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Background/Objectives: The aim of the study was to evaluate the prevalence of undiagnosed hearing impairment or central auditory processing disorders in children from I and VIII grades of primary schools in Warsaw. Methods: The participants in the study were 15,659 pupils from classes I and VIII attending primary schools in Warsaw. As part of the study, the hearing threshold for air conduction at frequencies of 0.5–8 kHz was determined, and a test assessing central auditory processing was performed: FPT (Frequency Pattern Test), DDT (Dichotic Digit Test), the Auditory Behaviour Scale (SAB), and an interview questionnaire developed for the program. Results: Abnormal test results were found in 1946 children, of which abnormal hearing screening test results were found in 678 children tested, while reduced central auditory processing results were found in 1268 children. Conclusions: The program implemented draws attention to the fact that tests of central auditory processing are included in the testing protocol. As has been shown, peripheral hearing testing alone is not sufficient to exclude abnormalities concerning the sense of hearing.

Background/Objectives: The aim of the study was to evaluate the prevalence of undiagnosed hearing impairment or central auditory processing disorders in children from I and VIII grades of primary schools in Warsaw. Methods: The participants in the study were 15,659 pupils from classes I and VIII attending primary schools in Warsaw. As part of the study, the hearing threshold for air conduction at frequencies of 0.5–8 kHz was determined, and a test assessing central auditory processing was performed: FPT (Frequency Pattern Test), DDT (Dichotic Digit Test), the Auditory Behaviour Scale (SAB), and an interview questionnaire developed for the program. Results: Abnormal test results were found in 1946 children, of which abnormal hearing screening test results were found in 678 children tested, while reduced central auditory processing results were found in 1268 children. Conclusions: The program implemented draws attention to the fact that tests of central auditory processing are included in the testing protocol. As has been shown, peripheral hearing testing alone is not sufficient to exclude abnormalities concerning the sense of hearing. [ABSTRACT FROM AUTHOR]

Human multiforme glioblastoma is characterized by an unfavorable prognosis, low survival rate and extremely limited possibilities for therapy. Rat C6 glioma is an experimental model for the study of glioblastoma growth and invasion. It has been shown that the growth and development of the tumor is accompanied by changes in the surrounding normotypic tissues [1]. These changes create a favorable environment for the development of the tumor and give it an evolutionary advantage [2]. Description of changes occurring in normotypic cells of the body upon their contact with tumor cells is of great interest. We have grown C6 glioma cells and rat astrocytes, as well as astrocyte cells co-cultured together with C6 glioma. We performed proteome-wide LC-MS analysis of these experimental groups. The data includes LC-MS/MS raw files and exported MaxQuant and ProteinPilot search results with fasta. Dataset published in the PRIDE repository project accession PXD026776.

Bacteria colonizing human intestine adhere to the gut mucosa and avoid the innate immune system. We previously demonstrated that Escherichia coli isolates can adsorb mucin from a diluted solution in vitro. Here, we evaluated the effect of mucin adsorption by E. coli cells on neutrophil activation in vitro. Activation was evaluated based on the detection of reactive oxygen species production by a chemiluminescent reaction (ChL), observation of morphological alterations in neutrophils and detection of exocytosis of myeloperoxidase and lactoferrin. We report that mucin adsorbed by cells of SharL1 isolate from Crohn's disease patient's inflamed ileum suppressed the potential for the activation of neutrophils in whole blood. Also, the binding of plasma complement proteins and immunoglobulins to the bacteria was reduced. Desialylated mucin, despite having the same adsorption efficiency to bacteria, had no effect on the blood ChL response. The effect of mucin suggests that it shields epitopes that interact with neutrophils and plasma proteins on the bacterial outer membrane. Potential candidates for these epitopes were identified among the proteins within the bacterial outer membrane fraction by 2D‐PAGE, fluorescent mucin binding on a blot and HPLC‐MS/MS. In vitro, the following proteins demonstrated mucin adsorption: outer membrane porins (OmpA, OmpC, OmpD and OmpF), adhesin OmpX, the membrane assembly factor OmpW, cobalamine transporter, ferrum uptake protein and the elongation factor Ef Tu‐1. In addition to their other functions, these proteins are known to be bacterial surface antigens. Therefore, the shielding of epitopes by mucin may affect the dynamics and intensity of an immune response.

Abstract Background Cryptic peptides (cryptides) are small bioactive molecules generated via degradation of functionally active proteins. Only a few examples of plant cryptides playing an important role in plant defense have been reported to date, hence our knowledge about cryptic signals hidden in protein structure remains very limited. Moreover, little is known about how stress conditions influence the size of endogenous peptide pools, and which of these peptides themselves have biological functions is currently unclear. Results Here, we used mass spectrometry to comprehensively analyze the endogenous peptide pools generated from functionally active proteins inside the cell and in the secretome from the model plant Physcomitrella patens. Overall, we identified approximately 4,000 intracellular and approximately 500 secreted peptides. We found that the secretome and cellular peptidomes did not show significant overlap and that respective protein precursors have very different protein degradation patterns. We showed that treatment with the plant stress hormone methyl jasmonate induced specific proteolysis of new functional proteins and the release of bioactive peptides having an antimicrobial activity and capable to elicit the expression of plant defense genes. Finally, we showed that the inhibition of protease activity during methyl jasmonate treatment decreased the secretome antimicrobial potential, suggesting an important role of peptides released from proteins in immune response. Conclusions Using mass-spectrometry, in vitro experiments and bioinformatics analysis, we found that methyl jasmonate acid induces significant changes in the peptide pools and that some of the resulting peptides possess antimicrobial and regulatory activities. Moreover, our study provides a list of peptides for further study of potential plant cryptides.

Crohn's disease (CD) is a type of inflammatory bowel disease (IDB). The endoscopic picture of Crohn's disease includes thickened submucosa, transmural inflammation, fissuring ulceration, and non-caseating granulomas. Intestinal microbiome dysbiosis has been described systematically in patients with IBD. In recent decades it was detailed that Escherichia coli, especially adherent-invasive E. coli (AIEC) pathotype, has been implicated in the pathogenesis of IBD, including Crohn's disease (Palmela, et al., 2018). In comparison with commensal strains of E. coli, AIEC strains have a large adhesive-invasive potential therefore its surface composition is of great interest. We presented a dataset of the membrane proteins of strains isolated from patients with Crohn's disease. From the set of Escherichia coli isolated from Crohn's disease patients [2] we chose three isolates with strongest AIEC pathotype. We performed proteome-wide LC-MS analysis of membrane fraction of this isolates after invasion or adhesion-invasion to human intestinal CaCo-2 cell line and prior to this (control). The data including LC-MS/MS raw files and exported MaxQuant search results with fasta files were deposited to the PRIDE repository project accession PXD014250. Keywords: Escherichia coli, AIEC, Crohn's disease, LC-MS/MS, Membrane proteins, Proteome

Introduction: Electronic sick leave certificates, called e-ZLA, were being implemented nationwide in Poland from 1 January 1 2016 until 30 November 30 2018. During the time of implementation doctors in Poland could issue sick leave certificates alternatively in electronic or in the paper form. Since 1 December 2018 sick leave certificates are to be issued in the whole Poland electronically only. Practice change: Paper form certificates in Medical and Diagnostic Centre (CMD) – an integrated care organization located in Siedlce (Poland) used to be prepared with the help of the registration or nurse staff. The average work time consumed for that process was calculated in CMD for 13 minutes per one paper form certificate. CMD is serving approximately 85000 patients and issues about 1500 sick leaves certificates every month. Therefore, CMD made an effort of rapid implementation of electronic sick leave certificates issuing. Aim and theory of change: The vendor of computer application for managing of health care related processes introduced in February 2018 in CMD’s client application a new functionality of issuing electronic sick leave certificates. The personnel of CMD was trained adequately. Timeline: The first e-ZLA in the CMD was issued on 20February 2018. After short period of time when the correctness of sickleaves certificates issued via client application was being verified, the change was implemented in the whole organization. Highlights: The concept of having an e-certificate uploaded and stored within the system was highly appreciated by CMD staff. The average time of e-ZLA issuing and its online transmission is 2-3 min compared to 13 min for managing paper-form sick leave certificates. Between 20 February 2018 and 30 November 2018, CMD doctors used to issue about 1200 e-ZLAs monthly. The necessity of writing multiple sick leave certificates for patients having more than one employer was also eliminated. This system allows also for review the history of e-ZLAs received by the patient and thus prevent potential abuses. Conclusions: As a result of e-ZLA introduction, the registration staff and nurses were relieved from paper work related to issuing paper-form certificates and additional administrative tasks related to providing copies of sick leave certificates to health insurer branches. Decrease of paper work burden resulted in saving of time which could be sacrificed for patients. Enabling the release of electronic sick leave certificates was an important milestone on the way to better integrated care.

Introduction: Coordinated care implementation plans in Poland will be based on solutions developed in Primary Health Care PLUS project co-financed from the European Social Fund. Adequate communication strategy is required to promote patients’ participation. Description of policy context and objective: The aim of communication strategy proposed by National Health Fund (Narodowy Fundusz Zdrowia – NFZ) was to invite patients by sending the message to the society that the new coordinated care model in their medical entities offers better services, easier access to doctors and free prevention programs. Key communication channels were: local media (interviews with site managers, articles and press releases), visuals (announcements, posters, leaflets, gadgets) and direct contact with coordinators, responsible for answering patients’ questions at the facility level. Regional branch of NFZ introduced "FOR PATIENT" tab on the own www.pozplus.pl portal. Targeted population: The project started on 1st July 2018. Current target number of its first component - health check-ups - is 41402 patients. 7923 patients (4582 females and 3341 males) were invited for health check-ups by 41 medical entities till the end of August 2018. The number of invitations and resulting numbers of receptions or refusals is monitored by NFZ. Highlights: There were 1429 (18%) refusals: 742 females and 687 males. The only entity which had no refusals - NZOZ Zdrowie in Janów Lubelski - having small rural population of 2700 participating in the project - invited 247 patients (159 females and 88 males) till end of September 2018, what resulted in 247 HCUs started; and 5 basic HCUs and 57 in-depth ones completed until cut-off date. To reveal the source of this success, interviews with 3 health educators working in the entity were conducted, followed by validation with 2 managers. They described own proven methods of communication with the local society added. The entity was experienced in similar activities (grant in chronic diseases area in 2013), and the local society appreciated carrying out effective and valuable preventive actions, for which they received local distinctions. The information about the program PHC PLUS was disseminated locally with help of: village administrator (printed materials), local priest (advertisements in the church), commune office and workplaces (information boards), local voluntary fire fighters (during local events) and physicians contacting individual patients for another reasons. Some patients joined NZOZ Zdrowie in Janów Lubelski thanks to this information action. This promotional campaign was conducted only for 2 months resulting in many patients willing to participate, spontaneous self-referrals, waiting lists and no refusals in case of an invitation obtained. Transferability: Adding locally used confident methods of communication, and reliance on an earlier authority was found to be very effective and such initiatives should be promoted in next steps of implementation of coordinated care across the country in Poland in wider scale or in other countries of the region. Conclusions: Past experiences and high level of engagement of local society resulted in effective implementation of communication strategy. Coherence and effectiveness of the messages would depend on the cooperation between the entities involved in such projects.

Introduction: Disease management programs are a component of the coordinated care project Primary Health Care PLUS (PHC PLUS) in Poland, co-financed from the European Social Fund under the Operational Program Knowledge Education Development, financed under the European Commission Priority Axis 4 and 5. Together with health check-ups, coordinators of care and patient education it constitutes a set of systemic solutions aimed at creating a coordinated care system. Description of policy context and objective: The essence of the disease management program is that health care providers offer active care for chronically ill patients. Disease management process starts with the diagnosis that is followed by in-depth diagnostics, and results in individual medical care plan preparation with the active patient’s involvement. It includes therapeutic measures aimed at treating the disease or minimizing its effects. Services financed under the disease management program include diagnostics and treatment of patients with selected diseases by a primary care physician in collaboration with specialists in diabetes, endocrinology, cardiology, neurology, pulmonology, rehabilitation and with physiotherapist. Targeted population: PHC PLUS pilot project is targeted at adult patients diagnosed with or suspected of at least one of 11 chronic diseases: type II diabetes, spontaneous hypertension, chronic coronary heart disease, chronic heart failure, persistent atrial fibrillation, bronchial asthma, COPD, hypothyroidism, parenchymal or nodular goiter, osteoarthritis of the peripheral joints and spinal pain syndrome. The stage of disease should allow treatment in primary health care. The disease management programs started on 1st July 2018 in 41 medical entities. Now, 1412 patients have agreed to participate in the cardiology program, 809 are treated in the rheumatology/neurology field, 440 in endocrinology, 370 are diabetic patients and only 149 use the pulmonology program. There were 16 refusals to participate in the disease management programs although the diagnosis has been made. Many patients are still in the process of classification, which gives a chance to increase theirs number soon. Transferability: Implementation of such a program can bring particularly great benefits in countries that do not allocate large amounts of money to health care. The implementation of the program in Poland will also result in the characterization of the model operating process and characteristics of pathways. The solutions developed can be used as a starting point for other countries willing to implement the disease management programs. Conclusions: The implementation of the disease management program increases the competence of the primary care physicians. They manage the budget entrusted, under which they can commission for example rehabilitation, which causes a significant acceleration of the healing process. In addition, the PHC physicians obtain access to: telemedicine, specialist consultations; a wider range and the number of preventive and educational activities; a wider range of diagnostic and physiotherapeutic services; and consulting with other outpatient care specialists. Thanks to the implementation of the PHC PLUS project patients can have a chance to actively participate in decision taking. This is an important step towards patient empowerment.

Introduction: The main responsibility of health care entities is to improve public health and stimulate patients to take care of their own health. An inseparable element of health promotion is the health education. It consists of developing skills of maintaining and improving health, of individuals and society in general and creating a health-friendly environment. Introduction of high quality health education is the main aim of the project `Explore the Value of Primary Health Care – Value of PHC` project in Poland. Description of political context and objectives: Health education in Poland is provided to a limited extent. Health care system focuses rather on specialist and hospital care. Patients in Poland pay only little attention to prophylaxis; they do not want to participate willingly in activities promoting healthy lifestyle nor visit education centers. The main objective of the “Explore the value of primary health care” program is to change this. The biggest challenge for health education in Poland is to develop a systemic solution offering comprehensive support for patients. This could be achieved by appointing health educators in primary health care and promoting their services. The program started in March 2018 and is planned for 2 years. Population targeted: The project is targeted at 26,168 patients and 434 health professionals will be involved. Ultimately, health education should cover all population of Poland. Highlights: The aim of the project is to develop and implement tools for educating the medical and non-medical staff, which is to be responsible for patient education. Health education activities include a comprehensive doctor’s visit, health checkup, and educational consultation made by nurse, dietitian and/or psychologist. Medics are involved in this project as well. They participate in trainings on customer service, patients’ rights, prophylactic programs and rules governing health care system. In the project, certain tools facilitating cooperation between primary health care doctors and outpatient doctors will also be developed and implemented. Transferability: An effective health education system requires the implementation of three health care policy instruments: adjustment to environmental conditions, support for self-health care and financial determinants. Top-down guidelines are to be created by a team of specialists, to be provided to patients by health educators. The educators have to be thoroughly prepared and trained with regard to health knowledge and communication. A patient-educator conversation should be preceded by an analysis of patient’s knowledge and studying preferences, i.e. based on words (lecture, conversation, discussion), observation and assessment (measurement of patient’s parameters, presentation of appropriate pro-health behavior with regard to a particular illness) or practical activities (brainstorming, problem solving role play). Conclusions: Simple education programs in primary health care have shown to be ineffective. Implementation of coordinated activities might improve health condition of the population. A substantive and commonly available education system can help to reduce the costs of health care by exerting a positive influence on patient’s behavior.

Introduction: The subject of this study was to collect patient opinions related to coordinated health care organization before pilot implementation phase of a coordinated care project Primary Health Care PLUS (PHC PLUS) in Poland, co-financed from the European Social Fund. The research was intended to verify hypotheses regarding patients’ satisfaction, the role of coordinator and patients’ health education, recruitment to health checkups, access to specialists and individual disease management. Methodology: The study employed qualitative (focus group interviews – FGIs – 24 adult patients in 3 subgroups, 17 questions) and quantitative (computer-assisted internet interviews – CAWI – representative sample of 1000 patients, 18 questions) techniques. CAWI questions derived from FGI discussions. To be enrolled, patients had to use public primary or specialist health care at least twice in the last two years. The study was carried out in April - May 2017. Results: FGIs revealed that the concept of regular health checkups performed among non-symptomatic patients was accepted, but the proposed exclusion of patients older than 65 years of age was contested. The idea of disease management met approval. The main benefit pointed out was the fast diagnosis followed by coordinated treatment in PHC with specialists’ support. 76,2% of patients in CAWI agreed for sharing their medical data to medical staff involved, if this improves the treatment process. 84.3% of patients appreciated adding their health information to patient accounts, 4.9% were against and 1.3% definitely excluded that. The risk of being treated by incompetent specialist was raised during FGIs and confirmed during CAWI, so patients expected to be allowed to change doctor in such a case. However, patients would be ready to give up their own choice of a specialist, if the waiting time for the diagnosis is reduced to about 2 weeks. The role of health care coordinator was appreciated. Discussion and conclusions: Respondents declared that coordinated care concept meets their expectations. They were interested in participation in health checkups and disease management programs, perceived as a solution to avoid queuing for specialists’ visits and to shorten the time needed to establish the diagnosis. The need for greater engagement in the treatment process did not deter the proposed solutions. Patients also positively evaluated the role of a health care coordinator. 62.2% of patients were ready to change the healthcare institution, if the existing one does not offer the coordinated care. Lessons learned: The common belief among patients is that the implementation of coordination in Poland will result in positive changes in the organization of public health care. Thus, changes planned in this sector might be welcomed by most of patients. Limitations: Opinions gathered could not be verified by patients in the real-life setting, but a high degree of trust was granted by them. Future studies: Further studies focused on patients’ satisfaction should be conducted after the implementation of coordinated care. Adjustment of the model dependent on geographical location (urban vs. rural) could be considered.

One of the dysbioses often observed in Crohn's disease (CD) patients is an increased abundance of Escherichia coli (10–100 fold compared to healthy individuals) (Gevers et al., 2014). The data reported is a large-scale proteome profile for E. coli isolates collected from CD patients and healthy individuals. 43 isolates were achieved from 30 CD patients (17 male, 12 female, median age 30) and 19 isolates from 7 healthy individuals (7 male, median age 19). Isolates were cultivated on LB medium at aerobic conditions up to medium log phase. Protein extraction was performed with sodium deoxycholate (DCNa) and urea, alcylation with tris(2-carboxyethyl)phosphine and iodacetamide. Protein trypsinolysis was performed as described in (Matyushkina et al., 2016). Total cell proteomes were analysed by shotgun proteomics with HPLC-MS/MS on a maXis qTOF mass-spectrometer. The data including HPLC-MS/MS raw files and exported Mascot search results was deposited to the PRIDE repository project accession: PXD010920, project https://doi.org/10.6019/PXD010920. Keywords: E. coli, Proteome, Crohn's disease, HPLC-MS/MS

Although postpartum sexual problems are common, there is a poor understanding of the underlying influencing factors and the impact of the infant feeding method on the mother's sexual life. A cross-sectional control study was conducted with a group of 253 women during their postpartum period. This study aimed to investigate the effects of different infant feeding methods on female sexual life after childbirth. The study followed the STROBE guidelines for cross-sectional control analysis. The study design included a questionnaire characterizing sociodemographic, obstetric and breastfeeding variables and the PL-FSFI (Female Sexual Function Index). The authors collected the data in compliance with the CAWI (Computer-Assisted Web Interview) research methodology—an interview conducted via an Internet channel. Each respondent received and completed the survey provided to them via the same online link. This study included women in the postpartum period: 170 breastfeeding women (study group) and 83 formula-feeding women (control group). There were statistically significant difference between the groups that practiced different types of breastfeeding. Out of all the PL-FSFI-assessing domains, the highest average score for the whole group correlated with satisfaction and the lowest score correlated with lubrication use. Our findings indicate that women practicing only breastfeeding are more likely to develop sexual problems. In order to maintain sexual health and promote long-term breastfeeding, extensive and professional counseling is needed for couples about postpartum sexuality and the factors that affect it, such as breastfeeding. [ABSTRACT FROM AUTHOR]