Deriving the dietary approaches to stop hypertension (DASH) score in women from seven pregnancy cohorts from the European alphabet consortium

The ALPHABET consortium aims to examine the interplays between maternal diet quality, epigenetics and offspring health in seven pregnancy/birth cohorts from five European countries. We aimed to use the Dietary Approaches to Stop Hypertension (DASH) score to assess diet quality, but different versions have been published. To derive a single DASH score allowing cross-country, cross-cohort and cross-period comparison and limiting data heterogeneity within the ALPHABET consortium, we harmonised food frequency questionnaire (FFQ) data collected before and during pregnancy in ≥26,500 women. Although FFQs differed strongly in length and content, we derived a consortium DASH score composed of eight food components by combining the prescriptive original DASH and the DASH described by Fung et al. Statistical issues tied to the nature of the FFQs led us to re-classify two food groups (grains and dairy products). Most DASH food components exhibited pronounced between-cohort variability, including non-full-fat dairy products (median intake ranging from 0.1 to 2.2 servings/day), sugar-sweetened beverages/sweets/added sugars (0.3–1.7 servings/day), fruits (1.1–3.1 servings/day), and vegetables (1.5–3.6 servings/day). We successfully developed a harmonized DASH score adapted to all cohorts being part of the ALPHABET consortium. This methodological work may benefit other research teams in adapting the DASH to their study’s specificities

The effect of coping strategy on quality of life in patients with NSCLC

Mariusz Chabowski,1,2 Beata Jankowska-Polańska,3 Katarzyna Lomper,3 Dariusz Janczak1,2 1Division of Surgical Procedures, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland; 2Department of Surgery, 4th Military Teaching Hospital, Wroclaw, Poland; 3Division of Nursing in Internal Diseases, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland Background: A cancer diagnosis is a source of emotional distress. The aim of the study was to evaluate coping strategies in patients with non-small-cell lung carcinoma and to assess how coping strategies along with other factors affect their quality of life. Patients and methods: A total of 185 patients with non-small-cell lung carcinoma were enrolled in this observational, cross-sectional study. Demographic and clinical data were collected. Strategies for coping with cancer were assessed using a shortened version of the Mental Adjustment to Cancer (MiniMAC) scale. Health-related quality of life was assessed using the Short Form-8 Health Survey. Results: Respondents (mean age: 62.84±9.6 years) most often emerged as using a fighting strategy, whereas a sense of helplessness was the strategy used least often. Overall, 65% of the respondents were revealed to have a medium level of constructive style of coping, whereas 62% had a medium level of destructive style. The coping style of nearly 50% of the respondents was predominantly constructive. Patients whose coping style was predominantly constructive had a significantly higher level of quality of life than patients whose coping style was predominantly destructive or whose results showed a balance between the two coping styles. Lung cancer patients had higher scores on the mental functioning scale (mental component summary = 50.20±39.26) than on the physical functioning scale (physical component summary = 40.07±28.58). Conclusion: The majority of lung cancer patients use effective strategies for coping with the disease, which correlates with a better quality of life; a compromised quality of life is associated with a destructive coping style. Physicians should endeavor to promote positive, constructive, problem-oriented strategies of coping, especially in patients with a compromised quality of life, where the disease is advanced and when there are comorbidities. Keywords: lung cancer, coping strategy, quality of lif

The influence of frailty syndrome on acceptance of illness in elderly patients with chronic obstructive pulmonary disease

Izabella Uchmanowicz,1 Beata Jankowska-Polanska,1 Mariusz Chabowski,2 Bartosz Uchmanowicz,1 Andrzej M Fal3 1Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 2Division of Nursing in Surgical Procedures, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 3Department of Healthcare Organisation and Economics, National Institute of Public Health, National Institute of Hygiene, Warsaw, Poland Abstract: COPD is one of the most debilitating diseases. Frailty syndrome and advanced age may decrease the acceptance of illness, quality of life, and worsen health conditions in these patients, as well as lead to an increase in health care expenses. The aim of the study was to assess how the level of frailty affects the acceptance of illness in elderly patients with COPD. We also aimed to evaluate the associations between sociodemographic and clinical factors and the level of acceptance of illness, anxiety, and frailty in this group of patients. The study included 102 COPD patients with a mean age of 63.2 (standard deviation =6.5) years and grades I (3%), II (37%), III (52%), and IV (8%) by Global Initiative for Chronic Obstructive Lung Disease. The Polish versions of the Acceptance of Illness Scale and Tilburg frailty indicator were used. Frailty syndrome was found in 77 (75.5%) patients, with an average score of 7.42 (standard deviation =2.24). Coexisting diseases such as hypertension (46.07%), coronary artery disease (32.35%), heart failure (28.43%), diabetes (18.63%), and heart arrhythmia (9.8%) were found among the subjects. The overall level of acceptance of illness was 20.6 (standard deviation =7.62). A lower level of acceptance of illness was associated with a higher level of frailty, especially in the physical and social domain. Elderly patients with severe COPD are more prone to frailty and decreased acceptance of their disease in comparison to patients with other chronic diseases. Assessment and management of frailty in the care of older COPD patients are likely to improve risk stratification significantly and help personalize management, leading to better patient outcomes. Keywords: frailty syndrome, COPD, acceptance of illness, elderly patients, Tilburg frailty indicator, TFI, Acceptance of Illness Scale, AI

Assessment of illness acceptance by patients with COPD and the prevalence of depression and anxiety in COPD

Izabella Uchmanowicz,1 Beata Jankowska-Polanska,1 Urszula Motowidlo,2 Bartosz Uchmanowicz,1 Mariusz Chabowski3 1Department of Clinical Nursing, Faculty of Health Science, 2Department of Thoracic Surgery, 3Division of Nursing in Surgical Procedures, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland Background: COPD is a civilization disease. It affects up to 8%–10% of population >30 years of age. Coexistence of depression occurs in 20%–40% of patients with COPD. Depression and anxiety reduce compliance and worsen prognosis. Objective: The aims of this study were to determine the degree of illness acceptance among patients with COPD, to examine the relation between disease acceptance and perceived anxiety and depression, and to verify which of the sociodemographic and clinical factors are associated with illness acceptance, anxiety, and depression. Materials and methods: The study included 102 patients with COPD (mean age 65.8 years), hospitalized due to exacerbations. Acceptance of Illness Scale and Hospital Anxiety and Depression Scale were used. For statistical analysis, Student’s t-test and Pearson’s r correlation coefficient were carried out. Results: The overall illness acceptance level was moderate with a tendency toward lack of acceptance (mean 20.6, standard deviation [SD] 7.62). The overall scores were 10.2 (SD 3.32) for anxiety and 10.8 (SD 4.14) for depression, which indicate borderline or high intensity of these symptoms. Acceptance of illness was negatively correlated with the intensity of depression symptoms (r=-0.46, P<0.05). Intensity of depression was significantly associated with intensity of smoking, duration of the disease, severity of dyspnea, and living in a rural area. Conclusion: Early identification and assessment of depression and anxiety symptoms allow health care providers to offer patients at risk of depression a special medical supervision. Rapid start of antidepressant therapy may increase illness acceptance and improve prognosis among patients with COPD. Keywords: COPD, depression, anxiety, acceptance of illnes

Quality of life and methods of coping with stress depending on the used form of therapy of rheumatoid arthritis treatment

Introduction: There are studies, which prove a positive influence of biological drugs on effects of medical therapy but there are few of them, which focus on aspects of quality of life and coping with stress. Purpose: To assess quality of life (QoL) and methods of coping with stress depending on the used form of therapy of rheumatoid arthritis (RA) treatment. Materials and methods: Comparative analysis included 64 patients: I group B – treated with the method of biological agents; II group T - treated according to rheumatologic standards. The study used: Short Form 36 (SF–36)- general questionnaire use for assessment QoL, HAQ (Health Assessment Questionnaire) scale of functional efficiency, Mini-COPE inventory for coping with stress. Results: Assessment of QoL with the use of the SF-36 questionnaire showed low QoL of patients in both groups. Higher QoL was observed in group B in all domains except PF domain where group T got a higher score. Analysis of QoL within total physical and mental health assessment also indicated higher QoL of patients from group B relatively PCS (39.8% vs. 33.5%) and MCS (56.9% vs. 40.9%; p<0.001). Analysis of coping with stress showed that the most common strategies of coping with stress in group B are positive: sense of humour (1.06 vs. 0.61; p=0.008) and planning (1.95 vs. 1.81), positive redefinition (1.59 vs. 1.48), acceptance (2.00 vs. 1.95). Whereas among patients in group T the strategy ‘turn to religion’ prevails (1.44 vs. 0.91; p=0.014). Conclusions: Biological agents favourably affect assessment of QoL and a degree of functional disability in patients with significant intensification of the disease symptoms. In patients treated with biological drugs using positive strategies of coping with stress, and difficult situation is observed. Patients treated with biological drugs show better satisfaction from treatment and fewer unfavourable symptoms resulting from the used therapy

Quality of life of patients with lung cancer

Jacek Polanski,1 Beata Jankowska-Polanska,2 Joanna Rosinczuk,3 Mariusz Chabowski,4 Anna Szymanska-Chabowska5 1Lower Silesian Oncology Center, Home Hospice, 2Department of&nbsp;Clinical Nursing, 3Department of Nervous System Diseases, Department of Clinical Nursing, 4Division of Nursing in Surgical Procedures, Department of Clinical Nursing, Faculty of Health Science, 5Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Wroclaw, Poland Abstract: Lung cancer is the major cause of oncologic-related death worldwide. Due to delayed diagnosis, 5-year survival rate accounts for only 15%. Treatment includes surgery, adjuvant chemotherapy, and radiation therapy; however, it is burdened by many side effects. Progress of the disease, severity of its symptoms, and side effects decrease significantly the quality of life (QoL) in those patients. The level of self-assessed QoL helps in predicting survival, which is especially important among patients receiving palliative care. Patients assess their functioning in five dimensions (physical, psychological, cognitive, social, and life roles), severity of symptoms, financial problems, and overall QoL. The QoL in lung cancer patients is lower than in healthy population and patients suffering from other malignancies. It is affected by the severity and the number of symptoms such as fatigue, loss of appetite, dyspnea, cough, pain, and blood in sputum, which are specific for lung tumors. Fatigue and respiratory problems reduce psychological dimension of QoL, while sleep problems reduce cognitive functioning. Physical dimension (related to growing disability) decreases in most of the patients. Also, most of them are unable to play their family and social roles. The disease is a frequent reason of irritation, distress, and depression. Management of the disease symptoms may improve QoL. Controlling the level of fatigue, pulmonary rehabilitation, and social and spiritual support are recommended. Early introduction of tailored palliative treatment is a strategy of choice for improvement of QoL in lung cancer patients. Keywords: lung cancer, prognostic factor, quality of life, adverse events, survival, public health medicin

Psychometric properties of the Polish version of the eight-item Morisky Medication Adherence Scale in hypertensive adults

Beata Jankowska-Polanska,1 Izabella Uchmanowicz,1 Anna Chudiak,1 Krzysztof Dudek,2 Donald E Morisky,3 Anna Szymanska-Chabowska4 1Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland; 2Department of Logistic and Transport Systems, Faculty of Mechanical Engineering, Wroclaw University of Technology, Wroclaw, Poland; 3Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA; 4Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Wroclaw, Poland Abstract: Low adherence to pharmacological treatment is often associated with poor blood pressure control, but identification of nonadherent patients in outpatient settings is difficult. The aim of the study was to translate and evaluate the psychometric properties of the Polish version of the structured self-report eight-item Morisky Medication Adherence Scale (MMAS-8) among patients with hypertension. The study was conducted in a family doctor practice between January and July 2015. After a standard &ldquo;forward&ndash;backward&rdquo; procedure to translate MMAS-8 into Polish, the questionnaire was administered to 160 patients with hypertension. Reliability was tested using a measure of internal consistency (Cronbach&rsquo;s &alpha;) and test&ndash;retest reliability. Validity was confirmed using known group validity. Three levels of adherence were considered based on the following scores: 0 to &lt;6 (low); 6 to &lt;8 (medium); and 8 (high). Complete questionnaires were returned by 110 respondents (mean age: 60.7 years &plusmn;12.6; 54.6% were female). The mean number of pills taken daily was 3.61&plusmn;4.31. The mean adherence score was 6.42&plusmn; 2.0. Moderate internal consistency was found (Cronbach&rsquo;s &alpha;=0.81), and test&ndash;retest reliability was satisfactory (r=0.461&ndash;0.905; P&lt;0.001). Reproducibility expressed by Cohen&rsquo;s &kappa; coefficient =0.61 was good. In high-adherent patients, the percentage of well-controlled blood pressure was higher than in low-adherent patients (33.3% vs 19.1%, &chi;2=0.87, P=0.648). Psychometric evaluation of the Polish version of the MMAS-8 indicates that it is a reliable and valid measure tool to detect nonadherent patients. The MMAS-8 may be routinely used to support communication about the medication-taking behavior in hypertensive patients. Keywords: Morisky scale, medication adherence, hypertension, validation, pharmacological treatmen

Polypharmacy Management in the Older Adults: A Scoping Review of Available Interventions

Background: Polypharmacy paves the way for non-adherence, adverse drug reactions, negative health outcomes, increased use of healthcare services and rising costs. Since it is most prevalent in the older adults, there is an urgent need for introducing effective strategies to prevent and manage the problem in this age group. Purpose: To perform a scoping review critically analysing the available literature referring to the issue of polypharmacy management in the older adults and provide narrative summary. Data sources: Articles published between January 2010–March 2018 indexed in CINHAL, EMBASE and PubMed addressing polypharmacy management in the older adults. Results: Our search identified 49 papers. Among the identified interventions, the most often recommended ones involved various types of drug reviews based on either implicit or explicit criteria. Implicit criteria-based approaches are used infrequently due to their subjectivity, and limited implementability. Most of the publications advocate the use of explicit criteria, such as e.g. STOPP/START, Beers and Medication Appropriateness Index (MAI). However, their applicability is also limited due to long lists of potentially inappropriate medications covered. To overcome this obstacle, such instruments are often embedded in computerised clinical decision support systems. Conclusion: Multiple approaches towards polypharmacy management are advised in current literature. They vary in terms of their complexity, applicability and usability, and no “gold standard” is identifiable. For practical reasons, explicit criteria-based drug reviews seem to be advisable. Having in mind that in general, polypharmacy management in the older adults is underused, both individual stakeholders, as well as policymakers should strengthen their efforts to promote these activities more strongly