The role of local government units in increasing access to therapeutic rehabilitation services for patients with musculoskeletal diseases

Chronic diseases of the osteoarticular and muscular system belong to a group of health problems that lead to a limitation of the organism's efficiency, making it difficult or impossible for individuals to function normally. Of the forms of treatment used for chronic diseases of the osteoarticular system, rehabilitation is by far the most common. These activities are mainly financed by the National Health Fund, as well as by social insurance. A complementary role is played by local governments that finance medical rehabilitation for their residents in the form of health policy programmes, implemented as public health tasks. An important argument in favour of rehabilitation at the self-governmental level is the long waiting time for medical rehabilitation services financed by the National Health Fund.           The aim of the paper was to show the role of local government in increasing access to therapeutic rehabilitation services for patients with musculoskeletal diseases. The paper discusses such issues as the importance of musculoskeletal diseases for the efficiency of individuals, organization and financing of guaranteed services in curative rehabilitation, as well as increasing access to these services at the local government level

Ecophysiological determinants of the human skeletal system

This review assessed relationships between external factors and the level of joint pathology (hip, knee, ankle, elbow, shoulder, hands and feet) in humans with dysplastic arthritis, psoriatic arthritis, rheumatoid arthritis, Sjögren’s syndrome, systemic lupus erythematosus, systemic sclerosis, degenerative joint disease, ankylosing spondylitis, osteoporosis, osteomalacia and gout. The accumulation of physiologically different chemical elements in different types of bones in humans of different ages allows for a more accurate assessment of the causal quoted response from parallel biochemical systems. These allow a better understanding of the link between exposure arising from smoking, alcohol, drugs, diseases, heredity, effects of amalgam dental fillings, diet, food preferences, chemical elements, occupational and environmental exposure to toxicants, lipoperoxidation and pro-antioxidant reactions. Physiology of the osteoarticular system determines what is responsible for bone and long-term body accumulation of toxic metals, which may be involved in the pathogenesis of bone diseases. While relationships between stressors, antioxidant system and bone condition predict potential risks in certain abnormalities and change oxidative stress. Elemental instability in the environment combined with salinity, acidity, redox potential and local changes in hydrochemical balance, enhances adverse effects. Processes of remodeling and bone mineralization continue throughout life and therefore may be a determinant of long-term accumulation of toxicants. Environmental issues affecting bioaccumulation of chemical elements in the osteoarticular system in humans is poorly understood. Alloplastic procedures, including the need for prostheses, supplemented by image layouts oxidative enzyme activities, as well as lipoperoxidation and the level of stress proteins, give a complete picture of skeletal response to external stressors. Simultaneously, the analysis of the impact of stressors on bones allows a more accurate tracing of causal quoted responses from parallel reactions. They have a direct relationship with stressors and affect the nature and degree of responses and defense capabilities. Thus they have a role in the diagnosis of diseases of the skeletal system

Wybrane zmienne socjodemograficzne a jakość życia pacjentów ze zmianami zwyrodnieniowymi kręgosłupa odcinka szyjnego

Introduction. Degenerative diseases of the spine are a problem that threatens the modern population around the world.Aim. Thus the main aim of the study was to assess the impact of socio-demographic variables such as: gender, age,education, place of residence, type of work, marital status on the assessment of the quality of life by patients withdegenerative lesions of the cervical spine.Material and Methods. The study was conducted at the non-public nursing care facility in Lipno on a group of 103patients diagnosed with degenerative disease of the cervical spine. The study was conducted using the method ofdiagnostic survey. It consisted in the assessment of patients within a period of at least 6 months from the diagnosis,using an own-made questionnaire and a standardized tool, the WHOQOL-BREF questionnaire.Results. It was found that the quality of life of men is better in the psychological field than that of women.Furthermore younger people function better in the somatic and psychological fields compared to older people.Mentally working people assess their quality of life better than physical workers. The higher and better the education,the better the quality of life in the somatic, social and environmental field. Moreover people in relationships showa better quality of life in the social field compared to single people. The place of residence of the respondents doesnot affect their quality of life.Conclusions. Back pain is a significant clinical, social and economic problem. What’s more, they significantly reducethe quality of life of patients. (JNNN 2021;10(1):18–25)Wstęp. Choroby zwyrodnieniowe kręgosłupa stanowią problem, który zagraża współczesnej populacji na całym świecie.Cel. Głównym celem pracy była ocena wpływu zmiennych socjodemograficznych takich jak: płeć, wiek, wykształcenie,miejsce zamieszkania, rodzaj wykonywanej pracy, stan cywilny na ocenę jakości życia przez pacjentów ze zmianązwyrodnieniową odcinka szyjnego kręgosłupa.Materiał i metody. Badanie zostało przeprowadzone w Niepublicznym Zakładzie Pielęgnacyjno-Opiekuńczymw Lipnie na grupie 103 pacjentów z rozpoznaną chorobą zwyrodnieniową kręgosłupa odcinka szyjnego. Badanieprzeprowadzono za pomocą metody sondażu diagnostycznego. Polegało ono na ocenie pacjentów w okresie minimum6 miesięcy od postawienia diagnozy, za pomocą kwestionariusza ankiety własnego autorstwa oraz wystandaryzowanegonarzędzia — Kwestionariusza WHOQOL-BREF.Wyniki. Stwierdzono, że jakość życia mężczyzn jest lepsza w dziedzinie psychologicznej w porównaniu z kobietami.Ponadto osoby młodsze lepiej funkcjonują w dziedzinach somatycznej i psychologicznej w porównaniu z osobamistarszymi. Osoby wykonujące pracę umysłową lepiej oceniają swoją jakość życia w porównaniu z osobamiwykonującymi pracę fizyczną. Im wyższe i lepsze wykształcenia tym lepsza jakość życia w dziedzinie somatycznej, socjalnej i środowiskowej. Co więcej osoby będące w związkach wykazują lepszą jakość życia w dziedzinie socjalnejw porównaniu z osobami samotnymi. Miejsce zamieszkania badanych nie ma wpływu na ich jakość życia.Wnioski. Dolegliwości bólowe kręgosłupa stanowią istotny problem kliniczny, społeczny a także ekonomiczny.Co więcej w sposób znaczący obniżają jakość życia pacjentów. (PNN 2021;10(1):18–2

Assessment of functional mobility and body mass index among patients with a total knee replacement: a retrospective study in Indian population

Background: Obesity is associated with an increased risk of osteoarthritis, and the incidence of obese patients requiring a total knee replacement (TKR) has increased in recent years. A high body mass index (BMI) may influence post‐TKR rehabilitation outcomes. The aim of the present study was to assess the effects of obesity on functional mobility outcomes following post‐TKR rehabilitation in Asian patients where BMI was not as high as those reported in similar studies performed other countries other than Asian.Methods: A total of 125 patients were categorized as normal weight (n=25), overweight (n=25), class I obese (n = 25), or class II/III obese (n=25 each). Patients were retrospectively followed up for 6 months after undergoing TKR followed by 2 months of active rehabilitation. Outcome measures were recorded at baseline and at the 2‐month and 6‐month follow-up assessments and included the Western Ontario and McMaster Universities Osteoarthritis Index and the following tests: functional reach, single‐leg stance, ten‐meter walk, timed up and go, chair rise, and stair climbing.Results: A 4×3 (group×time) repeated‐measures analysis of variance showed significant improvement in all of the outcome measures for all of the BMI groups at the 2‐month and 6‐month follow-up assessments (p<0.05 for all). No significant intergroup differences at the 2‐month and 6‐month follow-up assessments were observed for any of the mobility measures except the functional reach and single‐leg stance (p<0.05).Conclusions: Patients with class II/III obesity benefit from early post‐TKR outpatient rehabilitation and respond well. Also, the patients with lower BMIs showed significant improvements and patients with a high BMI might require additional balance-based exercises in their post-TKR rehabilitation protocols

Akromegalia — nowe spojrzenie na pacjenta. Polskie propozycje postępowania diagnostyczno-terapeutycznego w akromegalii w świetle aktualnych doniesień

is usually delayed and is often associated with the development of various complications causing premature mortality. In patients with hypertension, heart failure, diabetes, and arthropathy that is non-specific for age, attention should be paid to the occurrence of somatic signs of acromegaly. As a screening test, insulin-like growth factor-1 (IGF-1) concentration should be assessed. Further diagnostic and treatment procedures are possible in specialised centres. The first-line therapy is selective transsphenoidal adenomectomy. Patients with a good prognosis related to a surgical removal of the pituitary tumour should be referred only to centres experienced in performing this type of procedure, after pharmacological preparation. Other patients, and those who have not recovered after surgical treatment, should be subjected to long-term pharmacotherapy with long-acting somatostatin analogues. In each case, the complications of acromegaly should be followed-up long-term and actively treated. This proposed new recommendation should be helpful for the management of patients with acromegaly. (Endokrynol Pol 2014; 65 (4): 326–331)Akromegalia jest rzadką chorobą spowodowaną nadmiernym wydzielaniem hormonu wzrostu (GH), zwykle przez guz przysadki. Rozpoznanie jest opóźnione i często związane z rozwojem różnych powikłań powodujących zwiększone zagrożenie zgonem. U chorych z nadciśnieniem, niewydolnością serca, cukrzycą, artropatiami, nietypowymi do wieku należy zwrócić uwagę na występowanie objawów akromegalii. Jako badanie przesiewowe należy wykonać oznaczenie stężenia insulinopodobnego czynnika wzrostu-1 (IGF-1). Dalsza diagnostyka i leczenie powinny być prowadzone w wyspecjalizowanych ośrodkach. Leczeniem pierwszego rzutu jest wybiórcze usunięcie gruczolaka przysadki z dostępu przez zatokę klinową. Pacjenci rokujący wyleczenie operacyjnym usunięciem guza przysadki powinni być kierowani do ośrodków z doświadczeniem w tego typu zabiegach, po przygotowaniu farmakologicznym. Pozostali chorzy oraz ci po nieskutecznym leczeniu neurochirurgicznym powinni być długotrwale leczeni analogami somatostatyny. W każdym przypadku następstwa akromegalii winny być przez całe życie monitorowane i aktywnie leczone. Proponowane nowe zalecenia powinny być pomocne w postępowaniu z pacjentami chorymi na akromegalię. (Endokrynol Pol 2014; 65 (4): 326–331

Changing incidence of oral and maxillofacial tumours in East Java, Indonesia, 1987-1992. Part 2: Malignant tumours

A total of 2193 tumours of the mouth and jaw diagnosed at the Laboratorium Patologi Anatomi Fakultas Kedokteran Universitas Airlangga, Indonesia from 1987 to 1992, inclusive, was studied. Malignant tumours constituted 45.3 of the lesions. Almost 71 of the malignant tumours were squamous cell carcinomas. The remainder were salivary gland tumours (21.5) and sarcomas (4.5). The male to female ratio for malignant tumours was 5.1:4.7. The incidence of malignant tumours per 100,000 population over the 6-year study period was 2.64. The yearly incidence seemed to increase except in 1990, when it dropped. The incidence of squamous cell carcinoma over the 6 years was 2.1. Calculation of the odds ratio suggested that people aged 40 and over are 5.8 times more likely to develop squamous cell carcinoma. Copyright 2001 The British Association of Oral and Maxillofacial Surgeons

Factorii de risc în etiologia morbidităţii prin maladii osteoarticulare

Summary. Risk Factors in the Etiology of Osteoarthritis Morbidity. The study of the diseases of the osteoarticular system is important not only because of their high rate, but also because the increase in these diseases, as observed in the past years. It was established that drinking water hardness differs in each of the three geographical regions of Moldova and it was found a weak correlation between high hardness level and osteoarthritis morbidity. The population who uses potable water with a high level of a mineralization, according to scientific bibliography, is at risk of developing osteoarthritis. The estimation of the health risk associated with well-water hardness demands a more thorough study in the given area.Резюме. Факторы риска в этиологии костносуставной заболеваемости В изучении заболеваемости костносуставной системы важен не только ее высокий уровень, но и тенденция к увеличению этих болезней, как это было зафиксировано за последние годы. Было установлено, что питьевая вода по жесткости различается в основных трех географических районах Молдовы и обнаруживается неопределенная корреляция между превышением нормы жесткости води и заболеваемостью костно-суставной системы. Насел ение, которое употребляет питьевую воду с высоким уровнем минерализации, согласно данным литературы, подвержено риску заболевания костно-суставной системы

Cluster Analysis To Identify Elderly People's Profiles: A Healthcare Strategy Based On Frailty Characteristics.

The new social panorama resulting from aging of the Brazilian population is leading to significant transformations within healthcare. Through the cluster analysis strategy, it was sought to describe the specific care demands of the elderly population, using frailty components. Cross-sectional study based on reviewing medical records, conducted in the geriatric outpatient clinic, Hospital de Clínicas, Universidade Estadual de Campinas (Unicamp). Ninety-eight elderly users of this clinic were evaluated using cluster analysis and instruments for assessing their overall geriatric status and frailty characteristics. The variables that most strongly influenced the formation of clusters were age, functional capacities, cognitive capacity, presence of comorbidities and number of medications used. Three main groups of elderly people could be identified: one with good cognitive and functional performance but with high prevalence of comorbidities (mean age 77.9 years, cognitive impairment in 28.6% and mean of 7.4 comorbidities); a second with more advanced age, greater cognitive impairment and greater dependence (mean age 88.5 years old, cognitive impairment in 84.6% and mean of 7.1 comorbidities); and a third younger group with poor cognitive performance and greater number of comorbidities but functionally independent (mean age 78.5 years old, cognitive impairment in 89.6% and mean of 7.4 comorbidities). These data characterize the profile of this population and can be used as the basis for developing efficient strategies aimed at diminishing functional dependence, poor self-rated health and impaired quality of life.132224-3