Znaczenie wsparcia społecznego dla poziomu lęku i depresji oraz obciążenia opiekunów pacjentów po udarze mózgu – wyniki wstępne

Background. Stroke is a medical emergency, it occurs suddenly, putting the patient and his family in a new, unexpected and extremely stressful situation. About 70 000 people suffer stroke every year in Poland and the number is constantly increasing. Potential intervening factor, which influenced functioning of caregivers of patients with stroke may be social support, in the form of a health educational program.Aim. The aim of the study was to determine the importance of social support in the form of health educational program for anxiety and depression level and burden of stroke patients’ caregivers.Material and methods. The study group consisted of 22 caregivers (family members) of the patients hospitalized in the Department of Neurology for Adults, Medical University Hospital in Gdansk, with a stroke or TIA. The study was conducted in the period from January 2008 to February 2010. The research method was preexperimental study, one-group pretest-posttest design, without a control group. The evaluation assessed the level of anxiety and depression among caregivers and the level of caregivers burden load level (3 and 6-12 months after the occurrence of stroke in a close relative), the study compared with baseline during hospitalization.Results. The level of anxiety among caregivers ranged on the border between the lack of disturbance (0-7 pts.) and the symptoms of borderline (8-10 pts.). Based on the HADS scale there was no depression in this group. The level of emotional exhaustion in the group of careers was at the average level. However, depersonalization among caregivers performed at a low level. Caregivers highly evaluated their capabilities, to provide care for stroke relatives.Conclusions. 1. When the time passes from the occurrence of the incident stroke, the level of anxiety and depression among caregivers decreased. In the first study, the level of caregivers’ anxiety was significantly lower in the case of better functional status of the patient. 2. In the research population, there were no high-level of burden. 3. With the improvement of neurological and functional status of the stroke patients, the level of emotional exhaustion significantly decreased and significantly increased assessment of own capabilities of taking care. 4. In the study population of caregivers reported no high-level of burden. There was no statistically significant differences in the impact of applied health educational program on the level of anxiety and depression and caregivers burden. (PNN 2013;2(1):18-26)Wprowadzenie. Udar mózgu jest stanem zagrożenia życia, występuje nagle, stawiając chorego i jego rodzinę w nowej, niespodziewanej oraz niezwykle stresującej sytuacji. Rocznie w Polsce na udar mózgu zapada około 70 tys. osób i liczba ta stale wzrasta. Potencjalnym czynnikiem interwencyjnym wpływającym na funkcjonowanie opiekunów pacjentów po udarze mózgu może okazać się wsparcie społeczne, w formie programu edukacji zdrowotnej.Cel. Określenie znaczenia wsparcia społecznego, w formie programu edukacji zdrowotnej, dla poziomu lęku i depresji oraz obciążenia opiekunów pacjentów po udarze mózgu.Materiał i metody. Grupę badawczą stanowiło 22 opiekunów (członkowie rodzin) pacjentów hospitalizowanych w Klinice Neurologii Dorosłych UCK w Gdańsku, z powodu udaru mózgu bądź TIA. Badania przeprowadzono w okresie od stycznia 2008 roku do lutego 2010 roku. Zastosowano metodę preekseprymentalną (ang. preexperimental study), schemat jednogrupowy z dwukrotnym pomiarem (ang. one-group pretest-posttest design), bez grupy kontrolnej. Ocenie poddano poziom lęku i depresji oraz poziom obciążenia opiekunów, po upływie 3 i 6-12 miesięcy od chwili wystąpienia udaru mózgu u osoby bliskiej, w porównaniu z badaniem wyjściowym podczas hospitalizacji chorego.Wyniki. Poziom lęku wśród opiekunów wahał się na granicy między brakiem zaburzeń (0-7 pkt.) a objawami granicznymi (8-10 pkt.). W oparciu o skalę HADS nie odnotowano zaburzeń depresyjnych w tej grupie. Poziom wyczerpania emocjonalnego w badanej grupie opiekunów kształtował się na średnim poziomie. Natomiast depersonalizacja wśród opiekunów występowała na niskim poziomie. Opiekunowie chorych po udarze mózgu wysoko oceniali własne możliwości, co do sprawowania opieki na bliskim.Wnioski. 1. Wraz z upływem czasu od wystąpienia incydentu naczyniowego zaobserwowano obniżenie poziomu lęku i depresji wśród opiekunów. W pierwszym badaniu poziom lęku opiekuna był istotnie niższy w przypadku lepszego stanu funkcjonalnego pacjenta. 2. W badanej populacji opiekunów nie odnotowano wysokiego poziomu obciążenia. 3. Wraz z poprawą stanu funkcjonalnego i neurologicznego pacjenta, obniżał się istotnie poziom wyczerpania emocjonalnego opiekuna oraz istotnie zwiększała się ocena jego możliwości, co do sprawowania opieki. 4. Nie uzyskano istotnych statystycznie różnic w zakresie wpływu zastosowanego programu edukacji zdrowotnej na poziom lęku i depresji oraz obciążenia opiekunów pacjentów po udarze mózgu. (PNN 2013;2(1):18-26

Low-dose aspirin does not improve ovarian stimulation, endometrial response, or pregnancy rates for in vitro fertilization

BACKGROUND: The purpose of this study is to determine if low-dose aspirin improved ovarian stimulation, endometrial response, or IVF pregnancy rates in our program. METHODS: Retrospective analysis of 316 consecutive IVF cycles from 1995 through 2001. Aspirin 80 mg daily was initiated at the start of luteal leuprolide in 72 cycles. The 244 controls received no aspirin during treatment. RESULTS: The live birth rate in aspirin users was 29%, slightly lower compared to 41% in the no aspirin control group (p = 0.07). Implantation rates were 21% with aspirin and 30% in the control population (p = 0.01). There was no difference in the maximal endometrial thickness between aspirin and non-aspirin groups. The two groups were similar regarding age, gonadotropin ampules, embryos, number of embryos transferred, prior parity, diagnosis, use of intracytoplasmic sperm injection, and stimulation protocol. CONCLUSION: Low-dose aspirin was not beneficial to IVF patients in our program. Aspirin does not enhance endometrial thickness, augment the ovarian response, or improve pregnancy rates

Folding of the apolipoprotein A1 driven by the salt concentration as a possible mechanism to improve cholesterol trapping

The folding of the cholesterol trapping apolipoprotein A1 in aqueous solution at increasing ionic strength is studied using atomically detailed molecular dynamics simulations. We calculate various structural properties to characterize the conformation of the protein, such as the radius of gyration, the radial distribution function and the end to end distance. Additionally we report information using tools specifically tailored for the characterization of proteins, such as the mean smallest distance matrix and the Ramachandran plot. We find that two qualitatively different configurations of this protein are preferred, one where the protein is extended, and one where it forms loops or closed structures. It is argued that the latter promote the association of the protein with cholesterol and other fatty acids.Comment: 14 pages, 6 figures. To appear in "Selected Topics of Computational and Experimental Fluid Mechanics", Springer, J. Klapp, G. Ru\'iz, A. Medina, A. L\'opez & L. Di G. Sigalotti (eds.), 201

β-delayed γ-proton decay in 56Zn: analysis of the charged-particle spectrum

A study of the beta decay of the proton-rich T-z = 2 nucleus Zn-56 has been reported in a recent publication. A rare and exotic decay mode, beta-delayed gamma-proton decay, has been observed there for the first time in the fp shell. Here, we expand on some of the details of the data analysis, focussing on the charged particle spectrum

Medication errors in the Middle East countries: a systematic review of the literature

Background: Medication errors are a significant global concern and can cause serious medical consequences for patients. Little is known about medication errors in Middle Eastern countries. The objectives of this systematic review were to review studies of the incidence and types of medication errors in Middle Eastern countries and to identify the main contributory factors involved. Methods: A systematic review of the literature related to medication errors in Middle Eastern countries was conducted in October 2011 using the following databases: Embase, Medline, Pubmed, the British Nursing Index and the Cumulative Index to Nursing & Allied Health Literature. The search strategy included all ages and languages. Inclusion criteria were that the studies assessed or discussed the incidence of medication errors and contributory factors to medication errors during the medication treatment process in adults or in children. Results: Forty-five studies from 10 of the 15 Middle Eastern countries met the inclusion criteria. Nine (20%) studies focused on medication errors in paediatric patients. Twenty-one focused on prescribing errors, 11 measured administration errors, 12 were interventional studies and one assessed transcribing errors. Dispensing and documentation errors were inadequately evaluated. Error rates varied from 7.1% to 90.5% for prescribing and from 9.4% to 80% for administration. The most common types of prescribing errors reported were incorrect dose (with an incidence rate from 0.15% to 34.8% of prescriptions), wrong frequency and wrong strength. Computerised physician rder entry and clinical pharmacist input were the main interventions evaluated. Poor knowledge of medicines was identified as a contributory factor for errors by both doctors (prescribers) and nurses (when administering drugs). Most studies did not assess the clinical severity of the medication errors. Conclusion: Studies related to medication errors in the Middle Eastern countries were relatively few in number and of poor quality. Educational programmes on drug therapy for doctors and nurses are urgently needed

Maternal marijuana use has independent effects on risk for spontaneous preterm birth but not other common late pregnancy complications

Widespread legalisation of marijuana raises safety concerns for its use in pregnancy. This study investigated the association of marijuana use prior to and during pregnancy with pregnancy outcomes in a prospective cohort of 5588 nulliparous women from the international SCOPE study. Women were assessed at 15 ± 1 and 20 ± 1 weeks’ gestation. Cases [278 Preeclampsia, 470 gestational hypertension, 633 small-for-gestational-age, 236 spontaneous preterm births (SPTB), 143 gestational diabetes] were compared separately with 4114 non-cases. Although the numbers are small, continued maternal marijuana use at 20 weeks’ gestation was associated with SPTB independent of cigarette smoking status [adj OR 2.28 (95% CI:1.45–3.59)] and socioeconomic index (SEI) [adj OR 2.17 (95% CI:1.41–3.34)]. When adjusted for maternal age, cigarette smoking, alcohol and SEI, continued maternal marijuana use at 20 weeks’ gestation had a greater effect size [adj OR 5.44 (95% CI 2.44–12.11)]. Our data indicate that increasing use of marijuana among young women of reproductive age is a major public health concern

Stochastic Analysis of the SOS Response in Escherichia coli

BACKGROUND: DNA damage in Escherichia coli evokes a response mechanism called the SOS response. The genetic circuit of this mechanism includes the genes recA and lexA, which regulate each other via a mixed feedback loop involving transcriptional regulation and protein-protein interaction. Under normal conditions, recA is transcriptionally repressed by LexA, which also functions as an auto-repressor. In presence of DNA damage, RecA proteins recognize stalled replication forks and participate in the DNA repair process. Under these conditions, RecA marks LexA for fast degradation. Generally, such mixed feedback loops are known to exhibit either bi-stability or a single steady state. However, when the dynamics of the SOS system following DNA damage was recently studied in single cells, ordered peaks were observed in the promoter activity of both genes (Friedman et al., 2005, PLoS Biol. 3(7):e238). This surprising phenomenon was masked in previous studies of cell populations. Previous attempts to explain these results harnessed additional genes to the system and deployed complex deterministic mathematical models that were only partially successful in explaining the results. METHODOLOGY/PRINCIPAL FINDINGS: Here we apply stochastic methods, which are better suited for dynamic simulations of single cells. We show that a simple model, involving only the basic components of the circuit, is sufficient to explain the peaks in the promoter activities of recA and lexA. Notably, deterministic simulations of the same model do not produce peaks in the promoter activities. CONCLUSION/SIGNIFICANCE: We conclude that the double negative mixed feedback loop with auto-repression accounts for the experimentally observed peaks in the promoter activities. In addition to explaining the experimental results, this result shows that including additional regulations in a mixed feedback loop may dramatically change the dynamic functionality of this regulatory module. Furthermore, our results suggests that stochastic fluctuations strongly affect the qualitative behavior of important regulatory modules even under biologically relevant conditions, thus emphasizing the importance of stochastic analysis of regulatory circuits