Zdravljenje bolezni prebavil v Srednji in Vzhodni Evropi : podatki, ki jih zdravniki v primarni zdravstveni oskrbi sami sporočajo

Background. Gastrointestinal disorders account for 7-10% of all consultations in primary care. General practitioners’ management of digestive disorders in Central and Eastern European countries is largely unknown. Aims. To identify and compare variations in the self-perceived responsibilities of general practitioners in the management of digestive disorders in Central and Eastern Europe. Methods. A cross-sectional survey of a randomized sample of primary care physicians from 9 countries was conducted. An anonymous questionnaire was sent via post to primary care doctors. Results. We received 867 responses; the response rate was 28.9%. Over 70% of respondents reported familiarity with available guidelines for gastrointestinal diseases. For uninvestigated dyspepsia in patients under 45 years, the "test and treat" strategy was twice as popular as "test and scope". The majority (59.8%) of family physicians would refer patients with rectal bleeding without alarm symptoms to a specialist (from 7.6% of doctors in Slovenia to 85.1% of doctors in Bulgaria; p<0.001). 93.4% of respondents declared their involvement in colorectal cancer screening. In the majority of countries, responding doctors most often reported that they order fecal occult blood tests. The exceptions were Estonia and Hungary, where the majority of family physicians referred patients to a specialist (p<0.001). Conclusions. Physicians from Central and Eastern European countries understood the need for the use of guidelines for the care of patients with gastrointestinal problems, but there is broad variation between countries in their management. Numerous efforts should be undertaken to establish and implement international standards for digestive disorders’ management in general practice.Uvod. 7-10 % vseh posvetov v primarni zdravstveni oskrbi se nanaša na bolezni prebavil. O zdravljenju bolezni prebavil s strani splošnih zdravnikov v Srednji in Vzhodni Evropi ni na razpolago veliko podatkov. Cilji. Ugotoviti in primerjati razlike v samozaznani odgovornosti splošnih zdravnikov pri zdravljenju bolezni prebavil v Srednji in Vzhodni Evropi. Metode. Naredili smo presečne ankete na randomiziranem vzorcu splošnih zdravnikov v primarni zdravstveni oskrbi iz devetih držav. Po pošti smo zdravnikom v primarni zdravstveni oskrbi poslali anonimni vprašalnik. Rezultati. Prejeli smo 867 odgovorov, stopnja odzivnosti je bila 28,9 %. Več kot 70 % anketirancev je v odgovorih navedlo, da so seznanjeni z razpoložljivimi smernicami za bolezni prebavil. Za neraziskano dispepsijo pri bolnikih, mlajših od 45 let, je bila dvakrat bolj priljubljena strategija »testiranja in zdravljenja« kot pa strategija »testiranja in gastroskopije«. Večina (59,8 %) zdravnikov v primarni zdravstveni oskrbi bi bolnike z rektalnimi krvavitvami brez znakov alarma napotila k specialistu (od 7,6 % zdravnikov v Sloveniji do 85,1 % zdravnikov v Bolgariji; p<0.001). 93,4 % anketirancev je potrdilo svojo udeležbo pri presejalnih pregledih za odkrivanje raka debelega črevesa in danke. V večini držav so zdravniki najpogosteje poročali, da naročajo testiranje za odkrivanje prikritih krvavitev v blatu. Izjema pri tem sta bili Estonija in Madžarska, kjer večina zdravnikov v primarni zdravstveni oskrbi napoti paciente k specialistu (p<0.001). Zaključki. Zdravniki iz Srednje in Zahodne Evrope razumejo potrebo po uporabi smernic za nego bolnikov z boleznimi prebavil, vendar pa je pri obravnavi veliko razlik med posameznimi državami. Treba si je prizadevati in sprejeti ukrepe za vzpostavitev in izvajanje mednarodnih standardov za obravnavo bolezni prebavil v splošni praksi

Axillary lymph node and early breast cancer diagnostics. A case report

Understanding of the anatomy of the axillary lymph nodes is important in diagnostic and treatment procedures for breast cancer. An interesting case is presented here of breast cancer without a breast tumour. The first symptom of the disease was lymphadenopathy of the axillary region. This kind of case is extremely rare in clinical practise (one case per 1-5 years) and constitutes a great problem for specialists, since in many cases the primary neoplasm source is unknown. The anatomical and clinical implications of such a situation are discussed

Land use change in three Carpathian communities (Niedźwiedź, Szczawnica and Trzciana) in the second part of the 20th century

Celem niniejszej pracy jest określenie kierunków zmian użytkowania ziemi w ostatnim trzydziestoleciu XX wieku, w Karpatach, na przykładzie trzech gmin (Niedźwiedź, Szczawnica i Trzciana). Materiałem źródłowym dla przeprowadzanych badań były czarno-białe zdjęcia lotnicze (lata 70.) i ortofotomapy (rok 2003). Przeprowadzone analizy wykazały wzrost powierzchni leśnej, nieużytków z obszarami porzuconymi oraz obszarów zabudowanych i infrastruktury technicznej a także spadek powierzchni obszarów użytkowanych rolniczo. Największą dynamiką zmian charakteryzowały się obszary poniżej 600-700 m n.p.m. na stokach o nachyleniach poniżej 10C.The aim of this paper is to analyse the main trends in land use change in the last thirty years of the 20th century in the Carpathians, based on the assessment of change in three communities: Niedźwiedź, Szczawnica and Trzciana. The research focused on two points in time; the 1970s and the year 2003. The sources of information about land use in the periods analysed period were aerial photographs (1970s) and orthophotomaps (2003). The results show an increase in forest cover, the abandonment of land and built-up areas, and a decrease in agricultural land. The most dynamic changes occurred in the areas below 600-700 m a.s.l. and on slopes below 10C

Tourism and Recreation: Contemporary Threats and Opportunities for Development

Praca recenzowana / peer-reviewed pape

An interlaboratory comparison of mid-infrared spectra acquisition: Instruments and procedures matter

Diffuse reflectance spectroscopy has been extensively employed to deliver timely and cost-effective predictions of a number of soil properties. However, although several soil spectral laboratories have been established worldwide, the distinct characteristics of instruments and operations still hamper further integration and interoperability across mid-infrared (MIR) soil spectral libraries. In this study, we conducted a large-scale ring trial experiment to understand the lab-to-lab variability of multiple MIR instruments. By developing a systematic evaluation of different mathematical treatments with modeling algorithms, including regular preprocessing and spectral standardization, we quantified and evaluated instruments' dissimilarity and how this impacts internal and shared model performance. We found that all instruments delivered good predictions when calibrated internally using the same instruments' characteristics and standard operating procedures by solely relying on regular spectral preprocessing that accounts for light scattering and multiplicative/additive effects, e.g., using standard normal variate (SNV). When performing model transfer from a large public library (the USDA NSSC-KSSL MIR library) to secondary instruments, good performance was also achieved by regular preprocessing (e.g., SNV) if both instruments shared the same manufacturer. However, significant differences between the KSSL MIR library and contrasting ring trial instruments responses were evident and confirmed by a semi-unsupervised spectral clustering. For heavily contrasting setups, spectral standardization was necessary before transferring prediction models. Non-linear model types like Cubist and memory-based learning delivered more precise estimates because they seemed to be less sensitive to spectral variations than global partial least square regression. In summary, the results from this study can assist new laboratories in building spectroscopy capacity utilizing existing MIR spectral libraries and support the recent global efforts to make soil spectroscopy universally accessible with centralized or shared operating procedures

The Differences in the Prevalence of Cardiovascular Disease, Its Risk Factors, and Achievement of Therapeutic Goals among Urban and Rural Primary Care Patients in Poland: Results from the LIPIDOGRAM 2015 Study

From MDPI via Jisc Publications RouterHistory: accepted 2021-11-28, pub-electronic 2021-11-30Publication status: PublishedFunder: Valeant Pharmaceuticals; Grant(s): unrestricted educational grantA nationwide cross-sectional study, LIPIDOGRAM2015, was carried out in Poland in the years 2015 and 2016. A total of 438 primary care physicians enrolled 13,724 adult patients that sought medical care in primary health care practices. The prevalence of hypertension, diabetes mellitus, dyslipidaemia, and CVD were similar in urban and rural areas (49.5 vs. 49.4%; 13.7 vs. 13.1%; 84.2 vs. 85.2%; 14.4 vs. 14.2%, respectively). The prevalence of obesity (32.3 vs. 37.5%, p 0.01) and excessive waist circumference (77.5 vs. 80.7%, p 0.01), as well as abdominal obesity (p = 43.2 vs. 46.4%, p 0.01), were higher in rural areas in both genders. Mean levels of LDL-C (128 vs. 130 mg/dL, p = 0.04) and non-HDL-C (147 vs. 148 mg/dL, p = 0.03) were slightly higher in rural populations. Altogether, 14.3% of patients with CVD from urban areas and 11.3% from rural areas reached LDL 70 mg/dL (p = 0.04). There were no important differences in the prevalence of hypertension, diabetes, dyslipidaemia, and CVD, or in mean levels of blood pressure, cholesterol fractions, glucose, and HbA1c between Polish urban and rural primary care patient populations. A high proportion of patients in cities and an even-higher proportion in rural areas did not reach the recommended targets for blood pressure, LDL-C, and HbA1c, indicating the need for novel CVD-prevention programs

Nauka prawa finansowego po I dekadzie XXI wieku

Księga pamiątkowa dedykowana profesorowi Apoloniuszowi Kosteckiem

Zarządzanie bezpieczeństwem zbiorowego podejmowania decyzji w jednostkach naukowych w okresie postpandemicznym

Under the pressure of sanitary restrictions, the potential of information techno- logies available to the academic communities for over a dozen years, but not used for various reasons, is released. As a specific case of this trend, a migration from brick-and-mortar voting towards the remote voting by electronic means may in- tensify in the post-pandemic period at universities. This phenomenon requires an in-depth analysis, the aim of which is to facilitate the management of academic units to choose optimal solutions in the coming years, when such decisions can be made without time pressure and invasive sanitary restrictions. In the process of electronic remote voting, security is a key requirement, which has a number of various attributes: authenticity, correctness, anonymity, verifiability, receipt- freeness, availability. In response to these, to some extent contradictory, requi- rements, the world of science has been developing protocols and systems based on cryptographic formalisms for years. This article explains the main challenges related to security of remote electronic voting, from which even advanced solu- tions implemented in academic practice are not free