The role of primary health care in long-term care facilities during the COVID-19 pandemic in 30 European countries: a retrospective descriptive study (Eurodata study).

BACKGROUND AND AIM: Primary health care (PHC) supported long-term care facilities (LTCFs) in attending COVID-19 patients. The aim of this study is to describe the role of PHC in LTCFs in Europe during the early phase of the pandemic. METHODS: Retrospective descriptive study from 30 European countries using data from September 2020 collected with an ad hoc semi-structured questionnaire. Related variables are SARS-CoV-2 testing, contact tracing, follow-up, additional testing, and patient care. RESULTS: Twenty-six out of the 30 European countries had PHC involvement in LTCFs during the COVID-19 pandemic. PHC participated in initial medical care in 22 countries, while, in 15, PHC was responsible for SARS-CoV-2 test along with other institutions. Supervision of individuals in isolation was carried out mostly by LTCF staff, but physical examination or symptom's follow-up was performed mainly by PHC. CONCLUSION: PHC has participated in COVID-19 pandemic assistance in LTCFs in coordination with LTCF staff, public health officers, and hospitals.

Clinical pathway of COVID-19 patients in primary health care in 30 European countries: Eurodata study.

BACKGROUND: Most COVID-19 patients were treated in primary health care (PHC) in Europe. OBJECTIVES: To demonstrate the scope of PHC workflow during the COVID-19 pandemic emphasising similarities and differences of patient's clinical pathways in Europe. METHODS: Descriptive, cross-sectional study with data acquired through a semi-structured questionnaire in PHC in 30 European countries, created ad hoc and agreed upon among all researchers who participated in the study. GPs from each country answered the approved questionnaire. Main variable: PHC COVID-19 acute clinical pathway. All variables were collected from each country as of September 2020. RESULTS: COVID-19 clinics in PHC facilities were organised in 8/30. Case detection and testing were performed in PHC in 27/30 countries. RT-PCR and lateral flow tests were performed in PHC in 23/30, free of charge with a medical prescription. Contact tracing was performed mainly by public health authorities. Mandatory isolation ranged from 5 to 14 days. Sick leave certification was given exclusively by GPs in 21/30 countries. Patient hotels or other resources to isolate patients were available in 12/30. Follow-up to monitor the symptoms and/or new complementary tests was made mainly by phone call (27/30). Chest X-ray and phlebotomy were performed in PHC in 18/30 and 23/30 countries, respectively. Oxygen and low-molecular-weight heparin were available in PHC (21/30). CONCLUSION: In Europe PHC participated in many steps to diagnose, treat and monitor COVID-19 patients. Differences among countries might be addressed at European level for the management of future pandemics.

Differences between Rural and Urban Practices in the Response to the COVID-19 Pandemic: Outcomes from the PRICOV-19 Study in 38 Countries.

This paper explores the differences between rural and urban practices in the response to the COVID-19 pandemic, emphasizing aspects such as management of patient flow, infection prevention and control, information processing, communication and collaboration. Using a cross-sectional design, data were collected through the online PRICOV-19 questionnaire sent to general practices in 38 countries. Rural practices in our sample were smaller than urban-based practices. They reported an above-average number of old and multimorbid patients and a below-average number of patients with a migrant background or financial problems. Rural practices were less likely to provide leaflets and information, but were more likely to have ceased using the waiting room or to have made structural changes to their waiting room and to have changed their prescribing practices in terms of patients attending the practices. They were less likely to perform video consultations or use electronic prescription methods. Our findings show the existence of certain issues that could impact patient safety in rural areas more than in urban areas due to the underlying differences in population profile and supports. These could be used to plan the organization of care for similar future pandemic situations.

The reliability of patient blood pressure self-assessments - a cross-sectional study.

OBJECTIVE: Home blood pressure monitoring (HBPM) is an increasingly important tool in managing hypertension (HTN); however, its efficacy depends on its accuracy. This study aimed to explore the differences between blood pressure (BP) measurements conducted by patients and medical professionals and the patient demographic factors correlating with inaccurate self-measured BP levels. METHODS: One hundred hypertensive patients completed a questionnaire inquiring about their health status and HBPM procedures and were filmed while measuring their BP using their own devices. A researcher then measured the patients' BP using a calibrated sphygmomanometer to assess the accuracy of patient-performed readings. This cross-sectional study was conducted in five primary healthcare centers in Kraków, Poland. RESULTS: The mean differences in systolic and diastolic BP readings by patients and researchers were 8.36 mmHg (SD = 10.90 mmHg) and 2.16 mmHg (SD = 9.12 mmHg), respectively. Inaccuracies in patient BP measurements were associated with a less than high school education level, patients' age, and a family history of HTN. CONCLUSION: Patient self-measured BP levels were higher than researcher values, likely due to a higher patient error rate. Healthcare providers must increase training regarding correct HBPM techniques offered to patients; such efforts should be directed at all hypertensive patients, emphasizing the most error-prone demographics.

COVID-19 vaccine short-term adverse events in the real-life family practice in Krakow, Poland.

BACKGROUND: In manufacturers' trials, vaccination against COVID-19 proved to be safe and effective. The officially reported frequency of vaccine adverse events (VAEs) in Poland is lower than that declared by the manufacturers. The anti-vaccination activists questioned the trustworthiness of official data. OBJECTIVES: The aim was to explore the real-life prevalence of VAEs in general practice settings and the factors that may influence it. METHODS: In this pragmatic, mixed prospective and retrospective study, patients vaccinated against COVID-19 between May and October 2021 in three GP practices in Krakow, Poland, were enrolled. Their demographic (age, sex, level of education) and clinical data (weight and height, smoking status, history of allergies, COVID-19 and chronic diseases) were collected. Then, they were interviewed about VAEs they experienced. RESULTS: Out of 1530 patients invited to participate, 1051 (69%) agreed and were eligible for analyses. Only 8.8% did not report any VAE. Pain at the injection site was the most frequently reported reaction (800, 76.2%). The most prevalent systemic ones were excessive fatigue/lethargy (527, 50.6%), sleep/circadian rhythm disturbances (433, 41.6%) and headache (399, 38.3%). Fifty required medical assistance - 39 experienced presyncope (3.7%) and 11 loss of consciousness (1.1%). Only two others were hospitalised. Females, younger adults, those with higher education and with a history of COVID-19 reported systemic VAEs more frequently, while those who were older and obese were less likely to report local reactions. CONCLUSION: Although more than 90% of patients vaccinated against COVID-19 in general practice settings may experience VAEs, in short-term observation, the vast majority are localised and mild.

The response of primary care practices in rural and urban settings in Poland to the challenges of the COVID-19 pandemic.

INTRODUCTION: In the wake of COVID-19 primary care practices have had to overcome and to adapt to several challenges in providing quality care. An international consortium led by Ghent University, Belgium, set up the PRICOV-19 project to study how primary care practices in 38 countries responded to the new challenges. OBJECTIVE: The aim of the study was to describe how Covid-19 impacted the organisation of primary care practices in rural and urban environments in Poland, including the organisation of patient flows, infection prevention, information processing, and communication. MATERIAL AND METHODS: This is cross-sectional questionnaire-based survey among primary care practices. In Poland, the survey was distributed among primary care practices in 16 Polish regions. 180 practices participated in the study. In the analysis of the data U-Mann Whitney or t-test for independent groups, and Wilcoxon test were used to compare the organisation of care before and since the pandemic. RESULTS: Over two-thirds of practices made considerable changes in their structure due to COVID-19; over three-quarters introduced security procedures for phone registrations, but only a quarter still offered consultations without a prior appointment. The use of video consultation quadrupled, and teleconsultations became almost universal. Rural practices were significantly more likely to offer active care for deprived patient groups. A significant increase in infection prevention measures occurred in both urban and rural practices. CONCLUSIONS: COVID-19 brought challenges that spurred changes to the organisation of primary care practices as they sought to continue offering quality care. Despite these hardships, new opportunities for effective changes to clinical operations and organization have emerged and will benefit global health systems in the face of new crises.

Associations between myeloperoxidase and paraoxonase-1 and type 2 diabetes in patients with ischemic heart disease.

BACKGROUND: The phrase "dysfunctional high-density lipoprotein" has been developed in the literature to describe the particle which loses its basic role- anti-oxidative and anti-inflammatory activity. In this porcess, the significance of enzymes- pro-oxidant myeloperoxidase (MPO) and antioxidant paraoxonase-1 (PON-1) from the perspective of HDL-C function has been noted. AIMS: The objective of this study was to analyze the associations between two enzymes -MPO and PON-1 and type 2 diabetes (T2DM) in patients with ischemic heart disease (IHD). METHODS: An observational cross-sectional study including 70 patients with IHD of whom 35 had also T2DM, and 35 had no T2DM. Laboratory tests (MPO, PON-1, fasting glucose, glycated hemoglobin, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, and high-sensitivity C-reactive protein) were performed. RESULTS: The study revealed a significant difference in the serum concentration of the enzymes between patients with IHD with and without T2DM. Our results showed increased MPO concentration levels in diabetic patients. The analysis also revealed that T2DM is independently associated with an increase in MPO levels. Simultaneously, a decrease in PON-1 levels was observed in patients with T2DM. The study also revealed that T2DM is independently associated with a decrease in PON-1 levels. CONCLUSIONS: In patients with type 2 diabetes the profile of enzymes involved in high-density lipoprotein metabolism in patients with IHD is worse than in patients without T2DM. The increase in the levels of MPO, an enzyme with oxidative and atherogenic properties and on a decrease in PON-1 levels, an enzyme with antioxidant and atheroprotective properties is observed.

Responding to COVID-19: The Suitability of Primary Care Infrastructure in 33 Countries.

COVID-19 proved that primary care (PC) providers have an important role in managing health emergencies, such as epidemics. Little is known about the preparedness of primary care practice infrastructure to continue providing high quality care during this crisis. The aim of this paper is to describe the perceived limitations to the infrastructure of PC practices during COVID-19 and to determine the factors associated with a higher likelihood of infrastructural barriers in providing high quality care. This paper presents the results of an online survey conducted between November 2020 and November 2021 as a part of PRICOV-19 study. Data from 4974 practices in 33 countries regarding perceived limitations and intentions to make future adjustments to practice infrastructure as a result of the COVID-19 pandemic were collected. Approximately 58% of practices experienced limitations to the building or other practice infrastructure to provide high-quality and safe care during the COVID-19 pandemic, and in 54% making adjustments to the building or the infrastructure was considered. Large variations between the countries were found. The results show that infrastructure constraints were directly proportional to the size of the practice. Better pandemic infection control equipment, governmental support, and a fee-for-service payment system were found to be associated with a lower perceived need for infrastructural changes. The results of the study indicate the need for systematic support for the development of practice infrastructure in order to provide high-quality, safe primary care in the event of future crises similar to the COVID-19 pandemic.

Practice and System Factors Impact on Infection Prevention and Control in General Practice during COVID-19 across 33 Countries: Results of the PRICOV Cross-Sectional Survey.

Infection prevention and control (IPC) is an evidence-based approach used to reduce the risk of infection transmission within the healthcare environment. Effective IPC practices ensure safe and quality healthcare. The COVID-19 pandemic highlighted the need for enhanced IPC measures and the World Health Organization (WHO) emphasized the need for strict adherence to the basic principles of IPC. This paper aims to describe the IPC strategies implemented in general practice during the COVID-19 pandemic and to identify the factors that impact their adoption. Data were collected by means of an online self-reported questionnaire among general practices. Data from 4466 practices in 33 countries were included in the analysis. Our results showed a notable improvement in IPC during COVID-19 with more practices reporting that staff members never wore nail polish (increased from 34% to 46.2%); more practices reporting that staff never wear a ring/bracelet (increased from 16.1% to 32.3%); and more practices using a cleaning protocol (increased from 54.9% to 72.7%). Practice population size and the practice payment system were key factors related to adoption of a) range of IPC measures including patient flow arrangements and infrastructural elements. An understanding of the interplay between policy, culture, systemic supports, and behavior are necessary to obtain sustained improvement in IPC measures.

Distress and Wellbeing among General Practitioners in 33 Countries during COVID-19: Results from the Cross-Sectional PRICOV-19 Study to Inform Health System Interventions.

Emerging literature is highlighting the huge toll of the COVID-19 pandemic on frontline health workers. However, prior to the crisis, the wellbeing of this group was already of concern. The aim of this paper is to describe the frequency of distress and wellbeing, measured by the expanded 9-item Mayo Clinic Wellbeing Index (eWBI), among general practitioners/family physicians during the COVID-19 pandemic and to identify levers to mitigate the risk of distress. Data were collected by means of an online self-reported questionnaire among GP practices. Statistical analysis was performed using SPSS software using Version 7 of the database, which consisted of the cleaned data of 33 countries available as of 3 November 2021. Data from 3711 respondents were included. eWBI scores ranged from -2 to 9, with a median of 3. Using a cutoff of ≥2, 64.5% of respondents were considered at risk of distress. GPs with less experience, in smaller practices, and with more vulnerable patient populations were at a higher risk of distress. Significant differences in wellbeing scores were noted between countries. Collaboration from other practices and perception of having adequate governmental support were significant protective factors for distress. It is necessary to address practice- and system-level organizational factors in order to enhance wellbeing and support primary care physicians.

General practitioners' perceptions of using virtual primary care during the COVID-19 pandemic: An international cross-sectional survey study.

With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. We explored GPs' perspectives on the main benefits and challenges of using digital virtual care. GPs across 20 countries completed an online questionnaire between June-September 2020. GPs' perceptions of main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. A total of 1,605 respondents participated in our survey. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and accompanying legal frameworks. Main challenges included patients' preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital virtual care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues, and regulatory weaknesses. At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how during the pandemic. Lessons learned can be used to inform the adoption of improved virtual care solutions and support the long-term development of platforms that are more technologically robust and secure.

Digital maturity and its determinants in General Practice: A cross-sectional study in 20 countries.

Background: The extent to which digital technologies are employed to promote the delivery of high-quality healthcare is known as Digital Maturity. Individual and systemic digital maturity are both necessary to ensure a successful, scalable and sustainable digital transformation in healthcare. However, digital maturity in primary care has been scarcely evaluated. Objectives: This study assessed the digital maturity in General Practice (GP) globally and evaluated its association with participants' demographic characteristics, practice characteristics and features of Electronic Health Records (EHRs) use. Methods: GPs across 20 countries completed an online questionnaire between June and September 2020. Demographic data, practice characteristics, and features of EHRs use were collected. Digital maturity was evaluated through a framework based on usage, resources and abilities (divided in this study in its collective and individual components), interoperability, general evaluation methods and impact of digital technologies. Each dimension was rated as 1 or 0. The digital maturity score was calculated as the sum of the six dimensions and ranged between 0 to 6 (maximum digital maturity). Multivariable linear regression was used to model the total score, while multivariable logistic regression was used to model the probability of meeting each dimension of the score. Results: One thousand six hundred GPs (61% female, 68% Europeans) participated. GPs had a median digital maturity of 4 (P25-P75: 3-5). Positive associations with digital maturity were found with: male gender [B = 0.18 (95% CI 0.01; 0.36)], use of EHRs for longer periods [B = 0.45 (95% CI 0.35; 0.54)] and higher frequencies of access to EHRs [B = 0.33 (95% CI 0.17; 0.48)]. Practicing in a rural setting was negatively associated with digital maturity [B = -0.25 (95%CI -0.43; -0.08)]. Usage (90%) was the most acknowledged dimension while interoperability (47%) and use of best practice general evaluation methods (28%) were the least. Shorter durations of EHRs use were negatively associated with all digital maturity dimensions (aOR from 0.09 to 0.77). Conclusion: Our study demonstrated notable factors that impact digital maturity and exposed discrepancies in digital transformation across healthcare settings. It provides guidance for policymakers to develop more efficacious interventions to hasten the digital transformation of General Practice.

Barriers and attitudes towards cervical cancer screening in primary healthcare in Poland - doctors' perspective.

BACKGROUND: Healthcare systems have adopted different strategies to reduce the burden of cervical cancer. In Poland, a population-based screening program was implemented in 2006, leading to a downward trend in cervical cancer burden. However, screening rates are still low in relation to other EU member states. In Poland, Pap smears are mainly performed by gynecologists rather than Primary Health Care (PHC) physicians. Little is known about the experiences and attitudes of the latter regarding cervical cancer screening in a PHC setting. METHODS: A cross-sectional questionnaire-based survey was carried out among 43 PHC physicians from the Malopolska region in Poland. Barriers and attitudes towards cytology in a PHC setting were evaluated. RESULTS: Approximately 35% of surveyed physicians reported having experience in performing cytology. Almost 75% of PHC physicians lacked the necessary equipment in their office to perform the screening. None of the studied physicians performed Pap smears in their office at the time. The reasons included: shortage of competence (78.57%) and time (69.05%), the perception of Pap smears as a task for gynecologists (69.05%), the lack of financial incentives (61.90%), and the belief that their patients would be unwilling to undergo the test in their PHC physician's office (33.33%). More than three quarters (76.74%) declared they would be ready to perform Pap smears if the tests were additionally paid. No significant associations between PHC physicians' characteristics and their willingness to perform cytology screening were found. CONCLUSION: The primary barrier to perform Pap smears by PHC physicians does not lie in their personal reluctance but in the organization of the healthcare system. Provision of required training and proper funding allocation can likely improve the screening rate of cervical cancer in Poland.

The quality of patients' self-blood pressure measurements: a cross-sectional study.

BACKGROUND: The accurate and independent measurement of blood pressure (BP) by patients is essential for home BP monitoring (HBPM) and determining the quality of hypertension (HTN) control. This study aimed to evaluate the BP self-measurement techniques of hypertensive patients and their accuracy in accordance with established guidelines. We sought to identify the common errors that patients make and suggest improvements that can be implemented in the primary healthcare setting to increase the reliability of HBPM conducted by hypertensive patients. METHODS: One hundred patients diagnosed with HTN completed a questionnaire inquiring about their health and demographic data and BP monitoring practices. Patients were then observed and filmed while measuring their BP on their own devices in five primary healthcare centres in Kraków, Poland. The correctness of their techniques was assessed in accordance with the European Society of Hypertension guidelines on HBPM. RESULTS: Only 3% of patients measured their BP without error; 60% made three or more errors. The most frequent error, made by 76% of subjects, was incorrect sphygmomanometer cuff placement (above or below heart level, or/and the indicator mark was not aligned with the brachial artery). Regarding patients' previous instruction for the correct use of their devices, 36% of patients referred to their monitor's user manual, 22% did not receive any prior assistance, and only 29% were adequately counselled by physicians on how to measure their BP correctly. CONCLUSIONS: Our findings suggest that primary healthcare physicians and their personnel often do not adequately instruct patients on how to measure their BP correctly. Therefore, healthcare systems must provide patients with more adequate training and reference materials on the best practices of BP monitoring.

Evaluating the Impact of COVID-19 on the Adoption of Virtual Care in General Practice in 20 Countries (inSIGHT): Protocol and Rationale Study.

BACKGROUND: In recent decades, virtual care has emerged as a promising option to support primary care delivery. However, despite the potential, adoption rates remained low. With the outbreak of COVID-19, it has suddenly been pushed to the forefront of care delivery. As we progress into the second year of the COVID-19 pandemic, there is a need and opportunity to review the impact remote care had in primary care settings and reassess its potential future role. OBJECTIVE: This study aims to explore the perspectives of general practitioners (GPs) and family doctors on the (1) use of virtual care during the COVID-19 pandemic, (2) perceived impact on quality and safety of care, and (3) essential factors for high-quality and sustainable use of virtual care in the future. METHODS: This study used an online cross-sectional questionnaire completed by GPs distributed across 20 countries. The survey was hosted in Qualtrics and distributed using email, social media, and the researchers' personal contact networks. GPs were eligible for the survey if they were working mainly in primary care during the period of the COVID-19 pandemic. Descriptive statistical analysis will be performed for quantitative variables, and relationships between the use of virtual care and perceptions on impact on quality and safety of care and participants' characteristics may be explored. Qualitative data (free-text responses) will be analyzed using framework analysis. RESULTS: Data collection took place from June 2020 to September 2020. As of this manuscript's submission, a total of 1605 GP respondents participated in the questionnaire. Further data analysis is currently ongoing. CONCLUSIONS: The study will provide a comprehensive overview of the availability of virtual care technologies, perceived impact on quality and safety of care, and essential factors for high-quality future use. In addition, a description of the underlying factors that influence this adoption and perceptions, in both individual GP and family doctor characteristics and the context in which they work, will be provided. While the COVID-19 pandemic may prove the first great stress test of the capabilities, capacity, and robustness of digital systems currently in use, remote care will likely remain an increasingly common approach in the future. There is an imperative to identify the main lessons from this unexpected transformation and use them to inform policy decisions and health service design. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/30099.

Reorganisation of GP surgeries during the COVID-19 outbreak: analysis of guidelines from 15 countries.

BACKGROUND: General practitioners (GPs) play a key role in managing the COVID-19 outbreak. However, they may encounter difficulties adapting their practices to the pandemic. We provide here an analysis of guidelines for the reorganisation of GP surgeries during the beginning of the pandemic from 15 countries. METHODS: A network of GPs collaborated together in a three-step process: (i) identification of key recommendations of GP surgery reorganisation, according to WHO, CDC and health professional resources from health care facilities; (ii) collection of key recommendations included in the guidelines published in 15 countries; (iii) analysis, comparison and synthesis of the results. RESULTS: Recommendations for the reorganisation of GP surgeries of four types were identified: (i) reorganisation of GP consultations (cancelation of non-urgent consultations, follow-up via e-consultations), (ii) reorganisation of GP surgeries (area partitioning, visual alerts and signs, strict hygiene measures), (iii) reorganisation of medical examinations by GPs (equipment, hygiene, partial clinical examinations, patient education), (iv) reorganisation of GP staff (equipment, management, meetings, collaboration with the local community). CONCLUSIONS: We provide here an analysis of guidelines for the reorganisation of GP surgeries during the beginning of the COVID-19 outbreak from 15 countries. These guidelines focus principally on clinical care, with less attention paid to staff management, and the area of epidemiological surveillance and research is largely neglected. The differences of guidelines between countries and the difficulty to apply them in routine care, highlight the need of advanced research in primary care. Thereby, primary care would be able to provide recommendations adapted to the real-world settings and with stronger evidence, which is especially necessary during pandemics.

Are students at Krakow universities turning to energy-boosting dietary supplements?

INTRODUCTION: Recent studies have revealed an increase in the consumption of dietary supplements including frequency of use of caffeine, which is addictive and potentially harmful in higher doses. Energy drinks include high doses of caffeine and are particularly targeted at young people. OBJECTIVE: The aim of the study was to investigate the frequency of use of caffeine-containing energy products, associated factors and understanding the associated side- effects in university students. MATERIAL AND METHODS: A cross-sectional questionnaire-based survey was conducted among students of the 5 largest Universities in Krakow. Statistical significance was set at the 0.05 level. RESULTS: Around 35% of respondents reported the use of different supplements including high doses of caffeine. Frequency of caffeine-containing products consumption was significantly higher in female students compering to males. Also, those respondents who originated from big cities were more likely to use caffeine-containing products. The study revealed that these substances were also more popular among those participants who study economics. Most students use these substances in order to reduce feeling tired and the duration of sleep, others mainly to increase concentration prior to examinations. Almost one fourth of the group who used these substances admitted to having experienced some sideeffects in the past. They suffered mainly from insomnia, but also from excessive stimulation and muscle trembling. Almost half of the substances users did not know of any potential side-effects. CONCLUSIONS: Attempts should be made to increase public awareness of the side-effects of these substances, particularly among the student population. These campaigns should be targeted especially at female students who come from bigger cities. This study is a step towards drawing attention to this issue.

Impact of family physicians on cervical cancer screening: cross-sectional questionnaire-based survey in a region of southern Poland.

BACKGROUND: Despite worldwide efforts in encouraging routine pap smears for early detection of cervical cancer, Poland's screening rate lags behind the rest of the European Union at 20.2%. Family physicians (FPs) in Poland rarely perform pap smears, and little is known about the experiences and attitudes of Polish patients regarding pap smear screening in a primary healthcare (PHC) setting. METHODS: A cross-sectional questionnaire-based survey was performed. Questionnaires were distributed among 43 FPs and 418 of their patients in one Polish region. The data from patients were associated with the doctors' characteristics. Descriptive statistics, the χ2 test and the Mann-Whitney U test were used for analysis. RESULTS: Nearly two-thirds of patients (66%) declared willingness to undergo free pap smear screening by their FPs, with the most common reason being time saved. Among those objecting to receive pap smears from their FPs, immediate specialist care provided by gynaecologists in case of adverse results was the main concern. The factors that positively influenced the patients' decision to undergo cervical cancer screening in PHC were: (1) living in a city with more than 100 000 inhabitants, (2) being single, (3) having a female FP or (4) a physician with specialty training in family medicine. CONCLUSION: There is high level of acceptance for pap smears performed in PHC offices among patients in Poland. They are more likely to comply with the screening due to easy access. Establishing a solid physician-patient relationship is also crucial in encouraging screening.

High-density lipoprotein (HDL) cholesterol - more complicated than we think?

INTRODUCTION AND OBJECTIVE: There are some clinical situations where a high level of HDL cholesterol (HDL-C) may be unfavourable. In these situations, HDL-C may undergo some changes, and even if its quantity is within the reference range, its quality is no longer the same. BRIEF DESCRIPTION OF STATE OF KNOWLEDGE: Diabetes is the state of elevated oxidative stress. Studies conducted to-date have revealed an increased production of the reactive forms of oxygen as the result of tissue damage in diabetes patients. The expression 'dysfunctional HDL' has been coined in the literature to describe high-density lipoproteins that lose their antioxidative and anti-inflammatory properties, that is, HDL-C that loses its basic functions. Recent observational studies have confirmed that the atheroprotective activity of properly functioning HDL-C is frequently impaired in clinical situations associated with oxidative stress. The presented review lays the foundation for a new approach to understanding how the functional properties of HDL help reduce cardiovascular risk. CONCLUSIONS: In the light of presented findings it seems that there is a need to seek a better diagnostic marker than HDL-C level. This study presents some possible directions for future research to bring us closer to the full understanding of the HDL particle and its role in patients with ischemic heart disease and type 2 diabetes.

Assessment of ovarian reserve in patients with ovarian endometriosis following laparoscopic enucleation of a cyst accompanied by CO2 laser ablation or electroablation.

INTRODUCTION: Endometriosis affects about 5-15% of women in the reproductive period. One of the most important complications of pelvic endometriosis is infertility. OBJECTIVE: The assessment of ovarian endometriosis therapy with the use of combined laparoscopic techniques (cyst enucleation with electroablation/CO2 laser ablation) and their influence on the preservation of the ovarian reserve. MATERIALS AND METHOD: Fifty-eight patients aged 19-40 with diagnosed ovarian endometriosis underwent pre-surgical assessment of their ovarian reserve consisting of antral follicle count (AFC), basal ovarian volume (BOV) and FSH level. Twenty-four patients underwent laparoscopic enucleation of the cyst with CO2 laser ablation and thirty-four patients had enucleation with successive electroablation. The ovarian reserve of the patients was reassessed during follow-up assessments three and six months after surgery. RESULTS: In neither group was there a statistically significant decrease of AFC after three or six months. Additionally, in the group that underwent enucleation with electroablation, a significant drop in FSH level was observed after three months. This group was characterized by a statistically significant decrease in BOV at the three- and six-month follow-up assessments. 17% patients had ovarian relapses visible in the ultrasound scan at the six month follow-up assessment. In the group of patients who underwent enucleation with CO2 laser ablation, BOV had not changed significantly, while a high rate of ovarian relapses (39%) was observed. CONCLUSIONS: The lack of significant changes in AFC level after the surgeries suggests an initial positive evaluation of both techniques in the context of ovarian reserve preservation. The detrimental BOV decrease after enucleation with electroablation and high relapse rate after enucleation after CO2 laser ablation shows that further research is needed in order to optimize the laparoscopic techniques of endometriosis therapy.