The individual face to face with public health: a conflict of interests or a conflict of conditions?

Sytnik-Czetwertyński Janusz, Cianciara Dorota. The individual face to face with public health: a conflict of interests or a conflict of conditions? Journal of Education, Health and Sport. 2016;6(2):223-237. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.46590http://ojs.ukw.edu.pl/index.php/johs/article/view/3394https://pbn.nauka.gov.pl/works/716770  The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 755 (23.12.2015).755 Journal of Education, Health and Sport eISSN 2391-8306 7© The Author (s) 2016;This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, PolandOpen Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium,provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License(http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited.This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercialuse, distribution and reproduction in any medium, provided the work is properly cited.The authors declare that there is no conflict of interests regarding the publication of this paper.Received: 05.01.2016. Revised 12.02.2016. Accepted: 21.02.2016.  The individual face to face with public health: a conflict of interests or a conflict of conditions? Janusz Sytnik-Czetwertyński Uniwersytet Kazimierza Wielkiego w Bydgoszczy, Poland Dorota Cianciara Institute of Epidemiology and Health Promotion, School of Public HealthMedical Centre for Postgraduate Education, Warsaw, Poland  AbstractThe freedom of man and the freedom of the citizen are two entirely different domains. By nature, man is created for freedom, yet he does not possess the ability to effectively provide himself with a feeling of security. Man is therefore forced to negotiate, and in exchange for the abandonment of certain rights to freedom, receives a guarantee of relative peace. In order to enforce its obligations, the state is sometimes forced, in the name of the public good, to pacify the intentions of the individual and enforce pro-social actions. The issue discussed here is therefore reduced to the following: is the domain of public health one of those which should remain under the complete, or merely partial, control of the state (such as defence for instance), or should it remain open to the rights and demands of citizens? The conclusion seems to be the following: the public health perspective is a social one and there is therefore little room for a wide-ranging dialogue with the individual. On the other hand, the system cannot close itself entirely to the reactions of society, since it is supposed to serve people and not its own ideals. It must possess the capacity to not lose sight of people and their problems, so often defying any prognoses and expectations, within the process of enacting public health policy.  Key words: face to face, public health

Negative opinion on work as variable of career shift among doctors in Poland. Are we running out of doctors in post-COVID times?

Introduction and objective. Work conditions and evaluation, stress, professional burnout among doctors are the subject of analyzes and research in Poland. Less attention is focused on the problem of leaving the profession. The aim of the study was to determine the relationship between the socio-demographic and professional characteristics of doctors and the subjective assessment of their current work and the willingness to undertake an alternative career. Material and methods. A survey was conducted among 315 doctors attending courses at the Medical Center of Postgraduate Education in 2018/19. The questionnaire consisted of 14 questions. The dependent variable was the declaration of willingness to change the medical profession to another, if it was possible to maintain income. The explanatory variables were socio-demographic and professional characteristics: gender, age and the performance of surgical and non-surgical specialties as well as subjective assessment of current professional work in terms of 10 attributes of a doctor's work. The analysis used the Pearson χ2 test, Spearman's rank correlation coefficient and clustering. Results. The vast majority of doctors admitted that their work was interesting (95.9%), but nervous (90.5%) and threatening (77.8%). Nervousness was significantly more often indicated by young doctors. 18.1% of physicians declared their willingness to change their profession. The desire to change profession was most strongly associated with the opinion that work was unpleasant and disgusting. Conclusions. More doctors reported the disadvantages of their work than its advantages. Every fifth declared a willingness to change their profession. The willingness to change profession was strongly related to the overall negative assessment of one's own work. Presumably, as a result of the COVID-19 pandemic, more and more doctors will evaluate their work negatively, which may prompt them to change their profession. This situation requires monitoring the impact of COVID-19 on the workforce and taking remedial measures.Wprowadzenie i cel pracy. Warunki i ocena pracy, stres, wypalenie zawodowe wśród lekarzy są przedmiotem analiz i badań w Polsce. Mniej uwagi skupia problem odejścia od zawodu. Celem badania było określenie związku między cechami społeczno-demograficzno-zawodowymi lekarzy i subiektywną oceną ich aktualnej pracy a chęcią podjęcia kariery alternatywnej. Materiał i metody. Przeprowadzono badanie ankietowe wśród 315 lekarzy odbywających kursy w Centrum Medycznym Kształcenia Podyplomowego w roku 2018/19. Kwestionariusz składał się z 14 pytań. Zmienną objaśnianą była deklaracja chęci zmiany zawodu lekarza na inny, jeśli utrzymanie dochodów byłoby możliwe. Zmiennymi objaśniającymi były cechy społeczno-demograficzno-zawodowe: płeć, wiek i wykonywanie zabiegowej i niezabiegowej specjalności lekarskiej oraz subiektywna ocena aktualnej pracy zawodowej w aspekcie 10 atrybutów pracy lekarza. W analizie wykorzystano test χ2 Pearsona, współczynnik korelacji rang Spearmana oraz klasteryzację. Wyniki. Zdecydowana większość lekarzy przyznała, że ich praca jest interesująca (95,9%), ale nerwowa (90,5%) i zagrażająca (77,8%). Nerwowość była istotnie częściej wskazywana przez młodych lekarzy. Chęć zmiany zawodu zadeklarowało 18,1% lekarzy. Chęć zmiany zawodu była najsilniej związana z opinią, że praca jest nieprzyjemna i odrażająca. Wnioski. Więcej lekarzy zgłaszało wady swojej pracy niż jej zalety. Co piąty zadeklarował chęć zmiany zawodu. Chęć zmiany zawodu była silnie związana z całościowo negatywną oceną własnej pracy. Przypuszczalnie w wyniku pandemii COVID-19 coraz więcej lekarzy będzie negatywnie oceniać swoją pracę, co może skłaniać do zmiany zawodu. Sytuacja ta wymaga monitorowania wpływu COVID-19 na kadrę oraz podejmowania środków zaradczych. &nbsp

The phenomenon of urbanisation from a public health perspective. Urban spaces as a possible source of epidemics and pandemics caused by an infectious disease

Introduction Urbanisation is a global process leading to development of urban infrastructure and thus an increase in the population of urban areas. Health threats, including epidemics of infectious diseases that may break out in growing urban areas, can spread quickly and their effects could spread outside of the local territory. Purpose To outline the relationship between globalising, post-modern urbanisation processes, in particular the specific form of extended urbanisation, and the risks posed by infectious diseases that could give rise to new epidemics or pandemics. State of knowledge Health risks occurring at the local level of an urban area react to, and simultaneously affect, health situation occurring at an indefinite distance from the original site of the event. An important impact on the situation are the expanding or newly emerging urban areas, which cause negative changes in social conditions, and the increase in spatial mobility of the global population, which facilitates the spread of infectious diseases. Summary Understanding 21st century urban trends is the key to improving collective health. Adopting a "public health perspective" regarding values and attitudes towards social phenomena and reality, as well as the necessary methods of conduct, seems to be one of the main challenges of the current era in which people around the world, regardless of the country's development status and level of resources, currently live in within one “ecosystem of infectious diseases”. Planned and controlled urbanization, taking into account the achievements of modern epidemiology, including molecular epidemiology, will help will help along the remediation of the cities of the future

Hepatocellular carcinoma - diagnosis and treatment

Rak wątrobowo-komórkowy najczęściej jest następstwem wirusowego zapalenia wątroby. W ciągu ostatnich dekad wskaźniki zachorowalności i umieralności zwiększają się. U większości chorych nowotwór rozpoznaje się w zaawansowanym stadium. Możliwość określenia populacji o zwiększonym ryzyku wystąpienia nowotworu uzasadnia prowadzenie u chorych z marskością programu wczesnego wykrywania za pomocą obrazowania wątroby w odstępach 6-miesięcznych. Rozpoznanie powinno być oparte na ocenie stanu klinicznego łącznie z obrazowaniem i badaniem mikroskopowym. Resekcja jest leczeniem z wyboru u chorych z ograniczeniem choroby do jednej okolicy wątroby i jej prawidłową czynnością oraz nieobecnością cech wrotnego nadciśnienia. Przeszczepienie wątroby stanowi najlepszą metodę w przypadku niewielkich zmian stwierdzonych w przebiegu marskości wątroby. Chemioembolizacja i termoablacja są skutecznymi metodami postępowania w przypadku niewielkich zmian o średnicy do 3 cm w przypadku braku możliwości ich resekcji lub przed transplantacją wątroby. Systemowa chemioterapia ma niewielką wartość, natomiast zastosowanie sorafenibu - drobnocząsteczkowego inhibitora angiogenezy - może przedłużyć czas przeżycia u wybranych chorychHepatocellular carcinoma usually is a consequence of underlying viral hepatitis. Both, the incidence and mortality rates have increased in recent decades. The majority of patients are still diagnosed with advanced disease. The identifiable population at risk of development malignancy makes early detection a realistic possibility and every 6 months liver imaging is currently recommended for patients with cirrhosis. The diagnosis should be based on clinical findings together with radiologic imaging and microscopic examination. Resection is preferred treatment for patients with the disease confined to one region of the liver and preserved hepatic function with no evidence of portal hypertension. Liver transplantation is the best option for small lesions found in cirrhosis. Chemoembolization and thermoablation are effective methods of treatment of small - up to 3 cm in diameter - lesions in patients who otherwise are not candidates for resection or as a bridge to liver transplantation. Systemic chemotherapy is of marginal value, whereas the use of sorafenib - a small-molecule angiogenesis inhibitor - may prolong survival in well-selected patients

The problem of lesser evil within the context of public health

Sytnik-Czetwertyński Janusz, Cianciara Dorota. The problem of lesser evil within the context of public health. Journal of Education, Health and Sport. 2016;6(10):299-308. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.162532 http://ojs.ukw.edu.pl/index.php/johs/article/view/3947       The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 755 (23.12.2015). 755 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Author (s) 2016; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 02.10.2016. Revised 02.10.2016. Accepted: 20.10.2016.       The problem of lesser evil within the context of public health     Janusz Sytnik-Czetwertyński UKW w Bydgoszczy, Poland   Dorota Cianciara Szkoła Zdrowia Publicznego w Warszawie, Poland     Abstract   The issue of public health also includes broad ethical questions. It is here for instance that we find so-called decisions of conscience. Since medical practice is full of moral dilemmas, transferred into the domain of public health, for instance when a doctor decides to provide, in individual cases, costly medical procedures while being simultaneously aware that the funds used for these procedures, could save many more people whose ailments are less costly. These situations force the medical practitioner into making a decision, despite the fact that all the possible choices are morally reprehensible . There exist many moral dilemmas, where the person making the decision cannot find a satisfactory solution, while also being forced to make a decision. Normally, the decision maker then calls upon the category of so-called lesser evil. But this category is no justification – lesser evil is still evil. Which is why it is worth asking what the situation of lesser evil is for the decision maker . What is a moral choice within a public health policy?   Key words: public health, the ethical dilemma, naturalis

Present and future possibilities for early diagnosis of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) represents the fifth most common cancer in the world, and the third most frequent oncological cause of death. The incidence of HCC is on the increase. HCC typically develops in patients with chronic liver diseases, and cirrhosis, usually with viral etiology, is the strongest predisposing factor. Nowadays HCC diagnosis is a multistage process including clinical, laboratory, imaging and pathological examinations. The prognosis of HCC is mostly poor, because of detection at an advanced, non-resectable stage. Potentially curative treatment (surgery) is limited and really possible only for cases with small HCC malignancies. For this reason, more effective surveillance strategies should be used to screen for early occurrence of HCC targeted to the population at risk. So far, the generally accepted serological marker is α-fetoprotein (AFP). Its diagnostic accuracy is unsatisfactory and questionable because of low sensitivity, therefore there is a strong demand by clinicians for new HCC-specific biomarkers. In this review, we will focus on other biomarkers that seem to improve HCC diagnosis, such as AFP-L3, des-γ-carboxyprothrombin, α-l-fucosidase, γ-glutamyl transferase, glypican-3, squamous cell carcinoma antigen, a new generation of immunoglobulin M-immunocomplexes, and very promising gene-expression profiling

Pigment epithelium-derived factor and matrix metalloproteinase-9 in liver cirrhosis

Background/Aim: The aim of this study was to assess the role of serum pigment epithelium-derived factor (PEDF) and matrix metalloproteinase-9 (MMP-9) in progression of liver cirrhosis and development of hepatocellular carcinoma (HCC). Patients and Methods: Serum levels of PEDF and MMP-9 were tested in 212 patients with liver cirrhosis and in a control group of 30 healthy volunteers. HCC was diagnosed in 45 of the 212 patients studied (21%). Results: Serum PEDF and MMP-9 were higher in the study group than that in the control group (P < 0.001). In patients with alcoholic or mixed (alcoholic and viral hepatitis-related) cirrhosis, serum PEDF was higher than that in other patients (13970.2 ± 13406.9 ng/ml vs. 8563.5 ± 9602.7 ng/ml, P = 0.008). In patients with viral hepatitis-related cirrhosis, significantly higher PEDF levels were recorded in those with HCC (13429.1 ± 12045.8) than that in patients without HCC (6660.1 ± 7927.1; P = 0.04). There was a trend for higher serum MMP-9 in patients with HCC (5778.7 ± 12426.6 vs. 1389.8 ± 1944.7 in those without HCC; P = 0.07). Significant negative correlation between serum MMP-9 and serum alpha-fetoprotein in patients with HCC was observed (r = −0.54; P = 0.04). Conclusion: Serum PEDF and MMP-9 could be auxiliary markers in diagnosis of HCC, especially in patients with low alpha-fetoprotein level. Alcohol consumption can affect serum PEDF