Profilaktyka nowotworów u kobiet w Polsce. Sukces, czy niepowodzenie? Opinie pacjentów, lekarzy i instytucji odpowiedzialnych za stan zdrowia – metaanaliza = Prevention of cancer in women in Poland. Success or failure? Opinions of patients, physicians and institutions responsible for health – meta-analysis

Kołłątaj Witold, Karwat Irena Dorota, Kołłątaj Barbara, Piecewicz-Szczęsna Halina, Sowa Magda. Profilaktyka nowotworów u kobiet w Polsce. Sukces, czy niepowodzenie? Opinie pacjentów, lekarzy i instytucji odpowiedzialnych za stan zdrowia – metaanaliza = Prevention of cancer in women in Poland. Success or failure? Opinions of patients, physicians and institutions responsible for health – meta-analysis. Journal of Education, Health and Sport. 2016;6(6):318-328. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.55608 http://ojs.ukw.edu.pl/index.php/johs/article/view/3585 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: 05.05.2016. Revised 25.05.2016. Accepted: 10.06.2016. Profilaktyka nowotworów u kobiet w Polsce. Sukces, czy niepowodzenie? Opinie pacjentów, lekarzy i instytucji odpowiedzialnych za stan zdrowia – metaanaliza Prevention of cancer in women in Poland. Success or failure? Opinions of patients, physicians and institutions responsible for health – meta-analysis Witold Kołłątaj1, Irena Dorota Karwat2, Barbara Kołłątaj2, Halina Piecewicz‑Szczęsna2, Magda Sowa3 1Klinika Endokrynologii i Diabetologii Dziecięcej, Uniwersytet Medyczny w Lublinie 2Katedra i Zakład Epidemiologii i Metodologii Badań Klinicznych, Uniwersytet Medyczny w Lublinie 3Katedra i Zakład Zdrowia Publicznego, Uniwersytet Medyczny w Lublinie Adres do korespondencji: dr hab. n. med. Witold Kołłątaj Klinika Endokrynologii i Diabetologii Dziecięcej z Pracownią Metaboliczną UM w Lublinie ul. Profesora Antoniego Gębali 6, 20-093 Lublin e-mail: [email protected] Słowa kluczowe: nowotwory, profilaktyka, kobiety, opinie, metaanaliza. Keywords: cancer prevention, women, opinions, meta-analysis. Streszczenie Wstęp Choroby nowotworowe od wielu lat stanowią w Polsce drugą przyczynę zgonów. Co roku, z tego powodu, umiera niemal 100 000 osób, a liczba zgonów ma tendencję rosnącą. Wyniki leczenia nowotworów w Polsce są gorsze, niż w krajach Europy, diagnostyka często spóźniona, a profilaktyka niewystarczająco skuteczna. W celu poprawy stanu zdrowa społeczeństwa, rosną nakłady na leczenie i profilaktykę. W Polsce profilaktykę koordynuje Narodowy Program Zwalczania Chorób Nowotworowych. Cel pracy Celem pracy jest próba rzetelnej oceny stanu profilaktyki nowotworów u kobiet w Polsce, uwzględniającej opinie zarówno organów odpowiedzialnych za ochronę zdrowia, lekarzy, organów kontroli, jak i pacjentów. Materiał i metody Materiał stanowiły sprawozdania podmiotów odpowiedzialnych za realizację profilaktyki nowotworów u kobiet, akty prawne, publikacje naukowe oceniające realizację profilaktyki nowotworów u kobiet w Polsce oraz dane z Audytu Społecznego Narodowych Programów Profilaktyki Nowotworowej. Wyniki i omówienie Ministerstwo Zdrowia oraz Narodowy Fundusz Zdrowia publikują dane, które podkreślają osiągnięcia profilaktyki nowotworów u kobiet w Polsce, natomiast opinie fachowych pracowników służby zdrowia (wyrażone w konkluzji realizowanych prac badawczych) oraz pacjentów wskazują na znaczne dysproporcje między założeniami programów profilaktycznych a ich faktyczną realizacją. Wśród niedociągnięć wymieniane są przede wszystkim niewystarczające działania edukacyjne, niedociągnięcia organizacyjne (nieuwzględnianie w harmonogramie badań grafiku pracy pacjentek, niewłaściwe informowanie o terminach badań, błędy w dystrybucji wezwań na badanie, nieprzyjazne kobietom warunki badania) oraz inne czynniki, które kobiety określają, jako podważające zaufanie do jakości badania. Najwięcej negatywnych emocji budzi stan komunikacji z grupami docelowymi kobiet oraz zaniedbania z zakresu edukacji. Wnioski Optymistyczne oceny osiągnieć Narodowego Programu Zwalczania Chorób Nowotworowych ogłoszone przez Ministerstwo Zdrowia nie znajdują pełnego pokrycia w opiniach zarówno organów kontrolnych, pacjentów, jak i środowiska medycznego. Liczne negatywne oceny programów profilaktycznych oraz sugestie głębokich reform Narodowego Programu Zwalczania Chorób Nowotworowych nie mają wpływu na plany Ministerstwa Zdrowia. Celowym wydaje się analiza przyczyn takiego stanu rzeczy, kiedy to opinie świata nauki, wyrażane między innymi w publikacjach naukowych, nie skłaniają Ministerstwa Zdrowia do refleksji lub przynajmniej do wszczęcia polemiki ze środowiskiem naukowym i lekarzami praktykami. Summary Introduction For many last years, neoplastic diseases have been the second cause of death in Poland. Every year, such diseases are the reasons for almost 100 000 cases of death. The mortality because of neoplasms has got the increasing tendency. The results of cancer treatment in Poland are worse than in many European countries, diagnoses often delayed and the prevention insufficiently effective. In order to improve the health status of Polish population, the expenditures on treatment and prevention have been slightly raised. In Poland, the prevention is coordinated by the National Cancer Control Program. Aim The aim of the study was the assessment of cancer prevention in women in Poland, taking into account opinions of both Polish Ministry of Health, audit institutions, patients and the medical community. Material and methods The material consists of the reports of entities responsible for the implementation of cancer prevention in women, legislative acts, scientific publications evaluating the implementation of the prevention of cancer in women in Poland as well as data from the National Social Audit Program Cancer Prevention. Results and Discussion While the Ministry of Health and the National Health Fund publish data that highlight the achievements, medical community's opinions (expressed as the conclusions of ongoing researches) as well as the opinions of patients show a significant disparity between the objectives of prevention programs and their actual implementations. Among mentioned shortcomings there are: educational and organizational negligence (working hours of facilities dealing with the prevention are coinciding with the working hours of women, incorrect information about the terms of preventive procedures, improper schemes of distribution of calls for screenings, embarrassing and unpleasant conditions of screenings) as well as other factors that women define as those that prejudice them to take part in such medical procedures. The most negative emotions concern the mechanisms of communication between screening centers and the target groups of women and educational negligence. Conclusions 1. The optimistic assessment of achievements of the National Cancer Control Program proclaimed by the Polish Ministry of Health are not fully covered in the opinions of audit institutions, patients and the medical community. 2. Numerous negative opinions concerning prevention programs and suggestions of deep reform of the National Cancer Control Program have no effect on the plans of the Polish Ministry of Health. 3. It seems appropriate to analyze the causes of this state of affairs, when the opinions expressed by medical community, among others, published as scientific publications, do not tend to reflect the Ministry of Health, or at least to initiate a polemic with the medical-scientific experts and practitioners

Meeting needs for rehabilitation equipment and home adjustments among the disabled in their life environment

Introduction The elimination of functional barriers resulting from disability through the provision of adequate orthopaedic and rehabilitation equipment, and homes adjusted for disability is the precondition for an efficient and independent functioning, and high quality of life of the disabled. The objective of the study was recognition of the needs of the disabled declared by them, and the degree of satisfaction with these needs. Material and Methods The study covered 478 disabled from the Lublin Region. The research instrument was the ‘Questionnaire for the Disabled’ designed by the authors. Results Considering the needs expressed by the respondents concerning the provision of orthopaedic and rehabilitation equipment and meeting these needs, four groups were distinguished: No Needs – 30.1%, Needs Partially Met – 22.4%, Needs Fully Met – 37.7%, Needs Not Met – 9.8%. The group Needs Not Met was characterized by younger age, in the group Needs Partially Met worse indicators of the state of health were noted, more frequent independent living, loneliness and low material standard. Considering the expressed needs for home adjustments adequate to disability and meeting these needs, three groups were distinguished: No Needs – 59.6%, Needs Not Met – 15.9%, and Needs Met – 24.7%. The group Needs Not Met more rarely covered respondents living in residential homes, compared to those living independently in rural or urban areas. The group Needs Met more rarely included rural inhabitants, while more frequently including the disabled who had a high material standard. Conclusions Both the provision of orthopaedic equipment and adjustment of the home to disability are insufficient with respect to the needs. The meeting of these needs is significantly conditioned by high or very high material standard. The lack or incomplete satisfaction with the needs for rehabilitation equipment is associated with a relatively younger age, independent, single residence and low material standard. Living in an residential home means better adjustment of the living environment, and better provision with orthopaedic and rehabilitation equipment

Successes and pitfalls of chronic peritoneal dialysis in infants – a Polish nationwide outcome study

Introduction: Peritoneal dialysis (PD) is a preferred method of renal replacement therapy for end-stage renal disease in children. Recent advances have allowed chronic PD to be provided to children of all ages and sizes. Material and methods: The study was designed as a national (10 dialysis centres), multicentre retrospective analysis of the medical history of 33 children who started chronic peritoneal dialysis in their infancy between 1993 and 2005, with a follow-up period of at least 24 months. Results: The nutritional status of the infants was unsatisfactory. The mean SDS of body weight at the start was -2.0, at 1 year of age -1.7. Only 40% of infants were adequately nourished at 1 year of age. Long-term follow-up analysis showed that 12 children received a kidney transplant, 13 were still on dialysis (4 changed method) and 6 died (mortality rate in the first year of life of 9%). In 2 children we observed an improvement of renal function. We observed a relatively high (1/8.8 patient-months) peritonitis rate in the analysed children when compared to 1 : 22 patient-months in all children undergoing PD in Poland. Conclusions: The results of our survey have shown that the management of dialysed infants is still a challenge for the medical team and families, but longterm results of the therapy are encouragin

Hypertension treatment preferences in long-term dialysed children in Poland : a survey of pediatric nephrologists

Wstęp Przewlekła choroba nerek prowadzi do rozwoju nadciśnienia tętniczego u większości chorych. Leczenie nadciśnienia towarzyszącego niewydolności nerek jest utrudnione przez ograniczenia w stosowaniu wielu preparatów i brak wystarczających doświadczeń klinicznych, a ponadto istniejące obecnie rekomendacje nie obejmują w ogóle chorych ze schyłkową niewydolnością nerek. Wybór terapii hipotensyjnej ogranicza też młody wiek chorych, gdyż wielu leków nie można stosować u dzieci. Celem badania była analiza jakości leczenia przeciwnadciśnieniowego u dzieci ze schyłkową niewydolnością nerek poddawanych przewlekłej dializoterapii. Materiał i metody Analizą objęto wszystkie dzieci dializowane w Polsce w dniu 30 listopada 2004 roku (n = 134). Uzyskano informacje dotyczące grup stosowanych leków oraz dawek preparatów, a także opinie lekarzy na temat doboru leków stosowanych przy nagłym wzroście ciśnienia tętniczego oraz tych, których dzieciom dializowanym nie powinno się podawać. Wyniki Nadciśnienie tętnicze stwierdzono u 74 (55%) dzieci (47 chłopców, 27 dziewczynek). Najczęstszą przyczyną niewydolności nerek w grupie dzieci z nadciśnieniem było kłębuszkowe zapalenie nerek (27/74). W badanej grupie 65% dzieci leczono za pomocą kilku leków hipotensyjnych, 32% za pomocą jednego leku, a 3% jedynie metodami niefarmakologicznymi. Mimo aktywnego leczenia, zaledwie u 58% dializowanych dzieci prowadziło ono do obniżenia wartości ciśnienia tętniczego poniżej 95 percentyla dla wzrostu i wieku. Najmniejszą skuteczność kontroli ciśnienia tętniczego obserwowano w przypadku leczenia skojarzonego, zwłaszcza wielolekowego. Najczęściej stosowanymi lekami byli antagoniści wapnia, które podawano u ogółem 73% dzieci, w tym u 43/48 w politerapii, a 11/24 w monoterapii. Inhibitory konwertazy angiotensyny były najczęściej stosowane w monoterapii (50%). Mimo znanych kontrowersji, przy nagłym wzroście ciśnienia tętniczego stosowano najczęściej nifedipinę. Wnioski Badanie wykazało, że w Polsce odsetek dializowanych dzieci wymagających leczenia nadciśnieniowego sięga 55%, w tym większość z nich wymaga podawania kilku leków. Pomimo że zasady leczenia są podobne we wszystkich ośrodkach, skuteczność leczenia pozostaje niezadowalająca (58%).Background Chronic kidney disease is associated with the development of arterial hypertension in a vast majority of patients. The treatment of hypertension in these subjects is difficult and challenging due to a limited clinical experience with most drugs and no widely recognised recommendations for patients with end-stage renal disease. A choice of antihypertensive drugs is further narrowed by the young age of the patients since almost all drugs are not recommended in children with renal failure. The aim of this nationwide retrospective analysis was to assess the hypertension treatment patterns in the population of children with chronic kidney diseases (CKD) undergoing hemodialysis or peritoneal dialysis in Poland. Material and methods Among all 134 children dialysed on 30th November 2004 in 13 pediatric dialysis centres in Poland seventy four (55%; 47M, 27F) children were hypertensive. For each patients the treating physicians filled a questionnaire that allowed to collect the following data: the primary kidney disease, chronic dialysis treatment, diagnostic criteria of hypertension and present antihypertensive medication if any. Additionally we asked of the doctors’ preference for a therapy for the acute rise in blood pressure and suggestions which drugs, in their opinion, should not be used in dialysed children. Results In the hypertensive dialysed patients the most frequent causes of chronic kidney disease were chronic glomerulopathies (27/74). Thirty two percent of children were on monotherapy whereas 65% required combined treatment. The therapy was adequate only in 58% of subjects. The lowest rate of efficacy was detected in patients requiring a combined antihypertensive therapy. Among antihypertensive drug classes calcium channel blockers were administered most frequently (in 73% of children, in 11/24 cases in monotherapy and in 43/48 patients in combination). Angiotensin converting enzyme inhibitors were most frequently administered in monotheraphy (50%). Nifedipine was preferred in acute blood pressure rise in children. Conclusion We conclude that incidence of hypertension in dialysed children in Poland is relatively high. The pattern of the treatment was quite uniform, although the efficacy was relatively low (58%)

Hypertension treatment preferences in long-term dialysed children in Poland - a survey of pediatric nephrologists

Wstęp Przewlekła choroba nerek prowadzi do rozwoju nadciśnienia tętniczego u większości chorych. Leczenie nadciśnienia towarzyszącego niewydolności nerek jest utrudnione przez ograniczenia w stosowaniu wielu preparatów i brak wystarczających doświadczeń klinicznych, a ponadto istniejące obecnie rekomendacje nie obejmują w ogóle chorych ze schyłkową niewydolnością nerek. Wybór terapii hipotensyjnej ogranicza też młody wiek chorych, gdyż wielu leków nie można stosować u dzieci. Celem badania była analiza jakości leczenia przeciwnadciśnieniowego u dzieci ze schyłkową niewydolnością nerek poddawanych przewlekłej dializoterapii. Materiał i metody Analizą objęto wszystkie dzieci dializowane w Polsce w dniu 30 listopada 2004 roku (n = 134). Uzyskano informacje dotyczące grup stosowanych leków oraz dawek preparatów, a także opinie lekarzy na temat doboru leków stosowanych przy nagłym wzroście ciśnienia tętniczego oraz tych, których dzieciom dializowanym nie powinno się podawać. Wyniki Nadciśnienie tętnicze stwierdzono u 74 (55%) dzieci (47 chłopców, 27 dziewczynek). Najczęstszą przyczyną niewydolności nerek w grupie dzieci z nadciśnieniem było kłębuszkowe zapalenie nerek (27/74). W badanej grupie 65% dzieci leczono za pomocą kilku leków hipotensyjnych, 32% za pomocą jednego leku, a 3% jedynie metodami niefarmakologicznymi. Mimo aktywnego leczenia, zaledwie u 58% dializowanych dzieci prowadziło ono do obniżenia wartości ciśnienia tętniczego poniżej 95 percentyla dla wzrostu i wieku. Najmniejszą skuteczność kontroli ciśnienia tętniczego obserwowano w przypadku leczenia skojarzonego, zwłaszcza wielolekowego. Najczęściej stosowanymi lekami byli antagoniści wapnia, które podawano u ogółem 73% dzieci, w tym u 43/48 w politerapii, a 11/24 w monoterapii. Inhibitory konwertazy angiotensyny były najczęściej stosowane w monoterapii (50%). Mimo znanych kontrowersji, przy nagłym wzroście ciśnienia tętniczego stosowano najczęściej nifedipinę. Wnioski Badanie wykazało, że w Polsce odsetek dializowanych dzieci wymagających leczenia nadciśnieniowego sięga 55%, w tym większość z nich wymaga podawania kilku leków. Pomimo że zasady leczenia są podobne we wszystkich ośrodkach, skuteczność leczenia pozostaje niezadowalająca (58%).Background Chronic kidney disease is associated with the development of arterial hypertension in a vast majority of patients. The treatment of hypertension in these subjects is difficult and challenging due to a limited clinical experience with most drugs and no widely recognised recommendations for patients with end-stage renal disease. A choice of antihypertensive drugs is further narrowed by the young age of the patients since almost all drugs are not recommended in children with renal failure. The aim of this nationwide retrospective analysis was to assess the hypertension treatment patterns in the population of children with chronic kidney diseases (CKD) undergoing hemodialysis or peritoneal dialysis in Poland. Material and methods Among all 134 children dialysed on 30th November 2004 in 13 pediatric dialysis centres in Poland seventy four (55%; 47M, 27F) children were hypertensive. For each patients the treating physicians filled a questionnaire that allowed to collect the following data: the primary kidney disease, chronic dialysis treatment, diagnostic criteria of hypertension and present antihypertensive medication if any. Additionally we asked of the doctors’ preference for a therapy for the acute rise in blood pressure and suggestions which drugs, in their opinion, should not be used in dialysed children. Results In the hypertensive dialysed patients the most frequent causes of chronic kidney disease were chronic glomerulopathies (27/74). Thirty two percent of children were on monotherapy whereas 65% required combined treatment. The therapy was adequate only in 58% of subjects. The lowest rate of efficacy was detected in patients requiring a combined antihypertensive therapy. Among antihypertensive drug classes calcium channel blockers were administered most frequently (in 73% of children, in 11/24 cases in monotherapy and in 43/48 patients in combination). Angiotensin converting enzyme inhibitors were most frequently administered in monotheraphy (50%). Nifedipine was preferred in acute blood pressure rise in children. Conclusion We conclude that incidence of hypertension in dialysed children in Poland is relatively high. The pattern of the treatment was quite uniform, although the efficacy was relatively low (58%)

Selected health and social needs resulting from state of health of disabled rural inhabitants from the aspect of problems with defining disability

Introduction The state of health of an individual and the population depends on many factors, their number and type constituting a specific background of consequences which model the level of health. Human health status is determined by so many factors that despite many scientific studies, also from philosophical aspect, to-date an unequivocal determination of the term – health has not been possible. A similar situation concerns the defining of disease and states of disability. Determination of the dimensions of disability in this respect should be based on a long-term, multi-stage prospective population epidemiological studies, with consideration of constantly performed corrections in order to specify health and social needs. Place of residence, i.e. rural or urban area, is one of the factors which condition the state of health of an individual and the population. Objective The aim of the study was presentation of the most important medical and social problems resulting from the state of health of adult disabled persons living in rural areas from the aspect of defining disability. The main goal was pursued based on two sources of results of research, the first of which were the results of a study conducted within the system of statutory research at the Chair and Department of Epidemiology, Medical University in Lublin. The other source were the results of studies published by other researchers concerning the discussed problem. Selected results of own study and studies by other researchers The article presents the selected results of studies which constitute a certain type of a compendium of scientifically documented problems of the disabled, with particular consideration of such characteristics as: place of residence, causes of disability, objective and subjective state of health, health and social needs. On the level of organization of some studies the dimensions of disability were also considered in rural settlements, communes and provinces. In 1987-1990, a study of the disabled was carried out by a team of researchers from the Institute of Rural Health in randomly selected rural areas of agricultural and industrialized character. Parallel to the above-mentioned study, a comprehensive, all-Polish research of the state of health of rural population was conducted at the Institute of Rural Health. Among the many goals of these studies was the assessment of the state of health and determination of medical and social needs of the disabled. In order to perform a reliable and valid evaluation for the qualification of the examined population of the disabled a 5-degree scale of medical epicrisis was developed. A relatively large research task concerned the epidemiological trends in the occurrence of chronic diseases and the size of disability in Poland during 1990-2006. Own research instruments and data from the reports by the Main Statistical Agency (GUS) and other institutions were used for analysis. The subsequent research task concerned analysis of the selected epidemiological characteristics of disability in Poland and their importance for health care organizations. Patients in hospital wards were examined, as well as primary health care units, specialist outpatient departments, residential homes and occupational therapy workshops. The main aim of the next research task (2013-2015) was determination of the trends in the occurrence of the most important problems of the disabled, according to the cause of disability, as well as the importance of the obtained study results for health care organizations and health policy in the Lublin Province. Also, Lech Panasiuk dealt with the selected characteristics of the state of health of rural inhabitants, and performed analysis of the most important medical and social problems of adult inhabitants of the Lublin Province. The results of studies published by other Polish and international institutions were also presented. Summary and conclusions Similar to many countries, the percentage of the disabled in Polish society is determined in terms of estimates. The main reason for such a situation is the lack of uniform methods and principles of qualification of persons into the group of the disabled. The greatest problems of the disabled living in rural areas include multimorbidity, lack or insufficient provision of rehabilitation, orthopaedic equipment and technical aids, loneliness and various forms of discrimination. It is necessary to carry out multi-thematic health education addressed to rural inhabitants, both the disabled and healthy. Great hopes for improving the quality of life of people with disabilities are connected with the philosophy of the International Classification of Functioning, Disability and Health. To-date, this is the only classification addressing the need for unification of the assessment of the state of health, with consideration of the environment where the disabled person lives, and evaluation of this person’s potential. Similar to earlier Classifications and definitions, the ICF is a ‘live’ classification because efforts are still continuing to make it more comprehensive and detailed

Comparison of the quality of night paediatric urgent care in rural and urban areas of Lublin Province, eastern Poland – Appraisals by parents of children requiring medical attention

Introduction The quality of primary medical care for children in Poland is unsatisfactory. In the ranking known as ‘the European Health Consumer Index’, Poland (taking the patient point of view on healthcare quality) is classified on the 27th position out of the 33 possible. The unsolved problems concern inter alia the quality and availability of night paediatric urgent care. Objective The aim was assessing the quality as well as the level of satisfaction with the night paediatric urgent care in the Lublin Province of eastern Poland. Material and Methods The materials for this study consisted of 540 parents of children aged 6–16 years benefiting from night paediatric urgent medical assistance in Lublin Province. The survey was conducted using the Original Survey Questionnaire. Results Inhabitants of the Lublin Province (regardless of place of residence) generally assessed the quality and accessibility of night paediatric urgent care facilities as only satisfactory. Inhabitants living in rural areas have worse access to night paediatric urgent care facilities because of having to travel greater distances, and receive less comprehensive medical assistance than inhabitants living in more urbanized areas, and they are more often referred to hospital emergency departments. During the past five years, both the availability and quality of night paediatric urgent care did not change significantly. Conclusions Inhabitants of the Lublin Province (regardless of place of residence) generally assessed the quality as well as accessibility of night paediatric urgent care facilities as only satisfactory. Rural residents have more reasons for dissatisfaction than urban dwellers. Both the quality and availability of such medical care needs to be improved

E-patient as a challenge for physicians

pacjent, choroba, lekar

Male infertility and human environmental pollution

Introduction. Man is the only being that has created an artificial environment, or civilization. The development of civilization entails changes in the environment. The rapid growth of the impact of human economic activity has led to such changes that are able to threaten not only other living creatures but also themselves. Increasing environmental pollution are well-known factors negative influencing on human environment. Is now a global problem. Anthropogenic pollution contribute to the unfavorable demographic changes and grooving number of health problems of the population. Unfavourable demographic changes manifest themselves as not only increment in the number of deaths and malformations (defects in the reproductive organs), but also as decrement in the fertility rates being the consequence of increasing the growing problem of couples infertility. There is observed the increasing role of male factor in the couple infertility problem. In some developed countries its participation rate reaches 50%. Objective. The aim of the study is to assess the impact of environmental pollution on human development and reproductive function of male gonads. Material and methods. The study was carried out using the method of data analysis published in the works and scientific reports. Current state of knowledge. The paper presents information on identified environmental pollution with proven adverse effects on the development of the gonads and the their reproductive function. There are also known possible negative impacts of environmental pollution on carcinogenesis in male gonads. Wider awareness of the negative impact of environmental pollution and attempts put emphasis on primary prevention can give better long-term effects than increasing spending on the therapies of developmental disorders as well as gonadal dysfunctions symptoms including fertility problems. Conclusions. • Among the environmental pollutants there are many chemicals adversely affecting the organogenesis as well as reproductive function of testicles. • Many of these contaminants are pesticides or chemicals currently approved for use in agriculture and industry, including the food and cosmetics industry. • Those chemicals, adversely affecting organogenesis and testicular generative function, are present in air, water and foods, packaged foods and everyday objects - including clothes (ingredients sponges), perfumes, creams and detergents. • The increase in environmental pollution coincides with the deterioration of sperm quality and reduction in male infertility in highly civilized countries. • Striving for continuous reduction of the environmental seems to be necessary to stop the growing problem of couples infertility

Samoleczenie wśród studentów medycyny Uniwersytetu Medycznego w Lublinie = Self-medication practice among medical students of Medical University in Lublin

Sowa Magda, Kołłątaj Witold, Kołłątaj Barbara, Karwat Irena Dorota, Szakuła Justyna. Samoleczenie wśród studentów medycyny Uniwersytetu Medycznego w Lublinie = Self-medication practice among medical students of Medical University in Lublin. Journal of Education, Health and Sport. 2015;5(7):439-452. ISSN 2391-8306. DOI 10.5281/zenodo.20851 http://ojs.ukw.edu.pl/index.php/johs/article/view/2015%3B5%287%29%3A439-452 https://pbn.nauka.gov.pl/works/589949 http://dx.doi.org/10.5281/zenodo.20851 Formerly Journal of Health Sciences. ISSN 1429-9623 / 2300-665X. Archives 2011–2014 http://journal.rsw.edu.pl/index.php/JHS/issue/archive   Deklaracja. Specyfika i zawartość merytoryczna czasopisma nie ulega zmianie. Zgodnie z informacją MNiSW z dnia 2 czerwca 2014 r., że w roku 2014 nie będzie przeprowadzana ocena czasopism naukowych; czasopismo o zmienionym tytule otrzymuje tyle samo punktów co na wykazie czasopism naukowych z dnia 31 grudnia 2014 r. The journal has had 5 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 1089. (31.12.2014). © The Author (s) 2015; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland and Radom University in Radom, 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/3.0/) 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/3.0/) 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: 20.06.2015. Revised 15.07.2015. Accepted: 15.07.2015.   Samoleczenie wśród studentów medycyny Uniwersytetu Medycznego w Lublinie Self-medication practice among medical students of Medical University in Lublin   Magda Sowa1, Witold Kołłątaj2, Barbara Kołłątaj3, Irena Dorota Karwat3, Justyna Szakuła4   1Katedra i Zakład Zdrowia Publicznego Uniwersytetu Medycznego w Lublinie 2Klinika Endokrynologii i Diabetologii Dziecięcej z Pracownią Endokrynologiczno - Metaboliczną Uniwersytetu Medycznego w Lublinie 3Katedra i Zakład Epidemiologii Uniwersytetu Medycznego w Lublinie 4Katedra Zdrowia Publicznego, Wydział Nauk o Zdrowiu Uniwersytetu Medycznego w Lublinie   Adres do korespondencji: dr hab. n. med. Witold Kołłątaj Klinika Endokrynologii i Diabetologii Dziecięcej z Pracownią Metaboliczną UM w Lublinie ul. Profesora Antoniego Gębali 6, 20-093 Lublin e-mail: [email protected]   Słowa kluczowe: samoleczenie, studenci medycyny, leki OTC.   Streszczenie   Wstęp Samoleczenie polega na samodzielnie podjętym przez chorego działaniu, polegającym na stosowaniu leków lub aplikowaniu metod leczniczych, bądź mających potencjalne właściwości  lecznicze, w celu przywrócenia zdrowia lub poprawy jakości życia. Głównymi powodami, dla których ludzie sami podejmują próby leczenia są uwarunkowania kulturowe, brak czasu, niedostatki finansowe, trudny dostęp do lekarzy specjalistów (kolejki), przekonanie, iż błahe dolegliwości nie wymagają pomocy specjalisty, oraz łatwy dostęp do wielu środków leczniczych. Cel pracy Celem pracy była ocena zjawiska samoleczenia wśród studentów medycyny Uniwersytetu Medycznego w Lublinie. Materiał i metody Badaniem zostali objęci studenci medycyny Uniwersytetu Medycznego w Lublinie. Dobór próby dokonany został metodą doboru proporcjonalnego reprezentatywnego. Liczba osób poddana badaniu była proporcjonalna do liczby osób z poszczególnych lat studiów.  W badaniu udział wzięło 267 studentów w wieku 19-32 lat życia, w tym 168 kobiet (62,9%) i 99 mężczyzn (37,1%). Metodą badawczą był sondaż diagnostyczny, a narzędziem badawczym Autorski Kwestionariusz Ankiety. Badanie przeprowadzono w październiku 2014. Wyniki Termin samoleczenie kojarzy się studentom medycyny na ogół z samodzielnym (bez konsultacji z lekarzem) stosowaniem leków do odręcznej sprzedaży – OTC (over-the-counter drugs) (71% ankietowanych) oraz ze stosowaniem tak zwanych domowych sposobów leczenia (60%). Spośród badanych, 23% studentów metody samoleczenia stosowało „zawsze” lub „niemal zawsze” w razie pojawienia się objawów chorobowych, 58% – okazyjnie,  11% nigdy. Wśród osób decydujących się na samoleczenie, najpopularniejsze było stosowanie leków OTC (99% ankietowanych), fitoterapia (27%), ciepłe okłady i plastry rozgrzewające (24.8%)  oraz środki spożywcze używane w sposób niekonwencjonalny (21%). Studenci medycyny bardzo chętnie sięgają po leki OTC. Niemal 90% przyznało, iż zdarza im się z takich leków korzystać, chociaż tylko 6% wyraziło opinię, że takie leki są w pełni bezpieczne i nie stwarzają żadnego zagrożenia dla pacjenta. Stosowanie leków OTC tłumaczą najczęściej łatwością ich zakupu (56% ankietowanych), wcześniej uzyskanymi dobrymi  efektami terapeutycznymi (36%) i atrakcyjną ceną (16%). Wśród OTC studenci medycyny preferują leki „na przeziębienie i grypę”, przeciwbólowe i przeciwzapalne, leki z innych grup stosowane są zdecydowanie rzadziej. Wnioski • Studenci medycyny chętnie korzystają z metod samoleczenia. Tylko 11% ankietowanych studentów medycyny nigdy nie korzystało z tych metod leczenia. • Studenci najchętniej sięgają po leki grupy OTC i fitoterapię. • Ze względu na wysoką liczbę osób stosujących metody samoleczenia, należy podjąć próby skutecznej edukacji młodzieży akademickiej w zakresie zalet i wad stosowania takiej formy terapii.   Keywords: self-treatment, students of medicine, OTC drugs.   Summary   Introduction The phenomenon of self-medication is defined as using drugs or applying treatment methods with potential therapeutic properties without consultation or consent of a doctor in order to restore health or improve quality of life. The main reasons why people attempt to treat themselves are cultural factors, lack of time, financial shortcomings, difficult access to specialists (queues), the belief that trivial ailments do not require a specialist, and easy access to a variety of medications. Aim of the study The aim of the study was to assess the scope of phenomenon of self-medication among medical students of the Medical University of Lublin. Materials and methods The survey were conducted among medical students of the Medical University of Lublin. The study group consisted of representative samples of all 1-6 year study groups.  The study involved 267 students aged between 19-32 years, including 168 women and 99 men. There was used the diagnostic survey method based on the author's questionnaire. The study was conducted in October 2014. Results Medical students, usually, define the term self-treatment as an independent (without consulting a doctor) use of OTC (over the counter) medications (71% of respondents) or so-called home treatment (60%) applied to restore health or improve quality of life. Among the surveyed  students 23% of respondents use methods of self-treatment "always" or "almost always" in case of any symptoms of the disease appearance, 58% – of polled do it occasionally, 11% have never applied such methods of treatment. Among those opting for self-treatment, the most common was the use of OTC drugs (99% of respondents), herbal medicine (27%), warm poultices and warming plasters applying (24.8%) and foodstuffs used in an unconventional way (21%). Medical students are very eager to use OTC drugs. Almost 90% polled confessed that they had been using such drugs in the past, although only 6% of them checked the opinion that such drugs are completely safe and do not pose any danger to the patient. The attitude towards use of OTC drugs has been explained by students by ease of purchase (56%), previously obtained good therapeutic effects (36%) and attractive price (16%). Polled medical students prefer OTC "cold and flu", analgesic and anti-inflammatory medications. Other OTC drugs are used by them much less frequently. Conclusions • Medical students are willing to use methods of self-treatment. Only 11% of polled medical students have never applied such methods of treatment. • While opting for self-medication, they usually use OTC drugs and herbal medicine methods. • Due to the high number of medical students using self-medications methods, it should be made attempts to improve education of students on the advantages and disadvantages of using of these forms of therapy