Social Activities Of Patients Research Articles

Efficacy and safety of Aviandr in the treatment of anxiety in patients with adjustment disorders after COVID-19

To investigate the efficacy and safety of Aviandr in the treatment of anxiety in patients with adjustment disorders after COVID-19. A multicenter prospective open-label study included 109 patients of both sexes aged 18 to 65 years (70 women, 39 men, average age - 41.4±13.18 years) with a leading complaint of anxiety (Hamilton scale score, HAM-A ≥18 - ≤24), which arose after acute coronavirus infections. Clinical manifestations had to meet the diagnostic criteria F43.2 ICD-10. The drug Aviander was prescribed 20 mg 2 times a day for 4 weeks. At the end of taking the drug, patients were monitored for another 1 week (a delayed follow-up visit). Psychopathological, statistical and parametric research methods were used using standardized HAM-A, Montgomery-Asberg scales (MADRS), visual analog asthenia scale (VASH-A), Sheehan Disability Scale (SDS), digital character substitution test (DSST), general clinical impression scale (CGI). Data from 109\110 patients were analyzed to evaluate efficacy\safety. Aviandr was administered 20 mg 2 times daily for 4 weeks. Patients were followed for 1 week (delayed follow-up visit) at the end of treatment. Reducing the intensity of anxiety on the HAM-A scale was - 14.2±4.92 or 69.4±22.66% by the end of treatment. The response rate to therapy (responders are patients with a decrease in the total score on the HAM-A ≥50%) was 83.49%. Remission was achieved (sum of HAM-A scores ≤7) by the end of treatment 68.81% of patients, and 79.8% of patients at the follow-up visit. Significant changes were obtained on the MADRS, VAS-A, SDS and DSST scales. According CGI 45.9% of patients had «much improved» and 43.1% of patients had «very much improved» by the end of treatment; 58.7% of patients had «much improved» and of 33.9% patients had «very much improved» at the follow-up visit. 38 adverse events were reported in 27 (24.55%) patients during the study. A definite association with study drug was reported between 5 mild adverse events in 4 (3.64%) patients. No subjects withdrew from the study due to an adverse event. Positive dynamics (reduction of anxiety symptoms, decrease in asthenia) persisted after discontinuation of the study drug. No cases of withdrawal syndrome were observed. According to the results of the study, the anxiolytic, antidepressant, antiasthenic and pro-cognitive effects of Aviandr were observed. An increase in the social activity of patients was observed.

Molecular mechanisms of the development of the phenomena of peripheral and central sensitization in rheumatoid arthritis

Modern tactics for the treatment of rheumatoid arthritis is aimed at achieving remission or low activity of the disease, the maximum elimination of the manifestations of the disease and the restoration of physical and social activity of patients. At the same time, despite the wide range of the most modern pathogenetic agents, a good therapeutic response can’t be obtained in all cases. A difficult problem is the so-called rheumatoid arthritis RA (difficult to treat), in which two or more sequentially prescribed genetically engineered biological drugs or JAK inhibitors are ineffective. One of the important factors negatively affecting the outcome of RA treatment are functional disorders of the nociceptive system, such as peripheral and central sensitization. These phenomena, associated with persistent activation of nociceptive neurons and the development of nociplastic changes, are caused by systemic autoimmune inflammation and the influence of various cytokines and chemokines on the neuronal membrane. This review considers the molecular biological aspects of the formation of peripheral and central sensitization in RA, with a separate analysis of the pathogenetic role of individual interleukins.

Advances on the Treatment of Allergic Rhinitis by Traditional Chinese Medicine and Western Medicine

Background: Allergic rhinitis is a common and high incidence disease in clinic, which has a certain impact on the work, life and social activities of patients. Modern medicine still lacks effective treatment methods for such diseases. In recent years, clinical cases of children and adolescents have also increased year by year. Objective: In order to provide references for further study and practical treatment on allergic rhinitis, this paper summarized the advances on the treatment of allergic rhinitis by Traditional Chinese Method (TCM) and Western Medicine Method (WMM) in clinical practice and study. Method: Through detailed review and study of literatures, the theory and clinical experiences in TCM, WMM, and integrated treatment of the two were analyzed and summarized. Conclusions: TCM conducts personalized treatment for patients by syndrome differentiation. The main means are to regulate the body’s health Qi and Yang Qi. Drugs, acupuncture, psychology and other means of treatment are all used and the effects of treatment are very well. WMM mainly relieves the infiltration of local inflammatory cells, expands local capillaries, improves nasal permeability and alleviates the occurrence of allergic graduation by using kinds of drugs or surgery. Though both TCM and WMM are effective and have some common characteristics and each has its own characteristics, the combination of TCM and WMM has a good prospect and is more effective and can effectively reduce the adverse reactions of patients, because TCM is to change patients’ own constitution and the starting point of WMM is to eliminate the pathogen.

Cardiovascular risk factors for cognitive deficiency and options for correction

Cardiovascular risk factors for the development of cognitive impairment and Alzheimer’s disease are ranked among the most significant ones, especially in elderly patients. The review provides data on the influence of such factors as arterial hypertension, arterial hypotension, heart failure, coronary heart disease, etc. on the development of cognitive deficiency. The presence of two or more of these risk factors generally tends to increase the possibility of the development of Alzheimer’s disease. The author examines the relationship between these factors and the development of Alzheimer’s disease. Insights into how CVD risk factors can cause progressive cognitive impairment provides further insight into the pathophysiology of Alzheimer’s disease and the identification of methods to prevent or treat CV risk factors for cognitive decline. The course and outcome of cardiovascular diseases depend on the patient’s age, previous medical history, lifestyle, primary prevention, genetic and pathological factors that affect structural and hemodynamic functions. The article addresses issues of therapy of these disorders. Methods of non-pharmacological therapy are discussed: the importance of the patient’s lifestyle, physical activity, nutritional issues, social activity of patients. Much attention is paid to the role of cognitive training in the management of patients with cognitive impairments. The correction of risk factors for stroke and the progression of chronic circulatory disorders is one of the most elaborated areas. The therapeutic potential drugs with a multifactorial mechanism of action are discussed. One of them is Ginkgo biloba extract EGb 761®, which meets the regulated content of active ingredients (flavone glycosides, terpene lactones and ginkgolic acid) and, perhaps, promises to be a more rational choice in the treatment of cognitive impairment. The role of Ginkgo biloba extract EGb 761® in the treatment of cardiovascular diseases is discussed.

The use of underwater horizontal traction and mechanotherapy in the complex treatment of degenerative spondylolisthesis of the lumbosacral spine: a pilot clinical study

To study the effectiveness of underwater horizontal traction in combination with mechanotherapy in patients with non-stenosing unstable degenerative spondylolisthesis of the lumbosacral spine of the 1st degree, accompanied by pain. The clinical study included 14 patients (mean age 50.21 years). Patients underwent underwater horizontal traction of the spine according to the modified Pushkareva-Vozdvizhenskaya method in a variable mode, the procedures were performed every other day, for a course of 6 procedures. After completion of the traction procedure, patients were recommended to put on a fixing lumbosacral corset, in which they rested for 30 minutes in the supine position. At the end of the rest period, the patients performed training of the back muscles with biofeedback on the mechanotherapeutic complex of simulators for 30 minutes daily, except for weekends, for a course of 10 procedures. All patients completed the course of treatment, during the procedures no side effects or deterioration were noted. During the treatment, motor and daily activity significantly improved according to the Oswestry scale (p=0.002), the severity of the pain syndrome and its effect on the patient's activity decreased, according to the Roland-Morris questionnaire (p=0.003). According to an objective assessment of the muscle strength of the lumbosacral spine at the initial level, no deviations from the normative parameters were revealed, however, during the treatment, a significant increase in strength was noted in all muscle groups. Underwater horizontal traction of the spine in variable mode according to Pushkareva-Vozdvizhenskaya is an effective and safe method of conservative treatment of unstable non-stenosing degenerative spondylolisthesis of the 1st degree, accompanied by back pain, which helps to reduce the intensity of the pain syndrome and improve the daily motor and social activity of patients. The traction method should be supplemented with therapeutic exercises using mechanotherapeutic simulators to achieve a clinical result.

Communication and social activities of patients with amyotrophic lateral sclerosis living at home

Communication and social activities of patients with amyotrophic lateral sclerosis living at home

Ability to Participate in Social Activities of Rheumatoid Arthritis Patients Compared with Other Rheumatic Diseases: A Cross-Sectional Observational Study.

Objectives: To compare the ability to participate in social activities among rheumatoid arthritis patients with other rheumatic disease patients and identify potentially implicated factors. Patients and methods: Between June and November 2019, we consecutively selected patients aged ≥18 years with RA (defined according to ACR/EULAR 2010), SpA (ASAS/EULAR 2010), and SLE (ACR 1997). Main outcome measures: Ability to participate in social roles and activities evaluated using the PROMIS score v2.0 short-form 8a (PROMIS-APS). Secondary outcomes: Participation in social activities according to a series of variables (mobility, depression, satisfaction with social relationships, social isolation, company, emotional support, instrumental support, and support via information). We evaluated the association between the ability to participate in social activities and associated variables using multivariable linear regression analysis. Results: The study population comprised 50 patients with RA (33.1%), 51 patients (33.8%) with SpA, and 50 patients (33.1%) with SLE. The mean PROMIS-APS scores were similar in the three groups. The multivariable analysis for the whole sample showed that the ability to participate in social activities was inversely associated with depression and directly with social satisfaction, mobility, company, and age. The stratified analysis revealed an inverse association between inflammatory activity and ability to participate in social activities in patients with RA and SpA, but not in those with SLE. Conclusion: All patients with RA, SpA, and SLE had a similar ability to participate in social activities. This was associated with other psychosocial factors (social satisfaction, mobility, company, depression) and clinical factors (age and inflammatory activity).

Patient with constipation syndrome at the ambulatory-polyclinic reception: actual aspects of differential diagnosis and treatment

Constipation is a serious medical and social problem due to the widespread prevalence of this condition, a decrease in the quality of life and social activity of patients. For the successful treatment of constipation, it is necessary to establish the causes leading to the violation of the stool in the patient. And this task is a priority for the doctor at the outpatient stage.The clinical features of constipation largely depend on their cause, duration, severity and characteristics of intestinal damage. Constipation is often accompanied by general somatic and other gastroenterological symptoms.Within the framework of the review article, the main conditions and diseases are considered, in the clinical picture of which there is constipation syndrome, which must be considered by the doctor at the outpatient stage when conducting differential diagnosis and prescribing appropriate treatment, which also presupposes impact on causal factors. Currently, drugs based on high molecular weight polyethylene glycol 4000 are widely used to treat chronic constipation in adults and children in most countries of the world. Preparations based on polyethylene glycol 4000 are affordable and easy to use, they can be used both on an outpatient basis and in a hospital. Polyethylene glycol 4000 preparations act quickly, are highly effective and well tolerated, have a high safety profile (practically does not affect homeostasis) both for adult patients and in pediatric practice. International clinical trials have shown the possibility of long-term use of polyethylene glycol 4000 preparations.Current international clinical guidelines and domestic clinical guidelines for the treatment of constipation recommend the use of polyethylene glycol 4000 preparations instead of lactulose and volume-forming laxatives in the symptomatic treatment of constipation in children and adults. In the second part of the review, the possibilities of polyethylene glycol 4000 and the first domestic drug polyethylene glycol 4000 in the treatment of chronic constipation are considered.

CIRCADIAN RHYTHM AND INDICATORS OF SYSTEMIC INFLAMMATION IN PATIENTS WITH PSORIASIS AND CONCOMITANT ALIMENTARY OBESITY

Psoriasis is one of the most common dermatoses, affecting from 2% to 4% of the world's population, according to the statistics from WHO. The recent increase in the incidence of comorbid psoriasis and obesity leads to severe, atypical, disabling, and treatment-resistant forms of dermatosis, which significantly impair the quality of life of patients, reduce the efficiency and social activity of patients, thus acquiring not only a medical but also a social significance. There is a theoretical justification for a possible role of circadian rhythm disorders, manifested by changes in eating behavior, reduced sleep duration, and individual chronotype of patients in the development of obesity, chronic low-intensity inflammation, and some chronic autoimmune diseases such as psoriasis. However, this issue remains understudied and insufficiently substantiated. Therefore, the aim of our research was to identify the correlation between the circadian rhythm in terms of changes in the chronotype of human working capacity and indicators of systemic inflammation in patients with extensive psoriasis and concomitant alimentary obesity. The results of correlation analysis showed a high negative correlation between the working capacity chronotype in patients and the level of IL-33, as well as a medium negative correlation between the working capacity chronotype in patients and the level of IL-6 and CRP. Therefore, changes in the circadian rhythm to the evening type of human working capacity chronotype may increase the level of systemic inflammation in patients with extensive vulgar psoriasis and concomitant alimentary obesity. Thus, further in-depth study of the relationship between systemic inflammation and circadian rhythm changes in patients with extensive vulgar psoriasis and concomitant alimentary obesity is promising and essential for the development of scientifically substantiated principles for early prevention and timely correction of these comorbidities.

OBESITY AND CIRCADIAN RHYTHM DISORDERS IN PATIENTS WITH PSORIASIS

Psoriasis is one of the most common dermatoses, which according to WHO world statistics affects from 2% to 4% of the world's population. The problem of psoriasis is quite relevant as it is associated with an increase in morbidity, chronic recurrence, an increase in the number of severe and disabling forms of dermatosis. Despite a large number of scientific studies, the aetiology and pathogenesis of this chronic dermatosis is still remaining unclear. Among the factors contributing to the development of psoriasis, psychosomatic disorders have been considered to play a significant role. Disruption of protective and adaptive mechanisms leads to structural and functional disorders at all levels, including the neuroendocrine and immune systems and this is regarded as the pathogenetic basis of psoriasis. Many individuals develop a hyperphagic way of responding to a stressful situation that is manifested by depression, anxiety, chronic stress, sleep disorders and changes in eating behaviour that in turn lead to weight gain and further development of obesity with a number of metabolic disorders and to changes in the circadian rhythm. The recent increase in comorbid psoriasis and obesity leading to severe, atypical, disabling, and treatment-resistant forms of dermatosis significantly impairs the quality of life of patients, reduces the efficiency and social activity of patients with psoriasis, therefore psoriasis is regarded as the social problem as well. Thus, further in-depth study of the relationship and pathogenesis of the comorbidity between psoriasis, obesity and circadian rhythm changes is promising and essential for the development of scientifically sound principles of early prevention and timely correction of comorbidities.

The capacity and effectiveness elimination domestic animals allergens: myths and realities

At present, sensitization to airborne allergens in domestic animals is absolutely rightly considered one of the key risk factors for the development of allergic rhinitis and bronchial asthma, as well as largely determines the development of severe forms of atopic dermatitis and respiratory allergosis. Of particular importance is the fact that, unlike other triggers, the elimination of allergens in domestic animals is often associated with internal resistance from patients. Various aspects of this problem are associated with a large number of baseless statement that lead to inadequate prevention and therapy, as well as negatively affecting the social activity of patients and their families. The article presents the current data on the prevalence of sensitization, the properties and clinical significance of the allergens of domestic animals, outlines approaches to conducting elimination activities.

Insomnia and cognitive behavioral therapy for chronic back pain

To manage patients with chronic back pain (CBP) is one of the urgent problems of modern medicine, as CBP is associated with high disability, considerable socioeconomic costs, and low quality of life. Concurrent disorders, such as insomnia, depression, and anxiety, which make a significant contribution to the severity of CBP and related disability, are frequently disregarded when managing patients with CBP. Insomnia is observed in the majority of patients with CBP, but it is relatively rarely diagnosed, therefore the bulk of patients do not receive appropriate treatment. Cognitive behavioral therapy (CBT) combined with therapeutic exercises is one of the most effective treatments in patients with CBP; moreover, of great importance is the identification of concomitant insomnia, whose treatment with CBT is able not only to improve sleep, but also to reduce pain and to increase the physical and social activities of patients. A positive combination treatment effect is achieved due to a change in the patients’ ideas about the prognosis and causes of the disease, as well as to the increased intensity of physical activity and to the prevention of strenuous exercise and static stresses.

Isoimperatorin (ISO) reduces melanin content in keratinocytes via miR-3619/CSTB and miR-3619/CSTD axes.

Melanin metabolism disorders may cause severe impacts on the psychological and social activities of patients. Different from the other two steps of melanin metabolism, namely synthesis and transport, little has been known about the mechanism of melanin degradation. Isoimperatorin (ISO) suppressed the activity of tyrosinase, an essential enzyme in melanin biosynthesis, hence, we investigated the effects and mechanism of ISO in melanin reduction. ISO stimulation significantly reduces the melanin contents and PMEL 17 protein levels; meanwhile, the activity and the protein levels of two critical lysosomal enzymes, Cathepsin B and Cathepsin D, can be significantly increased by ISO treatment. MiR-3619 inhibited the expression of CSTB and CSTD, therefore affecting ISO-induced degradation of melanin. In summary, ISO reduces the melanin content via miR-3619/CSTB and miR-3619/CSTD axes. ISO could be a potent skin-whitening agent, which needs further in vivo and clinical investigation.

Diarrhea-Predominant Irritable Bowel Syndrome: Medical Management Update.

Irritable bowel syndrome (IBS) is a prevalent gastrointestinal disorder, which impacts the quality of life, work productivity and social activities of patients. Diarrhea-predominant IBS (IBS-D) is one of several subtypes, and accounts for approximately one third of all cases. Currently available treatments are typically unable to alleviate the cardinal symptoms of IBS-D, including abdominal pain and diarrhea, and a clinical unmet need remains for an effective treatment which simultaneously relieves multiple symptoms. Patients may benefit from a multipronged, individualized approach, including dietary modifications, and psychological and pharmacological therapies. The aim of this review is to provide an update on the available and upcoming treatment options for IBS-D in Canada, with reference to the recently updated Canadian IBS consensus guidelines. Initial treatment approaches include lifestyle modifications, dietary modifications, and non-prescription therapies such as peppermint oil. While some medications such as tricyclic antidepressants are also used to treat IBS-D symptoms, eluxadoline and rifaximin are the only two pharmacological therapies approved for the treatment of IBS-D in Canada. Key clinical trial data for the currently available pharmacological options are presented to provide an overview of the efficacy and safety of these agents

Cognition with magnetic resonance imaging findings and social activities in patients with multiple sclerosis in a Japanese cohort

AbstractObjectiveWe investigated the association of magnetic resonance imaging (MRI) findings and social activities with cognition in Japanese patients with multiple sclerosis (MS).MethodsCognition was evaluated by the Brief International Cognitive Assessment for MS (BICAMS), using previously published data for 156 Japanese patients with MS. The BICAMS results were analyzed with available MRI data, focusing on hyperintense lesions on T2/fluid‐attenuated inversion recovery images. Logistic regression analysis was used to assess associations between the BICAMS scores and social activities (i.e. “student,” “employed full time,” “employed part time,” “homemaker” and “unemployed because of MS”). The independent variables were the BICAMS scores, and the Expanded Disability Status Scale, sex, age at examination, education and disease duration. The dependent variable was the “social activity.”ResultsAnalysis of variance showed that patients with MS and more cerebral lesions on MRI had lower scores in all three domains of the BICAMS (the Symbol Digit Modalities Test, the second edition of the California Verbal Learning Test and the revised Brief Visuospatial Memory Test). Scores of all three domains were also significantly lower in patients with cerebellar lesions. Regarding social activities, patients who were unemployed because of MS had lower BICAMS scores compared with employed patients. However, the BICAMS domain scores did not independently affect the other social activities.ConclusionsHigher numbers of cerebral lesions and the presence of cerebellar lesions evaluated by MRI affect cognitive function based on the BICAMS. Cognitive function might affect social activities in patients with MS.

Emotional disorders in patients with Parkinson's disease on the background of the comorbid pathology of autoimmune genesis

Parkinson's disease is one of the most common neurodegenerative diseases, which affects more than 1% of the world's population, is over 65 years old, and the incidence rate can double by 2030. This pathology is accompanied by both motor and non-motor manifestations (NMM). One of the frequent types of affective disorders in patients with PD is depression. Depression can worsen both the motor and social activity of patients with PD. Understanding the factors associated with depressive symptoms contributes to early detection and timely treatment. In a number of studies, depression and anxiety are recognized as a major factor in the poor quality of life of patients with PD. Aim of the research. To study the features of emotional disorders in patients with Parkinson's disease (PD) and autoimmune thyroiditis (AIT). Materials and methods . 109 patients with PD at the age from 47 to 75 years were examined. The main group of patients consisted of ІА and ІB subgroups, control group - ІІА and subgroups IIB. Conducted general clinical and neurological examination, assessment of motor functions using the unified PD scores (UPDRS), neuropsychological testing (Becky Depression Rating Scale (BDI), Hamilton Alarm Scale (HARS), PDQ-39 quality of life assessment, statistical analysis with program Statistica 6.0. Results. The study showed the presence of depression in 84 patients with PD, which is 77.1%, and anxiety disorders in 73 patients, respectively 67.0%. The analysis of the depression and anxiety index in the dynamics showed a statistically significant difference in the subgroups ІА and ІB. There was a strong statistically significant direct correlation between the scores for the detection of affective disorders and the patient's quality of life indicator (PDQ-39) during the initial examination and a year later in subgroups IA and IB. Conclusions. There was a statistically significant difference in affective disorders in dynamics in patients with PD and AIT. The influence of the level of anxiety and depression on the quality of life of patients with PD and AIT was revealed, which indicates a high medico-social significance of these disorders

Virtual Reality as an upper Limb Rehabilitation Approach

Cerebrovascular diseases seriously reduce the quality of life of patients. One of the priority tasks of restoring individual independency, daily living and social activity of patients is to restore basic motor skills such as the reaching, manipulating, and bimanual tasks an coordination. For successful recovery of movement necessary to conduct training in real environment, active participation of the patient, and interactive biofeedback that allows the patient to control the correct performance of motor tasks and adjust their own efforts. Evolution of computer technology gives an opportunity to improve the classical approaches in stroke rehabilitation. To make rehabilitation process met necessary terms, in everyday practice often used high technological devices, such as virtual reality (VR) systems. The technical basis of VR is an artificial three-dimensional environment that is created with computer and displayed on the screen. These technologies allow recreating the necessary training environment for motor skills relearning, as well as to provide interactive biofeedback and make rehabilitation process more intensive. This review present an information about history of VR technology developments, experience of upper limb rehabilitation using VR systems and comparative analysis of different VR based rehabilitation approaches.

The role of design in creating a comfortable environment of the hospice

The article reveals the essence and the role of design in creating the environment of the hospice. The main components of the concept of "comfort" are analyzed from the point of view of organization of subject-spatial environment of hospices.They include physiological parameters of the environment, psychological climate and social activity of patients. It was found that comfort is achieved with the simultaneous interaction of all these components, and the variations in the levels of comfort are conveyed according to the type and quality of space. The synthesis of these components while studying the literature data and global experience in the design of hospices has allowed to identify several characteristic features of design in the space formation. Based on this data the author considers the ways of organization of a comfortable environment through proper use of means of design. The basic values of design in planning hospices have been stated in accordance with the advanced regulations.

Leisure and social participation in patients 4–10 years after aneurysmal subarachnoid haemorrhage

Objective: To investigate the long-term resumption of leisure and social activities in patients with aneurysmal subarachnoid haemorrhage (aSAH) and to determine the role of executive dysfunction and aneurysms in anterior brain regions in particular.Method: Leisure and social functioning of 200 patients with aSAH having anterior or posterior aneurysms was determined using the Role Resumption List (RRL). Executive functioning was investigated using the Dysexecutive Questionnaire (DEX) and sub-scales Social Convention (SC) and Executive Cognition (EC). Mood, fatigue and cognitive problems were investigated with the Hospital Anxiety and Depression Scale (HADS) and Brain Injury Symptom Checklist (BISC).Results: Of all patients, 46.5% reported complete return to previous leisure activities and 61.5% reported no changes in social interactions. HADS depression score, fatigue, DEX-EC sub-scale score and work status post-aSAH were predictors of leisure resumption. For social re-integration, HADS depression score, cognitive problems and fatigue were predictors. Aneurysm location did not influence leisure and social re-integration.Conclusions: A substantial number of the patients still experience problems in resuming previous activities in the chronic phase post-aSAH, influenced by cognitive, executive and depressive problems, as well as current work status and fatigue. Aneurysm location does not seem to influence this resumption.

Professional and social activity of patients after heart transplant.

The aim of the study is to describe both professional and social activities of patients after heart transplant. Ninety-five heart transplant patients treated at the Silesian Center for Heart Diseases in Zabrze were surveyed, comprising 29 women (30.5%) and 66 men (69.5%). The average age of respondents was 54.3 years old (standard deviation (SD) = 15 years); the average period that had elapsed since the heart transplant was 7.1 years (SD = 4 years). We designed a questionnaire as a tool for collecting information from patients. Twenty-five percent of patients worked at the time of completion of the questionnaire. Eighty percent of those patients were working before and after the transplant, 20%--only after transplantation (p < 0.05). A different job position at a new workplace had 47.8% of patients, 34.8% of them had the same job position at the same work place as they had had before, 63.4% of the heart transplant respondents were pensioners. Eighty-two percent of patients had a certificate with a designated degree of disability--among them: 69% had a certificate for a significant degree of disability, 22%--for a moderate degree of disability. Among those surveyed, 52.5% said that their financial situation had not changed whereas 34.5% of those surveyed reported a change for the worse. Thirty-seven percent of respondents reported changes in family relationships. Seventy-seven percent reported that they received help from family members, as compared with 19% who did not. Only 25.3% of the patients treated at the Silesian Centre for Heart Diseases after heart transplant are employed and it is one of the lowest employment rates in this category of patients in Europe. One third of working patients have the same work place as they had before their operation. Heart transplant is a cause of changes in family relationships. Most often family bonds are strengthened but sometimes family members become nervous, impatient and unwilling to talk about the transplant.