medical and biological sciences

Transkrypt

UNIWERSYTET MIKOŁAJA KOPERNIKA w TORUNIU
COLLEGIUM MEDICUM im. LUDWIKA RYDYGIERA
W BYDGOSZCZY
MEDICAL
AND BIOLOGICAL
SCIENCES
(dawniej
ANNALES ACADEMIAE MEDICAE BYDGOSTIENSIS)
TOM XXIII/4
październik – grudzień
ROCZNIK 2009
REDAKTOR NACZELNY
Editor-in-Chief
Grażyna Odrowąż-Sypniewska
ZASTĘPCA
REDAKTORA NACZELNEGO
Co-editor
Jacek Manitius
SEKRETARZ REDAKCJI
Secretary
Beata Augustyńska
REDAKTORZY DZIAŁÓW
Associate Editors
Mieczysława Czerwionka-Szaflarska, Stanisław Betlejewski,
Roman Junik, Józef Kałużny, Jacek Kubica, Wiesław Szymański
KOMITET REDAKCYJNY
Editorial Board
Aleksander Araszkiewicz, Beata Augustyńska, Michał Caputa, Stanisław Dąbrowiecki, Gerard Drewa, Eugenia Gospodarek,
Bronisław Grzegorzewski, Waldemar Halota, Olga Haus, Marek Jackowski, Henryk Kaźmierczak, Alicja Kędzia,
Michał Komoszyński, Wiesław Kozak, Konrad Misiura, Ryszard Oliński, Danuta Rość, Karol Śliwka, Eugenia Tęgowska,
Bogdana Wilczyńska, Zbigniew Wolski, Zdzisława Wrzosek, Mariusz Wysocki
KOMITET DORADCZY
Advisory Board
Gerd Buntkowsky (Berlin, Germany), Giovanni Gambaro (Padova, Italy), Edward Johns (Cork, Ireland),
Massimo Morandi (Chicago, USA), Vladimir Palička (Praha, Czech Republic)
Adres redakcji
Address of Editorial Office
Redakcja Medical and Biological Sciences
ul. Powstańców Wielkopolskich 44/22, 85-090 Bydgoszcz
Polska – Poland
e-mail: [email protected], [email protected]
tel. (052) 585-3326
www.medical.cm.umk.pl
Informacje w sprawie prenumeraty: tel. (052) 585-33 26
e-mail: [email protected], [email protected]
ISSN 1734-591X
UNIWERSYTET MIKOŁAJA KOPERNIKA W TORUNIU
BYDGOSZCZ 2009
Medical and Biological Sciences, 2009, 23/4
CONTENT
p.
REVIEWS
Katarzyna Skonieczna, Marcin Woźniak, Urszula Rogalla, Patrycja Daca,
Marta Mielnik, Katarzyna Linkowska, Marta Gorzkiewicz, Jarosław
Bednarek, Edyta Rychlicka, Anna Czarnecka, Tomasz Grzybowski
– Genome sequencers – towards personalized genomics and medicine . . . . . . . . . . . . . . . . . . . . . . . . . .
5
M a c i e j Ś n i e g o c k i – Image analysis – medical and technical problem . . . . . . . . . . . . . . . . . . . . . . . . . .
11
ORIGINAL ARTICLES
A n n a B e d n a r e k , B e a t a J ę d r u s z a k – Health threats in children in the selected rural environment
17
M a r t a C e b u l a k , A n n a K s y k i e w i c z - D o r o t a – Structure of utilization of nursing time in psychiatric ward – preliminary studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
J e r z y E k s t e r o w i c z , M a r e k N a p i e r a ł a – Morphological build of physical education students
at the Kazimierz Wielki University in Bydgoszcz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31
M i r o s ł a w a F e l s m a n n , E l ż b i e t a K ę d z i e r s k a – Patients suffering from acute coronary
syndromes and the accompanying anxiety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
37
M a r i u s z K l i m c z y k – Sport profiles of 13-year-old pole vault jumpers . . . . . . . . . . . . . . . . . . . . . . . . . .
45
Monika Wiłkość, Beata Augustyńska, Aleksander Araszkiewicz, Kinga
S o b i e r a l s k a - M i c h a l a k , A n n a D u d z i c - K o c , P i o t r B i j a k o w s k i – Cognitive
functions in alcohol dependent patients. A description of a new cognitive battery – QMT (Quick Mind
Testing) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
51
CASE REPORT
Małgorzata Łukowicz, Jan Pawlikowski, Paweł Zalewski, Magdalena
Weber-Zimmermann, Katarzyna Ciechanowska, Agnieszka Pawlak
– Body weight supoort during treadmill therapy in patients after SCI – case study . . . . . . . . . . . . . . . . .
59
SPIS TREŚCI
str.
PRAGE POGLĄDOWE
Katarzyna Skonieczna, Marcin Woźniak, Urszula Rogalla, Patrycja Daca,
Marta Mielnik, Katarzyna Linkowska, Marta Gorzkiewicz, Jarosław
Bednarek, Edyta Rychlicka, Anna Czarnecka, Tomasz Grzybowski
– Sekwenatory genomowe – narzędzia spersonalizowanej genomiki i medycyny . . . . . . . . . . . . . . . . . .
5
M a c i e j Ś n i e g o c k i – Analiza obrazu – wspólny problem lekarza i inżyniera . . . . . . . . . . . . . . . . . . . . .
11
PRACE ORYGINALNE
A n n a B e d n a r e k , B e a t a J ę d r u s z a k – Zagrożenia zdrowotne u dzieci w wybranym środowisku
wiejskim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
M a r t a C e b u l a k , A n n a K s y k i e w i c z - D o r o t a – Struktura wykorzystania czasu pracy pielęgniarek na oddziałach psychiatrycznych – badania wstępne . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
J e r z y E k s t e r o w i c z , M a r e k N a p i e r a ł a – Budowa morfologiczna studentów Uniwersytetu
Kazimierza Wielkiego w Bydgoszczy z kierunku wychowania fizycznego . . . . . . . . . . . . . . . . . . . . . . . .
31
M i r o s ł a w a F e l s m a n n , E l ż b i e t a K ę d z i e r s k a – Pacjenci z ostrymi stanami wieńcowymi
a towarzyszący im lęk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
37
M a r i u s z K l i m c z y k – Profile sportowe 13-letnich skoczków o tyczce . . . . . . . . . . . . . . . . . . . . . . . . . .
45
Monika Wiłkość, Beata Augustyńska, Aleksander Araszkiewicz, Kinga
S o b i e r a l s k a - M i c h a l a k , A n n a D u d z i c - K o c , P i o t r B i j a k o w s k i – Funkcje
poznawcze u pacjentów uzależnionych od alkoholu. Opis nowej baterii testów poznawczych – QMT
(Quick Mind Testing) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
51
OPIS PRZYPADKU
Małgorzata Łukowicz, Jan Pawlikowski, Paweł Zalewski, Magdalena
Weber-Zimmermann, Katarzyna Ciechanowska, Agnieszka Pawlak
– System dynamicznego odciążenia w terapii chodu na bieżni u pacjenta po urazie rdzenia kręgowego
– prezentacja przypadku . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
59
Regulamin ogłaszania prac w Medical and Biological Sciences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
65
Medical and Biological Sciences, 2009, 23/4, 5-10
REVIEW / PRACA POGLĄDOWA
Katarzyna Skonieczna, Marcin Woźniak, Urszula Rogalla, Patrycja Daca, Marta Mielnik, Katarzyna Linkowska,
Marta Gorzkiewicz, Jarosław Bednarek, Edyta Rychlicka, Anna Czarnecka, Tomasz Grzybowski
GENOME SEQUENCERS – TOWARDS PERSONALIZED GENOMICS
AND MEDICINE
SEKWENATORY GENOMOWE – NARZĘDZIA SPERSONALIZOWANEJ GENOMIKI
I MEDYCYNY
Department of Molecular and Forensic Genetics, Chair of Forensic Medicine, Nicolaus Copernicus University
Collegium Medicum in Bydgoszcz
Head: PhD Tomasz Grzybowski
Summary
In recent years, the development in the DNA sequencing
technology has resulted in the invention of new platforms for
DNA sequence analysis. The achievements in sequencing
technology offer promising opportunities for a fast and
cheap, full genome determination which spur research
development in biodiversity studies, agriculture or
personalized medicine. This review provides information on
both whole genome sequencers and sequencing technology
applied in each instrument to determine the nucleotide
sequence of complete genomes.
Streszczenie
W ostatnich latach rozwój technologii sekwencjonowania
DNA zaowocował powstaniem nowych urządzeń
umożliwiających poznanie sekwencji DNA. Osiągnięcia
dokonane w dziedzinie sekwencjonowania niosą obiecujące
możliwości szybkiego i taniego poznania sekwencji pełnych
genomów, a tym samym rozwoju badań nad zróżnicowaniem
organizmów, rozwojem rolnictwa czy też tzw. „medycyny
spersonalizowanej”. Niniejsza praca dostarcza informacji
o sekwenatorach genomowych oraz wykorzystywanych
w nich metodach sekwencjonowania stosowanych do
określania sekwencji nukleotydowej pełnych genomów.
Key words: Automated Capillary Array Analyzer, FLX Sequencer, Illumina/Solexa Analyzer, SOLiD Analyzer, Heliscope
Sequencer, SMRT Sequencer, Nanopore DNA Sequencer
Słowa kluczowe: sekwenator kapilarny, sekwenator FLX, sekwenator Illumina/Solexa, sekwenator SOLiD, sekwenator
Heliscope, sekwenator SMRT, sekwenator Nanopore
INTRODUCTION
Information about the whole genomic DNA
sequence of individuals could provide us with a better
understanding of its influence on a phenotype of
organisms. This would have a great impact on and
application to many areas of our life, such as energy
production (selection and/or modification of organisms
like bacteria or fungi to produce energy), agriculture
(selection and/or modification of plants, which would
boost crop yields) and especially to our health as
information about the genome sequence and its
variation could provide information on disease risk,
diagnosis and proper treatment.
In 1977 two methods of sequencing, proposed by
Sanger and Maxam and Gilbert respectively, were
6
Katarzyna Skonieczna et al.
announced and brought the opportunity to determine
the DNA sequence [1, 2]. Since then, development in
sequencing technology, which allows to improve the
sequencing speed, has led to the introduction of new
instruments for DNA sequence determination to the
market.
AUTOMATED CAPILLARY ARRAY ANALYZER
The chain termination sequencing method
developed by Frederick Sanger is based on the DNA
chain
termination
by
dideoxyribonucleotide
triphosphates (ddNTP’s). The original Sanger method
relied on oligonucleotide chain elongation with
deoxyribonucleotide triphosphates (dNTP’s) by DNA
polymerase, which was terminated by incorporation of
32
P labeled ddNTP. Four separate reactions were
performed for one DNA template, each containing
unlabeled dNTP’s and one of four ddNTP terminators:
ddATP, ddCTP, ddGTP, ddTTP. As the DNA
polymerase was not able to distinguish between
dNTP’s and ddNTP’s, and lack of 3’OH group of
ddNTP stopped the elongation of DNA, a mixture of
fragments of different size was obtained in a single
experiment. The determination of the DNA sequence
was then elucidated from denaturing acrylamide gel
electrophoresis of the four sequencing reactions
running simultaneously on the same gel [1]. The
modification of the Sanger method based on the usage
of four ddNTP’s labeled with fluorescent dyes of
different colors in a single reaction is called dye
terminator sequencing. The separation of the DNA
fragments of varying lengths and DNA sequence
determination could be further provided by slab gel or
capillary
electrophoresis;
however,
capillary
electrophoresis is much less time-consuming [3]. The
first automated 1-capillary array analyzer for capillary
electrophoresis was developed by Applied Biosystems
and commercialized in 1995. Three years later, in
1998, Applied Biosystems introduced the highthroughput automated 96-capillary sequencer to the
market [4]. Since then, the dye terminator sequencing
technology with the application of an automated
capillary array sequencer has been applied for whole
genome sequencing of many species from bacteria [5]
to a human [6, 7]. The highest throughput of currently
available capillary sequencers can be achieved on ABI
3730xl instrument, capable of sequencing 96 DNA
fragments (each with reads longer than 900 bp) in a
single run time of 3 hours [4]. Despite the above, the
method is still too time- and cost-consuming for large
genome sequencing projects, given the growing need
for sequence data from many fields of molecular
biology. To put the matter of costs and time in a
perspective one should realize that sequencing of the
entire human genome with one high-throughput 96capillary analyzer would take about 60 years and cost
over 30 million US dollars [8]. Thus, invention of new
sequencing technologies was necessary to speed up the
generation of new large sets of sequence data from
either genomes or transcriptomes of different
organisms. Below we present a few of those new
sequencing techniques, some of them currently
available and some announced to arrive to the market
in the near future.
FLX GENOME SEQUENCER
The method used to elucidate the DNA sequence
with the FLX instrument relies on an emulsion
polymerase chain reaction (emPCR), which allows the
clonal amplification of a 400 bp long DNA fragment
and a subsequent pyrosequencing reaction (sequencing
by synthesis method) performed in a PicoTiterPlate
(PTP) on an FLX instrument [9]. Emulsion PCR is a
reaction of DNA amplification in a water-in-oil
emulsion. During emPCR a single DNA fragment is
linked to the specific adaptor and bound to a single
streptavidin-coated bead. Thereafter DNA carrying
beads are suspended in a water-in-oil emulsion, so that
each bead with a single DNA fragment resides in an
individual emulsion droplet, and DNA fragments are
amplified in the polymerase chain reaction. As a result
of emPCR each bead is coated with millions of copies
of a single DNA fragment. Subsequently beads
carrying amplified DNA are placed into fiber-optic
wells on PTP where one bead resides in one well
(which is determined by the size of a well), and a DNA
sequence is determined through a pyrosequencing
reaction on the FLX sequencer [10]. During
pyrosequencing the universal sequencing primer
anneals to the DNA fragment and afterward is
elongated in repeated cycles of sequential dNTP
incubations and washing with apyrase enzyme (which
degrades nucleotides) between each dNTP flow. dNTP
incorporation to the growing DNA strand (whenever it
happens) causes the release of inorganic
pyrophosphate, which is measured chemiluminescently
by a charge-coupled device (CCD) camera and allows
the DNA sequence to be determined [11]. The FLX
analyzer was developed by 454 Life Science and
Genome Sequencers - towards personal genomics and medicine
Roche Diagnostics and commercialized in 2007. The
highest throughput of the FLX instrument could be
achieved with Titanium reagents, which allow to
generate 1 million reads of up to 400 bp long in a
single sequencing run that takes less than 10 hours [9].
The disadvantage of the FLX genome sequencer is low
quality of reads of nucleotide homopolymers longer
than eight bases [10]. During the last two years the
FLX analyzer has made it possible to sequence and resequence whole genomes of bacteria, viruses, plants,
and humans [12, 13]. High throughput and ability to
perform reads from a single molecule, whose length
covers the average length of DNA extracted from
fossils, allowed the application of FLX instrument for
sequence determination of degraded ancient DNA
(aDNA). The analysis of aDNA, which could be
extracted from hair shafts or bones would have a great
impact on evolutionary studies. To date, the FLX
analyzer has enabled aDNA sequence of Neanderthal
[14], mammoth [15] or Tasmanian Tiger [16] to be
determined. The FLX instrument was also applied in
the investigation of the methylation status of CpG sites,
transcriptome analysis, metagenomics studies or small
RNA molecules characterization [9].
ILLUMINA/SOLEXA ANALYZER
Sequencing DNA with the Illumina/Solexa
Analyzer is based on sequencing by synthesis method
that employs reversible terminators with removable
fluorescent dyes. To determine the sequence of DNA,
the molecule is fragmented and ligated to adaptors.
Subsequently DNA fragments are attached to the
optically transparent surface, known as flow cell, via
adaptors that bind to the adaptor complementary
sequence that resides on a flow cell. During bridge
PCR, DNA fragments that are bound by adaptors to the
flow cell to create a “bridge” are amplified to obtain
approximately 1000 clonal copies of an individual
DNA molecule that forms a local cluster on a flow cell.
Up to 100 million clusters of different DNA fragments
could be obtained on a single flow cell. Sequencing of
DNA molecules in the clusters is carried out on the
Illumina/Solexa Analyzer with a universal sequencing
primer. Throughout the DNA sequencing one of four
reversible terminators labeled with different removable
fluorescent dyes is incorporated to the growing DNA
chain and the laser detection enables the determination
of the DNA sequence. Next, the fluorescent dye is
removed and the 3’OH group of the incorporated
nucleotide is regenerated allowing DNA elongation
7
with the next reversible terminator [17, 18]. The
Illumina/Solexa Genome Sequencer was designed by
Illumina, Inc. and introduced to the market in 2006.
The analyzer is able to generate at least 1 Gb of
sequence composed of 35 bp long reads in a single run
that takes approximately 3 days [17]. Application of
the Illumina/Solexa Sequencer to whole genome resequencing enabled the determination of the DNA
profiles of many species, for example, human [18],
Caernohabditis elegans [19] or Bacillus subtilis [20].
The Illumina/Solexa sequencer was also applied for
transcriptome analysis, metagenomics or characterizing
the DNA methylation patterns [17].
SOLiD™ ANALYZER
The SOLiD (Sequencing by Oligonucleotide
Ligation and Detection) system, which was designed
and commercialized in 2007 by Applied Biosystems,
takes advantage of sequencing by ligation technology
to determine the sequence of DNA [4]. Preparation of
DNA fragments for sequencing with the SOLiD
analyzer begins with sequencing library construction
through the emPCR process. Thereafter the 3’OH end
of DNA fragments is chemically modified so that the
molecules bind covalently to the glass surface. The
sequencing step of the DNA template on the SOLiD
analyzer begins with sequencing primer hybridization
and subsequent repeated cycles of ligation of
fluorescently labeled di-base probes and color
detection [4, 21]. To date, the application of the SOLiD
Analyzer to whole genome sequencing has been
published only for Escherichia coli [22]; however,
Applied Biosystems announced the re-sequencing of
the whole human genome with this instrument early
this year. The SOLiD instrument was also applied to
whole transcriptome analysis of undifferentiated mouse
embryonic stem cells, mouse blastomere, colon cancer
cell line HT-29 or Bacillus anthracis. The highest
throughput of the SOLiD sequencing platform could be
achieved with the SOLiD 3 System, which enables the
generation of up to 20 Gb data of more than 50 bp long
reads in a single sequencing run that takes
approximately 7 days [4].
HELISCOPE™ SINGLE MOLECULE SEQUENCER
Sequencing DNA templates with the Heliscope
Sequencer relies on True Single Molecule Sequencing
(tSMS) technology. The tSMS technology begins with
DNA library preparation through DNA shearing and
8
addition of poli(A) tail to generated DNA fragments.
Next, DNA fragments hybridized to the poli(T)
oligonucleotides are attached to the flow cell and
simultaneously sequenced in parallel reactions. The
sequencing cycle consists of DNA extension with one
out of four fluorescently labeled nucleotides, which is
followed by nucleotide detection with the Heliscope
sequencer. Subsequent chemical cleavage of
fluorophores allows the next cycle of DNA elongation
to begin with another fluorescently labeled nucleotide
and so enables the determination of the DNA sequence
[23]. The Heliscope sequencer was developed by
Helicos Biosciences Corporation and is capable of
sequencing up to 28 Gb in a single sequencing run that
takes about 8 days. The Heliscope sequencer generates
short reads with a maximal length of 55 bases [24]. So
far the Heliscope sequencer has been applied for
genome sequencing of the M13 virus [23].
NANOPORE DNA SEQUENCER
In contrast to all DNA sequencers mentioned
above, sequencing a DNA molecule with the Nanopore
DNA sequencer is free of nucleotide labeling and
detection. DNA sequencing with the Nanopore
instrument is based on converting the electrical signal
of nucleotides passing through a nanopore into the
DNA sequence. The nanopore is an α-hemolysin pore
with a covalently attached cyclodextrin molecule – the
binding site for nucleotides. During the sequencing
process the ionic current that passes through the
nanopore is blocked by the nucleotide (previously
cleaved by exonuclease from a DNA strand) that
interacts with cyclodextrin. The time period of current
block is characteristic for each base and enables the
DNA sequence to be determined [28, 29, 30]. The
Nanopore sequencer is still under development by
Oxford Nanopore Technologies [28].
SMRT™ SEQUENCER
CONCLUSIONS
DNA sequencing with the SMRT (Single Molecule
Real Time) sequencer relies on single molecule real
time sequencing by synthesis method provided on the
sequencing chip containing thousands of zero-mode
waveguides (ZMWs). The sequencing reaction of a
DNA fragment is performed by a single DNA
polymerase molecule, which is attached to the bottom
of each ZMW, so that each DNA polymerase resides
at the detection zone of ZMW. During the sequencing
reaction the DNA fragment is elongated by DNA
polymerase with dNTP’s that are fluorescently labeled
at the terminal phosphate moiety (each nucleotide is
labeled with a fluorophore of different color). DNA
sequence is determined on the basis of fluorescence
nucleotide detection with CCD array, which is
performed before nucleotide incorporation, while the
labeled dNTP forms a cognate association with the
DNA template. The fluorescence pulse is stopped after
phosphodiester bond formation, which causes the
release of a fluorophore that diffuses out of ZMW.
Subsequent labeled nucleotide incorporation and
detection allows to determine the DNA sequence [25,
26, 27]. The SMRT sequencer was designed and is still
being developed by the Pacific Bioscience company.
Although the SMRT instrument is not available on the
market, the company claims that the SMRT analyzer
(capable of obtaining 100 Gb per hour with reads
longer than 1000 in a single run) will be
commercialized in 2010 [25].
A wide range of genome sequencers is currently
available (3730xl sequencer, FLX sequencer,
Illumina/Solexa sequencer, SOLiD sequencer,
Heliscope sequencer) or will be soon available (SMRT
sequencer) on the market (Tab. I).
Genome sequencers reviewed in this paper allow to
generate high quality sequencing data from many
thousands or even millions of single sequence reads
varying from 35 to more than 1000 bp. All of the
genome analyzers are capable of obtaining short reads,
whereas long reads are obtainable only with the 3730xl
capillary analyzer, FLX genome sequencer or SMRT
sequencer. Although short reads are sufficient for
whole genome re-sequencing, they might be
inadequate for de novo sequencing, due to problems
related to sequence assembly in segments of genomic
DNA containing sequence repeats.
The current commercially available highthroughput genome sequencers such as the FLX,
Illumina or SOLiD platforms allow the whole human
genome to be re-sequenced for a fraction of costs
required to perform the same task with Sanger
technology. The goal is to determine the human
genome sequence for no more than 1000 US dollars
[30], which would enable individual genomes to be
analyzed on a routine basis. To promote the
development of human genome sequencing technology
the X PRIZE Foundation established the Archont X
Genome Sequencers - towards personal genomics and medicine
9
Table I. Properties of sequencers
Tabela I. Charakterystyka sekwenatorów
GENOME
SEQUENCER TYPE
(RODZAJ
SEKWENATORA
GENOMOWEGO)
3730xl Capillary
Analyzer
(sekwenator
kapilarny 3730xl)
FLX Sequencer
(sekwenator FLX)
Illumina/Solexa
Analyzer
(sekwenator
Illumina/Solexa)
SOLiD 3 System
(system SOLiD 3)
Heliscope Sequencer
(sekwenator
Heliscope)
SMRT Sequencer
(sekwenator SMRT)
Nanopore Sequencer
(sekwenator
Nanopore)
SEQUENCING
TECHNOLOGY
(TECHNOLOGIA
SEKWENCJONOWANIA)
dye terminator sequencing
(sekwencjonowanie z
wykorzystaniem
znakowanych
„terminatorów”)
pyrosequencing
(pirosekwencjonowanie)
Sequencing-by-synthesis
with reversible terminators
(sekwencjonowanie poprzez
syntezę z wykorzystaniem
odwracalnych
„terminatorów”)
sequencing-by-ligation
(sekwencjonowanie poprzez
ligację)
single molecule sequencingby-synthesis
(sekwencjonowanie
pojedynczych cząsteczek
poprzez syntezę)
single molecule real-time
sequencing-by-synthesis
(sekwencjonowanie
pojedynczych cząsteczek
poprzez syntezę w czasie
rzeczywistym)
Nanopore sequencing
(nanosekwencjonowanie*)
MAXIMAL READ
LENGTH
(MAKSYMALNA
DŁUGOŚĆ
ODCZYTU)
> 900 bp
BASES/RUN
(ILOŚĆ ZASAD\
EKSPERYMENT)
RUN TIME
(CZAS
TRWANIA
EKSPERYMENTU)
3 hours
(3 godziny)
COMMERCIALLY
AVAILABLE
(DOSTĘPNOŚĆ NA
RYNKU)
400 bp
400 Mb
10 hours
(10 godzin)
35 bp
1 Gb
3 days
(3 dni)
YES
(TAK)
YES
(TAK)
50 bp
20 Gb
7 days
(7 dni)
YES
(TAK)
55 bp
28 Gb
8 days
(8 dni)
YES
(TAK)
> 1000 bp
100 Gb
1 hour
(1 godzina)
NO
(NIE)
No information (brak
informacji)
No information
(brak informacji)
No
information
(brak
informacji)
NO
(NIE)
96 Kb
YES
(TAK)
* - „nanosekwencjonowanie” to proponowana przez autorów niniejszego artykułu nazwa techniki polegającej na ustalaniu sekwencji
DNA na podstawie sygnałów generowanych przez nukleotydy przechodzące przez otwór o średnicy kilku nanometrów
PRIZE for Genomics in Ocotber 2006. The 10 million
US dollar award will be given to the first team that will
be able to sequence 100 human genomes in 10 days for
no more than 10,000 dollars per genome [31]. None of
the currently available sequencers presented above
could reach the 1000 dollar genome or the Archont X
PRIZE.
REFERENCES
1. Sanger F., Nicklen S., Coulson A.R.: DNA sequencing
with chain-terminating inhibiotrs. Proc. Natl. Acad. Sci.
USA (1997) 74:5463-5467.
2. Maxam A.M., Gilbert W.: A new method for sequencing
DNA. Proc. Natl. Acad. Sci. USA (1997) 74:560-564.
3. Huang X.C., Quesada M.A., Mathies R.A.: DNA
Sequencing Using Capillary Array Electrophoresis. Anal.
Chem. (1992) 64:2149-2154.
4. http://www.appliedbiosystems.com/
5. Oh J.D., Kling-Backhed H., Giannakis M. et al.: The
complete genome sequence of a chronic atrophic gastrisis
Helicobacter pylori strain: Evolution during disease
progression. Proc. Natl. Acad. Sci. USA (2006)
103:9999-10004.
6. Lander E.S., Linton L.M., Birren B. et al.: Initial
sequencing and analysis of the human genome. Nature
(2001) 409:860-921.
7. Venter J.C., Adams M.D., Myers E.W.: The sequence of
the human Genome. Science (2001) 291:1304-1351.
8. Bennett S.T., Barnes C., Cox A. et al.: Toward the 1,000
dollars human genome. Pharmacogenomics (2005)
6:373-382.
9. http://www.454.com/
10. Margulies M., Egholm M., Altman W.E. et al.: Genome
sequencing in microfabricated high-density picoliter
reactors. Nature (2005) 437:376-380.
11. Ronaghi M., Karamohamed S., Pettersson B. et al.: RealTime DNA Sequencing Using Detection of
Pyrophosphate Release. Anal. Biochem. (1996) 242:8489.
12. Ronaghi
M.,
Shokralla
S.,
Gharizadeh
B.:
Pyrosequencing for discovery and analysis of DNA
sequence variations. Pharmacogenomics (2007) 8:14371441.
13. Rounsley S., Marri P.R., Yu Y., et al.: De Novo Next
Generation Sequencing of Plant Genomes. Rice (2009)
2:35-43.
14. Green R.E., Malaspinas A.S., Krause J. et al.:
A Complete Neandertal Mitochondrial Genome
Sequence Determined by High-Throughput Sequencing.
Cell (2008) 134:416-426.
10
15. Gilbert M.T., Drautz D.I., Lesk A.M., et al.: Intraspecific
phylogenetic analysis of Siberian woolly mammoths
using complete mitochondrial genomes. Proc. Natl.
Acad. Sci. USA (2008) 105:8327-8332.
16. Miller W., Drautz D.I., Janecka J.E. et al.: The
mitochondrial genome sequence of the Tasmanian tiger
(Thylacinus cynocephalus). Genome Res. (2009) 19:213220.
17. http://www.illumina.com/
18. Bentley D., Balasubramanian S., Swerdlow H.P., et al.:
Accurate whole human genome sequencing using
reversible terminator chemistry. Nature (2008) 456:5359.
19. Hillier L.W., Marth G.T., Quinlan A.R., et al.: Wholegenome sequencing and variant discovery in C. elegans.
Nat. Methods (2008) 5:183-188.
20. Srivatsan A., Han Y., Peng J., Tehranchi A.K., et al.:
High-Precision,
Whole-Genome
Sequencing
of
Laboratory Strains Facilitates Genetic Studies. PLoS
Genet. (2008) 4:e1000139.
21. Ondov B.D., Varadarajan A., Passalacqua K.D., et al.:
Efficient mapping of Applied Biosystems SOLiD
sequence data to a reference genome for functional
genomic application. Bioinformatics (2008) 24:27762777.
22. Durfee T., Nelson R., Baldwin S., et al.: The Complete
Genome Sequence of Eschrichia coli DH10B: Insights
into the Biology of a Laboratory Workhorse. J. Bacteriol.
(2008) 190:2597-2606.
23. Harris T.D., Buzby P.R., Babcock H., et al.: SingleMolecule DNA Sequencing of a Viral Genome. Science
(2008) 320:106-109.
24. http://www.helicosbio.com/
25. http://www.pacificbiosciences.com/
26. Levene M.J., Korlach J., Turner S.W., et al.: Zero-Mode
Waveguides for Single-Molecule Analysis at High
Concentrations. Science (2003) 299:682-686.
27. Eid J., Fehr A., Gray J., et al.: Real-Time DNA
Sequencing from Single Polymerase Molecules. Science
(2009) 323:133-138.
28. http://www.nanoporetech.com/
29. Astier Y., Braha O., Bayley H.: Toward Single Molecule
DNA
Sequencing:
Direct
Identification
of
Ribonucleoside
and
Deoxyribonucleoside
5’Monophosphates by Using an Engineered Protein
Nanopore Equipped with a Molecular Adapter. J. Am.
Chem. Soc. (2006) 128: 1705-1710.
30. Rusk N.: Cheap third-generation sequencing. Nat.
Methods (2009) 6:244-245.
31. http://www.xprize.org/
Address for correspondence:
PhD Marcin Woźniak
ul. Skłodowskiej-Curie 9
85-094 Bydgoszcz
tel. (052) 585-35-56
e-mail: [email protected]
Received: 26.05.2009
Accepted for publication: 21.07.2009
REVIEW / PRACA POGLĄDOWA
Maciej Śniegocki
IMAGE ANALYSIS – MEDICAL AND TECHNICAL PROBLEM
ANALIZA OBRAZU – WSPÓLNY PROBLEM LEKARZA I INŻYNIERA
Department of Neurotraumatology, Nicolaus Copernicus University
Summary
Not only is medicine full of humanism, but also it counts
on many technological modernizations in this field of
science. Modern technologies are frequently used in therapy.
However, the most important is to present illnesses and
monitor therapy. Technical development gives access to
many pieces of information, which can be called a media
chaos. Technological development has changed the way in
which radiologists analyze images. They used to analyze
only one available picture, whereas nowadays they are able
to compare as many pictures as were taken. If research on
digital analysis is stopped, therapy and diagnostics will not
achieve the highest level of advance. The mainstream of
researches on digital way of analyzing images is presented in
this essay. The most important problem which is taken into
consideration in this article is cooperation between doctors
and engineers.
Streszczenie
Współczesna medycyna, mimo przepajającego ją
humanizmu, opiera się na zdobyczach techniki. Nowoczesne
technologie znajdują codzienne zastosowanie w terapii.
Najważniejszą wydaje się obrazowanie procesów
chorobowych i monitoring terapii. Postęp technologiczny
umożliwia dostęp do wielkiej ilości informacji, które
stanowią szum informacyjny. Radiolog, który dotychczas
w zaciszu gabinetu analizował pojedynczą kliszę
fotograficzną, jest obecnie zasypany setkami obrazów w
jednym badaniu, ponadto, istnieje możliwość wykonania
setek takich badań w ciągu doby.
Zatrzymanie prac nad cyfrową analizą obrazu nie jest
możliwe, ponieważ spowoduje automatycznie ograniczenie
diagnostyki i terapii chorych z wszystkimi tego
następstwami. Praca przedstawia główne kierunki badań
i opracowań inżynierów i lekarzy w zakresie cyfrowej
analizy obrazu. Szczególnie podkreślona jest rola bliskiej
współpracy pomiędzy nimi oraz konieczność wypracowania
wspólnego języka zrozumiałego dla obu stron uczestniczących w tym procesie.
Key words: image analysis, CT, MRI, USG, co-operation
Słowa kluczowe: analiza obrazu, tomografia komputerowa, rezonans magnetyczny, ultrasonografia, współpraca
Although modern medicine is very humanistic,
technical achievements have a great influence on its
development. Biotechnical, metallurgical, optical,
scientific, chemical and other inventions are often used
in diagnostics and therapy. Imaging diseases and
monitoring therapy seem to be the most important in
medicine. Radiologists frequently use new techniques
and technologies which help them to gather a great
amount of information which is called information
noise. Doctor, who used to analyse simple photo on his
own, now is able to carry out analysis of many pictures
at the same time. It is possible to make hundreds of
such medical examinations during 24 hours. If research
on digital picture analysis stops, diagnostics and
therapy will be bound to cease automatically.
Digital radiology has a very serious problem with
collecting data because of having no more storage
space for modern pictures and photos. A widely used
method of changing classical picture into a digital one
is the use of a digital camera or a laser scanner (1).
Famous program Adobe Photoshop 6.0 makes editing
radiological photos easier and more popular. What is
more, it also makes them more legible. Editing
radiological photos and data is possible with a simple
computer with 256 Mb RAM at least. Modern digital
cameras have resolution close to 2-3 mega pixels. For
12
Maciej Śniegocki
radiology it is important to use cameras with lens
which allow to focus on things which are close to the
camera. The transfer of photos from the camera to
a computer is done by USB. It is not done
automatically, but manually. The effect depends on
person’s knowledge and skills.
Digital pictures are available in a few types which
are called formats: bits maps (.bmp), a standard type of
pictures in the Windows system, GIF (.gif) Graphical
Interchange Format, with 256 colors only, JPEG (.jpg)
Joint Photographic Experts Group Format mostly used
in the Internet, TIFF (.tif) Tagged Image File Format –
elastic bits maps, commonly used in printing and
publishing.
A Photoshop user has many possibilities to edit
picture in an appropriate way to achieve its highest
quality. This program allows to rotate picture in any
way that is needed, select and delete inappropriate
parts of the picture – it is possible to change the shape,
size, color, contrast and brightness of the photo. It is
also possible to add some comments, footnotes and
elements such as arrows or overlapping pictures.
Digital camera and graphical programs let people
convert traditional radiological photos into digital data
with a small cost, which leads to achieving an
acceptable standard of the pictures. It is important that
any change in an original radiogram must be accepted
by the owner of the photo. Converting and
manipulating the data may create an opportunity and
simultaneously a danger to change pictures or
introduce fake data.
25 years ago one of the most important American
medical organizations – ACR (American College of
Radiology) signed an agreement with NEMA (National
Electrical Manufacturers Assosiation). The aim of this
agreement was to establish a standard of medical
imaging. No one expected how important it would be
for the development of digital radiology in the XXIst
century (2). Looking back, there are some doubts if
DICOM solved all problems connected with digital
visualization of medical data. The medical imaging
standard, which was created in 1985, guarantees now
compatibility between all active departments of
radiology, as well as in a whole hospital. The main
advantage and the main aim of imaging standard is
providing criteria according to which such process
must be conducted. Nowadays, when technological
changes are so often, the biggest problem is to rate if it
is not a disadvantage for digital radiology. There is a
race between producers of medical software
(PACS/RIS/HIS), whose aim is to offer users as many
functions as possible and use the biggest number of
possibilities which are available by using medical
hardware that is already in hospital (3.4). However, to
make it commonly available on the market, it has to
satisfy the requirements given by e.g. DICOM’s
standards. Assessment of the problem from a doctor’s
and an economist’s point of view is definately positive
– independent body takes care of compatibility
between devices from different producers, which
prevents monopolizing.
We have to face a lot of challenges – the
importance of telemedicine and work at distance
grows, the amount of medical digital data increases in
geometric rate and technology of recording data on
mobile media constantly develops . How is DICOM’s
standard in such a situation? DICOM is updated every
2 months. However, it may seem not to be up-to-date
as the parts 10 or 12 of the “Declaration of compliance
with DICOM”, which were written more than 10 years
ago, are barely changed, which may be perceived as
obvious archaism even by a medic (5,6).
It is not a mystery that with progressive
specialization of medical units their requirements are
becoming less and less common. To avoid DICOM as
an obstacle in their development, it should be
incorporated into the Integration Profiles, which were
developed by IHE (Intergrating the Healthcare
Enterprise). The organization, which does not create
any new standards, puts them appropriately in practice.
An example of such a conception is the product
Agfa – a specific system of digital radiography
dedicated to radiology. This system co-operates with
X-ray cameras, which produce radiation with small or
big energy and also may prepare digital simulation for
small or big dose of radiation.
The new system of computed radiotherapy is
a complete solution, which allows to make radiological
pictures by digital radiography methods. In contrast to
traditional technology, which was based on
photographic film, digital photos may be edited, which
allows to improve contrast and visibility of details.
The new system of radiotherapy can support a few
irradiation stands. It is offered with the CR 25.0
system. The system is a supplement and can even
replace electronic stands which are prepared for EPID
pictures, because quality of the photos is better than the
EPID system. Fields of exposure and resolution of
pictures are also bigger. It is possible to co-operate
with a common type of picture cassettes, which allows
to manipulate photos easily.
Thanks to not using traditional plate and chemical
processing in a darkroom any more, the new system of
radiotherapy is really economical. Pictures taken by
DICOM can be put into an information network, which
allows to transmit and share them.
The main point is the fact, that this system was
created in connection with specific requirements of
Image analysis - medical and technical problem
radiotherapist, which are different than medical
requirements. Software system is easy to use and
transmission of photos can be done by DICOM. Nearly
60-70% of examinations are based on radiology, which
similarly to other sciences wants to use new digital
techniques. Radiology changes the way in which
pictures are saved from analog to digital. It also
benefits from electronic transmission and data saving.
Lack of highly qualified radiological staff and the need
to increase the effectiveness of work cause using
digital techniques. Another factor is the PACS system
(Picture Archiving and Communication System).
Digital techniques are to improve work in a small
hospital departments. If use of digital radiology is
encouraged, possible challenges should also be
presented. In analog radiology it is hardly possible that
all processors break down at the same time, whereas in
digital radiology, for example in the DR technique,
such a security no longer exists. Systems should be
connected with different installations which allow to
save and store data at least for 24 hours. In the case
when the PACS system fails, functionality gradually
decreases as it is in the CT/MR system. At the same
time radiologists carry on their work with CT or MR
photos on consoles.
Of course, discussion about computed systems
which let analyze pictures is a part of academic
research until their importance and practical purpose is
realised. All medical techniques are to help take
therapeutic decisions and decrease possibility of
making a mistake. This goal can be achieved by
imaging structures a doctor is interested in.
13
Fig. 2. Haemorrhagic zone presented in brain tumour
Fig. 3. The reason of bleeding presented in brain tumour
Fig. 1. Brain tumour
Figures 1, 2, 3 present brain tumour. Picture
analysis is needed. In the Figure 1 the change in brain
is not clear enough to assess its topography properly.
Use of an appropriate technique allows to locate it
exactly. In the Figure 3 the reason of bleending in brain
tumour is presented. It is important for operation
planning.
14
Maciej Śniegocki
Fig. 4. LS spine injury
Fig. 6. LS spine injury. 3D picture
Figures 4, 5, 6 present spine just after injury and
show the possibility to assess effects of treatment. It is
achieved by an assessment of bone’s union and 3D
visualization of spine’s deformation.
Final diagnosis and treatment not always can be
based only on classical radiography. Figure 7 presents
compression fracture of thoracic vertebra. It is not
possible to say if it is better to operate or not. Figure 8
presents an analysis of radiogram by digital methods,
which shows spinal cord compression and makes it
easier to decide if it is necessary to operate or not.
Fig. 5. LS spine injury. Assessment of bone union after
operation
Fig. 7. Thoracic vertebra fracture
Image analysis - medical and technical problem
15
Fig. 10. Patient after vertebroplasty procedure. Example of
use of picture analysis methods
Fig. 8. Spinal cord compression. The same as in the Figure 7
Classical radiograms are not able to solve every
problem.
Is the bone cement in Figure 9 in the right place or
not? The answer cannot be based only on this picture.
A method of image analysis should also be used to
decide if vertebroplasty was successful.
Picture analysis methods are very useful to assess
the effect of an operation. They are used to assess if
implants which stabilize spine are put correctly.
Fig. 11. Incorrect setting of TPF screw – operation is needed
Fig. 9. Classical radiogram after vertebroplasty procedure
Fig. 12. TPF screw is put improperly. Operation is needed
16
Maciej Śniegocki
The doctor who helps immediately after accident
often has difficulties to assess radiograms quickly,
because he/she does not have time to do some more
radiological projections. Figure 13 presents craniovertebral junction damage not very clearly. Only the
use of digital methods lets choose a proper kind of
treatment.
The main aim of this essay is to encourage medical
higher education institutions to co-operate with
technical ones. Based on my experience I can tell that a
co-operation between a doctor, an engineer and a
scientist allows to use equipment efficiently. Doctor
expects to find appropriate data to decide about
treatment. The main problems with medical techniques
which must be solved by scientists are: making sick
cells more evident, making healthy tissue which is
located improperly more evident, imaging changes in a
body after accident, imaging location of implants,
including these which cannot be seen in classical
radiology.
I hope the co-operation between doctors and
scientists is open to such new methods, because their
aim is worthy – it is people’s health and life.
LITERATURE
Fig. 13. Damage of cranio-vertebral junction after accident
Fig. 14. Fracture of the first cervical vertebrae
All the problems reviewed are difficult for both the
doctor who faces them during diagnosis and treatment,
and the engineer who is interested in medical
techniques. The article shows how important an
analysis of pictures is. Nowadays, every medical
examination is connected with many pictures, from
which any may be the most important to save patient’s
life. Only computed method, which allows to analyze
many pictures, gives a solution to this problem and lets
assess health status and choose appropriate data. If
modern digital methods are not used, much of the
potential of diagnostic equipment will be wasted,
which can result in difficulties with curing and
restoring patient’s efficiency.
1. 1.Chalazonitis AN, Koumarianos D, Tzovara J,
Chronopulos P. Journal of Digital Imaging, 2003, 16,
216-229.
2. 2.http://www.nema.org.
3. PACS users wise to maintain DICOM object integrity,
Erik L., Ridley, 2006.
4. Exploring PACS Secrets -- How to fix DICOM, Michael
J., Cannavo, 2006.
5. The
Dicom
Standard,
Dicom
Analyser,,
http://www.dicomanalyser.co.uk/, 2006.
6. Digital Imaging and Communications in Medicine;
NEMA PS 3 2004 ed.; Global Engineering Documents,
Englewood CO, 2004.
7. DICOM Basics, Oosterwijk, Herman and Paul T.
Gihring; 3nd ed.; OTech, Inc., Aubrey, TX; 2002.
Katedra i Klinika Neurochirurgii i Neurotraumatologii
UMK w Toruniu
Collegium Medicum im. L. Rydygiera
ul. M. Curie Skłodowskiej 9
85-090 Bydgoszcz
tel.: (52) 585 45 10
fax: (52) 585 40 31
ORIGINAL ARTICLE / PRACA ORYGINALNA
Anna Bednarek1, Beata Jędruszak2
HEALTH THREATS IN CHILDREN IN THE SELECTED RURAL ENVIRONMENT
ZAGROŻENIA ZDROWOTNE U DZIECI W WYBRANYM ŚRODOWISKU WIEJSKIM
1
Head of the Chair and Department of Paediatric Nursing, Faculty of Nursing, Medical University in Lublin
2
Nurse working in the educational environment in the Łęczna county
Summary
I n t r o d u c t i o n . The quality of health in the
population of the developmental age is shaped from the
babyhood under the influence of diverse factors, i.e.
intracorporeal and environmental ones as well as the health
culture of the family and school. Patterns of health behavior
are developed. Biologically negative patterns bring about
threats or loss of health of an organism. Health education and
health promotion among children and young people are
included in essential tasks of nurse in an educational
environment.
T h e o b j e c t i v e . Identification of health threats in
the selected school community in the rural area.
M a t e r i a l s a n d m e t h o d s . There were analyzed
823 cards of preventive examination of pupils of the primary
school in the Łęczna town near Lublin, in the years 2007 and
2008, with regard to health threats . 85.0% of pupils
attending the school come from the rural environment. The
primary school in Łęczna belongs to the All-Poland Network
of Schools Promoting Health.
R e s u l t s . Essential health threats observed in 38.9 %
of cases result from different dysfunctions of the osseoarticular system . An often observed illness of the sight organ
in the analyzed school community is first of all shortsightedness (35.7%). At the primary school in classes of the
Ist-IIIrd grade allergoses are a quite common health threat
(6.0%), including bronchial asthma, which constituted 3.4%
of the allergy cases. In the IVth-VIth grade classes additional
complications are: eating disorders (3.8%), excess weight
(4.9 %), short height (8.8 %), chronic illness, i.e. epilepsy 1.4%, diabetes - 2.3% and mental handicap – 1.0%.
C o n c l u s i o n s . 1. On the basis of an analysis of
medical documentation of pupils of the primary school the
number and character of health threats were stated. Among
the health threats illnesses of the locomotor system , eyesight
defects as well as allergoses prevailed. 2. The knowledge
about the health situation of pupils allows to define the
educational priorities and develop effective programs of
prevention of the identified threats.
Streszczenie
W s t ę p . Jakość zdrowia w populacji wieku
rozwojowego kształtuje się od wczesnego dzieciństwa pod
wpływem różnorodnych czynników, tj. wewnątrzustrojowych, środowiskowych oraz kultury zdrowotnej
rodziny i szkoły. Bionegatywne wzorce zachowań
zdrowotnych wywołują zagrożenia bądź utratę zdrowia
organizmu. Edukacja zdrowotna oraz promocja zdrowia
wśród dzieci i młodzieży należy do istotnych zadań
pielęgniarki w środowisku nauczania i wychowania.
C e l p r a c y . Identyfikacja zagrożeń zdrowotnych
wybranej społeczności szkolnej dzieci wiejskich.
M a t e r i a ł i m e t o d y . Przeanalizowano 823 karty
profilaktycznego badania zdrowia uczniów szkoły
podstawowej w miejscowości Łęczna k/Lublina, w roku
2007 i 2008, w zakresie występowania zagrożeń
zdrowotnych. Do szkoły uczęszcza 85,0% uczniów ze
środowiska wiejskiego. Szkoła Podstawowa w Łęcznej
należy do Ogólnopolskiej Sieci Szkół Promujących Zdrowie.
Wyniki.
Istotne
zagrożenia
zdrowotne,
zaobserwowane w 38,9% przypadków, wynikają z różnych
dysfunkcji układu kostno-stawowego. Często obserwowane
choroby narządu wzroku w analizowanej społeczności
szkolnej to przede wszystkim krótkowzroczność (35,7%).
18
Anna Bednarek, Beata Jędruszak
W szkole podstawowej w klasach I-III dość powszechnym
zagrożeniem zdrowotnym są choroby alergiczne (6,0%),
w tym astma oskrzelowa, która stanowi 3,4% przypadków.
W klasach IV-VI dodatkowymi problemami są zaburzenia
odżywiania (3,8%), nadwaga (4,9%), niskorosłość (8,8%),
choroby przewlekłe, tj. epilepsja – 1,4%, cukrzyca – 2,3%
oraz upośledzenie umysłowe – 1,0%.
W n i o s k i . 1. Na podstawie analizy dokumentacji
medycznej uczniów szkoły podstawowej zaobserwowano
ilości i jakość zagrożeń zdrowotnych, wśród których
przeważały problemy związane z chorobami narządu ruchu,
wadami wzroku oraz chorobami alergicznymi. 2. Wiedza na
temat sytuacji zdrowotnej uczniów umożliwia określenie
priorytetów edukacyjnych oraz wypracowanie skutecznych
programów w zakresie profilaktyki rozpoznanych zagrożeń.
Key words: health threats, children, rural environment
Słowa kluczowe: zagrożenia zdrowotne, dzieci, środowisko wiejskie
INTRODUCTION
Conditionings of the health in the population of
children and young people are strictly influenced by
diverse environmental modifiers. Among them the
progressing degradation of the natural and social
environment, of the status and socio-economic situation
of the family as well as working and learning conditions
do not support maintaining optimal attitudes towards
the care of one’s own health [1].
Eliminating harmful factors from the environment
for the sake of correct functioning and shaping the
health culture belongs to significant tasks of the social
policy implemented by different public sectors and in
the indirect way monitored by educational and
promotional actions of health service employees [2].
A lifestyle, i.e. a system of behaviours and health
attitudes, is the most important factor conditioning the
health of an individual. Biologically negative health
behaviours trigger threats or loss of one's health.
Effects of the deficiency of pro-health attitudes and
occurrence of behaviours risky for the health usually
appear after many years. Children and young people do
not usually notice the direct connection between their
behaviour and health and, in general, are not very
susceptible to educational influences [3].
Review of the medical literature concerning the
health status of the Polish society, including children
and young people, isn't satisfactory. Studies reveal that
over half of the Polish society displays wrong health
behaviours, and about 90% of Poles do not notice the
connection between worsening of their health and lack
of care for it [4]. The evaluation of pro-health
behaviours and resulting from them health threats is an
important component of preventive and emergency
actions carried out in the population at the
developmental age, which is supposed to encourage
children and young people to make deliberate, prudent
and healthy choices [5, 6].
The aim of the study was to identify health threats in
the selected school community of countryside children.
MATERIAL AND METHOD
There were analyzed 823 cards of preventive
examination of pupils of the primary school in the town
Łęczna near Lublin, in 2007 and 2008, with regard to
health threats. The health card of a pupil consists of four
parts. First of them includes information obtained from
parents about the health and social functioning of the
child in the family and surroundings. Second part
includes data obtained from the class tutor concerning
identified school problems of the pupil. The third and
fourth part concern the information obtained from the
school nurse, being the result of conducted screening
tests, and the information obtained from a primary
health care doctor, being a general evaluation of health
and results of physical examination. The statistical
software SPSS 14.0PL with the use of numbers,
percentage calculations, chi square test of compliance
and chi square test of independence, were used.
RESULTS
823 pupils attend the school in the Łęczna town,
icluding Ist-IIIrd grade classes - 411 pupils (207 boys
and 204 girls) and the IVth – VIth grade classes - 421
pupils (212 boys and 209 girls). The school is located in
the centre of the town. The school operates in a twoshift system of work and the school nurse’s room and
the dentist's surgery are in the school building. The
school is attended by 85.0% of pupils from the rural
environment. The primary school in Łęczna belongs to
the All-Poland Network of Schools Promoting Health.
Health threats observed in pupils of the Ist-IIIrd
grade classes of the primary school (Figure 1) result
from different dysfunctions of the osseo-articular
Health threats at children in the chosen country environment
system and they predominate in boys (33.4%). Among
the dysfunctions pravail flat and lopsided feet - 10.9%
of pupils of the Ist-IIIrd grade classes of primary
education and abnormal spinal curvatures - 3.9% of
pupils, also of the upper grade classes of the primary
school. About 2.0% of pupils have flat foot, and 1.5%
asymmetry of shoulder blades. Slouch, coming off
shoulder blades and round back are found in 1.0% of
pupils. Hyperkyphosis do not appear among the
examined population of school children.
19
In the IVth-VIth grade classes (Figure 2) the
structure of health threats looks similar, and additional
problems are: eating disorders (3.8 %), excess weight
(4.9 %), short height (8.8 %), chronic illnesses, mainly
epilepsy - 1.4 % and diabetes - 2.3 % and low-grade
mental deficiency – 1.0 %
60%
50%
p < 0,001
40%
30%
20%
10%
35%
p < 0,001
p < 0.001
30%
0%
chłopcy
dziewczęta
Wady narządu ruchu - Defects in the motor organ
Wady narządu wzroku - Defects in the sight organ
Choroby alergiczne - Allergoses
Niskorosłość - Short height
Niedobór m. ciała - Deficiency of the body weight
Nadwaga - Exscess weight
Otyłość - Obesity
Wady serca - Heart defects
Wady mowy - Flows in the speech
Wady słuchu - Hearing defects
Epilepsja - Epilepsy
Cukrzyca - Diabetes
Upośledzenie umysłowe w stopniu lekkim - Mental Handicap in the slight grade
25%
20%
15%
10%
5%
0%
chłopcy boys
dziew czę ta girls
Wady narządu ruchu - Deffe cts in the m otor or gan
Wady narządu wzrok u - De fect in the sight organ
Choroby alergiczne - Allergos es
Nisk orosłość - Short he ight
Nadw aga - Excess w eight
Otyłość - Obes ity
Wady se rca - Heart defe cts
Wady m ow y - Spe ech defe cts
Wady słuchu - He aring defe cts
Epile ps ja - Epilepsy
Fig. 1. Structure of health threats amongst pupils of the lower
grade (I-III) classes of primary school
Ryc. 1. Struktura zagrożeń zdrowotnych wśród uczniów klas
młodszych (I-III) szkoły podstawowej
Another problem is short height in 12.1% of pupils
and eyesight defects in 11.2% of boys and 9.8% of girls.
Often observed illnesses of the sight organ in the
analyzed school community are mainly shortsightedness, and in 1.4% long-sightedness. Squint
occures in 1.7% of children, but disorders connected
with seeing colours and astigmatism in 1.0% of the
pupils.
At the primary school in classes of Ist-IIIrd grade
allergoses are a common health threat 6.0%), including
the bronchial asthma, which constitutes 3.4% of cases in
the analyzed group. Over 4.4 % of pupils of the primary
education are obese, and 1.5 % are overweight. The next
health threat is connected with speech disorders (4.2%),
while in 1.2% of pupils hearing defects appear. To sum
up, health threats in pupils of the lower grade classes of
the primary school are connected first of all with
different dysfunctions of the locomotor system, with
sight and speech defects, metabolic disorders and
physical development, as well as allergoses of the
respiratory tract.
Fig. 2. Health threats in pupils of upper grade (IV-V) classes
Ryc. 2. Zagrożenia zdrowotne uczniów klas starszych (IV-V)
In the group of priority health threats in pupils of the
primary school (Figure 3) there prevail: shortsightedness - 18.4%, short height - 5.6%, obesity 4.9%, scoliosis - 4.6 %, bronchial asthma - 2.8% and
diabetes - 2.3%. Both amongst younger pupils, as well
as the upper grade primary school pupils (Figure 4)
health threats appeared more often in boys than in girls.
Problemy
zdrowotne
Heath
problems
*p<0,05
Skolioza
Scoliosis
4,6%*
KrótkoWzroczność
Shortsightedness
18,4%*
Astma
oskrzelowa
Bronchial
asthma
2,8%*
Niski wzrost
Short height
5,6%*
Otyłość
Obesity
4,9%*
Cukrzyca
Diabetes
2,3%*
Fig. 3. Priority health threats of pupils of the primary school
Ryc. 3. Priorytetowe zagrożenia zdrowotne uczniów szkoły
podstawowej
Anna Bednarek, Beata Jędruszak
20
p < 0,001
60
50
40
chłopcy boys
30
dziewczynki
girls
20
10
0
I-III
IV-VI
Fig. 4. Distribution of health threats depending on the sex of
the study subjects
Ryc. 4. Podział zagrożeń zdrowotnych ze względu na płeć
badanych
DISCUSSION
School age is a period of rapid development of
children, when they develop or deepen health
irregularities and when health behaviours and abilities
of the children children are shaped [7].
Over years substantial and
organizational
assumptions as to the health care for pupils at school
underwent many changes. At first health of a pupil was
associated exclusively with providing appropriate
sanitary-hygienic conditions at school. The pupil
himself/herself and his/her health problems were treated
as secondary issue. In recent years a single pupil has
become the priority interest of the school Health
Service, along with his health status and development
and the quality of his/her family environment.
Therefore, monitoring parameters of the biological,
psychological and social development, conducted by a
nurse in the educational environment, constitutes the
essential element of the identification of children’s
disorders and undertaking preventive actions, and of
health promotion in the population of school children
[8].
Since 1999 a new system of health care for pupils at
school has caused that the nurse in the educational
environment has been working independently in the
partner cooperation with a primary health care doctor.
Simultaneously the duty of promoting health amongst
pupils is also assigned to the teaching staff of the school
and children’s parents [9.10].
The present organization of the school system gives
the possibility of providing children and young people
with comprehensive preventive health care, particularly
screening tests, preventive medical check-ups, health
education and psychological and pedagogical care.
Participation of educational environment nurses in the
preventive care of pupils is becoming more and more
significant. This tendency reveals the need to accept by
nurses specific professional tasks related to health
promotion and health education [1.2].
Data obtained during the analysis of medical
documentation of the study pupils allows to define their
health status as unsatisfactory. Numerous health threats
result from different disorders and dysfunction mainly
of the locomotor system and eyesight. Growing adverse
ecological influences decide about the growing
prevalence of allergoses. Also of the growing number of
metabolic disorders manifesting itself in excess weight
and obesity is alarming.
Health threats observed at the primary school in
Łęczna are consistent with the health problems
characteristic for the entire population of school
children.
Studies by Wojnarowska [11] and Felińczak et al.
[12] also show that about 39.7% of children have
different irregularities concerning health, above all
dysfunctions of the locomotor system, eyesight defects,
metabolic disorders and allergoses. Own studies clearly
show that a high percentage of children (82.5%) are
categorized to many sorts of “unhealthy” groups due to
their various health problems.
Similar data is presented in analyses of other
authors. Examinations conducted amongst 15.951
children from educational institutions in Bielsko – Biała
show that health problems already occur in nursery
schools in 23.3% of children, and at primary schools
and lower secondary schools the most common
irregularities concern the locomotor system - 41.1%,
eyesight defects - 14.7%, somatic development - 7.8%
and allergoses of the respiratory system - 5.8% [13].
Unhealthy lifestyle of modern societies is bringing
about more and more negative effects on health, of
which consequences are particularly harmful to the
youth.
An analysis of the health situation at the primary
school in Łęczna gives guidelines concerning the scope
of duties of the nurse working in an educational
environment, which should include both the
identification of health problems in individual pupils
and help in solving them, as well as the health education
and setting oneself an example to follow [14, 15].
Health threats at children in the chosen country environment
CONCLUSIONS
1. In the group of children from the primary school in
Łęczna different health threats were found, first of
all disorders of the locomotor system, eyesight
defects and allergoses, which are consistent with the
health problems characteristic for the entire
population of children in Poland.
2. Sex of the examined pupils has a diversifying
character as health threats occur more often in boys
than in girls.
3. The analysis of health threats in pupils of the primary
school allows to define the priorities in the education
and prevention in the population of school children.
REFERENCES
9.
10.
11.
12.
13.
14.
15.
1.
2.
3.
4.
5.
6.
7.
8.
Pawlaczyk B.: Zarys pediatrii. PZWL, Warszawa, 2005
Żołnierczuk-Kieliszek D.: Zachowania zdrowotne i ich
związek ze zdrowiem, (w): Zdrowie Publiczne (red.)
Kulik T., Latalski M., Czelej, Lublin 2002, 75-93.
Ostręga W.: Opieka pielęgniarska nad uczniami w
środowisku szkolnym. Magazyn Pielęgniarki i Położnej,
2002, 4, 10-14.
Cisińska A., Jałmużna T.: Pielęgniarka i Położna wobec
edukacji zdrowotnej, (w): Zdrowie Publiczne, 2003, 3/4,
113-115.
Sygit K., Sygit M. i współ.: Znaczenie znajomości
zachowań zdrowotnych młodzieży wiejskiej dla poprawy
stanu zdrowia, (w): Zdrowie Publiczne, 2003, 1/2, 113117.
Jodkowska M., Ostręga W., Oblacińska A.: Zasady i
metodyka nadzoru w profilaktycznej opiece zdrowotnej
nad uczniami. IMiDZ, Warszawa, 2003.
Oblacińska A. (red.): Standardy i metodyka pracy
pielęgniarki i higienistki szkolnej. Warszawa, 2003
Siemiński M.: Środowiskowe zagrożenia zdrowia. PWN,
Warszawa, 2008.
21
Woynarowska B.: Problemy zdrowotne – epidemiologia,
(w): Woynarowska B. (red): Zdrowie i Szkoła, PZWL,
Warszawa, 2000.
Górniak K.: O potrzebie działań profilaktycznokorekcyjnych i rehabilitacyjnych w środowisku
szkolnym. Ann. UMCS, 2003, 58 (supl. 13): 51-56.
Wojnarowska B., Mazur J.: Zachowania zdrowotne
młodzieży szkolnej w Polsce: wyniki badań HBSC, 2002.
Zdrowie Publiczne, 2004;114 (2): 159-167.
Felińczak A., Ziarkiewicz G. i współ.: Analiza
porównawcza oceny zachowań zdrowotnych młodzieży
w wieku 16-18 lat na podstawie badań własnych oraz
przeglądu literatury. Pol. Med. Rodz. 2004; 6 (1): 337340.
Ślusarski J.: Samoświadomość dorastającej młodzieży w
zakresie zdrowego stylu życia i sposobu odżywiania się.
Zdrowie Publiczne, 2002;112 (supl.1): 188-191.
Lipska R.: Zachowania zdrowotne uczniów. Edukacja i
dialog, 1994; 3 (56): 13-18.
Kołłajtis-Dołowy A., Pietruszka B.: Stosowanie diet
alternatywnych w wybranej grupie młodzieży. Ann.
UMCS 2003;58 (supl. 13): 51-56.
Chair and Department of Paediatric Nursing, Faculty
of Nursing
Medical University in Lublin
tel.: 817185375, 607607115
Marta Cebulak1, Anna Ksykiewicz-Dorota2
STRUCTURE OF UTILIZATION OF NURSING TIME IN PSYCHIATRIC WARDS
– PRELIMINARY STUDIES
STRUKTURA WYKORZYSTANIA CZASU PRACY PIELĘGNIAREK
NA ODDZIAŁACH PSYCHIATRYCZNYCH – BADANIA WSTĘPNE
¹ Zakład Pielęgniarstwa Klinicznego i Teorii Pielęgniarstwa, Instytut Ochrony Zdrowia,
Państwowa Wyższa Szkoła Zawodowa w Jarosławiu
² Katedra i Zakład Zarządzania w Pielęgniarstwie, Wydział Pielęgniarstwa i Nauk o Zdrowiu,
Uniwersytet Medyczny w Lublinie
kierownik: dr hab. n. med. prof. nadzw. UM Anna Ksykiewicz-Dorota
Summary
I n t r o d u c t i o n . The effectiveness of the functioning
of a health care unit depends on highly specialist diagnosis
and treatment, and on proper staff management. Hence, the
selection of adequate methods of staff scheduling is so
important, so that their number would be in accordance with
the demands of patients for a specified type of service, and
simultaneously guarantee the effective use of these methods.
The introduction of changes in the organization of
nursing care requires, among other things, an analysis of the
utilisation of working time and the structure of activities
performed at nurses’ workplaces.
T h e o b j e c t i v e of the study was to determine the
utilisation of working time, and the structure of activities
performed by charge nurses in general psychiatric wards.
Materials and methods.
The study was
conducted in general psychiatric wards at one of the
psychiatric hospitals in the Rzeszów region. The research
methods were: a continuous observation (day-long
observation) and snapshot observation (Tippett’s method).
Day-long observation was an introduction for snapshot
observation. The presented studies are of preliminary
character and will be continued in other psychiatric hospitals
of various reference level.
R e s u l t s . For the needs of analysis of the research
material obtained, the activities performed by nurses were
divided into four basic working time fractions: direct nursing,
indirect nursing, coordination and current organization of
work in the ward, breaks at work and personal activities.
The study showed that the degree of utilization of
working time by nurses in general psychiatric wards is
unsatisfactory. Analysis of the research material showed that
only 36.70% of the working time was devoted to direct
nursing, while the remaining 63.30% were non-nursing
activities, including: preparation for performing primary
tasks (direct nursing), keeping records, communication
within the team, provisioning the ward, breaks and personal
activities.
C o n c l u s i o n s . The results obtained allow us to
presume that in the general psychiatric wards examined the
degree of utilization of nurses’ working time is
unsatisfactory, and the structure of activities evokes
reservations. While introducing changes into the organization
of nursing care attention should be paid to the structure of
activities performed by nurses and the performance of all
occupational functions, according to the specificity of the
ward and patients’ demand for care.
24
Marta Cebulak, Anna Ksykiewicz-Dorota
Streszczenie
W s t ę p . Efektywność funkcjonowania zakładu opieki
zdrowotnej zależy zarówno od wysoko specjalistycznego
diagnozowania i leczenia, jak i od odpowiedniego
zarządzania kadrami. Stąd tak istotny jest wybór
odpowiednich metod planowania kadr, tak aby ich liczba
była zgodna z zapotrzebowaniem chorych na określony typ
świadczeń, a jednocześnie gwarantowała efektywne ich
wykorzystanie.
Wprowadzenie zmian w organizacji opieki
pielęgniarskiej wymaga m.in. analizy wykorzystania
czasu pracy oraz struktury czynności wykonywanych
na pielęgniarskich stanowiskach pracy.
C e l e m p r a c y było ustalenie wykorzystania czasu
pracy oraz struktury czynności wykonywanych przez
pielęgniarki odcinkowe oddziałów psychiatrii ogólnej.
M a t e r i a ł i m e t o d y . Badania przeprowadzono
na oddziałach psychiatrii ogólnej jednego ze szpitali
psychiatrycznych w województwie podkarpackim.
Metodami badawczymi były: obserwacja ciągła
(fotografia dnia pracy) i obserwacja migawkowa
(metoda Tippetta). Obserwacja ciągła była wstępem do
obserwacji migawkowej. Badania te mają charakter
wstępny i będą kontynuowane w innych szpitalach
psychiatrycznych o różnym poziomie referencyjności.
W y n i k i . Dla potrzeb analizy uzyskanego
materiału badawczego, czynności wykonywane przez
pielęgniarki pogrupowano w cztery podstawowe
frakcje czasu pracy: pielęgnację bezpośrednią,
pielęgnację pośrednią, koordynowanie i bieżące
organizowanie pracy na oddziale oraz przerwy w pracy
i czynności osobiste.
Z przeprowadzonych badań wynika, że stopień
wykorzystania czasu pracy pielęgniarek oddziałów
psychiatrii ogólnej jest niezadowalający. Analiza materiału
badawczego wykazała, że tylko 36, 70% czasu pracy
stanowiła pielęgnacja bezpośrednia, pozostałe 63, 30% to
czynności pozapielęgnacyjne, w skład których wchodzą:
przygotowanie się do wykonania zadań głównych
(pielęgnacji
bezpośredniej),
dokumentowanie,
komunikowanie się w zespole, zaopatrzenie oddziału
oraz przerwy i czynności osobiste.
W n i o s k i . Uzyskane wyniki pozwalają stwierdzić, że
w badanych oddziałach psychiatrii ogólnej stopień
wykorzystania
czasu
pracy
pielęgniarek
jest
niezadowalający, a struktura czynności budzi zastrzeżenia.
Przy wprowadzaniu zmian w organizacji opieki
pielęgniarskiej należy zwrócić uwagę na strukturę
czynności wykonywanych przez pielęgniarki oraz realizację
wszystkich funkcji zawodowych, zgodnie ze specyfiką
oddziału i zapotrzebowaniem pacjentów na opiekę.
Key words: structure of working time, psychiatric ward, nursing care
Słowa kluczowe: struktura czasu pracy, oddział psychiatryczny, opieka pielęgniarska
INTRODUCTION
For every organization, including a health care unit,
the employees are the most valuable resource, who, by
their collective effort, contribute to the realisation of the
goals assumed by the organization. Due to workers’
knowledge, skills, motivation and engagement, the
organization may offer good quality services. However,
salaries constitute the greatest load, i.e. approximately
60-80% of the total costs in each health facility.
Therefore, in many countries, studies concerning the
evaluation of the effectiveness of care provided by
physicians, nurses and midwives are still being
undertaken to more effectively utilise employees’
potential in the future, and to improve the quality of
services provided [1, 2, 3, 4, 5].
The study of working time is the source of
information concerning the existing state of the
organization, its efficiency and productivity. This study
determines the structure of working time, including
wasted work time, its amount, character and causes. It
also creates a basis for finding methods for elimination
of the wasted time [5].
Without the knowledge of the structure of working
time it is difficult to undertake actions in order to
improve its effectiveness and better utilization of the
working time of the staff employed.
The study of working time of nurses constitutes
a starting point for the introduction of changes in the
organization of nursing care, nursing staff scheduling,
services cost calculation and economisation of activities
of this occupational group.
The objective of the studies was to determine the
structure of utilization of the working time of charge
nurses in general psychiatric wards.
MATERIAL AND METHODS
The studies were conducted within 10 days, in two
general psychiatric wards at one of the psychiatric
hospitals in the Rzeszów region, and covered 8-hour
morning and afternoon duties. A total number of 1, 040
observations were registered. The studies are of
Structure of utilization of nursing time in psychiatric wards - preliminary studies
preliminary character and will be continued in other
psychiatric wards of various reference levels.
The structure of working time at workplaces of
charge nurses was determined on the basis of two
methods: day-long observation and snapshot
observation (Tippett’s method). The research tools were
standardised charters: individual day-long observation
and snapshot observation. Day-long observation,
consisting of the detailed registration of all activities
performed by an employee in the ward, was an
introduction for snapshot observation.
Snapshot observation is the method of sample
studies, its assumptions being based on principles of the
representative method, probability theory and
mathematical statistics, providing a high level of
confidence (up to 99.7%). The number of snapshot
observations was determined according to the following
formula:
P(100 – P)
N = 4 -----------------L²
where:
N – number of observations required;
P – value of the smallest fraction determined on the
basis of day-long observation;
L – mean squared error (absolute error), the value of
which in the presented research is ±2 [6, 7, 8].
RESULTS
For the needs of analysis of the research material
obtained, the activities performed by the nurses were
divided into four basic fractions, according to the
proposal for division of working time presented by
Lenartowicz:
Fraction 1: direct nursing, which covers nurses’
activities focused on patients and their families,
performed in the presence of patients or their family
members, or other significant activities, i.e. activities
associated with the maintenance of a patient’s personal
hygiene and the hygiene of the nearest surroundings,
activities associated with nutrition and excretion,
patient’s mobility and body position, diagnosis making
and treatment, communication with patients and/or their
families;
Fraction II: indirect nursing: i.e. activities
performed away from a patient, which are preparatory
or closely associated with direct nursing, i.e. keeping
records, communication with the staff directly
concerning patients, preparation of all activities within
the scope of direct nursing;
25
Fraction III: coordination and current organization
of work in the ward. This fraction covers activities
connected with the functioning of the ward, providing
adequate conditions for hospitalization of patients in
the ward, their treatment and nursing, i.e. information
within the team (among other things: reports in the
ward, handing over the ward between shifts, giving and
receiving orders, cleaning and tidying, office work
activities not requiring nursing qualifications;
Fraction IV: breaks at work and personal activities,
including breaks designed for leisure and physiological
needs, and personal activities (non-duty), associated
with neither patient care nor organization of work in the
ward [9, 10].
The investigations showed that the nurses in general
psychiatric wards devoted 36.70% of their time to direct
nursing. Non-nursing activities (auxiliary) performed
away from patients occupied 63.30% of the nurses’
working time, including: activities connected with
indirect nursing, coordination and current organization
of work in the ward, breaks and personal activities.
Table I presents the percentage of individual fractions
within the structure of working time of nurses.
Table I. Percentage of individual fractions in the structure of
nurses’ working time during 8-hour duty (% and
minutes)
Tabela I. Udział poszczególnych frakcji w strukturze czasu
pracy pielęgniarek podczas ośmiogodzinnego
dyżuru (dane w % i w minutach)
Lp.
No.
1.
2.
3.
4.
5.
Frakcja czasu pracy
Working time fraction
Pielęgnacja bezpośrednia
Direct nursing
Pielęgnacja pośrednia
Indirect nursing
Koordynowanie
i bieżące organizowanie
pracy na oddziale
Coordination and current
organisation of work in the
ward
Przerwy w pracy
i czynności osobiste
Breaks and personal
activities
Ogółem
Total
Czas w %
Percentage
of time
Czas w
minutach
Minutes
36.70
176.16
28.00
134.40
10.65
51.12
24.65
118.32
100
480
Within direct nursing, the nurses utilised the greatest
amount of time for therapeutic activities – 9.7%,
followed
by
diagnostic
activities
–
8.6%,
communication with patients and their families – 8.4%,
activities connected with the maintenance of personal
hygiene and hygiene of the surroundings - 5.0%;
26
activities associated with nutrition and excretion –
3.5%, while activities pertaining to patients’ body
position and mobility constituted 1.5% of the total
working time. The results of the studies indicate that
charge nurses on 8-hour duty devoted 176.16 min. on
average to direct nursing. Table II presents the detailed
percentage contribution of individual sub-fractions
within direct nursing in the structure of nurses’ working
time (% and minutes).
Table II. Percentage of time of individual direct activities in
working time structure during an eight – hour duty
(data in % and minutes)
Tabela II. Udział czasu poszczególnych rodzajów czynności z
zakresu pielęgnacji bezpośredniej w strukturze
czasu pracy pielęgniarek podczas ośmiogodzinnego
dyżuru (dane w % i w minutach)
Grupy czynności z zakresu
Lp. pielęgnacji bezpośredniej
No. Groups of activities within direct
care
Higiena
osobista
chorego
i najbliższego otoczenia
1.
Personal hygiene and hygiene
of the nearest surroundings
Żywienie i wydalanie
2.
Nutrition and excretion
Ruch i pozycja pacjenta
3.
Patient’s position and mobility
Diagnozowanie
4.
Making a diagnosis
Leczenie
5.
Treatment
Komunikowanie się z
pacjentem i (lub) jego rodziną
6.
Communication with patients
and (or) their families
Ogółem
7.
Total
Czas w %
Percentage
of time
Czas w
minutach
Minutes
5.00
24.00
3.50
16.80
1.50
7.20
8.60
41.28
9.70
46.56
8.40
40.32
36.70
176.16
The second basic fraction of working time was the
time of indirect nursing, i.e. activities performed away
from a patient, which are of a preparatory character and
closely associated with patient care. In the wards
examined, the mean value for this fraction was 28.00%
of working time. Indirect nursing consisted of three subfractions:
a) preparation for activities and procedures within
the scope of direct nursing or those ordered by
physicians, e.g. preparation of drugs, intravenous drips,
dressings, tool kit building, etc., taking 11.7% (56.20
min.) of the working time;
b) keeping records of doctors’ orders, procedures
performed, dates of appointments for specialist tests and
consultations, writing reports, supplementation of
individual nursing records, etc., taking 10.30% (49.40
min.) of the working time;
c) conversation with staff members, directly or on
the phone, directly concerning patients, which
constituted 6.00% (28.80 min.) of the working time.
The third fraction of working time in the wards
examined constituted breaks and personal activities,
which occupied 24.65% (118.32 min.) of nurses’
working time.
The time devoted by nurses to coordination and
current organization of work in the ward was 10.65%
(51.12 min.) of the working time, including the
provision of information within the team – 7.08%
(33.98 min.), cleaning and tidying – 1.50% (7.2 min.),
provisioning the ward – 1.15% (5.52 min.), office
activities not requiring nursing qualifications – 0.92%
(4.42 min.).
DISCUSSION
The Pareto principle is of great importance in
undertaking actions on behalf of the quality of care.
This principle shows both the scope of effectiveness of
to-date methods of work, and the directions for
improvement of the present state of things. According to
the Pareto principle, in ineffective systems 20% of
activities performed by employees (key tasks) decide
about 80% of the effects, and the opposite, the
remainder – 80% of activities (secondary activities)
focuses on 20% of the effects [11, 12].
If the relationship between the costs of work and
effects is in accordance with the Pareto principle, in
order to obtain a better quality of care, efforts should be
undertaken to change this ratio [11, 12].
At nursing workplaces the most important activities
are those within the scope of direct nursing, and these
activities should be the basis in the structure of working
time of charge nurses. According to Ksykiewicz-Dorota
after Daugherty, the auxiliary time (non-nursing) should
constitute from 10-25% of the total time [4].
In the national health system there is a lack of
research concerning the ultilisation of working time by
nurses in psychiatry. A review of the Polish literature
shows that the studies pertaining to the structure of
working time of nurses and midwives in national
hospitals (apart from psychiatry) were conducted by,
among other researchers, Lenartowicz, KsykiewiczDorota et al., and Kowalska. The researchers indicated
that the structure of nurses’ and midwives’ working
time was not optimal , because the nursing activities
resulting from doctor’s orders constituted from 25 to
50% of the working time [10, 13, 14, 15, 16, 17, 18].
Studies concerning the utilisation of working time
by nurses in psychiatric wards were also carried out in
Northern Ireland. The studies confirmed that the nurses
devoted less than a half of their working time - 42.7% to direct nursing, whereas the remaining time – 57.3% to auxiliary activities (non-nursing). Within the direct
activities the nurses devoted 9.39% of their time to the
administration of drugs, 7.56% - to individual therapy,
including 6.75% to psychotherapeutic interactions with
a patient, 5.81% - surveillance of meals, 4.98% - social
conversations, 3.62% - group therapy, 3.21% - electric
shock therapy, 2.43% - escorting to other wards or other
hospitals, 1.36% - activities in treatment rooms (e.g.
blood taking, making dressings), 1.97% - noninteractive close observation, 1.84% - activities within
the scope of physical care (washing, feeding, toilet),
0.53% - interactive close observation. The nurses in the
study devoted a small amount of time (6.75%) to
psychotherapeutic interactions. As emphasized by the
authors, conversation with a patient occupies a
considerable part of psychiatric care, and the amount of
time devoted to a patient is an important indicator of
quality. For psychiatric nurses in particular ,
concentration on interaction with patients should be of
primary importance. Some nurses involved in the study
perceived themselves as not fully competent to
undertake psychotherapeutic interactions. The authors
highlight that the studies were conducted on a small
sample in one environment, and should be repeated on a
larger study group. Despite these limitations, they are of
an opinion that the research provides guidelines
concerning changes in the organization of nursing care,
education of nurses and further investigations in this
area [19]. The technique of measuring working time
used in the studies was day-long observation. This
technique is rarely applied to determine the structure of
a workday due to low objectivity of the results and a
change in the behaviour of the employee who is aware
of the presence of the observer (which was indicated by
the authors); the technique is also time consuming [7].
Results similar to the above-mentioned were
obtained by Furaker who examined the utilisation of the
working time of psychiatric nurses in a psychiatric ward
at a hospital in Sweden. The results of these studies also
show that a relatively small percentage of working time
– 41% - is utilised by psychiatric nurses for direct care
[20]. The author applied day-long self-observation as
the method to evaluate the structure of nurses’ working
time. The application of day-long self-observation for
the evaluation of working time is methodologically
27
incorrect, and leads to decreased reliability of the results
obtained due to high subjectivity. Day-long selfobservation is a good basis for improvement of
qualifications and better utilisation of own time at work;
however, apart from that, it has no value as a method for
the evaluation of the structure of working time, i.e. its
standardisation. In order to determine the structure of
the utilisation of working time, the following methods
of its measurement should be applied: a continuous
observation (day-long observation) and snapshot
observation (Tippett’s method) [7].
Results of research conducted in the United
Kingdom indicated that psychiatric nurses devoted only
21.8% of their working time to direct activities. The
author stressed that in many countries psychiatric nurses
devote a small amount of time to the activities for which
they have been trained [21].
Similar conclusions were formulated by some
Australian researchers who investigated nurses’
working time in a psychiatric hospital in Adelaide. The
objective of that study was to determine whether there
occur differences in time devoted by nurses to direct
activities depending on the number of staff, with the
same number of patients. Analysis of the research
material confirmed that when the number of nurses on
duty increased, the amount of time devoted to direct
nursing remained relatively constant, whereas the
amount of time which the nurses spent on staff-staff
interactions increased with the number of staff [22].
In the own studies, the time devoted to direct
nursing was 36.7% of the total amount of time. The
greatest amount of time within direct activities was
devoted by nurses to diagnostic and treatment activities,
which constituted approx. 50% of all direct activities.
A high percentage of diagnostic activities within nurses’
working time in general psychiatric wards was due to
the fact that according to the adopted division of work,
apart from diagnostic activities within this sub-fraction,
such activities as observation of a patient or
participation in doctor’s visit were also classified as
diagnostic. In the wards studied, the nurses did not fully
perform care and educational tasks, which are the basic
nature of professional nursing and are decisive for the
essential quality of the work [23]. Sometimes the nurses
omitted some activities, or executed them in
a superficial way not in accordance with the principles
and technique of their performance. This, for instance,
concerned therapeutic conversations, psychological
support, providing information and education,
28
observation of a patient, toilet of the whole body or oral
cavity.
The presented own studies and international reports
show that the structure of working time in psychiatric
wards is unsatisfactory, and there is a need for
improvement.
Analysis of the own research material indicates that
efforts should be undertaken to shorten non-nursing
time to an indispensable minimum, while prolonging the
time devoted to direct nursing, and within direct
nursing, for the realisation of all occupational functions,
according to the hospital specificity and patient demand
for care. It is also worth mentioning that the structure of
working time depends not only on nurses or their direct
supervisors, but also on the organizational and technical
conditions in the ward, provisioning it and method of
management by higher level managerial staff.
6.
7.
8.
9.
10.
11.
12.
CONCLUSIONS
13.
1. Based on snapshot observation, it was noted that
direct nursing occupied 36.70% of time, on average,
in the structure of nurses’ working time in general
psychiatric wards. The remaining working time
concerned indirect nursing – 28.00%, breaks and
personal activities – 24.65%, and coordination and
current organization of work – 10.65%.
2. The nurses in the wards studied devoted the greatest
amount of direct nursing time to diagnostic and
treatment services, while they did not fully perform
care and educational tasks.
3. While introducing organizational changes, attention
should be paid to the structure of activities
performed by nurses and the realisation of all
occupational functions, according to the specificity
of the hospital and patient’s demand for care.
REFERENCES
1. Kulczycka K., Ksykiewicz-Dorota A., Saracen A.,
Karauda M., Gradowska S.: Specificity of staff
management in the system of health care. Ann. UMCS
Sect. D 2005; 60(16): 172-175.
2. Amstrong M.: Managing human resources. Strategy and
action. Second Edition. Professional Business School
Publishers, Kraków 1998.
3. Dyk D., Wołowicka L.: Scientific studies in nursing from
international perspective. Polish Nursing 1999, 8:5-11.
4. Ksykiewicz-Dorota A. Nursing staff scheduling in
inpatient treatment. Czelej Publishers, Lublin 2001.
5. Sapuła R., Wdowiak L., Sitko S.J.: Measurement of
working time of medical rehabilitation physicians in
14.
15.
16.
17.
18.
19.
20.
21.
22.
Rehabilitation Ward. Ann. UMCS Sect. D 2004;59
supl.14[cz.]6:91-96.
Mikołajczyk Z.: Organizational techniques in solving
management problems. State Scientific Publishers,
Warszawa 1994.
Ksykiewicz-Dorota A. (red.): Management in nursing.
Czelej Publishers, Lublin 2005.
Kulczycka K., Ksykiewicz-Dorota A., Karauda M.,
Saracen A., Gradowska S.: Metodological problems of
evaluation of staff resources in obstetric midwifery. Ann.
UMCS Sect. D 2005; 60(16): 167-171.
Lenartowicz H.: Measurement of working time in
inpatient treatment. Nurse and Midwife. 1985; 0(6):6-8.
Lenartowicz H.: Nursing staff in inpatient treatment.
(From studies on utilisation of working time and
professional qualifications). Medical University, Lublin
1987.
Obłój K.: Micro-school of management. State Economic
Publishers, Warszawa 1994.
Ksykiewicz-Dorota A., Rusecki P. (ed.): Improvement of
organization of nursing care in inpatient. Editorial Office
ABRYS, Kraków – Lublin 1996.
Rogala-Pawelczyk G, Piątek A, Ksykiewicz-Dorota A:
Utilisation of working time by nurses. In: Systemic
changes in organization of nursing care in military
hospitals and military spa hospitals in Cracow Military
District [Materials from III Sesssion, II Congress of Polish
Nurses]. Ed. A. Ksykiewicz-Dorota. Busko-Zdrój, 2425.V.1994:48-51.
Rogala-Pawelczyk G.: Structure of activities and
utilisation of working time by nurses at workplaces.
Problems of Nursing 1995;1-2(5):94-99.
Ksykiewicz-Dorota A., Wysokiński M., Kurek M.:
Standards for nursing staff scheduling in intensive care
units and artificail kidney centres. Public Health.
2002;112(1):55-59.
Ksykiewicz-Dorota A, Karauda M: Working time
schedule of midwives in obstetric-neonatal unit versus the
level of mother satisfaction with care. Ann. UMCS Sect. D
2004; 59 (2):371-374.
Ksykiewicz-Dorota A, Saracen A.: Structure of working
time of midwives in maternity ward organized in roomingin system. Pol. J. Environ. Stud. 2007;16 (5A): 253-256.
Kowalska A.: Utilisation of working itme by
environmental nurses in Łódź and the Łódź Region.
Theory and practice of organization of health protection.
Vol. 1: Primary health care in Poland. Łódź 1990:131-138.
Whittington D., McLaughlin C.: Finding time for patients:
an exploration of nurses' time allocation in an acute
psychiatric setting. J Psychiatr Ment Health Nurs. 2000
Jun;7(3):259-268.
Furåker C.: Nurses' everyday activities in hospital care. J
Nurs Manag. 2009 Apr 1;17:269-277.
Martin T: Psychiatric nurses' use of working time. Nurs
Stand. 1992 Jun 3-9;6(37):34-6.
Sandford DA, Elzinga RH, Iversen R.: A quantitative
study of nursing staff interactions in psychiatric wards.
Acta Psychiatr Scand. 1990 Jan;81(1):46-51.
23. Ciechaniewicz W.: Pielęgniarka. W: Ciechaniewicz In
(ed.): Nursing practical training. Vol. 1. Ed. State Medical
Publishers, Warszawa 2006:136-183.
Marta Cebulak
Państwowa Wyższa Szkoła Zawodowa
Instytut Ochrony Zdrowia
Czarnieckiego 16
37-500 Jarosław
Tel./fax 0-16 624-46-03
29
Jerzy Eksterowicz, Marek Napierała
MORPHOLOGICAL BUILD OF PHYSICAL EDUCATION STUDENTS
AT THE KAZIMIERZ WIELKI UNIVERSITY IN BYDGOSZCZ
BUDOWA MORFOLOGICZNA STUDENTÓW UNIWERSYTETU KAZIMIERZA WIELKIEGO
W BYDGOSZCZY Z KIERUNKU WYCHOWANIA FIZYCZNEGO
Department of Physical Education, Kazimierz Wielki University in Bydgoszcz
Head: dr Mariusz Zasada
Summary
The size of human body undergoes continuous changes. The
changes are caused by genetic and environmental conditions. It is
observed that variability in development of the population
depends on economical situation, place of living (town,
countryside), family headcount, education. Acceleration and
secular trends in individual and environmental development are
perceived. Depending on general conditions of the environment,
both positive secular trends and negative trends (i.e. decrease of
the size of a human body over successive decades), are noticed.
Morphological changes of numerous populations, including those
of students from various academic centres are being evaluated.
The aim of this work, based on the examination of the 1st
year physical education full-time students (32 males and 18
females) of the Kazimierz Wielki University in Bydgoszcz, was
to:
•
determine specific body proportions (lengths, widths,
circumferences and composition of body mass),
•
indicate the condition of nutrition (by means of the AMC
index),
•
compare this year’s results with the previous year students
of the same specialization.
The examination of the specific morphological features was
carried out in December 2008, and the presentation of the results
was tabular and graphical.
The most numerous group shared the athletic build
(women – over 55%, men 50%), less numerous were
leptosomatic (ca. 40% of women and 44% of men), whereas
pyknics were in the least numerous group. Body mass index
(BMI) shows that the majority of the study group is
characterized by proper body mass and arm muscle
circumference (AMC) proves that students are exceptionally
well-nourished.
In spite of considerable scientific output in the field of
physical development there is still need for further research
of the phenomenon since the matter analyzed in the present
work has not been fully examined.
Streszczenie
Wielkość ciała ludzkiego na przestrzeni dziejów ulega
ciągłym zmianom. Powodem tych zmian są uwarunkowania
genetyczne i środowiskowe. Obserwuje się zmiany w rozwoju
populacji w zależności od sytuacji ekonomicznej, miejsca
zamieszkania
(miasto,
wieś),
liczebności
rodziny,
wykształcenia itp. Dostrzega się akcelerację i trendy sekularne
w rozwoju osobniczym i środowiskowym. W zależności od
ogólnych warunków otoczenia, odnotowuje się zarówno
pozytywne trendy sekularne, jak i negatywne, które oznaczają
zmniejszenie rozmiarów ciała ludzkiego pomiędzy kolejnymi
dekadami. Ocenie zmian morfologicznych podlegają liczne
populacje, w tym również studenci z wielu ośrodków
akademickich.
Celem niniejszej pracy było określenie wybranych
rozmiarów ciała (długościowych, szerokościowych, obwodów,
oraz składu i masy ciała) studentów I roku (32 mężczyzn i 18
kobiet)
z kierunku wychowania fizycznego studiów
stacjonarnych
Uniwersytetu Kazimierza Wielkiego
w Bydgoszczy. Badania wybranych cech morfologicznych
przeprowadzono w grudniu 2008 roku, a wyniki
32
przedstawiono tabelarycznie i graficznie. Rezultaty
tegorocznych badań bydgoskich studentów z kierunku
wychowania fizycznego przedstawione w niniejszym
opracowaniu porównano z wynikami z roku poprzedniego
tego samego kierunku.
Najliczniejszą grupę stanowią osobnicy o budowie
atletycznej (kobiety ponad 55%, mężczyźni 50%, mniej
licznie występują leptosomatycy (ok. 40% kobiet i 44%
mężczyzn, a najmniejszą grupę stanowią piknicy (ponad 5%
kobiet i ok. 6% mężczyzn). Wskaźnik BMI pokazuje, że
większość badanych charakteryzuje się prawidłową masą
ciała, a wskaźnik AMC określa, że studenci wyróżniają się
dobrym stanem odżywienia.
Pomimo znacznego dorobku naukowego w dziedzinie
poznawania zjawisk dotyczących rozwoju fizycznego,
istnieje potrzeba dalszego ich prowadzenia, gdyż omawiana
tematyka jest nadal ważna i nie do końca zbadana.
Key words: morphological features, physical education students
Słowa kluczowe: budowa morfologiczna, studenci
INTRODUCTION
The size of human body undergoes continuous
changes. The process of phylogenetic creation of a man
has led to today’s form of Homo Sapiens. On the other
hand, the ontogenetic changes lead to shaping of
individuals adjusted to living in certain conditions,
which may influence the species’ procreation ability.
The human ontogenesis is a cohesive process which
takes into account the genetic and environmental
conditions [1]. Undoubtedly changes in the
population’s evolution depending on economic
situation, place of living (city, countryside), the family
headcount, education, etc. are observed for this reason.
Acceleration and secular trends in ontogenesis and
environmental evolution are noticed [2]. Depending on
general surrounding conditions, positive as well as
negative secular trends are noted, which signify the
decrease of the human body size over successive
decades. Knowledge of these processes allows to select
such educational and pedagogical methods for the
young generation, which are conducive for optimal
psycho-physical development of young people.
The aim of this work is to describe the size of
human body, including the composition and body
mass, of 1st year physical education full-time students
(both males and females) of the Kazimierz Wielki
University in Bydgoszcz. The results may serve to
describe the health condition of the young generation,
to make the medical development forecasts, as well as
the needs of the science of ergonomics in a broad
sense.
RESEARCH MATERIAL AND METHODOLOGY
The research was carried out in December 2008. It
covered 50 1st year full-time physical education
students (32 men and 18 women) of the Kazimierz
Wielki University in Bydgoszcz.
The following anthropometric measurements were
taken: body height (cm), body mass (kg), thickness of
three dermal-aliphatic folds (mm) held in different
body spots, i.e. in the back, below the bottom shoulder
blade angle (subscapular skinfold - SCSF) – the
horizontal fold; over the triceps muscle of arm (triceps
skinfold -TSF) – vertical fold; and over crista iliaca
(suprailiac skinfold - SISF) – oblique fold.
Furthermore, using the placement of certain
anthropometric points, the length measurements of the
following body parts were conducted: arm
measurement (a-r), forearm (r-sty), upper limb (a-da
III), lower limb (tro-B) and foot (pte-ap).
Analogically, the widths of the following body
parts were measured: shoulders (a-a), hips (ic-ic),
pelvis (is-is), hand (mm-mu), palm (mr-mu) and foot
(mtt-mtf).
Selected circumference measurements were taken :
chest - while full breathing in and full breathing out,
waist, hips, arm - tensed and loosened, as well as thigh
and calf. The anthropometric measurements were
taken by means of mobile medical scales – model:
TANITA BF 662M and the anthropometric tool-kit
(anthropometer, compasses, anthropometric tape, slidecompasses, foldometer) produced by a Swiss firm
Siber Hegner & Co. Ltd. in accordance with the
guidelines presented by Z. Drozdowski [3].
According to the mentioned measurements, values
of some somatic indexes were calculated: BMI (Body
Mass Index, kg/m2), WHR (Wist to Hip Ratio), AMC
(Arm Muscle Circumference, cm), FM (Fat Mass, kg)
by means of the Durnin – Womersley algorithm,
proportional Fat Mass (%FM), FFM (Fat Free Mass,
kg) and proportional Fat Free Mass (%FFM).
Particular BMI values were presupposed for men
and women: under 19.0 – body mass deficit, 19.0 –
25.0 - proper body mass, 25.1 – 29.9 - overweight,
30.0+ - obesity [4]. The border value of WHR index,
which enables to note obesity is over 0.95 for men and
Morphological build of physical education students at the Kazimierz Wielki University in Bydgoszcz
over 0.85 for women, and AMC value of under 22.7
for men and under 20.8 for women indicates
malnutrition.
The arm circumference (cm) was taken into
consideration, then the arm muscles circumference was
calculated in order to describe the AMC aluminous
nutrition according to the formula: arm circumference
– (3.14 x thickness of the dermal-aliphatic fold over
the triceps). In order to explain the results, the
following AMC evaluation criteria were taken into
consideration: proper nutrition: men – over 22.8 (slight
malnutrition 22.7-20.2; moderate malnutrition 20.117.7; and heavy malnutrition – below 17.7) and women
– over 20.9 (20.8-18.6; 18.5-16.2; and below 16.2
respectively) [3].
The somatic build of students was characterized
according to Kretschmer’s typology based on the
guidelines applied by Curtis with the use of the Rohrer
index. Sex was taken into account in all measurements
and calculations. Average values ( X ) and standard
deviations (s) were calculated. The results obtained in
the present year were compared to those from the
previous year, the differences were determined by the
t-student test, and the magnitude of the differences was
determined by the Mollison index [3].
THE RESEARCH RESULTS
Table I presents numerical characteristics of the
examined morphological features of the students who
started studies in the academic year 2008/2009. The
results may be used to monitor the differences of
particular morphological features between physical
education students from successive academic years and
may constitute material which will document the
values of mentioned parameters.
Using the slenderness characteristics according to
Kretschmer’s typology and Curtis’s key, it may be
noticed that the most numerous group of students
consists of individuals of athletic build (women – over
55%, men 50%). Leptosomatics are less numerous (ca.
40% of women and 44% of men). The pyknics are the
least numerous (5% and 6% respectively). The
graphical image of slenderness profiles is shown in the
Figure 1.
Based on the measurements of body height and
mass, BMI was calculated. It may be stated that
average body mass values in the examined group are:
23.41 for men, 22.30 for women. Figure 2 shows BMI
for all examined students. Around 19% of men and 6%
of women are overweight.
33
Table I. Numerical characteristics of some somatic features
of men and women
Men
(N-32)
Tested feature
x 1 σ1 x 2 σ 2
body height (cm) (B – V)
body mass (kg)
FM (kg) fat mass ( kg)
FM (%)
fat mass (%)
FFM (kg) fat free mass ( kg)
FFM (%) fat free mass (%)
- sum of skin – fat folds (mm)
- under lower shoulder blade angle
(mm)
- over the triceps muscle (mm)
- over the iliac bone (mm)
length measurements (cm):
- arm (a-r)
- forearm (r-sty)
- upper limb (a – da III)
- lower limb (tro-B)
- foot (pte-ap)
width measurements (cm):
- shoulders (cm) (a-a)
- hips (cm) (ic – ic)
- pelvis (cm) (is –is)
- hand (cm) (mm-mu)
- palm (cm) (mr-mu)
- foot (cm) (mtt-mtf) t
circumference measurements (cm):
chest (aspiration) (cm)
chest (expiration) (cm)
waist (cm)
hips (cm)
arm (tensed) (cm)
arm (relaxed) (cm)
thigh (cm)
calf (cm)
BMI body mass index
AMC Arm Muscle Circumference
WHR Wist to Hip Ratio
60
Women
(N- 18)
181,0
76,7
12,23
15,73
64,48
84,27
30,3
10,8
9,0
10,5
8,01
9,7
3,62
3,14
7,17
3,14
6,70
2,6
2,0
3,3
170,01
64,3
18,34
28,38
45,93
71,62
34,2
11,1
12,9
10,2
7,02
6,36
3,25
2,80
3,66
2,80
8,0
2,88
3,72
2,70
32,51
27,43
79,45
91,88
27,15
2,51
1,86
3,95
3,89
1,51
29,04
25,65
72,48
86,85
25,19
1,65
1,78
3,64
6,23
1,30
43,07
30,59
24,23
10,93
8,78
10,14
1,89
2,19
2,29
0,64
0,64
0,67
39,61
32,62
23,97
9,59
7,79
9,35
1,56
3,32
2,36
0,35
0,28
0,52
97,31
91,82
78,02
95,53
32,88
29,93
52,93
36,78
23,4
27,11
0,82
91,82
5,53
5,32
6,15
2,28
2,67
3,77
2,82
1,70
2,42
0,04
91,81
87,66
71,57
97,11
28,35
26,76
54,70
36,68
22,3
22,81
0,74
5,22
4,61
3,45
5,43
1,71
1,69
3,04
1,72
1,7
1,30
0,03
55,6
50
50
40
43,7
38,9
30
w omen
men
20
10
5,5
6,3
0
leptosomatics
athletes
pyknics
Fig. 1. Body slenderness of the tested women and men
AMC index was used to evaluate nutrition of the
examined group. Average values prove that both
women (AMC = 22.81) and men (AMC = 27.11) are
remarkably well-noutrished .
The border value of the WHR index (0.95 for men
and 0.85 for women) – under which obesity is
identified – was not exceeded (by any of the examined
individuals), which indicates no obesity (Figure 3).
34
30,0
29,0
w omen
28,0
men
27,0
26,0
25,0
24,0
23,0
22,0
21,0
20,0
19,0
18,0
1
3
5
7
9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55
Fig. 2. BMI of the tested women and men
0,95
w omen
men
0,90
0,85
0,80
0,75
0,70
0,65
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32
Fig. 3. WHR of the tested women and men
DISCUSSION
Changing life conditions caused by social and
economic transformations urge investigators to
frequently monitor and evaluate the state of physical
evolution of the society. In order to observe the
changes which occur in the morphological build of
students, it is necessary to conduct systematic research,
which numerous academic centres perform [5, 6, 7, 8,
9].
The research work done by L. Cymek and partners
[5] among students from Słupsk indicated differences
in somatic build of female students examined in 1994
and 2000. The year 1994 students were, on average,
1.02 kg heavier, had deeper chests and larger humerus
and thighbone epiphysis than the year 2000 students.
The examined year 2000 students were, on average,
2.44 cm higher and had higher values of the length
features.
The problem of greatness of changes in
morphological features occurring during a sports camp
was examined by J. Eksterowicz and partners as well
as J. Eksterowicz, M. Napierała [10, 11]. They
observed significant changes concerning differences in
circumference of hips, chest during full breath in and
full breath out (1%) as well as in thigh measurements
(5%). In the group of examined women, the average
body mass, BMI and adipose (not statistically
examined) decrease was noticed. Some slight
differences in systolic and diastolic pressure
measurements appeared. The differences in pulse rate
measurements proved statistically significant – 1%.
Anthropometric parameters of students and
physical activity were the issues of the research of J.
Szymelfejnik and partners [12]. The results, among
other things, proved that moderate physical activity is
favourable to keeping a proper body mass.
This year’s results of Bydgoszcz physical education
students described in the present study were compared
to the last year’s results from the same university
specialization. The results constitute a document
showing morphological build changes. Despite a
considerable academic output in the field of research
concerning the physical development, there is a need
for continuation of the research, as the presented issue
is still important and not entirely investigated .
The results of morphological measurements of men
and women made in 2008 were presented in the Table
II and Table III and they were compared to the
analogical measurements from 2007. The results for
both men and women in particular years differ. It
shows that in the case of male groups the dermalaliphatic fold over the triceps was thicker, but the waist
size and the WHR index were smaller (statistically
relevant differences). In the group of examined
women, they had higher average results of FM (kg),
FM (%), arm circumference and the AMC index
(statistically relevant difference). Average values of the
total sum of dermal-aliphatic folds, the thickness of the
fold below the inferior angle of the shoulder blade over
the crista iliaca, waist circumference as well the WHR
index rate decreased (statistically relevant).
The largest differences defined by the Mollison
index were stated among male individuals with the
FM% of 0.65, waist circumference of 0.60 and the
WHR of 0.50, and among female individuals with arm
circumference of 1.37, WHR of 1.33 and the thickness
over the crista iliaca of 1.30. The graphical image of
the differences is shown in the Figure 4.
Morphological build of physical education students at the Kazimierz Wielki University in Bydgoszcz
35
Table II. Comparison of values of morphological measurements CONCLUSIONS
in men (years 2007 and 2008)
Men 2007 Men 2008
N=87
N=32
S
S
Tested feature
X
body height (cm)
body mass (kg)
FM (%) fat mass (%)
sum of skin – fat folds (mm)
below the inferior angle of the
shoulder blade (mm)
over the triceps (mm)
over the iliac bone (mm)
arm length measurement (cm)
waist measurement (cm)
hip measurement (cm)
BMI body mass index
AMC Arm Muscle Circumference
WHR Waist to Hip Ratio
d
u
WM
0,5
0,4
1,73
2,03
0,31
0,21
2,44
3,23
0,06
0,04
0,48
0,65
X
10,6
13,7
7,79
8,43
2,87
2,72
65,7
27,83
6,70 64,48
5,34 30,3
7,17 1,22 0,84
6,70 2,47 1,88
-0,17
0,37
1,91 10,8
2,6
0,42 0,83
0,16
2,77
4,08
3,13
5,76
5,68
2,11
3,21
0,04
2,01
3,3
2,67
5,32
6,15
1,70
2,42
0,04
0,92
1,13
0,17
3,18
0,47
0,01
0,39
0,02
0,46
0,34
-0,06
-0,60
-0,08
-0,01
-0,16
-0,50
180,5
76,3
10,38
8,08
9,37
30,1
81,2
96,0
23,41
27,5
0,84
181,0
76,7
12,23
15,73
9,0
10,5
29,93
78,02
95,53
23,40
27,11
0,82
8,01
9,7
3,62
3,14
1,98*
1,55
0,29
3,88**
0,81
0,03
0,71
2,42*
N – numbers , X – average value, S - standard variation, u - statistical
importance of differences * p<0,05;** p<0,01;t α = 0,05 = 1,98; t α = 0,01 = 2,56,
d – difference of statistical averages,
W M - Mollison indicator
1. The most numerous group of students shared the
athletic build, less numerous were leptosomatics,
whereas pyknics were in the least numerous group.
2. The average BMI result confirms proper body mass
(23.41 for men and 22.3 for women).
3. The AMC index proves that both examined women
and examined men are characterized by, on
average, good nutrition (average result for men –
27.11, for women – 22.81).
4. No obesity was stated in the examined group
according to BMI, which was additionally
confirmed by the WHR index (men – 0.82, women
– 0.74).
BIBLIOGRAPHY
1. Wolański N., (2006), Rozwój biologiczny człowieka,
Wydawnictwo Naukowe PWN, Warszawa.
2. Łaska – Mierzejewska T., (1999), Antropologia w
sporcie i wychowaniu fizycznym, Wydawnictwo COS,
Women
Women 200
2007/8
9
d
u WM
Warszawa.
Tested feature
N=45
N=18
3. Drozdowski Z., (1998), Antropometria w wychowaniu
S
S
X
X
fizycznym, Wydawnictwo AWF, Poznań.
170,0 4,97 170,01 7,02 0,01 0,01
0,001
body height (cm)
63,7
6,66 64,3
6,36 0,6 0,33
0,09
body mass (kg)
4. Woynarowska B., (2008), Edukacja zdrowotna, PWN,
16,3
3,44 18,34 3,25 2,04 2,21* 0,63
Warszawa.
25,4
3,50 28,38 2,80 2,98 3,54** 1,06
FM (%) fat mass (%)
47,4
4,28 45,93 3,66 1,47 1,37
-0,40
5. Cymek L., Rożnowski F., Zaworski B., (2002),
40,83 5,33 34,2
6,55 6,63 3,82** -1,01
sum of skin – fat folds (mm)
Środowiskowe uwarunkowania rozwoju fizycznego
2,88 1,68 2,54* -0,58
below the inferior angle of the 12,78 3,37 11,1
studentek Pomorskiej Akademii Pedagogicznej w
shoulder blade (mm)
14,34 4,28 12,9
3,72 1,44 1,33
-0,38
over the triceps (mm)
Słupsku, [w:] Ontogeneza i promocja zdrowia w aspekcie
13,71 4,49 10,2
2,70 3,51 3,80** -1,3
over the iliac bone (mm)
medycyny, antropologii i wychowania fizycznego, (red.)
26,0
2,27
28,35
1,71
2,35
4,46**
1,37
arm measurement length (cm)
75,2
6,64 71,57 3,45 3,63 2,83** -1,05
waist measurremont (cm)
Malinowski A., Tatarczuk J., Asienkiewicz R., Oficyna
96,3
5,04 97,11 5,43 0,81 0,51
0,15
hip measurement (cm)
Wydawnicza Uniwersytetu Zielonogórskiego.
22,0
1,92 22,3
1,7
0,3 0,61
0,18
BMI body mass index
6. Paś A., (2005) Charakterystyka cech somatycznych
AMC Arm Muscle Circumferen 21,5 2,04 22,81 1,30 1,31 3,03** 1,00
0,78
0,05 0,74
0,03 0,04 4,31** -1,33
WHR Wist to Hip Ratio
studentek i studentów kierunków wychowania
fizycznego w świetle wybranych wskaźników, [w:]
N – numbers , X – average value, S - standard variation , u - statistical
importance of differences * p<0,05;** p<0,01;t α = 0,05 = 2,00; t α = 0,01 = 2,66 ,
Promocja zdrowia w hierarchii wartości, (red.) Lewicka
W., Jasik J., „Annales”, Sectio D, vol. LX, Suppl. XVI,
d – difference of statistical averages W M - Mollison indicator
nr 4, Uniwersytet Marii Curie –
Skłodowskiej, Lublin, s 45 – 52.
7. Napierała M. , Cieślicka M.,
Dmitruk K., (2007), Budowa
morfologiczna
a
zdolności
motoryczne studentów I roku
wychowania
fizycznego
Uniwersytetu Kazimierza Wielkiego
w Bydgoszczy, „Annales”, (red.) W.
Śladkowski, Universitatis Mariae
Curie–Skłodowska,
Sectio D,
Medicina, Lublin, vol. LXII, Suppl.
XVIII, nr. 5, s. 226-229.
8. Lewandowski
A.,
(1999),
Środowisko a czynniki budowy i
sprawność studentów medycyny,
[w:]
Zdrowie i sprawność
Fig. 4. Differences in the tested values measured by Mollison’s rate
Table
III.
Comparison of values of morphological
measurements in women (years 2007 and 2008)
36
motoryczna w kulturze fizycznej dzieci i młodzieży,
(red.) M. Zasada, WSP, Bydgoszcz.
9. Asienkiewicz R., (2002), Charakterystyka porównawcza
budowy somatycznej studentów i studentek kierunków
pedagogicznch
na
przykładzie
rzeszowskiej
i
zielonogórskiej WSP, [w]: Ontogeneza i promocja
zdrowia
w
aspekcie
medycyny,
antropologii
i wychowania fizycznego, (red.) Malinowski A.,
Tatarczuk J., Asienkiewicz R., Oficyna Wydawnicza
Uniwersytetu Zielonogórskiego, Zielona Góra.
10. Eksterowicz J., Napierała M., Dmitruk K., (2007),
Zmiany
morfologiczne
studentów
z
kierunku
wychowania fizycznego w trakcie letniego obozu
sportowego, „Medical and Biological Science”, nr 21/3,
s. 49 - 52.
11. Eksterowicz J., Napierała M., (2008), Wpływ obozu
letniego na zmiany morfologiczne u studentek
Uniwersytetu Kazimierza Wielkiego w Bydgoszczy z
kierunku wychowania fizycznego, [w]: Exercitatio
corpolis – motus – salus, (red.) M. Bence, Univerzita
Mateja Bela, Banska Bystrica, s. 49 – 57.
12. Szymelfejnik J., Jarząbek J., Eksterowicz J., Cichoń R.,
(2007), Parametry antropometryczne studentów a
aktywność fizyczna, Międzynarodowa Konferencja
Naukowa pt. Interdyscyplinarny wymiar nauki o
zdrowiu, UMK, CM Bydgoszcz, s. 424-431.
Jerzy Eksterowicz
Uniwersytet Kazimierza Wielkiego w Bydgoszczy
Katedra Kultury Fizycznej
ul. Sportowa 2
85-091 Bydgoszcz
tel.: 601 63 91 81
Mirosława Felsmann, Elżbieta Kędzierska
PATIENTS SUFFERING FROM ACUTE CORONARY SYNDROMES
AND THE ACCOMPANYING ANXIETY
PACJENCI Z OSTRYMI STANAMI WIEŃCOWYMI A TOWARZYSZĄCY IM LĘK
Department of Pedagogy and Nursing Didactics, Nicolaus Copernicus University
Head: Mirosława Felsmann MD, PhD
Summary
Acute coronary syndromes have taken on the form of a
„modern epidemic”. It is believed that by the year 2020 the
number of deaths caused by heart disease will have increased
by almost 100%. In Poland acute myocardial infarction
morbidity reaches 100 thousand people annually. Taking into
account the fact that the majority of these individuals are in
their productive age, humanity attacked by these diseases
bears enormous losses. This situation has prompted scientists
to carry out research to determine the cause of the diseases
and compile effective ways of prevention and treatment.
Many researches have shown that psychological factors have
an influence on the emergence, course and treatment of the
disease. Attention has also been focused on anxiety as
a symptom accompanying myocardial infarction.
The main objective of the presented study and research
was to gain information on the occurrence and cause of the
increase of anxiety in patients hospitalized due to acute
coronary syndrome. 100 patients treated for acute coronary
syndrome in the Cardiology Ward of the Provincial Hospital
in Włocławek took part in the research. The research was
conducted based on a self-constructed survey and the Polish
version of the STAI questionnaire.
Conducting an exact analysis of the obtained results
allowed for the conclusion that socio-demographical and
health factors significantly influence the level of anxiety
experienced by individuals. Results show that the highest
level of anxiety occurs in patients with primary education
residing in urban areas and in those hospitalized for the first
time who have no information about the disease and about
the principles of a healthy lifestyle. It is therefore essential to
pay particular attention to the proper health wise education,
of hospitalized patients suffering from acute coronary
syndrome.
Streszczenie
Ostre zespoły wieńcowe przybrały w niektórych krajach
formę „nowoczesnej epidemii”. Przyjmuje się, że do 2020
roku należy się spodziewać prawie 100% przyrostu zgonów
spowodowanych chorobami serca. W Polsce zachorowalność
na ostry zawał serca sięga 100 tysięcy osób rocznie. Biorąc
pod uwagę fakt, że są to głównie osoby w wieku
produkcyjnym, ludzkość nękana tym schorzeniem ponosi
ogromne straty. Sytuacja ta skłoniła naukowców do
prowadzenia badań w celu ustalenia przyczyny choroby oraz
opracowania skutecznego zapobiegania jej i leczenia. Wiele
badań wykazało, że wpływ na powstawanie, przebieg
i leczenie tej choroby mają czynniki psychologiczne.
Zwrócono również uwagę na lęk jako objaw współwystępujjący przy ataku serca.
Głównym celem prezentowanej pracy i przeprowadzonych badań było uzyskanie informacji na temat
występowania oraz przyczyn nasilenia lęku u chorych
hospitalizowanych z powodu ostrych zespołów wieńcowych.
Badaniem objęto 100 pacjentów leczonych z powodu ostrego
zespołu wieńcowego w Oddziale Kardiologii Szpitala
Wojewódzkiego we Włocławku. Badania przeprowadzono
opierając się na ankiecie własnej konstrukcji oraz
kwestionariuszu STAI.
38
Dokonanie wnikliwej analizy uzyskanych wyników
pozwoliło na ustalenie, że czynniki socjo-demograficzne
i zdrowotne w istotny sposób wpływają na poziom lęku.
Wyniki wskazują, że najwyższy poziom lęku występuje u
chorych zamieszkujących na wsi i mających wykształcenie
podstawowe oraz u osób hospitalizowanych po raz pierwszy,
nieposiadających informacji na temat choroby i nieznających
zasad zdrowego stylu życia. W opiece nad chorymi
hospitalizowanymi z powodu ostrych zespołów wieńcowych
należy zatem zwrócić szczególną uwagę na prawidłową
edukację zdrowotną.
Key words: anxiety, acute coronary syndromes
Słowa kluczowe: lęk, ostre stany wieńcowe
INTRODUCTION
MATERIAL AND METHOD
Throughout the 60’s-80’s of the XXth century a
series of clinical tests were conducted in which special
attention was paid to the group of socio-demographical
factors which provoke circulatory disturbances.
Emotions leading to the development of these diseases
were the main interest, it was also pointed out that such
emotional states as anger, depression and anxiety along
with the experience of stress are connected with an
unfavourable cardiologic prognosis.
Many cardiologists pay attention to the anxiety
accompanying a heart attack and treat this emotional
state as one of the elements compiling the acute
coronary syndrome and note that it can lead to a series
of adverse consequences.
Because disease always constitutes a greater or
smaller life threat, occurrence of anxiety is hence an
understandable event . Under normal circumstances an
individual is able to look at his/her concerns from a
perspective and determine actions which will help
him/her deal with the causes and the concerns
themselves. An ill individual experiences a state of
concern which is pervasive and intense, disturbing
normal functioning. Thus, the problem of anxiety
occurrence in patients with severe heart disease cannot
be ignored by any team of doctors taking care of such a
patient. The extent of emotional difficulties connected
with myocardial infarction is best characterized by
Dudley White, who wrote: “It is necessary to
recognize that the heart may return to health more
quickly than the state of mental depression, which is a
frequent complication” [ 1].
Surely there exist a number of factors influencing
the occurrence and level of intensification of anxiety in
patients hospitalized due to acute coronary syndrome.
An analysis of these factors and their influence on the
level of anxiety experienced by cardiology patients is
also a fundamental objective of the presented study.
The research material used in this study was
gathered among patients being treated for acute
coronary syndromes in the Cardiology Ward and
Stimulator Implant Centre of the Provincial Hospital in
Włocławek. The research was carried out from
February to June 2008. The respondents who took part
in the study were informed about its point and aim and
then confirmed their participation by signature. The
approval of the Bioethical Commission was also
obtained prior to commencing the research.
The research was conducted on a group of 100
hospitalized respondents suffering from acute coronary
syndrome, whose cardiologic and general states
allowed for participation.
The group of respondents comprised of individuals
aged between 41 and 79. The largest group consisted
of 43 individuals aged between 55-69, then 36
individuals aged between 41-54 and 21 individuals
aged between 10-79. Male respondents were
undoubtedly the leaders- 61individuals whereas only
39 female respondents agreed to take part in the
research. Amongst the respondents, 40 individuals
stated to have secondary education, 25 vocational
education, 21 primary education and 14 higher
education. 75 individuals from the group resided in
urban areas and 25 in rural areas. The majority of the
group (64) were not occupationally active, only 36
were employed. 80 of them had already been
hospitalized a number of times, only 20 of them were
in a hospital for the first time.
A self-constructed survey and the STAI (X1)
(State-Trait Anxiety Inventory) were used to gather
material for analysis. The collected research material
was subjected to quantitative and qualitative analysis in
accordance with the objectives and purpose of the
study. The statistical software package STATISTICA
7.1 for Windows StatSoft ® company was used for the
statistic analysis.
The State-Trait Anxiety Inventory STAI compiled
by C.D. Spielerger, R.L. Gorsuch and R.E Lushene, an
Patients suffering from acute coronary syndromes and the accompanying anxiety
adaptation of the American State-Trait Anxiety
Inventory (STAI). The adaptations to Polish standards
were prepared by C.D. Spielberger, J. Strelau, M.
Tysarczyk, K. Wrześniewski.
The construction of the STAI is based on the
differentiation between transitional and conditional
anxiety known as individual anxiety state and anxiety
as a relatively stable personality trait. The raw results
of the STAI scale may vary between 20 points- low
level of anxiety, to 80 points- high level of anxiety.
After obtaining the raw results they were transformed
into sten scores for an overall sample of adults,
standardized in 2000.
The interpretation of the sten scores is as follows:
0-4 points - low level anxiety, 5-6 points - increased
anxiety, 7-10 points - high level anxiety [2].
RESULTS
Testing normal distribution showed that the
analyzed parameters are characterised by a distribution
differing from normal. Due to that fact nonparametric
tests were carried out in order to grade differences
between groups: Kruskal-Wallis and Mann-Whitney.
The value of p≤0.05 was adopted as statistically
significant and was marked as „*”. Variability of the
examined parameters was illustrated in the form of
descriptive statistics: arithmetic mean (M) and standard
deviation (SD).
To verify the hypothesis concerning the impact of
socio-demographic factors on the occurrence and level
of anxiety in patients hospitalized due to acute
coronary syndromes, an analysis of the relationship
between demographic variables and the level of
anxiety was carried out. Results show that age is not a
variable which has an influence on the level of anxiety.
A significant variable turned out to be the gender of the
examined patients. It appears that women are
characterized by a higher level of anxiety than men,
therefore further analysis was carried out after a gender
subdivision was introduced. Table No. I and its results
indicate that education has an influence on the level of
anxiety in those patients who took part in the study.
The highest level of anxiety was experienced by the
individuals with primary education, and the lowest by
those with higher education. In both cases the level of
significance was 0.01, therefore the studied
relationships were statistically significant. In the case
of women no significant relationship between
education and the level of anxiety was noted. On the
39
other hand, in the case of men such a relationship
proved to exist: the higher the education the lower the
level of anxiety, with the level of significance being
0.0024.
Table I. The level of anxiety depending on the level of
education of the respondents
Education
Primary
N
21
M
8,71
SD
1,79
p
1
Vocational
Secondary
Higher
2
3
4
25
40
14
8,44
7,55
6,71
1,87
2,16
1,86
0,03712-4
0,01081-4
According to the results in the Table II patients
residing in the country react with a higher level of
anxiety than those residing in cities. No attention was
paid to the differences between men and women living
in the same area (rural or urban). The level of
significance of the gained results which prove the
existence of a higher level of anxiety in individuals
living in the countryside is close to p=0.05 showing
that the obtained results are statistically significant.
Table II. The level of anxiety in relation to the place of
residence of respondents divided according to
gender
Place of residence
city
country
p
N
M
SD
N
M
SD
Men
45
7,38
2,14
16
8,13
2,47
0,1357
Women
30
8,20
1,79
9
9,11
0,93
0,2713
Total
75
7,71
2,03
25
8,48
2,08
0,0521
Patients hospitalized for the first time experience a
higher level of anxiety than those hospitalized more
frequently. However, the statistically significant
difference applies only to women (Table III).
Table III. The level of anxiety in the hospital depending on
the frequency of hospitalization of the respondents
divided according to gender
Number of hospitalizations
Once
M
SD
7,46 2,26
N
48
Women
7
9,71
0,49
32
8,13
1,70
0,0122*
Total
20
8,25
2,12
80
7,81
2,05
0,2833
Men
More times
M
SD
7,60 2,25
p
N
13
0,7984
It was hypothetically assumed that the level of
anxiety would be lower in the cases of patients who
40
have some knowledge about their condition. Data from
Table IV clearly indicates a statistically significant
difference between the level of anxiety in individuals
with adequate knowledge about their condition, and
those individuals who received no knowledge or for
whom the obtained knowledge was not enough.
Table IV. The level of anxiety depending on the respondents
knowledge about the disease, divided according to
gender
Table V. The level of anxiety depending on the respondents’
knowledge of the principles of healthy lifestyle
Lifestyle
Yes
Rather yes
Rather no
No
1
2
3
4
N
SD
Men
50
7,24
Women
29
Total
79
M
7,13
8,40
9,38
8,42
SD
2,26
1,67
0,74
1,77
p
0,02871-3
Table VI. The level of anxiety depending on the respondents’
knowledge of the principles of healthy lifestyle
divided according to gender
Knowledge about the disease
Yes
M
N
46
20
8
26
Lifestyle
p
p
N
Yes
M
SD
N
No
M
SD
Men
45
7,16
2,29
16
8,75
1,61
0,0103*
0,2156
Women
21
8,29
1,68
18
8,56
1,69
0,6320
0,0026*
Total
66
7,52
2,16
34
8,65
1,63
0,0108*
N
No
M
SD
2,26
11
9,09
1,30
0,0084*
8,17
1,79
10
9,10
0,99
7,58
2,14
21
9,10
1,14
According to the statistic analysis a lack of
knowledge about the condition increases the level of
anxiety in men more than in women. The level of
statistical significance was 0.0084 meaning that the
obtained results were of importance for the research
conducted.
Knowledge of the principles of a healthy lifestyle
and proper health behaviour after leaving the hospital
influences the level of anxiety experienced by patients
with acute heart disease in a significant way. (Table
V) Respondents with the choice of four answers: „yes”,
„rather yes”, „rather no” and „no” mainly (46
individuals) answered „yes” and they were those
patients who had the lowest level of anxiety (M=7.13).
Whereas the smallest number of individuals (8)
answered “rather no” and it was in those cases that the
level of anxiety was the highest (M=9.38). In the
remaining sub-groups the level of anxiety was similar
and varied between M=8,40 to M=8.42. The obtained
results are statistically significant (p=0.029).
The following stage of verification of the
hypothesis concerning the correlation between
knowledge about a healthy lifestyle and the level of
anxiety calculated the results according to all of the
respondents and according to gender. Owing to small
group size in this analysis, two types were singled out
linking the answers „ yes” and „rather yes” as „yes”
and „rather no” and „no” as „no”.
The
interdependence between knowledge about a healthy
lifestyle and the level of anxiety in the group of
respondents is shown in the Table VI.
The analysis of the above calculations shows that
statistically significant results were obtained
throughout the whole group of respondents which, in
turn, shows that individuals who know about the
principles of a healthy lifestyle display a significantly
lower level of anxiety (M=7.25) in comparison with
those who answered that they did not know the
principles of a healthy lifestyle (M=8.65). An analysis
carried out in a group of male respondents and in
a group of female respondents shows that, in the case
of men, a significant relationship between knowledge
about a healthy lifestyle after leaving hospital and the
level of anxiety exsisted, whereas no such statistically
significant differences were found in women.
DISCUSSION
Many contemporary cardiologists treat anxiety as
one of the factors accompanying the symptoms of
a heart attack, which bring about an array of negative
consequences. Williams and others have carried out
a research questionnaire among 36 cardiologists
belonging to different American clinics. They were
asked about the most common problem which they
encounter during the treatment of patients suffering
from cardiovascular disease. Anxiety was cited as the
fundamental difficulty in working with these patients.
Similar results were obtained by Fisher, who sent out
surveys to many cardiology centres in different
countries. One of the questions asked was aimed at the
main psychological problem which doctors have with
their cardiology patients. Out of 56 obtained replies
from 30 countries anxiety or fear were the most
frequently mentioned. Out of 50 heart attack patients
examined by Hackett, 40 displayed symptoms of
anxiety during their stay in the Cardiac Intensive Care
Ward. Similar values were obtained by the same
authors in later studies. Out of 24 patients 21 admitted
to suffer from anxiety [3].
Within the last thirty years many articles paying
attention to the problem of anxiety accompanying
cardiology patients have been published in cardiology
magazines. Studies on 845 cardiology patients from the
Cardiac Intensive Care Ward in the Thorax Centre of
the University Hospital in Rotterdam, showed that 80%
of them (680 individuals) displayed strong anxiety.
About 1500 residents of London between the age of
40 and 64, along with 2280 residents of Boston and
over 51000 American citizens took part in a research
program in which a distinct relationship between the
high level of anxiety and cardiac deaths was stated [1].
The above results clearly show that it is vital to take
into consideration the anxiety experienced by cardiac
patients as it plays a destructive role during the period
of hospitalization and thereafter.
61 male respondents and 39 female respondents
took part in the research program. This does not mean
that men are more prone to acute coronary syndromes
than women. On the contrary, the latest
epidemiological data shows that the number of female
cardiac patients is higher. The fact that more men took
part in the research may be due to the fact that women
more frequently refused to cooperate. It may be
important to mention that the choice of respondents
was made based on the disease entity, good general
health and cardiovascular status and voluntary consent
to participate in the study. This places certain
restrictions on the interpretation of the results in
relation to other people (not covered by the survey), so
these results should be cautiously generalized. The
short period of hospitalization also caused a
complication in the choice of patients. Modern
treatment techniques, mainly invasive treatment,
reduced the period of hospitalization to 3-4 days.
In the group of respondents the most numerous
were patients with secondary education and the least
numerous with higher education. When discussing the
aspect of the obtained results it is worth mentioning
that very different results were obtained in studies
conducted in Asia and Europe, which showed that
individuals with higher and secondary education suffer
from coronary disease more frequently than those with
41
primary or no education. In contrast, studies conducted
in the United States by Rosenman show that
individuals with higher education are less likely to
suffer from heart attacks. Another American
researcher, Shekelle, stated that myocardial infarction
is much more common in individuals with primary and
secondary education. It is believed that the incidence of
ischemic heart disease may be particularly high in
individuals with primary education as they are assigned
tasks for which they are not prepared. These
controversial results highlight the complexity of the
research issue and do not allow to draw specific
conclusions [4].
Research results show that hospitalization due to
acute coronary syndrome is generally accompanied
with a higher level of anxiety (M=7.90), with a
standard deviation (2.06). While dealing with the same
relationship between genders, the results showed that
women display a greater increase of anxiety as a
currently experienced emotional state than men. This
result may be connected with that fact that, in our
culture, states of anxiety are less approved in men than
in women, and for this reason it may be assumed that
the surveyed male respondents did not admit to be
experiencing anxiety.
It appeared that age has no impact on the level of
anxiety experienced by the group of respondents.
However, there is a strong likelihood that the small
number of respondents in particular groups of
examined patients had an impact on the obtained
results. When comparing individuals residing in rural
areas and those residing in the urban areas it turned out
that rural dwellers react with a higher anxiety level
than those residing in the city. Perhaps this is
associated with lower awareness of health issues of the
rural population which is connected with worse access
to programs of health promotion and prevention of
cardiovascular disease. It is possible to assume that
education also has an influence in this matter because,
as an earlier analysis of these results has shown,
individuals with lower education react with a higher
level of anxiety than those with higher education and it
is commonly known that most of the rural residents
have primary or vocational education. Following this
logic, it is possible to refer to studies by Antonina
Ostrowska concerning the influence of the mechanisms
of social determinants on health behavior, which show
that individuals living in larger cities pay more
attention to their health and life style [5].
42
A Comparison of the level of anxiety in patients
hospitalized repeatedly and patients who are in the
hospital for the first time shows that patients
hospitalized for the first time, especially women,
experience higher levels of anxiety than patients
repeatedly hospitalized. When considering this issue
based on the theoretical grounds of the matter it can be
assumed that, for patients who experience their first
contact with hospital, it is a new situation which
requires an additional adaptation effort. Individuals
who are in hospital for the first time frequently suffer
from insomnia, increased tension and anxiety and are
often surprised and terrified. Anxiety and depression
are natural reactions of patients who have experienced
an attack, especially when it is their first experience of
a life-threatening situation that requires assistance from
others. This situation is especially difficult for
individuals who valued their independence and relied
on themselves [6].
It seems therefore important to take into account,
both the theoretical aspects and the results obtained
when dealing with patients who have been hospitalized
for the first time.
Special attention should be paid to the results which
indicate that individuals who suffer from acute
coronary disease and possess information about their
illness have a statistically significant lower level of
anxiety. Research results indicating that lack of
information increases the level of anxiety more in male
patients than in female patients, were also of
significance for this study. Many authors dealing with
psychological problems of post heart attack patients
draw attention to how big an impact on the process of
recovery well-provided information about the disease
has. According to Braunwald emphasis should be
placed on the patients’ awareness of their illness while
still in hospital. According to the author, the patient
should be informed about the nature of ischemic heart
disease and how to behave after leaving hospital [7].
The results obtained during the study show that
awareness of life style and proper health behavior in a
statistically significant way lowers the level of anxiety,
especially in male patients. Educating patients in order
to motivate them to introduce changes to their current
system of values and life style not only leads to the
reduction of fear and anxiety, but also facilitates the
patients’ self-treatment after leaving hospital [8].
Both the presented study and the studies of many
other authors were carried out not only for theoretical
reasons but also for practical ones. Acute coronary
syndromes are in fact one of the most common causes
of hospital admissions in the industrialized countries,
but also in Poland constitute a serious health problem.
Despite the long tradition of research into the
psychological factors which are significant in ischemic
heart disease, still thousands of patients are deprived of
professional help in dealing with life after having a
heart attack. Multi-dimensional actions, which would
increase the effectiveness of treatment and help in the
process of recovery and the broadly understood
psychosocial rehabilitation of acute coronary syndrome
patients, are of vital importance.
CONCLUSIONS
Summarizing the results of the study and the
considerations on the treatment of anxiety as an
emotional state that occurs among patients with acute
coronary conditions, the following conclusions can be
formulated:
1. Anxiety is one of the basic emotional
responses leading to a number of adverse
consequences that occur in patients with
acute coronary syndrome.
2. Patients hospitalized because of acute cardiac
conditions experience raised levels of
anxiety. The results show that women
experience a greater increase of fear than
men.
3. Results concerning the relationship between
socio-demographic factors and the level of
anxiety showed that education and place of
residence have a significant impact on the
level of anxiety, but there was no such
relationship with regard to age and
occupational activity.
4. Statistically significant data regarding the
impact of health on the level of anxiety was
obtained. Results showed that patients who
were hospitalized for the first time, did not
receive information about the disease and did
not know the rules of a healthy lifestyle are
characterized by the highest level of anxiety.
From the perspective of research it is
important that the correlation between health
factors and increased anxiety is at a much
greater statistically significant level among
men than among women.
5. In the care of patients treated due to acute
heart disease particular attention should be
paid to proper health education, which should
contain information about the disease and the
principles of a healthy lifestyle. These factors
significantly affect the level of anxiety as an
emotional state.
REFERENCES
1. Opolski G., Filipiak K.J., Poloński L. (red.): Acute
Coronary Syndromes. Urban & Partner, Wrocław 2003.
2. Wrześniewski K., Santorski J.: State-Trait Anxiety
Inventory. Polish adaptation of STAI, Polish
Psychological Society, Warsaw 1987.
3. Wrześniewski K.: The psychological problems of
patients with myocardial infarction. PZWL, Warsaw
1986.
4. Dzikowski W.: How to take care of your heart. Polish
Cultural Foundation, London 1991.
5. Majchrowska A.: Selected elements of sociology.
Manual for students, Publisher - Czelej, Lublin 2003.
6. Maties P.: Heart Attack Patient’s Guide,Doctor’s
Publisher PZWL, Warsaw, 2005.
7. Braunwald E., Goldman L.: Cardiology, Medical
Publisher Urban & Partner, Wrocław 2003.
8. Widomska-Czekajska T. (red.): Outpatient Cardiologic
Care. PZWL, Warsaw 1994.
Praca finansowana z grantu UMK 31/2008
Department of Pedagogy and Nursing Didactics
Nicolaus Copernicus University
Mirosława Felsmann
85- 801 Bydgoszcz
ul Techników 3
[email protected]
43
Mariusz Klimczyk
SPORT PROFILES OF 13-YEAR-OLD POLE VAULT JUMPERS
PROFILE SPORTOWE 13 LETNICH SKOCZKÓW O TYCZCE
Faculty of Physical Education, Kazimierz Wielki University in Bydgoszcz
Head: dr Mariusz Zasada
Summary
I n t r o d u c t i o n . Based upon longtime observations
backed by studies and research, it can be concluded that
achieving the best results in top-level sport competitions is
feasible when accompanied by a high level of motor
capabilities of sportsmen and a skill to utilize them
appropriately in competitions.
An ongoing improvement in a longstanding training
process of, among others, pole vault jumpers, is related to the
use of a wide array of training means and methods assignable
to the proper development of individual motor capabilities.
A well-defined profile of motor preparation of individual
sportsmen provides a basis for planning, control and
processing of training schedules.
In order to develop an optimal training plan, the
realization of which will contribute to intended progress in
a sport result, it is essential to establish a specific sport
profile for individual sportsmen who may vary in terms of
their level.
M a t e r i a l s a n d m e t h o d s . The study was
conducted from the year 2002 to 2008 on the group of 27
boys aged 13, who underwent a basic training in a pole vault
jump in the “Zawisza” Bydgoszcz and “Gwardia” Piła sports
clubs. They trained 3 times a week in their clubs. A training
unit equals 60-90 minutes. At school, the boys attended 3
hours of physical education classes weekly, and the main
objective of the PE classes was shaping general physical
fitness. For the purposes of the present study, the following
research methods and tools were utilized: testing physical
fitness, recording sport results, methods of statistical
analysis.
R e s u l t s . In the first part of the study, an analysis of
physical development of 13-year-old pole vault jumpers was
conducted. It was observed that the coefficient of variation
fluctuated significantly, i.e. from 3.6 (lower limb length,
where the mean value was 85.17 cm, the minimum 79.1 cm,
and the maximum 93 cm at standard deviation of 3.06) up to
19.47 (chest expansion at mean, minimum, maximum values
and standard deviation of 6.83 cm, 4.50 cm, 11.00 cm and
1.33 cm respectively).
The analysis of the body weight to body height ratio
showed that the value of this parameter for the competitor
with the best result in a pole vault jump (295cm /P.K./) was
1.05, whereas for the athlete whose score was the worst of all
(190 cm /M.P./), it was 0,93. The mean value of this
parameter for the jumpers under the study was 1.04.
The analysis of physical fitness of 13-year-old pole vault
jumpers proved a significant variability of variation
coefficient in individual control tests, ranging from 386 in the
second stage of a running test (between 5 and 10 metres of
the stage; a 15-metre run with a pole with the plant; a 20metre run-up) where the mean value was 0.8s, the minimum
0.75s, the maximum 0.88s, standard deviation was 0.03 up to
66.63 s in pull-ups to a fixed bar (quantity), with the mean
value of 6.07, the minimal value of 1 pull-up, whereas the
maximum was 16 pull-ups, the standard deviation being 4.05.
In the present study there was developed an example
profile of sport preparation of those competitors who
achieved the best and the worst result in a pole vault jump
(P.K. and M.P. respectively) with respect to the group mean
value (in this case these were 27 thirteen-year-old jumpers)
in individual control tests.
When comparing the results of the best athlete (P.K.)
with the mean value, it becomes emergent that this particular
sportsman outperformed the group in the majority of tests. It
should be noted that this competitor achieved his best result
in a number of pull-ups to a fixed bar (16 times), and came
third in a 15-metre running test with a pole. In turn, the
results of M.P. were in all cases below the mean group value,
46
Mariusz Klimczyk
and his worst result was in a 15-metre running test with a
pole and in feet lifting to a fixed bar (2.48 s and 2 times
respectively). These results were the worst in the study
group.
S u m m a r y . The analysis of physical development
demonstrated considerable fluctuation in the coefficient of
variation. The differences between competitors were ranging
from 3.6 (lower limb length) up to 19.47 (chest expansion).
The analysis of physical fitness confirmed even greater
differences between the athletes in a 15-metre running test
with a pole with the plant and a 20-metre run-up, where the
results ranged from 3.86 (the second stage, i.e. the distance
between the fifth and tenth metre), up to 66.63 in pull-ups to
a fixed bar (quantity).
Developing an individual sport profile for each
competitor will make it possible to demonstrate their current
sport capabilities. It also gives an opportunity to make
corrections in training plans with particular attention paid to
the “weakest points” of athletes’ sport preparation. What is
remarkable in the present study, is the reason why
a sportsman achieving the best result in a pole vault jump in
four control tests obtained lower scores than the mean value
of the group was.
Thus, an individual sport profile will make it possible,
assuring systematic control and appropriate corrections in
training plans, to manage sport development of competitors
properly and to bring their pole vault jump results to the
highest sport result attainable to them.
Streszczenie
W s t ę p . Na podstawie prowadzonych przez wiele lat
obserwacji, popartych badaniami i doświadczeniami
szkoleniowymi, stwierdzić można, że osiąganie najlepszych
wyników sportowych na zawodach najwyższej rangi jest
możliwe przy wysokim poziomie rozwoju zdolności
motorycznych sportowców i umiejętności ich wykorzystania
w okoliczności zawodów sportowych.
Nieustanne
doskonalenie
wieloletniego
procesu
treningowego, między innymi skoczków o tyczce, jest
związane z wykorzystaniem szeregu środków i metod
treningowych
przynależnych
również
właściwemu
rozwojowi poszczególnych zdolności motorycznych.
Podstawą planowania, kontroli oraz przetworzenia
planów szkolenia jest określony profil przygotowania
motorycznego poszczególnych sportowców.
W celu stworzenia optymalnego planu treningowego, by
jego realizacja przyczyniła się do zamierzonej progresji
wyniku sportowego, należy dla poszczególnych ćwiczących
reprezentujących określony poziom sportowy wytyczyć
konkretny profil sportowy.
M a t e r i a ł i m e t o d y . Badania prowadzono
w latach 2002-2008. Objęto nimi 27 chłopców w wieku 13
lat uprawiających skok o tyczce w klubie sportowym
„Zawisza” Bydgoszcz i „Gwardia” Piła, na etapie szkolenia
podstawowego. Ćwiczący 3 razy w tygodniu uczęszczali na
zajęcia treningowe w klubie. Jednostka treningowa wynosi
60-90 min. W szkole realizowali program wychowania
fizycznego w wymiarze 3 lub godzin lekcyjnych tygodniowo,
z akcentem na kształtowanie ogólnej sprawności fizycznej.
W pracy posłużono się następującymi metodami i narzędziami badań: ocena rozwoju fizycznego: testowanie
sprawności fizycznej, rejestracja wyników sportowych,
metody statystycznego opracowania.
W y n i k i b a d a ń . W pierwszej części badań
przeprowadzona została analiza rozwoju fizycznego 13letnich tyczkarzy, gdzie zauważyć można znaczne wahania
współczynnika zmienności od 3,6, (długość kończyny dolnej,
gdzie wartość średnia wyniosła 85,17 cm, minimalna 79,1
cm, a maksymalna 93 cm przy odchyleniu standardowym
3,06) do 19,47 (rozmach klatki piersiowej przy wartości
średniej,
minimalnej,
maksymalnej
i
odchyleniu
standardowym wynoszącym odpowiednio 6,83 cm, 4,50 cm,
11,00 cm i 1,33).
Przeprowadzona analiza stosunku masy ciała do jego
wysokości wykazała, że wartość tego wskaźnika
u zawodnika posiadającego najlepszy wynik w skoku
o tyczce (295 cm /P.K./) wyniosła 1,05, a u sportowca
z najsłabszym rezultatem (190cm /M.P./) 0,93. Średnia
wartość tego wskaźnika u badanych sportowców to 1,04
Analiza poziomu sprawności fizycznej, której zostali
poddani 13 letni zawodnicy uprawiający skok o tyczce
dowiodła bardzo duże zróżnicowanie współczynnika
zmienności w poszczególnych próbach kontrolnych od 3,86
w próbie na drugim odcinku pomiędzy 5-10 m (biegu na 15
m z tyczką z założeniem z 20 m nabiegu), gdzie wartość
średnia wyniosła 0,8 s, minimalna 0,75 s, maksymalna 0,88s,
a odchylenie standardowe 0,03 do 66,63 w podciąganiu na
drążku (ilość), przy średniej wynoszącej 6,07, wartości
minimalnej wynoszącej 1 podciągnięcie na drążku, natomiast
maksymalnie jeden z zawodników podciągnął się na drążku
16 razy, odchylenie standardowe w tej próbie wyniosło 4,05.
W pracy opracowano przykładowy profil sportowego
przygotowania zawodników, którzy uzyskali najlepszy
i najsłabszy wynik w skoku o tyczce (odpowiednio P.K.;
M.P.) do średniej grupy (w tym przypadku 27
trzynastoletnich tyczkarzy) w poszczególnych próbach
kontrolnych.
Analiza wyników badań, jeśli porównamy efekty
zawodnika, który uzyskał najlepszy rezultat w skoku o tyczce
(P.K.), ze średnią wykazała, że sportowiec ten w zdecydowanej większości prób przewyższał osiągniętymi przez
siebie wynikami średnią grupy. Przy czym, indywidualnie
najlepszy wynik uzyskał w próbie polegającej na jak
największej liczbie podciągnięć na drążku (16 razy), trzeci
w próbie biegowej na 15 m z tyczką. Z kolei wyniki
wszystkich prób M.P. plasują się poniżej średniej, gdzie
wyraźnie najsłabszy wynik sportowiec ten uzyskał w biegu
na 15 m z tyczką i w próbie unoszenia stóp do drążka
(odpowiednio: 2,48 s i 2 razy) (są to najgorsze rezultaty
w badanej grupie).
P o d s u m o w a n i e . Analiza rozwoju fizycznego
wykazała znaczne wahanie współczynnika zmienności.
Sport profiles of 13-year-old pole vault jumpers
Różnice międzyosobnicze mieszczą się w granicy pomiędzy
3,6 (długości kończyny dolnej) do 19,47 (rozmach klatki
piersiowej). Natomiast analiza poziomu sprawności fizycznej
dowiodła istnienia jeszcze większych różnic międzyosobniczych od 3,86 w próbie na drugim odcinku pomiędzy 5 m10 m (biegu na 15 m z tyczką, z założeniem z 20 m nabiegu),
do 66,63 w podciąganiu na drążku (liczba).
Opracowanie indywidualnego profilu sportowego dla
poszczególnych ćwiczących umożliwia wykazanie ich
aktualnych możliwości sportowego przygotowania, daje
sposobność naniesienia korekt w planach treningowych, ze
zwróceniem szczególnej uwagi na „słabsze strony”
47
przygotowania sportowego zawodników. W przypadku
omawianym w pracy ciekawe jest to, dlaczego sportowiec
osiągający najlepszy wynik sportowy w skoku o tyczce
uzyskuje w czterech próbach kontrolnych wyniki słabsze od
średniej grupy.
Takie opracowanie indywidualnego profilu sportowego
umożliwi, przy systematycznej kontroli i odpowiednich
korektach w planach treningowych, właściwie kierowanie
rozwojem sportowym zawodników i doprowadzenie ich
wyniku w skoku o tyczce do najwyższego możliwego do
uzyskania przez nich sportowego poziomu.
Key words: somatic build, pole vault, training
Słowa kluczowe: rozwój fizyczny, sprawność fizyczna, indywidualny profil sportowy
INTRODUCTION
RESEARCH MATERIAL
Based upon longtime observations backed with
studies and research, it can be concluded that achieving
the best results in top-level sport competitions is
feasible when accompanied by a high level of motor
capabilities of sportsmen and a skill to utilize them
appropriately in competitions (1, 2 and others).
Extremely high records established in pole vault
have motivated coaches to seek reserves in a training
process. Moreover, the process of training planning
should be dependent on the most advanced
technologies, exercise machines and simulators
available that foster the optimization of training tasks
and their effects from early stages of a training (2, 3,4).
An ongoing improvement in a longstanding
training process of, among others, pole vault jumpers,
is related with the use of a wide array of training means
and methods assignable to a proper development of
individual motor capabilities (5, 6, 7, 8, 9 and 10).
The basis for the planning, control and processing
of training plans is a well-defined profile of motor
preparation of individual sportsmen (2).
In order to establish an optimal training plan, the
realization of which will contribute to the progress in a
sport result, it is essential to draw up a specific sport
profile for individual sportsmen who may vary in terms
of their level (2, 8, and 11).
The objective of the study was to develop
individual profiles of sport preparation of 13-year-old
pole vault jumpers.
The study was conducted from the year 2002 to
2008 in the group of 27 boys aged 13, who underwent
a basic training in a pole vault jump in the “Zawisza”
Bydgoszcz and “Gwardia” Piła sports clubs. They
trained 3 times a week in their clubs. A training unit
equals 60-90 minutes. At school, the boys attended 3
hours of Physical Education classes, where the main
objective was shaping general physical fitness.
RESEARCH METHODS
In the present study the following research methods
and tools were utilized:
• assessing physical development,
• testing physical fitness,
• recording sport results,
• methods of statistical analysis.
THE ASSESSMENT OF PHYSICAL
DEVELOPMENT
In order to assess physical development, the
measurements of such somatic traits as length, width,
circumference and weight were taken.
1) body height (basis-vertex),
2) body weight,
3) torso length (suprasternale-symphysiom),
4) lower limb length (basis-symphysion),
5) upper limb length (acromion-daktylion III),
6) shoulder width (acromion-acromion),
7) pelvis width (iliocristale-iriocristale),
8) thigh circumference,
9) lower limb circumference,
Mariusz Klimczyk
48
10)
11)
12)
13)
shoulder circumference,
chest circumference at inhalation,
chest circumference at exhalation,
chest expansion (volume difference in chest at
inhalation and exhalation)
The Rohrer’s index of somatic build was calculated
based on the ratio of body weight to body height.
body weight (g) x 100
------------------------------body height (cm) 3
The measurements were taken using a large sliding
caliper, medical scales and metric tape.
CONTROL OF PHYSICAL FITNESS
7. Feet lifting to a fixed bar with arms straight.
8. Rope climbing (3-meter long rope).
9. Pull-ups using a fixed bar.
10. Pole vault (cm).
The athletes were given precise instructions prior to
the above tests. A 15-minute warm-up preceding the
test was conducted by a coach.
METHODS OF STATISTICAL ANALYSIS
The study results were processed statistically by
calculating arithmetic averages, standard deviation,
minimum and maximum value of a set, and the
differentiation within the group was evaluated on the
basis of the coefficient of variation (V).
In order to develop fitness tests that would
comprehensively evaluate jumpers’ physical fitness at
the training stage under the study, a comparison with
STUDY RESULTS AND DISCUSSION
other disciplines was utilized. Namely, a jumper can be
compared to a sprinter (at a run-up stage), a long jump
The first stage of the present research was devoted
athlete or a triple jumper (the ”step” phase), an athlete
to the analysis of physical development of 13-year-old
doing a forward roll to a handstand (in one of the
pole vault jumpers, where significant fluctuations in
phases of a jump), and finally to an acrobat
the coefficient of variation were noted, i.e. from 3.6
(performing complex evolutions while jumping over a
(lower limb length, where the mean value was 85.17
bar) (12, 13). The International Fitness Test developed
cm, minimum 79.1 cm, and maximum 93 cm at
by the International Committee on the Standardization
standard deviation of 3.06) up to 19.47 (mean,
of Physical Fitness Tests was also used.
minimum, maximum value of chest expansion and
The following parameters were recorded:
standard deviation were 6.83cm, 4.50 cm, 11.00 cm
1. A 15-metre run with a 20-metre run-up
and 1.33 respectively) (See Table I). The remaining
2. A 15-metre run with a 20-metre run-up with a
parameters under the study are shown in the Table I.
pole
Table I. Results of physical development tests of 13-year-old pole vault
3. A 15-metre run with a pole
jumpers (n-27)
with a 20-metre run-up the
last 15 metres split into three
Parameters
Statistic values
It.
under the study
5-metre stages (with light
M
min
max
SD
V
1 body height
sensors located at each stage);
(cm)
159.87
149
178
6.22
3.89
the time was recorded for
2 body
weight (kg)
42.32
32.1
71
7.16
16.91
each stage separately and for
3 shoulder girdle
all of them
width (cm)
35.59
29.4
40.3
2.56
7.2
4 pelvic girdle
4. A standing long jump: the
width (cm)
23.97
21.5
28.5
1.53
6.4
5 lower limb
jumper stands at a line and
length (cm)
85.17
79.1
93
3.06
3.6
then takes off and lands using
6 upper limb
length (cm)
70.34
65.3
79.1
3.37
4.79
both feet.
7 thigh
5. A long jump with a 35-metre
circumference (cm)
43.64
36.5
52.5
2.96
6.77
8 lower leg
run-up: 20 meters of approach
circumference (cm)
31.42
25
41.2
3.14
9.99
9 shoulder
run, the last 15 meters of
circumference (cm)
22.1
17.5
28.5
1.87
8.46
maintaining
rhythm
and
10 chest circumference
at inhalation (cm)
79.54
70.5
94
4.56
5.74
entering the jump.
11 chest circumference
6. An approach run to a long
at exhalation (cm)
72.7
65
88
4.18
5.75
12 chest
jump.
expansion (cm)
6.83
4.5
11
1.33
19.47
13 torso
length (cm)
44.71
40
47.6
2.11
4.71
Sport profiles of 13-year-old pole vault jumpers
The analysis of the body weight to the body height
ratio revealed that the value of this parameter for the
athlete who achieved the best results in a pole vault
jump (295cm /P.K./) was 1.05, whereas for the weakest
athlete (190cm /M.P./) it was 0.93. The mean value of
this parameter in the subjects was 1.04 (Table II).
Table II. Index of body build per Rohrer of 13-year-old pole
vault jumpers (n-27) and of the best and the worst
pole vault jump result (P.K., M.P)
Subject
P.K
M.P.
M (mean) (n-27)
Rohrer
index
1.05
0.93
1.04
The main objective of the study was to develop an
individual profile of sport preparation of 13-year-old
pole vault jumpers. In order to accomplish that, the
results of control tests conducted for individual athletes
were contrasted with the mean result of the group. An
example profile of sport preparation for the best and
worst sportsman (P.K.; M.P. respectively) was
developed in the present paper and contrasted with the
group mean value (including 27 thirteen-year-old
jumpers) in respective control tests.
pole vault
jump result (cm)
295
190
233.89
x
The analysis of physical development level, to
which 13-year-old pole vault jumpers were subjected,
indicated considerable fluctuation in the coefficient of
variation in individual control tests from 3.86 in the
test of a second stage between the fifth and tenth metre
(a 15-metre run with a pole with the plant and a 20metre run-up), where the mean value was 0.8 s,
minimum 0.75 s, maximum 0.88s, and standard
deviation was 0.03, up to 66.63 in pull-ups to a fixed
bar (quantity), with the mean value of 6.07, the
minimum value being 1 pull up, whereas the maximum
value for one competitor was 16 pull-ups, and the
standard deviation in this test was 4.05 (Table III).
1
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Parameters
under
analysis
1 15-metre run
with a 20-metre run-up (s)
2 15-metre run with a pole
with a 20-metre run-up (s)
3 15-metre run with a pole
with the plant and 20m run-up(s)
P.K.: 295cm; (
statistic values
M
min
max
SD
V
2.13
1.94
2.3
0.1
4.52
2.28
1.98
2.48
0.12
5.33
2.43
2.25
2.67
0.1
4.19
0.79
0.72
0.85
0.03
3.99
0.8
0.75
0.88
0.03
3.86
0.84
0.76
0.94
0.04
5.35
216.74
195
265
15.8
7.29
447.07
394
555
31.34
7.01
2.21
1.98
2.42
0.1
4.67
6
2
12
2.39
39.76
12.34
6.51
17.2
2.88
23.32
6.07
1
16
4.05
66.63
233.89
190
295
24.86
10.63
5 5m - 10m (s)
6 10m - 15m(s)
10 feet lifting to a bar
(qty)
11 rope climbing (s)
3-metre rope
12 pull-ups to a fixed bar
(qty)
13 pole vault jump result (cm)
3
4
5
6
7
8
9
10
11
12
13
): M.P.; 190cm (
)
Fig. 1. The profile of an individual sport preparation of 13year-old jumpers who scored the best and the worst
result in a pole vault jump: P.K. – 295cm and M.P. –
190cm
4 0 - 5m(s)
7 standing long jump
(cm)
8 long jump
(cm)
9 run-up to a long jump (s)
2
15-metre run with a 20-metre run-up(s),
15-metre run with a pole with a 20-metre run-up (s),
15-metre run with a pole and the plant and 20-metre run-up (s),
0 - 5m (s),
5m - 10m (s),
10m - 15m (s),
standing long jump (cm),
long jump (cm),
run-up to a long jump (s),
feet lifting to a fixed bar (qty),
3-metre rope climbing (s),
pull-ups to a fixed bar (qty)
pole vault jump result (cm).
Table III. Level of physical fitness of 13-year-old jumpers (n-27)
It.
49
When comparing the results of
a competitor with the best result
in a jump (P.K.) with the mean
value, it is apparent that this
particular
sportsman
outperformed the group mean
value. It should be noted that this
competitor achieved his best
result in pull-ups to a fixed bar
(16 times), and came third in a 15metre running test with a pole. It
is curious that this athlete’s result
was the fourth below the group
mean result (See Figure 1).
Whereas , the results of M.P. were
in all cases below the mean value,
and the worst result was obtained
in a 15-metre running test with a
pole and in feet lifting to a fixed
bar (2.48 s and 2 times
respectively). These results were
the worst in the study group.
50
Mariusz Klimczyk
SUMMARY
The analysis of physical development revealed
considerable fluctuation of the coefficient of variation.
The differences between the subjects were all between
3.6 (lower limb length) up to 19.47 (chest expansion).
Moreover, the analysis of the level of physical
development proved even greater differences ranging
from 3.86 in the second stage between the fifth and
tenth metre (a 15-metre run with the plant and 20metre run-up), up to 66.63 in pull-ups to a fixed bar
(quantity).
Establishing an individual sport profile for each
competitor will make it possible to demonstrate their
current sport capabilities. It also gives an opportunity
to introduce corrections into training plans with
particular attention paid to the “weakest points” of
competitors’ sport preparation. What is remarkable in
the study in question, is the reason why the athlete
achieving the best result in a pole vault jump in four
control tests obtained lower scores than the mean value
for the group. The coach’s role in this case is to direct
the preparation process so that this athlete improves the
result significantly (especially in a run with a pole with
the plant, where it is crucial to hold the pole at the right
angle to the ground, to master the running technique
and dropping the pole tip into the box /the latter phase
poses serious difficulties especially to beginner
jumpers/).
The development of an individual sport profile will
make it possible, providing systematic control and
corrections in training plans are maintained, to direct
the sport development of athletes properly and to bring
their pole vault result to the highest level attainable to
them.
REFERENCES
1. Kochanowicz K.: Kompleksowa kontrola w gimnastyce
sportowej. AWF, Gdańsk 1998.
2. Kochanowicz K.: Podstawy kierowania procesem
szkolenia sportowego w gimnastyce. AWFiS, Gdańsk
2006.
3. Napierała M., Cieślicka M., Muszkieta R., Szark M.,
Klimczyk M., Żukow W., Swimming endurance of 10 –
13-year old children determined by the Cooper test in
water, [w]: Current challenges of tourism and recreation
to the health. Physiotherapeutic aspects in the prevention
and treatment of diseases in marine tourism, (red.)
Kwaśnik Z., Żukow W., Muszkieta R., Napierała M.,
Radom College in Radom, Radom 2009, s. 58 - 69.
4. Sozanski
H. (red.): Podstawy
teorii Treningu
sportowego. AWF, Warszawa 1999.
5. Prusik K.: Podstawy indywidualizacji treningu
sportowego biegaczy na orientację. AWFiS, Gdańsk
2003.
6. Harre D. (1985): Trainingslehre. Sportverlag. Berlin
1985, s. 279.
7. Naglak Z.: Metodyka trenowania sportowca. AWF
Wrocław 1991.
8. Płatonow W. N.: Obszczaja tieorija podgotowki
sportsmienow w olimpijskom sportie. Olimpijskaja
Literatura, Kijew 1997.
9. Shephard R.J., Astrond P.O.: Endurance in sport.
Blackwell Scientific Publikations 1992.
10. Zasada M.: Przygotowanie fizyczne specjalne
gimnastyków w procesie treningu sportowego.
Wydawnictwo Uniwersytetu Kazimierza Wielkiego,
Bydgoszcz 2008.
11. Kruczalak E.: Biegi krótkie. W: Lekkoatletyka, biegi
pod red. Z. Mroczyńskiego. AWF, Gdańsk 1997, s. 5254.
12. Klimczyk M.: Kierowanie i kontrola szkolenia sportowego tyczkarzy na etapach wstępnym i podstawowym.
Wydawnictwo Uniwersytetu Kazimierza Wielkiego,
Bydgoszcz 2008.
13. Zaglaniczny J.: Technika i metodyka nauczania skoku
o tyczce. W: Lekkoatletyka, skoki, rzuty, wieloboje pod
red. Z. Mroczyńskiego. AWF, Gdańsk 1995, s. 667-691.
Faculty of Physical Education
Kazimierz Wielki University in Bydgoszcz
kierownik: dr Mariusz Zasada
ul. Sportowa 2
85-091 Bydgoszcz
tel,/fax. 663089733 (052} 37 67 910
Monika Wiłkość1,2, Beata Augustyńska1, Aleksander Araszkiewicz1, Kinga Sobieralska-Michalak3,
Anna Dudzic-Koc1, Piotr Bijakowski1
COGNITIVE FUNCTIONS IN ALCOHOL DEPENDENT PATIENTS.
A DESCRIPTION OF A NEW COGNITIVE BATTERY – QMT (Quick Mind Testing)
FUNKCJE POZNAWCZE U PACJENTÓW UZALEŻNIONYCH OD ALKOHOLU.
OPIS NOWEJ BATERII TESTÓW POZNAWCZYCH – QMT (Quick Mind Testing)
1
Psychiatry Department, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz
Department of Individual Differences Psychology, Institute of Psychology, Kazimierz Wielki University
in Bydgoszcz
3
Department of Clinical Psychology, University of Nicolaus Copernicus in Toruń
2
Summary
Numerous studies have investigated the effects of alcohol
consumption on cognitive processes. It was suggested that
continued substance involvement in adolescence leads to
greater neurocognitive difficulties, nevertheless cognitive
deficits may also be a risk factor for the development of drug
and alcohol dependence. Chronic use of alcohol has been
consistently associated with cognitive impairments including
attention mechanisms, information processing, visual spatial perception, working memory, problem solving and
decision making. In order to address cognitive domains
which are reported to be vulnerable to the alcohol abuse we
constructed the computerized cognitive battery QMT – Quick
Mind Testing. The battery consists of six tests. The study
included 16 male patients hospitalized at the Psychiatric
Clinic of the University Hospital No 1 in Bydgoszcz with an
alcohol dependency diagnosis and 16 healthy males.
Conclusions: 1. The alcohol dependent patients performed
worse in the following parameters of QMT: mean reaction
time for incorrect reactions (Test 2), mean reaction time for
correct target reactions (Test 4), reaction time in subliminal
priming task (Test 5) and number of correct responses in part
2 and 3 of Test 3. 2. It may be concluded that reaction time is
the most vulnerable cognitive parameter in alcohol dependent
patients. 3. The QMT is a quick, precise and effective
computerized method to measure reaction time, attention and
subliminal processing. 4. Our study was preliminary. The
results obtained should be confirmed in a larger cohort.
Streszczenie
Liczne badania wykazały wpływ nadużywania alkoholu
na funkcje poznawcze. Wskazuje się, iż długotrwałe
spożywanie alkoholu w okresie adolescencji prowadzi do
deficytów kognitywnych, jednocześnie deficyty poznawcze
mogą być czynnikiem ryzyka wystąpienia uzależnień od
substancji psychaktywnych. Chroniczne nadużywanie
alkoholu związane jest z wystąpieniem zaburzeń funkcji
poznawczych, tj.: funkcji uwagi, przetwarzania informacji,
percepcji wzrokowo-przestrzennej, pamięci operacyjnej,
rozwiązywania problemów oraz podejmowania decyzji.
Komputerowa bateria testów poznawczych QMT – Quick
Mind Testing jest propozycją narzędzia, które umożliwia
diagnozę tych obszarów poznawczych, które wskazano jako
szczególnie podatne na wystąpienie zaburzeń u osób
uzależnionych od alkoholu. Bateria składa się z sześciu
testów. Badanie przeprowadzone zostało u 16 mężczyzn
hospitalizowanych w Katedrze i Klinice Psychiatrii UMK, w
Szpitalu Uniwersyteckim nr 1 w Bydgoszczy z rozpoznaniem
uzależnienia od alkoholu oraz u 16 zdrowych mężczyzn z
grupy kontrolnej. Osoby uzależnione od alkoholu uzyskały
gorsze wyniki w zakresie: średniego czasu reakcji dla
odpowiedzi niepoprawnych (Test2), średniego czasu reakcji
52
Monika Wiłkość et al.
dla poprawnych reakcji targetowych (Test 4), czasu reakcji
w prymowaniu podprogowym (Test 5) oraz liczby
odpowiedzi poprawnych w części 2 i 3 Testu 3
w porównaniu z grupą kontrolną. Uzyskane wyniki sugerują,
iż czas reakcji jest najbardziej podatnym na zaburzenia
parametrem kognitywnym u pacjentów uzależnionych od
alkoholu. Bateria QMT wydaje się szybkim, precyzyjnym
i efektywnym narzędziem do komputerowego pomiaru czasu
reakcji, uwagi i podprogowego przetwarzania informacji.
Badanie to miało charakter wstępny, a wyniki powinny
zostać potwierdzone na wiekszej grupie badawczej.
Key words: cognitive functions, alcohol dependence
Słowa kluczowe: funkcje poznawcze, uzależnienie od alkoholu
Numerous studies have investigated the effects of
alcohol consumption on cognitive processes. A
longitudinal study by Tapert and Brown (1) suggested
that continued substance involvement in adolescence
leads
to
greater
neurocognitive
difficulties,
nevertheless cognitive deficits may also be a risk factor
for the development of drug and alcohol dependence.
Chronic use of alcohol has been consistently associated
with cognitive impairments including attention
mechanisms, information processing, visual - spatial
perception, working memory, problem solving and
decision making (2, 3, 4).
It was demonstrated that simple reaction time (RT)
and complex RT are also impaired in alcohol
dependent patients, leading to slowing of one's
response to simple stimuli (5, 6). Researches on the
effect of alcohol on simple RT have concluded that
even a low dose of alcohol can impair performance (7,
8, 9). In the study on attention mechanism Maylor et al.
(10), using a visual-tracking task, found that speed of
detection was impaired by alcohol. A measurement of
total information processing by reaction time, vigilance
and attention tasks showed greater impairment in dualtask conditions compared to single-task conditions.
Generally, results suggest that, when demands are
higher, such as in dual - task conditions, the deficits in
performance due to alcohol become more significant.
Such results have been described as the deleterious
effects of alcohol on central processing capacity over
time (10, 11). Bartl et al. (12) found three times more
errors in a concentration task, two times more errors in
RT tasks and two times more in a visual structuring
task due to alcohol, compared to performance in a
placebo (no alcohol) condition. Similarly, Maylor et al.
(10) found that errors increased with task complexity
in RT tasks. The results of Zinn et al. (13) have showed
the greatest impairment in timed motor tasks with
visual perception elements and memory demands. On
the other hand it was suggested that information
processing could be impaired at the same time when
motor functions are facilitated, hence, false alarms and
errors occur as premature reactions (6). Individuals
with alcohol dependency are characterized by both
attention bias and prepotent response inhibition deficit.
Noel et al. (3) assumed that presenting alcohol-related
information to be suppressed in a go/no-go task to the
participants addicted to alcohol, would exhibit greater
cognitive disinhibition. In order to verify the
hypothesis, author examined a group of forty recently
detoxified individuals and healthy controls. The task
required a motor response to the targets and no
response to distractors. The results showed that the
group of alcohol dependents made significantly more
commission errors (reaction go when a distractor
displayed) and more omission errors (inhibited reaction
no go when a target displayed) compared to controls.
The results of many researches confirm that
information does not have to be consciously perceived
to initiate motor reaction according to the intention of
the participant. The results also indicate that motor
reaction can be initiated before the stimulus, which to
be responded, becomes part of the conscious
perception (14, 15, 16).
Subliminal priming is a technique that allows
testing of the influence of subliminal information on
our behavior. This technique is based on presenting the
prime before the stimulus to be responded (target).
Prime can be a word, picture or sound and is presented
for a very short period of time (few miliseconds).
Prime can influence the reaction to the target by
facilitating it or inhibiting.
Neumann and Klotz (16) were the first to show that
subliminal information can not only influence
perception but also affect motor reaction. Usually,
when prime points to the same direction as target
(compatible trails), responses to the target are faster
and reaction times shorter and more accurate. However
when prime and target point to different directions
(incompatible trials) reaction times are longer (17, 18,
19, 20, 21, 22, 23). In this case a positive (straight)
priming effect can be observed.
Eimer and Schalghecken obtained an interesting
result (24, 25, 26, 27, 28, 29, 30). They found that in
case of compatible trials reaction times to target can be
Cognitive functions in alcohol dependent patients. A description of a new cognitive battery - QMT (Quick Mind Testing)
longer comparing to incompatible trials. This effect is
called negative or reversed.
Subliminal priming is a sensitive method which
allows to detect even small differences in processing
visual information and can be a useful tool for testing
cognitive processes. An interesting question should be
asked: are there any differences in strength and
direction of priming effect between healthy people and
alcohol dependent patients? If alcohol dependent
patients suffer from cognitive deficits, which, as a
result, may lead to problems in recognizing the
structure of the stimulus, positive priming effect should
be observed. Healthy controls should have a negative
priming effect independently of time intervals between
prime and target.
In order to check if different priming effects are
linked with difficulties in recognizing the structure of
stimulus, the additional experiment of
stimulus
degradation was performed. It should be assumed that
alcohol dependent patients need more time to complete
the test comparing to healthy controls, however, the
accuracy of responses should be high.
METHODS
In order to address cognitive domains which are
reported to be vulnerable to the alcohol abuse we
constructed the computerized cognitive battery QMT –
Quick Mind Testing. The battery consists of six tests.
Test 1. This test assesses simple reaction time. The
stimuli are visual (green star). A total of 25 stimuli are
presented to the participant who is asked to respond as
quickly as possible by pressing a spacebar after each
stimulus. The reaction time and number of correct
responses are measured.
Test 2. This test is based on go/no-go paradigm. It
assesses sustained attention and response control. The
participant is asked to respond by pressing a spacebar
while given certain stimuli (“go„ response) and inhibit
that response under a different set of stimuli (‘no-go”
response). The frequency of “go” stimuli relative to
“no-go” stimuli is 80%, which maintains a bias and
tendency to respond on every trial. The total number of
stimuli is 100 of which 75 are main targets and 25
distractors. All the stimuli are visual (4 stimuli for “go”
responses and 2 for “no-go” responses). The
presentation of a stimulus lasts 350 ms, or until
participant responds. Practice trials are given and the
participant is trained in the correct performance of the
test before formal testing is initiated. The measures
53
include the number of correct and incorrect responses,
as well as reaction times for all “go” and “no-go”
responses.
Test 3. This test measures the selective attention
and process of visual perception. The participants are
required to cross out target stimuli embedded among
distractors. The participant touches the target stimuli
directly on the touch screen, when the touch is
available. Otherwise the participants use the left mouse
button to select the target stimuli. Altogether 300
stimuli are randomly displayed on the screen - 75 of
them are targets and 225 are distractors. Test consists
of 3 parts. In each part different stimuli are presented:
numbers, letters and blue arrows, respectively. Each
part has a total time of 1 minute to complete the task.
After finishing one part, test advances to the next part
until all the parts are completed. The number of correct
and incorrect responses is measured.
Test 4. This test measures sustained attention,
cognitive inhibition and discrimination abilities. It is
based on continuous performance paradigm. Eighty
stimuli are presented to a participant. Twenty percent
of the stimuli are targets. Stimuli are presented for 200
ms each. The participant is instructed to respond with a
right key press whenever the target stimulus is
proceeded by a particular distractor stimulus. The left
key is pressed for all other stimuli, including the
particular distractor stimulus, the target stimulus that
was not preceded by the particular distractor stimulus,
or any other stimulus. Practice trials are given and the
participant is trained in the correct performance of the
test before formal testing is initiated. The number of
correct and incorrect responses and reaction times are
measured.
Test 5. This test measures the process of subliminal
priming. Double arrows pointing to the left or to the
right were used both as primes and targets. Mask
consisted of 20 randomly generated lines. A new
random mask was constructed in each trial. Prime and
mask are presented on the left and on the right from the
fixation point. A target is presented in the center of the
screen. Three SOA – Signal Onset Asynchrony (time
intervals between prime and target) are used: 80, 160,
and 240 ms. The participant is required to respond
according to the direction of the target by pressing the
right key on the keyboard. Reaction time and
percentage of correct responses are measured.
Test 6. The test measures the recognition and
processing of the structure of the visual stimulus. The
arrow-shaped dot pattern in a rectangular dotted frame
54
(64 dots) is displayed on the screen. Each arrow
consists of 15 dots pointing to the left or to the right.
Stimuli are degraded by placing 10 (medium level of
degradation) to 14 (high level of degradation) dots
from the surrounding frame of the intact stimuli to
random positions within the frame on places not
occupied by dots of the arrow. The participant is
required to respond according to the direction of the
stimulus by pressing the right key on the keyboard.
Reaction time and percentage of correct and incorrect
responses are measured.
All the tests of QMT were programmed in Java
JDK 6.
SUBJECTS
The study included 16 male patients aged 41.6 ± 12
years old hospitalized at the Psychiatric Clinic of the
University Hospital No 1 in Bydgoszcz with a
diagnosis of alcohol dependency and 16 healthy male
volunteers aged 43 ± 9 years with no history of any
psychiatric disorder, substance abuse or serious
somatic illnesses. There was no statistical difference
between mean age and years of education in both
groups. The Bioethics Committee of the Nicolaus
Copernicus University Collegium Medicum in
Bydgoszcz approved the study. Informed consent was
received from all participants after the aim and
procedure of the study had been fully explained to
them.
Also, they indicate lower number of correct
responses in part 2 and 3 of Test 3 in patients’ group
compared to control group. For statistical analysis tStudent test was performed, using SPSS 14.0.
statistical software (p<0.05).
In Test 5 of QMT reaction times and percentage of
correct responses were measured relative to the target
stimulus. The statistical analysis of the reaction time
and percentage of correct responses for patients’ and
control group was performed in ANOVAs using
within-subject factors such as Compatibility
(compatible vs incompatible) and SOA (60, 120,240).
The mean reaction times for compatible and
incompatible trials are presented separately for each
group in Figure 1 and 2.
RTs were shorter in the control group compared to
the patients’ one (412 ms vs 503), p = 0.02. RTs also
depended on SOA, the shortest reactions were for SOA
240 (445 ms) then for SOA 120 (449ms), the longest
for SOA 60 (478 ms), p < 0.001. A significant
interaction was noted between Group and SOA, p =
0.03. RTs were shorter with SOA for each group, but
only the difference between SOA 60 and SOA 120 was
significant (post hoc p=0.05). RTs were equally long
for compatible and incompatible trials, p = 0.25.
RESULTS
Table 1 below demonstrates significant differences
between patient and control groups obtained in tests 14 of QMT. These results show longer mean reaction
time for incorrect reactions in Test 2 and longer
reaction time for correct target reactions in Test 4 in
patients’ group compared to healthy controls.
Fig. 1. RTs in compatible and incompatible trials for each
SOA in control group
Table 1. Significant differences between patients and healthy
controls for tests 1-4 of QMT
Parameter
Test 2 – mean RT for
incorrect reactions (ms)
Test 3 – number of correct
responses in part 2
Test 3 – number of correct
responses in part 3
Test 4 – mean RT for correct
target reactions (ms)
Patients’
group
X ± SD
423.8 ± 110.9
Control group
X ± SD
p
336.2 ± 115.5
0.036
32.1 ± 8.9
40.2 ± 7.4
0.014
17.4 ± 4.1
22.1 ± 4.7
0.008
12.6 ± 2.3
7.1 ± 5
0.001
Fig. 2. RTs in compatible and incompatible trial for each
SOA in patients’ group
Percentage of correct responses was similar in
control and patients’ group, p = 0.64. Percentage of
correct responses in each group depended on SOA,
p=0.002. All participants obtained 70%, 72%, 75% for
SOA 240, SOA 120, SOA 60 respectively. Three - way
interaction between the factors: Group, SOA,
Compatibility was significant, p = 0,05, control group
differed from patients’ group regarding compatibility
and SOA. Post hoc comparison indicated that PC in
incompatible trials for SOA 240 was higher in the
control than patients’ group, and also PC in
incompatible and compatible trials for SOA 60 and 120
was higher in the control group than in the
experimental group for SOA 240 in incompatible trials,
(p=0.05). Mean percentage of correct responses for
compatible and incompatible trials is displayed
separately for each group
Fig. 3. PC in compatible and incompatible trial for each SOA
in control group
Fig. 4. PC in compatible and incompatible trial for each SOA
in patients’ group
The statistical analysis has not demonstrated any
differences in performance of patients and healthy
controls in Test 1 and Test 6 of QMT.
55
DISCUSSION
The results obtained demonstrated longer mean
reaction time for incorrect reactions in Test 2 in
patients’ group compared to the control group. This
effect of slower reaction in patients is also
demonstrated in Test 4. These data confirmed the
previous finding that reaction time is one of the
cognitive areas impaired by alcohol (5, 6). However, in
Test 1, which measures simple reaction time no
differences between the groups were found. It may
indicate that the effect on reaction time is greater in a
task with higher cognitive demand.
Moreover, lower number of correct responses in
part 2 and 3 of Test 3 was found in the patients’ group
compared to the control group. These results may
demonstrate deficits of visual processing, especially in
scanning the visual field.
Subliminal priming is a technique that allows to
test the influence of subliminal information (the one
below the conscious level) on our behavior. Positive or
negative effect of priming can be observed. Mask has
an active impact on direction of priming effect. We
expected positive compatibility effect in alcohol
dependent patients independently of SOA or negative
compatibility effect if time between prime and target
was long enough, due to cognitive deficits, which,
consequently, may lead to problems in recognizing the
structure of the stimulus, mask. In controls, negative
compatibility effect independent of SOA was expected.
However, we did not note differences in strength and
direction of priming effect between healthy people and
alcohol dependent patients measured by Test 5 of
QMT. The compatibility effect and interaction between
Group and Compatibility were not significant.
Discrepancies in results among particular participants
were observed. Some of them had the strong negative
and some had the strong positive compatibility effect,
so in consequence the compatibility effect was
suppressed. Probably, in order to observe these effects,
larger groups are needed. Alcohol dependent patients
needed more time to respond to the imperative
stimulus than the healthy controls. This indicates that
alcohol dependent patients might have more
difficulties with identification of an arrow direction,
which is why they needed more time to give an
answer. It confirmed the results of Maylor et al. (1990)
who found that speed of detection can be impaired by
alcohol.
56
CONCLUSIONS
1. The alcohol dependent patients performed worse in
the following parameters of QMT: mean reaction
time for incorrect reactions (Test 2), mean reaction
time for correct target reactions (Test 4), reaction
time in subliminal priming task (Test 5) and
number of correct responses in part 2 and 3 of Test
3.
2. It may be concluded that reaction time is the most
vulnerable cognitive area in alcohol dependent
patients.
3. The QMT is a quick, precise and effective
computerized method to measure reaction time,
different functions of attention and subliminal
processing.
4. Our study was preliminary. The results obtained
should be confirmed in a larger cohort.
REFERENCES
1. Tapert SF, Brown SA. Neuropsychological correlates of
adolescent substance abuse: four-year outcomes. J Int
Neuropsychol Soc. 1999;5(6):481-93.
2. Schweizer T.A., Vogel-Sprott M., Danckert J., Roy E.A.,
Skakum A., Broderick C.E. Nauropsychological profile
of acute alcohol intoxication during ascending and
descending
blood
alcohol
concentration.
Neuropsychopharmacology, 2006 Jun; 31 (6): 1301-9.
3. Noel X., Linden M., d'Acremont M., Colmant M., Hanak
C., Peic I., Verbanck P., Bechara A. (2005). Cognitive
biases toward alcohol-related words and executive
deficits in polysubstance abusers with alcoholism.
Addiction 100; 1302-1309.
4. Loeber S, Duka T, Welzel H, Nakovics H, Heinz A, Flor
H, Mann K. Impairment of cognitive abilities and
decision making after chronic use of alcohol: the impact
of
multiple
detoxifications.
Alcohol
Alcohol.
2009;44(4):372-81.
5. Lemon, J., Chesher, G., Fox, A., Greeley, J. and Nabke,
C. (1993) Investigation of the hangover effects of an
acute dose of alcohol on psychomotor performance.
Alcoholism: Clinical and Experimental Research 17,
665–668.
6. Tzambazis K., Stough C. Alcohol impairs speed of
information processing and simple and choice reaction
time and differentially impairs higher-order cognitive
abilities. Alcohol and Alcoholism 2009 44(9).
7. Gustafson, R. (1986a) Effect of moderate doses of
alcohol on simple auditory reaction time in a vigilance
setting. Perception and Motor Skills 62, 683–690.
8. Gustafson, R. (1986b) Alcohol and vigilance
performance: effect of small doses of alcohol on simple
visual reaction time. Perception and Motor Skills 62,
951–955.
9. Gustafson, R. (1986c) Alcohol and vigilance
performance: effect of small doses of alcohol on simple
auditory reaction time. Perception and Motor Skills 63,
99–102.
10. Maylor, E. A., Rabbitt, P. M., James, G. H. and Kerr, S.
A. (1990) Effects of alcohol and extended practice on
divided-attention
performance.
Perception
and
Psychophysics 48, 445–452.
11. Rohrbaugh, J. W., Stapleton, J. M., Parasuraman, R.,
Frowein, H. W., Adinoff, B., Varner, J. L., Zubovic, E.
A., Lane, E. A., Eckardt, M. J. and Linnoila, M. (1988)
Alcohol intoxication reduces visual sustained attention.
Psychophysiology 96, 442–446.
12. Bartl, G., Lager, F. and Domesle, L. (1996) Test
performance with minimal alcoholic intoxication.
Blutalkohol 33, 1–16.
13. Zinn S, Stein R, Swartzwelder HS: Executive functioning
early in abstinence from alcohol. Alcoholism: Clinical
and Experimental Research 2004; 28: 1338–1346.
14. Dehaene, S., Naccache, L., Le Clec'H, G., Koechlin, E.,
Mueller, M., Dehaene-Lambertz, G. et al. (1998).
Imaging unconscious semantic priming. Nature, 395,
597-600.
15. Klotz, W., Wolff, P. (1995). The effect of a masked
stimulus on the response to the masking stimulus.
Psychological Research 58, 92-101.
16. Neumann, O., Klotz, W. (1994). Motor responses to
nonreportable, masked stimuli: Where is the limit of
direct parameter specification? In Umilta, C. and
Moscovitch, M. (Eds.), Conscious and Unconscious
Information Processing (pp. 123-150). Cambridge, MA,
MIT Press.
17. Ansorge, U., Klotz, W. & Neumann, O. (1999). Manual
and verbal responses to completely masked
(unreportable) stimuli: Exploring some conditions for the
metacontrast dissociation. Perception 27, 1177-1189.
18. Damian, M. F. (2001). Congruity effects evoked by
subliminally presented primes: automaticity rather than
semantic priming. Journal of Experimental Psychology:
Human Perception and Performance, 27, 154-165.
19. Jaśkowski, P., Skalska, B. i Verleger, R. (2003). How the
self controls its "automatic pilot" when processing
subliminal
information.
Journal
of
Cognitive
Neuroscience, 15, 911-920.
20. Jaśkowski, P., Van der Lubbe, R. H. J., Schlotterbeck, E.
i Verleger, R. (2002). Traces left on visual selective
attention by stimuli that are not consciously identified.
Psychological Science, 13, 48-54.
21. Kiefer, M. i Spitzer, M. (2000). Time course of conscious
and unconscious semantic brain activation. NeuroReport,
11, 2401-2407.
22. Klinger, M. R., Burton, P. C. i Pitts, G. S. (2000).
Mechanisms of unconscious priming: I. Response
competition, not spreading activation. Journal of
Experimental Psychology.Learning, Memory and
Cognition, 26, 441-455.
23. Verleger, R., Jaśkowski, P., Aydemir, A., Van der Lubbe,
R. H. J. i Grön, M. (2004). Qualitative differences
between conscious and non-conscious processing? On
24.
25.
26.
27.
28.
29.
negative and positive priming effects induced by masked
arrows. Journal of Experimental Psychology: General,
133, 494-515.
Schlaghecken, F. i Eimer, M. (1997). The influence of
subliminally presented primes on response preparation.
Sprache und Kognition, 16, 166-175.
Eimer, M., Schlaghecken, F. (1998). Effects of masked
stimuli on motor activation: Behavioral and
electrophysiological evidence. Journal of Experimental
Psychology: Human Perception and Performance, 24,
1737-1747.
Schlaghecken, F. i Eimer, M. (2000). A centralperipheral asymmetry in masked priming. Perception i
Psychophysics, 62, 1367-1382.
Eimer, M. i Schlaghecken, F. (2001). Response
facilitation and inhibition in manual, vocal, and
oculomotor performance: Evidence for a modalityunspecific mechanism. Journal of Motor Behavior, 33,
16-26.
Schlaghecken, F. i Eimer, M. (2001a). Partial response
activation to masked primes is not dependent on response
readiness. Perceptual and Motor Skills, 92, 208-222.
Eimer, M. i Schlaghecken, F. (2002). Links between
conscious awareness and response inhibition: Evidence
from masked priming. Psychonomic Bulletin i Review, 9,
514-520.
57
30. Schlaghecken, F. i Eimer, M. (2002a). Motor activation
with and without inhibition: Evidence for a threshold
mechanism in motor control. Perception i Psychophysics,
64, 148-162.
Katedra Psychiatrii
UMK w Toruniu
Collegium Medicum im. L. Rydygiera
85-096 Bydgoszcz
ul. Kurpińskiego 19
tel.: (52) 585 40 39
fax: (52) 585 37 66
CASE REPORT / OPIS PRZYPADKU
Małgorzata Łukowicz, Jan Pawlikowski, Paweł Zalewski, Magdalena Weber-Zimmermann, Katarzyna
Ciechanowska, Agnieszka Pawlak
BODY WEIGHT SUPPORT DURING TREADMILL THERAPY IN PATIENTS
AFTER SCI – CASE STUDY
SYSTEM DYNAMICZNEGO ODCIĄŻENIA W TERAPII CHODU NA BIEŻNI U PACJENTA PO
URAZIE RDZENIA KRĘGOWEGO – PREZENTACJA PRZYPADKU
Chair and Department of Laser Therapy, Nicolaus Copernicus University
Head: dr n. med. Małgorzata Łukowicz
Summary
I n t r o d u c t i o n . Body weight support therapy is a
concept of rehabilitation that uses an external device to
support a percentage of a patient’s body weight allowing
them to perform a variety of therapeutic activities in an
upright position and safe environment.
Typically in
aeurological pathologies, the patient’s body weight is
supported in between 20-40% to assist in developing proper
gait patterns and improvements in cardiovascular and
muscular endurance with less physical demand. The ability to
initiate exercise early in the rehabilitation process can be of
benefit to the patient by allowing neural pathways to develop
through muscular patterning.
T h e p u r p o s e of our study was to present a case
study of a young male patient after spinal cord injury at the
level T12 who had gait therapy on a treadmill in dynamic
unweighting. He was admitted to Rehabilitation Department
5 months after the injury and he had one month training.
M a t e r i a l a n d m e t h o d s . We supported his
weight on the level of 20%, the time of therapy was
dependent on patient’s capacity, we started from 5 minutes
and stopped at 30 minutes. We used special scales for
evaluation of patient’s mobility and disability: ASIA scale,
WISCI II, TWT, spirometry, HR and others.
C o n c l u s i o n s . The main benefits of this kind of
therapy are: the increase of muscle strength of hip adductors
and quadriceps bilaterally, the increase of time without
fatigue, we did not observe any complaints from the
cardiovascular system.
Streszczenie
W s t ę p . Dynamiczne odciążenie, czyli system
odciążenia pacjenta podczas reedukacji chodu na bieżni lub
na otwartej przestrzeni (korytarz) jest systemem rehabilitacji,
w którym wykorzystuje się urządzenia do podtrzymania
masy ciała pacjenta, aby umożliwić pacjentowi
wykonywanie ćwiczeń w pozycji wyprostowanej, z dużym
poczuciem bezpieczeństwa. Ten system terapii zwiększa
możliwości funkcjonalne pacjenta z niekompletnym urazem
rdzenia kręgowego, niektórymi chorobami neurologicznymi,
po urazie czaszkowo-mózgowym. W schorzeniach typowo
neurologicznych stosuje się odciążenie w zakresie 20-40%
masy ciała, aby umożliwić wykonanie prawidłowego wzorca
chodu, poprawić wytrzymałość mięśniową oraz zmniejszyć
obciążenia krążeniowo-oddechowe. Wczesne rozpoczęcie
reedukacji chodu u pacjentów ze schorzeniami
neurologicznymi może przynieść korzyści w postaci
stymulacji szlaków nerwowych i rozwoju prawidłowych
wzorców ruchowych.
C e l e m p r a c y była wstępna ocena miesięcznej
terapii chodu na bieżni w systemie dynamicznego odciążenia
u pacjenta po urazie rdzenia kręgowego.
M a t e r i a ł i m e t o d a . Przedstawiono przypadek
pacjenta, lat 32, po urazowym uszkodzeniu rdzenia
kręgowego na poziomie Th12. Terapię rozpoczęto 5 miesięcy
60
Małgorzata Łukowicz et al.
po urazie. Stosowano odciążenie 20% i czas terapii
uzależniony od możliwości pacjenta, początkowo pacjent
tolerował sesje po 5 minut, ostatecznie, po 4 tygodniach
terapii, pacjent chodził na bieżni 30 minut dziennie. Ocena
pacjenta obejmowała badanie wg skali ASIA, WISCI, ocenę
parametrów chodu, spirometrię, badanie ciśnienia tętniczego
krwi, AS, ankietę.
W y n i k i . Pacjent wydłużył dystans chodu, wzrosła
siła mięśni przywodzicieli uda z 1 na 2 w skali Lovetta, oraz
mięśni czworogłowych uda z 1-2 do 3 w skali Lovetta.
Key words: SCI, BIODEX, body weight support, treadmill, gait
Słowa kluczowe: uraz rdzenia kręgowego, BIODEX, system dynamicznego odciążenia, trening chodu na bieżni, chód
INTRODUCTION
The annual value of spinal cord injuries oscillates
within the range from 7000 to 10000 and usually
concerns the age group of 16 to 30 year old. The
amount of accidents increases along with the
development of means of transport as well as
technology. Most patients after spinal cord injury (SCI)
still want to walk, hence the question ‘What is my
chance to walk again?’ directed to physicians,
physiotherapists, nurses appears.
Body weight support (BWS) treadmill training
presents one of the method for gait therapy. The
method is based on neurobiological principle that part
of recovery process depends on neuroplasticity as well
as specific and unspecific activity of uninjured nervous
system. The training, electrostimulation and
pharmacology contribute to the improvement of
treatment results in patients suffering from acute spine
cord injury.
Body weight support therapy applied in patients
with adynamia (muscular weakness) improves the gait
motor activity within free environment. Studies
concerning the therapy will allow to disseminate the
method as well as evolve the standards of therapeutic
management.
Most patients suffering from SCI aim to
accomplish vertical position and a gait, thus new
methods of therapy are searched for to achieve the goal
– walking. So far, there has been no effective method
of treatment that would result in spinal cord
regeneration. However, a number of the functional
therapy methods allow to take efforts to create the
same methods of compensation and influence the
plasticity of the central nervous system. The early
tilting the patient to erect position and walk therapy
influence the activation of spinal cord generator,
prevent from muscular athropy and circulatory as well
as vascular complications and also increase the general
fitness.
Many researches concerning the body weight
support therapy were conducted within last few years
among patients suffering from spinal cord and central
nervous system injuries, Parkinson’s disease and
patients after strokes, to evaluate the therapy’s
superiority in various models application. There are
questions concerning the therapy and individual
session duration, the moment of its beginning, the
velocity of a gait as well as extent of body weight
support. The functional tests, neurophysiological
examinations including EMG, PW as well as physical
efficiency test predominate in methodology. They
show the effectiveness of the method and encourage
further examinations.
Dynamic body weight support during reeducation
of walking on treadmill or open in the environment
(corridor) presents a concept of rehabilitation that uses
an external device to support patient’s body weight,
which allows to perform a variety of therapeutic
activities in an upright position and safe environment.
The body weight support increases the functional
abilities of patients suffering from incomplete spinal
cord injury. Typically used in neurological pathologies,
the patient’s body weight is supported to the extent of
20-40% to assist developing of proper gait patterns and
improving cardiovascular and muscular endurance with
less physical demand at the same time.
The physiological benefits are the following:
Symmetric body weight support of both limbs
assures the equal length of steps as well as
duration of the limb support phase, which
influences the proper biomechanics of gait and
regeneration of the proper gait patterns.
Decrease of parasympathetic activity – reduction
of muscular tone (decrease of spastic reflexes) as
well as increase of the range of movement within
joints.
Decreased load of both the circulatory and
respiratory system, which is of great importance
in case of patients with decreased efficiency, after
long-lasting lying and injuries. 40% body weight
Body weight support during treadmill therapy in patients after SCI - case study

support lessens the oxygen absorption, which
makes the long-lasting exercises possible.
The body weight support enables the therapy at a
very early stage after serious injuries, surgical
procedures within joints, spinal fracture. The
therapy allows to adjust the body weight support
to medical recommendation.
Axial traction enables the management of a
patient suffering from spinal ailments.
Medical cover in a system of body weight support
enables rehabilitation of patients suffering from
dysequlibrium and dyssynergia decreasing the
possibility of fall. Somatosensory stimulation
secures the proprioceptive feedback in body
location over the base of gait, which also releases
the correct gait patterns.
Sense of security.
The aim of this research project was to evaluate
benefits resulting from the regular gait rehabilitation
supported by treadmill ambulation training in the
BIODEX system of dynamic unweighting for patients
suffering from spinal cord injury located at the level of
Th12.
61
adjusted optimally to affect the patient in a small extent
(20% of the body mass) and to enable the economical
gait at the same time
The evaluation included examinations in
accordance with ASIA and WISCI scale, encompassed
estimation of the gait parameters, spirometry,
examination of arterial blood pressure, AS, therapy
evaluation questionnaire.
RESULTS
The initial time of therapy was 5 minutes. After
this, patient felt tired and the training was interrupted.
At first, active commitment of two therapists was
needed. The therapists were moving lower extremities
of the patient according to the rhythm of a treadmill.
The patient was equipped with orthopedic orthoses
preventing from foot drop (photo 1). After few
sessions, the patient wearing ortheses was able to move
his limbs at a rate possible for him . After 30 minutes,
there were no symptoms of physical fatigue (photo 2).
MATERIAL AND METHOD
The case of a 32-year old patient after incomplete
spinal cord injury located at the level of Th12 was
introduced. The therapy procedures were applied
within 5 months after the injury.
Criteria of application: spinal cord injury, sitting
without support, lack of contraindications for tilting the
patient to erect position, cooperation, motivation, lack
of joint contracture and periarticular ossifications.
MEP as well as ENG examination were carried out. In
MEP examination: lack of tibial muscles response –
bilateral, lack of quadriceps muscle of thigh response
at right side, response from quadriceps muscle of thigh
at the left side. Motor NCS: correct amplitudes of
motor potential as well as adequate velocity of
conductivity within tibial nerves – bilateral, minimal
amplitude of motor potential from peroneal nerve at
the right side, lack at the left side.
The patient was subjected to rehabilitation
supported by GAIT TRAINER 2 treadmill ambulation
for 5 days a week, during 4 weeks, starting from 5
minutes (for the sake of intolerance symptom) up to 30
minutes per day (without intolerance symptoms). The
intensity of BIODEX body weight support was
Photo 1. Beginning of the therapy assisted by 2 therapists
Photo 2. At the end of the therapy – independent gait with
orthopedic ortheses
62
Evaluation of the patient, according to ASIA scale,
before and after the therapy is shown in the table Ia and
Ib.
0.93 m, support time: R-60%, L-40%.. After therapy
acceptable time: 30 minutes and more, average gait
velocity: 0.55 m/s, average step length: R 0.66m, L 0.8
m, support time: R-60%, L-40%.
Table Ia. Evaluation according to ASIA scale, before therapy
Table Ib. Evaluation according to ASIA scale, after therapy
Level
Motion R
Motion L
Tactile
sensation
R/L
Algaesthesia
R/L
Level
C3
C3
C4
C4
Motion R
Motion L
Tactile
sensation
R/L
Algaesthesia
R/L
C5
5
5
2/2
2/2
C5
5
5
2/2
2/2
C6
5
5
2/2
2/2
C6
5
5
2/2
2/2
C7
5
5
2/2
2/2
C7
5
5
2/2
2/2
C8
5
5
2/2
2/2
C8
5
5
2/2
2/2
Th1
5
5
2/2
2/2
Th1
5
5
2/2
2/2
Th2
2/2
2/2
Th2
2/2
2/2
Th3
2/2
2/2
Th3
2/2
2/2
Th4
2/2
2/2
Th4
2/2
2/2
Th5
2/2
2/2
Th5
2/2
2/2
Th6
2/2
2/2
Th6
2/2
2/2
Th7
2/2
2/2
Th7
2/2
2/2
Th8
2/2
2/2
Th8
2/2
2/2
Th9
2/2
2/2
Th9
2/2
2/2
Th10
2/2
2/2
Th10
2/2
2/2
Th11
2/2
2/2
Th11
2/2
2/2
Th12
2/2
2/2
Th12
2/2
2/2
L1
2/2
1/1
L1
2/2
1/1
L2
4
4
2/2
1/1
L2
4
4
2/2
1/1
L3
1
1
1/1
1/1
L3
3
2
1/1
1/1
L4
0
0
1/1
0/0
L4
0
0
1/1
1/1
L5
0
0
1/1
0/0
L5
0
0
1/1
0/0
S1
0
0
1/1
0/0
S1
0
0
1/1
0/0
S2
1/1
0/0
S2
1/1
0/0
S3
0/0
0/0
S3
0/0
0/0
S4-5
0/0
0/0
S4-5
0/0
0/0
In accordance with Lovett scale (before therapy):
adductor muscles of hip joint: 1/5, quadriceps muscle
of thigh R and L: 1/5. The strength of adductor muscles
of hip joint increased: 2/5 as well as the strength of
quadriceps muscle of thigh (2/5) at the left side and
(3/5) at the right side. The patient reported burning
sensation at the external side of his left calf. The
patient had no sensations around this area before.
In accordance with WISCI scale, before therapy, 9
points were given (>10 metres, walker, ortheses,
without assistant), 12 after therapy (>10 metres, 2
crutches, ortheses, without assistant). The gait time has
decreased at the examined distance.
In accordance with gait parameters evaluation:
acceptable time period: 5 minutes, average gait
velocity: 0.46 m/s, average step length: R 1.01 m, L
The evaluation of circulatory and respiratory
efficiency is shown in the table IIa and IIb.
Table IIa. AS, arterial blood pressure and number of breaths
before therapy
Parameter
Heart rhythm
Arterial blood pressure (mmHg)
Number of breaths
Beginning
66
130/90
End
78
160/100
12
24
Table IIb. AS, arterial blood pressure and number of breaths
after therapy
Parameter
Heart rhythm
Arterial blood pressure (mmHg)
Number of breaths
Beginning
End
60
66
130/90
130/90
12
20
Body weight support during treadmill therapy in patients after SCI - case study
The inspiration volume of patient increased; flowvolume parameters did not reveal any significant
changes; number of breaths decreased after each
session (Table IIa).
The patient assessed the sense of security as very
good and so he assessed the results of therapy. The
patient suggested performing the therapy twice a day
and revealed willingness to cooperate.
DISCUSSION
Shepherd & Carr (1999) show three advantages of
the method (20):
1. It enables rehabilitation of the whole gait
cycle.
2. It improves the pace as well as the step
length.
3. It presents the optimal form of aerobic
exercises for patients with spinal cord
injury.
Nymark et al. (1998) confirmed that a patient
suffering from incomplete spinal cord injury reveals
effective results of this form of therapy. Gardner et al.
(1998), Wernig (1999) proved the improvement of
independent gait of a patient even after a few years
after injury. Behrman & Harkema (2000) described the
range of sensory signals needed for correct gait
reciprocal patterns of patients after SCI during
rehabilitation supported by treadmill ambulation
training:

The correct response of walking induced
by a speed of treadmill.

The maximal body weight support
applied during the standing phase.

Full extension of trunk and head.

Nearly standard kinematics of gait cycle
for hip, knee and tarsal joint.

Time synchronization of extension and
load of the extremity which adopts the
body weight with simultaneous body
weight support of the other one.

Motion of upper extremities during the
gait (thanks to the body weight support).
The present study concern the BWS system as a
profitable method of therapy in patients after spinal
cord injury [3, 7, 8] as well as after cerebral stroke [4,
5]. The best results are achieved within the first 12
months after the injury, when neuroplasticity is the
biggest.
63
Wirz, Zemmon, Rupp et al. described the pulse as
well as arterial blood pressure during the gait. The
decrease of arterial blood pressure as well as increase
of pulse occurred [19]. The improvement of gait
parameters and general fitness were noticed [10, 14,
15]. The authors underlined the importance of
therapists in the process of correct positioning of the
lower extremities as well as walking (one therapist at
each side of the body and third one to stabilize the
pelvis, if necessary). The motion evoked by therapists
is not symmetric, hence new robots for gait automation
are being constructed [1, 4, 5]. The unsymmetric
motion also limits the application of Biodex, however
if advanced devices are not available and therapists
assist carefully, it could be used as a sufficient method
of gait treatment in patients suffering from
neurological dysfunctions.
Rehabilitation of gait supported by treadmill
ambulation training contributes to the improvement of
general fitness, gait, increase of muscle force and
enables the independent shifting of lower extremities
supported by orthoses preventing from foot drop.
CONCLUSIONS
BWS therapy contributed to the extension of gait
distance as well as enabled crutches supported gait
(WISCI scale: 9-12). The strength of adductor muscles
of thigh increased from 1 to 2 according to Lovett
scale, quadriceps muscles of thigh from 1-2 to 3
according to Lovett scale. The physical efficiency
improved. The patient was satisfied with the therapy
as well as the high sense of security. Body weight
support and rehabilitation of gait simulated on
treadmill bring measurable profits to patients after
spinal cord injury.
LITERATURE
1. Behrman Andrea L., Harkema Susan J.: Locomotor
Training After Human Spinal Cord Injury: A Series of
Case Studies. Phys. Ther, Vol. 80, No. 7, July 2000, p.
688-700.
2. Barbeau H., Pepin A., Norman K.E., Ladouceur M.,
Leroux A.: Walkig After Spinal Cord Injury: Control and
Recovery. Neuroscientist, 4:14-24, 1998.
3. Hall KM, Cohen ME, Wright J, Call M, Werner P.:
Characteristics of the Functional Independence Measure
in traumatic spinal cord injury. Arch Phys Med Rehabil.
1999 Nov;80(11):1471-6.
64
4. Herterich B, Steube D, Buhner M.: Treadmill therapy in
patients after ischaemic stroke. Rehabilitation (Stuttg).
2004,Jun;43(3):137-41.
5. Inácio Teixeira da Cunha Filho, PT, PhD; Peter A.C.
Lim, MD; Huma Qureshy, PT, MS; Helene Henson, MD;
Trilok Monga, MD; Elizabeth J. Protas, PT, PhD: A
comparison of regular rehabilitation and regular
rehabilitation with supported treadmill ambulation
training for acute stroke patients. Journal of
Rehabilitation Research and Development.Vol. 38 No. 2,
March/April 2001.
6. Macko RF, DeSouza CA, Tretter LD, Silver KH, Smith
GV, Anderson PA, Tomoyasu N, Gorman P, Dengel
DR.: Treadmill aerobic exercise training reduces the
energy expenditure and cardiovascular demands of
hemiparetic gait in chronic stroke patients. A preliminary
report. Stroke. 1997 Feb;28(2):326-30.
7. Marino RJ., Goin JE, Development of a short-form
Quadriplegia Index od Function Scale. Spinal Cord,
1999, 37: 289-296.
8. Melis EH, Torres-Moreno R, Barbeau H, Lemaire ED,
Analysis of assisted –gait characteristics in persons with
incomplete spinal cord injury. Spinal Cord, 1999, 37:
430-439.
9. Middleton JW, Harvey LA, Batty J, Cameron I, Quirk R,
Winstanley J., Five additional mobility and locomotor
items to improve responsiveness of the FIM in
wheelchair-dependent individuals with spinal cord injury.
Spinal Cord. 2006, Aug;44(8):495-504. Epub 2005 Dec
6.
10. Middleton JW, Truman G, Geraghty TJ., Neurological
level effect on the discharge functional status of spinal
cord injured persons after rehabilitation. Arch Phys Med
Rehabil. 1998 Nov;79(11):1428-32.
11. Morganti B , Scivoletto G , Ditunno P , Ditunno J F and
Molinari M , Walking index for spinal cord injury
(WISCI): criterion validation. Spinal Cord (2005) 43, 27–
33.
12. Ota T, Akaboshi K, Nagata M, Sonoda S, Domen K, Seki
M, Chino N., Functional assessment of patients with
spinal cord injury: measured by the motor score and the
Functional Independence Measure. Spinal Cord. 1996
Sep;34(9):531-5.
13. Pinter MM, Dimitrijevic MR, Gait after spinal cord
injury and the central pattern generator for locomotion.
Spinal Cosd, 1999, 37, 531-537.
14. Sawicki Gregory S., Domingo Antoinette, Ferris Daniel
P., The effects of powered ankle-foot orthoses on joint
kinematics and muscle activation during walking in
individuals with incomplete spinal cord injury. J
Neuroengineering Rehabil. 2006; 3: 3.
15. Stinear James W., Hornby T George, Stimulationinduced changes in lower limb corticomotor excitability
during treadmill walking in humans. J Physiol. 2005
September 1; 567(Pt 2): 701–711.
16. Subbaru Jay V., Walking After Spinal Cord Injury Goal
or Wish? West.J.Med 1991, May, 154: 612-614.
17. Visintin M., Barbeau H., Korner-Bitensky N., Mayo
N.E., A New Approch to Retain Gait in Stroke Patients
Through Body Weight Support and Treadmill
Stimulation. Stroke, 1998, 9:1122-1128.
18. Werner C, Von Frankenberg S, Treig T, Konrad M,
Hesse S. Treadmill training with partial body weight
support and an electromechanical gait trainer for
restoration of gait in subacute stroke patients: a
randomized crossover study. Stroke. 2002 Dec;
33(12):2895-901.
19. Wirz M., Zemon D.H., Rupp Ruediger, Scheel A.,
Colombo G., Dietz V., Hornby G, Effectiveness of
Automated Locomotor Training in Patients With Chronic
Incomplete Spinal Cord Injury: A Multicentral Trial.
Archiv of Phys.Med.and Rehab, 2005, 86: 672-80.
20. Haas BM, Jones F. Physical activity and exercise in
neurological rehabilitation. Stokes M. Physical
Management in Neurological Rehabilitation. Elservier
Mosby. Edinburgh, London, New York, Oxford,
Phyladelp
Uniwersytet Mikołaja Kopernika w Toruniu
Collegium Medicum im. Ludwika Rydygiera
w Bydgoszczy
Katedra i Zakład Laseroterapii i Fizjoterapii
ul. Marii Skłodowskiej-Curie 9
85-094 Bydgoszcz
tel.:. +48 52 5853485
Regulamin ogłaszania prac w Medical and Biological Sciences
1.
2.
3.
4.
5.
6.
7.
8.
9.
Redakcja przyjmuje do druku wyłącznie prace
poprzednio nie publikowane i nie zgłoszone do
druku w innych wydawnictwach.
W Medical and Biological Sciences zamieszcza
się:
artykuły redakcyjne
prace
a) poglądowe,
b) oryginalne eksperymentalne i kliniczne,
c) kazuistyczne,
które mogą być napisane w języku polskim lub
angielskim.
Objętość pracy wraz z materiałem ilustracyjnym, piśmiennictwem i streszczeniem nie powinna przekraczać 15 stron maszynopisu przy
pracach poglądowych oraz 12 stron przy pracach oryginalnych i kazuistycznych. Przekroczenie objętości skutkuje opłatą 100 zł od dodatkowej strony.
Praca powinna być napisana jednostronnie
w programie Word (na jednej stronie może być
do 32 wierszy, tj. 1800 znaków, margines z lewej strony – 4 cm), czcionką 12 pkt., interlinia
– 1,5.
W nagłówku należy podać:
a) imiona i nazwiska autorów oraz tytuły naukowe,
b) tytuł pracy (również w j. ang.),
c) nazwę kliniki (zakładu) lub innej instytucji, z której praca pochodzi,
d) tytuł naukowy, imię i nazwisko kierownika kliniki (zakładu), innej instytucji,
e) adres do korespondencji, który powinien
zawierać również e-mail, tel i faks.
Każda praca powinna zawierać streszczenie
w języku polskim i angielskim oraz słowa kluczowe w j. polskim i angielskim, a także piśmiennictwo.
Praca przygotowana w języku angielskim powinna zawierać tytuł w j. polskim, streszczenie
w j. angielskim i polskim oraz słowa kluczowe
w j. angielskim i polskim.
Prace oryginalne powinny mieć następujący
układ: streszczenie w języku polskim i angielskim, słowa kluczowe w j. polskim i angielskim, wstęp, materiał i metody, wyniki, dyskusja, wnioski, piśmiennictwo.
Tabele i ryciny należy ograniczyć do niezbędnego minimum. Tabele numerujemy cyframi
rzymskimi. Tytuł tabeli w jęz. polskim i angielskim umieszczamy nad tabelą. Opisy wewnątrz
10.
11.
12.
13.
14.
15.
16.
17.
tabeli zamieszczamy w języku polskim i angielskim.
Ryciny (fotografie, rysunki, wykresy itp.) numerujemy cyframi arabskimi. Tytuł ryciny
w jęz. polskim i angielskim umieszczamy pod
ryciną. Opisy wewnątrz rycin zamieszczamy
w języku polskim i angielskim.
Odnośniki do piśmiennictwa zaznaczamy
w tekście cyframi arabskimi i umieszczamy
w nawiasie kwadratowym.
Streszczenie powinno mieć charakter strukturalny, tzn. zachować podział na części, jak tekst
główny. Objętość streszczenia zarówno w języku polskim jak i angielskim – ok. 250 wyrazów.
Autor dostarcza pracę na dyskietce oraz 3 egzemplarze, w tym 1 kompletny, zgodny z dyskietką, zawierający nazwiska autorów i nazwę
instytucji, z której praca pochodzi (patrz pkt. 5
i 9) oraz 2 egz. przeznaczone dla recenzentów
bez nazwisk autorów, nazwy instytucji i innych
danych umożliwiających identyfikację.
Na dyskietce w odrębnych plikach powinny być
umieszczone:
a) tekst pracy,
b) tabele,
c) ryciny (fotografie w formacie BMP, TIF,
JPG lub PCX; ryciny w formacie WMF,
EPS lub CGM),
d) podpisy pod ryciny i tabele w formacie
MS Word lub RTF.
Fotografie powinny mieć postać kontrastowych
zdjęć czarno-białych na błyszczącym (ewentualnie matowym) papierze. Na odwrocie należy
podać imię i nazwisko autora, tytuł pracy, numer oraz oznaczyć górę i dół.
Należy zaznaczyć w tekście miejsca, w których
mają być zamieszczone ryciny. Wielkość ryciny: podstawa nie powinna przekraczać 120 mm
(z opisami).
Piśmiennictwo – tylko prace cytowane w tekście (maksymalnie 30 pozycji) – powinno być
ponumerowane i ułożone wg kolejności cytowania, każdy tytuł od nowego wiersza. Pozycja
piśmiennictwa dotycząca czasopisma musi zawierać kolejno: nazwisko, inicjał imienia autora
(ów) – maksymalnie trzech – tytuł pracy, tytuł
czasopisma wg skrótów stosowanych w „Index
Medicus”, rok, numer tomu i stron. Przy cytowaniu pozycji książkowej (monografii, podręczników) należy podać nazwisko i inicjały
imion autorów, tytuł dzieła, wydawcę, miejsce
i rok wydania.
18. Z pracą należy przesłać oświadczenie, iż nie
była ona dotąd publikowana, a także że nie została złożona do innego wydawnictwa oraz
zgodę kierownika zakładu na publikację.
19. Do każdej pracy należy dołączyć oświadczenie
podpisane przez wszystkich współautorów, że
aktywnie uczestniczyli w jej realizacji i przygotowaniu do druku oraz akceptują bez zastrzeżeń
tekst pracy w formie przesłanej do redakcji.
20. Prace niespełniające wymogów regulaminu
będą zwracane autorom.
21. Redakcja zastrzega sobie prawo poprawiania
usterek stylistycznych oraz dokonywania skrótów.
22. Za prace zamieszczone w Medical... autorzy nie
otrzymują honorarium.
23. Redakcja nie przekazuje autorom bezpłatnych
egzemplarzy Medical...
24. Prace publikowane w Medical... są oceniane
przez dwóch recenzentów.
25. Medical and Biological Sciences są punktowane zgodnie z listą czasopism Ministerstwa Nauki i Informatyzacji i otrzymują 4 punkty.
Redakcja:
Medical and Biological Sciences
ul. Powstańców Wielkopolskich 44/22
85-090 Bydgoszcz
Dyżury sekretarza Redakcji: wtorek 11.00-13.00
tel.: (052) 585 33 26
Opracowanie redakcyjne i realizacja wydawnicza:
Redakcja z siedzibą w Bydgoszczy: Krystyna Frąckowiak, Ewa Wiśniewska
ul. Powstańców Wielkopolskich 44/22, 85-090 Bydgoszcz
tel./faks: 052 585 33 25, e-mail: [email protected]
BYDGOSZCZ 2009
Nakład: 100 egz.
Druk i oprawa: Drukarnia cyfrowa UMK, ul. Gagarina 5, 87-100 Toruń, tel.: 056 611 22 15

medical and biological sciences

Transkrypt

Podobne dokumenty

Prawna obsługa biznesu Legal services to business

Free radical scavengers can modulate the DNA

Neuroticism and compulsive overeating

Dpit47: a DNA polymerase chaperone

A taxia