The history of louse-borne typhus and geomedizine.

The experience of World War I made popular the concept of medical geography (geomedicine in English, geomedizine in German), which became part of Nazism's philosophy of national welfare, safety, and solidarity. The Nazis used it to create propaganda to show some groups as rats, vermin, and Untermenschen (subhumans). In this way, more than 10 million people were killed under the Nazi regime: 6 million Jews, plus more than 5 million Gypsies, Jehovah's Witnesses, and other individuals who were not part of the German theory of "master race." The Germans' fear of typhus that spread in the Wehrmacht was so immense that during the occupation, Polish doctors used this phobia to organize a resistance movement. Contemporarily, the scope of geographic medicine encompasses the following research areas: spatial differentiation of disease incidents and the process of disease diffusion, geographic inequalities in the population's health level, and morbidity determinants among the inhabitants of developing countries. In the first half of the 19th century, it played an essential role in the activities aimed against epidemics of infectious diseases, including louse-borne typhus (epidemic typhus), cholera, and typhoid, linking these diseases to cultural determinants. Under the influence of this idea, the concept of doctor-hygienist emerged, and social medicine began to evolve.

Donor Safety, Discrepancies Between Practice and Theory: Analysis of the Polish Supreme Audit Office's Report.

The introduction and development of genetic testing has caused the emergence of numerous dilemmas, which pertain to the performed tests, their results, and the influence they have on an individual person. To minimize potential doubts, it is crucial to ensure compliance with established procedures and to fulfill all test-associated formalities. In 2018, a report of the Polish Supreme Audit's Office (a governmental control agency) on the quality of genetic tests revealed that there is much to be done in the field of laboratory diagnostics in Poland. The inspection of six selected laboratories performing genetic tests identified shortcomings in terms of formalities accompanying the process of performing laboratory tests, keeping patient documentation and personal data protection. Although the observed shortcomings pertained to legal aspects of genetic tests, and not the quality of the tests themselves, the aforementioned may be detrimental to the individual person and the society (eg, lack of consent undermines the concept of biological material ownership), may cause legal liability to the laboratory personnel and even undermine public trust in genetic testing.

Quality of Informed Consent in Mammography Screening-The Polish Experience.

Breast cancer is one of the leading forms of cancers in women worldwide. In Poland, it accounts for approx. 20% of all cancers diagnosed, with approximately 11,000 new cases and 5000 deaths from this disease annually. To prevent unfavourable statistics, Poland introduced free breast cancer screening programmes, available to women aged 50-69. Over a million women take advantage of this programme each year. The aim of the research was to assess the quality of consent women give prior to mammography screening and address the question of whether this quality is sufficient to make an informed choice. The study was conducted on a representative group of 600 Polish women over 50 years old (475 of them had undergone mammography screening), who agreed to take part in the study. Using the computer-assisted interview technology (CATI) method, all women were asked about their perception of breast cancer and screening and those who had undergone mammography were quizzed about the consent process. They will form the focus of this research. The validated tool contained items on both the benefits and risks of screening. The results indicate that the quality of informed consent was insufficient. A discrepancy was observed in the awareness between the benefits and risks of mammography screening. The main motivations to undergo screening were: prophylactic purposes and the free-of-charge nature of this health service. Population-based screening programmes for breast cancer should be reconsidered in terms of information policy, and the quality of informed consent should be increased.

Convalescents' Reports on COVID-19 Experience-A Qualitative Study.

BACKGROUND: The dynamic character of the COVID-19 pandemic and its social consequences caused several medical and societal issues and dilemmas. The aim of our qualitative research was to capture and analyze attitudes and beliefs of convalescents who experienced mild symptoms of COVID-19 in the first wave of the pandemic and decided to donate their plasma for therapeutic purposes. MATERIAL AND METHODS: The article presents results of qualitative research conducted on the basis of grounded theory (GT) methodology. Empirical material includes 10 in-depth interviews conducted with respondents who had mild or asymptomatic disease and, after recovery, voluntarily donated their plasma to the Regional Centre for Blood Donation and Blood Treatment (RCKiK). Data were collected in May and June 2020 in Poland. Qualitative analysis was focused on the experience of convalescents who entered the social role of a sick person in individual, social, and organizational dimensions. RESULTS: The social role of the patient in the narratives of convalescents was related to three stages: (1) initiation to the role, (2) staying in the COVID-19 patient role, and (3) leaving the role. Research results enabled the distinction of three basic descriptive categories ("ontological uncertainty", "the global and individual dimension", and "being sick in the disease-infected environment"), which became epistemological framework for a detailed description of the roles played by an individual COVID-19 patient during the pandemic. CONCLUSIONS: The disease, despite its mild course, generated a number of non-medical issues, and the entire process of being ill was burdened with institutional and emotional struggles. The experience of mild COVID-19 is significantly modified by disease institutionalization. These results may contribute to a better understanding of the psychosocial dimension of COVID-19 and convalescents' motivations for plasma donation.

Influence of Umbelliferone on the Anticonvulsant and Neuroprotective Activity of Selected Antiepileptic Drugs: An In Vivo and In Vitro Study.

Umbelliferone (7-hydroxycoumarin; UMB) is a coumarin with many biological properties, including antiepileptic activity. This study evaluated the effect of UMB on the ability of classical and novel antiepileptic drugs (e.g., lacosamide (LCM), levetiracetam (LEV), phenobarbital (PB) and valproate (VPA)) to prevent seizures evoked by the 6-Hz corneal-stimulation-induced seizure model. The study also evaluated the influence of this coumarin on the neuroprotective properties of these drugs in two in vitro models of neurodegeneration, including trophic stress and excitotoxicity. The results indicate that UMB (100 mg/kg, i.p.) significantly enhanced the anticonvulsant action of PB (p < 0.01) and VPA (p < 0.05), but not that of LCM orLEV, in the 6-Hz test. Whether alone or in combination with other anticonvulsant drugs (at their ED50 values from the 6-Hz test), UMB (100 mg/kg) did not affect motor coordination; skeletal muscular strength and long-term memory, as determined in the chimney; grip strength; or passive avoidance tests, respectively. Pharmacokinetic characterization revealed that UMB had no impact on total brain concentrations of PB or VPA in mice. The in vitro study indicated that UMB has neuroprotective properties. Administration of UMB (1 µg/mL), together with antiepileptic drugs, mitigated their negative impact on neuronal viability. Under trophic stress (serum deprivation) conditions, UMB enhanced the neurotrophic abilities of all the drugs used. Moreover, this coumarin statistically enhanced the neuroprotective effects of PB (p < 0.05) and VPA (p < 0.001) in the excitotoxicity model of neurodegeneration. The obtained results clearly indicate a positive effect of UMB on the anticonvulsant and neuroprotective properties of the selected drugs.

Prescriptions as quality indicators of pharmaceutical services in Polish community pharmacies.

BACKGROUND: Assessment of community pharmacies' quality of service is a very difficult task, resulting from the multiplicity and variety of provided services as well as patient-related factors (i.e. their health condition, expectations, education level or cultural and social background). Although proceedings of pharmaceutical professionals are to a great extend legally determined and described in various acts and regulations, work diligence should be one of the most characteristic traits of a professional pharmacy employee. Many publications addressing the quality of services provided by pharmaceutical employees focus on patient satisfaction, here the authors focused on more objective methods i.e. prescription analysis. OBJECTIVE: The main aim of the study was to assess whether post-inspection National Health Fund reports would constitute a reliable source of quality assessment of pharmaceutical services provided by community pharmacies. METHODS: The study is an in-depth quality and quantity analysis of 28 post-inspection quarterly reports conducted by the National Health Fund between 2013 and 2019. RESULTS: Vast majority of inspections ended in stating a variety of irregularities. CONCLUSIONS: The analysis of irregularities contained in the National Health Fund's post-inspection reports does not seem an appropriate indicator of assessing the quality of pharmaceutical services provided in community pharmacies, because of its targeted character. Inappropriate performance of professional duties by staff members is the main source of irregularities in the implementation of prescriptions for reimbursable medications. There is a need to improve staffs' professional competence and ultimately the quality of pharmaceutical services.

Typhus works of Rudolf Weigl, PhD, Ludwik Fleck, MD, and Eugeniusz Lazowski, MD, against the Nazis.

Typhus has been present in Central Europe and Russia since the 19th century, but it was not until 1918 that it became an epidemic problem in Poland. Poverty, general devastation, unsanitary living conditions, and the extensive spread of the disease forced the Polish government to organize effective measures to improve the population's health. One such measure was the establishment of a typhus research center in Lviv. The center was led by Rudolf Weigl, who in the 1930s succeeded in elaborating a clinically effective vaccine. In September 1939, when the Germans invaded Poland, the problem of typhus returned, primarily due to the ghettos where the Nazis confined Jews in poor, crowded, and unsanitary conditions. Later, in 1941 when Nazis tried to invade the Soviet Union (where typhus was endemic), the typhus vaccine-the work of Weigl and Ludwik Fleck (also an employee of the Lviv institute)-was in high demand. The Germans feared typhus due to its persistence and speed of spread. The Nazi typhus phobia was also used by some Polish doctors who took advantage of this disease to protect their patients from being deported or located in camps. An example of such a doctor was Eugeniusz Lazowski, who even organized a "false pandemic" to save the local population.

Safety of Medical Devices in Poland - Analysis of Withdrawn and Suspended Certificates of Compliance.

INTRODUCTION: In the European Union, the process of controlling currently used medical devices is carried out and determined by legal provisions. The law stipulates that each entity responsible for using medical equipment must confirm its safety with an appropriate certificate issued by a notifying body. In Poland, the entity responsible for keeping records as to the withdrawn and suspended certificates, is the Office for Registration of Medicinal Products, Medical Devices, and Biocidal Products (URPL). Certification is required for all medical devices prior to their introduction onto the market and during their use. PURPOSE: The article presents data concerning the number of medical devices that failed to meet the certification criteria. METHODS: The research method is an analysis of available subject literature and a report on withdrawn and suspended certificates of medical devices in Poland. RESULTS: In the years 2014-2020, the notified bodies withdrew and suspended 13,354 certificates for medical devices, of which 9792 certificates were withdrawn, 2852 suspended and one falsified. CONCLUSION: The suspension or withdrawal of a certificate for medical devices due to the inefficiency, obsolescence, imprecision, or safety of the devices is an action that improves the safety of patients. Such action reduces the number of medical damages and the obligation to pay compensation to those injured.

Prevalence and Characteristics of Orthorectic Disorders in Adolescence and Young People: Polish Preliminary Studies.

The aim of this work was to assess orthorectic behaviors among young people and to evaluate their attitudes towards caring for their health. The study was conducted in 2019 on a group of 538 respondents aged 16-35. After analysis, 65 questionnaires were eliminated from further research, and the assessment of orthorectic disorders was performed using a method based on the modified ORTO-15 questionnaire on a group of 473 respondents. A large percentage of them exhibited an increased risk of orthorectic behaviors (32.8), which was higher among women than men (34.7% and 28.2%, respectively). People with higher risks of orthorectic disorders significantly more often reduced their consumption of foods high in fats and sugars. Attitudes of people with orthorectic disorders towards health care proved neutral, with a tendency to be positive. Nutritional behaviors observed in the studied group show some irregularities, which indicates the need for preventive and educational measures aimed at increasing awareness of the role of proper nutrition among young people. The obtained results may be the basis for further research on ON symptoms. One of the major areas of future research would be to create a reliable diagnostic tool which would allow for distinguishing between orthorexia and overdiagnosis.

Informed Consent in Obligatory Vaccinations?

Vaccinations cause controversies for numerous reasons: medical, religious, and even personal. The following paper focuses on one more, underestimated conflict between individual autonomy and public health in regard to obligatory childhood vaccinations. Every medical intervention should be preceded by informed consent; however, informed consent in the case of obligatory vaccinations cannot be voluntary and valid. Moreover, asking parents to sign an informed consent form is paradoxical in a situation where not signing it will lead to legal consequences. Our paper tries to accentuate the issue of involuntariness and invalidity of informed consent in the case of obligatory vaccination and tries to propose a solution that acknowledges requirements for vaccinations and makes parents feel safer coming in and out of a vaccination visit.

Vaccination refusal. Autonomy and permitted coercion.

The article presents vaccination obligation in relation to the existing or newly enacted legislation. Mass vaccinations and a wave of criticism they cause, forces us to reflect on the limits of medical intervention in the human body and the boundaries granted to individual's freedom and autonomy. This problem is universal and exists mainly in countries without mandatory vaccinations. Analyzing recent years, it must be underlined that a process in some legislatures has been introduced to enforce various forms of vaccination coercion. Although, refusing vaccinations has been treated liberally, the last wave of epidemics in the United States and Europe forced the creation of a different approach. Gradually in the USA, a duty (not a 'coercion') of vaccination is being enforced. Occurring epidemics, (e.g. measles) and dangers resulting from them, force authorities to violate the principle of autonomy and restrict individuals' freedoms regarding their own body. The article presents legal solutions relating to vaccinations in the United States and Europe i.e. administrative decisions imposing vaccinations, solutions conditioning social existence and financial penalties for not complying with this obligation and proposes a solution based on financial liability that will balance out patients' autonomy and public security.

Vaccinations-Between free will and coercion.

Dynamically changing social situation associated with migrations, increasing freedom rights, popularity of anti-vaccine movements and the resulting from that decrease in herd immunity, forces the medical society and the governments of various countries to reflect on the attitude toward vaccinations. Issues of freedoms and self-determination frequently do not accept any medical coercion in case of prophylactic vaccinations, however, recent waves of epidemics revealed that there is a necessity for undertaking strict legal actions to encourage vaccinations. After analyzing various legal approaches toward vaccinations we believe that personal coercion in case of vaccination refusal has too far reaching sanctions and propose the possibility of balancing the right to autonomy and the medical coercion. We postulate that vaccination refusal should be equivalent with covering frequently high medical costs in case of infection, The threat of financing medical treatment should influence the decision making process of those opposing vaccinations simultaneously respecting their rights not too get vaccinated.