Jolanta Lewko

Median nerve conduction impairment in patients with diabetes and its impact on patients' perception of health condition: a quantitative study.

IntroductionImpaired mobility and compromised manual dexterity leading to difficulties with the activities of daily living (ADL) are an inherent part of the clinical picture in diabetes. Hand function in diabetes is influenced by a variety of pathologies: the median nerve, the most important nerve of the hand, can suffer from metabolic disturbances, ischemia and/or entrapment neuropathies. The resulting deterioration in functional capacity is likely to have significant consequences for the ability to perform ADL, influencing adjustment to diabetes and affecting quality of life. The aim of the present study was to examine the influence of hand function as measured by median motor nerve conduction on quality of life, taking into account various aspects of functioning in patients with diabetes, including activities of daily living, psychological status and acceptance of illness.Patients and methodsSeventy one hospital patients with diabetes participated in the study. Electrophysiological recordings of conductance in the median nerve were obtained for both hands and the relationship between hand function and functional status (BI), depression and anxiety (HADS), adjustment to illness (AIS) and their effect on quality of life (SF-36v2 and QLI) was studied.ResultsDamage to the median nerve of the left hand was associated with significant differences in functioning in the physical, but not the mental component of the SF-36v2, p = 0.03 and in functional status (p = 0.006). QOL was associated with depression, patient age, acceptance of illness, functional ability and to a small, but significant extent with median nerve damage to the right hand on the measure of conduction velocities (R2 =0.726).ConclusionsNerve conductance studies demonstrated a small, but significant effect of hand function on quality of life. Impairment of the median nerve in the left hand was associated with functional difficulties in the activities of daily living and a diminished quality of life in the area of physical functioning. No dependencies of this kind were found for the right hand, which may reflect the greater compensatory capacity of the right hand resulting from improved efficiency due to practice.

Influence of Smoking Cigarettes on Cerebral Blood Flow Parameters

Introduction: While chronic cigarette smoking can lead to increased risk of stroke, the acute effects of smoking have not been established. We studied the changes in blood flow parameters in the major cerebral arteries caused by smoking one cigarette. Method: Using transcranial color-coded sonography (TCCS), we studied the anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), and the internal carotid artery (ICA) of 36 healthy male volunteers before and after they smoked one cigarette. Results: Blood flow velocity increased to a different degree in all but one of the arteries examined after participants smoked a single cigarette: The end diastolic velocity increased significantly by 7.8% in the PCA, 8% in the ACA, and 14.4% in the MCA. The peak systolic velocity increased significantly by 7.5% in the MCA. Blood flow velocity remained unchanged in the ICA only. Blood pressure and heart rate increased as did the flow velocity ratio for the MCA/ICA. The pulsatility index decreased after smoking from 0.92 ± 0.13 to 0.87 ± 0.14 in the MCA, 0.93 ± 0.15 to 0.87 ± 0.13 in the ACA, and 0.95 ± 0.17 to 0.89 ± 0.16 in the PCA. Conclusions: The results suggest that the direct effect of smoking on cerebral circulation includes peripheral vasodilatation with possible constriction of the main trunk of the basal cerebral arteries.

Quality Assurance in Gerontological and Geriatric Training Programs: The European Case

Quality assurance (QA) in gerontological and geriatric education programs is regarded as essential to maintain standards, strengthen accountability, improve readability of qualifications, and facilitate professional mobility. In this article the authors present a summary of international developments in QA and elaborate four international trends, including the pros and cons of QA. Furthermore, the authors focus on accreditation and credit transfer opportunities in vocational and academic education programs for primary care practitioners, including nurses, home care workers, social workers, physiotherapists, and family doctors involved in the care of older people in nine European countries and highlight changes that have occurred over the last decade. Vocational education and professional training in elderly care at the basic and postgraduate specialization level remains extremely diversified, reflecting the lack of standardization for programs outside the higher education sector. The situation is ripe for the implementation of the European Qualifications Framework, which is intended to promote transparency, comparability and portability of qualifications at different levels and the introduction of a credit transfer system for vocational education to be established in 2012.

Effect of BMI on quality of life and depression levels after bariatric surgery

BACKGROUND Studies conducted in Poland have found that 1% (~300,000) of Polish adults are obese. The degree of weight loss and reduction of discomfort associated with severe obesity are used to evaluate bariatric surgery outcomes. From the patients point of view, QoL and mental health are the most important determinants of successful surgery, which is why interest in QoL assessment has increased. OBJECTIVES To assess the effect of BMI on quality of life and depression levels depending on the type of bariatric surgery. MATERIAL AND METHODS The group included 57 women and 43 men aged 20-60 years (mean age 40 years) with BMI from 36 to 40 (31%) and > 40 (69%). Twelve patients (12%) underwent laparoscopic adjustable gastric binding (LAGB), 58 (58%) sleeve gastrectomy, and 30 (30%) Roux-en-Y Gastric Bypass (RYGB). The Bariatric Analysis and Reporting Outcome System (BAROS) was used to assess QoL. The severity of mood disorders was assessed using the Self-Rating Scale of Depression and Anxiety. RESULTS Six months or 1 year after bariatric surgery, the number of patients with BMI > 40 had decreased from 69 to 14%. We found that the time since bariatric surgery contributed to a significant (p < 0.01) difference in BAROS outcomes. In the long-term perspective, we observed better quality of life. CONCLUSIONS MA-QoL II is a useful tool in assessing bariatric surgery, including quality of life. Long-term monitoring will be essential in determining psychological changes and the degree of weight loss.

Effectiveness of bariatric procedures based on selected laboratory parameters of patients from rural areas in Polish population

BACKGROUND Rural areas in Poland are inhabited by over 15 million people, i.e. 39.5% of Polish population, including about 5 million rural residents in the Podlaskie province. The incidence of obesity is associated with increased prevalence of obesity-related conditions. Studies that have been conducted do not confirm the efficacy of conservative treatment of obesity, but show that bariatric procedures produce the best longterm results. OBJECTIVES The aim of the study was to present the effects of bariatric obesity treatments (laparoscopic adjustable gastric banding [LAGB], sleeve gastrectomy [SG], Roux-en-Y gastric bypass [RYGB]) on body mass index (BMI), selected diabetes control parameters, dyslipidemia, hepatic and renal enzymes, blood count and hypertension control. MATERIAL AND METHODS The study group comprised a total of 100 consecutive patients from rural areas qualified for bariatric procedures. Most of the patients (69.07%) underwent SG; 11.34% underwent LAGB; and 19.59% underwent RYGB. Comorbidities included hypertension (35%), type 2 diabetes (52%) and hyperlipidemia (15%). Glucose, insulin, HbA1C, alanine and aspartate aminotransferase, bilirubin, total and fraction cholesterol, creatinine, urea, uric acid and CRP levels, as well as blood count and blood pressure values, were assessed prior to surgery and during follow-up visits 3 and 6 months after the procedures. BMI, percentage of excess weight loss (%EWL) and percentage of excess body mass index loss (%EBMIL) were assessed. RESULTS Consistent, significant decreases in BMI were observed 3 months (39.31 ± 4.70) and 6 months (35.74 ± 4.52) after surgery. The largest BMI reduction at the 6-month follow up was observed for SG (12.29%), and the smallest was observed for LAGB (9.02%). CONCLUSIONS Improvements in the general health status of the patients were observed, as well as normalization of metabolic parameters (glucose, cholesterol, triglycerides, hepatic enzymes).