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Background Long-term care units’ residents do not constitute a homogeneous population. Providing effective care, tailored to individual needs, is crucial in this context. It can be facilitated by suitable tools and methods, which include needs assessment along with the physical, psychological and social aspects of care. We thus applied a cluster approach to identify their putative groupings to enable the provision of tailored care. Methods The needs of 242 residents of care homes in four Polish cities (Poznan, Wroclaw, Bialystok and Lublin), aged 75–102 years (184 females), with the Mini-Mental State Examination (MMSE) score ≥ 15 points, were assessed with the CANE (Camberwell Assessment of Need for the Elderly) questionnaire. Their independence in activities of daily living was evaluated by the Barthel Index (BI), and symptoms of depression by the Geriatric Depression Scale (GDS). The results of MMSE, BI and GDS were selected as variables for K-means cluster analysis. Results Cluster 1 (C1), n = 83, included subjects without dementia according to MMSE (23.7 ± 4.4), with no dependency (BI = 85.8 ± 14.4) and no symptoms of depression (GDS = 3.3 ± 2.0). All subjects of cluster 2 (C2), n = 87, had symptoms of depression (GDS = 8.9 ± 2.1), and their MMSE (21.0 ± 4.0) and BI (79.8 ± 15.1) were lower than those in C1 (p = 0.006 and p = 0.046, respectively). Subjects of cluster 3 (C3), n = 72, had the lowest MMSE (18.3 ± 3.1) and BI (30.6 ± 18,8, p p p p p p = 0.015). There were also differences in the patterns of needs between the clusters. Conclusions Clustering seems to be a promising approach for use in long-term care, allowing for more appropriate and optimized care delivery. External validation studies are necessary for generalized recommendations regarding care optimization in various regional perspectives.

This study aims to investigate whether wearing face masks (filtering facepieces, FFP class 2) with personal protective equipment (FPP2/PPE), while working a 12-h shift in a COVID-19 referral center, affects the blood saturation, heart rate (HR), and well-being of health care providers (HCPs). The study included a group of 37 HCPs. To perform continuous recordings of the SpO2 and heart rate (HR) in real time, we used a Nellcor PM10N (Covidien, Mansfield, MA, USA) portable monitoring system. SpO2, HR, and HCP well-being scales were measured during two 3-h shifts, while HCPs worked during a 12-h period. Additionally, each subject completed a questionnaire concerning their well-being. The difference in the SpO2 level between the 1st and 2nd working shifts while wearing an FFP2/PPE was small, with a median decrease in SpO2 of −1%. The scales of the well-being indicators increased within the shift. They were mainly fatigue and thirst with median scores of 2 out of 6 (range 0–4). We assume that during a 12-h period, a work scheme that consists of a 3-h shift in FFP2/PPE and a 3-h rest period (working without FPP2/PPE) is a reliable and safe solution for HCPs working in specialized COVID-19 referral hospitals.

This study aims to investigate whether wearing a filtering facepiece class 3 respirators with personal protective equipment (FPP3/PPE) during work in the intensive care unit (ICU) affects the blood saturation (SpO2), the heart rate (HR), and the well-being of health care workers (HCWs). This preliminary study included a group of 21 volunteers (including 16 females (76%), with a median age of 23 years). Each worker served as his own control and performed the test two times: they wore the FFP3/PPE and did not wear it for a three-hour shift in the ICU. The working with an FFP3/PPE compared to not working with an FFP3/PPE caused a significant, but within normal ranges, influence on the level of SpO2 with a mean decrease of − 1.43%. The highest reduction in the SpO2 was − 2.29% and occurred after 150 min of work. All of the score scales of the well-being markers increased consecutively but moderately during the shift while wearing the FFP3/PPE. We assume that a 3-h shift rhythm is a safe and reliable solution, i.e., three hours of working in the FFP3/PPE in the ICU, followed by rest or working without an FFP3/PPE.

Cel pracyUtworzenie polskiej adaptacji Krótkiej Skali Objawów Negatywnych (Brief Negative Symptom Scale – BNSS), ocena zgodności wewnętrznej polskiej wersji skali BNSS oraz przeprowadzenie korelacji między oceną w skali BNSS, a oceną w Skali Zespołów Pozytywnego i Negatywnego schizofrenii (Positive and Negative Syndrome Scale – PANSS) w grupie chorych na schizofrenię.MetodaPrzeprowadzono procedurę polskiej adaptacji formularza oceny (Scoresheet), obejmującego 13 punktów zorganizowanych w 6 podskal (anhedonia, brak prawidłowego dystresu, asocjalność, awolicja, blady afekt i alogia), podręcznika (Manual) oraz zeszytu szkoleniowego (Workbook) skali BNSS. Badania psychometryczne wykonano u 40 chorych na schizofrenię paranoidalną (20 mężczyzn i 20 kobiet), w wieku 44+13 lat, o długości choroby 17+10 lat i nasileniu objawów w skali PANSS 56+16 punktów, otrzymujących niezmienione leczenie farmakologiczne w okresie ostatnich 3 miesięcy.WynikiPolska wersja została zaakceptowana przez twórców skali. Analiza rzetelności wykazała wysokie wyniki wskaźnika alfa-Cronbacha zarówno dla całej skali (0,97), jak i dla poszczególnych podskal (0,74-0,93). Skala BNSS i jej podskale wykazywały wysoką istotną korelację z całkowitym wynikiem PANSS oraz z podskalą objawów negatywnych PANSS zarówno oryginalną, jak i zmodyfikowaną.WnioskiUzyskane wyniki wskazują na dobre własności psychometryczne polskiej wersji skali BNSS i na jej możliwą przydatność w badaniach objawów negatywnych schizofrenii prowadzonych w naszym kraju.

ObjectivesYoga is an ancient form of physical activity (PA) that encompasses meditation, stretching and breathing techniques. Although the benefits of PA and associated lifestyle interventions are clear, we here addressed the paucity of evidence regarding the specific relationship between yoga and quality of life (QOL) in adults in Poland. We hypothesised that participation in PA and yoga could result in a positive impact on QOL.DesignCross-sectional, self-administered questionnaire-based survey. Both the quantitative and qualitative variables were statistically compared. Multivariate analyses were performed using linear regression. Results were determined based on age, sex and education level; a pSettingQuestionnaires were delivered to participants online, at high schools and universities, and in elderly communities in Poland.Participants714 polish citizens aged over 18 participated in the study; there are no specific entry and exclusion criteria besides age.ResultsStatistically significant differences (pConclusionsThe study shows that both regular PA and yoga practices could improve QOL; however, PAG-Y produced higher QOL scores than PA of other types. This outcome may be explained by the impact of physiological and psychological aspects within yoga practice. These results suggest that this unique combination impacts health more positively than other kinds of PA alone.

Background The concomitant use of two or more mood stabilisers (MS), second-generation antipsychotics (SGA), lamotrigine as well as antidepressants, is frequently reported in the treatment of bipolar patients The aim of this study was to investigate the pattern of pharmacological treatment with special regard to polypharmacy defined as two or more psychiatric drugs taken at the same time in the same patients with bipolar disorder discharged from psychiatric units in Poland. Method Pharmacotherapy of 127 consecutive patients (57 females and 70 males) with an ICD-10 diagnosis of bipolar disorder (BP) at the point of discharge from five psychiatric regional hospitals/units in Poland, was evaluated in 2015/2016 on the basis of medical files. The effect of treatment on mental status at discharge was examined using the Clinical Global Impression-Improvement scale (CGI-I). Results When only MS, SGA and lamotrigine, were taken into account, 78 (61%) of patients were prescribed two, 27 (21.3%) three and one patient four medications. The combination of MS and SGA was most commonly used (n = 61, 48%). Medications preferred by Polish psychiatrists at patients’ discharge were valproates (n = 69, 54%), olanzapine (n = 48, 37%), quetiapine (n = 47, 37%) and lamotrigine (n = 33, 25.9%). Thirty patients (23.6%) were prescribed lithium. No relationships were found between polypharmacy and patients’ age, duration of illness and the rate of CGI-I. However, polypharmacy was significantly associated with types of bipolar disorder, particularly with the bipolar I disorder. Conclusion The prevalence of polypharmacy especially with MS and SGA in the treatment of bipolar patients discharged from psychiatric units in Poland is high. The most significant factor predisposing to polypharmacy is a diagnosis of bipolar – I disorder. In general, our study confirms trends observed in other countries.

Introduction This is a prospective study, first to compare the frequency of depressive symptoms in stroke survivors treated, and non-treated, with intravenous thrombolysis and second, to explore relationships between post-stroke depression (PSD) and stroke treatment modalities, taking into account other possible determinants of PSD, including post-traumatic stress symptoms. Methods Groups of 73 thrombolysed and 73 non-thrombolysed patients matched for age and gender were examined at 3 and 12 months after discharge. PSD was assessed using the Beck Depression Inventory. Post-traumatic stress symptoms (PTSS), disability and social support were assessed with the Impact of Event Scale-Revised, the Barthel Index and the Berlin Social Support Scale. Results At 3 months, PSD was present in 23.3% of the thrombolysed and 31.5% in the non-thrombolysed groups (p = 0.265). At 12 months, the frequencies were 29.2 and 20.6% (p = 0.229). Logistic regression of the combined group of thrombolysed and non-thrombolysed patients indicated that at 3 months, the adjusted predictors of PSD were disability (OR 24.35), presence of PTSS (OR 9.32), low social support (OR 3.68) and non-thrombolytic treatment (OR 3.19). At 12 months, the predictors were disability (OR 15.78) and low education (OR 3.61). Limitations The use of a questionnaire for the detection of depression, the relatively small sample size and a significant drop-out rate could limit the interpretation of these results. Conclusions (1) Thrombolysed and non-thrombolysed stroke survivors had similar frequency of depressive symptoms although the thrombolysed patients had more severe neurological deficits in the acute phase. It can be assumed that if thrombolysis had not been used, depressive symptoms would have been more frequent. (2) Lack of the rt-PA treatment was associated with three-time greater odds of screening for PSD at 3 months post-stroke, after adjustment for other PSD correlates. (3) Therefore, thrombolytic therapy seems to have a positive, but indirect, effect on patients’ mood, especially in the first months after stroke. (4) All stroke patients, irrespective of the method of treatment, should be monitored for the presence of depression.

CelCelem pracy było utworzenie polskiej wersji Skali Samooceny Objawów Negatywnych (Self-report of Negative Symptoms -SNS), ocena jej zgodności wewnętrznej oraz przeprowadzenie korelacji między oceną w skali SNS, a oceną w Krótkiej Skali Objawów Negatywnych (Brief Negative Symptom Scale – BNSS), w grupie chorych na schizofrenię.Materiał i metodyPrzeprowadzono procedurę polskiej adaptacji francuskojęzycznej wersji skali SNS obejmującej 20 punktów zorganizowanych w 5 podskal: asocjalność, spłycenie afektu, alogia, awolicja i anhedonia. Badania psychometryczne wykonano u 40 chorych na schizofrenię paranoidalną (20 mężczyzn i 20 kobiet), o nasileniu objawów w skali Positive and Negative Syndrome Scale (PANSS) 56+16 punktów, otrzymujących niezmienione leczenie farmakologiczne w okresie ostatnich 3 miesięcyWynikiPolska wersja skali SNS została zaakceptowana przez twórcę skali, prof. Sonię Dollfus. Analiza rzetelności SNS wykazała wysokie wartości wskaźnika alfa-Cronbacha zarówno dla całej skali (0,91), jak i dla poszczególnych podskal (0,61-0,85). Skala SNS i jej podskale wykazywały istotną korelację z całkowitym wynikiem BNSS, jak również wartościami jej odpowiednich podskal, co potwierdza trafność skaliWnioskiZnamienny statystycznie poziom zgodności całej skali oraz poszczególnych jej domen z wynikami skali klinicznej BNSS przemawia za adekwatnością oceny objawów negatywnych przez samego chorego na schizofrenię. Uzyskane w niniejszej pracy dobre własności psychometryczne polskiej wersji skali SNS mogą wskazywać na jej przydatność w badaniach objawów negatywnych prowadzonych w naszym kraju

The aims of this study were to examine prospectively the course of neurological and functional recovery and health related quality of life (HRQoL) in ischaemic stroke patients after intravenous thrombolysis, to assess the 1-year outcome and to determine the early predictors. A group of 53 consecutive patients were assessed at admission to the acute stroke unit (T0), before their discharge (T1), and at 3 (T2) and 12 (T3) months after hospital discharge. The National Institutes of Health Stroke Scale (NIHSS), the Barthel Index (BI) and the Stroke Specific Quality of Life Scale (SSQoL) were used to evaluate stroke severity, functional disability and health related quality of life (HRQoL). A good outcome was defined as simultaneous improvement in all three scales. At T0, 83 % of the patients had severe or moderate neurological impairment. Additionally, 77 % demonstrated very severe or severe disability when assessed by the BI. 74 and 79 % of the patients reported an acceptable HRQoL at 3 and 12 months following discharge, respectively. Neurological and functional status improved significantly over time with most changes occurring during hospitalization and the subsequent 3 months. At T3, 75.5 % of the patients had the good outcome which had been independently predicted by the level of stroke related disability at T0. A majority of the stroke survivors treated with thrombolysis achieved a good outcome. The measurement of stroke specific HRQoL, as a tool for gathering information from the patient, should be incorporated in the assessment of post-stroke recovery and outcome.

Objectives The aim of the study was to evaluate the Camberwell Assessment of Need for the Elderly questionnaire (CANE) in assessing the needs of elderly individuals living in long-term care institutions (LTCI) in Poland. Setting and Participants The needs of 173 residents were assessed. The inclusion criteria were age (at least 75 years of age) and the lack of severe cognitive impairment (Mini Mental Scale Examination score of at least 15 points). Measurements In all participants, met and unmet needs were assessed by themselves and by the nursing staff involved in care activities. Results The number of met needs assessed by the staff was higher than in the users’ opinions (p

ObjectivesThe aims of the study were: (1) to evaluate longitudinally symptomatic remission in first-episode (FE) schizophrenia, (2) to describe symptoms, social functioning and quality of life (Qol) in relation to remission status, and (3) to determine the long-term outcome of schizophrenia and its early predictors.MethodsSixty-four patients were assessed 1 month after a first hospitalization (T1), 12 months (T2), 4–6 years (T3), and 7–11 years (T4) after T1. The patients were allocated to three remission groups according to their remission status over the whole observation period, e.g. stable remission (SR), unstable remission (UR) and non-remission (NR). The PANSS, Social Functioning Scale and WHOQoL were used to evaluate the patients’ psychosocial functioning levels, symptomatic and functional remissions and satisfying QoL. A good outcome was defined as meeting, simultaneously, the criteria of symptomatic and functional remissions and satisfying QoL at T4, while failure to meet all of these criteria was defined as a poor outcome.ResultsAmong them, 17.2% patients were in stable remission, 57.8% in unstable remission and 25.0% were unremitted at all time points. The SR group had lower levels of psychopathological symptoms and reported better social functioning and QoL than the NR group. During the follow-up, the symptoms increased, social functioning slightly improved and QoL did not change. At T4, 53% of the sample had a poor outcome, which was independently predicted by the longer duration of untreated psychosis and a lack of satisfying QoL at T1.ConclusionsOur results demonstrate that: (1) the long-term course in schizophrenia is heterogeneous and that three illness trajectories exist, (2) social functioning and QoL are only partially connected with symptomatic remission (3), the risk of a poor outcome may potentially be reduced by appropriate interventions at an early stage of the illness.

Objectives To assess the prevalence of considerable burden among caregivers of stroke survivors at 6 months (Time 1) and 5 years after stroke (Time 2), to analyse changes in burden severity over time and to identify factors associated with the burden. Methods Eighty eight patient/caregiver pairs were assessed. Caregiver burden was measured with the Caregiver Burden Scale. Socio-demographic, stroke-related and psychological characteristics were analysed as potential determinants of the burden. Exact multiple logistic regression was used to identify the predictive factors. Results Considerable burden was reported by 44% of the caregivers at Time 1 and 30% at Time 2. The burden was independently associated with caregivers’ sense of coherence and amount of time spent caregiving at Time 1, and with caregivers’ anxiety at Time 2. Conclusions A significant proportion of the caregivers experienced considerable burden in the post-acute and chronic phases of stroke, although this proportion declined over time. Several characteristics were associated with the increased burden at different time points. All the independent predictors related to aspects of the carers. Practice implications Programmes including education about coping strategies and time management, as well as respite care provision, could be beneficial and might help to reduce the burden of caregiving.

[b]Objective[/b]. To measure the intensity of depressive symptoms in the populations residing in rural areas of western Poland, and to delineate the putative association between the intensity of depression and selected socio-demographic and clinical factors. [b]Materials and method.[/b] The study covered 445 adults recruited from one family physician practice in the rural area of Wielkopolska region. The following tools were applied: Beck Depression Inventory (BDI), the WHO WHOQoL-Bref quality of life assessment scale, and a socio-demographic and clinical questionnaire elaborated by the authors. [b]Results.[/b] Depressive symptoms were observed in approx. 30% of the patients. The intensity of symptoms correlated with age, female gender, and inversely correlated with the quality of life. There was no association between depressive symptoms and level of education (counted as years of education), number of somatic illnesses, and family burden of psychiatric disorders. [b]Conclusion[/b]. Symptoms of depression were noted in approx. 30% of patients who consulted their family physician. The Beck questionnaire is a simple tool whose application could decidedly improve the recognition of depression. It is worth taking note of factors that may be connected with the intensity of depressive symptoms – gender, the number of diagnosed somatic illnesses, and the quantity of drugs administered.

Background Conflicting data regarding the efficacy of antidepressants of different mechanism of action on unexplained painful physical symptoms (UPPS) in depression have been published so far. Objective The aim of this study was to compare the impact of escitalopram (ESC), nortriptyline (NOR), and venlafaxine (VEN) on UPPS in patients with major depression. Materials and methods Sixty patients, participants in the GENDEP study, with a diagnosis of depression according to the ICD-10 criteria were randomly assigned to treatment with ESC (10–30 mg, mean dose 15.2, standard deviation [SD]±9.2) or NOR (50–150 mg, mean dose 106.2, SD±8.2). Additionally, 30 patients who were treated with VEN (75–225 mg, mean dose 181.3, SD±8.8) were included. Before inclusion (day 0) and throughout the study (days 14, 28, 42, 56), the severity of pain was monitored using the visual analog scale. Results The patients treated with ESC, NOR, and VEN did not differ in the intensity of pain at days 0, 14, 28, 42, and 56. Conclusion Our results do not support the hypothesis suggesting the superiority of VEN over ESC and NOR in the management of UPPS in major depression.

The aim of this study was to examine the validity and reliability of the Polish WHOQOL - Bref in a sample of 908 respondents. The Bref is a generic quality of life (QoL) instrument designed for cross - cultural use. Correlational and multivariate analyses confirmed the relevancy of individual items and domains supporting the construct validity of the scale. Multiple regression analyses of the domain scores with two overall questions (dependent variable) showed that all four domains made a significant contribution in explaining the variance in overall QoL. The psychological domain made the strongest contribution (unstandardized B coefficient = 0.10, r2 = 0.41), followed by the social, environmental and physical domains. When overall health satisfaction was considered as the dependent variable, the physical domain contributed most strongly (unstandardized B coefficient = 0.21, r2= 0.43) followed by the psychological and environmental domains. Exploratory factor analyses resulted in a four factors solution with 24 items explaining 49.6% of the cumulative variance. Confirmatory factor analyses lended marginal support for the goodness of fit of the four-domain model. The physical domain was found to be strongest in differentiating between unhealthy and healthy subjects, followed by psychological and social domains. Acceptable internal consistency was shown with Cronbach's alpha coefficients being greater than 0.70 for all domains with the exception of the social domain. Further exploration of the scales validity and conceptual clarity need further testing in Polish and international samples.

The assessment of social functioning and subjective quality of life in relation to symptomatic remission in schizophrenia patients after a first psychiatric hospitalization, as well as the analysis of connection between intensity of psychopathological symptoms and the level of functioning and quality of life, taking into account the status of remission and duration of illness.Sixty-four patients were assessed, at 13 months (1st examination) and at mean 8 years (2nd examination) after the first hospitalization, and compared with two control groups of healthy persons. The following scales were used: Positive and Negative Syndrome Scale (PANSS), Social Functioning Scale (SFS), WHO Quality of Life (WHOQoL--Bref) scale and Global Assessment Scale (GAS).At first examination, the score of SFS domains was not significantly different between patients in remission and without remission while the score of most domains of WHOQoL was significantly higher in patients with remission. At second examination, the scores of both SFS and WHOQoL were significantly higher in patients with remission and did not differ significantly from healthy persons. In both examinations, significant correlations between PANSS and SFS and WHOQoL scores were found, especially in patients without remission.At mean 8 years after first psychiatric hospitalization, 2/3 of the patients with schizophrenia did not get a symptomatic remission and had worse social functioning and quality of life compared to patients with remission and to healthy controls. Psychopathological symptoms correlated significantly with social functioning and quality of life, especially among patients without remission.

Despite a significant progress in prevention, treatment and management in the past decades, stroke remains the most common disabling chronic condition in adult population. It may be a source of serious temporary or permanent consequences. These consequences should be recognised and measured for defining and implementation of remedial interventions and for optimum utilisation of health care resources. The aim of this work was to present sequels of stroke, taking into account objective and subjective indices, as documented in the recent literature of the subject. Selected data on mortality and survival following stroke were presented, the up-to-date literature was reviewed and register-based prospective studies were presented on quality of life (QoL) in post-stroke patients. Systematic reviews and meta-analyses of randomised controlled trials (RCTs) were summed up, related to efficacy of interventions aimed at improving QoL of the patients. Moreover, the studies were reviewed on burden and QoL experienced by caregivers of post-stroke patients and results were summed up of RCT synthesis aimed at reducing the burden and at improving QoL in the caregivers. The analysed studies indicated that stroke exerts a long-term, negative effect on patients' QoL, promoting a decrease in this measure and burdening a significant proportion of the family caregivers. The applied till now different interventions and programmes targeted at the patients and at their carers analysed in RCTs showed no or modest effects on improving of QoL or reducing the caregiver's burden.

Background The term antipsychotic polypharmacy (APP) refers to the concurrent use of two or more antipsychotic drugs in schizophrenia. The aim of this study was to investigate the range of APP in schizophrenic patients discharged from psychiatric units in Poland, and to determine its demographical and clinical correlates. Methods Data on the pharmacological treatment of 207 patients with a diagnosis of schizophrenia, discharged from six psychiatric hospitals from September–December 2011 were recorded by experienced psychiatrists. Clinical and demographical information was obtained on each patient. The severity of symptoms at admission, and their improvement during hospitalization were assessed using the Clinical Global Impression Scale. Results At discharge, 52.7% of the patients were prescribed one, 42.5% two and 4.8% three antipsychotic drugs (AP). When two AP were applied, it was usually a combination of two second generation antipsychotics (SGA) (46%), or of both first generation antipsychotics (FGA) and SGA (48%). The SGA's olanzapine and risperidone were those most commonly prescribed. Patients treated with two or more AP had a higher number of previous hospitalizations than patients receiving antipsychotic monotherapy. Mood stabilizers were prescribed for nearly one third of the patients, while antidepressants and benzodiazepines were prescribed for fewer than 10%. Conclusions The prevalence of polypharmacy in Poland is similar to that reported in other countries. This may suggest that, in a substantial proportion of schizophrenic patients clinical response to the antipsychotic monotherapy is unsatisfactory. Further studies focusing on the efficacy and safety of strategies in the treatment of patients with schizophrenia not responding to antipsychotic monotherapy are necessary.

Multiple sclerosis (MS) is the second most common cause of disability among nervous system diseases. This disease causes reduced quality of life of patients and those caring for them. Quality of life (QoL) measures consist of at least three broad domains: physical, mental and social. In the field of medicine, researchers have often used the concept of health-related quality of life, which specifically focuses on the impact of an illness and/or treatment on patients’ perception of their status of health and on subjective well-being or satisfaction with life. Subjective factors of QoL in MS patients include perception of symptoms, level of fitness, self-image, satisfaction with family life, work, the economic situation, interaction with other people, social support and life in general. Objective factors include the clinical picture of disease, social status, social and living conditions and the number and intensity of social contacts. While many generic and specific questionnaires have been developed to assess QoL in patients with MS, including general fatigue, there is a lack of specific questionnaires assessing QoL of caregivers. In this paper, a review of selected studies on QoL and caregiver burden in MS and a summary of the most popular questionnaires measuring burden and QoL are presented. Special attention is paid to the first questionnaire specific for QoL of carers of persons with MS, CAREQOL-MS by Benito-Leon et al.

To estimate the proportion of locomotor disabilities in two elderly populations in Sweden and Poland, respectively. To estimate the perceived quality of life (QoL) in the disabled groups in samples from each country using a model developed by Carol Estwing Ferrans.The study comprised three parts: an epidemiological screening test for identification of individuals with a locomotor disability, an analysis of background data of importance and home visits with evaluations of quality of life and functional capacity. Home visits were made using the Quality of Life Index, (QLI) of Ferrans and Powers and a functional scale, the Standardized Practical Equipment (SPE). Data were collected for the period 1991-1996.In the population part of the study, with 1,380 respondents (78%) comprising elderly Swedish persons, 288 reported a locomotor disability. This can be compared with 425 among 1,045 respondents (52%) in a Polish elderly group. The tests at the home visits (Sweden, n = 89; Poland, n = 84) showed that both men and women in the Swedish group reported significantly higher scores for the total QLI (max. 30.00) with men reporting 26.68 points compared to 19.73 and women reporting 21.39 points compared to 19.40 and for three of the four subscales. Also, the Polish group scored lower for balance and mobility (SPE).The study provides an important view of the life situation measured with the QLI tool and the SPE for elderly persons with locomotor disorders in Sweden and Poland during the mid-1990s. The results are congruent with epidemiological reports on the poor health situation in Poland, particularly during that time. A new investigation among the elderly with locomotor disorders in the two countries today might provide different results.

An overall aim of treatment in multiple sclerosis is to lower the negative impact of the disease on functioning and quality of life of patients. Therefore, a measurement of functioning and quality of life should be included in the evaluation of the effectiveness of treatment. In this paper the most commonly used quality of life questionnaires, either generic and specific, were presented. Information about clinical and functional status is useful in the interpretation of the quality of life assessment results. Because of that, instruments for the assessment of depression, cognitive functions, functional ability and fatigue in multiple sclerosis were also described.

In Europe, since the 40's of the previous century the tendency of decreasing number of stroke cases has been observed. In Poland, epidemiological data concerning the stroke have shown relatively stable index of stroke incidence and stroke mortality rates in the last few decades. The decline concerns mostly early poststroke mortality which results directly in the increase of the number of people who have recovered from stroke. However, the index of post-stroke mortality is still higher in Poland than in other European countries and the USA. The prognosis referring to the incidence in next years, caused by demographic alterations related to the increasing number of elderly people, is not optimistic. Significant increase of population at the age of 65 and more is going to contribute to the increase of the number of new stroke cases in Poland and other European countries. This fact becomes a challenge both for hospitals, care-giver agencies and patients' families.

The majority of concepts of quality of life (QoL) include both objective and subjective dimensions. The objective aspect of QoL after traumatic brain injury (TBI) concentrates on patients' functioning in physical, psychological, social and cognitive domains. The subjective component refers to life satisfaction and individual evaluation of life as a whole or in the domains. The aim of this paper was to review research on QoL in TBI patients taking into account this bidimensional framework. The studies reviewed show that TBI has a significant, long-term impact on all QoL domains. Subjects with TBI score significantly lower than non-injured controls or normative groups. Traumatic brain injury has a more profound effect on the psychosocial domains than on the physical domain, which means that the impact of TBI is cumulative. Further research should focus on prognostic factors of QoL and on the role of rehabilitation in prevention of deterioration in QoL of patients and their caregivers.

To evaluate prospectively the course of schizophrenia in men and women after a first psychiatric hospitalization in terms of socio-vocational situation, social functioning and psychopathological status.A study sample consisted of 74 patients (46 males, 28 females), examined 1 month (T. 1), 13 months (T. 2) after a discharge, and 4-6 years after T. 1 (T.3). The research instruments were: a questionnaire for socio-demographic data and information about the illness course, Social Functioning Scale (SFS) and PANSS.During the follow-up period, the socio-vocational situation and psychopathological status has worsened. The percentage of patients unemployed or not studying increased by 26%, whilst those receiving a disability pension by 50%. Despite of the pharmacological treatment, symptoms severity increased, particularly in the group of negative symptoms and general psychopathology (p0.01). Social functioning showed a significant trend to improve but only in some domains. Between T. 1 and the last follow-up, there was an increase in total SFS and in 3 out of the 7 domains. This improvement was particularly noticeable in the group of female patients hospitalized before the age of 20 years (p0.05). Female patients, regardless of age of their first hospitalization, scored higher in the Independence performance domain.(1) The early course of schizophrenia appears to be heterogeneous. This was reflected by the deterioration of socio-vocational situation and psychopathological status, and by a variability of the changes in social functioning. (2) This heterogeneity and non-parallel changes should be taken into account when planning and evaluating therapeutic interventions. (3) The early course of schizophrenia seems to be more beneficial for female patients.

This study involved a naturalistic, prospective project assessing objective and subjective dimensions of quality of life (QoL) and the range of its putative determinants in first-episode schizophrenia. Seventy-four patients, mean age 24.7 years, participated in the study. The patients were assessed 1 month following the first hospitalisation (Time 1), 12 months later (Time 2), and 4–6 years after Time 1 (Time 3). The Social Functioning Scale and World Health Organisation Quality of Life-BREF (WHOQOL-BREF) were applied to evaluate objective and subjective QoL, respectively. The Positive and Negative Syndrome Scale was used to examine psychopathological status, and the Global Assessment Scale was applied to evaluate social adjustment prior to hospitalisation. The objective and subjective QoL was relatively low at Time 1. Over time, the objective QoL improved in three domains, decreased in one domain, and remained stable in three domains. The subjective QoL did not change. The most important predictors of both dimensions of QoL were psychopathology and duration of untreated psychosis. Because psychopathology seems to have the greatest impact on the QoL, there is a need to develop community psychosocial treatment to reduce these symptoms and to support patients in the early phase of the disease.

Although poststroke fatigue concerns almost 60% of patients, still little is known about its pathogenesis and contributing factors. Therefore, the purpose of this study was to evaluate the severity of fatigue in terms of its impact on physical, psychological and social functioning as well as to determine the relation between fatigue and clinical, demographic and psychological factors.Patients (n = 50) with acute first-ever stroke admitted to the neurological department were interviewed at 3 months after discharge. Poststroke fatigue was assessed using the Polish version of the Fatigue Impact Scale. Neurological status was examined with the Scandinavian Stroke Scale, functional status with the Barthel Index, and emotional status with the Beck Depression Inventory. Styles of coping with stress were identified using the Coping Inventory for Stressful Situations. Sex, age, type of stroke and lesion location were documented as well.Ninety percent of patients demonstrated high level of fatigue in physical functioning, 16% in the psychological domain, and 18% in the social domain. In the univariate analyses, impact of fatigue on patients functioning significantly correlated with age, lower mood, neurological and functional status, as well as with styles of coping. Emotion-oriented coping was associated with lower level of fatigue, whereas the reverse was found regarding task-oriented coping. In the multivariate analyses the emotion-oriented style of coping was the most important correlate of fatigue.The causes of poststroke fatigue appear to be multifactorial. Psychological factors, especially coping strategies, might be an important area for future interventions.

An overall aim of treatment in multiple sclerosis is to minimize the negative impact of the disease on functioning and quality of life of patients. Therefore, a measurement of functioning and quality of life should be included in the evaluation of the effectiveness of treatment. In this paper, the most commonly used quality of life questionnaires, either generic or specific, are presented. The information about clinical and functional status are useful in the interpretation of the quality of life assessment results. Therefore, the instruments for the assessment of depression, cognitive functions, functional ability and fatigue in multiple sclerosis are also described.

Surviving of a stroke may be considered as a major stressful life event. Neurological and functional deficits often lead to a loss of independence, social alienation, depression and deterioration of the quality of life. Earlier correlational studies have shown that social support may mediate responses to stroke and improve patients' quality of life. The aim of this article was to review randomized controlled trials (RCTs) concerning the role of professional social support in the quality of life after stroke. The vast majority of the RCTs published in the last decade did not show any positive impact of support on the psychosocial consequences of a stroke. It does not mean, however, that professional support is necessarily ineffective. The reviewed RCTs may fail to detect benefits because of some methodological and theoretical limitations. There is a need of further research but more attention should be given to a power analysis, selection of an appropriate outcome measure and standardisation of a study procedure. It is also important to found research deliberately on existing social support theories.

The importance of social support for mentally ill people has been increasingly emphasized in recent years. This has resulted from studies showing that family and professional support plays an important role in preventing rehospitalizations and in improving quality of life of patients with schizophrenia. This article presents and analyses the findings of current research concerning the effectiveness of social support in rehabilitation programmes as well as highlights the problem of matching the type and quantity of social support provided to the patients' needs and to the phase of the disease.

A quadripartite concept, the Good Life for older people, was developed by the American psychologist M. P. Lawton and forms the theoretical framework of this study. Ninety Swedish and 93 Polish subjects, aged > or = 60 years who had reported locomotor disturbances in selected samples from the two countries, took part in the study. Interviews were performed using the Philadelphia Geriatric Center Multilevel Assessment Instrument (PGCMAI) and functional testing was done using the Standardized Practical Equipment (SPE). The Polish elderly scored lower in most domains of the PGCMAI, which meant a worse life situation according to the Good Life model. On the SPE, scoring was lower in the Polish group, mainly on items related to balance and mobility. There was a logic convergent validity between the PGCMAI and the SPE in the whole group. The somewhat more complicated life situation for the Polish elderly has to be further analysed.

Stroke is an important cause of morbidity and mortality in postmenopausal women. The aim of the study was to evaluate functional and psychological quality of life in women after a first-ever stroke as well as to identify independent predictors of post-stroke quality of life.Cross-sectional and correlational study.A group of 46 women (mean age 67.1 yrs) after a first-ever ischemic stroke was followed up for 6 months after the onset of the stroke. Quality of life was assessed with the Polish versions of Sickness Impact Profile and Quality of Life Index. The variables studied were neurological and functional status, depression, lateralization, age, gender, marital status, education, living arrangement, emotional support.The study has shown that the quality of life of investigated women was significantly worse than that of subjects' from a comparative group. Neurological status, depression and emotional support was the most important correlates of quality of life.Rehabilitation focused on fostering physical independency, treatment of depression and strengthening social support may be decisive factors in improving post-stroke quality of life.

Patients with major depression often report pain. In this article, we review the current literature regarding the prevalence and consequences, as well as the pathophysiology, of unexplained painful physical symptoms (UPPS) in patients with major depressive disorder (MDD). UPPS are experienced by approximately two-thirds of depressed patients. The presence of UPPS makes a correct diagnosis of depression more difficult. Moreover, UPPS are a predictor of a poor response to treatment and a more chronic course of depression. Pain, in the course of depression, also has a negative impact on functioning and quality of life. Frequent comorbidity of depression and UPPS has inspired the formulation of an hypothesis regarding a shared neurobiological mechanism of both conditions. Evidence from neuroimaging studies has shown that frontal-limbic dysfunction in depression may explain abnormal pain processing, leading to the presence of UPPS. Increased levels of proinflamatory cytokines and substance P in patients with MDD may also clarify the pathophysiology of UPPS. Finally, dysfunction of the descending serotonergic and noradrenergic pathways that normally suppress ascending sensations has been proposed as a core mechanism of UPPS. Psychological factors such as catastrophizing also play a role in both depression and chronic pain. Therefore, pharmacological treatment and/or cognitive therapy are recommended in the treatment of depression with UPPS. Some data suggest that serotonin and noradrenaline reuptake inhibitors (SNRIs) are more effective than selective serotonin reuptake inhibitors (SSRIs) in the alleviation of depression and UPPS. However, the pooled analysis of eight randomised clinical trials showed similar efficacy of duloxetine (an SNRI) and paroxetine (an SSRI) in reducing UPPS in depression. Further integrative studies examining genetic factors (e.g. polymorphisms of genes for interleukins, serotonin transporter and receptors), molecular factors (e.g. cytokines, substance P) and neuroimaging findings (e.g. functional studies during painful stimulation) might provide further explanation of the pathophysiology of UPPS in MDD and therefore facilitate the development of more effective methods of treatment.

Background and purpose The aim of the study was to evaluate quality of life (QoL) in multiple sclerosis (MS) patients and to assess the relationship between QoL and social support taking into account key clinical factors and other socio-demographic variables. Material and methods Two hundred and ten MS patients (150 women and 60 men) aged between 21 and 59 years were evaluated; the MS group was compared with 108 healthy controls. QoL (MSQOL-54), disease severity (Expanded Disability Status State, EDSS), social support (Social Provisions Scale, SPS), mood (Beck Depression Inventory, BDI) and basic clinical and demographic data were assessed. Results Disease severity was mild (EDSS 13) were present in 41% of patients. Mean physical health composite of MSQOL-54 was 53.6 ± 20.7 and mean mental health composite was 60.0 ± 19.8. MS patients scored significantly lower than healthy subjects. Mean SPS was 78.2 ± 10.9 (range, 6–96) which indicated high social support. In bivariate analysis, social support correlated significantly with the majority of MSQOL domains; in multivariate analysis, however, this relationship was not significant. Emotional well-being was the main predictor of QoL, in both physical and mental domains. Conclusions MS influences QoL but to a greater extent in the physical than the psychological domain. The role of social support in QoL is generally positive but its protective function may be weakened when interacting with other factors. Depression is the main predictor of QoL when adjusted for other factors. Thus, treatment of mood disturbances might significantly improve QoL in MS patients.