Andrzej Steciwko

The impact of telehome care on health status and quality of life among patients with diabetes in a primary care setting in Poland.

BACKGROUND Telehome care has been proposed as a solution to the challenges of providing effective and affordable care for patients with diabetes. METHODS A total of 100 adult patients with type 2 diabetes-divided between insulin and noninsulin requiring-was enrolled in a randomized, controlled trial aimed at investigating the effects of telehome monitoring. The experimental group (n = 50) received an in-home wireless glucose monitor and transmitter, whereas the control group (n = 50) was instructed to follow the conventional arrangement. RESULTS There was an overall reduction in HbA1c values in both experimental and control groups after 6 months. A significant difference in HbA1c values between the groups was observed only among the noninsulin-requiring patients (decline from 6.95% ± 0.82% to 6.66% ± 0.86% in IB vs. 7.21% ± 2.02% to 7.2% ± 1.86% in IIB; p = 0.02). The experimental group reported considerably less hyperglycemic and hypoglycemic events. The profile of the patient who benefited the most from telemonitoring consisted of older, more educated patient who had acquired the disease relatively recently, and who spends most of the time at home. The experimental group had higher overall scores on quality of life measures and sense of control over diabetes. There was a positive association between educational attainment and ability to use the telemonitoring system without help (p = 0.045). CONCLUSIONS Although not conclusive because of the small sample and short observation period, the study suggests that telehome monitoring is an effective tool in controlling type 2 diabetes in a primary care setting.

Telemedicine for diabetes support in family doctors' practices : a pilot project

A telemedicine support system for diabetes management was compared with standard monitoring of patients with diabetes. The telemedicine system was composed of two modules: a Patient Unit and a Medical Unit connected by the telecommunication network. The study involved 60 patients of family doctors’ practices in the Lower Silesia Region who were diagnosed with diabetes. There was no significant difference in haemoglobin A1c between telemonitoring and the traditional group of diabetic patients during the survey. The patients’ quality of life slightly improved in the telemonitoring (mean score 3.4) and the traditionally monitored group (mean score 3.2), but there was no significant difference between them. Most of the telemonitoring patients (75%) expressed the desire to continue with telemedicine support and nearly 60% of patients monitored with traditional methods wanted to be included in the telemedicine group. The system seems to be reliable, simple to use and friendly for the patients.

Immune Response to Influenza Vaccine in Hemodialysis Patients with Chronic Renal Failure

Chronic renal failure and dialysis belong to contraindications to vaccination with live vaccines. The objective of this study was to evaluate the humoral response to influenza vaccination consisting of the formation of antibodies against hemagglutinin and neuraminidase in patients undergoing chronic hemodialysis due to chronic renal failure. The study included 173 patients treated at a dialysis station in the Silesian region in Poland. The patients were assigned to the following groups: Group A-71 hemodialysis patients, mean age 65.4 ± 14.5 years; mean time of dialysis therapy 38.9 ± 31.7 months, vaccinated against influenza; Group B-39 hemodialysis patients, mean age 64 ± 13.5 years; mean time of dialysis therapy 45.0 ± 45.2 months, not vaccinated against influenza; and Group C-63 healthy patients, mean age 44.1 ± 21.2 years, vaccinated against influenza - control group. The vaccinated patients (Groups A & C) received a single dose of Agrippal influenza vaccine (Novartis) containing hemagglutinin from three strains of the influenza virus: A/Brisbane/59/2007 (H1N1), A/Brisbane/10/2007 (H3N2), and B/Brisbane/60/2008. The serological response to vaccination was assessed from antihemagglutinin (anti-HA) and antineuraminidase antibody assays (anti-NA). We found that the protection level of antibodies (protection rate) against H1 was only 40% among the vaccinated hemodialysis patients, as opposed to 65% in controls. The level of anti-H3 antibodies was similar in both groups of vaccines; 68% in dialysis patients and 75% in controls. The level of anti-HB antibodies was higher in the dialysis patient than in controls; 70% vs. 38%, respectively. The response rate to H1 antigen a month after vaccination was almost twice lower in the hemodialysis patients than in healthy controls vaccinated against influenza; 37% vs. 65%, respectively. We conclude that there is a rather insufficient serological response in the group of hemodialysis patients vaccinated with a single dose of influenza vaccine.

Quality of life and acceptance of illness among patients with chronic respiratory diseases

The purpose of this study was to determine quality of life (QoL) and acceptance of illness in patients with chronic respiratory diseases. The study involved 315 adult patients of the mean age of 63.9±15.7 years. The World Health Organization Quality of Life Instrument Short Form and the Acceptance of Illness Scale were used. The mean score for QoL was 2.0±1.3. The highest scores were obtained in the Social Relationship Domain (13.9±2.7) and the lowest in the Environmental Domain (10.5±2.2). The strongest correlations within QoL domains were noted between Physical and Psychological Domains: r=0.611 (p<0.001), Psychological and Social Domains: r=0.605 (p<0.001). The overall degree of illness acceptance was low (26.0±7.8). The strongest correlations were observed between illness acceptance and Physical: r=0.591 (p<0.001) and Psychological Domains: r=0.450 (p<0.001). We conclude that illness acceptance can be augmented by improving the patients clinical state and by the provision of psychological support and QoL by improving the Psychological and Environmental Domains.

Low-frequency electromagnetic stimulation may lead to regression of Morris hepatoma in buffalo rats

OBJECTIVE The influence of low-frequency electromagnetic (LF-EM) waves on the processes of carcinogenesis and tumor growth has been the subject of experimental investigations for more than two decades and the results are promising. In parallel, an interesting method of complementary medicine, biophysical-information therapy (BIT) or bioresonance therapy (BRT), which in principle is based on LF-EM stimulation, has emerged. BRT has been known since the late 1980s but is still poorly studied. The idea of applying BRT to tumors is based on two main premises: (1) endogenous biophotonic emission in the case of tumors is different from that produced by healthy tissues/cells and (2) BRT effects are believed to be primarily manifested at the immune-system level. Consequently, we decided to study the influence of BRT on a dynamic and well-known process: the expansion of transplantable hepatoma in rats. DESIGN The study was carried out on female Buffalo rats with implanted Morris tumors (three experimental and one control group). Fourteen (14) consecutive in vivo exposures using a BRT device (BICOM B15, REGUMED Regulative Medizintechnik Gmbh, Graefelfing, Germany), were made from the third day after inoculation of the tumors. Biometric observations, intra vitam (tumor volume, growth ratio), were completed with histologic investigation (implantation locus, selected internal organs [lungs]). RESULTS Thirty-one (31) cases (69%; n = 45) of total tumor regression were observed in experimental groups and these individuals were anesthetized to enable histologic verification to be made. No lung metastases--usually observed in tumor-bearers--could be detected. Moreover, in the inoculation loci, traces of former implantation and tumor absorption were found to be associated with high activity of cell-mediated immune response. No regressions were observed in the control group. CONCLUSIONS We cannot exclude the possibility that LF-EM signals transmitted via BRT into the tumor-bearers may stimulate two separate processes: effective immunological response and/or tumor-cell death. The method appears to be capable of inducing the regression of transplantable hepatoma in vivo, thus is a potential subject of further studies.

A survey of Internet use for health purposes in Poland

We investigated the use of the Internet for health-related purposes in Poland. A telephone survey was performed of 1027 people between 15 and 80 years old who were selected from the Polish population by random sampling. The study showed that the Internet was used by 47% of the respondents (n = 483) and 37% of the respondents (n = 376) had used it at least once a week. Almost 80% of responders used the Internet to obtain information about health or illness (n = 383) and 43% of them did it at least once a month. The respondents used the Internet for health purposes mainly to read about health or illness (95%). Only 3% of them approached the family physician, specialist or other health professional over the Internet. However, when choosing a new doctor, 45% of respondents stated that the doctors provision of Internet-based services was of importance. At present the Internet is not used as a health communications channel but it is clear that many Polish people are interested in Internet-based health services.

Health behaviors and quality of life among patients with chronic respiratory disease.

The purpose of this study was to analyze health behaviors of patients with chronic respiratory disease and the correlations between health behaviors (HB) and quality of life (QoL). The study involved 256 adult patients (135 women and 121 men), mean age was 62.6 ± 16.1 years, with chronic respiratory disease. The research tools consisted of the Health Behavior Inventory (HBI) and the World Health Organization Quality of Life Instrument Short Form. The mean general score for HB was 85.6 ± 17.8. Most patients (74 persons) obtained high scores (7-10 stens). The strongest correlations between QoL and HB were as follows: Psychological Domain correlated with positive mental attitude (r = 0.308, p < 0.001), healthy eating habits (r = 0.224, p = 0.001), and with the level of health behaviors (r = 0.222, p = 0.003); Social Relationship Domain correlated with positive mental attitude (r = 0.282, p < 0.001) and healthy eating habits (r = 0.238, p < 0.001). We conclude that QoL in patients with chronic respiratory diseases is significantly shaped by their health behaviors.

Psychiatric symptomatology and personality in a population of primary care patients

INTRODUCTION AND OBJECTIVE Psychiatric disorders (and their high rates of prevalence) in primary care have been widely analyzed, but the problem of underdiagnosis remains unresolved. This becomes increasingly more important in rural health centres in the face of lack of epidemiological data from these centres. The aim of this study is focused on the relationship between general health, psychiatric symptomatology and personality characteristics in the context of an adequate diagnosis. MATERIALS AND METHODS 518 primary care patients in 6 Polish urban clinical centres were studied using (in order of administration): a sociodemographic questionnaire, the General Health Questionnaire (GHQ-28) and Eysenck Personality Questionnaire (EPQ-R). RESULTS The investigated sample was representative for urban primary care patients. The findings confirmed a significant association between neuroticism and general health. The strongest relation with current functioning and mental distress of the patients (GHQ general score) was observed in case of symptoms of anxiety and insomnia. The symptoms of depression may be the most difficult to identify (psychiatric symptoms assessed using GHQ sub-scales). CONCLUSIONS According to the GHQ assumptions and confirmed by the presented study, sub-threshold psychiatric symptomatology affects the functioning of primary care patients and their general health. This correlates with personality factors. Improving adequacy of diagnosis becomes extremely important, as it may often be the only chance for appropriate therapy of mental problems for people living in rural areas due to lower availability of specialistic mental services. Further epidemiological studies concerning rural primary care and prevalence of the spectrum of mental disorders need to be conducted.