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Introduction and Objective: Women comprise the majority of emergency call-takers and dispatchers (ECDs) in Poland. This workplace requires high mental resilience, control and tolerance of unpredictable events. Working during the first waves of the COVID-19 pandemic may have been particularly overburdening for female ECDs. The aim of the study was to estimate the level of perceived life stress and its relationship with marital status, number of children, education level, workplace requirements, and number of shifts., Material and Methods: A cross-sectional survey was conducted among 308 women working in 14 emergency call centres during the first waves of the COVID-19 pandemic. The survey employed The Perceived Stress Scale (PSS-10). A multivariate analysis of the effect of multiple variables on the quantitative variable was conducted using the linear regression method., Results: The study confirmed the assumption about the high level of perceived stress during the first wave of the pandemic. It was revealed that for one-third of the women, the level of perceived stress was high and related to the number of on-call duties and the number of children at home. Higher education co-occurred with higher levels of women's helplessness, while being married co-occurred with its lower levels. There were differences in the level of stress due to workplace requirements., Conclusions: Female ECDs face additional life stress because of the gender roles. In the analysis of the effects of the pandemic, the gender dimension should be taken into account in the assessment of public health.

It is known that the perception of bitterness is mediated by type 2 bitter taste receptors (TAS2Rs). However, recent reports have suggested that the carbonic anhydrase 6 (CA6) gene may also influence bitterness sensing. Genetic variants in these genes could influence dietary intake of brassica vegetables, whose increased consumption has been observed in the literature, though inconsistently, to decrease breast cancer (BC) risk. We hypothesized that the estimated odds ratios (ORs) for the association between BC and taster diplotype (PAV/PAV) and/or genotype A/A, will be in the direction of increased BC risk, potentially due to reduced consumption of brassica vegetables. Using a case-control study of BC in Polish women in Poland (210 cases and 262 controls) and Polish immigrant women to USA (78 cases and 170 controls) we evaluated the association of the taster diplotypes in TAS2R38 gene and genotypes in the CA6 gene and BC risk in these two populations individually and jointly. No significant increase in risk was observed for the TAS2R38 PAV/PAV diplotype (tasters) in each population individually or in the joint population. For the CA6 gene, in the joint population, we observed an increased BC risk for the combined G/A and G/G genotypes (non-tasters) vs A/A (tasters), OR = 1.41 (95% CI 1.04-1.90, p = 0.026) which after adjustment for False Discovery Rate (FDR), was not significant at p≤0.05 level. However, for the joint population and for the combined genotype of the two genes AVI/AVI+G* (non-tasters) vs. PAV/*+A/A (tasters), we observed a significant increase in BC risk, OR = 1.77 (95%CI 1.47-2.74, p = 0.01), for the non-tasters, which remained significant after FDR adjustment. In conclusion for the joint population and the joint effect for the two bitter sensing genes, we observed an increase in BC risk for the bitterness non-tasters, association which is in the opposite direction to our original hypothesis., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Łukasiewicz-Śmietańska et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The outbreak of the COVID-19 pandemic caused the healthcare system to drastically reduce in-person visits and suddenly switch to telemedicine services to provide clinical care to patients. The implementation of teleconsultation in medical facilities was a novelty for most Polish patients. In Poland, the main telehealth services were provided in the form of telephone consultations. The aim of this study is to determine patients' perceptions of telemedicine in the context of their experiences with the healthcare system during the COVID-19 pandemic. In this study, we presented how the evaluation of telemedicine services from the perspective of patients in Poland changed in the context of the ongoing pandemic. We conducted two surveys (year by year) on a representative quota sample of the Polish population (N = 623). This ensured that our observations took into account the evolution of views on telemedicine over time. We confirmed the well-known relationship that innovations introduced in the healthcare sector require a longer period of adaptation. We also identified significant concerns that limit the positive perception of telemedicine and compared them with experiences described in other countries.

Introduction and Objective: Improper diet of children and their preference for sweet taste may be risk factors for the development of obesity and childhood caries. The aim of the study was to evaluate the taste preferences of preschoolers and to estimate the methods used by parents to shape the nutritional behaviour of their children., Material and Methods: The research covered 108 preschool children and 86 parents. All children completed a pictorial questionnaire containing images of 32 food products. The children expressed their preferences (I really like, I like, I don't like) by choosing the appropriate emoji. The questionnaire for parents concerned the diet of children on days off from kindergarten. The nutritional status of children was evaluated on the basis of the BMI. Children with normal weight/underweight and those overweight / obese were compared using χ 2 or the exact Fisher test., Results: Most preschoolers indicated that they liked the most crisps, jam, sweets, chocolate and sweet drinks. They also enjoyed fruits which are naturally sweet: apples (97%) and bananas (94%). The favourite vegetables were cucumbers (84%), potatoes (83%), and carrots (77%). Children had a tendency to make incorrect food choices. Fast food was very popular, while fish was disliked. Parents reported that children like meatless sweet dishes (crêpes, pancakes, dumplings). Such factors as unlimited access to sweets at home (p=0.05) and rewarding/motivation with sweets (p=0.013) were significantly associated with a child's overweight/obesity status. Excess body weight was found in 22.1% of children (overweight - 3.5 %; obesity -18.6%)., Conclusions: Children had a clear preference for sweet taste. Reducing the consumption of sweets and increasing the nutritional awareness of parents and children may prevent the development of childhood obesity.

Objectives: To assess the impact of classical socioeconomic factors on the use and non-use of dental services on a representative sample of Polish population., Methods: The study was based on face-to-face surveys conducted by GUS (Statistics Poland) on 13,376 respondents in 2010 and 12,532 individuals in 2013., Results: The percentage of people using dental services in the highest income group was approximately twice as high as that in the lowest one (Q1: 7.0% vs. Q5: 16.4%), with the same being true for education (the lowest education group: 8.3% vs. the highest education group: 18.0%), and place of residence (inhabitants of rural areas: 9.2% vs. inhabitants of largest cities: 15.9%) in 2013. The analysis has shown the disparities in not using dental services when in need to be less clear-cut., Conclusions: The conducted research, based on two independent periods, a representative population sample, univariate analysis and the multivariate regression model has revealed pronounced social inequalities in dental care use. It is a challenge to determine the factors which contribute most to health inequalities and the interventions which are most effective in reducing them.

Introduction and Objective: Measuring the level of patient satisfaction is a useful tool in delivering quality care that is responsive to consumer preferences. Various socio-demographic factors might be considered as potential predictors of patient satisfaction. The aim of the study was to assess whether place of residence (rural/urban) affects patient satisfaction with hospital health care., Material and Methods: Data were obtained using face-to-face questionnaire, administered in five large, urban hospitals in Podlaskie Province, north-eastern Poland, during 2014-2018. The study sample comprised of 1,624 participants (585 rural, 1039 urban) who assessed satisfaction with 28 hospital health care items. The means and standard deviations were presented to compare 28 satisfaction items between the rural and the urban samples. Regression analysis was used to determine whether location difference (rural vs urban) affected patient satisfaction with various domains of hospital health care., Results: The mean results of 28 satisfaction items on the 1-5 scale were similar among the rural and the urban samples, and generally skewed towards positive experiences. In the univariate analysis, significant associations between place of residence and patient satisfaction were identified with regard to three components of inpatient care: 1) hospital settings and staff care, 2) doctors' professional skills, and 3) hospitalization outcomes. After adjusting for socio-demographic variables, the association remained significant only with respect to satisfaction with hospitalization outcomes (b = 0.121; SE = 0.055; p = 0.028)., Conclusions: Some evidence for differences in patient satisfaction by place of residence was found. Study findings may be helpful in implementing care quality improvement programmes.

Introduction: Low birth weight (LBW) is an important indicator of the healthy of the population and reflects the living conditions, health and health behaviours of pregnant women., Objective: To assess the relationship between Gross Enrollment Rate at the Tertiary Education Level, average salary, Gross Domestic Product per capita, unemployment, housing area, urbanization and low birth weight in Polish sub-regions., Material and Methods: An ecological study was undertaken using data on socio-economic and demographic features and LBW in 2005-2014. The units of observation were 66 Polish sub-regions according to the NUTS-3 classification. Two models were used to assess the influence of SES variables on LBW incidence rate in a 10-year study period. The first was the Poisson regression model adjusted for density of population, which was followed by the multivariable model using the GEE method of model parameters estimation., Results: In Poland, significant slow changes in the LBW incidence rate were observed in 2005-2014 (AAPC = -0.44%/year). In model 1, the increase in LBW was associated with an increase in unemployment (1.005) and decrease of average salary (0.987), GERTEL (0.990) and housing area (0.991). In model 2, an unfavorable association was detected between the density of population (1.068) and a still existing relationship with unemployment (1.004), average salary (0.990) and GERTEL (0.991)., Conclusions: Protective factors for newborns' health were a higher level of education and income. The results indicate the need to take actions to reduce the risk factors of LBW among pregnant women living in densely populated areas.

The purpose of this study was to show that some elements have a proven antioxidative effect and are essential for the proper development and functioning of the human body. The study also assessed the concentration of selected elements and total antioxidant status (TAS) in a group of male inhabitants of Białystok, Poland, who are professionally active in the metal industry. The study group comprised 163 men aged 55-64 years. The concentration of the analyzed elements was determined using flame (Zn and Cu) and electrothermal (Se, Cd, and Pb) atomic absorption spectrometry. Spectrophotometric test kits were used to assay the TAS and glutathione reductase (GR) activity in serum. The results suggested the mean concentration of Se in serum was 54.04 ± 12.10 μg/L, which was below the reference range. A significant negative correlation was observed between the concentration of Se in the serum and Pb and Cd concentrations in the whole blood of the studied men. The concentrations of the other elements, antioxidant potential, and GR activity were within the reference range. A statistically significant positive correlation was observed between Pb and Cd, indicating combined exposure and a considerable negative correlation between lead and selenium as well as between lead and TAS. Selenium and TAS are likely to modify the adverse effects of Pb in the bodies of the studied men. The results indicate that it is necessary to constantly monitor men who are occupationally exposed to heavy metals, maintain a healthy lifestyle, and introduce effective preventive measures at a local level.

Introduction and Objective: One of the main factors determining the burden of breast cancer is the effectiveness of measures taken to combat this cancer including urban-rural differences. The aim of the study was to analyse the differences in breast cancer incidence and disease stage distribution among urban and rural women in the Świętokrzyskie Province as a part of a strategy for breast cancer control., Material and Methods: The study of disease stage distribution included 483 female residents of Świętokrzyskie Province who were diagnosed in 2013 with invasive breast cancer, and reported to Świętokrzyskie Office for Cancer Registration. Urban-rural differences in breast cancer incidence in 2002-2013 were presented using Range Ratio (RR). Changes in incidence trends in urban and rural areas were analysed using joinpoint models. Annual Percentage Change (APC) of the rates was calculated for each time trend., Results: Breast cancer incidence rate in the urban female population was higher than in rural women with RR, amounting to 1.43. However, the analysis of trends showed that the pace and direction of change were developing negatively among inhabitants of rural areas. In 2002-2013, in rural women, the age-standardized rate (ASR) values increased by 2.8% per year (p<0.05). The course of ASR trends showed statistically significant urban-rural differences (p=0.004). Analysis of urban-rural differences in disease stage distribution revealed a non-significantly higher proportion of cases with localised stage in urban than in rural areas, amounting to 51.0% and 43.9%, respectively., Conclusions: Existing health inequalities indicate the need to intensify activities in rural areas and should be the starting point for making key decisions in combating breast cancer.

Introduction: The issue of inequalities in the use of health services and health inequalities between urban and rural dwellers is a subject of numerous scientific reports, but similar publications on dental health are scarce., Objective: The aim of this study is to assess the correlations between the use or non-use of dental services and the classical socio-economic factors (SES) in urban and rural groups in a representative population of Poland., Material and Methods: The analysis consisted in desk research based on a questionnaire survey conducted by the Central Statistical Office of Poland on 12,532 individuals (urban areas - 6411, rural areas - 6121) in 2013. The chi-squared test, multivariate and univariate logistic regression models were applied., Results: There were major differences in the use of dental services depending on income level, education and source of income among rural and urban populations, as well as differences between these populations. Urban dwellers had 1.34 times greater odds of using dental services than rural ones (95% CI: 1.20-1.51). In the case of the highest income group, the odds were 3.26 (95% CI 2.21-4.83) times greater in cities and 2.07 (95% CI 1.51-2.85) times greater in villages than the odds in the lowest income group. In the highest education group, the odds were 1.58 (95% CI 1.17-2.13) times greater in urban areas and 2.08 (95% CI 1.48-2.91) times greater in rural areas than the odds in the lowest education group., Conclusions: There are considerable inequalities in the use of dental services, yet the differences in non-use, despite such a need, are less evident. This could imply that health disparities arise not only from economic constraints and unavailability of health care, but also from health attitudes and behaviours.

Introduction: The sharp decline in the total fertility rate in Poland coincided with broader socio-economic changes, which resulted in its reduction to the lowest level observed among the countries of Central and Eastern Europe. Objective. The aim of the study was to investigate and evaluate the changing patterns of reproductive behaviour in rural and urban areas, depending on the demographic and socio-economic features in Poland., Material and Methods: Information about live births in Poland in the years 1995-2014 were obtained from the Central Statistical Office. Registered cases of live births in rural and urban areas were analyzed considering the maternal features (age, marital status, main source of income). To evaluate the changes in fertility and comparisons between rural and urban areas, Joinpoint Regresssion was used., Results: In 1995-2014, a shift in the age of highest fertility from 20-24 years to 25-29 years was observed. This occurred at the same time as a reduction in the fertility rate per 1,000 women aged 15-29 years, more pronounced in rural areas (95.8 to 60.0) than in urban areas (63.4 to 51.5), while in women aged 30-49 years, a faster increase in fertility was observed in urban areas (16.4 to 32.0) than in rural areas (27.5-29.2). Fertility trends between rural and urban areas differed significantly. A significant increase in live births for employed mothers was shown mainly in 2005-2009; later, the growth rate in rural areas was slower and in urban areas the growth trend stopped., Conclusions: The postponement of births and reduction of fertility in women aged 15-29 requires active measures aimed at creating favourable conditions for achieving economic independence for the younger generation, as well as combining work with raising children, especially in rural areas., Abbreviations: APC - annual percentage change; AAPC - average annual percentage change; CSO - Central Statistical Office; TFR - total fertility rate.

Background/aims: The study was carried out to evaluate the changes in the eating habits and lipid parameters in a 21-year follow-up on a group of 435 men living in Poland., Methods: The studied population was composed of the same subjects: a group of men who were first studied in the years 1987-1989 and in 2008-2010. The following data was gathered: body mass, body mass index (BMI), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride concentration in blood serum., Results: The changes in the eating habits among the studied men registered throughout the 21-year period were positive since they showed a reduction in the caloric content of their diet (p < 0.001), lower total fat content (p < 0.001), total amount of carbohydrates (p < 0.001), sucrose (p < 0.001), iron (p < 0.001), and featured more vitamins: A (p < 0.002), B1 (p < 0.001), and C (p < 0.001). An adverse trend was observed in terms of constant calcium shortages in their food portions (ns). A 21-year follow-up of the studied group showed significant differences in terms of weight (p < 0.001), BMI (p < 0.001), and all cholesterol fractions (p < 0.001) in their blood serum, except cholesterol alone (ns)., Conclusion: It is important to continue observing the dietary trends in the studied group, with the focus on the occurrence of potential changes in their bodies., (© 2018 S. Karger AG, Basel.)

Objectives: The aim of this study was to estimate indirect costs associated with losses in productivity due to sickness absence among registered workers in Poland., Material and Methods: Data on sick leave durations in 2013 was obtained from the Social Insurance Institution (SII) (Zakład Ubezpieczeń Społecznych - ZUS). Based on the number of assumptions, this data was used for calculating absence durations. The costs of lost productivity were estimated on the basis of the measure of gross value added., Results: Estimated losses in productivity due to absenteeism in 2013 together accounted for 4.33% of gross domestic product (GDP) (17.09 billion euro). In the female population, the total value of losses amounted to 9.66 billion euro, but excluding the costs of pregnancy, childbirth, and puerperium (2.96 billion euro), it was 6.7 billion euro. In the male population, the loss amounted to 7.43 billion euro. The highest overall costs of sickness absence based on age were found in the age group of 30-39 years (5.14 billion euro, including pregnancy, childbirth, and puerperium - 1.474 billion euro; respiratory diseases - 0.632 billion euro, injuries and poisonings - 0.62 billion euro). In the group of people aged > 40 years, the highest cost was generated by bone-muscular diseases (1.553 billion euro) and injuries and poisoning (1.251 billion euro). Higher losses in the productivity of women in addition to pregnancy, childbirth, and puerperium were due to mental and behavioral disorders (0.71 billion euro), diseases of the genitourinary system (0.38 billion euro), and neoplasms (0.35 billion euro). At the same time, in men, compared to women, we observed higher losses due to injuries and poisoning (1.65 billion euro), and diseases of musculoskeletal (1.26 billion euro), nervous (0.79 billion euro), circulatory (0.65 billion euro), and digestive (0.41 billion euro) systems., Conclusions: Improvement and further development of effective strategies for prevention of complications of pregnancy and chronic diseases in the workplace are necessary. Policies aimed at reduction of sickness absence could potentially increase prosperity and the socioeconomic situation in Poland. Int J Occup Med Environ Health 2017;30(6):917-932., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Purpose: The purpose of the study was the assessment of the expression of IL-1β and IL-6, and the proteins regulating their biological activity, namely IL-1RII, IL-1Ra, as well as sIL-6Rα, sgp-130 in leukemic lymphocytes and autologous neutrophils of B-CLL patients., Material/methods: The study involved a group of B-cell chronic lymphocytic leukemia patients and healthy volunteer blood donors. The presence of chosen proteins and their natural regulators was confirmed by Western blot., Results: Western blot analysis showed a decreased expression of IL-1β and IL-6 in the leukocytes of B-CLL patients. Decreased expression of sIL-6Rα has been observed in lymphocytes, with a simultaneous increase of expression in PMNs. Lower expression of sgp-130 was found in B cells while its expression was elevated in the neutrophils of patients in early stages of the disease., Conclusions: The changes observed in the expression of IL-1 and IL-6 seem to exclude their immediate involvement in the progress of B-CLL. However, the presented changes in the expression of proteins regulating IL-1β and IL-6 in PMNs indicate a potential role of early immune response cells also in advanced stages of the disease., (Copyright © 2016 Medical University of Bialystok. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)

Introduction: European countries are characterized by low mortality during the infancy period compared to other areas of the world. However, there are significant disparities in the state of infant health which are related to socio-economic conditions and place of residence., Objective: Analysis of mortality in Poland from foetal and maternal causes (length of gestation, birth weight, maternal age) in the neonatal and post-neonatal period depending on place of residence (rural and urban areas) in 2004-2013., Materials and Method: Data on mortality during the neonatal and infancy period in 2004-2013 was obtained from the Central Statistical Office. Diagnosed cases of deaths in rural and urban areas were analyzed, taking into account the causes of death according to ICD-10, the duration of pregnancy in weeks, birth weight, and maternal age. Trend analysis and comparison of mortality between rural and urban areas were performed using the Poisson regression model., Results: In rural areas, neonatal and post-neonatal death rates due to congenital malformations were siginificantly higher than in urban areas. The mortality rate was also higher in rural areas in children born to women aged 20-34 years, and children born after 37 weeks gestation with low birth weight. In the cities, higher post-neonatal mortality was due to respiratory diseases, and in children born after 37 weeks gestation to mothers under the age of 20 years. A decrease in the mortality of newborns and infants was observed, but in rural areas neonatal mortality decreased significantly more slowly., Conclusions: The results indicate the need to intensify programmes aimed at improving access to prenatal and maternity care, especially among women in rural areas.

Background: Health status of infants is related to the general state of health of women of child-bearing age; however, women's occupational environment and socio-economic conditions also seem to play an important role. The aim of the present ecological study was to assess the relationship between occupational environment, industrial pollution, socio-economic status and infant mortality in Poland., Methods: Data on infant mortality and environmental and socio-economic characteristics for the 66 sub-regions of Poland for the years 2005-2011 were used in the analysis. Factor analysis was used to extract the most important factors explaining total variance among the 23 studied exposures. Generalized Estimating Equations model was used to evaluate the link between infant mortality and the studied extracted factors., Results: Marked variation for infant mortality and the characteristics of industrialization was observed among the 66 sub-regions of Poland. Four extracted factors: "poor working environment", "urbanization and employment in the service sector", "industrial pollution", "economic wealth" accounted for 77.3% of cumulative variance between the studied exposures. In the multivariate regression analysis, an increase in factor "poor working environment" of 1 SD was related to an increase in infant mortality of 40 (95% CI: 28-53) per 100,000 live births. Additionally, an increase in factor "industrial pollution" of 1 SD was associated with an increase in infant mortality of 16 (95% CI: 2-30) per 100,000 live births. The factors "urbanization and employment in the service sector" and "economic wealth" were not significantly related to infant mortality., Conclusion: The study findings suggested that, at the population level, infant mortality was associated with an industrial environment. Strategies to improve working conditions and reduce industrial pollution might contribute to a reduction in infant mortality in Poland.

The aim of the study was to analyse the level and the trends of Potential Years of Life Lost due to main causes of deaths in Poland in 2002-2011, with consideration of place of residence, urban-rural. The material for the study was the number of deaths due to main causes in Poland in years 2002-2011, based on data from the Central Statistical Office. Premature mortality analysis was conducted with the use of PYLL indicator (PYLL - Potential Years of Life Lost). PYLL rate was calculated according to the method proposed by J. Romeder, according to which the premature mortality was defined as death before the age of 70. Time trends of PYLL rate and the annual percent change (APC) were assessed using the Joinpoint Regression Programme. Rural/urban ratio was used to presented the differences in premature mortality between rural and urban areas . In years2002-2011, the PYLL rate for all-cause deaths decreased by 13.2% among men and 16.0% among women in rural areas, whereas in urban decreased it decreased by 15.7% among men and 14.9% among women. In 2011, the main causes of PYLL among men in rural areas were: external causes (32.3%), cardiovascular diseases (23.5%) and cancers (19.4%); in urban areas: cardiovascular diseases (24.7%), external causes (24.3%) and cancers (20.9%). Among women in rural areas, the leading causes were: cancers (39.9%), cardiovascular diseases (20.1%) and external causes (15.1%). The main causes of premature mortality among women in urban areas were: cancers (41.7%), cardiovascular diseases (19.6%) and external causes (11.1%). Premature mortality among men in rural areas was significantly higher than in urban for all analysed causes of death, with the exception of ischaemic heart diseases and colorectal cancer. Premature mortality among women in rural areas was significantly lower than in urban for all analysed cause of deaths, except of cerebrovascular diseases, external causes, suicides and traffic accidents. The presented epidemiological situation for premature mortality indicate differences in the state of health of the inhabitants in urban and rural areas in Poland. The leading causes of premature mortality are caused by preventable deaths, which leads to a need to intensify measures in primary and secondary prevention.

Aim: The aim of this study was to analyze the level and trends of perinatal mortality by mother's place of residence (urban vs rural area) in Poland in 2002-2012., Material and Method: This study was based on the data of the Central Statistical Office on the number of live births, infant deaths (0-6 days) and stillbirths by mother's place of residence (urban vs rural area), reported in 2002-2012 in 16 provinces and Poland in general. Joinpoint model was used to analyze perinatal mortality rate trends over time and average annual percent change (APC). Urban/rural ratio was employed to demonstrate the differences in perinatal mortality between urban and rural areas., Results: In the period analyzed, perinatal mortality in Poland decreased by 3.4% (p<0.05) and 2.7% (p<0.05) per year in urban and rural areas, respectively. Having considered urban areas, perinatal mortality rate was decreasing at the fastest pace in the following provinces: Pomorskie (APC) = -6.6%, p<0.05), Warmińsko-Mazurskie (APC) = -5.4%, p<0.05), Lubuskie i Świętokrzyskie (APC = -4.5%, p<0.05) while for rural areas - Dolnośląskie (APC = -4.3%, p<0.05), Wielkopolskie, Zachodniopomorskie (APC = -3.7%, p<0.05) and Śląskie (APC = -3.2%, p<0.05)., Conclusions: In the study period, a decrease in perinatal mortality was reported in Poland, both in urban and rural areas. The level of perinatal mortality rate as well as the pace of these changes differed between provinces.

Introduction: Treatment delay is a major problem of contemporary oncology. Knowing the time interval between diagnosis and initiation of treatment, together with monitoring this adverse prognostic factor, is an important element of the treatment planning process in the population and can contribute to the improvement of patients' curability., Objective: To assess the waiting time for first treatment of women diagnosed with breast cancer in 2001-2002 in Podlaskie Voivodeship., Materials and Methods: During 2001-2002, there were 709 cases of women with breast cancer who reported to the Voivodeship Cancer Registry in Bialystok. 659 women were diagnosed with a primary invasive breast tumour. A cohort of 499 women who were treated with a curative intent was selected from this group. The waiting time in the created cohort was calculated as the number of days between the date of the breast cancer diagnosis and date of the first treatment., Results: The average time between the date of diagnosis and date of the first treatment was 38 days. The median was 14 days. 28.6% of patients from the selected cohort waited longer than 28 days. The treatment of rural women was initiated faster than the treatment of urban patients.

Introduction: School health education programmes are among the instruments for the prevention of tobacco smoking among children and adolescents. Knowledge obtained in evaluation studies of these programmes indicates the degree of their effectiveness and serves to improve their quality., Objective: Recognition and evaluation of the effect of two-year anti-tobacco programme of health education on the changes in the level of knowledge, attitudes and behaviours of adolescents., Materials and Method: An intervention study was originated in May 2007, and covered 859 first-year schoolchildren from eight public junior high schools in Białystok in Poland, from among 3,318 schoolchildren attending 33 schools. The sample was selected by means of two-stage stratified sampling with consideration of two groups: an intervention group covered with educational actions (417 schoolchildren), and a control group (442 schoolchildren), where anti-tobacco education was not carried out. Before the educational programme and after its completion an evaluation of knowledge, attitudes and behaviours of junior high school adolescents was performed with respect to nicotinism, based on a survey. The educational part consisted in conducting within 2 years, 4 educational classes and 2 competitions concerning tobacco-related problems., Results: After two years, in the group of adolescents covered by the educational programme a significant increase was observed - by 11.6% - in the percentage of schoolchildren who were familiar with the negative effects of tobacco smoking, and an increase by 4.4% of those who were convinced that smoking is harmful. With respect to adolescents' attitudes, the effect of the programme was noted in only one of six components analyzed. After completion of the two-year educational programme, both in the group covered by this programme and the control group, the percentage of smokers significantly increased (by 12.8% and 12.7%, respectively)., Conclusions: It is necessary to evaluate the health education programme from the aspect of both the actual hard effects of the anti-nicotine programme (changes in behaviour), and indirect effects - soft (knowledge, skills) which are a basis for the potential verification of the programme in order to increase its effectiveness.

Introduction: Health education used for increasing the effectiveness of intervention actions should cover a number of factors which exert an effect on learning., Objective: Recognition of the extent to which gender may determine the effects of an anti-tobacco health education programme., Material and Methods: The intervention study was undertaken in May 2007, and covered 859 first-year schoolchildren in Białystok. The sample was selected by means of two-stage stratified sampling with consideration of two groups: an intervention group and a control group., Results: In the group of girls, the 2-year educational programme resulted in an increase in knowledge concerning the negative effects of cigarette smoking by 21%, and being familiar with anti-tobacco actions and campaigns carried out in Poland by 24.5%. Among boys, an increase was observed only with respect to the knowledge of anti-tobacco actions and campaigns - by 10.7%. Considering the attitudes of girls after the completion of the programme, changes were noted with respect to three from among the six elements analyzed. However, among boys, after completion of the project, no changes were noted in any of the analyzed elements of attitude. In girls who participated in the anti-nicotine programme, the percentage of smokers did not increase, while an increase in this percentage was observed among girls of the control group and boys in both groups., Conclusions: Different effects of the 2-year anti-tobacco programme obtained in the area of knowledge, attitude and behaviour should constitute a premise for the modification of educational programmes from the aspect of the variety of methods, techniques and instruments which would be adequate for adolescents' predispositions resulting also from their gender.

Introduction: The results of breast cancer treatment depend mainly on better detection in mammography screening and, consequently, a higher proportion of women with early stage of the disease. They depend also on a better access to health care services and the effectiveness of oncological treatment. One of the methods of breast cancer control is a breast-conserving surgery. With a proper patients' classification for the treatment, the results of the breast-conserving surgery do not differ in relation to mastectomy. That's why, the availability of breast-conserving surgical methods is particularly important, especially in a population in which a population screening is conducted., Objective: The analysis of the selected aspects of the breast cancer treatment's standard in Podlaskie Voivodeship., Patients and Methods: In years 2001-2002, 709 cases of women with breast cancer were reported to the Voivodeship Cancer Registry in Bialystok. 659 women were diagnosed with a primary invasive breast cancer. Based on a cohort of 499 women treated with radical methods the following indicators, recommended by WHO for the evaluation of the breast-conserving surgery's availability, were calculated: a percentage of patients with whom breast-conserving surgery was used, a proportion of breast cancer cases receiving post-operative breast radiotherapy after breast-conserving surgery and a proportion of breast-conserving surgery in pT1 cases., Results: The breast-conserving surgery has been used much less frequently in Podlaskie Voivodeship than in Western Europe, but more frequently than in Poland in general., Conclusion: It should be aimed to provide a surgical treatment with the use of breast-conserving surgical methods to the highest possible percentage of patients. The increase of the percentage of patients treated with breast-conserving surgery methods can be a result of an effective screening realisation.

The aim of the study was to evaluate differences in the results of the curative treatment received by women with breast cancer in urban and rural area in Podlaskie Voivodship in 2001-2002 before the introduction of the National Cancer Control Programme. The analysis was based on 449 women with breast cancer, who received curative treatment in years 2001-2002. Relative 5-year survival rates as function of age and stage among urban and rural women population were calculated. The results showed that survival rates in Podlaskie Voivodship among curatively treated women with breast cancer were 81.9% but they differed between urban and rural areas. Patients living in rural areas had much lower survivals than those living in urban areas at local and regional stage of disease. In all age groups considered in the study survivals in rural areas were lower than in urban ones in which survivals were higher in 55-64 age group. These results indicated the necessity intervention in order to increase the access to the health care system and effectiveness of early detection and also improved treatment standards for more disadvantaged rural areas. These results should be also considered in monitoring of the National Cancer Control Programme introduction in Poland in 2006.

Background: Migration and ethical recruitment of health care workers is receiving increased attention worldwide. Europe's aging population is creating new opportunities for medical doctors for finding employment in other countries, particularly those of a better standard of living., Methods: We conducted a survey among 1214 medical students in five out of eleven universities in Poland with medical schools in October 2008. A series of statistical tests was applied to analyse the characteristics of potential migrants. Projections were obtained using statistical analyses: descriptive, multifactorial logistic regression and other statistical methods ., Results: We can forecast that 26-36% of Polish medical students will emigrate over the next few years; 62% of respondents estimated the likelihood of emigration at 50%. Students in their penultimate year of study declared a stronger desire to migrate than those in the final year. At the same time, many students were optimistic about career opportunities in Poland. Also noted among students were: the decline in interest in leaving among final year students, their moderate elaboration of departure plans, and their generally optimistic views about the opportunities for professional development in Poland., Conclusions: The majority of Polish students see the emigration as a serious alternative to the continuation of their professional training. This trend can pose a serious threat to the Polish health care system, however the observed decline of the interest in leaving among final year students, the moderate involvement in concrete departure plans and the optimistic views about the opportunities for professional development in Poland suggest that the actual scale of brain drain of young Polish doctors due to emigration will be more limited than previously feared.

Introduction: About 90% of Polish adults with hypercholesterolemia are not aware of their disease or are not treated., Objectives: The aim of the study was to evaluate hypercholesterolemia control in general practice and to assess the implications of introducing the nationwide Program of Cardiovascular Disease Prevention (PCVDP)., Patients and Methods: Sixty-six primary care clinics were scheduled to participate in the study. In half of them, PCVDP was implemented (active clinics), the remaining 33 constituted the control group. Study participants were selected from a group of persons aged 35-55 years with medical records established before January 1, 2005. Patients with coronary heart disease, stroke, or peripheral atherosclerosis were excluded. In a random sample of patients scheduled for the study, medical records were reviewed followed by an interview, physical examination, and blood lipid tests., Results: The availability of data on total cholesterol (TC) levels increased from 19.2% to 40.5% in patients from the active clinics and did not change in the control group. Hypercholesterolemia treatment was reported more often in the active clinics than in the control group (4.4% and 3.3%, respectively, P <0.01). Patients from the active clinics more often reported that a physician informed them about increased TC levels compared with the control group (29.1% and 24.1%, respectively, P <0.01). However, the percentage of patients with increased TC or low-density lipoprotein cholesterol levels and those using statins did not differ between the study groups., Conclusions: PCVDP is an effective tool to identify subjects with hypercholesterolemia but has no effect on the rate of achieving the recommended treatment targets.

Aim: The study objective was to evaluate quantitatively the relationship between demographic characteristics, socio-economic status and medical care resources with all cause mortality in Poland., Materials and Method: Ecological study was performed using data for the population of 66 subregions of Poland, obtained from the Central Statistical Office of Poland. The information on the determinants of health and all cause mortality covered the period from 1st January 2005 to 31st December 2010. Results for the repeated measures were analyzed using Generalized Estimating Equations GEE model. In the model 16 independent variables describing health determinants were used, including 6 demographic variables, 6 socio-economic variables, 4 medical care variables. The dependent variable, was age standardized all cause mortality rate., Results: There was a large variation in all cause mortality, demographic features, socio-economic characteristics, and medical care resources by subregion. All cause mortality showed weak associations with demographic features, among which only the increased divorce rate was associated with higher mortality rate. Increased education level, salaries, gross domestic product (GDP) per capita, local government expenditures per capita and the number of non-governmental organizations per 10 thousand population was associated with decrease in all cause mortality. The increase of unemployment rate was related with a decrease of all cause mortality. Beneficial relationship between employment of medical staff and mortality was observed., Conclusions: Variation in mortality from all causes in Poland was explained partly by variation in socio-economic determinants and health care resources.

Extended spectrum β-lactamases production is one of the most common mechanism of resistance to extended spectrum β-lactam antibiotics is increasing worldwide. Twenty five strains of Klebsiella pneumoniae isolated from clinical specimens were tested. Based on the phenotypic confirmatory test all these strains were defined as ESBL producers named ESBL(+). The plasmid DNA from each strains was used to investigate the presence of blaSHV genes responsible for extended spectrum β-lactamases production. Moreover, susceptibility of these strains to antibiotic other than β-lactams in was tested.

Background: Despite a decline since 1991, cardiovascular diseases (CVD) are the major burden on public health in Poland., Aim: To assess the impact of the national Programme of Cardiovascular Disease Prevention (PCVDP) on the quality of primary CVD prevention in clinical practice., Methods: Sixty six primary care centres were invited to join the project (2-6 in each province). Half of these centres participated in the PCVDP (in other words, they were 'active' clinics) and the other half was included in the control group. A random sample of 300 patients aged 35-55, free of coronary heart disease, with no history of stroke or peripheral artery disease, and with medical documentation going back at least to 1 January 2005 was selected for the study in each centre. From the total of 3,940 patients in active clinics, 3,162 were judged to be eligible for the study and their medical records were reviewed. All were invited for examination. This was finally attended by 2,314 patients from active clinics and 2,101 from the control group., Results: Before the introduction of the PCVDP, the percentage of patients with available information on risk factors in medical records was similar in the active and in the control clinics, and varied from more than 40% (hypertension) to less than 5% (weight and waist circumference). After the introduction of the PCVDP, the proportion of subjects with available information on risk factors greatly increased in the clinics which took part in the PCVDP. Knowledge of CVD risk factors was similar in the two studied groups. When asked, about 10% of patients in both groups could not list a single CVD risk factor. Smoking was the most frequently recognised risk factor (named by more than 60% of patients) and diabetes the least (less than 15%). No significant difference was found between the active and control clinics in the frequency of counselling as to smoking, diet, weight reduction or exercise. Only about 40% of smoking patients had received advice on smoking cessation. Counselling on diet had been received by about 40% of patients. Less than 20% of patients had been advised to reduce weight, with about 25% having received advice to increase their physical activity. Control of risk factors was poor and there was no significant difference between the active and control clinics in terms of the proportion of patients who reached prevention targets., Conclusions: 1. The PCVDP appears to be effective in identifying high risk patients. 2. The effectiveness of the routine management of risk factors in primary care is very low. 3. Addressing via the PCVDP all decisions as to the extent and means of intervention on risk factors to primary care physicians appears to be ineffective. 4. There is a need to introduce an effective structured intervention on risk factors and add it to the PCVDP.

The aim of the study was to evaluate differences in breast cancer incidence and stage of disease between the urban and rural female population in Podlaskie Voivodship in 2001-2002, before the introduction of the Population Screening Programme in 2006. Analysis was based on 696 breast cancer cases diagnosed in years 2001-2002 and registered in the CR in Bialystok (Voivodship Cancer Registry). An average annual number of incidence, as well as crude and standardised incidence rates, were calculated. Age-specific incidence rates for 5-year age groups were also calculated and grouped as follows: < 50, 50-69, > =70 years old. Incidence differences related to place of residence: urban or rural, were presented with the use of u/r (urban/rural) ratio. In order to evaluate the stage of disease, a simplified classification recommended by ENCR (European Network of Cancer Registries) for population registries (localised, regional, metastatic) was applied. The breast cancer incidence rate in the urban population was higher than in rural areas with u/r ratio amounting to 1.4. The highest incidence and largely marked differences between urban and rural areas were among women aged 50-69 years with the u/r ratio amounting to 1.8. Overall, the proportion of stage localised in Podlaskie Voivodship was 33.1 percent and differed between urban and rural areas. The proportion of localised cancer was higher in urban areas, but patients were younger when compared to those living in rural areas. Knowledge of differences in incidence and breast cancer stage in urban and rural women investigated in this research, together with other epidemiological indicators, should be used for monitoring the Population Screening Programmes in these populations.

The aim of the study was to evaluate differences in breast cancer 5-year relative survival rates between the urban and rural female population in Podlaskie Voivodship in 2001-2002, before the introduction of the Population Screening Programme in 2006. The analysis was based on 659 breast cancer cases diagnosed in 2001-2002 and registered in CR in Białystok (Voivodship Cancer Registry). Relative survival and relative excess of risk of death after 5 years of diagnosis as function of age and stage among urban and rural women population were calculated. The results showed that survival rates in Podlaskie Voivodship were low (69.4%) in comparison to the European average (79.4%), and they differed between urban and rural areas. Patients living in rural areas had a much lower survival rate than those living in urban areas at local and regional stage of disease, whereas survivals were higher at the metastatic stage. In all age groups considered in the study, the survivals in rural areas were lower than in urban areas. The multivariate analysis confirmed that both the cancer stage and place of residence are independent prognostic factors. Relationship with age was not confirmed. The research results indicate low curability of breast cancer in Podlaskie Voivodship, and significant differences between urban and rural areas. These results need to be considered in the planning and monitoring of further intervention in order to increase the effectiveness of prevention and treatment standards for more disadvantaged rural areas. It is particularly significant when implementing the National Cancer Control Programme.

The aim of this study was to estimate nutrition and physical activity of students in Gastronomic School in Białystok. Questionnaire about nutrition and physical activity took on April 2008 in 74 students. The content of energy and main nutrition values were calculated and compared to the recommended values. Students diet included normal of energy, protein, fats and carbohydrates. Only 58% girls and 61% boys had intensive physical activity. Change of nutrition and moderate in physical activity is recommended for the students.

The measurements of radioactive caesium contents in bottom sediments were carried out in four lakes. First samples (47) were taken in 1992-95. The repeat sampling (109) was performed from the same places in 2005. We examined eight chosen areas in these lakes. In six of them, we observed statistically significant differences in the level of radioactive caesium. It indicates the permanent decrease in the level of 137Cs. The mean annual decrease in the level of radioactive caesium, taking into consideration the radioactive decay, was from 4.2 to 7.8%. In two areas of the profundal zone, we did not observe statistically significant differences in the level of radioactive caesium (lakes Garbas and Rogale Wielkie). Taking into consideration the radioactive decay of caesium, it means about the appearance of the process of accumulation of 137Cs in these areas.

The purpose of this research was to determine the level of physical activity, and free time spent in the sitting position by secondary school students in the sokolski district. The research was conducted on 796 students who were in the 17 to 19 age range. It was carried out in March and April of the 2005-2006 school year using the diagnostic poll method. The students filled out an anonymous questionnaire (modified in 2001, part of an international research regarding youth's health behavior). The results showed not enough physical activities, a lot of sedentary activities. There was a great disproportion between these two types of activities.

The purpose of this research was the evaluation of the use of cigarettes and alcohol among secondary school students in the sokolski district. Information about the sample, date and method of research was presented in the first part of the study. This part analyses answers to questions concerning: alcohol and smoking initiation, and the frequency of smoking, drinking and being under the influence of alcohol (intoxication). The research showed that 44.09% of the students in the 17 to 19 age range tried smoking cigarettes. 52.42% of them smoke somehow frequently, 26.49% smoke daily. 80.4% of students declared to have experimented with alcohol. 17.34% of students were under the influence of alcohol (intoxication) at least once during their lifetime. The most frequently consumed alcoholic beverage was beer.

Introduction: Smoking is a commonly recognized risk factor of civilization diseases. The number of damaging compounds, including carcinogenic, inhaled by a smoker and exhaled, is directly proportional to a number of smoked cigarettes. Health promotion and prevention are bases of fighting strategy with health risk connected with smoking. The aim of the study was to contrast the number of sold cigarettes in one year in Poland, calculated per capita in selected years of 20th century and at the beginning of current century. The details, which are analysed in the study considering a total number of cigarettes sold in Poland, come from The Statistical Yearbooks and The Demographical Yearbooks of the Central Statistical Office. The analysis showed that in the year 2003 the number of cigarettes sold in Poland, calculated per capita were 4.3 times larger in comparison to the number of cigarettes sold in Poland, calculated per capita in the year 1923. In fact, the difference of the number of sold cigarettes is more unfavorable because the details which concerned cigarettes disposal do not include significant illegal cigarettes import. The highest number of cigarettes sold in Poland, calculated per capita in the analysed period of time, was noticed in the years: 1979--2741 cigarettes, 1980--2679 cigarettes and in 1987--2671 cigarettes, and the lowest was at the beginning of the analysed period: in 1923--450 cigarettes, in 1938--600 cigarettes and in 1949--893 cigarettes. Smoking spread in Poland at the beginning of current century which is measured by the number of sold cigarettes and noticed changes in statistics, calculated per capita, although downward trend is still on the high level.

The aim of the paper is to present the relation between the manner of nutrition, its consequences for [people's] health and the contents of Polish health programmes at the turn of the century. As far as quantity and quality are concerned, the nutrition manners in Poland of the second half of the 20th century were far from the accepted norms and recommendations. Changes of feeding habits which came after 1991 had many different consequences. In the discussed period occurence of diseases dependent on malnutrition, such as: diseases of cardiovascular system and neoplastic diseases and frequent occurence of diabetes and obesity, was intensified. It should be also stated that the nutrition issues in health programmes implemented in Poland of that period at different levels were not given proper consideration. The study ends with a comment and conclusions answering the question posed in the title which point to an urgent necessity to take some measures in the discussed field.