Mariusz Jaworski

Enhancing Doctors’ Competencies in Communication With and Activation of Older Patients: The Promoting Active Aging (PRACTA) Computer-Based Intervention Study

Background Demographic changes over the past decades call for the promotion of health and disease prevention for older patients, as well as strategies to enhance their independence, productivity, and quality of life. Objective Our objective was to examine the effects of a computer-based educational intervention designed for general practitioners (GPs) to promote active aging. Methods The Promoting Active Aging (PRACTA) study consisted of a baseline questionnaire, implementation of an intervention, and a follow-up questionnaire that was administered 1 month after the intervention. A total of 151 primary care facilities (response rate 151/767, 19.7%) and 503 GPs (response rate 503/996, 50.5%) agreed to participate in the baseline assessment. At the follow-up, 393 GPs filled in the questionnaires (response rate, 393/503, 78.1%), but not all of them took part in the intervention. The final study group of 225 GPs participated in 3 study conditions: e-learning (knowledge plus skills modelling, n=42), a pdf article (knowledge only, n=89), and control (no intervention, n=94). We measured the outcome as scores on the Patients Expectations Scale, Communication Scale, Attitude Toward Treatment and Health Scale, and Self-Efficacy Scale. Results GPs participating in e-learning demonstrated a significant rise in their perception of older patients’ expectations for disease explanation (Wald χ2=19.7, P<.001) and in perception of motivational aspect of older patients’ attitude toward treatment and health (Wald χ2=8.9, P=.03) in comparison with both the control and pdf article groups. We observed additional between-group differences at the level of statistical trend. GPs participating in the pdf article intervention demonstrated a decline in self-assessed communication, both at the level of global scoring (Wald χ2=34.5, P<.001) and at the level of 20 of 26 specific behaviors (all P<.05). Factors moderating the effects of the intervention were the number of patients per GP and the facility’s organizational structure. Conclusions Both methods were suitable, but in different areas and under different conditions. The key benefit of the pdf article intervention was raising doctors’ reflection on limitations in their communication skills, whereas e-learning was more effective in changing their perception of older patients’ proactive attitude, especially among GPs working in privately owned facilities and having a greater number of assigned patients. Although we did not achieve all expected effects of the PRACTA intervention, both its forms seem promising in terms of enhancing the competencies of doctors in communication with and activation of older patients.

Primary care patients' expectations regarding medical appointments and their experiences during a visit: does age matter?

Introduction There is evidence that meeting patients’ expectations toward health care correlates with involvement in the treatment they receive. The most important patient expectations concern certain types of information: explanation of disease and treatment, health promotion, and improvement in quality of life. Other demands include proper rapport and emotional support. The aim of this paper was to examine different patient groups over the age of 50 years and their expectations toward medical visits, evaluated before a visit and after the visit. Patients and methods The study group consisted of 4,921 primary health-care patients. The patients received self-administered questionnaires that they filled in before and after the appointment with the doctor. Interviews with patients were conducted individually by specially trained interviewers. The PRACTA Patient Expectations Scale was used to measure the appointment-related expectations of the patients. Results We observed differences related to age in patients’ expectations before medical visits regarding the following factors: disease explanation, treatment explanation, quality of life, rapport, and emotional support. The same differences were not observed on health promotion. Evaluation of patients’ appointment-related experiences after the visit showed that there were significant differences between the age-groups regarding all types of expectations included in the study. Differences between previsit and postvisit measurements were statistically significant in all age-groups. Patients who received less than they expected from doctors outnumbered those who received what they expected or more in all the groups. Conclusion Patients’ expectations toward medical visits are conditioned by age. Therefore, doctors should pay more attention to requirements related to age in their effort to identify and satisfy expectations. This is particularly important in light of the discrepancy between previsit expectations and the actual experiences of patients evaluated after the visit.

The role of gender in the active attitude toward treatment and health among older patients in primary health care—self-assessed health status and sociodemographic factors as moderators

BackgroundActive attitude toward treatment and health (ATH) leads to improved cooperation and better health outcomes in patients. Supporting it in the population of older adults is a growing need in primary care. Recognising the role of gender, health and other sociodemographic factors can help to distinguish patients who need the most assistance in activation from general practitioners (GPs). The objective of the study was to investigate gender differences in ATH as well as the moderating role of self-assessed health (SAH) and selected sociodemographic factors (age, education, financial status, marital status).MethodsA cross-sectional, multicentre study among 4936 primary care older patients (aged 50+) was conducted. The PRACTA-Attitude toward Treatment and Health questionnaire (PRACTA-ATH) was used to measure the cognitive, emotional (positive and negative affect), and motivational dimensions of ATH. Patients were approached before and after their visits in the primary health-care facilities randomly selected in Central Poland.ResultsGeneralised linear models (GENLIN) revealed the main effects of gender, SAH, and sociodemographic characteristics, such as financial status, marital status and education. Interaction effects of gender and age (Wald’s χ2 = 24.767, p < 0.001 for ATH Global), as well as gender and SAH (Wald’s χ2 = 16.712, p < 0.002 for ATH Global) on ATH were found. The most assistance in regard to ATH was required by men aged 50–74 and men declaring good self-assessed health. Generally, women declared a more active attitude than men, showing more knowledge (M = 5.40, SD = 0.07 and M = 5.21, SD = 0.07, for women and men, respectively, p = 0.046), positive emotion (M = 5.55, SD = 0.06 and M = 5.33, SD =0.06, for women and men, respectively, p = 0.015) and motivation to be involved in their health issues (M = 5.71, SD = 0.07 and M = 5.39, SD = 0.07, for women and men, respectively, p = 0.001). The level of negative emotions related to health was not significantly different between genders (p = 0.971).ConclusionsThe need to create health promoting programmes taking account of particular gender differences in older adults emerges. In regard to clinical practice, building a sense of efficacy and individual responsibility for health, providing information about the means of health promotion and prevention, and recognising health-related cognitions, is recommended especially for men who feel well and are less advanced in age (50–74).

Testing a New Tool Assessing Attitude Towards Treatment and Health in Primary Health Care Setting: Senior Patients and Doctors Perspectives

Aims: Patients’ attitude towards treatment and health (ATH) is crucial for compliance at all stages of treatment. This study examined the psychometric properties of the developed PRACTA Attitude Towards Treatment and Health questionnaire, designed to measure ATH as perceived by seniors (PRACTA-ATH) and doctors (PRACTA-ATH-D) in primary health care. Methods: The data were collected in two waves of the Polish–Norwegian PRACTA project. Exploratory factor analyses (EFAs) were conducted on wave 1 data from senior patients (n = 3392) and their general practitioners (n = 491). Confirmatory factor analyses (CFAs) were conducted on wave 2 data. This was a new sample of senior patients (n = 2765) and a follow-up sample of doctors (n = 393). Results: The EFAs showed that the 16-item four-factor solution is the best solution reflecting the structure of both seniors and doctors’ ATH questionnaires. The CFAs conducted to establish the best unified model for PRACTA-ATH and PRACTA-ATH-D indicated three comparatively good solutions: the 16-item four-factor solution, the 12-item four-factor solution and the 12-item five-factor solution. Conclusions: The questionnaire is found appropriate for use among patients and doctors, and can be used as a good tool to monitor older patients’ ATH and concordance between doctors and patients’ perspectives.

The Bioavailability of Nutrients That Have a Health-Promoting Effect on Nervous System Function

Abstract The current lifestyle, stress, and improper diet may affect the quality of life on the one hand, and psychological functioning on the other hand. There are many studies highlighting the relationship of proper nutrition and psychological functioning, particularly cognitive functioning. This chapter focuses on and summarizes current research findings on relationship nutrition and neurological functioning in the context of changes of their bioavailability during the technological processes. The nutritional value of food ingredients as a result of technological processes gives favorable and unfavorable changes. These changes are associated with processing the technology of raw food, such as mechanical and biochemical processes. Mechanical processes could cause the loss of vitamins, minerals, as well as sugars. Biochemical processes (fermentation) could have a positive effect on the bioavailability of minerals and vitamins from group B. Sometimes; losses of vitamins may be greater than 60%. There are many factors that could affect the bioavailability of nutrients, especially contain substances that can promote and inhibit absorption, as well as the interaction with other ingredients. Knowledge about the bioavailability of nutrients from food is an important element in preventive medicine and improved health, especially in supporting the proper functioning of the nervous system.

A study of the factors determining motivational level to study of medical university students and a sense of identification with the future professional role

Background. The level of motivation to gain a specific medical knowledge is one of the important factors in the process of priming medical staff for work. Objectives. The aim of the research was to analyze the level of motivation to study in medical university students and the relationship between their motivation and the identification with the future professional role. Material and methods. The study was carried out in a group of 173 students of medicine, physiotherapy and medical rescue, aged 18–25 years. The research tool was the authors questionnaire enabling the assessment of the level of self-motivation to study and the identification with the future professional role. The statistical analysis was performed using the IBM SPSS Statistcs 21 software. The applied level of statistical significance was p ≤ 0.05. In order to examine the relation between the analyzed variables, the Spearman’s rank correlation coefficient was used. Results. The obtained results showed that the identification with the future medical profession among the students participating in the study was high. Additionally, it should be emphasized that in the examined group, the current motivation to study revealed a strong positive correlation with the level of identification with the future profession, and slightly weaker with the specific image of the work itself, as well as with the fulfillment of the expectations associated with the undertaken

Is sexology necessary in dermatology? Review of most common sexual dysfunction in skin disorders

In the latest literature attention is drawn to the role of skin changes during dermatological diseases in patients’ interpersonal relations. This is because many skin diseases are associated with severity of skin changes which are very often visible. Moreover, skin is important in human aesthetics and appearance. Because of this, the skin plays key roles for interpersonal communication, and real-life collaboration, because it is involved in emotional expression. Skin conductivity is sensitive to many different stimuli such as strong emotion, a startling event, pain, exercise, deep breathing, a demanding task, etc. [2,3].

ASSESSMENT OF INTEREST IN TAKING UP SECOND-CYCLE PROGRAMME IN PUBLIC HEALTH AMONG FIRST-CYCLE STUDENTS OF WARSAW MEDICAL UNIVERSITY

Introduction: Pursuant to the Bologna Declaration, a vast majority of students graduating from the first-cycle programme (Bachelor’s degree) at Warsaw Medical University (WMU) may enrol in the second-cycle programme (Master’s degree) in the same major or change a major after obtaining a Bachelors degree and start a programme e.g. in Public Health. Beginning in the academic year 2017-2018, the second-cycle programme in Public Health runs at the Faculty of Health Sciences, WMU as a full-time course (day studies), offering three specialities: Health Promotion, Healthcare Management, and Clinical Trials and Health Technology Assessment. Since 2017 Public Health Division, Faculty of Health Sciences, Warsaw Medical University has been the only one to offer a programme in Public Health in Warsaw as a member of ASPHER The Association of Schools of Public Health in the European Region. An original curriculum implemented since the academic year 2017-2018 matches European standards. A number of selected courses are taught in English, e.g.: International Health Policy and European Health Policy. The curriculum includes also modules of courses devoted to developing skills expected by employers: Prevention of burnout and Developing relationships with customers. Aim: The study aimed at assessing the interest in taking up second-cycle programme in Public Health among firstcycle students of Warsaw Medical University. Material: The study enrolled a total of 115 third-year Bachelors degree students of Warsaw Medical University (women comprising 57.9% of the total). Mean age was 21.92 years (SD: 1.61, median: 22, min. 21, max. 32). First-cycle students of Public Health constituted the largest subgroup (24.6%), followed by students of Emergency Medicine and Obstetrics (10.5%). Methods: Participation in the survey was voluntary. Respondents completed an original and anonymous questionnaire available online at: https://goo.gl/forms/j1rGpofw56TphmUM2. The questionnaire comprised three questions and additional questions on sociodemographic data. In the survey, the respondents assessed their interest in commencing the second-cycle programme in Public Health and indicated a speciality that was most interesting for them at a full-time Masters programme. The questionnaire was sent to students to their current email addresses by respective Deans Office staff members on May 22, 2017.The authors of the present study did not receive the approval of the Ethical Review Board of Warsaw Medical University for the study due to the fact that, according to the communication of the Ethical Review Board of WMU: “The Ethical Review Board do not give any opinion on surveys, retrospective, and other non-invasive studies.” Results: Less than half of the students (42.1%, n=48) considered taking up second-cycle programme in Public Health at the Faculty of Health Sciences, Warsaw Medical University. Most students were interested in the new speciality introduced in the academic year 2017-2018: Clinical Trials and Health Technology Assessment (47.9%). The remaining two specialities: Healthcare Management (25%) and Health Promotion (14.6%) taught in the Public Health Division, Faculty of Health Sciences, WMU since 2012 were much less popular. Conclusion: Steps should be taken on a large scale to inform candidates and first-cycle students about the career development prospects after graduation from Public Health and to encourage students to continue education on a Masters programme.

ATTEMPT OF COMPARISON OF ATTITUDES TOWARDS DEVELOPMENT OF COMMUNICATION SKILLS AMONG POLISH AND SWISS STUDENTS OF MEDICAL UNIVERSITIES

Introduction: A high level of communication skills of medical personnel significantly improves the effectiveness of treatment managed by an interdisciplinary team, quality of health care, including patient and personnel safety, as well as patient and family satisfaction with health services. Aim: The study attempted to evaluate attitudes towards development of communication skills among Polish and Swiss students of medical universities Material: The study enrolled a total of 343 students (women: n=278, 81%): from Poland (n=229; 66.8%) and Switzerland (n=114, 33.2%, University of Basel). Polish students represented seven universities, the largest number of students being from Warsaw Medical University (n=143, 41.7%), Collegium Medicum in Bydgoszcz (n=53, 15.5%), and the University of Rzeszów (n=22, 6.4%). The respondents studied at a total of 11 faculties, with students of medicine comprising the largest proportion (n=137, 39.9%), followed by students of nursing (n=77, 22.4%) and obstetrics (n=35, 10.2%). Most respondents studied full-time (n=332, 96.8%) and were first-cycle students (n=222, 64.7%). Subgroups comprising the first-year students (n=117, 34.1%), second-year students (n=77, 22.4%), and third-year students (n=68, 19.8%) were most numerous. Mean age of the study group amounted to 22.63 years (median: 22; min. 19, max. 55, SD: 2.75). Methods: The study was conducted with the use of a standardised questionnaire Communication Skills Attitude Scale (CSAS). The survey was performed in March and April 2017 using two electronic questionnaires: Polish and English language versions. Questionnaire reliability was evaluated with Cronbachs α coefficient of 0.775. The approval of the Ethical Review Board of Warsaw Medical University was not necessary due to the nature of the study (non-invasive survey conducted among students). Results: A vast majority of the respondents (n=338, 98.5%) agreed that they need to have good communication skills in order to be able to do their work well. A vast majority of students (n=250, 72,9%) believed that acquiring communication skills is as important as learning medicine and it develops team working skills (n=306, 89,2%). When asked to self-assess their communication skills, students rated their competence related to communication with patients and other staff members as good or very good (n=235, 68.5% and n=222, 64.7%, respectively). Conclusion: The study group agreed that education in communication skills is very important and crucial for taking up employment in a health profession. Therefore, despite a high level of self-assessment, it needs to be considered whether to include communication-related issues in the teaching contents.

Health suggestibility, optimism and sense of responsibility for health in diabetic patients

The study examined the relationship between sense of responsibility for health, health suggestibility, and dispositional optimism in diabetic patients (n = 110) with (n = 56) and without (n = 54) complications/accompanying diseases. The two groups of patients did not differ significantly in their sense of responsibility for heath, but health suggestibility was significantly higher and optimism was significantly lower in patients with complications. Health suggestibility and optimism had positive significant correlations with sense of responsibility for health in patients without complications, but in patients with complications, these correlations were not significant. However, the correlations between the two groups did not differ significantly suggesting lack of significant moderation effects due to complications. While it is understandable that suggestibility scores are higher and optimism lower in patients with complications, it is not easy to explain as to why the correlations were significant in patients without complications, but not in patients with complications. Further studies are warranted to draw any clinical implications of these results.