Comparison of SCORE-predicted risk of death due to cardiovascular events in women before and after menopause

Introduction: Approximately 55% of women in Europe die from cardiovascular events, mostly as a result of coronary diseases and cerebral stroke. There is a 10-year shift in the cardiovascular risk between women and men. The risk in a 55-year-old female patient is similar to that of a 45-year-old man, thus the risk among women increases rapidly around the age of 50, when menopause prevails to occur. The purpose of the study was to assess and compare the SCORE-predicted risk of a fatal cardiovascular incident in pre- and postmenopausal women. Material and methods: The cross-sectional study was conducted as part of community nursing practice. It covered 219 women - inhabitants of Krakow, aged from 30 to 65, without clinically validated cardiovascular diseases of arteriosclerotic and/or diabetic origin, who volunteered to take part in the study. The group was divided into three subgroups: K1 - menstruating women (n = 113), K2a - women after natural menopause (n = 88), and K2b - women after surgical menopause (n = 18). The study made use of a lifestyle questionnaire, which concerned the social and economic status, and lifestyle habits including tobacco smoking. Arterial blood pressure was measured, and total cholesterol concentration in blood (mmol/l) was recorded. Results: A high (≥ 5%) level of the SCORE risk was discovered in 14.3% of postmenopausal women, as compared to 0.9% in the group of menstruating women. An average risk of a fatal cardiovascular incident during the following 10 years was significantly higher among women from groups K2a (2.61%) and K2b (2.32%) as compared to K1 - menstruating women (0.38%). No difference was, however, discovered between groups of naturally (K2a) and surgically menopausal women (K2b). Conclusions: A significantly higher risk of SCORE-predicted death caused by a cardiovascular incident, as compared to the group of women in the premenopausal period, is characteristic of women in the postmenopausal period

Wpływ kąpieli w saunie na układ sercowo-naczyniowy

Sauna is a form of biomedical regeneration consisting of consecutive exposure to two opposite thermal agents. Firstly, during sauna bath, a person is exposed to high temperature (ranging from 70 to100 °C) at low relative humidity. Secondly, thermal exposure is followed by body cooling. One sauna bath consists of two or three repeated cycles of heat exposure followed by cooling off. Sauna can be applied in sport, recreation and therapy. The aim of this publication is to present cardiovascular changes elicited by the sauna bath. High temperature induces cutaneous vasodilation and, consequently, an incerase in cutaneous blood flow. Myocardial contractility and heart rate increase. These changes lead to alterations of blood pressure and cardiac output. Abnormalities of the electrocardiogram pattern, changes in activity of renin-angiotensin-aldosterone and blood rheological properties are observed. Cardiovascular responses to sauna bath depend both on the mode and intensity of warming and the applied methods of cooling. The risk of the sauna bath-related cardiovascular complications in healthy persons is small. Nevertheless, it is higher in individuals, who apply excessive heat exposure in order to reduce the body mass or combine sauna bathing with physical effort or alcohol consumption. However, sauna bathing in patients with cardiovascular disease should be used cautiously and preceded by individual assessment of potential risks, considering concomitant medication and the methods of both heat exposure and, especially, cooling off.Sauna jest zabiegiem ciepłoleczniczym, który wykorzystuje kontrastowość bodźca termicznego. Kąpiel w saunie odbywa się w pomieszczeniu o temperaturze 70-100 ºC i niskiej wilgotności względnej powietrza. Po ekspozycji ciepła następuje ochładzanie ciała. W czasie jednego pełnego zabiegu, naprzemienne przegrzewanie i ochładzanie, powtarzane jest dwa lub trzy razy. Sauna znajduje zastosowanie w sporcie, rekreacji i terapii. Celem pracy jest opisanie zmian zachodzących w układzie sercowo-naczyniowym. W wysokiej temperaturze otoczenia dochodzi do rozszerzenia skórnych naczyń krwionośnych i wzrostu skórnego przepływu krwi. Zwiększa się kurczliwość mięśnia sercowego, a częstotliwość pracy serca ulega przyspieszeniu. Pobyt w saunie wpływa na zmiany ciśnienia tętniczego krwi i pojemności minutowej serca. Stwierdzono także zmiany w zapisie EKG, aktywności układu reninaangiotensyna-aldosteron oraz właściwości reologicznych krwi. Reakcje zachodzące w układzie sercowo-naczyniowym uwarunkowane są zarówno intensywnością ogrzewania jak i sposobem ochładzania ciała. Ryzyko wystąpienia komplikacji sercowonaczyniowych pod wpływem sauny u osób zdrowych jest niewielkie, wyższe jednak u osób stosujących nadmierną ekspozycje np. celem redukcji masy ciała lub łączących korzystanie z sauny z wysiłkiem lub spożywaniem alkoholu. Korzystanie z sauny przez osoby z chorobami układu krążenia powinno być poprzedzone indywidualną oceną ryzyka z uwzględnieniem stosowanego równocześnie leczenia oraz sposobu aplikacji ciepła i ochładzania organizmu

Analysis of nurse staffing and factors determining the demand for health care in Poland

Recent studies have indicated that an adequate nurse staffing in a hospital exerts an effect on both the level of health services provided and the safety of patients. Numerous reports confirm the shortage of nurses who, has been observed in almost all European countries, and may threaten the quality of health care. The objective of the study is an analysis of nurse staffing and the factors which shape the demand for health care in Poland. The study was based on the analysis of scientific literature, legal acts and reports by Polish government and occupational organizations, which undertake the problem discussed. For years, in Poland, a decrease has been observed in nurse staffing rates per 1,000 inhabitants, compared to 15 countries of the European Union. The factors which affect the nurse staffing rate in Poland include changes in the sector of health care and the vocational education of nurses. Simultaneously, the limitations in employment of nurses are accompanied by an increased demand for health services. Considering the shortages in nurse staffing, and an increase in the demand for health services, there is a necessity to undertake systemic actions, both on the national and European level. Systemic solutions are necessary to prevent a divergence between increasing public health care demand and limited or even decreasing number of nurses willing to work in the profession. Otherwise the realization of the health policy goals might be hindered

Motor skills among high school adolescents : effect of the exercise program

To assess the basic motor skills and the effects of physical training improvement program in a group of adolescents. The study group comprised 133 students (92 women and 41 men) aged 17 to 19 years. First, the subjects' motor skills were tested using the Eurofit Fitness Testing Battery. Second, the general improving program of physical training was implemented during the same school year. Third, the Eurofit test was repeated at one year after the initial one. The SPSS 15.0 software was used to analyse the data. At the first measurement, only 2/133 students performed all the Eurofit tests on satisfactory (above the national sample 50%) level. In four of nine domains the results were below representative national sample. A year later, after completion of the training program, 37/133 students (27.1%) performed all Eurofit domains above the 50th percentile (P<0.001), the improvements were registered in previously deficit Eurofit Test constituencies. A low level of physical fitness has been observed in majority of adolescents. A general program of physical training leads to improvement of motor skills in a significant number of adolescents and the performance in the Eurofit test domains

Changes of physical mobility among patients with cognitive disorders provided with long-term institutional care in Poland

Demographic changes in European countries result in population aging, higher number of people with disabilities and chronic illness, thus lead to an increase in demand for care services. Currently there are no Polish publications and limited international works dealing with the evaluation of needs of long term care persons with cognitive disorders and other coexisting diseases. Assessment of physical mobility changes among patients with cognitive disorders provided with long-term institutional care in Poland. Study involved 160 persons with cognitive disorders (125 women and 35 men), age between 61-100 years. The study group included 80 patients of long-term care institution and 80 inhabitants of the social welfare home. The standardized Cognitive Assessment Scale (CAS) and the Barthel scale were used as the research tools. The analysis of physical mobility changes revealed that mean values did not show significant differences (p > 0.005) in either of the institution. However, high individual variability of physical mobility was observed. Some patients' health condition deteriorated significantly. Presented results indicate that patients with cognitive disorders provided with a long-term stationary care show diversified physical mobility in each of analyzed institution. These patients need individual and systematic assessment, which is a principal condition to provide an adequate long-term care in institutional settings

The occurrence of pressure ulcers and psychophysical efficiency in patients with cognitive disorders provided with long-term institutional care in Poland

Number of people requiring long-term institutional care is increasing in Poland. Older age, cognitive impairment, multidisease, falls, pressure ulcers, deficits in psychophysical efficiency often occur in patients benefiting from this type of service. The aim of the research was to evaluate the association between pressure ulcers and psychophysical efficiency in patients with cognitive disorders provided long-term institutional care. Study involved 160 persons with cognitive disorders (125 women and 35 men), age between 61–100 years. The study group included 80 patients of long-term care institution and 80 inhabitants of the social welfare home. The standardized Cognitive Assessment Scale (CAS), the Barthel scale, the Edmonton Functional Assessment Tool (EFAT) and the Observational Anxiety and Depression Scale were used as the research tools. The assessment was repeated three times: at the beginning, after three and six months. Respondents who experienced pressure ulcers (N = 28, 17.5%) were characterized by more severely impaired cognitive function (p < 0.001); dysfunction of functional status (p < 0.001), higher symptoms of tension, and anxiety (p = 0, 02) and a lower physical mobility (p < 0.001) than other patients without pressure ulcers. Patients with cognitive disorders provided with a long-term stationary care need systematic assessment of psychophysical activity, as a part of the of the pressure ulcer prevention program

Coaching in the professional and personal development of nurses

Wprowadzenie . Deficyt pielęgniarek obserwowany w UE (Unii Europejskiej) może mieć różne przyczyny m. in.: mało atrakcyjne warunki pracy, niepodejmowanie pracy w tej profesji (pomimo posiadanego wykształcenia) oraz wysoki wskaźnik wypalenia zawodowego. Wyzwaniem dla pracodawców oraz instytucji zajmujących się problemami współczesnego pielęgniarstwa pozostaje problem zachęcenia adeptów kierunku do podjęcia pracy w zawodzie i pozostania w nim na dłużej. Także duże znaczenie ma nauczenie pielęgniarek jak chronić się przed wypaleniem zawodowym, łączyć ambicje zawodowe z potrzebami rodziny a przede wszystkim osobistą satysfakcją z życia. Pośród potencjalnych rozwiązań wspomagających świadome zaplanowanie życia osobistego i dalszego rozwoju zawodowego, warto rozważyć wsparcie coacha, podobnie jak to ma miejsce w innych zawodach. Cel. Analiza sytuacji zawodowej pielęgniarek w kontekście potrzeby indywidualnego rozwoju z zastosowaniem metody coachingu. Metodyka. Zastosowano metodę analizy i krytyki piśmiennictwa naukowego. Podsumowanie i wnioski. Wykorzystanie elementów coachingu stwarza szansę, by pielęgniarka/pielęgniarz w sposób świadomy i planowy projektowali przebieg swojego rozwoju zawodowego synchronicznie z potrzebami i oczekiwaniami w życiu osobistym, rodzinnym i społecznym. Dodatkowymi korzyściami z zastosowania tej formy wsparcia są umiejętność lepszego radzenia sobie ze stresem, zachowanie równowagi pomiędzy pracą a życiem osobistym (tzw. work-life balance) oraz prewencja wypalenia zawodowego.Introduction . Shortage of nurses reported in the EU (European Union) among other causes is related to: non-attractive work conditions, lack of willingness to take up job as a nurse (despite their education), and high risk of professional burnout. Encouraging graduates to take up a job in the profession and remain is a challenge for employers and institutions involved in the problems of modern nursing. Teaching nurses how to: protect themselves from professional burnout, how to combine career ambitions, family needs and above all personal satisfaction is of utmost importance. Amongst possible solutions which enhance planning of career and personal development in a deliberate manner, as is the case in other professions, it may be worth considering the support of a coach. Aim. Analysis of the professional situation of nurses in the context of need for individual development using the coaching method. Method. A method of analysis and criticism of the literature was used. Conclusions and results. Coaching gives an op po rtun ity for conscious planning process of nurse professional development in synchrony with needs and expectations for personal, family and social life. Better stress management, maintaining work-life balance and professional burnout prevention are benefits provided by this approach

Efficacy of single and repeated administration of ketamine in unipolar and bipolar depression : a meta-analysis of randomized clinical trials

Background Due to unmet clinical needs for efficient drugs with a rapid onset of antidepressant effects, we aimed to evaluate the efficacy of single-dose ketamine in different subgroups of patients with major depression and establish whether repeated ketamine administration could be a viable strategy to maintain treatment gains. Methods Electronic databases (Medline via PubMed, Embase, Cochrane Library, Trip Database) were systematically searched until February 22, 2019, for published peer-reviewed randomized controlled trials (RCTs) concerning a single and repeated administration of ketamine in patients with major depression. All relevant RCTs were selected and critically appraised, and a meta-analysis of eligible studies was performed. Results A total of 20 studies were included in the meta-analysis. The largest effect of ketamine vs. controls in reducing depressive symptoms was observed at 24 h (SMD = - 0.89; 95% CI - 1.24; - 0.53; p < 0.00001); however, a significant difference was shown for up to 7 days after a single dose. Significant differences compared with controls were observed for up to 7 days in treatment-resistant patients and when ketamine was added to ongoing antidepressant treatment, while there were no significant differences at 7 days when ketamine was used as monotherapy. In patients with major depression, initial antidepressant effects of ketamine were maintained during repeated dosing. At 2-3 weeks of repeated ketamine treatment, significant reduction of depression severity scores was observed: SMD = - 0.70; 95% CI - 1.15; - 0.25 or SMD = - 0.81; 95% CI - 1.41; - 0.20 (depending on the dosing regimen used); p ≤ 0.009 vs placebo. Conclusions Our meta-analysis revealed rapid and robust antidepressant effects of single-dose ketamine in patients with treatment-resistant depression (TRD). By pooling data from RCTs, we showed for the first time that repeated ketamine administration is effective in sustaining initial antidepressant effects observed after single dosing