Management of respiratory tract infections in primary care in Poland--results of the happy audit 2 project.

OBJECTIVE: The Polish results of the international Happy Audit 2 project are reported which objective was to present therapeutic decisions made by general practitioners (especially antibiotics prescribed) and diagnostic methods applied to patients with respiratory tract infections (RTI). MATERIAL AND METHODS: [corrected] Following each visit of patient with respiratory tract infection, general practitioners participating in the study completed the questionnaire. The questionnaire included patient's data (age, gender), the duration of disease, clinical symptoms, diagnosis, prescribed antibiotics, additional testing as well as the influence of various factors on therapeutic decision. RESULTS: Having considered the results of HappyAudit in Poland, a total of 5,137 office visits of patients reporting symptoms of RTIs were analyzed. The average duration of symptoms before visiting GP was 4.8 days (compared to average 4.4 in other countries). Worth noting is that additional testing in diagnosis of RTIs was performed less frequently in Poland: rapid streptococcal test was conducted in 0.4% of cases (European average: 4.45%), CRP--in 2.2% of patients (average from other countries: 14.2%) and chest X-ray in 2.3% of cases compared to 14% in other project's participants. In Poland, the most frequently applied antibiotic was amoxicillin, which was used in 28.9% of cases ended with antibiotic prescribing (amoxicillin/pivampicillin were also predominant in other countries, excluding Sweden). In Poland, macrolides (22.4% of all prescriptions for antibiotic) and cephalosporins (12.1%) were frequently used. The results indicate that narrow-spectrum antibiotics are prescribed in Poland less frequently, with the example being penicillin V which was prescribed in 6.7% of patients with RTIs who were given antibiotic. CONCLUSIONS: Comparing the results of Happy Audit 2 in Poland and other project's participants, the major differences consist in rare use of phenoxymethylpenicillin in favour of amoxicillin and macrolides as well as infrequent use of additional testing in diagnosis of RTIs in Poland.

Association between cyberchondria and the use of complementary and alternative medicine (CAM) - a cross-sectional study.

INTRODUCTION AND OBJECTIVE: Cyberchondria has been described relatively recently as a behaviour characterized by excessive Internet searching for medical information related to increasing levels of health anxiety. Complementary and alternative medicine (CAM) refers to a broad set of health care practices that are not part of a country's traditional or conventional medicine, and are not fully integrated into the dominant health care system The aim of this study is to evaluate the relationship between cyberchondria and the use of complementary and alternative medicine. MATERIAL AND METHODS: A cross-sectional study was conducted from 25 April - 25 December 2022. A computer-assisted web interviewing (CAWI) survey technique was used. The study population consisted of 626 respondents who took part in the study. RESULTS: The severity of cyberchondria is associated with 'a greater number of CAM products used' (beta = 0.101; p = 0.043), 'a greater number of self-help techniques used' (beta = 0.210; p<0.001), searching for knowledge about CAM on the Internet (beta-0.199; p<0.001), using sources other than books (beta = -0.114; p = 0.025), younger age (beta = -0.170; p<0.001) and worse education (beta = -0.101; p = 0.033). CONCLUSIONS: The research results indicate that there is a link between cyberchondria and the use of CAM. However, since some components of the CSS-PL scale and self-rated health were not associated with more frequent use of CAM, it is likely that these results may not be fully reliable. The association between cyberchondria and CAM use should be investigated in further studies using comprehensive medical interviews.

Selected routine laboratory tests in the clinical assessment of patients with obstructive sleep apnea.

INTRODUCTION: Obstructive sleep apnea (OSA) is a chronic disease characterized by repetitive complete or partial occlusion of the upper airways during sleep with respiratory muscle effort, which leads to consecutive apneas and hypopneas. Obstruction of the upper airways during sleep leads to repetitive episodes of disrupted airflow and consequent changes in blood oxygenation, resulting in hypoxaemia and hypercapnia. Intermittent hypoxaemia induces the production of pro-inflammatory factors and promotes metabolic dysregulation and platelet aggregation. OBJECTIVE: The main aim of this study was to determine differences, if any, in selected standard parameters in routine laboratory tests often used in GP practice between patients with obstructive sleep apnea, without comorbidities, and a well-defined control group with the absence of this syndrome proven in polygraphic examination. MATERIAL AND METHODS: Of the 192 clinically assessed persons with suspected OSA and admitted to the Internal Medicine Department in Lublin, 85 were qualified for the study after application of exclusion criteria. Demographic and health behaviour-related data, medical history regarding sleep habits and cardiovascular disease, were collected from each patient. RESULTS: Apart from significantly higher MCV and MCH among the cpontrol group, no significant differences were found between patients with obstructive sleep apnea and the control group. CONCLUSIONS: The results can be useful for the holistic assessment of the health status of patients with newly-diagnosed OSA.

Prediction value of soluble urokinase plasminogen activator receptor (suPAR) in COVID-19 patients - a systematic review and meta-analysis.

INTRODUCTION AND OBJECTIVE: In COVID-19, the rapid prediction of the severity of a patient's condition using modern biomarkers can accelerate the implementation of appropriate therapy, and thus improve the patient's prognosis. MATERIAL AND METHODS: A meta-analysis was conducted of data available in the literature on the differences in baseline suPAR blood concentration between patients (1) who tested positive and negative for COVID-19, (2) who had severe and non-severe COVID-19, and (3) COVID-19 survivors and non-survivors. RESULTS: SuPAR levels in SARS-CoV-2 negative and positive patients varied and amounted to 3.61±1.59 ng/ml vs. 6.45±3.13 ng/ml, respectively (MD = -3.18; 95%CI: -4.71 to -1.66; p<0.001). suPAR levels among non-severe and severe COVID-19 patients were 7.06±2.64 ng/ml and 5.06±3.16 ng/ml (MD = 0.18; 95%CI: -2.48 to 2.83; p=0.90), respectively. Pooled analysis showed that suPAR levels between severe versus critical COVID-19 patients to be 5.59±1.54 ng/ml and 6.49±1.43 ng/ml, respectively (MD = -1.00; 95%CI: -1.31 to -0.70; p<0.001). The suPAR levels between ICU survivors versus non-survivors amounted to 5.82±2.33 ng/ml and 8.43±4.66 ng/ml (MD = -3.59; 95%CI: -6.19 to -1.00; p=0.007). In the case of in-hospital mortality, the mean suPAR level among survivors to hospital discharge was 5.63±1.27 ng/ml, compared to 7.85±2.61 ng/ml for patients who did not survive (MD = -3.58; 95%CI: -5.42 to -1.74; p<0.001). CONCLUSIONS: SuPAR levels are significantly elevated in severe COVID-19 illness and maybe useful in predicting mortality. Further studies are needed to determine cut-off points and clarify the association of suPAR levels with disease progression. This is of utmost importance given the ongoing pandemic and overburdened health care systems.

Uncovering the effects of COVID-19 on in-hospital cardiac arrest - a living systematic review and meta-analysis.

INTRODUCTION AND OBJECTIVE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a global pandemic and had a negative impact on the entire health care system. To understand the effect of COVID-19 on outcomes of in-hospital cardiac arrest (IHCA), a systematic review and meta-analysis of studies was designed to compare the pre- and intra-pandemic periods of adult patients who suffered cardiac arrest, and additionally by performing a sub-analysis related to COVID-19 positive vs. negative patients in the same group of patients. MATERIAL AND METHODS: To evaluate the impact of COVID-19 on IHCA outcomes a systematic review and meta-analysis was performed. Pubmed (MEDLINE), Scopus, Embase, Web of Science, and Cochrane database were searched for articles published from 1 January 2020 - 8 April 2023. RESULTS: Return of spontaneous circulation events among IHCA patients in pre-COVID-19 and COVID-19 pandemic periods varied and amounted to 64.0% vs. 60.0%, respectively (OR=1.23; 95%CI: 1.19 to 1.26; p<0.001). Re-arrest occurrence was 4.5% vs. 4.9%, respectively (OR=1.24; 95%CI: 1.00 to 1.53; p=0.05). Survival to hospital discharge (SHD) was 25.1% compared to 20.9% for COVID-19 period (OR = 1.17; 95%CI: 0.96 to 1.41; p=0.12). During the COVID-19 period, SHD in COVID-19 positive patients was 14.0% compared to 25.9% for patients without COVID-19 (OR=0.72; 95%CI: 0.28 to 1.86; p=0.50). 30-day survival rate among COVID-19 positive vs. negative patients was 62.6% vs. 58.3%, respectively (OR =0.99; 95%CI: 0.23 to 4.24; p=0.99). CONCLUSIONS: Patients with SARS-CoV-2 infection had reduced rates of ROSC and SDH, as well as poorer neurologic outcomes and increased in hospital re-arrests during the COVID-19 period. However, the 30-day survival rate was similar in SARS-CoV-2 positive and negative patients.

[The patient with an alcohol abuse problem family doctor practice]. / Pacjent z problemem alkoholowym w praktyce lekarza rodzinnego.

Doctors of many specialties, including the family doctors, encounter the problems of alcohol abuse in their patients. Due to the fact that many symptoms of dangerous diseases can be masked by the fact of alcoholism, a brief doctor's visit has to be conducted with watchfulness, caution and care. Family doctors have some brief testes (such as CAGE test, AUDIT test), besides of precise anamnesis and blood chemistry, which make it easier to identify a patient with an alcohol problem. People with disabilities are more exposed to alcohol abuse since they often experience additional factors such as unemployment, social isolation and homelessness. All of the above factors foster the more frequent alcohol usage. In Poland the main treatment method of alcohol addiction is psychotherapy practiced in the rehab centers. The detoxification treatment is voluntary and free of charge even though the patients checking into those facilities are doing it against their will. They are forced to do so by entourage, family, spouse or risk of unemployment. Acamprozate is considered as a drug, run to extend abstaining from alcohol. In the past, therapy with disulfiram substance was common, but now, it is considered as unethical behaviour. In practice of medicine, a patient with alcohol addiction creates not onlya medical but also legal problems. Therefore keeping of detailed medical documentation is very important as it may become significant evidence in the future.

[Toxicity of analgesics in the family doctor practice]. / Toksycznosc leków przeciwbólowych w praktyce lekarza rodzinnego.

Analgesic usage without any consultation with a physician is very common in Poland. It increases the risk of occurrence of the harmful effect or harmful interaction with other medicaments taken by the patient. The abuse of painkillers applies not only to opioid but also to nonopioid analgesics. The largest group of commonly available medicaments are NSAIDs. The most frequent undesirable effect of NSAIDs' is dyspepsia. Among the most dangerous, and very often the ones without any symptoms, are gastric and duodenum ulceration for which the bleeding and perforation may be the first manifestation. Each non steroidal anti-inflammatory drug taken in large doses can be a cause of analgesic nephropathy. Its deceitful course can delay the diagnosis leading to chronic kidney failure. A complex supplements, that include central acting substances, increase the risk of kidney damage, as well as physical and psychological addiction. NSAIDs can cause: the heart failure to be more severe, treatment resistant arterial hypertension, increase an effectiveness of anticoagulants or antidiabetic drugs. The problem is also that some medicaments are available without a prescription (acetylsalicylic acid, ibuprofen, acetaminophen), especially that they are ingredients of many complex supplements considered safe. Taking doses larger than therapeutic or simultaneously taking many supplements of the same active substance had many times led to poisoning and even death. Equally dangerous can be an abuse of tramadol, codeine and COX-2 inhibitors. Therefore, prudential prescription of NSAIDs, knowledge of risks related to therapy and informing the patients about their side effects, may decrease the number of patients abusing the analgesics which can lead to lowering the number of deaths caused by serious complications.

Comparison of health care systems in Poland and Great Britain by Poles staying temporarily in Great Britain prior to the COVID pandemic.

INTRODUCTION: Poland's accession to the European Union intensified migration for work purposes. One of the most popular destinations for emigration was Great Britain, which allocates more money to health protection than Poland, where there is a widespread belief that the quality of public health care is poor. However, more negative opinions were expressed by migrants about health care in Great Britain. OBJECTIVE: The aim of the study was to compare and assess the quality of health services in Poland and Great Britain prior to the SARS COVID-19 pandemic. MATERIAL AND METHODS: The study was conducted in the form of a questionnaire addressed to Poles who stay or stayed in the territory of Great Britain and used services provided by both Polish and British medical entities. 1,625 people took part in the study: 1,402 women (86.28%) and 223 men (13.72%). The survey contained 30 questions, of which statistically significant results were obtained in 5 of them. RESULTS: There was a statistically significant difference in the average assessments of health services in Poland and Great Britain. The availability of primary health care services and specialist services, other than gynaecology, in Poland was rated higher. In addition, the quality and costs of treatment received a much higher average score in the evaluation of Polish health care compared to the British system. CONCLUSIONS: Although the amount of financial outlays and statistical data should suggest the advantage of the British health care system, the respondents assessed the services provided in Poland being better.

Prevalence of target organ damage in hypertensive patients with coexisting obstructive sleep apnea.

INTRODUCTION AND OBJECTIVE: Obstructive sleep apnea (OSA) is associated with cardiovascular risk and higher mortality. Assessment of subclinical organ lesions is significant for prevention of clinically manifested complications which might result in death. The aim of the study was to assess the prevalence of subclinical target organ damage in hypertensive patients with OSA, and to establish whether these lesions are dependent on the intensity of sleep-disordered breathing. MATERIAL AND METHODS: The study covered 67 patients with OSA diagnosed on the basis of polygraphy. Depending on the apnea/hypopnea index (AHI), the patients were divided into two groups: G1 (n=32; AHI=5-30) and G2 (n=35; AHI>30). The control group C consisted of 31 hypertensive subjects with OSA risk estimated as low based on the Berlin Questionnaire (BQ). Each patient had the following parameters measured: intima-media thickness (IMT), ankle-brachial index (ABI), left ventricular mass index (LVMI), and estimated glomerular filtration rate (eGFR). RESULTS: The patients with severe OSA had significantly higher LVMI compared to the control group (130.99±44.6 g/m2 versus 106.61±27.86 g/m2; p=0.0332). The G2 group had higher eGFR than C (104.7±17.96 ml/min/1.73m2, 88.85±17.68 ml/min/1.73m2; p=0.0058). Similar results of eGFR were observed between G1 and C (104.35±21.06 ml/min/1.73m2, 88.85±17.68 ml/min/1.73m2; p=0.0081). G1 and G2 did not differ significantly in terms of eGFR. The other measured parameters, such as IMT and ABI, did not differ significantly between OSA and controls. CONCLUSIONS: Patients with severe OSA demonstrate signs of left ventricular hypertrophy, while early atherosclerotic lesions (ABI and IMT) were not more intense than in the control group. High eGFR levels may indicate hyperfiltration, which does not correlate with OSA intensity level.

The effect of zinc supplementation on the course of COVID-19 - A systematic review and meta-analysis.

INTRODUCTION AND OBJECTIVE: Zinc is a trace element that plays a role in stimulating innate and acquired immunity. The aim of the study was to determine the antiviral effect of the administration of zinc in COVID-19 patients. MATERIAL AND METHODS: A literature search was performed in P Web of Science, PubMed, Scopus and Cochrane databases from 1 January 2020 - 22 August 2022. In addition, reference lists of the included articles and their related citations in PubMed were also reviewed for additional pertinent studies. RESULTS: A total of 9 eligible studies were identified. In-hospital mortality in zinc supplementation patients, and patients treated without zinc, varied and amounted to 21.6% vs. 23.04% difference (OR=0.71; 95%CI: 0.62-0.81; p<0.001). 28-day to 30-day mortality in patients treated with zinc was 7.7%, compared to 11.9% for patients treated without zinc (OR=0.61; 95%CI: 0.35-1.06; p=0.08). In-hospital adverse events among patients treated with and without COVID-19 did not show any statistically significant differences in relation to acute kidney injury occurrence (12.8% vs. 12.4%, respectively; OR=0.63; 95%CI: 0.19-2.12; p=0.45, as well as need for mechanical ventilation (13.2% vs. 14.1%; OR=0.83; 95%CI: 0.52-1.32; p=0.43). CONCLUSIONS: Zinc supplementation is associated with lower COVID-19 in-hospital mortality. Additionally, it is risk-free in COVID-19 patients since there have been no negative side effects, such as acute renal damage or the requirement for mechanical ventilation compared to patients without COVID-19. Due to scientific evidence and the role it represents in the human body, zinc supplementation should be taken into consideration for COVID-19 patients as an adjunct therapy.

Fever, rash, and eosinophilia - early signs of angioimmunoblastic T-cell lymphoma.

Angioimmunoblastic T-cell lymphoma (AITL) is an uncommon lymphoma of elderly adults with a poor prognosis. AITL patients show systemic symptoms, lymphadenopathy, and not infrequently, skin rash with various dysimmune phenomena rashes. The case is presented of a 68-year-old male with skin rash, lymphadenopathy and hypereosinophilia who, after investigations, was diagnosed with AITL. Despite the treatment used, the patient's condition gradually deteriorated and died due to heart and kidney failure. The diagnosis of AITL is often established only after several weeks or months because of transient physical findings, non-specific symptoms, and a broad range of serologic or radiologic abnormalities. Some patients with AITL experience non-specific dermatitis and eosinophilia. The presented case should raise awareness of the presentations of AITL which is important for physicians to reach an accurate diagnosis.

Use of complementary and alternative medicine in patients with cancer and their relationship with health behaviours - Cross-sectional study.

INTRODUCTION AND OBJECTIVE: Although the use of complementary and alternative medicine (CAM) is common with Polish cancer patients, little is known about cancer patients' methods of using CAM and how it correlates with their health behaviour. The aim of the study was to determine the scope of application of complementary and alternative medicine methods among patients treated by oncology and to compare the health behaviours of patients who use alternative medicine with those who do not use these methods. MATERIAL AND METHODS: The studies were conducted from August 2019 - January 2020 in an Oncology Centre in south-eastern Poland. A cross-sectional study was conducted in a group of 208 oncological patients. The authors' own questionnaire and the standardized Health Behaviour Inventory were used. RESULTS: Most of the patients (85.09%) declared that they used complementary and alternative medicine methods. 45.19% of the respondents had a high rate of health behaviours. It was observed that there was no communication related to the use of CAM among the patients and healthcare staff. Patients using CAM demonstrated more positive health behaviours than those who were not using these methods (p<0.001). CONCLUSIONS: The majority of the surveyed patients suffering from cancer used complementary and alternative medicine and declared that it was very or slightly effective in strengthening the immune system and helpful in fighting cancer. The patients who used CAM exhibited a higher level of health behaviours than those who did not use these methods.

Importance of most frequent needs of the disabled in shaping areas of support in public health. Part 1. Analysis of selected demographic and social characteristics of the disabled with consideration of the causes of body dysfunction, legal disability status, and selected characteristics of the state of health.

INTRODUCTION AND OBJECTIVE: The disabled are a group with a heterogeneous structure of causes and needs. The occurring physical, health, and social barriers constitute areas of public health. Assessment of these barriers requires systematic studies in order to use results supporting the tasks of public health, indispensable for pursuing the challenges of sustainable development. The aim of the study was to discuss the selected demographic, social, living and housing, as well as economic characteristics of the disabled rural and urban inhabitants, which are important for shaping the tasks of public health. MATERIAL AND METHODS: The study group consisted of 676 disabled aged 19 - 98 years, including 56.4% of females and 43.6% of males, 38.0% of whom lived in rural areas. The disabled were qualified into a study group by the method of targeted sampling. The research instruments were an author-constructed Disability Questionnaire, and the Research Protocol. Statistical analysis was performed using the software IBM SPSS Statistics v. 27. The p values p < 0.05 were considered statistically significant. RESULTS: The level of risk of the phenomenon of disability was similar among both males and females. Higher risk was observed among widows and widowers, females with a low level of education, the disabled in older age groups, as well as those living in rural areas, maintaining themselves on non-earned sources of income, and running a single person household. The main causes of disability were diseases. CONCLUSIONS: 1. The majority of the population in the study were disabled with a legal grade of disability. 2. The analyzed characteristics fell within two groups: demographic and social, and health characteristics with difficult to separate health and social problems. 3. The most important problems in the area of public health were specified. 4. It is necessary to conduct studies considering demographic and social variables in order to level-up health inequalities between the disabled and those able-bodied. Effective solving of barriers and risks embedded in the social, family, and occupational situation prevents secondary disability, and also provides an opportunity for sustainable development in this population group.

Oxidative stress-induced growth inhibitor 1 in alcohol-induced liver cirrhosis.

INTRODUCTION AND OBJECTIVE: Human oxidative stress-induced growth inhibitor 1 (OSGIN1) is a protein identified in 2001 which belongs to the OKL38 protein family. The aim of the study was to investigate the levels of this protein depending on the severity of alcohol-induced liver cirrhosis. MATERIAL AND METHODS: The study group consisted of 60 patients: 30 patients with cirrhosis in the P-Ch A and B stage and 30 in the P-Ch C stage. The control group consisted of 18 healthy individuals without liver diseases, who did not abuse alcohol. Oxidative stress induced growth inhibitor 1 (OSGIN1), fibroblast growth factor 1 (FGF1) and fibroblast growth factor 21 (FGF21) were determined in blood serum using enzyme-linked immunosorbent assay (ELISA) kits. All absorbance readings were conducted using an Epoch Microplate Spectrophotometer (BioTek Instrumentals, Inc., Winooski, VT, USA). OSGIN1, FGF1 and FGF21 concentrations were determined using Sandwich enzyme immunoassay kits (by Cloud Clone Corp., Katy, TX, USA). Statistica 13.3 (TIBCO Software, Inc.) was used for data analysis. RESULTS: The concentration of OSGIN1 was 0.028 ± 0.017 in the control group which increased with the advancement of liver cirrhosis (stage of Pugh-Child): 0.075 ± 0.098 in the P-Ch A + B group and 0.121 ± 0.134 in the P-Ch C stage. Multiple comparison tests confirmed statistically significant differences in OSGIN1 concentration between the control group and P-Ch C (p <0.02). Significant correlations were noted between OSGIN1 and FGF1 (r = 0.39; p = 0.004) and between OSGIN1 and FGF21 (r = 0.53; p <0.0001). CONCLUSIONS: The study revealed that the level of OSGIN1 increased significantly in the P-Ch C stage of liver cirrhosis. It is possible that OSGIN1 may be used for the non-invasive diagnosis of ALD, but its possible diagnostic value is still very uncertain.

Anthropometric, body composition and behavioural predictors of bioelectrical impedance phase angle in Polish young adults - preliminary results.

INTRODUCTION AND OBJECTIVE: Bioimpedance analysis (BIA) phase angle (PhA) is an index of the integrity of cells and cellular membranes. The aim of the study was identification of behavioural and anthropometric predictors of PhA in a group of young adults. MATERIAL AND METHODS: A cross-sectional observational study of health behaviours, anthropometric indicators and body composition assessed by the BIA method was conducted in a group of Polish young adults (n=92) aged 18 - 24 (mean - 19.33, STD - 0.915). Behavioural variables included: level of physical activity, eating behaviours and nutritional knowledge. Body composition was analysed by means of BIA phase-sensitive 8-electrode medical SECA mBCA 525 device. RESULTS: The mean PhA value in the examined cohort was 6.38±0.75 (males - 7.22±0.72; females - 6.13±0.57). Males also showed higher statistically significant other body composition indices, excluding fat mass. The multiple regression model, including anthropometric variables and gender, which explained the effect of these variables on PhA, occurred to be significant (p<0.0000) and allowed explanation of the 82.49% of PhA variability. PhA was significantly predicted from body mass index (BMI), absolute fat mass, visceral adipose tissue value, skeletal muscle mass value and gender. The regression model, including behavioural predictors and gender, allowed explanation of the lower percentage of PhA variability (42.75%; p<0.0000) and included general intensity of health behaviours, level of nutritional knowledge, and gender. A regression model which would consider simultaneously anthropometric and behavioural variables could not be constructed. CONCLUSIONS: In the examined cohort, anthropometric and body composition variables showed a stronger predictive value with respect to PhA, compared to behavioural variables.

Anti-vaccine movements - a form of social activity for health care, ignorance or diversion aimed at destabilizing the health situation? Part 1. Epidemiological safety. Vaccinations - pros and cons.

INTRODUCTION: Vaccinations are a way accepted by science of preventing infectious diseases. Because of their epidemiological significance, vaccinations are considered compulsory in many countries and their evasion is penalized. Anti-vaccine movements may pose a threat to the epidemiological situation in many countries. The study presents the arguments formulated by opponents of vaccination and provides counter-arguments. MATERIAL AND METHODS: The study is based on the analysis of data stored in scientific databases, information obtained from Google, Bing and Yahoo on the Internet, as well as newspapers, magazines and opinion-forming websites. RESULTS: The slogans propagated by anti-vaccination movements are usually based on easily proven erroneous theories and lies, although there are also arguments expressing belief in the conspiracy of governments, politicians and vaccine manufacturers, or incompetence of scientists and practitioners. CONCLUSIONS: In recent years in Poland, the activity of movements against vaccination has increased significantly, and their propaganda, through its negative impact on social attitudes, threatens to destabilize the epidemiological situation. Analysis of arguments used by the opponents of vaccination suggests a lack of reliable knowledge, religious overtones (addressed to people with fundamentalist personalities), or the ill-will attitudes of anti-vaccine individuals/groups used for their own purposes. Familiarization with the arguments of anti-vaccine propaganda is necessary in order to implement effective methods of fighting such attitudes and beliefs.

Anti-vaccine movements - health care, ignorance or a diversion aimed at destabilizing the health situation? Part 2. Contemporary conditions for the functioning and development of anti-vaccination movements.

INTRODUCTION: Vaccinations are a way accepted by science of the struggle against infectious diseases. Because of their epidemiological significance, vaccinations are considered compulsory in many countries and their evasion is penalized. The WHO experts list anti-vaccine attitudes and movements among the top 10 threats to human health. Most people's refusals are mainly due to fears of anti-vaccine propaganda. Understanding this phenomenon will be the basis for improving the epidemiological situation in Poland. MATERIAL AND METHODS: The study is based on the analysis of data stored in scientific databases, as well as information obtained from Google, Bing and Yahoo and newspapers, magazines and opinion-forming websites. RESULTS: The anti-vaccine movements occur due different motivations, such as ignorance, fear and religious beliefs. Sometimes they can be supported by foreign services aimed at destabilization in selected areas of the globe. CONCLUSIONS: Increased activity and effective propaganda carried out by anti-vaccination movements is possible, among others, thanks to the development of the so-called 2nd generation of the Internet (Web2), enabling the free and difficult to control flow of information. Increasing data indicate that the activity of anti-vaccine movements may be a form of organized action (diversion in cyberspace) aimed at social, epidemiological, and economic destabilization of selected countries and regions. Among the various forms of combating anti-vaccination movements currently used are awareness-raising activities and restrictions on freedom on the Internet by monitoring information flow, blocking materials containing selected phrases or keywords associated with anti-vaccine propaganda, and sanctions imposed on people avoiding vaccination.

Background ionizing radiation and semen parameters of men with reproductive problems.

INTRODUCTION AND OBJECTIVE: The male reproductive system constitutes a set of tissues which are particularly sensitive to external factors. The aim of the study was to analyze the relationship between background radioactivity and the quality of the semen of the men who have reported to the infertility treatment facility in 2000-2016 in the Lublin region of eastern Poland. MATERIAL AND METHODS: The radioactivity of the ground-level air layer obtained from the Institute of Meteorology and Water Management in Wlodawa in the Lublin region was analysed. 4,250 spermiograms of patients who reported to the treatment facility for the first time due to infertility were analysed and correlated to background radioactivity in the Lublin region in 2000-2016. RESULTS: A long-term decrease in the percentage of morphologically normal spermatozoa of the patients was observed (r=-0.970; p<0.001 in 2000-2009 and r=-0.925; p=0.003 in 2010-2016). Men's age correlated negatively with sperm motility (r=-0.164; p=0.009) and morphology (r=-0.186; p=0.009). The percentage of spermatozoa with normal morphology was lowered by beta-isotopes of artificial origin in the air in 2000-2009 (r=-0.655; p=0.040) and by the exposure to gamma radiation of the ground-level atmosphere in 2010-2016 (r=-0.676; p=0.048). The percentage of sperm vitality was lowered by gamma radiation in the atmosphere (r=-0.636; p=0.006), but improved by beta isotopes in precipitation (r=0.686; p=0.002) in the whole of the analyzed period. CONCLUSIONS: The percentage of morphologically normal spermatozoa in patients who reported to the infertility treatment depends not only on the age of patient, but also on beta-isotopes of artificial origin and gamma radiation in the atmosphere. Beta isotopes in precipitation affect the improvement of sperm vitality.

Medical and socio-demographic determinants of depressive disorders in diabetic patients.

INTRODUCTION: Diabetes is a civilisation disease creating a serious challenge for public health. In Poland, approximately 2 million people suffer from diabetes, of which about 25% are unaware of their illness. A considerable part of persons with diabetes experience complications related with the disease. OBJECTIVE: The aim of the study was to determine the relationship between elements of the state of health and socio-demographic characteristics of diabetic patients treated in the Diabetes Clinic at the Institute of Rural Health (IMW) in Lublin, eastern Poland, and the occurrence of depressive symptoms in these patients. MATERIAL AND METHODS: The study was conducted in 2017-2018 among patients treated in the Diabetes Clinic at the Institute of Rural Health in Lublin, by the method of a diagnostic survey using the Beck's Depression Inventory and an author-constructed questionnaire, as well as data from the patients' medical records. The study included 314 patients from the Diabetes Clinic who expressed their informed consent to participate in the research. RESULTS: The study showed that diabetes is a disease which predisposes for the occurrence of depression. The occurrence of depressive symptoms of various degrees of intensity was confirmed in more than a half of the examined patients. Among the factors which exerted a significant effect on the occurrence of depressive symptoms were: diabetic neuropathy, type 2 diabetes, high BMI value, lack of occupational activity, poor material standard, and the need to obtain assistance in daily functioning due to the fact of being ill with diabetes. CONCLUSIONS: It is necessary to implement routinely performed examinations into the diagnostic-therapeutic process to assess the state of psychological health of diabetic patients, which would allow sufficiently early application of appropriate psychological or psychiatric intervention.

A 56-year-old man with RT-PCR negative nasopharyngeal swabs with Coronavirus Disease 2019 (COVID-19) Pneumonia.

INTRODUCTION: Diagnostic procedure in Coronavirus Disease 2019 (COVID-19) is based mainly on performing real-time-reverse transcription-polymerase chain-reaction (RT-PCR), which has been accepted as the gold standard method. In some cases, such as mutations of the SARS-CoV-2 genome, variable viral load kinetics or laboratory errors, it can be false-negative. CASE REPORT: The case is presented of a 56-year-old man with respiratory tract symptoms, with twice negative results of real-time-reverse transcription-polymerase chain-reaction of nasopharyngeal swabs and positive chest computed tomography, with typical findings for COVID-19 pneumonia. CONCLUSIONS: Patients with negative RT-PCR results, but with positive computed tomography findings characteristic for COVID-19, should be treated as well as those infected.