Perceived stress level among patients with chronic illness during covid pandemia

Introduction

The emergence of SARS-CoV-2 has enormously impacted healthcare systems around the world. Both patients and health care professionals have been subjected to a novel stressor which affects their everyday life and functioning. This issue is especially important to patients suffering from chronic diseases which had already been exposed to a psychological strain related to their primary diagnosis. As chronically ill patients are depending on the availability of a specific treatment i.e. in need of specific healthcare facilities and have more reasons to worry about their future and hence be more prone to suffer adverse psychological consequences than the general population.

Objectives

In this study we aimed to examine whether the psychological results of the pandemic affect chronically ill and whether the specific illness and other demographic factors account for any changes in perceived stress levels.

Methods

An online questionnaire has been distributed to 4 groups (n=369): 92 psoriasis patients, 73 dialysis patients, 100 patients after kidney transplantation and 104 multiple sclerosis patients. The study was conducted during the pandemic in Poland (June-July 2020). Perceived stress levels were measured by the Perceived Stress Scale (PSS).

Results

The preliminary results suggest elevated perceived stress levels among the studied groups. As the data are currently under statistical evaluation specific statistical conclusions are to be expected in November 2020.

Conclusions

As the described study was conducted during the SARS-CoV-2 pandemic in Poland, it stands to reason that the epidemiological situation affected the levels of perceived stress among chronically ill patients.

Can we reduce the stigmatisation experience with psychosocial interventions? An investigation of the meeting centre support programme impact on people with cognitive impairments

Introduction

People living with dementia or mild cognitive impairment (MCI) experience stigmatisation and there are not many specific psychosocial interventions dedicated to help them coping with this issue, reducing its impact on their lives.

Objectives

This study aimed to a) investigate the stigmatisation level among people with dementia and MCI in Poland, Italy and the United Kingdom and b) assess the role of the Meeting Centre Support Programme (MCSP) in decreasing stigmatisation.

Methods

We investigated outcomes for 114 people with dementia and MCI living in Italy, Poland and the UK who participated 6 months in MCSP or usual care (UC) using a pre/post-test control group study design. Level of stigmatisation was assessed with the Stigma Impact Scale: neurological impairment (SIS).

Results

Stigmatisation level (SIS) among participants varied from 2 to 65 (median=33.5; Q1=27; Q3=41) with people from the UK experiencing a statistically significantly higher level of stigmatisation than people in Italy and Poland. In Italy, stigmatisation was lower (p=0.02) in the MCSP group following the intervention. In Poland, the social isolation level did not significantly change in MCSP, but increased (p=0.05) in UC. In the UK, the social rejection level raised (p=0.03) in MCSP. Overall, the combined data of the three countries did not show statistically significant differences in SIS between MCSP and UC.

Conclusions

Stigmatisation among people with dementia and MCI is complex and seems culturally dependent. There is a great opportunity in psychosocial interventions to reduce the burden of stigma among people with dementia which requires further investigation.

Disclosure

No significant relationships.

The psychological burden of long-term care facilities personnel during the SARS-COV-2 pandemic – a national survey in poland

Introduction

The high COVID-19 morbidity and mortality are observed among residents in long-term care facilities (LTCF) worldwide. Employees of LTCF, who are facing a critical epidemiological situation endangering the vulnerable residents, are exposed to pandemic’s psychological consequences daily.

Objectives

The main aim of this study was to assess psychological consequences (somatic symptoms, anxiety and insomnia, social dysfunction, and depression) among LTCF employees exposed to the SARS-CoV-2 pandemic crisis. Moreover, we investigated if factors such as: personal protective equipment (PPE) availability, safety guidelines or access to psychiatric and psychological support at the workplace, correlated with the level of psychological distress experienced by personnel.

Methods

A cross-sectional study was conducted among personnel of LTCF in Poland. The survey consisted of the sociodemographic section, the authors’ questionnaire with questions related to COVID-19 exposure, working conditions, access to PPE and mental health services, GHQ Questionnaire-28.

Results

show that access to PPE (P= .018), to workplace safety guidelines (P= .031), psychological support at workplace (P<0.01), fixed shift schedule (P= .05) and feeling that the right number of staff are employed in the workplace (P= .009), were related to the lower severity of psychopathological symptoms evaluated with the GHQ-28.

Conclusions

The study indicates an evidence that LTCF personnel are susceptible to the development of anxiety, depression, insomnia and social dysfunction during the pandemic crisis. However, these can be modified by: access to PPE, safety guidelines and psychological support. Findings from this study lay a basis for effective interventions aiming to support psychological health within this group.

Social disability in different mental disorders

Objective

To assess the social disability of people with different psychiatric disorders.

Methods

Cross-site survey in five psychiatric hospitals (Dresden, Wrocław, London, Michalovce and Prague). Working-aged patients diagnosed (ICD-10) with schizophrenia and related disorders (F2), affective disorders (F3), anxiety disorders (F4), eating disorders (F5) and personality disorders (F6), were assessed at admission (n = 969) and 3 months after discharge (n = 753) using the Brief Psychiatric Rating Scale and the Groningen Social Disability Schedule. The main outcome measure was Interviewer-rated social disability.

Results

During acute episodes patients with personality, eating and schizophrenic disorders functioned less effectively than those with affective or anxiety disorders. After controlling for age and severity of psychopathology, there was no significant effect of the diagnosis (during remission), sex, education and history of disorder on disability. Site, employment and partnership were significant factors for the level of social disability in both measure points.

Conclusion

Severity of psychopathological symptoms, not the diagnosis of a mental disorder, was the most significant factor in determining the level of social functioning, particularly during the remission period. Site, employment and partnership appeared as significant factors influencing the level of social disability.

The Improvement of Memory Deficits after Whole-Body Cryotherapy - The First Report

BACKGROUND

Mild Cognitive Impairments (MCI) and dementia are still incurable. The Whole-Body Cryotherapy (WBC) - short, cyclic exposure to extremely low temperatures - has proven anti-inflammatory and anti-oxidative effects. It can also induce hormonal, lipid and neural changes.

OBJECTIVE

To evaluate the WBC effect on cognitive functioning and blood parameters of MCI patients.

MATERIALS AND METHODS

Participants with MCI undertook 10 WBC sessions. Cognitive functions and depressive symptoms were assessed before the first session, after the last session and 2 weeks later. Whole blood samples were collected.

RESULTS

The cognitive functioning improved after 10 WBC sessions (p<0.05), especially memory processes. WBC caused a significant (p<0.05) increase of NO plasma level, BDNF concentration (p<0.05) and reduction of IL-6 (p<0.05). The moderate relationship between NO and cognitive functioning was noticed after WBC.

CONCLUSION

The preliminary results of the first study evaluating WBC on memory deficits suggest that WBC may be useful as a supportive therapy of MCI.

Comparison of the adaptive implementation and evaluation of the Meeting Centers Support Program for people with dementia and their family carers in Europe; study protocol of the MEETINGDEM project

Background

The MEETINGDEM study aims to implement and evaluate an innovative, inclusive, approach to supporting community dwelling people with mild to moderate dementia and their family carers, called the Meeting Centers Support Program (MCSP), in three countries in the European Union (EU): Italy, Poland and United Kingdom. Demonstrated benefits of this person-centered approach, developed in The Netherlands, include high user satisfaction, reduced behavioral and mood problems, delayed admission to residential care, lower levels of caregiving-related stress, higher carer competence, and improved collaboration between care and welfare organizations.

Methods

The project will be carried out over a 36 month period. Project partners in the three countries will utilize, and adapt, strategies and tools developed in the Netherlands. In Phase One (month 1-18) activities will focus on establishing an initiative group of relevant organizations and user representatives in each country, exploring pathways to care and potential facilitators and barriers to implementing the program, and developing country specific implementation plans and materials. In Phase Two (month 19‑36) training will be provided to organizations and staff, after which the meeting centers will be established and evaluated for impact on behavior, mood and quality of life of people with dementia and carers, cost-effectiveness, changes in service use, user satisfaction and implementation process.

Discussion

An overall evaluation will draw together findings from the three countries to develop recommendations for successful implementation of MCSP across the EU. If the Meeting Centers approach can be widely implemented, this could lead to major improvements in dementia care across Europe and beyond.

Trial registration

The trial was retrospectively registered in May 2016: trial number: NTR5936.

Mild Cognitive Impairments and Whole-body Cryotherapy – Placebo Control Study

Introduction

Cognitive impairment is considered to be a result of oxidative stress and disturbances in inflammatory status. Whole-body cryotherapy (WBC), which is a short exposure to extremely low temperatures, probably regulates the release of cytokines and nitric oxide. The hypothesis is that WBC may be useful in the therapy of mild cognitive impairments (MCI).

Aims

The effect of the whole-body cryotherapy (WBC) on cognitive impairments was investigated.

Objectives

In this study the observation of several biological factors and cognitive functions were conducted to analyse the WBC influence on cognitive deficits.

Methods

People with MCI participated in 10 WBC sessions divided for experimental group (−110 °C till −160 °C) or control group (−10 °C till −20 °C). The MoCa test (scores 26 and lower) was used for inclusion criteria. Cognitive functions were measured with: TYM, DemTect and SLUMS at baseline and in follow-up. Biological factors (cytokines, BDNF, NO) were also assessed.

Results

It was shown that memory domains in experimental group improved after WBC sessions. Also modulatory effect on inflammatory mediators in plasma was shown. The results of this study consist of the comparison of experimental and control groups regarding to cognitive functions as well as biological factors.

Conclusions

Whole-body cryotherapy may be supposed to improve cognitive functions in MCI patients. The modulatory effect of WBC on immunological response may be considered as one of possible mechanisms of its action. However, there is no confirmation how long the effects resist so further investigations are needed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Not re-inventing the wheel: the adaptive implementation of the meeting centres support programme in four European countries

OBJECTIVES

The implementation of new health services is a complex process. This study investigated the first phase of the adaptive implementation of the Dutch Meeting Centres Support Programme (MCSP) for people with dementia and their carers in three European countries (Italy, Poland, the UK) within the JPND-MEETINGDEM project. Anticipated and experienced factors influencing the implementation, and the efficacy of the implementation process, were investigated. Findings were compared with previous research in the Netherlands.

METHOD

A qualitative multiple case study design was applied. Checklist on anticipated facilitators and barriers to the implementation and semi-structured interview were completed by stakeholders, respectively at the end and at the beginning of the preparation phase.

RESULTS

Overall, few differences between countries were founded. Facilitators for all countries were: added value of MCSP matching needs of the target group, evidence of effectiveness of MCSP, enthusiasm of stakeholders. General barriers were: competition with existing care and welfare organizations and scarce funding. Some countries experienced improved collaborations, others had difficulties finding a socially integrated location for MCSP. The step-by-step implementation method proved efficacious.

CONCLUSION

These insights into factors influencing the implementation of MCSP in three European countries and the efficacy of the step-by-step preparation may aid further implementation of MCSP in Europe.

The anxiolytic activity of n-3 PUFAs enriched egg yolk phospholipids in rat behavioral studies

Phospholipids play an important role in the biochemical and physiological processes of cells. An association between disturbed phospholipids metabolism in neuronal tissue and anxiety it was shown. The aim of this study was to examine the anxiolytic properties of phospholipids obtained from a new generation of eggs enriched in n-3 PUFA and its effect on locomotor activity in rat behavioral studies N-3 PUFA-enriched egg yolk phospholipids ("super lecithin") were added to the standard feed. Rats were fed by chow without (control group) or with (experimental group) addition of phospholipids. After six weeks of supplementation, the effect of phospholipids on locomotor activity in the open field test and anxiolytic properties in elevated plus maze and Vogel conflict test were examined. In the open field test the total distance traveled in the experimental group was similar to the control group. In the elevated plus maze test a six weeks phospholipids' administration significantly prolonged the time spent on the open arms by rats from experimental group compared to control group. The number of entries into the open arms was also increased but the difference was not statistically significant. The number of punished drinking water in the Vogel conflict test increased significantly in experimental versus control group. The obtained results suggest that the phospholipids isolated from n-3 PUFA enriched egg yolk have a specific anxiolytic effect, without general sedative influence.

Cryostimulation of whole body as a possible supportive biological approach in mild cognitive impairments

Background

Limitations of available treatment methods of dementia imply constant need to search for new, supplementary therapy strategies. There is a consensus that vascular lesions, oxidative stress, inflammatory processes and abnormal neurotransmission are associated with dementia. Due to the anti-inflammatory (modification of pro-inflammatory cytokines concentration), antioxidative effect of cryogenic temperatures as well as the hormonal and lipid changes, they may play an important role in preventing or inhibiting pathophysiological processes.

Aim

To assess the influence of whole-body cryostimulation on cognitive functions of patients with MCI.

Methods

RCT design is used to examine the influence of whole-body cryotherapy (WBC) on people with mild cognitive impairments (MCI) with the evaluation of psychometric, somatic and laboratory parameters. Participants undergo 10 sessions each day of 2–3 min of WBC in experimental group (−110 till −160 °C) and placebo (−20 °C). The CDR, MoCA, TYM, DemTect and SLUMS scales are used among others at baseline and follow-up. Preliminary data of 7 volunteers (n = 7, 49–79 years old) were presented. Results on Fig. 1.

Discussion

Among obtained psychometric results show that all, except of one, patients significantly improved their scores after WBC. That is a very promising feedback for future evaluation of WBC effectiveness in prevention of dementia in patients with MCI.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Anserine and carnosine supplementation in the elderly: Effects on cognitive functioning and physical capacity

The aim of this study was to investigate the potential beneficial effects of dietary anserine and carnosine (CRC) supplementation on cognitive functioning and physical activity of the elderly. The fifty-six subjects (65+) were allocated to the CRC group or placebo group at a 1:1 ratio. The double-blind procedure was used. Data were collected at the baseline and after 13-weeks of supplementation. In the follow up procedure fifty one subjects took part. Chicken meat extract (CME) containing 40% of CRC components (2:1 ratio of anserine to carnosine) was administered 2.5 g per day which allowed to rich the level of 1g CRC in dipeptides supplement. The cognitive function, physical capacity, body measurements, blood pressure and heart rate (HR) were assessed. After supplementation Body Mass Index (BMI) decreased significantly (p<0.05) in the CRC group performance comparing the placebo group. In two of six Senior Fitness Test the scores increased significantly (p<0.05) in CRC group comparing to the placebo group. The perceived exertion differed significantly (p<0.05) at the baseline and after follow up at the CRC group. The mean values of the Short Test of Mental Status (STMS) scores showed the significant (p<0.04) increase only in CRC group, in the subscores of construction/copying, abstraction and recall. Conducted anserine and carnosine supplementation in the elderly brings promising effects on cognitive functioning and physical capacity of participants. However, further studies are needed.

Test Your Memory (TYM) as a screening instrument in clinical practice - the Polish validation study

OBJECTIVES

The Test Your Memory (TYM) test is a short, self-administered screening cognitive instrument designed for the detection of Alzheimer's disease (AD). The study was aimed to examine the Polish version of TYM as a screening instrument in Polish clinical practice.

METHOD

In this study 199 patients were assessed whereas 131 patients with AD and mild cognitive impairments (MCI) and 94 healthy control subjects took part in the final analysis. The sensitivity and specificity of the TYM test were evaluated among the AD group and healthy control group. The TYM test was compared to other neuropsychological tests, such as Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT), DemTect and Verbal Fluency Test (FAS).

RESULTS

The average TYM score in healthy control group: 45.4, 40.9 in the MCI patients and 23.4 in AD patients. The Polish version of the TYM test showed good correlation with other neuropsychological instruments among AD patients. Participants aged ≥75 and those with primary education performed significantly worse in TYM. The TYM achieved the best differentiation between AD and the healthy control group for ≤39 cut-off with a sensitivity and specificity of 91% and 90%, respectively.

CONCLUSION

The Polish version of the TYM test is a useful instrument and may be seen as an alternative to the MMSE screening test in clinical practice in patients with dementia. However, the normative data suggested that the age and the level of education of the respondents should be considered as important factors affecting the interpretation of the final score.

Effects of supplementation with fish oil and n-3 PUFAs enriched egg yolk phospholipids on anhedonic-like response and body weight in the rat chronic mild stress model of depression

Polyunsaturated fatty acids play an important role in the human organism. They guarantee a normal function of nervous cells, influence neurotransmission, and build some elements of cellular membranes. Several reports indicate an association between a deficiency of polyunsaturated fatty acids and depression. The aim of this study was to examine the effects of diet supplemented with fish oil, which is rich in omega-3 polyunsaturated fatty acids (n-3 PUFAs) and n-3 PUFAs enriched phospholipids ("super lecithin") obtained from designed eggs on anhedonic-like response and body weight in the rat chronic mild stress (CMS) model of depression. The results showed that neither fish oil nor n-3 PUFAs enriched egg yolk phospholipids supplementation reversed disturbances caused by CMS, such as anhedonic-like state or reduction of body weight gain.

Quality of care in longer term mental health institutions in Poland

Objective

Development of Quality Indicator for Rehabilitative Care (QuIRC), experiences of Polish partner in implementation of the toolkit and preliminary assessment of care standards in longer term mental health institutions. Research constitutes a part of international project funded by European Commission.

Methods

Polish version of QuIRC has been tested in 20 psychiatric units across 3 regions in Poland. Selected facilities differed in terms of employment profile, living standards as well as location and service users turnover. Managers of participating units were interviewed using the refined tool with 145 items regarding domains indentified during previous phases of the DEMoB.inc project. Each participant was questioned by a single researcher during face-to-face meeting. Lacking answers were completed on basis of service users’ medical files and account departments’ documents when necessary.

Results

Manager of only 1 out of 21 units refused to participate in interview. The most common difficulties in data collection were in relation to the number of staff and staff training. These difficulties may be due to differences in the work patterns and training of staff in Polish units compared to other countries. In comparison to international results important differences in preliminary assessments of long term mental health care were found in several areas probably due to the early stage of deinstitutionalisation process in Eastern Europe. Development of the web based version of the toolkit will facilitate its implementation in research as well as internal assessments for units’ restructuring purposes.

Prevalence of insomnia in Poland - results of the National Health Interview Survey

BACKGROUND

Sleep disturbances are one of the most common underdiagnosed and undertreated health problems among the adult population.

OBJECTIVES

The aim of the study was to assess the prevalence of sleeping problems and their relation to sociodemographic characteristics in the Polish population, based on the results of the National Health Interview Survey carried out by the Central Statistical Office in 1996.

METHODS

A stratified sampling scheme, involving two steps, was used. Standardized prevalence ratios (SPRs and their 95% confidence intervals) were calculated. Assessment of sleep-related problems was based on six questions. A representative Polish sample (47 924 non-institutionalized, adult respondents) was interviewed.

RESULTS

Nearly one-fourth of Polish inhabitants suffered from insomnia. The percentage was significantly higher among women (28.1%) than among men (18.1%). The prevalence of insomnia increased with age and was highest in divorced respondents. Respondents of both sexes with higher educational levels suffered from insomnia less often than individuals with lower levels of education. The problem of insomnia applies in a similar degree to inhabitants of both rural and urban regions. About one-twentieth of inhabitants of Poland experienced recent sleep deterioration related to problems. It was associated positively with age, female gender and lower education. About 20% of the population get up not rested in the morning, women significantly more often than men, urban residents more often than rural ones.

CONCLUSIONS

Sleep-related problems are common and the results are comparable with those from other countries. The findings have important implications, such as the necessity of better education of the public community about the identification and possibilities of treatment of sleep disturbance.

[Assessment of short-term neuropsychologic changes after normothermic versus hypothermic coronary artery bypass grafting]

BACKGROUND

Coronary artery bypass grafting (CABG) is one of the main methods of treatment of coronary artery disease. Neuropsychological testing is a sensitive method for quantitative assessment of cognitive dysfunctioning following cardiopulmonary bypass. The aim of the present clinical study was to evaluate the neuropsychologic changes in CABG patients, operated with normothermic or hypothermic cardiopulmonary bypass (CPB).

METHODS

Neuropsychological changes were assessed in 33 first-time CABG patients before and 3-10 days after surgery. Patients underwent CABG with hypothermic (Gr. H, n = 17) or normothermic (Gr. N, n = 16) CPB with standard anesthesia. Neuropsychological performance was assessed using a well-established battery of 10 tests. A neuropsychological test battery includes: Digit Span-subtest of WAIS-R (PL), the Trail Making Test, Raven Test, Benton, Bourdon, Verbal Fluency (F,A,S), Turm von Hanoi, Rey Auditory Verbal Learning Test, Supermarket, WAIS-R (PL) Digit Symbol-subtest of WAIS-R (PL). All patients completed the test for perception, attention, immediate and delayed verbal and visual memory, visual and verbal learning, problem-solving strategies, abstraction, recognition, word fluency, visual- motor coordination and psychomotor speed. For comparison, the incidence of decline using the 1.5 standard deviation (at least in 2 tests) also was calculated.

RESULTS

Comparing the reliable change and SD methods, statistically significant differences in the incidence of decline were observed in 6 of the 10 neuropsychological measures. Patients' scores showed a significant deterioration in concentration of attention, immediate verbal memory, psychomotor speed, visuoconstructive tasks and verbal learning. Neuropsychological deficits were found in 66.7% of patients after surgery. Post-operative deficits were not associated with the method used (normothermia or hypothermia).

[The influence of whole body cryotherapy on mental health]

The paper presents a little known issue about the influence of wholebody cryotherapy on mental health. Observations of patients' behaviour after passing the cryogenic chamber leads to an interesting hypothesis. Short exposition to extreme cold has doubtless a profitable influence on man's frame of mind. Immediately after passing the cryogenic chamber, apart from the well known analgetic effect, we detect changes in patients' mental state such as improvement of mood, deep relaxation, freshening up, consolation, euphoria. This unusual state lasts for a long time after ending the cycle of cryotherapy. Different mechanisms of this effect are considered. New possibilities of this method have been presented. Durability of such an advantageous phenomenon are investigated in our research centre in Wrocław.