*Katarzyna Kozłowicz1, Beata Pawłowska2, Emilia Potembska2, Grażyna Chodorowska3, Dorota Krasowska3, 4
Evaluation of health behavior in patients with systemic sclerosis
Ocena zachowań zdrowotnych u pacjentów z twardziną układową
1Laboratory of Cosmetology and Aesthetic Medicine, Medical University of Lublin
Head of Laboratory: Iwona Jazienicka, MD, PhD
22nd Department of Psychiatry and Psychiatric Rehabilitation, Medical University of Lublin
Head of Department: Affiliate Professor Marcin Olajossy, MD, PhD
3Department of Psychiatric Nursing, Medical University of Lublin
Head of Department: Renata Markiewicz, MD, PhD
4Chair and Department of Dermatology, Venereology and Paediatric Dermatology, Medical University of Lublin
Head of Department: Affiliate Professor Dorota Krasowska, MD, PhD
Wstęp. Twardzina układowa (SSc) to przewlekła, postępująca choroba tkanki łącznej, która charakteryzuje się uszkodzeniem naczyń, zaburzeniami immunologicznymi i nadmierną kumulacją składników macierzy pozakomórkowej w skórze i narządach wewnętrznych. Pomimo intensywnych badań klinicznych leczenie przyczynowe twardziny układowej nie jest możliwe, a terapia modyfikująca przebieg choroby okazuje się nieskuteczna. Dlatego tak ważna jest rola zachowań zdrowotnych w utrzymaniu i umacnianiu własnego zdrowia w grupie chorych na SSc.
Cel pracy. Celem pracy było zbadanie zachowań zdrowotnych u chorych na SSc oraz określenie zależności pomiędzy wymienionymi czynnikami a nasileniem zmian skórnych i narządowych.
Materiał i metody. Badaniami objęto 80 pacjentów z rozpoznaną SSc, leczonych w Katedrze i Klinice Dermatologii, Wenerologii i Dermatologii Dziecięcej oraz w Katedrze i Klinice Reumatologii Uniwersytetu Medycznego w Lublinie, a także grupę kontrolną, dobraną odpowiednio pod względem zmiennych socjodemograficznych. W pracy zastosowano: sondaż diagnostyczny, który w części badawczej zawierał pytania dotyczące danych socjodemograficznych, badanie kliniczne i ocenę zachowań zdrowotnych pacjentów z SSc. Do oceny zachowań zdrowotnych wykorzystano Inwentarz Zachowań Zdrowotnych (IZZ).
Wyniki. Badania własne wykazały, że ogólny wskaźnik zachowań zdrowotnych w grupie chorych na SSc był istotnie wyższy niż w grupie kontrolnej (p < 0,001). Zależność taką stwierdzono w zakresie wszystkich badanych domen.
Wnioski. Chorzy na twardzinę układową wykazywali istotnie wyższy wskaźnik zachowań zdrowotnych aniżeli osoby z grupy kontrolnej, co wskazuje, że zagrożenie zdrowia mobilizowało pacjentów do zachowań prozdrowotnych.
Introduction. Systemic sclerosis (SSc) is a chronic progressing disease of connective tissue, characterized by damage to blood vessels, immunological disorders and excessive cumulation of extra cellular matrix components in the skin and internal organs. In spite of intense clinical studies, causative treatment of SSc is impossible, and the therapy modifying the course of disease turns out to be ineffective. That is why the role of health behaviors in maintaining and strengthening one’s health in the group of SSc is so important.
Aim. The aim of the study was to investigate health behaviors in SSc patients and determining the relationship between the above-listed factors and the intensity of skin and organic lesions.
Material and methods. The study included 80 patients with SSc treated in the Chair and Department of Dermatology, Venereology and Paediatric Dermatology and in the Chair and Department of Rheumatology of the Medical University of Lublin as well as the control group, matched in terms of sociodemographic variables. In this paper diagnostic survey, which in the research part contained questions concerning socio-demographic data, clinical and assessment of health behaviors of patients with SSc. Health Behavior Inventory (IZZ) was used to evaluate health behaviors.
Results. The author’s own studies revealed that the general index of health-related types of behavior in the group of patients with SSc was significantly higher than in the control group (p < 0.001). Such a dependence was found in all the examined domains.
Conclusions. Systemic sclerosis patients had a significantly higher rate of health-oriented behaviors than controls, suggesting that health threats mobilized patients for healthy behaviors.
Recognition of the key role of health behaviors in maintaining and strengthening health was an important change that took place in people’s minds in the second half of the twentieth century. The fact that seven of the top 10 causes of death are related to behavioral actors has increased the need for research in the field (1). For this reason, an important role in promoting health is attributed to raising public awareness of health and the factors influencing it, enabling people to control their own health and to strengthen the health of the individual and the environment. Health-oriented activities include habitual health behaviors, as well as targeted health activities. Health habits are the result of socializing processes and cultural influences. They are associated with the hygiene of everyday life, eating habits, physical activity, relaxation. On the other hand, targeted health activities are initiated in specific situations, related to promotional or preventive activities, and include human behavior in disease (2, 3).
Taking positive health behaviors is correlated, among others, with the evaluation of health, and this in turn affects the health motives resulting from the level of interest in one’s own health. Those who credit health highly, have a greater involvement in health-promoting behaviors, e.g. following a specific diet, smoking cessation, preventive examinations. People appreciate their health in situations of health threat and possibility of losing it (4-7).
The aim of the study was to answer the following research questions:
1. Do systemic sclerosis (SSc) patients differ significantly in evaluating their health behaviors from healthy individuals?
2. Does the clinical condition (thickness of skin fold, presence of calcinosis, acroosteolysis, ulcers and scars, scleroderma, microangiopathy, interstitial lung disease, heart disease, active phase of disease) have a significant impact on the health behavior of patients with systemic sclerosis?
Material and methods
The study included 80 patients with systemic sclerosis (70 women and 10 men) treated in the Chair and Department of Dermatology, Venereology and Paediatric Dermatology and in the Chair and Department of Rheumatology of the Medical University of Lublin as well as the control group, matched in terms of sociodemographic variables (71 women and 9 men respectively). All participants in the study were informed about its validity, the method of conducting it and signed an informed consent. The mean age of patients was 58.11 (SD = 11.55) and of the control group 55.70 years (SD = 14.49). The mean duration of illness in patients was 11.3 years. The SSc group did not differ significantly from the control group in terms of age, place of residence, type of work performed, marital status.
The study was conducted in accordance with a protocol approved by the Bioethics Commission for Surveillance of Clinical Studies at the Medical University of Lublin (KE-0254/123/2010).
The subjects from the study group underwent medical examinations. Particular attention was paid to the presence of: ulcers, scars, calcinosis and acroosteolysis. Modified Rodnan Skin Score was used to assess the severity of skin lesions (8). Changes in microcirculation were assessed by capillaroscopy, in lungs – by pulmonary function tests and high resolution chest computer tomography (HRCT klp). The esophageal lesions were assessed by contrast radiography of the upper gastrointestinal tract, using a barium sulphate suspension. Cardiac evaluation was based on electrocardiography (ECG) and echocardiography. There were performed routine laboratory tests, and immunological evaluations of serum antinuclear antibodies (ANA), ESR, CRP, and C3 and C4 complement components.
Socio-demographic data was determined on the basis of a survey by Katarzyna Kozłowicz.
The Health Behavior Inventory (IZZ) questionnaire contained 24 statements describing different types of behavior related to health, divided into 4 categories of health behaviors: proper eating habits, preventive behaviors, health practices, positive mental attitudes. Proper eating habits take into account firstly the type of consumed food (e.g. whole meal bread, vegetables, fruits). The statements describing preventive behavior concerned the observance of health recommendations, obtaining information on health and disease. On the other hand, health practices included daily habits of sleeping, recreation and physical activity. Positive mental attitudes include the range of health behaviors such as psychological factors, the avoidance of excessive emotions, stress, tensions, and depressing situations (9).
The Health Behavior Inventory is designed for testing healthy and sick adults. Used together with other tools, it can help in programming preventive measures, determining the directions of behavior modification and monitoring of changes in professional practices (9).
The respondents marked how often they performed health related activities and evaluated each of these behaviors in the inventory of the five-point scale: 1 – almost never, 2 – rarely, 3 – from time to time, 4 – often, 5 – almost always.
The numbers marked by the respondents were counted towards the overall index of health behaviors intensity. Its value ranged from 24 to 120 points. The higher the score, the greater was the intensity in declared health behaviors. The overall index, converted to standardized units based on the table, was interpreted according to the characteristics characterizing the sten score scale (9). Results within 1-4 sten, were treated as low, and within 7-10 sten as high, corresponding to about 33% of the lowest scores, and also the same of the highest scores in the scale. The results of 5-6 sten were treated as mediocre. In addition, the intensity of the four categories of health behaviors was separately calculated – the index was the average score in each category, i.e. the sum of points divided by 6 (9).
The results were analyzed statistically using STATISTICA 10.0 PL software. The normality of distribution of the individual variables was tested using Lilliefors’ test (a version of the Kolmogorov-Smirnov test) as well as the Shapiro-Wilk test.
Student’s t-test was used to compare interval variables between pairs of independent groups.
The Mann-Whitney U test was used to compare interval variables between two independent groups when the variables did not have a normal distribution.
Spearman’s Rho was used to calculate the correlations between the selected variables.
Table 1 shows the results of health behaviors assessed by IZZ questionnaire in patients with systemic sclerosis in comparison to healthy subjects (Student’s t-test).
Tab. 1. Evaluation of health behaviors examined by IZZ questionnaire in SSc patients and control group
|IZZ scales||Study group||Control group||t||p|
|Health Behavior Index||87.275||7.957||72.673||12.210||9.250||0.001|
|Positive mental attitude||19.838||3.595||14.752||6.352||6.393||0.001|
|Proper eating habits||20.475||2.667||23.119||4.327||-4.790||0.001|
The study confirms statistically significant differences in all health behaviors: positive mental attitudes, preventive behaviors, proper eating habits, and healthy practices among the group of patients and the controls. Persons with systemic sclerosis were significantly more likely than those from the control group to exhibit the above mentioned health behaviors.
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