BackgroundPrevention strategies for pressure ulcer formation remain critical in patients with an advanced illness. We analyzed factors associated with the development of pressure ulcers in patients hospitalized in a palliative care ward setting.Patients and methodsThis study was a retrospective analysis of 329 consecutive patients with a mean age (± standard deviation) of 70.4±11.8 years (range: 30–96 years, median 70.0 years; 55.3% women), who were admitted to the Palliative Care Department between July 2012 and May 2014.ResultsPatients were hospitalized for mean of 24.8±31.4 days (1–310 days, median 14 days). A total of 256 patients (77.8%) died in the ward and 73 patients (22.2%) were discharged. Two hundred and six patients (62.6%) did not develop pressure ulcers during their stay in the ward, 84 patients (25.5%) were admitted with pressure ulcers, and 39 patients (11.9%) developed pressure ulcers in the ward. Four factors assessed at admission appear to predict the development of pressure ulcers in the multivariate logistic regression model: Waterlow score (odds ratio [OR] =1.140, 95% confidence interval [CI] =1.057–1.229, P=0.001), transfer from other hospital wards (OR =2.938, 95% CI =1.339–6.448, P=0.007), hemoglobin level (OR =0.814, 95% CI =0.693–0.956, P=0.012), and systolic blood pressure (OR =0.976, 95% CI =0.955–0.997, P=0.023). Five other factors assessed during hospitalization appear to be associated with pressure ulcer development: mean evening body temperature (OR =3.830, 95% CI =1.729–8.486, P=0.001), mean Waterlow score (OR =1.194, 95% CI =1.092–1.306, P<0.001), the lowest recorded sodium concentration (OR =0.880, 95% CI =0.814–0.951, P=0.001), mean systolic blood pressure (OR =0.956, 95% CI =0.929–0.984, P=0.003), and the lowest recorded hemoglobin level (OR =0.803, 95% CI =0.672–0.960, P=0.016).ConclusionHyponatremia and low blood pressure may contribute to the formation of pressure ulcers in patients with an advanced illness.

Rheumatoid arthritis (RA) has a large and varied impact on the quality of life as associated with patient health including both physical and mental well-being. The aim of the study was to assess the factors that affect the assessment of the quality of life of RA patients depending on the prevalence of frailty syndrome. Material and methods:The study involved 106 patients with RA (82 women; mean age 65.83 ± 5.01), who had been hospitalized in the Silesian Centre for Rheumatology, Rehabilitation and Disability Prevention in Ustron, Poland. The patients that were included in the study were divided into two groups depending on the incidence of frailty syndrome: Group 1robust patients and Group 2patients with frailty syndrome.Results: Frailty syndrome was identified in 34.9% of the patients with recognized/diagnosed RA; in women, it was 36.14% and in men, it was 25.92%. The average TFI value was 4.11 ± 2.05; in the physical domain, it was 3.39 ± 1.66; in the mental domain, it was 0.41 ± 0.55 and in the social domain, it was 0.31 ± 0.48. The robust patients assessed their quality of life associated with sleep as being worse compared to patients with recognized frailty syndrome. Conclusion:Frailty syndrome has no significant impact on the assessment of the quality of life of patients with diagnosed RA. The factors that determine quality of life are different in robust patients and in patients with frailty syndrome. The assessment of the quality of life is affected by the degree of an individual's fitness regardless of the occurrence of frailty syndrome.

Purpose: Patients with diabetes are at increased risk of developing depression. The aim of the study was to determine the occurrence of depressive symptoms in patients with type 1 (T1DM) and type 2 diabetes (T2DM), including the association with different independent sociodemographic and clinical variables. Patients and Methods:The studies were carried out on 618 people, including 115 patients with T1DM and 215 patients with T2DM and 288 people without diabetes constituting two control groups. Subjects were characterized in terms of sociodemographic, clinical and biochemical aspects, and the occurrence of depressive symptoms using Beck Depression Inventory (BDI) was determined. In the logistic regression analysis, the correlations between BDI score and with independent variables such as sex, age, body mass index, duration of diabetes, HbA1c level, diabetic complications and mean arterial pressure were examined. Results: The mean BDI score was significantly higher in women and men with T1DM and T2DM compared to controls. In diabetic patients, depressive symptoms occurred more often in women than in men. Among patients with T1DM, the incidence of depressive symptoms was 17.5% of the women and 8.6% of the men and in patients with T2DM, the incidence of depressive symptoms was revealed in 28.9% of the women and in 19.8% of the men. In patients with T1DM and T2DM, the occurrence of depressive symptoms increases with age, HbA1c level and complications, and the risk of depressive symptoms turned out to be almost three times higher in women than in men with T2DM. Conclusion: The prevalence of depressive symptoms in diabetic patients is higher than in non-diabetics. Depressive symptoms account for 13% of the patients with T1DM and 24.7% of the patients with T2DM. The risk of depressive symptoms in T1DM and T2DM increases with age, HbA1c level and the presence of complications, and it is gender-related in T2DM only.

Cel pracy. Główny Inspektorat Sanitarny, corocznie publikując Program Szczepień Ochronnych, włącza się w realizację międzynarodowych wytycznych dotyczących profilaktyki zachorowań na grypę, które zalecają, aby personel medyczny regularnie poddawał się szczepieniom. Celem pracy było poznanie opinii pracowników medycznych-lekarzy, pielęgniarek, położnych i ratowników medycznych-na temat zalecanych szczepień przeciwko grypie oraz określenie czynników wpływających na częstotliwość wykonywania szczepień (występują tu trzy możliwości: profilaktyka regularna, nieregularna lub brak profilaktyki). Materiał i metody. W badaniu wzięło udział 105 pracowników bielskiego szpitala: 30 lekarzy, 55 pielęgniarek i położnych oraz 20 ratowników medycznych. Udział w anonimowym badaniu miał charakter dobrowolny. Wyniki. W badanej grupie 67,3% ankietowanych zdeklarowało nieszczepienie się przeciwko grypie, wśród nich aż 78,1% stanowiły pielęgniarki/położne i 75%-ratownicy medyczni. Nieregularnie poddaje się szczepieniom 20,2%, a regularnie szczepi się zaledwie 12,5% spośród wszystkich badanych osób. Procent osób szczepiących się regularnie lub sporadycznie w poszczególnych grupach zawodowych daje wynik: 59,8% wśród lekarzy oraz jedynie 21,8% w grupie pielęgniarek/położnych i 25% wśród ratowników medycznych. Wnioski. 1. Pomimo międzynarodowych zaleceń niewielu pracowników medycznych szczepiło się przeciwko grypie. 2. Grupą zawodową najczęściej deklarującą wykonywanie szczepień profilaktycznych przeciwko grypie byli lekarze. 3. Głównym powodem zaszczepienia się była chęć ochrony siebie przed zachorowaniem, natomiast przyczyną nieszczepienia się okazał się brak wiary w skuteczność szczepionki.

PurposeThe main purpose of this study was to compare the level of health-related quality of life (HRQoL) using Nottingham Health Profile (NHP) in Polish patients with rheumatoid arthritis (RA) during therapy applying disease-modifying antirheumatic drugs (DMARDs) with conventional synthetics (csDMARDs) or with csDMARDs in combination with biological drugs (bDMARDs). The second purpose was to analyze the correlation between the domain values of NHP and the demographic and clinical parameters, functional efficiency, and mood.Patients and methodsThe studies involved 212 patients with RA, divided into two groups: group I – 126 persons treated using csDMARDs, group II – 86 patients using csDMARDs in combination with bDMARDs. A diagnostic survey was used applying NHP for HRQoL, Beck Depression Inventory (BDI), and Health Assessment Questionnaire (HAQ). The 28-Joint Disease Activity Score (DAS-28) was calculated.ResultsThe patients with RA in both studied groups did not differ significantly in terms of all the NHP domains, values of HAQ and BDI. The DAS-28 value, the number of swollen joints, and the duration of morning stiffness were significantly smaller among patients from group II. However, in both groups, the majority of the analyzed components of NHP demonstrated significant correlations with values of HAQ and BDI and some of the domains of NHP – with DAS-28.ConclusionThe level of HRQoL, functional efficiency, and mood are comparable in patients treated conventionally and in combination with biological drugs. The HRQoL level shows correlation with the occurrence of depression symptoms, and the energy level, the sensation of pain, and physical abilities are covariates with daily activities. The intensity of the activity of RA as well as experiencing pain and the duration of morning stiffness is smaller among patients applying csDMARDs plus bDMARDs compared with patients treated only conventionally.