Does gender affect health-related quality of life in patients with type 2 diabetes (ADDQoL) in Central European countries?

OBJECTIVE

The aim of this study was to compare the impact of type 2 diabetes on quality of life (QoL), taking into account gender differences in relation to individual domains of Diabetes-Related Quality of Life Audit (ADDQoL) in adult men and women in Poland, the Czech Republic and Republic of Slovakia.

MATERIAL AND METHODS

The participants were 608 patients from the three countries, of whom 278 were women and 330 men with type 2 diabetes mellitus. The tool used was the Audit of Diabetes-Dependent Quality of Life (ADDQoL).

RESULTS

The overall average QoL was slightly higher in men than in women. In ADDQoL scores, mean weighted impact scores were negative for all domains. The domain which was the most affected by type 2 diabetes in both men and women from all three countries was the 'freedom to eat', while the 'living conditions' domain was the least affected. Diabetes had a slightly negative average weighted impact on most men and women - AWI<-3.0. Except for the different AWI scores in men with type 2 diabetes depending on their education, neither men nor women revealed any significant changes in terms of the impact of education, residence, marital status, smoking, hypertension, or taking anti-hypertensive drugs.

CONCLUSIONS

Type 2 diabetes mellitus negatively affects all the domains of life, in both men and women in all three countries; however, this impact is insignificant. The participants assessed their quality of life as good and very good.

Kinesiophobia in Elderly Polish Patients After Ischemic Stroke, Including Frailty Syndrome

INTRODUCTION

In patients after stroke, the relationship between the occurrence of kinesiophobia and the accompanying frailty syndrome, as well as the acceptance of the disease and the level of mood, has not been recognized so far. The aim of this study was to determine the prevalence of kinesiophobia in elderly Polish people after ischemic stroke, including the frailty syndrome and the associations between the prevalence of kinesiophobia and feelings of anxiety and degree of the illness acceptance.

METHODS

A cross-sectional study was used to achieve the study objectives. The study involved 152 hospitalized patients aged of minimum 60 (mean age 63), qualified for post-stroke rehabilitation, including 76 women and 76 men. The patients were divided into two groups, with kinesiophobia (119 persons) and without kinesiophobia (33 persons). The Tampa Scale of Kinesiophobia (TSK), the Tilburg Frailty Indicator (TFI), the Hospital Anxiety Depression Scale (HADS) and the Acceptance of Illness Scale (AIS) were used. Study results were calculated using MedCalc Software.

RESULTS

Kinesiophobia has been demonstrated in 78% of people after ischemic stroke. The values of TFI and HADS were higher in the patients with kinesiophobia (p<0.001). In patients with ischemic stroke, it was shown that the level of kinesiophobia increased with higher anxiety (p<0.001), higher total TFI score, (p<0.05), and a lower level of illness acceptance (p<0.001).

CONCLUSION

The occurrence of kinesiophobia in elderly Polish people after ischemic stroke is common and the determinants of its development are the coexistence of the frailty syndrome, anxiety and a low level of illness acceptance. In post-stroke patients, the presence of kinesiophobia should be considered, especially in the situation of comorbid frailty syndrome. The issue of kinesiophobia in patients after stroke requires further in-depth research, especially in the field of cognitive-behavioral prevention aimed at ways to reduce this phenomenon.

Psychometric Properties of the Polish Version of the Diabetes Distress Scale (DDS)

Background

Type 2 diabetes is a disease that affects the functioning and life of both the patient and their family. It involves the constant treatment, self-care, monitoring of blood glucose levels and adherence to physical activity recommendations. As a result, it causes discomfort, distress and reduces the quality of life.

Aim

Due to the lack of a scale that would precisely evaluate the level of distress in patients with diabetes in Poland, we decided to linguistically adapt the DDS scale to the Polish population and investigate its psychometric properties in relation to Polish patients.

Material

The study group consisted of 336 individuals in total, including 156 females (46.43%) and 180 males (53.57%), aged 59.13±8.4 on average. The patients were under the care of a specialist diabetes clinic. The research tool was the Diabetic Stress Scale (DDS).

Results and Conclusion

Our analysis showed that the reliability of both the scale and its components was at a good level. Only the RD-related part was characterised by a lower Cronbach’s alpha coefficient of 0.614. The DDS scale can be successfully used for the assessment of distress in the Polish population of patients with type 2 diabetes.

The association of the level of self-care on adherence to treatment in patients diagnosed with type 2 diabetes

AIMS

The study aimed to assess the impact of self-care on adherence to treatment in patients diagnosed with type 2 diabetes and effect of complex interaction of social, lifestyle, economic, environmental and behavioural.

METHODS

The study was carried out between June 2018 and May 2019 on 324 patients (162 females, 162 males) with type 2 diabetes. To measure the levels of self-care, the Self-Care of Diabetes Index (SCODI) questionnaire was used. Adherence to treatment was assessed with the Adherence in Chronic Diseases Scale (ACDS).

RESULTS

The highest scores of health behaviour were on the subscale of adherence with the mean value of 68.37, and the lowest results on the subscale of blood sugar self-monitoring, with the mean of 56.05. We found that low adherence to treatment was present in 52.47% of respondents, the moderate level in 39.20%, while only 8.33% of patients showed the high level. There were significant positive correlations between the ACDS and SCODI subscales (p < 0.05): self-care maintenance (0.436), self-care management (0.413), self-care monitoring (0.384), and self-care confidence (0.453).

CONCLUSIONS

Self-care affects on adherence in patients with type 2 diabetes. The higher self-efficacy in each of the areas of functioning, the higher the level of adherence to treatment. We found that demographic variables such as female sex, education and employment status can influence self-care in managing chronic illnesses such as type 2 diabetes.

Influence of Pain on the Quality of Life and Disease Acceptance in Patients with Complicated Diabetic Foot Syndrome

OBJECTIVE

The aim of the study was to evaluate the relationship between pain and quality of life and illness acceptance, anxiety and depression in a group of patients with complicated diabetic foot syndrome, following lower limb amputation.

PATIENTS AND METHODS

The studies were carried out in three stages: 7 days, 6 months and 12 months after surgery in a group of 100 patients after amputation of the lower limb due to complications resulting from type 2 diabetes. The study was performed using standardised instruments: WHOQOL-BREF, the Acceptance of Illness Scale (AIS), the Hospital Anxiety and Depression Scale (HADS), and the Visual Analog Scale (VAS) for pain intensity assessment.

RESULTS

Pain occurred in the examined patients throughout the study. The greatest intensity of pain was observed in the postoperative period and significantly weakened over time. Pain intensity was significantly associated with worse overall QoL perceived (-0.255, p=0.011/-0.283, p=0.005) and QoL scores in the physical and psychological domains at the first and second stage of the study (physical domains -0.257, p=0.011/-0.219, p=0.03 and psychological -0.22, p=0.029/-0.24/0.018). The intensity of pain negatively correlates with the acceptance of the disease in all three stages of the study, the greater the severity of pain, the lower the acceptance of illness (-0.298, p=0.003/-0.326, p=0.001/-0.26, p=0.009). The occurrence of anxiety and depression is highly dependent on the severity of pain, especially at the first and second stage of the study (anxiety 0.203, p=0.045/0.257, p=0.01, depression 0.299, p=0.003/0.253, p=0.012). The stronger the pain, the greater the severity of mood disorders.

CONCLUSION

Pain and its severity are associated with QoL in the patients with complicated diabetic foot syndrome following lower limb amputation. Disease acceptance was lower in patients experiencing more severe pain at all stages of the study. There is an association of pain with the occurrence of anxiety and depression in amputees, especially 6 months after surgery.

Polish Adaptation of the Self-Care of Diabetes Inventory (SCODI)

PURPOSE

As the guidelines indicate, education and self-care in diabetic patients are essential elements in the treatment process. The efficient evaluation of the level of self-care will enable the patient's needs to be identified and education and care to be optimised. The Self-Care of Diabetes Inventory (SCODI) is a valid and reliable tool which can measure self-care behaviours among patients with diabetes. The purpose of this study was to assess the reliability of the Polish version of the SCODI.

METHODS

The World Health Organization (WHO) translation protocol was used for the translation and cultural adaptation of the English version of the SCODI into Polish. The study included 276 Polish patients with type 2 diabetes (mean age 61.28±12.02 years). There were 145 men and 131 women in the study. The internal consistency of the SCODI was evaluated using Cronbach's Alpha.

RESULTS

The original four actor tool structure was confirmed. The mean overall levels of self-care in the four SCODI scales in the study group were self-care maintenance (67.66 pts; SD=18.55), self-care monitoring (61.81 pts; SD=24.94), self-care management (54.65 pts; SD=22.98) and self-care confidence (62.86 pts; SD=20.87). The item-total correlations were positive, so there is no need to change the scales of any of the questions. The overall consistencies for individual scales were assessed using Cronbach's Alpha: self-care maintenance (0.759), self-care monitoring (0.741), self-care management (0.695) and self-care confidence (0.932). Exploratory factor analysis and item factor loadings of the individual items ranged from 0.137 to 0.886 and, with two exceptions (questions number 23 and 32), were statistically significant (p<0.05).

CONCLUSION

The SCODI questionnaire has acceptable internal consistency and reliability in assessing self-care among diabetic patients in the Polish population. This reliable research tool can be managed in planned studies of Polish patients with diabetes.

Comparison of Diabetes-Dependent Quality of Life (ADDQoL) in Patients with T2DM in Poland, The Czech Republic, and Slovakia

INTRODUCTION

The purpose of the paper was to perform a comparative analysis of the impact of T2DM on QoL, including specific ADDQoL domains and associations between QoL, selected socio-demographic factors (including gender, age, education, residence, marital status, professional activity) or clinical parameters (HbA1c levels, fasting blood glucose, BMI, duration of DM, complications, treatment used), in adult diabetic patients from Poland, the Czech Republic and Slovakia. The study group included 608 patients diagnosed with T2DM. There were 214 patients from Poland, 196 from the Czech Republic and 198 from Slovakia.

RESULTS

Overall, respondents from all three countries rated their QoL as good or very good. The mean scores for the item "If I did not have diabetes, my quality of life would be" were slightly higher for Poles than for Slovaks and Czechs. In the ADDQoL results, the weighted impact scores were negative for all domains. The lowest scores in all three countries were found for "freedom to eat" for all patients; the highest for "living conditions". For Polish patients, the linear regression model demonstrated the following significant AWI predictors: pre-university education and past smoking. For Czech patients, the linear regression model demonstrated that none of the characteristics analyzed were significant independent predictors of AWI. In the For Slovak patients, the linear regression model demonstrated the following significant AWI predictors: higher education and concurrent heart failure.

CONCLUSION

In summary, our findings demonstrate that T2DM has a negative impact on all aspects of patients' QoL, which is the strongest in terms of the freedom to eat and dietary habits, regardless of the country. Education, past smoking, and concurrent heart failure were the only independent predictors of QoL in our study. This suggests a need for further research that would include more variables and a larger number of patients.

Comparison of health-related quality of life in patients with rheumatoid arthritis during conventional or conventional plus biological therapy in Poland

PURPOSE

The main purpose of this study was to compare the level of health-related quality of life (HRQoL) using Nottingham Health Profile (NHP) in Polish patients with rheumatoid arthritis (RA) during therapy applying disease-modifying antirheumatic drugs (DMARDs) with conventional synthetics (csDMARDs) or with csDMARDs in combination with biological drugs (bDMARDs). The second purpose was to analyze the correlation between the domain values of NHP and the demographic and clinical parameters, functional efficiency, and mood.

PATIENTS AND METHODS

The studies involved 212 patients with RA, divided into two groups: group I - 126 persons treated using csDMARDs, group II - 86 patients using csDMARDs in combination with bDMARDs. A diagnostic survey was used applying NHP for HRQoL, Beck Depression Inventory (BDI), and Health Assessment Questionnaire (HAQ). The 28-Joint Disease Activity Score (DAS-28) was calculated.

RESULTS

The patients with RA in both studied groups did not differ significantly in terms of all the NHP domains, values of HAQ and BDI. The DAS-28 value, the number of swollen joints, and the duration of morning stiffness were significantly smaller among patients from group II. However, in both groups, the majority of the analyzed components of NHP demonstrated significant correlations with values of HAQ and BDI and some of the domains of NHP - with DAS-28.

CONCLUSION

The level of HRQoL, functional efficiency, and mood are comparable in patients treated conventionally and in combination with biological drugs. The HRQoL level shows correlation with the occurrence of depression symptoms, and the energy level, the sensation of pain, and physical abilities are covariates with daily activities. The intensity of the activity of RA as well as experiencing pain and the duration of morning stiffness is smaller among patients applying csDMARDs plus bDMARDs compared with patients treated only conventionally.

Resistance of gloves and protective clothing materials to permeation of cytostatic solutions

OBJECTIVES

The objective of the work was to determine the resistance of selected protective clothing and glove materials to permeation of cytostatics such as docetaxel, fluorouracil, and doxorubicin.

MATERIAL AND METHODS

The following glove materials were used: natural rubber latex (code A), acrylonitrile-butadiene rubber (code B) and chloroprene rubber (code C). In addition, we tested a layered material composed of a non-woven polyester (PES), a polypropylene (PP) film, and a non-woven PP used for protective coats (code D). The cytostatics were analyzed by liquid chromatography with diode array detection. The tested samples were placed in a purpose-built permeation cell modified to be different from that specified in the standard EN 6529:2001.

RESULTS

The tested materials were characterized by good resistance to solutions containing 2 out of the 3 selected cytostatics: doxorubicin and 5-fluorouracil, as indicated by a breakthrough time of over 480 min. Equally high resistance to permeation of the third cytostatic (docetaxel) was exhibited by natural rubber latex, acrylonitrile-butadiene rubber, and chloroprene rubber. However, docetaxel permeated much more readily through the clothing layered material, compromising its barrier properties.

CONCLUSIONS

It was found that the presence of additional components in cytostatic preparations accelerated permeation through material samples, thus deteriorating their barrier properties. Int J Occup Med Environ Health 2018;31(3):341-350.

Relationships of Sexual Dysfunction with Depression and Acceptance of Illness in Women and Men with Type 2 Diabetes Mellitus

An increased prevalence of sexual disorders has been reported in patients with type 2 diabetes. The aim of this study is the assessment of the influence of the psychical condition, the concentration of glycated hemoglobin, the duration of diabetes, the body mass index, the age, and the subjective acceptance of the illness on sexual disorders occurring in women and men with type 2 diabetes. The study enrolled 215 patients (114 women and 101 men) with type 2 diabetes and 183 controls. Sexuality was determined in all of the studied subjects using: the Female Sexual Function Index (FSFI) in women and the International Index of Erectile Function (IIEF) in men. The occurrence of depression symptoms was determined using the Beck Depression Inventory (BDI), whereas the acceptance of the illness in diabetic patients using the Acceptance of Illness Scale (AIS). A sexual dysfunction was found in 68% of the studied diabetic women and 17% of controls. The point values of all the examined FSFI domains were significantly lower in women with diabetes than in controls (p < 0.001). Erectile disorders occurred in 82% of the studied men with diabetes and in 41% of the controls (p < 0.001). The point values of all the domains of FSFI and IIEF demonstrated a significantly negative correlation with the total BDI score, which was higher in patients with diabetes than in patients without diabetes, and a positive correlation with the total AIS score (p < 0.001). The occurrence of sexual dysfunction in patients with diabetes correlated with the age and the duration of diabetes. We conclude that sexual disorders in patients with type 2 diabetes demonstrate the correlation with the occurrence of depression and the acceptance of their illness. Sexual disorders in diabetic patients occur more frequently in older patients and in those with a longer duration of diabetes.

Mine rescuers' heat load during the expenditure of physical effort in a hot environment, using ventilated underwear and selected breathing apparatus

Mine rescuers' heat load under the same physical effort load (25% of the maximal oxygen uptake), using three types of breathing apparatus, in newly developed heat-removing underwear and outerwear was assessed for typical work conditions of mine rescuers, under milder and harsher ambient conditions of 32 and 38 °C, respectively, both at relative humidity of 85% and air velocity of 1.0 m/s. Expending physical effort at the same load while using different kinds of breathing apparatus resulted in a similar heat load. Under both milder and harsher ambient conditions, heat storage and sweating intensity were greater than the average limit value recommended by hygienic standards, which indicates that the use of breathing apparatus significantly hinders heat exchange with the environment. The developed clothing for mine rescuers was highly rated, and was considered by most people to be better than that used currently.

Independent Factors of Changes of Ankle-Brachial Index in Peripheral Arterial Occlusive Disease in Elderly Patients with or without Diabetes

Peripheral arterial disease (PAD) belongs to the commonly-occurring pathologies associated with elderly age. A simple tool for defining the severity of PAD is the ankle-brachial index (ABI). The purpose of this research was to determine independent factors of changes of ABI in elderly patients with occlusive PAD disease (PAOD) with and without diabetes. The research was carried out on 49 elderly patients with PAOD, including 29 patients with type 2 diabetes, and 20 patients without diabetes. The concentration of interleukin-6 (IL-6), E-selectin, fibrinogen, and C-reactive protein (CRP) in the blood serum was marked. In all patients, the independent factors of changes of ABI were determined with the use of the multiple logistic regression analysis. Our results show that in the group of patients with PAOD suffering from diabetes, it was demonstrated that the ABI was related to age, the duration of the symptoms of PAD, body mass index (BMI), low-density lipoprotein cholesterol, fibrinogen, and sex (determination coefficient R² = 0.699). In patients with PAOD without diabetes, the ABI was related to age, the duration of the symptoms of PAD, the levels of CRP, E-selectin, high-density lipoprotein cholesterol, and the glomerular filtration rate(determination coefficient R² = 0.844). We conclude that in elderly patients with PAOD with and without diabetes, the participation of independent factors related to the ABI is diversified; in patients with diabetes, the concentration of IL-6 and fibrinogen is lower, and the concentration of E-selectin is higher than in patients without diabetes.

[Use of personal protective equipment under occupational exposure to cytostatics]

BACKGROUND

A growing number of cancer cases enhances the usage of cytostatic agents and thereby contributes to the increase in the number of health care workers occupationally exposed to cytostatics.

MATERIAL AND METHODS

This article presents the results of the survey aimed at obtaining data on the reduction of occupational exposure through using personal protective equipment by the medical and pharmaceutical personnel involved in handling cytostatics. The questionnaires were sent by mail or e-mail to oncology hospitals and pharmacies preparing cytostatic drugs. Responses were received from 94 people employed in these workplaces. The main questions concerned the forms of cytostatics; job activities; types of personal protective equipment used and working time under exposure to cytotoxic drugs.

RESULTS

The majority (over 90%) of the healthcare personnel declared the use of personal protective equipment when working under conditions of exposure to cytostatic drugs. Depending on the type of protection, 15-35% of people reported that the most frequent time of their single use of the apron, the overalls, the gloves, the cap, the goggles or the respirators did not exceed few minutes. Gloves were changed most frequently. However, half of the responses indicated that the time after which the respondents removed protection equipment greatly differed.

CONCLUSIONS

Almost the whole group of respondents applied personal protective equipment when working under exposure to cytostatics. However, personal protective equipment was not used every time in case of exposure. The medical and pharmaceutical staff worked under exposure to cytostatics for a few or even dozen hours during the working day. Med Pr 2016;67(4):499-508.

Gloves against mineral oils and mechanical hazards: composites of carboxylated acrylonitrile-butadiene rubber latex

Resistance to permeation of noxious chemical substances should be accompanied by resistance to mechanical factors because the glove material may be torn, cut or punctured in the workplace. This study reports on glove materials, protecting against mineral oils and mechanical hazards, made of carboxylated acrylonitrile-butadiene rubber (XNBR) latex. The obtained materials were characterized by a very high resistance of the produced materials to oil permeation (breakthrough time > 480 min). The mechanical properties, and especially tear resistance, of the studied materials were improved after the addition of modified bentonite (nanofiller) to the XNBR latex mixture. The nanocomposite meets the requirements in terms of parameters characterizing tear, abrasion, cut and puncture resistance. Therefore, the developed material may be used for the production of multifunctional protective gloves.

[Exposure to mineral oils at worksites and novel solutions for polymer protective materials in selected personal protective equipment]

Exposure of workers to health hazards due to contact with mineral oils occurs primarily in the chemical, petrochemical, machine-building, metallurgic and car industries. Under worksite conditions, the respiratory system and the skin are the primary routes of entry of mineral oils into the human body. Long-term exposure of the skin to oily substances may lead not only to irritation and allergic lesions. The studies conducted in this area have confirmed a significant increase in the incidence of skin cancers in persons chronically exposed to mineral oils. Protection of workers' health at worksites associated with the risk of contact with mineral oils requires, in addition to collective protective and organizational solutions, personal protective equipment with appropriate protection and utility parameters confirmed by laboratory tests. The essential preventive measures include protection of the human skin by means of appropriate protective clothing and gloves, which provide an effective barrier against a wide spectrum of chemical compounds present in mineral oils. Knowledge of polymer materials is the prerequisite for designing more and more effective and functional protective clothing and gloves. Studies aimed at obtaining higher levels of skin protection against varied toxic substances, including mineral oils, have been conducted, among others, to develop modern glove and clothing materials ensuring resistance to oils. The rapid progress of nanotechnology and the use of nanoadditives in polymer materials has made it possible to undertake works aimed at developing modern polymer nanostructures designed for construction of oil-resistant protective clothing and gloves. In this review paper the authors have presented the current knowledge of polymer materials, from traditional ones to polymer nanostructures, used in personal equipment protecting against mineral oils.

The influence of a tilt training programme on the renin-angiotensin-aldosterone system activity in patients with vasovagal syncope

OBJECTIVE

We assessed the influence of short-term and long-term tilt training on the activity of the renin-angiotensin-aldosterone system (RAAS) in vasovagal patients.

METHODS AND RESULTS

Thirty-nine patients (28 F, 11 M) aged 39.7 +/- 11.2 years with a history of vasovagal syncope and a positive head-up tilt test (HUT) were studied. Blood samples for plasma renin activity (PRA) and aldosterone (ALDO) concentration were drawn at the baseline, immediately after HUT and 10 min after HUT, during the diagnostic, the negative short-term (2-5 days) follow-up HUT and long-term (1-3 months) follow-up HUT. Tilt training was started after diagnostic HUT. In diagnostic HUT, PRA increased significantly immediately after HUT comparing to the baseline, during recovery the values did not change. ALDO concentration increased after HUT comparing to baseline and further increased during recovery. After short-term tilt training, PRA and ALDO concentrations did not significantly change compared to their corresponding values in diagnostic HUT. After long-term tilt training, PRA did not significantly change compared to the values in the diagnostic and short-term follow-up HUT. ALDO concentration also did not change significantly at the baseline and immediately after HUT, and 10 min after HUT ALDO concentration was significantly lower than after diagnostic HUT.

CONCLUSIONS

Tilt training changes the response of RAAS to the prolonged orthostasis in vasovagal patients. The coupling between PRA and ALDO after diagnostic HUT has been found to be altered and the physiological relationship was restored after long-term tilt training. The beneficial effect of tilt training depends partially on changed RAAS activation.

Selection of sorption material for tests of pesticide permeation through protective clothing fabrics

The paper presents the results of studies on selecting a solid sorption material for absorbing liquid crop protection agents which permeate samples of protective clothing fabrics. The sorption materials were investigated and selected with an assumption that they should have a high recovery coefficient for biologically active substances, used as active ingredients in crop protection agents, at a presumed, acceptably high level. The selected substances were determined with a gas chromatograph equipped with an electron capture detector (dichlorvos, cypermethrin and 2,4-D) and a nitrogen-phosphorus detector (carbofuran). The tests demonstrated that polypropylene melt-blown type unwoven cloth had high recovery coefficients for all 4 active ingredients proposed for the study. The highest recovery coefficient, -.97, was obtained for carbofuran. The recovery coefficients obtained for the 3 remaining substances were lower: .89 for cypermethrin and 2,4-D, and .84 for dichlorvos.

Proposal for a method for testing resistance of clothing and gloves to penetration by pesticides

The paper presents the proposal for a method for testing the resistance of materials used for the production of protective clothing and gloves to penetration by concentrated chemical preparations of pesticides. It has been based to a large extent on the recommendations of European standards, with certain modifications resulting from the specific properties of non-volatile and non-water-soluble biologically-active components of pesticides. These modifications primarily involved the use of a solid sorption medium and adjustment of research apparatus to the research conditions consistent with the proposed method. The results of preliminary studies on penetration of the selected biologically-active components of pesticides (dichlorvos, 2,4-D, cypermethrin, carbofuran) through the selected protective materials (fabric coated with viton and butyl on both sides, rubberised fabric, butyl rubber) are presented. The study confirmed the usefulness of the proposed method for testing the resistance of materials protecting against the effect of pesticides.