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Katarzyna Lomper,1 Mariusz Chabowski,2 Anna Chudiak,1 Artur Białoszewski,3 Krzysztof Dudek,4 Beata Jankowska-Polańska1 1Division of Nursing of Internal Diseases, Department of Clinical Nursing, Faculty of Health Science, Wrocław Medical University, Wrocław, Poland; 2Division of Surgical Procedures, Department of Clinical Nursing, Faculty of Health Science, Wrocław Medical University, Wrocław, Poland; 3Department of Prevention of Environmental Hazards and Allergology, Warsaw Medical University, Warsaw, Poland; 4Faculty of Mechanical Engineering, Wrocław University of Science and Technology, Wrocław, Poland Background: Only 50%–75% of chronically ill patients take their medication as prescribed. The patient is found to adhere to treatment correctly and optimally if they accomplish 80% or more of the treatment plan. A questionnaire titled the Adherence to Refills and Medications Scale (ARMS) has been used in studies involving various populations and proved to be a simple instrument for measuring adherence, with good psychometric properties. Objective: The aim of this study was to develop a Polish version of the ARMS (ARMS-P), an instrument that identifies levels of adherence in the hypertensive population, and evaluate its psychometric properties. Methods: This cross-sectional study included 279 patients, including 166 females (mean age 66.5 years), hospitalized between September 2016 and March 2017 in the Department of Internal Medicine, Occupational Diseases, and Hypertension of Wroclaw Medical University, Poland. The 12-item ARMS was translated from English into Polish. The 12 items included in the final questionnaire comprise two subscales: adherence to taking medications (eight items) and adherence to refilling prescriptions (four items). Results: Patients in the good-adherence group were younger (P=0.017; P=0.048), more likely to be professionally active (P=0.041), better educated (P=0.037), and more likely to have normal blood pressure (P

Maria Łoboz-Rudnicka,1 Joanna Jaroch,1 Ewa Kruszyńska,1 Zbigniew Bociąga,1 Barbara Rzyczkowska,1 Krzysztof Dudek,2 Andrzej Szuba,3 Krystyna Łoboz-Grudzień1,4 1Department of Cardiology, T. Marciniak Hospital, Wrocław, Poland; 2Faculty of Mechanical Engineering, Wrocław University of Technology, Wrocław, Poland; 3Division of Angiology, Wrocław Medical University, Wrocław, Poland; 4Public Health Department, Wrocław Medical University, Wrocław, Poland Background: In recent years, there has been growing interest in the impact of gender-related factors on the function and structure of the arterial tree. The aim of our study was to identify gender-specific differences in the progression of carotid stiffness parameters with age and in the impact of risk factors on carotid stiffness. Subjects and methods: The study group included 256 subjects (mean age: 54.7 years): 134 women (52%) and 122 men (48%) with cardiovascular risk factors: hypertension, type 2 diabetes mellitus, dyslipidemia, smoking, and obesity. Local parameters of carotid stiffness: β stiffness index (β), Peterson’s elastic modulus (Ep), pulse wave velocity β (PWV-β) and arterial compliance (AC) were determined with ultrasound echo-tracking software application. Results: Women were characterized by lower AC than men (women: 0.57 mm2/kPa vs men: 0.69 mm2/kPa, p < 0.001) and the subanalysis in three age groups revealed that the difference in AC value between genders became significant over the age of 45 years. Although no significant difference in the value of β, Ep and PWV-β were found between genders in the whole study group, women

Beata Jankowska-Polańska,1 Anna Chudiak,1 Izabella Uchmanowicz,1 Krzysztof Dudek,2 Grzegorz Mazur3 1Department of Clinical Nursing, Wroclaw Medical University, 2Department of Logistics and Transport Systems, Faculty of Mechanical Engineering, Wroclaw University of Technology, 3Department and Clinic of Internal and Occupational Diseases and Hypertension, Wroclaw Medical University, Wroclaw, Poland Background: Low adherence to hypertension (HT) management is one of the major contributors to poor blood pressure (BP) control. Approximately 40%–60% of patients with HT do not follow the prescribed treatment. The aim of the study was to analyze the relationship between selected variables and adherence to hypotensive pharmacological treatment. Besides socioclinical variables, the study focused on the role of illness acceptance.Participants and methods: The study included 602 patients with HT. Adherence and acceptance of illness were assessed using the following validated instruments: the Acceptance of Illness Scale (AIS) and the Morisky Medication Adherence Scale (MMAS).Results: The high-adherence group comprised a significantly higher percentage of patients with high illness acceptance scale scores than that of patients with low-to-moderate scores (42.4 vs 31.8%; P=0.0081.5 times as likely to occur in the high acceptance group as in the low-to-moderate acceptance group (OR =1.58, 95% CI 1.14–2.19). Spearman’s rank correlation coefficients showed statistically significant correlations between adherence and sex (men ρ=–0.101; P=0.012), age >45–66 years (ρ=0.098; P=0.015), higher education level (ρ=0.132; P=0.001), grade ESC of HT (ρ=–0.037; P=0.057), receiving one-tablet polytherapy (ρ=0.131; P=0.015), and illness acceptance (ρ=0.090; P=0.024).Conclusion: Acceptance of illness is correlated with adherence to pharmacological treatment, and consideration should be given to more widespread assessment of illness acceptance in daily practice. Male sex, age >45–66 years, duration of illness grade ESC of HT, and receiving one-tablet polytherapy are significant determinants of adherence to pharmacological treatment in HT. Keywords: adherence, hypertensive treatment, illness acceptance

Beata Jankowska-Polańska,1 Krzysztof Dudek,2 Anna Szymanska-Chabowska,3 Izabella Uchmanowicz1 1Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 2Department of Logistic and Transport Systems, Faculty of Mechanical Engineering, Wroclaw University of Technology, 3Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland Background: Hypertension affects about 80% of people older than 80 years; however, diagnosis and treatment are difficult because about 55% of them do not adhere to treatment recommendations due to low socioeconomic status, comorbidities, age, physical limitations, and frailty syndrome.Aims: The purposes of this study were to evaluate the influence of frailty on medication adherence among elderly hypertensive patients and to assess whether other factors influence adherence in this group of patients.Methods and results: The study included 296 patients (mean age 68.8±8.0) divided into frail (n=198) and non-frail (n=98) groups. The Polish versions of the Tilburg Frailty Indicator (TFI) for frailty assessment and 8-item Morisky Medication Adherence Scale for adherence assessment were used. The frail patients had lower medication adherence in comparison to the non-frail subjects (6.60±1.89 vs 7.11±1.42; P=0.028). Spearman’s rank correlation coefficients showed that significant determinants with negative influence on the level of adherence were physical (rho =-0.117), psychological (rho =-0.183), and social domain (rho =-0.163) of TFI as well as the total score of the questionnaire (rho =-0.183). However, multiple regression analysis revealed that only knowledge about complications of untreated hypertension (β=0.395) and satisfaction with the home environment (β=0.897) were found to be independent stimulants of adherence level.Conclusion: Frailty is highly prevalent among elderly hypertensive patients. Higher level of frailty among elderly patients can be considered as a determinant of lower adherence. However, social support and knowledge about complications of untreated hypertension are the most important independent determinants of adherence to pharmacological treatment. Keywords: frailty syndrome, ageing, hypertension, medication adherence, geriatric syndrome

Beata Jankowska-Polańska,1 Izabella Uchmanowicz,1 Krzysztof Dudek,2 Grzegorz Mazur3 1Department of Clinical Nursing, Wroclaw Medical University, 2Department of Transport Systems, Faculty of Mechanical Engineering, Wroclaw University of Technology, 3Department and Clinic of Internal and Occupational Diseases and Hypertension, Wroclaw Medical University, Wroclaw, Poland Objective: The purpose of this study was to investigate the relationship between knowledge on arterial hypertension (AH) and its management, and adherence to pharmaceutical treatment. Methods: The study included 233 patients diagnosed with AH and treated with hypotensive drugs for at least 1 year. The 8-item © Morisky Medication Adherence Scale (MMAS-8) and the Hypertension Knowledge-Level Scale (HK-LS) were used.Results: Sixty-three percent of the patients had a low level of knowledge on AH, with the smallest proportion of correct answers provided for items related to non-pharmaceutical treatment, diet, hypertension definition, and drug adherence. When compared to patients with a high level of knowledge, those with a low knowledge had lower scores in the MMAS (6.45±1.45 vs 7.08±1.04; P=0.038). Multiple-factor analysis showed that statistically significant independent determinants of good adherence included a high level of knowledge (β=0.208; P=0.001), non-pharmaceutical treatment (β=0.182; P=0.006), and frequent blood pressure measurements (β=0.183; P=0.004). The most significant factor in MMAS was knowledge in the “drug adherence” domain (ρ=0.303; P

Beata Jankowska-Polanska,1 Izabella Uchmanowicz,1 Anna Chudiak,1 Krzysztof Dudek,2 Donald E Morisky,3 Anna Szymanska-Chabowska4 1Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland; 2Department of Logistic and Transport Systems, Faculty of Mechanical Engineering, Wroclaw University of Technology, Wroclaw, Poland; 3Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA; 4Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Wroclaw, Poland Abstract: Low adherence to pharmacological treatment is often associated with poor blood pressure control, but identification of nonadherent patients in outpatient settings is difficult. The aim of the study was to translate and evaluate the psychometric properties of the Polish version of the structured self-report eight-item Morisky Medication Adherence Scale (MMAS-8) among patients with hypertension. The study was conducted in a family doctor practice between January and July 2015. After a standard “forward–backward” procedure to translate MMAS-8 into Polish, the questionnaire was administered to 160 patients with hypertension. Reliability was tested using a measure of internal consistency (Cronbach’s α) and test–retest reliability. Validity was confirmed using known group validity. Three levels of adherence were considered based on the following scores: 0 to

Beata Jankowska-Polańska,1 Izabella Uchmanowicz,1 Krzysztof Dudek,2 Krystyna Łoboz-Grudzień1,3 1Department of Clinical Nursing, Wrocław Medical University, 2Department of Logistics and Transport Systems, Faculty of Mechanical Engineering, Wrocław University of Technology, 3Cardiology Unit, T Marciniak Lower Silesian Specialist Hospital, Emergency Medicine Centre, Wrocław, Poland Background: The aims of this study were to analyze the dynamics of quality of life (QoL) changes after 36 months from the percutaneous coronary intervention (PCI) depending on sex and identify baseline predictors of the follow-up QoL of patients hospitalized for acute coronary syndrome (ACS) and subjected to PCI.Methods and results: The study included 137 patients, females (n=67) and males (n=70), with ACS who underwent PCI. The QoL was assessed using the MacNew Heart Disease Health-Related Quality of Life questionnaire. The group of females scored lower in all the domains of the MacNew Heart Disease Health-Related Quality of Life questionnaire in the initial measurement (B1), in the measurement after 6 months (B2), and in the long-term follow-up measurement (36 months – B3). Despite the fact that both groups achieved improved QoL, its values were higher in the males. The average growth rate of the QoL score in the period from the sixth month to 36th month was higher in females than in males. In the univariate and multivariate analyses, significant independent predictors with a negative influence on the long-term QoL score included female sex (Ρ=−0.190, β=−0.21), age >60 years (Ρ=−0.255, β=−0.186), and diabetes (Ρ=−0.216, β=−0.216).Conclusion: In a 36-month follow-up of ACS patients treated with PCI, there were no statistically significant differences in QoL between sexes. In the entire cohort, there was improvement in QoL, which was higher in the case of the females studied. For the entire group, significant independent determinants of lower QoL 3 years after ACS included female sex, age >60 years, and diabetes. Keywords: quality of life, percutaneous coronary intervention, sex differences

Maria Łoboz-Rudnicka,1 Joanna Jaroch,1 Zbigniew Bociąga,1 Barbara Rzyczkowska,1 Izabella Uchmanowicz,2 Jacek Polański,3 Krzysztof Dudek,4 Andrzej Szuba,5 Krystyna Łoboz-Grudzień2 1Department of Cardiology, T. Marciniak Hospital, 2Public Health Department, Wroclaw Medical University, 3Private Practice, Na Biskupinie, Wroclaw, 4Faculty of Mechanical Engineering, Wroclaw University of Technology, 5Division of Angiology, Wroclaw Medical University, Wroclaw, Poland Background and purpose: There has been growing interest in the sex-related differences in the impact of cardiovascular (CV) risk factors on carotid intima–media thickness (CIMT). Therefore, we aimed at examining the influence of CV risk factors on CIMT in men and women and identifying differences between males and females in the risk profiles affecting CIMT. Patients and methods: The study group consisted of 256 patients (mean age 54.7 years), including 134 females (52%), with the following CV risk factors: arterial hypertension, type 2 diabetes mellitus, dyslipidemia, nicotine addiction, overweight, and obesity. Subjects with the history of any overt CV disease were excluded. CIMT was measured through B-mode ultrasound examination of the right common carotid artery. In the analysis of CIMT values at different ages, the patients were divided into three age groups: 1) 60 years. Regression analysis was used to examine the influence of CV risk factors on CIMT in men and women. Results: CIMT increased with age in both men and women. Women had lower values of CIMT than men (0.54 mm vs 0.60 mm, P=0.011). The analysis in three age subgroups revealed that CIMT values were comparable in men and women in group 1 (0.48 mm vs 0.48 mm, P=0.861), but over the age of 45 years, CIMT values became significantly lower in women compared to men (group 2: 0.51 mm vs 0.63 mm, P=0.005; group 3: 0.63 mm vs 0.72 mm, P=0.020). Significant differences were observed between the sexes in terms of risk factor impact on CIMT. In men, only three factors significantly affected CIMT: age (b=+0.009, P

In order to improve a corrosion resistance and biocompatibility of NiTi shape memory alloys, the surface of the NiTi alloy was covered by protective layers. The paper presents results of the layers composed of titanium nitride and hydroxyapatite (HAp). The TiN layers were deposited using the glow discharge technique and then the bioactive hydroxyapatite layer was formed from simulated body fluids solution. The results of the structure studies and microscopic observations confirmed that on the surface of the NiTi alloy a thin titanium nitride layer 35-50 nm thick (depending on the glow discharge technique parameters) was obtained. The structure of the deposited layers was studied by means of the X-ray diffraction technique. Also, mechanical parameters of obtained layers were characterized using nanoindentation. On the top of the titanium nitride, a layer consisted of hydroxyapatite and NaCl was formed. Applied parameters of deposition process did not lead to decomposition of the NiTi parent phase (B2) to the equilibrium ones.

Interspecific introgression is a potentially important source of novel variation of adaptive significance. Although multiple cases of adaptive introgression are well documented, broader generalizations about its targets and mechanisms are lacking. Multiallelic balancing selection, particularly when acting through rare allele advantage, is an evolutionary mechanism expected to favor adaptive introgression. This is because introgressed alleles are likely to confer an immediate selective advantage, facilitating their establishment in the recipient species even in the face of strong genomic barriers to introgression. Vertebrate major histocompatibility complex genes are well-established targets of long-term multiallelic balancing selection, so widespread adaptive major histocompatibility complex introgression is expected. Here, we evaluate this hypothesis using data from 29 hybrid zones formed by fish, amphibians, squamates, turtles, birds, and mammals at advanced stages of speciation. The key prediction of more extensive major histocompatibility complex introgression compared to genome-wide introgression was tested with three complementary statistical approaches. We found evidence for widespread adaptive introgression of major histocompatibility complex genes, providing a link between the process of adaptive introgression and an underlying mechanism. Our work identifies major histocompatibility complex introgression as a general mechanism by which species can acquire novel, and possibly regain previously lost, variation that may enhance defense against pathogens and increase adaptive potential. [ABSTRACT FROM AUTHOR]

Urbanization leads to complex environmental changes and poses multiple challenges to organisms. Amphibians are highly susceptible to the effects of urbanization, with land use conversion, habitat destruction, and degradation ranked as the most significant threats. Consequently, amphibians are declining in urban areas, in both population numbers and abundance, however, the effect of urbanization on population genetic parameters remains unclear. Here, we studied the genomic response to urbanization in two widespread European species, the common toad Bufo bufo (26 localities, 480 individuals), and the smooth newt Lissotriton vulgaris (30 localities, 516 individuals) in three geographic regions: southern and northern Poland and southern Norway. We assessed genome‐wide SNP variation using RADseq (ca. 42 and 552 thousand SNPs in toads and newts, respectively) and adaptively relevant major histocompatibility complex (MHC) class I and II genes. The results linked most of the genetic differentiation in both marker types to regional (latitudinal) effects, which also correspond to historical biogeography. Further, we did not find any association between genetic differentiation and level of urbanization at local scales for either species. However, urban smooth newts, but not toads, have lower levels of within‐population genome‐wide diversity, suggesting higher susceptibility to the negative effects of urbanization. A decreasing level of genetic diversity linked to increasing urbanization was also found for MHC II in smooth newts, while the relationship between MHC class I diversity and urbanization differed between geographic regions. We did not find any effects of urbanization on MHC diversity in the toad populations. Although two genetic environment association analyses of genome‐wide data, LFMM and BayPass, revealed numerous (219 in B. bufo and 7040 in L. vulgaris) SNPs statistically associated with urbanization, we found a marked lack of repeatability between geographic regions, suggesting a complex and multifaceted response to natural selection elicited by life in the city. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We aimed at determining the relationship between sleep disorders and daily activity and quality of life (QoL) of patients with rheumatoid arthritis (RA). MATERIALS AND METHODS: A systematic search of databases was carried out. We used the Cochrane guidelines to perform the meta- analysis following the PRISMA statement. Fifteen full-text papers were ultimately included in the subsequent statistical analyses. The study was registered in the PROSPERO database (No. CRD42021245664). RESULTS: In group 1, the mean sleep quality score measured with the Pittsburgh Sleep Quality Index (PSQI) was 6.93. The mean QoL score for the physical domain and the mental domain of the Short Form (36) Health Survey (SF-36) was 38.15 and 41.83, respectively. In group 2, the mean PSQI score was 7.21. The mean daily activity score measured with the Health Assessment Questionnaire (HAQ) was 0.80. A strong negative correlation was observed between the PSQI scores, and the SF-36 total score each unit increase in the SF-36 total score was associated with an average decrease of 0.35 points in the PSQI score. A one-point increase in the PSQI score was associated with an average decrease of 2.4 points in the QoL score measured with SF-36. CONCLUSIONS: RA patients have a low quality of sleep. Sleep disorders correlate negatively with the QoL scores in the physical and mental domains. [ABSTRACT FROM AUTHOR]