Search

The sediment flux through Himalayan rivers directly impacts water quality and is important for sustaining agriculture as well as maintaining drinking-water and hydropower generation. Despite the recent increase in demand for these resources, little is known about the triggers and sources of extreme sediment flux events, which lower water quality and account for extensive hydropower reservoir filling and turbine abrasion. Here, we present a comprehensive analysis of the spatiotemporal trends in suspended sediment flux based on daily data during the past decade (2001-2009) from four sites along the Sutlej River and from four of its main tributaries. In conjunction with satellite data depicting rainfall and snow cover, air temperature and earthquake records, and field observations, we infer climatic and geologic controls of peak suspended sediment concentration (SSC) events. Our study identifies three key findings: First, peak SSC events (≥99th SSC percentile) coincide frequently (57-80 %) with heavy rainstorms and account for about 30% of the suspended sediment flux in the semi-arid to arid interior of the orogen. Second, we observe an increase of suspended sediment flux from the Tibetan Plateau to the Himalayan Front at mean annual timescales. This sediment-flux gradient suggests that averaged, modern erosion in the western Himalaya is most pronounced at frontal regions, which are characterized by high monsoonal rainfall and thick soil cover. Third, in seven of eight catchments, we find an anticlockwise hysteresis loop of annual sediment flux variations with respect to river discharge, which appears to be related to enhanced glacial sediment evacuation during late summer. Our analysis emphasizes the importance of unconsolidated sediments in the high-elevation sector that can easily be mobilized by hydrometeorological events and higher glacialmeltwater contributions. In future climate change scenarios, including continuous glacial retreat and more frequent monsoonal rainstorms across the Himalaya, we expect an increase in peak SSC events, which will decrease the water quality and impact hydropower generation. [ABSTRACT FROM AUTHOR]

Soil erosion and sediment yield are strongly affected by land use/land cover (LULC). Spatially distributed erosion models are of great interest to assess the expected effect of LULC changes on soil erosion and sediment yield. However, they can only be applied if spatially distributed data is available for their calibration. In this study the soil erosion and sediment delivery model WATEM/SEDEM was applied to a small (2.84 km²) experimental catchment in the Central Spanish Pyrenees. Model calibration was performed based on a dataset of soil redistribution rates derived from point 137Cs inventories, allowing capture differences per land use in the main model parameters. Model calibration showed a good convergence to a global optimum in the parameter space, which was not possible to attain if only external (not spatially distributed) sediment yield data were available. Validation of the model results against seven years of recorded sediment yield at the catchment outlet was satisfactory. Two LULC scenarios were then modeled to reproduce land use at the beginning of the twentieth century and a hypothetic future scenario, and to compare the simulation results to the current LULC situation. The results show a reduction of about one order of magnitude in gross erosion (3180 to 350Mgyr-1) and sediment delivery (11.2 to 1.2Mgyr-1 ha-1) during the last decades as a result of the abandonment of traditional land uses (mostly agriculture) and subsequent vegetation recolonization. The simulation also allowed assessing differences in the sediment sources and sinks within the catchment. [ABSTRACT FROM AUTHOR]

A landslide affecting two small villages located on the Northwestern Italian Apennines has been investigated since the year 2000 through the use of different equipment. A complex monitoring system has been installed in the area. The system includes several inclinometers, piezometers and a raingauge. An Automatic Inclinometric System (AIS) has been also installed that automatically performs measurements, twice a day, along the entire length of a pipe that is 45m deep. This monitoring system has been set up to identify a methodology that allowed to deal with landslides, trying to predict their behaviour beforehand for warning purposes. Previous researches carried out in the same area for a period of about 7 months, in the year 2000, have allowed to identify a correlation between deep slope movements and rainfalls. In particular, it has been possible to determine the time lag needed for a rainfall peak to produce a corresponding peak of the landslide movements; this time lag was of 9 days. This result was possible because the AIS allows to obtain, as mentioned, daily inclinometric measurements that can be correlated with the recorded rainfalls. In the present report we have extended the analysis of the correlation between deep slope movements and rainfalls to a greater period of observation (2 years) to verify over this period the consistency of the time lag mentioned above. The time lag previously found has been confirmed. We have also examined the possibility to extend to the entire landslide body the correlation that has been found locally, analyzing the results of the remaining inclinometric tubes with traditional reading installed on the landslide and comparing them with the results of the AIS. The output of the tubes equipped with piezometric cells has also been analyzed. The relations existing among rainfalls, ground water level oscillations and the related slope movements have been explored. [ABSTRACT FROM AUTHOR]

Protection forests play an important role in mitigating the influence of natural hazards. Despite the growing need for protective functions due to aging forests and increased risk of natural disturbances, active forest management has become increasingly uncommon across the Alps. Active management of protection forests can be facilitated by state subsidies. This requires an objective delineation of forests with a direct protection function and the development of silvicultural techniques that mitigate natural hazards. A study of protection efficiency of beech-dominated forests in the Soteska gorge in NW Slovenia, where a main state road and railway are at risk from debris flows and rockfall, was performed. We assessed the starting points of debris-flow hazard based on a small-scale geological survey of the terrain characteristics and a local debris flow susceptibility map. We applied the TopRunDF model for determination of the run-out zones. Forest structure data were obtained from 26 sample plots. A detailed description and delineation of forest stands was performed. The results showed that these forests play an important role in the protection of infrastructure. Forest protection efficiency can be improved by stand thinning for stability and careful planning of regeneration patches over time and space. In areas where silvicultural measures cannot provide sufficient protection, technical measures are needed. Since these forests have not been managed for several decades, natural disturbances (windthrow) are frequent. Research findings suggest that regular assessment and management of these beech-dominated protection forests are necessary, contrary to the current practice of non-management in protection forests in Slovenia.

Limb amputation often results in a change of profession or withdrawal from the workforce. Occupational rehabilitation plays a key role in assisting individuals with finding, maintaining, and advancing in employment. The aim of this review was to determine the precise number of amputations performed in Poland from January 2014 to June 2022 and to present selected available rehabilitation programs aimed at the social reintegration of individuals after amputations, with a particular focus on vocational rehabilitation. The analysis was conducted in 2 stages. First, the team reviewed data obtained from the central IT system of the National Health Fund and analyzed it. Then, a literature review was conducted using English-language databases: PubMed, Scopus, Science Direct, Medline, and websites searched through Google Scholar and Google. A total of 29 sources (from the years 2006-2024) out of 75 found were analyzed. Articles were searched using the following keywords: "rehabilitation programs," "amputations," "occupational rehabilitation," "disability," "vocational activation," and "rehabilitation effectiveness." A significant number of amputations are performed in Poland. Individuals who undergo such procedures can benefit from occupational rehabilitation programs that facilitate a faster return to professional activity. It is crucial to develop and implement preventive measures aimed at reducing the incidence of amputations in Poland, as well as to introduce new vocational rehabilitation programs that will enable individuals with disabilities to return to professional activity more effectively and efficiently. Med Pr Work Health Saf. 2024;75(5):445-454., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Alcohol addiction is characterized by extensive alcohol consumption that dominates other behaviours previously important to a patient. According to data from The State Agency for Prevention of Alcohol-Related Problems, up to 900,000 people in Poland are addicted to alcohol. On average, approximately 9.7 L of pure alcohol per capita was consumed in 2021. Alcohol addiction may cause severe health problems and is one the key risk factors for various diseases. Stress plays an important role in the process of alcohol addiction and is also a predictor for lower enjoyment in life. On the other hand, sense of coherence may be a stronger protective factor. The aim of our study was to verify the relation between the level of perceived stress among patients with alcohol addiction and satisfaction with life. Because sense of coherence is a disposition that allows for managing stress effectively, the latter should be reflected in the results of multivariate analyses that take both the level of stress and sense of coherence into account. In the present study, sense of coherence and perceived stress were negatively correlated; therefore, strengthening internal resources for managing difficult and stressful situations is recommended.

Introduction: Current literature is inconclusive as to whether transversus abdominis (TrA) training can provide an additional benefit to pelvic floor muscle (PFM) training in female stress urinary incontinence (SUI). We designed a study to investigate the effect of PFM and TrA training on incontinence parameters., Material and Methods: 60 females with SUI were randomised to PFM training alone or PFM plus TrA training. They all attended 12 weekly training sessions by a single physical therapist and completed relevant questionnaires at baseline and study completion., Results: Both interventions reduced the number of incontinence episodes and improved quality of life (QoL) and sexual function. Women on PFM+TrA training reduced the number of used pads per day (p = 0.007), improved the QoL (p = 0.031) and the sexual lubrication score (p = 0.04), and reported better satisfaction rates compared to PFM alone (66.7% versus 43.3%). A subgroup analysis reported that women with pure SUI benefit more from combined PFM+TrA training compared to PFM alone (p = 0.04)., Conclusions: TrA add-on to PFM training was similar to PFM training alone in the reduction of incontinence episodes but was superior in reducing the number of pads needed, which suggests a beneficial effect on the severity of incontinence., Competing Interests: The authors declare no conflicts of interest., (Copyright by Polish Urological Association.)

Alcohol consumption is linked to over 200 diseases and injuries. It is also classified as a risk factor for several types of neoplasms as well as infectious diseases (i.e., HIV and tuberculosis). In 2019, among people aged 25 to 49, alcohol use was the leading risk factor for attributable burden of disease. There are many factors that affect alcohol drinking patterns such as social and economic status, social norms, cultural customs, availability of alcohol, etc. Stress also plays a significant role in the process of developing alcohol addiction. The aim of our study was to examine health patterns and stress levels among patients undergoing alcohol addiction treatment. The study sample consisted of 104 patients who were treated in a hospital ward due to alcohol dependence. Three standardized questionnaire tools were used to measure the sense of coherence and the level of stress among those patients. The main results suggest that the level of perceived stress correlated negatively with all dimensions of sense of coherence and all indicators of health behaviors, however, age was positively correlated with positive mental attitude, proper eating habits, and health behaviors. In conclusion, it is worth noting that developing patterns for positive health behaviors will make it possible to avoid alcohol dependence or reinforce the treatment results if alcohol dependence syndrome occurs.

(1) Background: Acceptance of illness is a process in which a person with an illness accepts its presence and treats it as an integral part of their life. With regard to alcoholism, acceptance of illness is one of the important elements of the healing process. (2) Methods: The study group consisted of 104 residents in an addiction treatment ward. Questionnaires SOC-29, AIS and PSS-10 were used to check levels of coherence, stress and acceptance of illness. The analysis was based on regression analysis. Patient age was analysed as a moderator of correlations between perceived indicators. Moderation analysis was based on the simple moderation model. (3) Results: The level of perceived stress correlated negatively with all areas of the sense of coherence and with acceptance of illness. All areas of the sense of coherence correlated with acceptance of illness positively. (4) Conclusions: The acceptance of illness by the patient is a factor that can be motivating for further treatment, through a positive approach to illness and strengthening the sense of control in experiencing it. The combination of strengthening behavioural, cognitive and motivational resources can be used in the treatment of people experiencing the challenges of addiction to alcohol.

The financial burden of adverse healthcare outcomes in Poland still remains unknown. The objective of the study was to estimate the cost of adverse healthcare outcomes in the Polish healthcare system. Cost calculation was performed on the basis of civil cases completed in Polish courts against doctors and healthcare entities. The research material consisted of 183 civil cases completed by a final judgment in 2011-2013. The case study was conducted in five out of forty-five district courts across the country. Out of 183 reviewed cases, 73 complaints ended up with favorable judgments (39.9%). The average value of the subject matter of the dispute was USD 78,675. The total expected value of lawsuits in the 183 reviewed cases was USD 11,299,020. The total amount awarded in 73 judgments from medical facilities to injured patients was USD 2,653,595, which on average means USD 36,351 per case. The average amount of awarded compensation was USD 33,317 per case. The average compensation amount in the analyzed cases was USD 11,724. The average one-time annuity for a patient was USD 11,788. The estimated costs of negative healthcare outcomes amounted to USD 8,000,000 per year.

Introduction: Alcohol dependence is one of the world's major health challenges. The salutogenic concept of health developed by Antonovsky focuses on the search for resources and factors supporting health. Its basic concept of the sense of coherence (SOC) focuses on strengthening the global orientation of the patient, and creating permanent internal resources that translate into the improvement of pro-health behavior, including the fight against alcoholism., Objective: The objective of this study was to determine the correlation between individual factors and the SOC as well as the influence of the SOC concept on pro-health behavior of people addicted to alcohol., Materials and Methods: The study group consisted of 110 men undergoing treatment in an addiction treatment ward. To check the level of the SOC, two standardized questionnaires, Antonovsky's "SOC-29 Life Orientation Questionnaire" and Juczyński's "Health Behaviour Inventory", were used. The correlation coefficient between the sociodemographic variables was checked using the Pearson's r test., Results: A positive correlation was found with the intensity of pro-health behaviors for three sociodemographic variables. In people aged 43-65 (r = 0.299; p = 0.030), people with primary/vocational education (r = 0.276; p = 0.015), and respondents living in rural areas (r = 0.303; p = 0.028) a greater SOC was associated with pro-health behaviors., Conclusions: Individuals addicted to alcohol are characterized by a low SOC and a low level of pro-health behaviors. Strengthening the internal level of the SOC can constitute an element of addiction therapy when introducing health education to prepare the patient for independent life in sobriety.

Introduction and Objective: Cancer triggers many negative emotions in patients which affect the quality of life and low acceptance of the illness. The level of acceptance of illness is related to the level of pain and the degree of compliance with medical recommendations. The aim of the study is evaluation of the use of the Acceptance of Illness Scale (AIS) among people with cancer., Material and Methods: The study involved 1,187 patients (666 women aged 21-96 (M=58.17; SD=12.88) and 521 men aged 22-96 (M=67.12; SD=13.75) diagnosed with malignant cancer under outpatient care of the Maria Sklodowska-Curie Institute - Oncology Center in Warsaw. An acceptance of illness questionnaire developed by B. J. Felton, T. A. Revensson and G. A. Hinrichsen was used., Results: Socio-economic (education, place of residence, income, professional status) and medical (occurrence of metastases, type of treatment used) factors affect the level of acceptance of illness by patients. Stent standards were developed to determine the level of acceptance of illness in the low-average-high categories., Conclusions: The Acceptance of Illness Scale (AIS) should be used in the case of cancer patients. Assessment of the patient's acceptance of illness, as well as the factors affecting acceptance, will allow for the planning of appropriate treatment and psychotherapeutic support for specific patients, whose level of acceptance of illnes is the lowest.

BACKGROUND During the current Coronavirus Disease 2019 (COVID-19) pandemic, falls have been identified as a potential presenting symptom in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection; however, data on factors increasing fall risk in this patient population are limited. This study aimed to examine the factors that may predispose hospitalized COVID-19 disease patients to falls. MATERIAL AND METHODS In this retrospective observational study, hospitalized COVID-19 disease patients were examined for fall incidence, as well as demographics, comorbidities, and clinical and laboratory data. Patients were stratified according to their fall status and their characteristics were compared using Fisher's exact test or Mann-Whitney U test. A total of 312 hospitalized COVID-19 disease patients were enrolled (median age, 75 years; males, 51.3%), of whom 11 (3.5%) fell. RESULTS There was a greater prevalence of falls among patients who experienced arrhythmias than those that did not (28.6% vs 1.7%; P<0.001). Additionally, a significantly greater proportion of those that were discharged to the internal ward and to the intensive care unit fell (10.3% and 10.0%, respectively) compared to those that were discharged home (1.6%, P=0.008). Thyroid-stimulating hormone (TSH) was significantly elevated in patients who fell (5.3 vs 0.97 µIU/mL, P=0.013), while alanine aminotransferase (ALT) was significantly lower in those who fell (17.1 vs 33.5 IU/L, P=0.041). CONCLUSIONS Arrhythmias may be an important predisposing factor for falls in COVID-19 disease patients and fall prevention programs should prioritize interventions directed at this vulnerable patient population.

Background: Breast, ovarian, and endometrial cancer are among the most common causes of morbidity and mortality of women in Poland. In 2016, breast cancer was the most common cause of morbidity and the second leading cause of cancer deaths in women, endometrial cancer was the third most common cause of morbidity and the seventh leading cause of death, and ovarian cancer was the fifth most common cause of morbidity and the fourth leading cause of cancer deaths in women. The aim of the study was to assess the strategy of pain control, acceptance of the cancer and adjustment to life with disease in women with ovarian cancer, endometrial and breast cancer. This study shows how level of pain control, acceptance, and adjustment can differ among patients with the three kinds of cancer and which factors have the most influence on patients' adjustment to the disease., Methods: The study was carried out with 481 patients diagnosed with ovarian cancer, endometrial and breast cancer. In the study BPCQ, CSQ, AIS and Mini-MAC questionnaires were used., Results: In the BPCQ questionnaire the highest result was acquired in the scope of the impact of doctors (M = 16.45, SD = 4.30), differentiated by cancer location and socio-economic variables. In the CSQ test, the highest result was achieved by praying/hoping, differentiated by cancer location and socio-economic variables. The average AIS acceptance score was M = 27.48 (SD = 7.68). The highest result of the Mini-Mac scale was obtained by patients in the area of fighting spirit (M = 22.94, SD = 3.62), and these results depended on socio-economic and treatment-related variables but were not differentiated by cancer location., Conclusions: Patients attribute the highest importance in the disease to the influence of physicians, praying/hoping, and fighting spirit. The awareness of the pain management strategies of patients with cancer allows appropriate psychological support to be designed for specific groups of patients.

Introduction: Although falls occur extremely frequently, they are still one of the least investigated causes of death. According to the World Health Organization, around 37.3 million falls occur globally every year resulting in the deaths of over 660,000 adults and almost 30,000 children., Objective: The aim of this review is to evaluate the most up-to-date and comprehensive knowledge on falls and their consequences, especially in populations at the highest risk of fatal falls., Brief Description of State of Knowledge: Currently, there is a limited amount of literature which analyzes falls. Falls affect all age groups, but their location, cause, and severity vary among different populations. Individuals who are particularly at risk of falling at home include younger children and the elderly. Research indicates that falls are one of the main causes of work-related injuries and deaths, especially those occurring at significant heights. Falls in the home environment are the second most common cause of death in over 33% of accidents and the main cause of injury in 41.2% of accidents. During patient hospitalizations, falls generate additional burdens and costs on the healthcare system., Conclusions: This review elaborated on the nature of falls in different populations and analyzed the influence falls have on the healthcare system, in society, and on the economy. This knowledge is particularly important in an aging society, which will inevitably face increasing problems due to falls in the near future. As the emphasis on falls increases, leaders and lawmakers will be pushed to establish individualized prevention measures, as described in this review, for specific risk groups to effectively prevent falls and their consequences.

Background: Inpatient falls are common hospital adverse events. We aimed to determine inpatient fall rates in an urban public hospital and analyzed their characteristics across clinical departments., Methods: The study was conducted in a 350-bed urban, multi-specialty public hospital in the 2013-2019 period. Patient data were retrieved from the hospital's standardized falls reporting system. Descriptive statistics and statistical tests: chi2 and ANOVA tests with multiple comparison tests (post-hoc analysis) were used. For fall incidence estimation a joint-point regression was applied. p -value of 0.05 was considered as statistically significant for all the calculations., Results: The highest prevalence of falls was reported in the rehabilitation and internal medicine wards (1.915% and 1.181%, respectively), the lowest in the orthopedic (0.145%) and rheumatology wards (0.213%) ( p < 0.001). The vast majority of falls took place in the late evening and during the night (56.711%) and were classified as bed falls (55.858%). The crude incidence rate (cIR) of falls was 6.484 per one thousand hospitalizations. In the 2013-2017 period, an increase in total cIR was observed, reaching the peak value in 2016; it was followed by a slight decline from 2017 to 2019, however, differences in changes were observed between the wards., Conclusion: Fall rates and trends as well as circumstances of inpatient falls varied significantly among clinical departments, probably due to differences in patient characteristics., Competing Interests: The authors declare no conflicts of interest.

Falls are associated with increased morbidity and mortality, rising hospital readmission rates, decreased patient independence, and strained healthcare resources. In aged populations and individuals with multimorbidity, cardiovascular conditions may contribute towards an increased propensity to fall. The prevalence of cardiovascular conditions generally increases with age, and understanding potential fall risk factors may help to minimize the risk of falls and develop preventive interventions. Acting on even one such risk factor or introducing an appropriate intervention may reduce the overall propensity for a patient to fall. Further prevention strategies primed towards cardiovascular ailments should be elucidated and trialed.

Introduction: Currently, invasive cardiology techniques are the preferred method of treatment for patients with ST-elevation myocardial infarction (STEMI). Improving the care of patients with STEMI is possible by minimizing the time that elapses from the onset of pain to the start of treatment. As studies indicate, early pharmacotherapy, especially with antiplatelet and anticoagulant medications, allows for their early effectiveness., Aim: To assess the influence of early administration of antiplatelet (clopidogrel) and anticoagulant medications in the pre-hospital period in patients with ST-elevated myocardial infarction on the frequency of in-hospital deaths and on the left ventricular ejection fraction evaluated at hospital discharge., Material and Methods: In this study, a retrospective analysis of 573 patients hospitalized due to ST-segment elevation myocardial infarction in one of Krakow's hospitals from January 2011 to December 2015 (excluding the whole of 2013) was used as a research method., Results: As many as 97% of patients received pre-hospital pharmacotherapy, but only 46.0% of respondents received unfractionated heparin, and 19.2% received clopidogrel. The in-hospital mortality rate was 6.7%, but among patients prehospitally treated with clopidogrel and unfractionated heparin, the in-hospital mortality rate was 1.1%. Prehospital administration of clopidogrel significantly decreased the possibility of reduced left ventricular ejection fraction (OR = 0.27; 95% CI: 0.09-0.90)., Conclusions: Among pre-hospital procedures, only administration of a second antiplatelet drug (clopidogrel) significantly decreased the risk of reduced left ventricular ejection fraction, and administration of clopidogrel or heparin, or a combination of both, significantly decreased the risk of in-hospital death in patients with STEMI., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2021 Termedia Sp. z o. o.)

Purpose: The aim of this work was to evaluate postural stability on the balance platform averagely 2 years following meniscal repair., Methods: This is a retrospective, case-control comparative analysis of patients who underwent surgical repair for the isolated longitudinal traumatic meniscal tear versus matched healthy controls. The study group consisted of 30 patients (mean age 29.93 years; averagely 2.3 years after surgery) and the control group - of 30 people. Following physical examination and completion of the IKDC, and the Lysholm questionnaires, the evaluation of the postural stability using two single-leg stabilometry tests was performed. In the static test, the analyzed variables included deviations from the horizontal, vertical axes and the length of the balance path travelled. In the dynamic test, the length of the path travelled and the time to complete task were recorded. Between-limb and between-groups comparison of collected stabilometry tests were performed. Additionally, the IKDC and the Lysholm questionnaires scores were compared between the study and heathy groups., Results: No abnormalities were found on clinical examination in the study group nor any differences between the operated and contralateral knee ( p > 0.05). In stabilometry: (1) in the study group, the operated extremity scored worse than the contralateral limb (length of path traveled in: A) static test x = 56.7 cm SD = 37.91 cm vs. x = 21.6 cm SD = 9.06 cm; p = 0.002 and B) dynamic test x = 82.57 cm, SD = 50.43 cm vs. x = 53.32 cm, SD = 13.82 cm; p = 0.003); (2) In the control group, no leg-related differences were noted ( p > 0.05); (3) Between-group comparison revealed that the study group scored worse than the control group (length of path traveled in: A) static test x = 56.7 cm, SD = 37.91 cm vs. x = 17.23 cm, SD = 3.39 cm; p = 0.001 and B) dynamic test x = 82.57 cm, SD = 50.43 cm vs. x = 32.13 cm, SD = 9.41 cm; p < 0.001). Study group scored worse on IKDC scores ( p < 0.001) but not on Lysholm score ( p > 0.05)., Conclusions: Postural stability deficit persists despite a successful meniscal repair.

Introduction: An adverse event is an incident induced while providing health care services or resulting from it, not related to the natural course of a given disease or health condition, which causes or is likely to cause negative consequences for the patient, including their death, a threat to life, the necessity of hospitalisation or its prolongation, permanent or considerable health detriment; or is a foetal disease, congenital defect or the result of foetal damage., Objective: The aim of this analysis is to explore the problem of the occurrence of adverse events from the perspective of doctors and ward nurses who manage wards., Material and Methods: The research on the occurrence of adverse events among doctors and nurses (the management staff) was conducted with the use of a postal survey., Results: It was ascertained that 86.5% of the medical personnel had taken part in an adverse event, of which 20.2% took part in an occurrence associated with pharmacotherapy, 16.2% - in an event related to diagnostics and diagnosis, or an infection - 15.7%. 14.2% of respondents were involved in an occurrence linked to a medical device malfunction, and 14.1% - in an adverse event related to an operation., Conclusions: The adverse events most often identified in the nursing professional group are occurrences associated with pharmacotherapy, and in the doctors' professional group - occurrences related to diagnostics and diagnosis. The research established that the most frequent reason for not informing patients about the occurrence of an adverse event is fear of their filing a complaint. Medical management staff show high acceptance of an adverse event reporting system as a tool for improving patient safety.

BACKGROUND The aim of our study was to investigate the risk factors for falls in the rheumatoid arthritis (RA) patient population in Poland. This would be a major step towards the development of new fall prevention programs. MATERIAL AND METHODS There were 450 RA patients who met the criteria of the American College of Rheumatology who participated in this study. The average age of patient participants was 54.2 years; the average RA duration was 15.1 years. All patients filled out the study questionnaire regarding falls, medications, and diseases, and they filled out the Polish version of the Health Assessment Questionnaire (HAQ). RESULTS Of the 400 patients, 203 patients (51%) experienced falls. Out of the 268 falls experienced by study patients, 113 falls (42%) were due to an environmental cause, the remainder 155 falls were caused by health conditions. The number of falls positively correlated with HAQ scores (r=0.42, P<0.01) and the duration of RA (r=0.39, P<0.05). For individuals who had fallen 3 or more times, there was a stronger positive correlation between the number of falls and the total HAQ score (r=0.61, P<0.01). The main risk factors for falls in the study group were dizziness (odds ratio [OR]=3.42), the use of hypotensive medication (OR=2.82), foot deformities (OR=4.09), and a high HAQ score (OR=2.59). Other factors such as drug use (e.g., glucocorticoids), pain, and duration of RA were measured using a visual analogue scale, and were found not to have increased the risk for falls and fractures (P>0.05). CONCLUSIONS Knowledge about risk factors can help identify high-risk patients to help decrease their risk of falling, thus preventing fall-related injuries.

Introduction and Objective: Lymph node involvement is a strong predictor of disease recurrence and patient survival in vulvar cancer. The aim of the study was to evaluate the feasibility of sentinel lymph node (SLN) screening, the incidence of skip metastases, and lymph node lymphangiogenesis., Material and Methods: Fifty-five patients participated in this prospective, single centre study. A double SLN screening method was employed using radiocolloid (technetium-99 sulfur colloid) and 1.0% Isosulfan Blue. Immunohistochemistry, using a mouse monoclonal antibody against D2-40, was used to evaluate lymphatic vessel density (LVD). All calculations were performed using STATISTICA software v. 10 (StatSoft, USA, 2011); p < 0.05 was considered significant., Results: Using both methods of SLN detection, 100% accuracy was achieved, and skip metastases were diagnosed in only one woman (1.82%). Peri-tumour median LVD was significantly increased compared with matched intra-tumour samples (p < 0.001), while median LVD was significantly lower in negative, compared with positive SLN, regardless of whether matched non-SLN were negative (p < 0.001) or positive (p = 0.005). Metastatic SLN exhibited significantly higher median LVD compared with matched negative non-SLN (p = 0.015), while no significant difference in median LVD was detected between positive SLN and matched positive non-SLN. However, negative SLN had a significantly higher median LVD compared with matched negative non-SLN (p = 0.012)., Conclusions: SLN detection is a safe and feasible procedure in vulvar cancer. In patients without nodular involvement, SLN, compared with non-SLN, exhibited significantly higher median LVD, which may be an indication of its preparation to host metastases, and thus requires further investigation.

Objective: The purpose of this study was to estimate the prevalence of presenteeism in patients with communicable diseases in Poland., Subject and Methods: This study was based on data from the medical records of 2,529 patients aged 19-64 years. All of the patients were diagnosed with communicable diseases. The inclusion criteria were based on implementing decision concerning communicable diseases made by the Commission of the European Union. Associations between refusal to take sick leave and patients' age, gender, and diagnosis in terms of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) were tested. Linear regression analysis of the data acquired from the patients who agreed to take sick leave was further used to estimate the possible length of sick leave in patients who refused to take it., Results: The number of patients who refused to take sick leave was 18.1%. The presenteeism rate was related to the age of patients (periods of sick leave were longer in older patients) and the ICD-10 diagnosis (largely in bacterial intestinal infections and measles). The estimated number of days spent on sick leave in patients who refused to take it, assuming that they made a different decision and complied with it, was in the range of 4-6 days., Conclusion: The prevalence of presenteeism in the case of communicable diseases in Poland is lower than in the general population. However, as the refusals to take sick leave took place in the case of potentially contagious diseases, the negative impact on productivity may be significant., (© 2019 The Author(s) Published by S. Karger AG, Basel.)

Background: Cardiovascular disease accounts for nearly half of all deaths in Poland. The aim of this study was to assess both the duration and the delays of prehospital treatment in ST-segment elevation myocardial infarction (STEMI) patients and how it impacts left ventricle ejection fraction (LVEF) measured at the time of discharge and the frequency of in-hospital patient mortality., Methods: This study retrospectively analyzed medical records from January 2011 to December 2015 (excluding the year 2013) of 573 patients who were transported to a hospital with a diagnosis of STEMI., Results: The mean time of prehospital system delays was 59 min with a maximum time of 152 min and a minimum time of 23 min. The relationship between reduced LVEF (< 55%) and in-hospital patient mortality and the relationship between length of time from first medical contact (FMC) to hospital admission was analysed in 515 respondents. Extending the time of FMC to hospital admission by 1 min increased the chances of lowering LVEF by 2% (95% CI: 1.004-1.041) and increased the chances of death by 2% (95% CI: 1.002-1.04) in STEMI patients., Conclusions: This study emphasised how vital it is to minimise time spent with STEMI patients at the scene of their cardiovascular event by performing an ECG as quickly as possible and by immediately transporting the patient to the hospital with the targeted treatment. This may lead to the implementation of additional training in the field of ECG interpretation, increase the prevalence of teletransmission systems, and improve communication between Emergency Medical Services (EMS) and catheterization laboratories ultimately reducing patient mortality.

Introduction: Occupational burnout is a multifaceted phenomenon and a problem often encountered among medical personnel. An example of such a group are workers of the Emergency Medical Services (EMS). The aim of the present study was to make an attempt to assess the level of job burnout among professionally active employees of the EMS and to compare the different occupational groups (paramedics, nurses of the system, doctors of the system) according to four analyzed factors., Material and Methods: A cross-sectional study was performed using an on-line questionnaire. Four factors impacting the level of burnout were analyzed: 1) attitude to work; 2) workload; 3) contact with the patient; 4) attitude to stress). The minimum possible result on the scale is 36 points and the maximum - 252. Data were analysed by means of the Cronbach's alpha coefficient, the Spearman correlation, the Ramsey RESET test, the Chow test, VIF statistics., Results: The average score for occupational burnout was 131.0 points (SD ± 31.47). The tool's reliability measured by means of Cronbach's alpha was 0.910). Both nurses and doctors obtained higher results throughout the scale (β stand. 0.147 and 0.215). Significant differences were shown between the group working only in the Helicopter Emergency Medical Service (HEMS) teams and the other services (land EMS, emergency rooms, etc.) at the level of p < 0.000., Conclusions: EMS employees encounter varying degrees of threat by occupational burnout. Doctors working in the system are shown to have the highest level of burnout, while paramedics the lowest. Among all the jobs analyzed, the lowest level of occupational burnout has been demonstrated by employees of HEMS.

Introduction: Ability to work is most often defined as a relationship between a person's resources and requirements specific to a particular type of work. It is the result of interaction between job requirements in terms of physical and mental strain, capabilities and skills of the employee, as well as his/her health condition and own evaluation of functioning in a given organizational and social situation., Objective: The primary objective of the study was to evaluate the current value of the Work Ability Index (WAI) in a sample of employees in Poland., Material and Methods: The study sample was selected purposefully from 422,000 employees covered by the largest occupational health provider in Poland. The standard WAI questionnaire provided by CAWI (Computer-Assisted Web Interview) methodology was voluntary and completed anonymously by 688 employees within 12 months (0.16% response rate). The results were statistically analyzed using the Pearson's chi-squared test and correlation coefficient, independent-sample T test and one-way analysis of variance (p<0.05)., Results: It was found that the average value of WAI was 37.5 ± 7.7, and 37% of the participants represented low to moderate ability to work. The results showed no significant correlation between the WAI value and its 7 compounds and demographic variables. Nonetheless, a dependency between WAI level and industrial branch was observed., Conclusions: Subjects with moderate and low WAI (1/3 of the study population) had particular indications to implement prophylactic actions, especially for the health care employees and civil servants, whose ability to work may be subject to accelerated deterioration.

Introduction: DNA fragmentation factors 40 and 45 (DFF40 and DFF45) are final executors of apoptosis, and B-cell lymphoma 2 (Bcl-2) is a well-recognized apoptosis inhibitor. We aimed to evaluate DFF40, DFF45 and Bcl-2 immunoexpression in the normal human endometrium with respect to the glandular and stromal layer and in uterine myometrium., Material and Methods: DFF40, DFF45, and Bcl-2 expression was assessed via immunohistochemistry in the endometrium and myometrium collected postmenopausally and premenopausally during the proliferative and secretory phases of the menstrual cycle., Results: Compared to the myometrium and stroma, endometrial glands showed the highest DFF40 and DFF45 expression in pre- and postmenopausal specimens. DFF45, but not DFF40, glandular expression dependent on menstrual cycle phase and DFF40 and DFF45 scoring was significantly lower in postmenopausal specimens. Significantly higher Bcl-2 expression was observed in proliferative glandular endometrium compared to secretory and postmenopausal specimens. No cycle- or menopause-dependent changes were reported for stromal or myometrial DFF40, DFF45 or Bcl-2 expression. DFF40, DFF45 and Bcl-2 expression was independent of age, age at menarche and menopause, BMI, menstrual cycle and menses lengths, parity and gravidity., Conclusions: The study provides important evidence regarding menstrual cycle-dependent changes in the expression of DFF40, DFF45 and Bcl-2 in the normal human endometrium, especially in the glandular layer, and shows that their levels are stable in the normal uterine myometrium., Competing Interests: The authors declare no conflict of interest.

Introduction: Hepatitis A (HA) is caused by infection with the hepatitis A virus (HAV). The differential etiological diagnosis of acute hepatitis is based on a positive result of the serological test detecting IgM class anti-HAV. For epidemiological studies on past infection and seroprevalence of HAV in populations, the tests measuring IgG class anti-HAV or total anti-HAV are used. Since the 1990s, specific prophylaxis is possible by vaccination against HA. In Poland, vaccination is recommended and in majority is performed at own cost., Material and Methods: Database was obtained from electronic medical records of the 2 major private health care providers networks (Luxmed and Medicover) operating in Poland. During a 3-year period (2013-2015), 1,124 persons with unknown status of anti-HA vaccination were tested for the presence of total anti-HAV. Objective. The aim of the study was to evaluate the seroprevalence of anti-HAV among working professionals in Poland., Results: Anti-HAV were detected in 603 (53.6%) persons, while 521 (46.3%) tested negative. The study group was divided into 2 subgroups: 25-44 and 45-64-years-old. For detailed statistical analysis, the presence of anti-HAV was considered as a dependent variable, and its predictors were gender, age and the year of the test performance. The presence of anti-HAV was significantly more prevalent in older age group. The lack of specific antibodies was more prevalent in younger age group., Conclusions: Results of the study show increasing susceptibility to HAV infection in the younger age group, compared with the older age group of corporate professional employees in large cities in Poland. Since the epidemiological situation of HA is currently changing with increasing number of symptomatic cases of HA, it is suggested that employers might consider including an additional procedure of vaccination against HA into their private health insurance portfolio.

Introduction: Absenteeism and presenteeism are two main phenomena related to health problems and professional activity. Presenteeism is the involvement in a professional activity despite being ill. The purpose of the current study is to estimate the prevalence of presenteeism in Poland on the basis of medical records and to explore associations between presenteeism and patients' age, gender and type of medical problem. Another purpose is to provide estimates of the length of sick leave if it was accepted., Results: The amount of patients who refused to take a sick leave was 27.4%. There was a minor relationship between the refusals and gender (slightly higher in men) as well as strong effects of the age of patients (periods of sick leave were longer in older patients) and ICD-10 diagnosis (largely in acute diseases of the upper respiratory tract). The estimated number of days spent on sick leave in the group of patients that refused to take it, assuming that they made a different decision and complied to it, was in the range between 5 and 10 days., Discussion: The prevalence of presenteeism in Poland is relatively high. Since the largest proportion of refusals took place in the case of potentially contagious diseases, the negative impact on productivity may be even higher. Even though the relationship between presenteeism and wages remains unclear, the remarkable increase of wages in Poland within the last 20 years may explain the propensity to work despite being ill. Further research needs to consider the simultaneous use of medical records and self-measured productivity loss., Materials and Methods: The current study is based on data from medical records concerning 550,360 patients aged 19-64. Associations between refusals to take a sick leave and patients' age, gender, as well as diagnosis in terms of ICD-10 (International Statistical Classification of Diseases and Related Health Problems), were tested. Linear regression analysis on the data acquired from the patients who accepted to take a sick leave were further used to estimate the possible length of sick leave in the group of patients that refused to take it., Competing Interests: CONFLICTS OF INTEREST The authors declare no conflicts of interest.