Medical Services (EMS) and catheterization laboratories ultimately reducing patient mortality.
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http://dx.doi.org/10.1186/s13049-019-0616-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454716PMC
April 2019

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

Ann Agric Environ Med 2019 Mar 3;26(1):114-119. Epub 2018 Sep 3.

Medical University, Warsaw, 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 (βstand.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.
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http://dx.doi.org/10.26444/aaem/94294DOI Listing
March 2019

Work Ability Index (WAI) values in a sample of the working population in Poland.

Ann Agric Environ Med 2019 Mar 28;26(1):78-84. Epub 2018 Sep 28.

Department of Experimental and Clinical Pharmacology, Medical University, Warsaw, Poland.

Introduction: Ability to work is most often defined as a relationship between a person's resources and requirements specific to a particular type of work. It is the result of interaction between job requirements in terms of physical and mental strain, capabilities and skills of the employee, as well as his/her health condition and own evaluation of functioning in a given organizational and social situation.

Objective: The primary objective of the study was to evaluate the current value of the Work Ability Index (WAI) in a sample of employees in Poland.

Material And Methods: The study sample was selected purposefully from 422,000 employees covered by the largest occupational health provider in Poland. The standard WAI questionnaire provided by CAWI (Computer-Assisted Web Interview) methodology was voluntary and completed anonymously by 688 employees within 12 months (0.16% response rate). The results were statistically analyzed using the Pearson's chi-squared test and correlation coefficient, independent-sample T test and one-way analysis of variance (p<0.05).

Results: It was found that the average value of WAI was 37.5 ± 7.7, and 37% of the participants represented low to moderate ability to work. The results showed no significant correlation between the WAI value and its 7 compounds and demographic variables. Nonetheless, a dependency between WAI level and industrial branch was observed.

Conclusions: Subjects with moderate and low WAI (1/3 of the study population) had particular indications to implement prophylactic actions, especially for the health care employees and civil servants, whose ability to work may be subject to accelerated deterioration.
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http://dx.doi.org/10.26444/aaem/91471DOI Listing
March 2019

Immunoexpression of DNA fragmentation factor 40, DNA fragmentation factor 45, and B-cell lymphoma 2 protein in normal human endometrium and uterine myometrium depends on menstrual cycle phase and menopausal status.

Arch Med Sci 2018 Oct 31;14(6):1254-1262. Epub 2017 Jul 31.

Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow, Poland.

Introduction: DNA fragmentation factors 40 and 45 (DFF40 and DFF45) are final executors of apoptosis, and B-cell lymphoma 2 (Bcl-2) is a well-recognized apoptosis inhibitor. We aimed to evaluate DFF40, DFF45 and Bcl-2 immunoexpression in the normal human endometrium with respect to the glandular and stromal layer and in uterine myometrium.

Material And Methods: DFF40, DFF45, and Bcl-2 expression was assessed via immunohistochemistry in the endometrium and myometrium collected postmenopausally and premenopausally during the proliferative and secretory phases of the menstrual cycle.

Results: Compared to the myometrium and stroma, endometrial glands showed the highest DFF40 and DFF45 expression in pre- and postmenopausal specimens. DFF45, but not DFF40, glandular expression dependent on menstrual cycle phase and DFF40 and DFF45 scoring was significantly lower in postmenopausal specimens. Significantly higher Bcl-2 expression was observed in proliferative glandular endometrium compared to secretory and postmenopausal specimens. No cycle- or menopause-dependent changes were reported for stromal or myometrial DFF40, DFF45 or Bcl-2 expression. DFF40, DFF45 and Bcl-2 expression was independent of age, age at menarche and menopause, BMI, menstrual cycle and menses lengths, parity and gravidity.

Conclusions: The study provides important evidence regarding menstrual cycle-dependent changes in the expression of DFF40, DFF45 and Bcl-2 in the normal human endometrium, especially in the glandular layer, and shows that their levels are stable in the normal uterine myometrium.
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http://dx.doi.org/10.5114/aoms.2017.69383DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6209718PMC
October 2018

Immunity to hepatitis A virus among working professionals in Poland - Results of a 3-year serological survey 2013-2015.

Ann Agric Environ Med 2018 Sep 25;25(3):572-575. Epub 2018 Sep 25.

National Institute of Public Health, Warsaw, Poland.

Introduction: Hepatitis A (HA) is caused by infection with the hepatitis A virus (HAV). The differential etiological diagnosis of acute hepatitis is based on a positive result of the serological test detecting IgM class anti-HAV. For epidemiological studies on past infection and seroprevalence of HAV in populations, the tests measuring IgG class anti-HAV or total anti-HAV are used. Since the 1990s, specific prophylaxis is possible by vaccination against HA. In Poland, vaccination is recommended and in majority is performed at own cost.

Material And Methods: Database was obtained from electronic medical records of the 2 major private health care providers networks (Luxmed and Medicover) operating in Poland. During a 3-year period (2013-2015), 1,124 persons with unknown status of anti-HA vaccination were tested for the presence of total anti-HAV. Objective. The aim of the study was to evaluate the seroprevalence of anti-HAV among working professionals in Poland.

Results: Anti-HAV were detected in 603 (53.6%) persons, while 521 (46.3%) tested negative. The study group was divided into 2 subgroups: 25-44 and 45-64-years-old. For detailed statistical analysis, the presence of anti-HAV was considered as a dependent variable, and its predictors were gender, age and the year of the test performance. The presence of anti-HAV was significantly more prevalent in older age group. The lack of specific antibodies was more prevalent in younger age group.

Conclusions: Results of the study show increasing susceptibility to HAV infection in the younger age group, compared with the older age group of corporate professional employees in large cities in Poland. Since the epidemiological situation of HA is currently changing with increasing number of symptomatic cases of HA, it is suggested that employers might consider including an additional procedure of vaccination against HA into their private health insurance portfolio.
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http://dx.doi.org/10.26444/aaem/91467DOI Listing
September 2018

Impact of the doctor deficit on hospital management in Poland: A mixed-method study.

Int J Health Plann Manage 2019 Jan 22;34(1):187-195. Epub 2018 Aug 22.

The Polish Association for Medical Law, Krakow, Poland.

Objectives: The primary objective was to assess the scale and consequences of the doctor deficit in Poland with the main focus on hospital care providers. To provide the background for the above, an analysis of the system level responses to the problem was also conducted.

Data And Methods: A mixed-method approach was used. We triangulated data collected using 3 methods: (1) a literature review, (2) an analysis of the national statistical databases, and (3) in-depth interviews with hospital managers.

Results: Poland is characterized by the lowest number of physicians per 1000 population in the European Union (2.3 in 2015). Also, the age structure of the doctor working population constitutes an alarming factor (in 2015, approx. 48% of all practicing doctors and 61% of specialists were above 50). In recent years, numerous hospitals were forced to cease provision of specific services and/or close wards due to the doctor deficit. The high competition in employing doctors and pressure for wage increases puts hospital managers in situations where they must often choose between securing service provision (by offering higher wages for doctors) and maintaining the hospital's positive financial outcome (by containing costs).

Conclusion: In Poland, the long-term neglect of health workforce planning at the system level (there is neither a dedicated structure nor a formal strategy) has contributed to the current doctor deficit crisis. From the hospital managers' perspective, who are on the frontline of the problem impact, urgent solutions are needed that would at least alleviate its scale in the short term.
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http://dx.doi.org/10.1002/hpm.2612DOI Listing
January 2019

Refusal to take a sick leave as an estimate of the phenomenon of presenteeism in Poland.

Oncotarget 2018 Jun 15;9(46):28176-28184. Epub 2018 Jun 15.

Department of Cancer Prevention, Medical University of Warsaw, Warsaw, Poland.

Introduction: Absenteeism and presenteeism are two main phenomena related to health problems and professional activity. Presenteeism is the involvement in a professional activity despite being ill. The purpose of the current study is to estimate the prevalence of presenteeism in Poland on the basis of medical records and to explore associations between presenteeism and patients' age, gender and type of medical problem. Another purpose is to provide estimates of the length of sick leave if it was accepted.

Results: The amount of patients who refused to take a sick leave was 27.4%. There was a minor relationship between the refusals and gender (slightly higher in men) as well as strong effects of the age of patients (periods of sick leave were longer in older patients) and ICD-10 diagnosis (largely in acute diseases of the upper respiratory tract). The estimated number of days spent on sick leave in the group of patients that refused to take it, assuming that they made a different decision and complied to it, was in the range between 5 and 10 days.

Discussion: The prevalence of presenteeism in Poland is relatively high. Since the largest proportion of refusals took place in the case of potentially contagious diseases, the negative impact on productivity may be even higher. Even though the relationship between presenteeism and wages remains unclear, the remarkable increase of wages in Poland within the last 20 years may explain the propensity to work despite being ill. Further research needs to consider the simultaneous use of medical records and self-measured productivity loss.

Materials And Methods: The current study is based on data from medical records concerning 550,360 patients aged 19-64. Associations between refusals to take a sick leave and patients' age, gender, as well as diagnosis in terms of ICD-10 (International Statistical Classification of Diseases and Related Health Problems), were tested. Linear regression analysis on the data acquired from the patients who accepted to take a sick leave were further used to estimate the possible length of sick leave in the group of patients that refused to take it.
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http://dx.doi.org/10.18632/oncotarget.25592DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6021350PMC
June 2018

[Patient safety in poland according to analysis of medical adverse events].

Wiad Lek 2017;70(6 pt 1):1096-1101

Zakład Ekonomiki i Jakości W Ochronie Zdrowia, Katedra Zdrowia Publicznego, Wydział Nauk O Zdrowiu, Uniwersytet Medyczny Im. Piastów Sląskich We Wrocławiu, Wrocław, Polska.

The paper presents the analysis of rulings from regional commisions on health care malpractice in Poland wiith special attention to patient safety issues. The analysis entails causes, types and consequensence of 469 malpractice claims. In 23,7% of cases the claim was confirmed by commission. The most frequent types of malpractice was body injury. General surgery and othopedis were the major medical specialities when confirmed malpractices took place.
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June 2018

Large prospective validation and cultural adaptation of the Polish version of the Swiss Spinal Stenosis Questionnaire for patients with lumbar spinal stenosis.

Ann Agric Environ Med 2017 Dec 9;24(4):676-682. Epub 2017 Nov 9.

Chair of Neuropsychology, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland.

Objective: The aim of this prospective cohort study was to translate, validate and perform a cultural adaptation of the Polish version of the Swiss Spinal Stenosis Questionnaire (P-SSSQ), a disease-specific questionnaire for assessing symptom severity, physical function and satisfaction with treatment in patients with lumbar spinal stenosis (LSS).

Material And Methods: Patients were prospectively recruited at two orthopedic centres in Krakow, Poland, between January 2011 - October 2016. During the interview, each patient completed the P-SSSQ, SF-36 Health Survey, and a demographic data questionnaire. After translation, cross-cultural adaptation, and pilot testing, assessment was made of the internal consistency, test-retest reliability, construct validity, and responsiveness of the P-SSSQ subscales.

Results: Finally, 171 consecutive patients were included in the study. Cronbach's alpha and ICC values were above 0.8 for all three subscales of the P-SSSQ. The symptom severity domain was highly negatively correlated with physical functioning and bodily pain of SF-36, with Pearson correlation coefficients of -0.68 and -0.63, respectively. The physical function domain was highly negatively correlated with physical functioning (r = -0.62). The satisfaction subscale was also highly negatively correlated with the change in the symptom severity (r = -0.61) and physical function scale (r = -0.65).

Conclusions: The proposed version of the P-SSSQ showed excellent measurement properties and can be considered validated for use in Polish. It is easy to understand, quick to complete, and the psychometric properties of the original version are maintained.
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http://dx.doi.org/10.26444/aaem/78674DOI Listing
December 2017

Endometrial Polyps and Benign Endometrial Hyperplasia Have Increased Prevalence of DNA Fragmentation Factors 40 and 45 (DFF40 and DFF45) Together With the Antiapoptotic B-Cell Lymphoma (Bcl-2) Protein Compared With Normal Human Endometria.

Int J Gynecol Pathol 2018 Sep;37(5):431-440

Department of Gynecology and Oncology, Jagiellonian University Medical College (T.B., K.P.) Dietl Specialistic Hospital, Krakow (M.M.) Children's Memorial Health Institute, Warsaw (J.C.K.), Poland.

DNA fragmentation factor 40 (DFF40) is a key executor of apoptosis. It localizes to the nucleus together with DNA fragmentation factor 45 (DFF45), which acts as a DFF40 inhibitor and chaperone. B-cell lymphoma (Bcl-2) protein is a proven antiapoptotic factor present in the cytoplasm. In this study, we aimed to investigate DFF40, DFF45, and Bcl-2 immunoexpression in endometrial polyps (EPs) and benign endometrial hyperplasia (BEH) tissue compared with that in normal proliferative endometrium (NPE) and normal secretory endometrium (NSE) as well as normal post menopausal endometrium (NAE). This study used archived samples from 65 and 62 cases of EPs and BEH, respectively. The control group consisted of 52 NPE, 54 NSE, and 54 NAE specimens. Immunohistochemistry was used to detect DFF40, DFF45, and Bcl-2. DFF40, DFF45, and Bcl-2 were more highly expressed in the glandular layer of EPs and BEH compared with the stroma, and this was not influenced by menopausal status. Both glandular and stromal expression of DFF40, DFF45, and Bcl-2 were significantly higher in EPs compared with NPE, NSE, and NAE. Glandular BEH tissue showed significantly higher DFF40, DFF45, and Bcl-2 expression than in NPE, NSE, and NAE. No differences in the glandular expression of DFF40, DFF45, and Bcl-2 were observed between EP and BEH tissues, while Bcl-2 stromal expression in BEH was significantly lower than in EPs. Glandular, menopause-independent DFF40, DFF45, and Bcl-2 overexpression may play an important role in the pathogenesis of EPs and BEH.
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http://dx.doi.org/10.1097/PGP.0000000000000442DOI Listing
September 2018

Evaluation of exhaled breath temperature (EBT) as a marker and predictor of asthma exacerbation in children and adolescents.

J Asthma 2017 Sep 10;54(7):699-705. Epub 2017 Mar 10.

a Department of Pneumonology, Pediatric Allergy and Clinical Immunology , Poznan University of Medical Sciences , Poznan , Poland.

Introduction: Noninvasive and easy-to-use tools to monitor airway inflammation in asthma are needed to maintain disease control, particularly in pediatric population. The aim of the study was to evaluate exhaled breath temperature (EBT) in pediatric respiratory clinic setting.

Methods: We evaluated 37 children and adolescents with asthma (5-17 years; median: 11 years). The patients were followed up in stable condition and during exacerbations (paired observations in n = 19 subjects). We evaluated medication use, EBT, fractional exhaled nitric oxide (FeNO), spirometry and atopic status of patients.

Results: EBT was significantly higher in children with asthma exacerbation {entire group: median [interquartile range (IQR)]: 32.3 [1.1]°C vs. 33.8 [1.7]°C; p < 0.001 and mean ± SD: 33.1 ± 1.0°C vs. 33.6 ± 1.1°C; p = 0.038 for paired observations}. Significant correlation was observed between EBT and FeNO in the entire group (r = 0.22; p = 0.03). No difference was observed in EBT median values in atopic and non-atopic subjects in the entire group (median [IQR]: 32.6 [1.6] vs. 32.7 [2.0]; p = 0.88) and in subgroups. There was no difference in EBT values in patients receiving systemic or inhaled glucocorticosteroids (p = 0.45 and 0.83). There was no significant correlation between EBT and body or room temperature. The only significant predictor of exacerbation in logistic regression model was EBT {aOR = 2.4; 95% [confidence interval (CI)]: 1.4-4.1}. ROC analysis demonstrated applicability of EBT as a marker of asthma exacerbation in children (AUC = 0.748; p < 0.001; cut-off = 33.3°C; sensitivity: 64.3%; specificity: 82.1%).

Conclusions: We suggest that EBT may serve as marker and predictor of asthma exacerbation in children. EBT follow-up may be useful in asthma monitoring in children and adolescents.
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http://dx.doi.org/10.1080/02770903.2017.1290104DOI Listing
September 2017

Diagnostic significance of serum concentrations of soluble Fas ligand (sFasL) in children with autoimmune thyroid disease.

Autoimmunity 2017 May 21;50(3):192-198. Epub 2017 Feb 21.

a Department of Pediatric Endocrinology and Rheumatology and.

Introduction: The aim of the study was to assess serum levels of sFasL as a marker of thyroid dysfunction in children with autoimmune thyroid disease (AITD).

Design: The group comprised 45 newly diagnosed children with Hashimoto's thyroiditis and Graves' disease versus euthyroid control group: 11 with hypothyroidism (10 girls and 1 boy, aged 12.2 ± 1.9 years), 19 children with hyperthyroidism (15 girls and 4 boys, aged 12.4 ± 4.9 years) and 15 healthy subjects (7 girls and 8 boys, aged 10.5 ± 4.8 years).

Methods: Thyroid function (TSH, fT4, fT3), autoimmune (ATG, ATPO, TRAb) and anthropometric (weight, height, BMI, BMI-SDS, Cole index) parameters were evaluated. sFasL concentration was measured by ELISA. Nonparametric statistical test and ROC analysis were performed to assess the data.

Results: We found no significant differences in serum concentrations of sFasL between boys and girls in the studied groups. Significantly higher sFasL levels (median 0.26 ng/ml) were identified in children with hypothyroidism compared with the control group (median 0.06 ng/ml, p < 0.001) and in comparison to a group of children with hyperthyroidism (median 0.14 ng/ml, p < 0.05). ROC analysis indicates that sFasL effectively discriminated hypothyroid and healthy children (area under the curve/AUC = 0.897; p < 0,001; sensitivity: 100%, specificity: 73.3%), as well as both clinically opposing states: hyperthyroidism and hypothyroidism among themselves (AUC = 0.833; p= 0,003; sensitivity: 94,7%, specificity: 72.7%).

Conclusions: Our work shows that sFasL may be useful marker in the assessment of thyroid dysfunction in children with autoimmune thyroid disease.
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http://dx.doi.org/10.1080/08916934.2017.1289180DOI Listing
May 2017

The strategy of training staff for a new type of helicopter as an element of raising the security level of flight operations.

Int J Occup Saf Ergon 2015 ;21(4):558-67

a Medical University of Warsaw , Poland.

In 2008, the Polish Medical Air Rescue started replacing its fleet with modern EC135 machines. To ensure the maximum possible safety of the missions performed both in the period of implementing the change and later on, the management prepared a strategy of training its crews to use the new type of helicopter. The analysis of incidents that occurred during 2006-2009 showed that both the human and the technical factors must be carefully considered. Moreover, a risk analysis was conducted to reduce the risk both during general crew training and in the course of particular flight operations. A four-stage strategy of training pilots and crew members was worked out by weighing up all the risks. The analysis of data from 2010 to 2013 confirmed that the risk connected with flying and with all the activities involved in direct support aircraft operations is under control and lowered to an acceptable level.
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http://dx.doi.org/10.1080/10803548.2015.1095010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4706028PMC
March 2016

The role of the immune system and cytokines involved in the pathogenesis of autoimmune thyroid disease (AITD).

Endokrynol Pol 2014 ;65(2):150-5

Autoimmune thyroid disease (AITD) is the most common organ-specific autoimmune disorder. AITD development occurs due to loss of immune tolerance and reactivity to thyroid autoantigens: thyroid peroxidase (TPO), thyroglobulin (TG) and thyroid stimulating hormone receptor (TSHR). This leads to infiltration of the gland by T cells and B cells that produce antibodies specific for clinical manifestations of hyperthyroidism in Graves' disease (GD) and chronic autoimmune thyroiditis (cAIT). In addition, T cells in Hashimoto's thyroiditis induce apoptosis in thyroid follicular cells, leading ultimately to the destruction of the gland. Cytokines are involved in the pathogenesis of thyroid diseases working in both the immune system and directly targeting the thyroid follicular cells. They are involved in the induction and effector phase of the immune response and inflammation, playing a key role in the pathogenesis of autoimmune thyroid disease. The presence of multiple cytokines has been demonstrated: IL-1alpha, IL-1b, IL-2, IL-4 , IL-6, IL-8, IL-10, IL-12, IL-13, IL-14, TNF-alpha and IFN-gamma within the inflammatory cells and thyroid follicular cells. Finally, cytokines derived from T cells can directly damage thyroid cells, leading to functional disorders and may also stimulate the production of nitric oxide (NO) and prostaglandin (PG), thus increasing the inflammatory response in AITD. Immunological mechanisms involved in the pathogenesis of AITD are strongly related to each other, but differences in the image of cAIT and GD phenotype are possibly due to a different type of immune response observed in these two counteracting clinical thyroid diseases. This article describes the potential role of cytokines and immune mechanisms in the pathogenesis of AITD.
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http://dx.doi.org/10.5603/EP.2014.0021DOI Listing
December 2015

The clinical role of serum concentrations of selected cytokines: IL-1β, TNF-α and IL-6 in diagnosis of autoimmune thyroid disease (AITD) in children.

Autoimmunity 2014 Nov 7;47(7):466-72. Epub 2014 May 7.

Department of Pediatric Endocrinology and Rheumatology .

Chronic autoimmune thyroiditis (cAIT) leads to hypothyroidism due to T cell-mediated cytotoxicity in most cases. By contrast, Graves' disease (GD) with thyrotropin receptor stimulatory autoantibodies cause hyperthyroidism. Cytokines play a crucial role in modulating immune response in both disorders. The aim of study was to evaluate the concentrations of cytokines: IL-1β, TNF-α and IL-6 in these two opposite clinical and hormonal thyroid diseases. The study group consisted of 64 children, 44 newly diagnosed, untreated children with cAIT (n = 22; with hypothyroidism) and GD (n = 22; hyperthyroidism), and the control group of 20 healthy children. Cytokine concentrations were evaluated using the ELISA technique. The studied groups of children did not differ significantly in concentrations of IL-6 (p = 0.48) and TNF-α (p = 0.067). In children with hypothyroidism, we found significantly higher concentrations of IL-1β (median 2.16 pg/ml, IQR 0.87) compared to hyperthyroidism (median 1.39 pg/l, IQR 1.27) (p < 0.01) and the control group (median 1.88 pg/ml, IQR 1.04) (p < 0.05). The results of ROC curve analysis demonstrated the usefulness of IL-1β (AUC = 0.77, p = 0.003) and TNF-α (AUC = 0.691, p = 0.034) as diagnostic parameters in cAIT which enable discrimination of children with autoimmune thyroid disease from healthy individuals. Concentrations of these markers are increased in autoimmune hypothyroidism. We found no significant sex differences in the tested parameters. In conclusion, IL-1β and TNF-α may be considered as markers of hypothyroidism, and could efficiently discriminate between healthy and autoimmune hypothyroid children. Significantly higher concentrations of IL-1β in children with hypothyroidism may be used to distinguish children with cAIT from GD patients.
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http://dx.doi.org/10.3109/08916934.2014.914175DOI Listing
November 2014

How to inspire and involve future medical doctors in CF care?

J Cyst Fibros 2007 Sep 25;6(5):315-6. Epub 2007 Jan 25.

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http://dx.doi.org/10.1016/j.jcf.2006.12.006DOI Listing
September 2007