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Individual and contextual factors of nulliparas’ levels of depression, anxiety and fear of childbirth in the last trimester of pregnancy: intimate partner attachment a key factor?

Abstract

Background

Depression, anxiety and fear of childbirth have numerous consequences for women and their developing offspring. Insecure attachment in close adult relationships is considered to be a risk factor for depressive symptoms. This study aims to gain further insight into the risk factors for depressive and anxiety symptoms in nulliparous women during the third trimester of pregnancy regarding the main contextual relations, with an emphasis on partner attachment.

Methods

A group of 325 nulliparas in the third trimester of pregnancy was enrolled in a childbirth preparation program. The following instruments were applied: Experiences in Close Relationships-Revised, the Edinburgh Depression Scale, the Zung Anxiety Scale, and a questionnaire regarding fear of childbirth. Three separate multiple linear regression models were built to explore the associations between demographic, social and attachment variables and mental health functioning.

Results

Highly educated nulliparas and those with a higher level of co-workers’ emotional support experienced a lower level of anxiety when other predictors in the model were held constant. Of all the predictors in the model, only attachment anxiety and co-workers’ support were statistically significantly associated with the level of depression. Attachment anxiety was significantly associated with all three mental health indicators (level of depression, anxiety and fear of childbirth).

Conclusions

The results suggest that intimate attachment anxiety could be a key contextual factor for mood and anxiety mental health functioning during the third trimester of pregnancy, accessible to change. Our results could facilitate the formulation of interventions for reducing antenatal depressive symptoms.

Open access
Measuring quality in primary healthcare – opportunities and weaknesses

Abstract

The easy access to data from electronic patient records has made using this type of data in pay-for-performance systems increasingly common. General practitioners (GPs) throughout Europe oppose this for several reasons. Not all data can be used to derive good quality indicators and quality indicators can’t reflect the broad scope of primary care. Qualities like person-centred care and continuity are particularly difficult to measure. The indicators urge doctors and nurses to spend too much time on the registration and administration of required data. However, quality indicators can be very useful as starting points for discussions about quality in primary care, with the purpose being to initiate, stimulate and support local improvement work. This led to The European Society for Quality and Patient Safety in General Practice (EQuiP) feeling the urge to clarify the different aspects of quality indicators by updating their statement on measuring quality in Primary Care. The statement has been endorsed by the Wonca Europe Council in 2018.

Open access
Context Analysis in the Development of Diving Technologies

Abstract

The previous article described a new approach methodology1 for work on the development of technology for the use of the SCR CRABE SCUBA2 type diving apparatus. However, after its publication numerous questions emerged regarding the genesis of the research undertaken, also from foreign partners using the same rebreather. The work on changing the technology of use was preceded by analyses, which were available only to people involved in the decision-making process. Demonstrating all the details of the decision-making process may be tedious, but failing to present them at all might raise justified doubts about the advisability of conducting a long-term research cycle.

This article only presents preliminary analyses. The necessity to perform them resulted from the specific requirements for military technologies3 which, as broadly as possible, should be knowledge-based. The knowledge-based approach by its very nature allows continuous improvement of the adequacy of the predictions made, the estimation of the level of risk when diagnosing deviations from the repeatability or precision of the model, and the possibility of adapting the technology to the changing requirements of the user resulting from tactical considerations of its use.

Open access
Deep Diving underwater works in Poland

Abstract

In the article the author describes the Polish specificity of deep dives used in underwater deep-sea works. The article briefly discusses the methods of deep diving used in the world to proceed to underwater works in the Polish offshore zone of 50-90m depth (according to the Act; deep water works are works below a depth of 50m). When discussing these methods, the author describes the technical-organisational and formal conditions and the type of conducted works. It then presents the methodology for evaluating the effectiveness of the main element of deep-sea works, i.e. diving. It provides information on deepsea underwater works on the Baltic Sea carried out by the Department of Underwater Works Technology of the Naval Academy in cooperation with the Polish Navy until 2001 and civil companies to date. On the basis of his own data from underwater deep-sea works, the author presents the methodology of evaluation of their effectiveness from the point of view of deep dives. In his conclusions, he puts forward recommendations for improving the efficiency of such works.

Open access
Detection of Patent foramen Ovale with Contrast Enhanced Transcranial Doppler at Divers

Abstract

Patent foramen ovale (PFO) is a condition present in 25% of the adult population. It is a remnant of fetal foramen ovale which allows blood to pass from the right to the left atrium, bypassing the fetal lungs. In majority adults it does not have any clinical significance, but in some people it may allow shunting of venous blood into the left atrium (right – left – shunt or RLS), circumventing the lung filter, especially during sneezing, cough, lifting heavy equipment. Is such case, PFO may be a route for venous emboli or gas bubbles from veins to the arterial system. It is known as a paradoxical embolism and may be cause of ischaemic stroke or neurologic decompression sickness (DCI), inner-ear DCI and cutis marmorata. Transesophageal echocardiography is considered as a reference standard in detection of intracardial shunts. Its sensitivity and specificity ranges between 94%-100%. However, TEE is an invasive examination with potentially serious side effects. An alternative examination in RLS detection is contrast enhanced Transcranial Doppler (the bubble study or c-TCD). In comparison to TEE, Transcranial Doppler is not invasive, relatively not expensive and save technique. With its high sensitivity and specificity in detection of PFO, 97% and 93% respectively, it may improve detection of RLS and allow to conduct screening examination for PFO in divers.

Open access
Hyperbaric Oxygen Treatment is Associated with Lipid Inflammatory Response Assessed Uding Serum Platelet Activating Factor

Abstract

Hyperbaric oxygen (HBO) treatment is generally a relatively safe therapy for various conditions. However, there are some adverse side effects. For example HBO tratment has been reported to increase the production of free oxygen radicals(FRs). Furthermore, to our knowledge, no previous clinical research has been carried out to study the involvement of platelet-activating factor(PAF)as the lipid oxidative stressor in patients undergoing HBO treatment. A total of 45 patients included in this study were first given clinical assessment and laboratory measurements before starting HBO treatment and were named group baseline. After the HBO treatment, the same clinical and laboratory measurements from the same patients were repeated and this was named group sesion >20.As expected, long-term HBO treatment had no effect on oxLDL (oxidized low-density lipoprotein), a lipid oxidative stress(OS) marker. However, the mean PAF values in the second group showed a statistically significant increase compared to their pretreatment values, (P <0. 002).As this is a preliminary study, there is a need for more detailed investigations that demonstrate the association of HBO treatment with the lipid inflammatory response. Therefore, there is need for further clinical study for OS markers such as oxLDL in HBO treatment. Clinical prospective studies are required to confirm our laboratory findings.

Open access
Molecular Dimerisation in a Multilayer Adsorption Phase on Homogeneous Surfaces of a Solid Adsorbent

Abstract

Continuing the discussion on the description of adsorbate-adsorbate association on homogeneous surfaces of solids, an attempt was made to formulate an analytical form of adsorption equation for a multilayer adsorption phase. The validity of Berezin’s and Kiselev’s assumptions concerning the independence of adsorption in further layers from the model of the phenomenon in the first of them was discussed. The fundamental validity of this assumption has been demonstrated, simultaneously ridding it of its arbitrary character. The main aim of the study was to demonstrate the possibility of formulating a description assuming molecule association in the entire adsorption phase (and not only in the first layer). Theoretical considerations are confined to the case of dimerisation in the concentration range thus warranting the approximation characteristic of the Berezin and Kiselev model. The obtained final adsorption equation exhibits physically acceptable boundary properties; with adequate assumptions it amounts to the Brunauer, Emmett and Teller equation, the equation formulated earlier by one of the authors of this paper or the Langmuir equation.

Open access
Classification of primary caesarean sections in labor and its usefulness for analysis of Slovenian perinatal data

Abstract

Objective

To determine the usefulness of a novel classification of indications for caesarean section (CS) in labour in recognizing differences in clinical practice in different maternity units.

Methods

Data from the National Perinatal Information System (NPIS) for 2013 and 2014 were used to classify indications for CS in nulliparous women with spontaneous onset of labour at ≥37 weeks with single cephalic foetuses within 14 Slovenian maternity units into foetal distress and different sub-groups of dystocia according to use and dosage of oxytocin. Chi-square test was used for statistical comparison between units (P≤0.05 significant).

Results

There were 13,572 deliveries and 1,567 (12.0%) CS in nulliparous patients with spontaneous onset of labour at ≥37 weeks with single cephalic foetuses in Slovenia during the study period. Rates of CS in this group of women differed significantly among different maternity units (from 4.1% to 20.9%; P<0.001) suggesting significant differences in clinical practice. The most common indication for CS was cephalopelvic disproportion, which was diagnosed with different frequency in different units (from 11.2% to 45.9%; odds ratio 6.72; 95% confidence interval 3.10– 14.71; P<0.001).

Conclusions

It is possible to use NPIS data to retrospectively classify indications for CS. Such classification reveals significant differences among maternity units and could allow for a meaningful analysis of CS rates in different hospitals leading to evidence-based initiatives to decrease the incidence of primary CS.

Open access
Frailty assessment scales for the elderly and their application in primary care: A systematic literature review

Abstract

Background

The increase in the elderly population is causing changes and challenges that demand a comprehensive public health response. A specific characteristic of the elderly is their frailty. Today’s problems with identifying levels of frailty are being resolved by numerous tools in the form of frailty assessment scales. This systematic review establishes which frailty assessment scales for the elderly are being used and what their applicability in primary care is like in Slovenia and around the world.

Methods

Documents published after 2010 were searched for in the PubMed database using keywords and other specific criteria.

Results

A total of 177 search hits were obtained based on various search strings. The final analysis included 28 articles, of which three were systematic literature reviews. These three covered quantitative studies, mainly consisting of observational cross-sectional surveys or cohort studies. Three other studies featured non-systematic literature reviews. Quantitative studies (mainly cross-sectional surveys or cohort studies) prevailed among the remaining 22 articles. One study had a qualitative design (Delphi method). The main outcome measures observed by all studies were frailty assessment scales for the elderly, the majority of which were evaluated on a sample of the elderly.

Conclusions

None of the assessment scales examined are used as the gold standard for primary care. A variety of tools are being used in clinical practice to assess frailty in elderly patients, highlighting the need for standardization and guidelines. This requires evaluating the current assessment scales in terms of validity and reliability, and suitably improving them.

Open access
Health behaviour changes of cutaneous melanoma survivors in Slovenia – a qualitative study

Abstract

Introduction

Most data related to cutaneous melanoma survivors’ health behaviour comes from epidemiological studies and is predominantly concerned with safe-sun behaviour and self-examination. Data regarding other changes of health behaviour are scarce and so are qualitative studies in this realm. The aim of our research is to acquire insight into the experiences of patients with cutaneous melanoma in Slovenia. How did they react to the diagnosis, which changes did they introduce in their health behaviour and how do they assess the role of family doctors?

Methods

Using the qualitative approach of collective case reports, a demographically diverse group of patients with different forms and stages of cutaneous melanoma was selected. Semi-structured interviews conducted by a psychologist were recorded and transcribed verbatim. For data processing, the approach of Qualitative Content Analysis was applied.

Results

We integrated interviewees’ experiences after the diagnosis of cutaneous melanoma in several subcategories: either they did not introduce any changes or they mentioned changing their habits when exposed to the sun and performing skin self-examination; they also emphasized their ways of dealing with stress and raising awareness about melanoma among family members and friends. The role of family doctors in the prevention and care appears unclear; even contradictory.

Conclusion

We obtained insight into the experiences of Slovenian patients with cutaneous melanoma. The interviewees prioritised safe behaviour in the sun, strengthening of psychological stability and raising awareness about melanoma. Findings will be used in the creation of a structured questionnaire for national epidemiological survey.

Open access