Psychologiczne bariery udzielania pomocy medycznej dziecku = Psychological barriers in delivering first help for child

Czyż Rafał, Sarnowska Marta, Rutkowski Radosław, Kotowicz Kamila. Psychologiczne bariery udzielania pomocy medycznej dziecku = Psychological barriers in delivering first help for child. Journal of Education, Health and Sport. 2016;6(5):403-411. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.53173http://ojs.ukw.edu.pl/index.php/johs/article/view/3534  The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 755 (23.12.2015).755 Journal of Education, Health and Sport eISSN 2391-8306 7© The Author (s) 2016;This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, PolandOpen Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium,provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License(http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited.This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercialuse, distribution and reproduction in any medium, provided the work is properly cited.The authors declare that there is no conflict of interests regarding the publication of this paper.Received: 05.05.2016. Revised 25.05.2016. Accepted: 25.05.2016. Psychologiczne bariery udzielania pomocy medycznej dzieckuPsychological barriers in delivering first help for child Rafał Czyż1 ([email protected]), Marta Sarnowska2, Radosław Rutkowski3, Kamila Kotowicz41) Katedra Medycyny Ratunkowej Uniwersytetu Medycznego we Wrocławiu 2) Katedra Zdrowia Publicznego Uniwersytetu Medycznego we Wrocławiu 3) Katedra Biofizyki. Samodzielna Pracownia Biofizyki Układu Nerwowego Uniwersytetu Medycznego we Wrocławiu 4) Katedra i Klinika Psychiatrii Uniwersytetu Medycznego we Wrocławiu AbstraktUdzielanie pierwszej pomocy niejednokrotnie wymaga od potencjalnego ratownika przełamywania wielu wewnętrznych barier. Gdy dochodzi do zagrożenia życia lub zdrowia dziecka czynniki te w szczególności nasilają się i w istotnym stopniu determinują dalsze działania osoby niosącej pomoc na miejscu zdarzenia. Celem pracy była próba identyfikacji czynników psychologicznych, mogących wpływać na chęć udzielania pomocy dziecku w stanie nagłym. W badaniu wzięło udział 114 studentów w wieku 22,1±1,6 lat. Użyto autorskiej ankiety, składającej się z pytań, próbujących określić owe czynniki oraz testu wiedzy z zakresu pierwszej pomocy. Większość(65%) ankietowanych deklaruje ukończenie szkolenia z zakresu pierwszej pomocy osobie dorosłej, natomiast dziecka – zaledwie 42% studentów. Zaskakującym jest fakt, iż w ponad 80% szkoleń nie podjęto tematu dotyczącego pediatrycznej wersji AED. Wysoki odsetek studentów(60%) deklaruje podjęcie pomocy dziecku w sytuacji zagrożenia jego życia. Pozostała część ankietowanych, jako największą barierę w udzielaniu pomocy dziecku, określa obawę przed pogłębieniem istniejącego już urazu(54%). Dodatkowo częstymi powodami odstąpienia od pomocy są: brak wiedzy i umiejętności udzielania pomocy(30%), strach związany z zaistniałą sytuacją(21%) oraz obawa przed pociągnięciem do odpowiedzialności prawnej za wyrządzenie krzywdy(20%). W porównaniu płci, kobiety uzyskały wyższy średni wynik testu wiedzy niż mężczyźni (5,10±1,6vs.4,86±1,6), aczkolwiek zdecydowanie częściej w ankiecie wskazują jej brak jako czynnik ograniczający niesienie pomocy. Występowanie wielu czynników ograniczających studentów w udzielaniu pomocy dzieciom niesie za sobą konieczność organizowania systematycznych szkoleń z zakresu pierwszej pomocy. Słowa kluczowe: pierwsza pomoc, bariery psychologiczne.  Psychological barriers in delivering first help for child Delivering first aid many times requires from potential rescuer breaking many inside barriers. When occurs emergency situation where the child’s  health or life is endangered all of this factors intensify and in significant degree are determining further actions of the person delivering help on the spot. Aim of this study was an attempt of identification of psychological factors, being able to influence on willingness to deliver medical help for child in emergency state. In examination took part 114 students aged 22.1±1.6 years. Author’s questionnaire form was used. It consisted of questions which were trying to determine those psychological factors and first aid medical knowledge test. Majority (65%) of participants declare the fact of completion of adult first aid course, however of child first aid course – only 42% of students. Suprising is a fact, that in over 80% of trainings a subject of the paediatric AED version wasn't raised. High percentage of students (60%) declaring willingness of taking the help to the child in emergency state. The rest part of respondents, as the biggest barrier in help for child, is defining anxiety of deepening the already existing injury (54%). Additionally frequent reasons of giving up the help were: lack of knowledge and skills in delivering medical help (30%), fear associated with the existing situation (21%) and anxiety of drawing to the legal liability for harming (20%). In comparing the sex, women obtained higher average medical knowledge test results than men (5.10±1.6 vs 4.86±1.6), although definitely more often in questionnaire form show its lack as a limiting factor in delivering help. Occurrence of many factors which limiting students in delivering medical help for children bringing the need to organize systematic first aid courses.  Key words: first help, psychological barriers

Adverse childhood experiences and methylation of the FKBP5 gene in patients with psychotic disorders

Altered methylation of the FKBP5 gene has been observed in various mental disorders and attributed to the effects of adverse childhood experiences (ACEs). However, the level of FKBP5 methylation has not been investigated in patients with psychotic disorders. Therefore, in this study we aimed to determine the FKBP5 methylation in patients with psychosis and controls, taking into account the effects of ACEs. Participants were 85 patients with psychotic disorders, including first-episode psychosis (FEP) patients and acutely relapsed schizophrenia (SCZ-AR) patients, as well as 56 controls. The level of four CpG sites at the FKBP5 gene was determined in the peripheral blood leukocytes using pyrosequencing. After controlling for potential confounding factors, the level of FKBP5 methylation at one out of four tested CpG sites was significantly lower in FEP patients compared to other groups of participants. Significant main effects of parental antipathy and sexual abuse on the level of FKBP5 methylation were observed at the differentially methylated CpG site. Participants reporting this category of ACEs had significantly lower levels of FKBP5 methylation at this CpG site. Lower levels of FKBP5 methylation were associated with better cognitive performance and higher functional capacity in patients with psychosis. In controls, lower methylation of FKBP5 was related to worse performance of immediate memory and language skills. Our findings suggest that hypomethylation of the FKBP5 appears at early stages of psychosis and might be associated with a history of ACEs as well as less severe clinical manifestation

Effects of interactions between variation in dopaminergic genes, traumatic life events, and anomalous self-experiences on psychosis proneness : results from a cross-sectional study in a nonclinical sample

Background: there is a growing number of studies showing interactions between genetic polymorphisms associated with dopaminergic neurotransmission and traumatic life events (TLEs) on a risk of psychotic-like experiences (PLEs). Anomalous self-experiences (ASEs) have been associated both with TLEs as well as with PLEs. However, it remains unknown what is the role of ASEs in the complexity of gene - environment interactions on the emergence of PLEs. Patients and methods: we included 445 young adults - university students from three big cities in Poland. We used the Traumatic Events Checklist to assess TLEs, the Inventory of Psychotic-Like anomalous self-experiences in order to measure ASEs, and the Prodromal Questionnaire (PQ16) to record the level of PLEs. The following gene polymorphisms, related to dopaminergic neurotransmission, were determined: the catechol-O-methyltransferase (COMT) rs4680 polymorphism, the dopamine D2 receptor (DRD2) rs6277 polymorphism, and the dopamine transporter 1 (DAT1) rs28363170 polymorphism. Results: there was a significant effect of the interaction between the DAT1 polymorphism, a severity of ASEs, and a history of TLEs on the level of PLEs. Among the DAT1 10R/10R homozygotes with low level of ASEs, a severity of PLEs was significantly higher in individuals with a history of any TLEs. Higher scores of the PQ16 were associated with a greater severity of ASEs both in the DAT1 9R allele carriers and the DAT1 10R/10R homozygotes. Conclusion: our findings imply that genetic liability related to aberrant dopamine transport might impact the association between TLEs and PLEs in subjects with high levels of ASEs

The Assessment of Attitudes of Medical Doctors towards Psychiatric Patients—A Cross-Sectional Online Survey in Poland

(1) Introduction: Stigmatization is a multi-level process leading to depreciation of particular social groups. It is particularly visible among people suffering from mental illnesses. Patient stigmatization is a serious problem in psychiatric care; thus, a reliable assessment of its level is important in the context of effective medical interventions. The aim of this paper is to assess the level of stigmatization of psychiatric patients among doctors. (2) Methods: An online, quantitative, CAWI (Computer Assisted Web Interview) study was conducted in the form of an anonymous, voluntary survey addressed to doctors working in Poland. The questionnaire questions included a socio-geographic assessment and questions assessing the level of stigmatization. A standardized psychometric tool, the MICA-4 Scale for doctors, was also used. The results obtained were compared with the evaluation of the existing reports on stigmatization among Polish society. (3) Results: 501 doctors of various specialties and at various stages of career participated in the study. Most of the respondents were women (75%). The average score of MICA-4 obtained by the respondents was 40.26 (minimum 17; maximum 67; SD 8.93). The women’s score was lower than the men’s (p = 0.034). (4) Conclusions: Stigmatization of psychiatric patients is a common phenomenon among doctors. The type of performed work and career stage has an impact on the perception of psychiatric patients. Specialists scored highest in the MICA-4 Scale, similarly to physicians of surgical fields. Due to the prevalence of the phenomenon of stigmatization, especially among people who are meant to provide patients with help, there is an urgent need to implement anti-stigma programs

Methanol Production in the Brayton Cycle

This article presents the concept of renewable methanol production in the gas turbine cycle. As part of the work, an analysis was performed, including the impact of changing the parameters in the methanol reactor on the obtained values of power, yield and efficiency of the reactor, and chemical conversion. The aim of this research was to investigate the possibility of integrating the system for the production of renewable methanol and additional production of electricity in the system. The efficiency of the chemical conversion process and the efficiency of the methanol reactor increases with increasing pressure and decreasing temperature. The highest efficiency values, respectively η = 0.4388 and ηR = 0.3649, are obtained for parameters in the reactor equal to 160 °C and 14 MPa. The amount of heat exchanged in all exchangers reached the highest value for 14 MPa and 160 °C and amounted to Q˙ = 2.28 kW. Additionally, it has been calculated that if an additional exchanger is used before the expander (heating the medium to 560 °C), the expander’s power will cover the compressor’s electricity demand

The role of self-disturbances and cognitive biases in the relationship between traumatic life events and psychosis proneness in a non-clinical sample

Background: traumatic life events have been established as an environmental risk factor for psychosis. However, the exact mechanisms by which traumatic life events increase risk for psychosis are unknown. In the present study we tested an integrative model of traumatic life events being related to psychosis proneness via self-disturbances and cognitive biases. Methods: the sample consisted of 653 healthy people. Traumatic life events, self-disturbances, cognitive biases and psychosis proneness were assessed with self-report questionnaires. The direct and an indirect model of the relationship between traumatic life events and psychosis proneness were compared using path analyses with structural equation modelling in a cross-sectional study. Results: there was a significant direct effect of traumatic life events on psychosis proneness. However, path analysis suggested better fit of the indirect model including paths from trauma to psychosis proneness via cognitive biases and self-disturbances. There were significant paths from traumatic life events to cognitive biases and self-disorders. Self-disorders significantly predicted cognitive biases. Finally, cognitive biases and self-disorders significantly predicted psychosis proneness. Exclusion of any paths, apart from direct path in the model, significantly reduced model fitness. Discussion: the results revealed that a direct relationship between trauma and psychosis proneness became insignificant when taking into account the influence of self-disorders and cognitive biases. This suggests that the interactions between disrupted self-experience, impaired information processing and traumatic life events are of importance in psychosis proneness. This model should be further tested in a longitudinal study on a clinical sample

Self-disturbances, cognitive biases and insecure attachment as mechanisms of the relationship between traumatic life events and psychotic-like experiences in non-clinical adults : a path analysis

Although traumatic life events have been linked to psychotic-like experiences, the mechanisms of the relationship remain unclear. We investigated whether insecure (anxious and avoidant) attachment styles, cognitive biases and self-disturbances serve as significant mediators in the relationship between traumatic life events and psychotic-like experiences in non-clinical sample. Six-hundred and ninety healthy participants (522 females) who have not ever been diagnosed with psychiatric disorders took part in the study. Participants completed self-report scales that measure traumatic life events, psychotic-like experiences, cognitive biases, attachment styles and self-disturbances. Our model was tested with path analysis. Our integrated model fit to the data with excellent goodness-of-fit indices. The direct effect was significantly reduced after the mediators were included. Significant pathways from traumatic life events to psychotic-like experiences were found through self-disturbances and cognitive biases. Traumatic life events were associated with anxious attachment through cognitive biases. Self-disturbances, cognitive biases and anxious attachment had a direct effect on psychotic-like experiences. The results of our study tentatively suggest that traumatic life events are related with psychotic-like experiences through cognitive biases and self-disturbances. Further studies in clinical samples are required to verify our model

Effects of traumatic life events, cognitive biases and variation in dopaminergic genes on psychosis proneness

Aims: Recent studies have provided evidence that interactions between variation in dopaminergic genes and stressful experiences might impact risk of psychosis. However, it remains unknown whether these interactions impact the development of subclinical symptoms, including psychotic‐like experiences (PLEs). In this study, we aimed to test the effects of interactions between variation in dopaminergic genes and traumatic life events (TLEs) on a severity of PLEs. Methods: We assessed TLEs, cognitive biases, PLEs as well as the catechol‐O‐methyltransferase (COMT) rs4680 and the dopamine D2 receptor (DRD2) rs6277 gene polymorphisms in 445 university students at three urban areas. Results: There was a significant effect of the interaction between the COMT rs4680 and a history of any type of TLEs on a severity of PLEs. Among the COMT rs4680 Met allele carriers, a severity of PLEs was higher in individuals with a history of any type of TLEs. Further stratification of the sample revealed that this effect appears only in the group of participants with a high level of cognitive biases. The DRD2 rs6277 C allele was independently associated with a higher level of PLEs. Conclusions: Our results indicate that decreased dopamine catabolism related to the COMT gene polymorphism might increase psychosis proneness in individuals with a history of TLEs and high levels of cognitive biases. Variation in the DRD2 gene might exert independent effects on psychosis proneness. These findings imply that there are various levels of complexity in the models of interactions between genetic and environmental factors explaining the mechanisms underlying psychosis proneness

Coping styles and symptomatic manifestation of first-episode psychosis: Focus on cognitive performance

Cognitive deficits are widely observed in patients with psychosis and represent one of most important determinants of functional outcomes. It has been shown that patients with psychosis prefer maladaptive coping strategies over active coping styles. However, it remains unknown whether cognitive impairments are related to coping styles in psychotic disorders. Therefore, the aim of this study was to assess whether cognitive deficits observed in patients with first-episode psychosis (FEP) might impact the use of specific coping strategies. We recruited 40 FEP patients and 35 healthy controls. In our study, FEP patients were more likely to use maladaptive coping styles after adjustment for education level and medication effects. The use of maladaptive coping strategies was associated with greater impairments of visuospatial/constructional abilities and language skills in FEP patients. In addition, lower odds of using adaptive coping were related to higher levels of depressive symptoms in the group of patients. Adaptive coping was associated with better global cognitive performance in healthy controls. Our results indicate that cognitive impairments, especially worse performance of visuospatial/constructional abilities and language skills, might be related to the preference of maladaptive coping strategies. Lower odds of using adaptive coping styles might be associated with more severe depressive symptomatology.This study was funded from science budget resources granted for the years 2016-2019 (the Iuventus Plus grant awarded by the Ministry of Science and Higher Education, grant number: IP2015 052474).Scopu