What causes grief in dementia caregivers?

[Abstract] Alzheimer’s disease (AD) is the most prevalent neurodegenerative disease in the world. Most AD patients become dependent on their relatives, i.e. family caregivers. Providing care to a person with AD influences caregiver’s life and leads to feelings of grief, which often precede caregiver depression. The purpose of the article was to evaluate the Meuser and Marwit Caregiver Grief Inventory (MM-CGI-50) for use in Polish family caregivers and to find out determinants of grief of family caregivers of AD individuals living in Poland. A sample of 151 spouse and adult child caregivers of community-dwelling AD patients (95 females and 56 males) was interviewed to determine the influence of such factors as caregiver’s age, gender, family relation to the care recipient (CR) and caregiving-related changes in caregiver’s working time, leisure time and material status to find out the impact of caregiving role on intensity of caregiver grief. Caregiver grief was measured by means of MM-CGI-50. Additionally, carers were administered a questionnaire including patient’s and caregiver’s demographics. Also, CR’s dementia assessment was informant-based and determined with investigator-administered clinical dementia rating (CDR) scale. Of all analyzed factors, only caregiver’s informant dementia rating significantly influenced caregiver grief. To conclude, the effect of caregiver’s age, gender, family relation to the CR and caregiving-related changes in caregiver’s working time; leisure time and material status could not be found. To add, MM- CGI-50 can be effectively used to assess grief in Polish family caregivers of AD patients

Evaluation of Expression of the PTEN Gene, Oestrogen and Progesterone Receptors as Diagnostic and Predictive Factors in Endometrial Cancer

Endometrial cancer belongs to the commonest malignancy in females after breast cancer, malignant neoplasm of female genitals in Europe and North America but there is still not significant improvement as far as the curability of this neoplasm is concerned, especially its advanced forms. That is why there is need to define new factors that could be not only diagnostic but also predictve factors. In present study we analyzed the mRNA PTEN expression by quantitative real-time polymerase chain reaction (Q-PCR) in 123 women of endometrial carcinoma and 14 women of control group. Moreover we assessed oestrogen (ER) and progesterone receptors (PgR) in all cases. We defined the correlation between expression of PTEN gene and receptors and between PTEN expression and maturity grade of cancer. Neoplasm advancement grade G1 was diagnosed in 82.11 % of patients (n = 101), G2 in 9.76 % of patients (n = 12) and G3 in 8.13 % of patients (n = 10). Presence of ER and PgR and decreased expression of PTEN gene was found in majority of patients with endometrial cancer (79.12 % and 59.34 % respectively) and the most numerous group was with weak expression of ER and strong expression of PgR. There was no statistically significant difference in gene expression depending on receptors expression nor maturity grade of cancer (p > 0.05). Evaluation of expression of PTEN gene may turn out to be a very useful tool aimed at qualifying patients for different therapies of endometrial cancer and at searching of new diagnostic and therapeutic methods of this cancer independently on its receptor status nor maturity grade of cancer

The opinion of professional caregivers about the platform understAID for patients with dementia

Clinical research[Abstract] BACKGROUND: The person with dementia should be treated as an unique person regarding symptoms directly associated with dementia, such as problems with memory, hallucinations, and delusions, as well as other physical, mental, or neurological deficits. The symptoms not directly typical of dementia, such as musculoskeletal disorders or depression, should be also be considered in order to improve the quality of life of a person with dementia. That is why professional caregivers have to broaden their current knowledge not only of medical symptoms but also of the patient’s psychosocial condition and increase their inquisitiveness about the individual condition of the patient. The aim of the study was to get to know the opinion of professional caregivers about the UnderstAID platform and its usefulness for informal caregivers. MATERIAL AND METHODS: Participants in the study group consisted of professional caregivers: nurses, sociologists, psychologists, physiotherapists, and occupational therapists, all of whom specialized in geriatrics and had experience in working with people with dementia. All professional caregivers answered 24 questions that refer to positive and negative aspects of the UnderstAID platform. RESULTS: The study group of professional caregivers highly appreciated that the application could give support to caregivers (mean score of 4.78; 5 points means that they totally agreed, and 1 point means that they totally disagreed) and that a wide range of multimedia materials helped the informal caregivers to gain a better understanding of the contents (mean score of 4.78). There was a statistically significant correlation between the age of the professional caregivers and the frequency of positive opinions that the UnderstAID application gave support to caregivers of relatives with dementia (p=0.028) and the opinion that videos, photos, and pictures may help the informal caregivers to gain a better understanding of the contents (p=0.028). CONCLUSIONS: A group of professional caregivers positively assessed the UnderstAID platform. Caregivers, especially older caregivers, highly appreciated the usefulness of videos, photos, and pictures for gaining a better understanding of the contents.European Commission; AAL5/1/2013European Commission; AAL5/2/201

UnderstAID, an ICT platform to help informal caregivers of people with dementia: a pilot randomized controlled study

[Abstract] Information and communications technology (ICT) could support ambient assisted living (AAL) based interventions to provide support to informal caregivers of people with dementia, especially when they need to cope with their feelings of overburden or isolation. An e-learning platform (understAID application) was tested by informal caregivers from Denmark, Poland, and Spain to explore the technical and the pedagogical specifications, as well as evaluating the impact of its use on the psychological status of the participants. 61 informal caregivers completed the study taking part in the experimental (n=30) or control (n=31) groups. 33.3% of the caregivers were satisfied with the application and around 50% of the participants assessed it as technically and pedagogically acceptable. After using understAID the caregivers in the experimental group significantly decreased their depressive symptomatology according to the Center for Epidemiologic Studies Depression scale, but a possible benefit on their feelings of competence and satisfaction with the caring experience was also observed. The low scores obtained for satisfaction were highlighting issues that need to be modified to meet the informal caregivers’ needs in national, social, and cultural context. Some possible biases are also considered and discussed to be taken into account in future improvements of understAID application.European Commission; AAL-2012-5-10

Psychoterapia w chorobach o podłożu autoimmunologicznym — czy istnieje potrzeba wspomagania psychologicznego chorych z ZZSK i ŁZS?

Chorzy na łuszczycowe zapalenie stawów i zesztywniające zapalenie stawów kręgosłupa znacznie częściej doświadczają sytuacji problemowych w swoim życiu. W tych grupach znacznie częściej niż w populacji ogólnej współwystępują z objawami somatycznymi zaburzenia sfery psychicznej. Uwarunkowania tego rodzaju trudności można traktować wieloczynnikowo z uwzględnieniem obszarów środowiska zarówno zewnętrznego, jak i sfery intrapsychicznej. Jedną z wielu rekomendowanych interwencji jest utrzymanie możliwie jak najdłużej chorego w jego zwyczajowych rolach życiowych i zawodowych. Zgodnie z wynikami znakomitej większości badań, długotrwała nieobecność w pracy niesie za sobą zazwyczaj negatywne skutki dla pacjentów — im dłużej nie pracują, tym trudniejszy psychicznie jest dla nich powrót do pracy. Podstawąjednak minimalizacji problemów psychologicznych jest ich wczesna diagnostyka przy przyjęciu zdemedykalizowanejpostawy lekarza reumatologa oraz bliska współpraca z innymi specjalistami — psychologiem i psychiatrą. Forum Reumatol. 2019, tom 5, nr 3: 129–13

Predictors of caregiving satisfaction in informal caregivers of people with dementia

[Abstract] Objective. The prevalence of dementia is increasing and consequently the demands from families, institutions and healthcare system. Although a substantial amount of research on caregiving has emphasized the negative aspects of caregiving, specifically on caregiver burden and depression, less attention has been paid to the positive aspects of caregiving. The aim of the present work was to study the phenomenon of caregiving satisfaction in informal caregivers of people with dementia by assessing their likely predictors. Methods. A stress process model was used to study caregiver's satisfaction (measured using the Revised Caregiving Satisfaction Scale) on 101 informal caregivers of patients with dementia in relation to the caregiver's background and context, stress-related factors, and mediators. Results. The regression model has an adjusted R2 of 0.20, which indicates that having a consanguinity relationship with the care recipient, suffering from lower levels of subjective burden, and managing individuals with severe cognitive impairment are the most important predictors of higher caregiving satisfaction. Conclusion. Interventions focused on the enhancement of the caregiving satisfaction by increasing the understanding of the disease, should be especially addressed to caregivers without a consanguinity relationship and with high levels of subjective burden, and to those managing care recipients with mild or moderate stages of dementia.Ministerio de Industria, Energía y Turismo; AAL-2012-5-10

Modern therapies in rheumatology: the role of clinical trials

Recent decades have seen an increase in the effectiveness of therapies used. However, there are still many challenges facing modern medicine, including rheumatology. The development of modern therapies is made possible by large-scale clinical trials. Clinical trials are not only designed to verify the effectiveness of a therapy. They are also intended to assess the bioavailability, pharmacodynamics, metabolism, and elimination of therapeutic substances. In Poland, clinical trials have been conducted for many years. It is estimated that the costs currently borne by the sponsors of clinical trials in Poland amount to more than one billion per year. In rheumatology, clinical trials are important not only because of their scientific aspect, but also because they increase the availability of the latest and often most effective therapies for patients. Unfortunately, the availability of therapies under the National Health Fund in Poland is currently low. Thanks to clinical trials, a much higher proportion of patients in Poland have access to the latest generation of biologics and biosimilars based on produced human monoclonal antibodies. Given that new biological therapies can be expected to be registered in the coming years, the number of clinical trials will increase. Therefore, it is currently important to familiarise both doctors and their patients with the subject of clinical trials.W ostatnich dekadach można zaobserwować wzrost skuteczności stosowanych terapii. Jednak przed współczesną medycyną, w tym również przed reumatologią, wciąż jest jeszcze wiele wyzwań. Rozwój nowoczesnych terapii jest możliwy dzięki prowadzonym na szeroką skalę badaniom klinicznym. Badania kliniczne mają na celu nie tylko zweryfikowanie skuteczności prowadzonej terapii. Mają one również ocenić biodostępność, farmakodynamikę, metabolizm i wydalanie substancji leczniczych. W Polsce badania kliniczne są prowadzone od wielu lat. Szacuje się, że obecnie koszty ponoszone przez sponsorów badań klinicznych w Polsce wynoszą ponad 1 mld rocznie. W reumatologii badania kliniczne są ważne nie tylko ze względu na ich aspekt naukowy, ale również ze względu na zwiększenie dostępności do najnowszych i zarazem często najskuteczniejszych terapii dla pacjentów. Niestety, dostępność do terapii w ramach Narodowego Funduszu Zdrowia (NFZ) jest obecnie niewielka. Dzięki badaniom klinicznym o wiele większy odsetek pacjentów w Polsce ma dostęp do najnowszych generacji leków biologicznych i biopodobnych bazujących na wytworzonych ludzkich przeciwciałach monoklonalnych. Biorąc pod uwagę, że w kolejnych latach można spodziewać się rejestracji nowych terapii biologicznych, liczba badań klinicznych będzie wzrastać. Z tego względu tak ważne jest obecnie przybliżenie tematyki badań klinicznych zarówno lekarzom, jak i ich pacjentom

Disorders in the temporomandibular joints in pediatric patients - frequency of physiotherapy visits

Introduction: Temporomandibular disorders can be a challenge for both clinicians and patients. It is unclear what factors are associated with prolonged conservative care and patient dissatisfaction with treatment outcomes.Material and research method: A literature review was carried out in terms of methods of physiotherapeutic treatment following disorders of temporomandibular joints in pediatric patients. This work is for reference only. The PubMed and Google Schoolar databases were analyzed. The keywords used in the search were: "physiotherapy, temporomandibular joints and children", "manual therapy, temporomandibular joints and children". The authors focused on reports published in Polish and English from the last 10 years.Results: There is a need to combine standard therapy with physiotherapy in order to accelerate the treatment process.Conclusions: Physiotherapy is highly effective and non-invasive in the treatment of stomatognathic system disorders. A physiotherapist provides a number of therapeutic treatments that improve disorders in the temporomandibular joints

The features psoriasis challenges in aesthetic care

Psoriasis can affect many areas of the body, respectively; treatment should be directed to the affected areas according to their localization. The most difficult in treatment and aesthetic care are considered to be psoriasis of the nails, scalp, and palmar-plantar localization. These areas are visible all the time and well-groomed condition is of great importance for women. This article is devoted to the analysis of data on the peculiarities of care and the complexities of the treatment of psoriasis of aesthetic areas. Nail psoriasis is difficult to treat with topical therapy since the remedy must be optimized for penetration into the nail and surrounding tissues. Part of the inflammation in nail disease is located deep in the nail matrix and, therefore, is difficult to treat locally. Psoriasis of the scalp is difficult to treat with local and phototherapy, due to the need for specific hair and scalp care. Palms and soles often have particularly thick psoriasis plaques, which can interfere with the absorption of topical therapy and resist phototherapy. Patients with predominantly palmar-plantar disease often do not respond to several treatments, and many require combination therapy to control the disease. Collectively, psoriasis of the nails, scalp, and palmar-plantar psoriasis are considered complex conditions and often do not respond to standard treatment protocols and require aesthetic medicine measures

Feeding problems and temporomandibular dysfunction in children with cerebral palsy

Children with cerebral palsy encounter many problems in everyday life. One of them is feeding difficulties. These are some crucial problems which cause feeding disfunction in children with cerebral palsy. The first problem is structural abnormalities such as abnormal muscle tone and dysfunction of the temporomandibular articulation. Non-progressive brain injury manifests in uncoordinated mandibular movements, reduced biting force and alterations in muscular tone. Main muscles which are engaged in the process of eating are: masseter, suprahyoid or temporal muscles. Another issue which may be associated with feeding problem is excessive drooling and its variable consequences. The next dysfunction refers to breathing problem, which may be the primary or secondary reason of feeding difficulties. To summarize, the therapy of feeding dysfunction should contains harmonization of muscle tone, especially tone of muscles directly connected to the temporomandibular joint and stomatognathic system, reducing sialorrhea and regulating breathing