Państwo i Społeczeństwo / State and Society

Introduction: Professional development is recognized as a means of updating knowledge and skills, affects the quality of care and patient safety and leads to increased productivity for nurses.
Material and methods: The study included 508 nurses employed by hospitals. A diagnostic survey method and the Six Dimension Scale of Nursing Performance (SDNS) were used. The material was analyzed statistically.
Results: The nurses’ work performance index was 3.38, and their professional development index was 3.49. The responsibility criterion was rated at 3.84. The lowest scores occurred in the case of knowledge of nursing regulations (3.19) and professional autonomy (3.21). A high score of 3.71 was recorded in the area of taking on new responsibilities.
Conclusions: The professional development of nurses is satisfactory. Nurses demonstrate a strong awareness of responsibility and a high level of work performance in taking on new responsibilities. In the areas of autonomy and knowledge of nursing regulations they perform at a low level.

Introduction: The prolonged COVID-19 pandemic situation posed a significant risk of burnout and negative effects on the mental health of health care workers (HCWs).
Material and methods: The study group consisted of 97 HCWs who were actively employed during the first year of the COVID-19 pandemic. To assess their mental well-being, the following tools were used: the Link Burnout Questionnaire (LBQ), the Stress Perception Questionnaire (SPQ), the Inventory for Measuring Coping with Stress (COPE), and the Insomnia Severity Index (ISI).
Results: Significant differences were found in the use of stress coping strategies depending on age, gender, and years of work experience. 39% of HCWs exhibited a high level of Psychophysical exhaustion (LBQ), while 42% showed subthreshold insomnia. Individual dimensions of stress from the
Stress Perception Questionnaire (SPQ) significantly and positively correlated with LBQ and ISI.
Conclusions: It is recommended that the mental health of HCWs should be continuously monitored and that they should develop the ability to implement appropriate coping strategies in crisis situations, such as the COVID-19 pandemic, which may reduce the effects of stress, the impact of which on burnout and insomnia was demonstrated in this study.

Introduction: Globalization and migration, understood in many aspects, pose new challenges related to transcultural care in the health care system. The aim of this study was to find out the opinions of active nurses on the provision of care to patients from a cultural background other than their own.
Material and methods: The study included 113 professionally active nurses. The diagnostic survey method was used using an original survey questionnaire. The results were analyzed using the χ2 test and a percentage analysis of the responses, with a significance level of p > 0.05.
Results: Nearly two thirds of the respondents (66.4%) confirmed that they had encountered a culturally different patient in their professional practice. Statistical significance was not confirmed in the perception of the degree of difficulty of care in relation to language skills. Those under 35 years of age were more likely to indicate a feeling of uncertainty (p = 0.018) when dealing with a culturally/linguistically different patient, and those over 35 years of age were more likely to indicate motivation (p = 0.024). The need for additional training/courses on multiculturalism in nursing was cited by 69.9% of respondents.
Conclusions: The emotions of those in the nursing profession related to the care (experienced or hypothetical) of a patient from a cultural background different from their own, as well as the perception of such care, can be described as positive. The overwhelming majority of the respondents showed an interest in developing their own competences in caring for a culturally different patient, indicating the need to organize training sessions/courses for nurses on such topics.

Introduction: Myocardial revascularization aims to minimize residual ischemia and improve a patient’s quality of life. Patients scheduled for coronary artery bypass surgery usually have symptoms of anxiety and poor quality of life. Preoperative education can reduce the level of anxiety and improve the quality of life. This study aims to assess the impact of the education programme implemented in the preoperative period on the quality of life and symptoms of depression and anxiety among coronary artery bypass graft (CABG) surgery patients during the operation period.
Material and methods: The study group comprised 189 patients divided into two groups (n = 96 and n = 93). The MacNew questionnaire was used to assess the quality of life, and the HADS scale was used to assess the level of anxiety and depression.
Results: The average age of patients in both groups was 63 years. The dominant gender was male (n = 79 vs n = 74). No statistically significant differences were found between the groups. In the period before the procedure, the quality of life in both groups was the lowest in the physical area and the best in the emotional area. After the procedure, there was a statistically significant improvement in the quality of life in all areas. The intensity of anxiety was medium, and approximately 12% of the respondents showed symptoms of depression. After surgery, the severity of anxiety and depression was statistically significantly lower. Participation in education did not differentiate the quality of life or the severity of anxiety and depression.
Conclusion: Patients undergoing CABG experience an improvement in their quality of life and a reduction in symptoms of anxiety and depression compared to the period before the surgery. The education programme provided to CABG patients may positively impact QoL and reduce their anxiety among these patients.

Introduction: Healthcare Associated Infections pose a threat to the health and life of patients and may result in therapeutic failure. Raising awareness of the issue of HAI may have a positive impact on their control and combating.
Material and methods: This study included 3759 patients from the Clinical Department of Vascular Surgery of the Karol Marcinkowski Clinical Hospital in Zielona Góra between 2014 and 2016. The research used standard tools and hospital definitions from the European Centers for Disease Prevention and Control, as well as medical records.
Results: 108 HAI cases were diagnosed (incidence 2.9%). Surgical Side Infection was the most common and accounted for 72.2% of all infections (2.1%). Urinary tract infections accounted for 9.3% (0.3%), gastrointestinal tract infections 5.5% (0.2%) and pneumonia 4.6% (0.1%). The remaining forms of infections accounted for 8.3% (0.2%). The most common etiological factors causing HAI were Escherichia coli and made up 13.3% of infections, Staphylococcus aureus, which was present in 10.7% of infections and Enterococcus faecalis, found in 10.7% of infections.
Conclusions: The number of infected people in the Clinical Department of Vascular Surgery at the Karol Marcinkowski Clinical Hospital in Zielona Góra decreased. The most common form of infection was SSI, and the most common etiological factor causing infection was Escherichia coli. Age and gender influenced the occurrence of infections. The decrease in the number of infections between 2014 and 2016 in this hospital was related to infection prevention.

Introduction: Vaccinations are the most effective way to prevent infectious diseases. Therefore, the increasing rate of opt-out from vaccinations is worrying. The aim of this study was to assess the impact of parents’ attitudes towards children’s vaccinations on the implementation of the preventive vaccination programme (Polish: Program Szczepień Ochronnych, or PSO).
Material and methods: The study was conducted among parents of children registered with a non-public health institution in Kraków – Nowa Huta (single-centre study, N = 136). The study employed the diagnostic survey method, using the author’s own questionnaire, and the information from this was correlated with the data contained in the children’s immunization cards.
Results: It was shown that parents who had their children vaccinated in accordance with the PSO had a more favourable attitude towards preventive vaccinations than parents who did not do this, after taking into account the degree of trust in medical staff, the content of books and medical journals and the fact of previous occurrences of unfavourable post-vaccination reactions. It was found that for each unit by which parents’ positive attitude towards vaccinations increased, the probability of vaccinations according to the schedule increased by 43% (odds ratio = 1.43; 95% CI 1.12–1.82; p < 0.01).
Conclusions: Parents’ attitudes towards vaccinations influence the implementation of PSO. Attitude research is an important research area that will make it possible to develop more effective educational interventions among parents.

Introduction: The Act on the Profession of Physiotherapist has led to an increase in the importance of the profession. The document regulates issues related to the role of the physiotherapist in the therapeutic team, the scope of his or her duties and professional responsibility. The aim of this study was to assess the knowledge of hospital staff concerning the profession of the physiotherapist in light of the 2015 Act.
Material and methods: The study included 563 hospital employees from public hospitals. The diagnostic survey method was used. The research tool was a questionnaire of the author’s own design.
Results: Almost half of the respondents stated that the person authorized to provide rehabilitation is a rehabilitation therapist (48%), even though legally it is a physiotherapist (35%). The respondents mainly indicated the following as their place of work: hospital, a non-public health institution and care home. Around 20% of respondents incorrectly answered that the profession of physiotherapist is not an independent medical profession. Only 44% of the respondents declared that they worked with a physiotherapist, but as many as 76% of them believed that a physiotherapist should be a member of the therapeutic team. The respondents believed that educational action should be taken in the field of physiotherapy.
Conclusions: Despite the fact that several years have passed since the Act on the profession of the profession of physiotherapist was introduced, the state of knowledge of hospital staff about this group of professionals still needs to be updated.

Introduction: The aim of this study was to explore the extracurricular activity settings of school-aged children with and without disabilities, who selected the activities and whether they meet children’s interests.
Material and methods: A questionnaire was developed specifically for this study and included questions concerning children’s extracurricular participation.
Results: 90% of children from group A, 66% from group B, and 69% from group C participated in extracurricular activities. In group A, 67% of children chose activities together with parents, while in groups B (18.2%) and C (30.4%) teachers were often involved. Activities met the interest of most children, although the number of children for whom activities met their interest differed depending on who selected them.
Conclusions: The study found that children without disabilities were more likely to participate in extracurricular activities than their peers with a disability rating.

Introduction: Well organized training of football players is a prerequisite for improving their motor and tactical skills, which is necessary for attaining good results. The aim of this study was to assess the changes in fitness and physical capacity of non-professional football players.
Material and methods: A group of 21 male football players aged 16.2 ± 0.3 years, who play football at the Sport Academy Progres in Cracow, took part in this study. Fitness and physical capacity tests were conducted before and after the game season.
Results: The year-long training programme resulted in a marked improvement in explosive leg strength, in velocity at a distance of 10 m, in VO2max, and in the Beep test results.
Conclusions: Further studies are indispensable in order to elaborate more effective strategies aimed at improving fitness and physical capacity, which would enable a rational assortment of training loads and would prevent overexerting young players.

The pathophysiology of a reperfusion injury, which poses a challenge after a cardiac ischemic episode, is not fully understood. Several molecular processes show possible ways to counteract this phenomenon. One is to prepare the heart for the onset of an ischemic episode, which can be achieved by physical training of the patient or pharmacotherapy. Another approach is to act pharmacologically on the miRNA or NRF2 family of transcription factors.
Crucial for cardiac surgery is the use of an appropriate cardioplegin solution and to administer it correctly. Recent studies have focused particularly on the use of del Nido cardioplegin, which, when administered, allows for the extension of safe myocardial ischemia for up to 120 minutes in higher-risk patients. The use of trimetazidine makes it possible to reduce cardiovascular risk in older patients after surgery, and the administration of Alfacalcidol before valve surgery reduces the risk of perioperative complications.
By inducing pathological conditions in animals, it is possible to test compounds that can counteract these phenomena or reduce their severity. Compounds such as disulfiram, crocin, stachytin, gosypine, or metformin in combination with hydrogen can reduce the risk of cardiovascular complications and cardiac remodelling.
Cardioprotection is important in the pediatric population because of the effects of some therapies that cause iatrogenic myocardial damage. Administration of dexrazoxane or glutathione in combination with doxarubicin therapy can reduce myocardial damage in the pediatric population without reducing the efficacy of the chemotherapeutics. The cardioprotective effects of carvedilol, captopril, simvastatin and L-carnitine, as well as some supplements, have also been demonstrated.

Over the years, various attempts have been made to treat vasovagal syncope, AV block and sinus node dysfunction. Scientific research has excluded pharmacological treatment with beta-blockers as an effective therapy for these diseases. Current ESC guidelines recommend the use of pacemakers in these cases. The implantation of dual-chamber devices is highly effective in alleviating symptoms. However, this involves reoperation in the future to replace the device’s battery. This problem especially concerns young patients, in whom several reoperations are expected. This increases the risk of local and systemic infections. A new method of treatment is cardioneuroablation (CNA). It destroys the ganglion nodes with a radiofrequency current to reduce the parasympathetic component. Thanks to the modulation, the positive chronotropic effect on the heart is strengthened. The effectiveness of CNA ranges from 80 to 100%. CNA is also characterized by a low perioperative risk.

Pelvic organ prolapse is a serious gynaecological problem that affects many women at any age. Due to its complex, multifactorial etiology and the overlap of genetic and environmental factors, research on molecular and biochemical changes is challenging. The most important issue is the identification of women predisposed to organ prolapse so that preventive measures can be taken earlier to reduce the risk of prolapse. This article presents the results of research on the genetic component of pelvic organ prolapse.

This paper presents four cases of patients diagnosed with GIST-type tumours. In three patients the starting point of the tumor was the stomach, in one the small intestine. Three local radical procedures were performed (including one laparoscopic) and one excisional sampling due to infiltration of the pancreas and diaphragm. The article briefly discusses the treatment of mesenchymal tumours of the gastrointestinal tract.

Osteoporosis related to pregnancy and lactation is a rare, secondary form of osteoporosis. It involves a decrease in bone mineral density and disturbances in microarchitecture, leading to fractures. This paper presents a rare case where a 34-year-old patient was treated with denosumab for severe osteoporosis related to pregnancy and lactation. The diagnosis was made after extensive differential diagnosis had been conducted. After a year of denosumab treatment, an increase in mineral density, relief from pain, and functional improvement were achieved. Currently, there are no guidelines for treating such osteoporosis, but denosumab appears to be a safe and effective alternative to bisphosphonates.

Hypophosphatasia (HPP) is a rare, genetically inherited metabolic disorder caused by a mutation in the tissue-nonspecific alkaline phosphatase (TNALP) gene leading to loss of its function. The clinical presentation is highly heterogeneous, with mild forms often being asymptomatic for long periods. In adults, involvement of bone tissue leads to demineralization, which may result in a misdiagnosis of osteoporosis. In a 69-year-old patient, osteoporosis was initially diagnosed on the basis of abnormal densitometry results and antiresorptive therapy was initiated. Due to bone and joint pain, the patient was admitted to an osteoporosis outpatient clinic, where HPP was diagnosed due to low alkaline phosphatase (ALP) levels, TNALP gene mutation, kidney stones, and early tooth loss. Denosumab therapy was discontinued, while vitamin D supplementation was maintained. This paper emphasizes the necessity of a detailed differential diagnosis, especially in patients with an “osteoporotic” phenotype of the disease, in order to avoid iatrogenic use of antiresorptive medications.