[Assessment of occupational hazards and their prevention in the work of dental technicians during the COVID-19 pandemic]. / Ocena zagrozen zawodowych oraz ich profilaktyka w pracy techników dentystycznych w czasie pandemii COVID-19.

BACKGROUND: Work of a dental technician is associated with exposure to a number of harmful factors. We can distinguish: chemical, biological, physical and psychophysical factors. They contribute to many diseases, but not all of them are classified as occupational diseases. The main aim of the study was to assess the health hazards that occur in the workplace of a dental technician and their prevention during the COVID-19 pandemic. MATERIAL AND METHODS: An epidemiological cross-sectional study was conducted. A self-created questionnaire form containing 28 questions was used. The link to the survey was shared on social groups associating dental technicians. Participation in the study did not require logging in. During the data collection, the respondents' personal data were not collected and processed. RESULTS: 148 dental technicians participated in the study. The largest group were participants aged 21-25 (32%), the smallest group were people over 50 (6%). The most frequently occupied position was acrylic and plaster. More than 1/3 of those surveyed reported having allergies, most often to acrylic or metal. More than 20% of technicians reported experience of mechanical injuries several times a week or more. 17% of technicians declared professional burnout. 80% of technicians used protective clothing. Personal protective equipment was always used by only 22% of technicians, and as many as 29% of respondents never used the listed protective equipment. CONCLUSIONS: Not all dental laboratories were equipped with the necessary personal protective equipment. The most commonly used personal protective equipment included: disposable gloves, disinfectant liquid and extract. The COVID-19 pandemic contributed to a change in disinfection procedures in more than 1/3 of the respondents. 35% of them started using disinfection only after the outbreak of the pandemic, while most of the changes concerned the improvement of existing procedures. The length of work experience of technicians had an impact on exposure to stress and occupational burnout. Med Pr Work Health Saf. 2023;74(4):289-99.

Questionnaire-Based Study of 81 Patients in Poland to Evaluate the Course of Inflammatory Bowel Disease and the Effects of the COVID-19 Pandemic on Quality of Life and Mental State from February to June 2021.

BACKGROUND The COVID-19 pandemic affected many people worldwide, including those with chronic diseases. Our objective was to analyze its influence on medical care and the course of inflammatory bowel disease (IBD) in Poland. MATERIAL AND METHODS In 2021, 81 patients in Poland with IBD completed an original anonymous questionnaire about the impact of the COVID-19 pandemic on the course of their disease and mental status. The printed questionnaire was distributed to IBD patients treated at the Gastroenterology Outpatient Clinic of the University Clinical Hospital in Bialystok, and an online questionnaire was sent to patients via social media. Statistical analysis was performed using the chi-squared test, with a significance level of P<0.05. RESULTS The study group consisted of 46 women and 35 men with a mean age of 32.42 years. Fifty-nine patients had ulcerative colitis and 22 had Crohn disease. Patients reported significant deterioration in medication availability (50.62%) and restricted access to gastroenterology outpatient clinics (51.90%) (P<0.05). Of patients who contracted COVID-19, 89.47% did not require hospitalization, 32.10% (26/81) were asymptomatic, mild, or moderate, despite immunosuppressive biological treatment (27.16%, 22/81), or steroids (18.52%, 15/81). Over 50% of respondents stated the pandemic negatively affected their mental state and 30% of them associated that with worsening IBD. CONCLUSIONS During the pandemic, respondents were mainly concerned with difficulties in accessing the gastroenterology clinic and limited drug availability. The pandemic negatively affected patients' mental state. In cases of COVID-19 disease, patients with IBD were mostly asymptomatic and did not require hospitalization, despite therapy affecting the immune system.

Comparative Effectiveness of Various Eradication Regimens for Helicobacter Pylori Infection in the Northeastern Region of Poland.

PURPOSE: Due to the lack of systematic data on antibiotic sensitivity, the treatment of the highly prevalent and pathogenic Helicobacter pylori (H. pylori) infection still poses a significant problem. Therefore, the aim of our study was to compare the efficacy of the three most commonly used anti-H. pylori therapies in northeastern Poland. PATIENTS AND METHODS: This was a retrospective, single-center study performed on 289 outpatients with an H. pylori infection. Patients received one of the following three treatment regimens: (1) bismuth quadruple therapy (BQT) for 10 days, (2) metronidazole-based triple therapy (M-TT) for 10 or 14 days, and (3) levofloxacin-based triple therapy (L-TT) for 10 or 14 days. RESULTS: BQT, M-TT, and L-TT accounted for 93.2% of prescribed anti-H. pylori therapies. The overall success rate for all treatment regimens was 84.1% (243/289). The effectiveness of first- and second-line therapy was similar and reached 83.8% and 86.2%, respectively. The efficacy of the individual treatment regimens was as follows: (1) BQT-89.4% (84/94), (2) M-TT-80.6% (112/139) and 78.8% (26/33) for 10 and 14 days, respectively, and (3) L-TT-84.6% (11/13) and 100% (10/10) for 10 and 14 days, respectively. The overall duration of treatment and type and dose of proton pump inhibitor (PPI) had no effect on the treatment efficacy. CONCLUSIONS: In the northeastern part of Poland, 10-day BQT and 10- or 14-day L-TT are effective treatment regimens for H. pylori eradication and have appear to be superior to M-TT. Practitioners in our clinic followed mostly local anti-H. pylori therapy guidelines.

Relationship between Dietary Behaviors and Physical Activity and the Components of Metabolic Syndrome: A Case-Control Study.

Poor diet and low physical activity play an important role in the etiopathogenesis of metabolic syndrome. The aim of this study was to analyze the association between nutrient intake, groups of food products and physical exercise undertaken and the components of metabolic syndrome (MS). The study included 330 patients with MS, and the control group comprised of 270 subjects without MS. The food intake was assessed using 24-h dietary recall, and a 13-item Food Frequency Questionnaire. To assess nutrition knowledge, a Beliefs and Eating Habits Questionnaire was used. The level of physical activity was assessed using the International Physical Activity Questionnaire. Three patterns of behavior were identified: Prudent-Active, Western-Sedentary, and NotPrudent-notWestern-lowActive. In the Prudent-Active group, as compared to the NotPrudent-notWestern-lowActive subjects, the risk of central obesity, hypertension, hypertriglyceridemia, low HDL cholesterol and hyperglycemia occurrence was lower. There was also a lower proportion of patients with MS. As compared to the NotPrudent-notWestern-lowActive subjects, in the Prudent-Active group there was more than a two times higher chance of subjects with a high level of nutrition knowledge. Western diets have been proven to exert a detrimental effect on the components of MS. When designing intervention programs, education of patients with MS on dietary habits and physical activity should be considered.

Expression of VEGF, EGF, and Their Receptors in Squamous Esophageal Mucosa, with Correlations to Histological Findings and Endoscopic Minimal Changes, in Patients with Different GERD Phenotypes.

BACKGROUND: Gastroesophageal reflux disease (GERD) may present as nonerosive reflux disease (NERD), erosive esophagitis (EE), or be complicated by Barrett's esophagus (BE). The explanation as to what determines the phenotype of GERD is awaited. Therefore, we assessed the correlation between the growth factors expression and endoscopic as histologic findings in GERD patients. METHODS: The squamous esophageal epithelium of 50 patients (20-NERD, 7-EE, 15-BE, 8 controls) was examined by: (1) magnification endoscopy with evaluation of minimal GERD changes such as: microerosions, white spots, palisade blood vessels visibility, and intrapapillary capillary loops (IPCLs) appearance, (2) histology, (3) immunohistochemistry with evaluation of the expression of vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), and their receptors (VEGFR and EGFR). RESULTS: The expression of VEGF, but not VEGFR, EGF, and EGFR, was significantly increased in EE patients compared to NERD patients and controls. VEGF levels correlated significantly with the presence of white spots, but not with other minimal endoscopic and histologic features. The EGFR expression correlated positively with basal cell hyperplasia and enlarged IPCLs. CONCLUSIONS: Our findings suggest a correlation between growth factors expression and findings in conventional endoscopy, formation of endoscopic minimal changes, and histologic lesions.

Resting Metabolic Rate in Women with Endocrine and Osteoporotic Disorders in Relation to Nutritional Status, Diet and 25(OH)D Concentration.

There are speculations that vitamin D may be an important regulator of the energy metabolism. The aim of this study was to evaluate the influence of serum 25(OH)D concentration and nutritional status on the resting metabolic rate. The study group consisted of 223 women with endocrine and/or osteoporotic disorders. The control group consisted of 108 women, clinically healthy. The total 25(OH)D concentration level was measured with an assay using chemiluminescent immunoassay technology. Indirect calorimetry was applied to assess the resting metabolic rate. The mean resting metabolic rate was significantly lower in the group of women with metabolic disorders than in the control group. A correlation was found between serum 25(OH)D levels in healthy subjects and the resting metabolic rate. Significantly higher resting metabolic rate was found in women with normal serum 25(OH)D levels in comparison to subjects with deficient vitamin D levels. The control group demonstrated a relationship between body fat tissue and fat-free body mass and the resting metabolic rate. Both 25(OH)D concentration and body composition were factors influencing the resting metabolic rate in the group of healthy subjects. More research is needed to clarify the relationship between vitamin D status and metabolic rate in individuals with endocrine and osteoporotic disorders.

[Assessment of 25(OH)D concentration in people with metabolic syndrome working in agriculture]. / Ocena stezenia 25(OH)D u osób z zespolem metabolicznym pracujacych w rolnictwie.

BACKGROUND: Polish data on vitamin D deficiency in the population are incomplete. Vitamin D deficiency seems to be common, but there is a lack of studies concerning the concentration of 25(OH)D in people with high UV exposure. The aim of this study was to evaluate the plasma concentration of 25(OH)D in people with and without metabolic syndrome (MS), working in agriculture, the prevalence of its deficiency in these workers, and the correlation between the plasma concentration of 25(OH)D and traditional biomarkers of cardiovascular diseases. MATERIAL AND METHODS: The study included 332 people working in agriculture in the Lódz voivodeship, including 231 people with MS and 101 healthy ones. The plasma concentration of 25(OH)D was assessed using the chemiluminescent immunoassay technology. The vitamin D intake was assessed using a 24-h recall questionnaire using Diet 5.0 software. RESULTS: The mean plasma concentration of 25(OH)D was 13.64±8.01 ng/ml in MS workers, and it was significantly lower than in the healthy ones (26.61±10.12 ng/ml, p < 0.00001); the highest concentration of 25(OH)D was noted in summer months. Deficient plasma concentrations of 25(OH)D were found significantly more often in MS workers than in the controls (81.82% and 20.79%, respectively, p < 0.00001). No correlation was found between the plasma vitamin D concentration and its dietary intake. The plasma concentration of 25(OH)D correlated with age of the examined workers (r = -0.28, p = 0.023), high density lipoprotein concentration (r = 0.19, p = 0.036) and glucose concentration (Rho = -0.24, p = 0.02). A multivariate analysis of variance demonstrated that the body mass index affected significantly the mean value of the 25(OH)D concentration in MS workers. CONCLUSIONS: The concentration of vitamin D in the plasma of workers with MS was significantly lower than in the healthy controls despite the same high UV exposure; these workers also manifested significantly higher 25(OH)D deficiency than the control subjects. This study indicates the need for further research on the concentration of 25(OH)D in people with metabolic disorders regardless of UV exposure and vitamin D intake with a diet. Med Pr. 2021;72(1):9-18.

[An assessment of the antioxidant vitamins concentration in people with metabolic syndrome working in agriculture]. / Ocena stezenia witamin antyoksydacyjnych u osób z zespolem metabolicznym pracujacych w rolnictwie.

BACKGROUND: Vitamins A, C and E are important parts of the antioxidant barrier. Polish data on antioxidant vitamins deficiency in the population are rare, especially among physically active people with metabolic disorders. The aim of this study was to evaluate the serum concentrations of vitamins A, C and E in people with metabolic syndrome (MS) working in agriculture, the prevalence of their deficiency in these workers, and the correlation between antioxidant vitamins concentration and traditional biomarkers of cardiovascular diseases. MATERIAL AND METHODS: The study included 332 residents of the Lódz Voivodeship working in agriculture: 231 people with MS and 101 healthy ones. The serum concentrations of vitamins A, C and E were assessed using the chemiluminescent immunoassay technology. The antioxidant vitamins intake was assessed by means of a 24-h recall questionnaire using Diet 5.0 software. RESULTS: The mean serum concentrations of vitamins A, C and E were significantly lower in the MS workers than in the healthy ones No correlation was found between the antioxidant vitamins concentration and the dietary intake but there was a correlation between the antioxidant vitamins concentration and high-density lipoprotein cholesterol (HDL-C). A correlation was found between the serum concentrations of vitamins A and C, and vitamins A and E, in the MS workers. CONCLUSIONS: The serum concentrations of antioxidant vitamins in the MS workers were significantly lower than in the healthy controls, despite the similar physical activity level. The dietary intake had no impact on the serum concentrations of these vitamins. The HDL-C concentration in the MS workers correlated with the concentrations of all antioxidant vitamins. Med Pr. 2021;72(2):123-9.

Does place of residence affect patient satisfaction with hospital health care?

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

Reasons for low cervical cancer survival in new accession European Union countries: a EUROCARE-5 study.

PURPOSE: With better access to early diagnosis and appropriate treatment, cervical cancer (CC) burden decreased in several European countries. In Eastern European (EE) countries, which accessed European Union in 2004, CC survival was worse than in the rest of Europe. The present study investigates CC survival differences across five European regions, considering stage at diagnosis (local, regional and metastatic), morphology (mainly squamous versus glandular tumours) and patients' age. METHODS: We analysed 101,714 CC women diagnosed in 2000-2007 and followed-up to December 2008. Age-standardised 5-year relative survival (RS) and the excess risks of cancer death in the 5 years after diagnosis were computed. RESULTS: EE women were older and less commonly diagnosed with glandular tumours. Proportions of local stage cancers were similar across Europe, while morphology- and stage-specific RS (especially for non-metastatic disease) were lower in Eastern Europe. Adjusting for age and morphology, excess risk of local stage CC death for EE patients remained higher than that for other European women. CONCLUSION: Stage, age and morphology alone do not explain worse survival in Eastern Europe: less effective care may play a role, probably partly due to fewer or inadequate resources being allocated to health care in this area, compared to the rest of Europe.

Importance of financial liquidity in hospital management

INTRODUCTION: Financial liquidity management in hospitals is of great importance in ensuring access to medical care and continuity of health care service provision. It is one of the management's biggest challenges, which the possibility to conduct health care activity depends on. OBJECTIVE: The objective of this study was to assess the financial liquidity of public hospitals, based on the example of public hospitals in Podlaskie Voivodeship in years 2013-2017. MATERIALS AND METHODS: Revenues, expenses and financial performance levels were analysed and financial liquidity was evaluated with reference to current and quick ratios. Public hospitals, whose founding entity is the Podlaskie Voivodeship Self-government, were selected for the study. The assessment of the financial situation was based on the data from the hospitals' financial statements for years 2013-2017. The assessment was made with a special reference to financial liquidity. RESULTS: In years 2013-2017, a steady increase of revenues and expenses was observed in the case-study hospitals. The general financial performance of these entities improved significantly. During the assessment period, the current ratio in the hospitals was average, exceeding the optimal value. In the first hospital group (number of beds>250), the current ratio was below the optimal values (except for 2016). The second hospital group (number of beds<250) was characterised by liquidity ratios above the optimal value. CONCLUSIONS: Management of financial liquidity in hospitals, aimed at maintaining financial liquidity at optimal level, should be the management's priority action when managing the finances of a health care entity. These actions should be multi-directional and based on information about the financial situation of the hospitals and on the hospital's ratio analysis, which is vital for the management's decision making.

Effect of Sleeve Gastrectomy on Proprotein Convertase Subtilisin/Kexin Type 9 (Pcsk9) Content and Lipid Metabolism in the Blood Plasma and Liver of Obese Wistar Rats.

Nowadays, obesity and its complications are heavy burdens to western civilization. Surgical procedures remain one of the available therapies for obesity and obesity-associated diseases treatment. Among them, sleeve gastrectomy is the most common bariatric procedure. Despite the well-established fact that sleeve gastrectomy results in significant weight loss, some of its other divergent effects still need to be established. To fulfill this knowledge gap, we examined whether sleeve gastrectomy affects lipid metabolism in the plasma and liver of obese rats. We demonstrated that chronic high-fat diet feeding led to an increment in the level of Proprotein Convertase Subtilisin/Kexin (PCSK)-a regulator of plasma cholesterol concentration-in the liver, which was decreased after the gastrectomy. Moreover, we noticed significant increases in both plasma and liver contents of free fatty acids, diacylgycerides and triacylglycerides in the obese animals, with their reduction after the bariatric surgery. In conclusion, we revealed, presumably for the first time, that sleeve gastrectomy affects lipid metabolism in the liver of obese rats.

Inequalities in breast cancer incidence and stage distribution between urban and rural female population in Swietokrzyskie Province, Poland.

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

Changes in Dietary Patterns and the Nutritional Status in Men in the Metallurgical Industry in Poland Over A 21-Year Period.

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

Plasma Sphingolipids in Acute Pancreatitis.

Acute pancreatitis (AP) is a prevalent gastrointestinal disorder associated with systemic inflammatory response syndrome and, in the case of severe AP, a mortality rate ranging from 36% to 50%. Standard clinical treatment of AP includes intensive hydration, analgesia, and management of complications. Unfortunately, the direct treatment of AP at the level of its molecular pathomechanism has not yet been established. Recent studies indicate that the sphingolipid signaling pathway may be one of the important factors contributing to the development of inflammation in pancreatic diseases. In the current study, we sought to investigate this promising route. We examined the plasma sphingolipid profile of 44 patients with acute pancreatitis, dividing them into three groups: mild, moderate and severe AP. Samples were collected from these groups at days 1, 3 and 7 following their hospital admission. We demonstrated significant changes in blood plasma sphingolipids in relation to the time course of AP. We also found an inhibition of de novo ceramide synthesis in mild and moderate AP. However, the most important and novel finding was a significant elevation in sphingosine-1-phosphate (S1P) (a downstream metabolite of ceramide) in mild AP, as well as a dramatic reduction in the lipid molecule content in the early stage (days 1 and 3) of severe AP. This strongly indicates that plasma S1P could serve as a prognostic marker of AP severity.

Trends of potential years of life lost due to main causes of deaths in urban and rural population in Poland, 2002-2011.

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

Perinatal mortality in urban and rural areas in Poland in 2002-2012.

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

Trends of premature mortality in Swietokrzyskie Province (Poland), years 2002-2010.

BACKGROUND: Premature mortality in younger age groups influences the society as far as social and economic aspects are concerned. Therefore, it is important to come up with a tool which will allow to assess them, and will enable to implement only these health care measures that bring tangible benefits. That is the reason for introducing PYLL rate (PYLL - potential years of life lost), which is an addition to the analysis of premature mortality as it includes the number of deaths due to a particular cause and the age at death. OBJECTIVE: The purpose of this study was to analyse the level and trends of PYLL rate according to death causes in years 2002 -2010 in Swietokrzyskie Province. MATERIAL AND METHODS: The material for the analysis was the information from the Central Statistical Office on the number of deaths due to all causes registered among the inhabitants of Swiytokrzyskie Province in years 2002-2010. Causes of death were coded according to the 10th revision of the International Classification of Diseases. The analysis of premature mortality was carried out with the use of PYLL rate. PYLL rate was calculated according to the method proposed by Romeder, according to which the premature mortality was defined as death before the age of 70. The analysis of time trends of PYLL rate and the APC (annual percent change) of the PYLL rate were calculated using jointpoint model as well as the Jointpoint Regression Program (Version 4.0.1 - January 2013). RESULTS: In men, in years 2002 - 2007 PYLL rate increased by 1.5% per year (p<0.05). From year 2007 the trend went downward and PYLL rate decreased on average by 3.1% per year till year 2010. External causes of death, cardiovascular diseases and cancers in years 2002 - 2010 were the reason for almost 74.0% PYLL in men. In year 2010 PYLL rate due to all death causes amounted to 8913.8/105 and was three times higher than in women (2975.5/10(5)). In women, however, during the analysed period PYLL rate did not change significantly, and was dominated by cancers, cardiovascular diseases and external death causes. Similarly to men, those three groups of death causes were responsible for an average 76.0% PYLL. CONCLUSIONS: The analysis of the causes of premature mortality in Swietokrzyskie Province shows that in the majority of cases it is due to preventable deaths, which calls for the necessity of more intensive measures in primary and secondary prevention as well as the improvement in treatment standards, mainly of cardiovascular diseases, cancers, injuries and accidents.

Premature mortality due to cancer in Swietokrzyskie Province (Poland) in 1999-2010.

THE PURPOSE OF THE STUDY: The purpose of the study was to analyze the level and the trends of premature mortality caused by selected cancers in Swietokrzyskie Province in years 1999-2010. MATERIAL AND METHODS: The material for the study was the data published in the Swietokrzyskie Cancer Registry on the number of deaths caused by cancers as well as the information from the Central Statistical Office on the number of deaths due to general death causes in Swietokrzyskie Province in years 1999-2010. The premature mortality analysis was conducted with the use of PYLL indicator (PYLL - potential years of life lost). PYLL rate was calculated according to the method proposed by J. Romeder, according to which the premature mortality was defined as death before the age of 70. Time trends of PYLL rate and the average annual percent change (APC - annual percent change) were assessed usingjointpoint models as well as the Jointpoint Regression Program (Version 4.0.1 - January 2013). RESULTS: In year 2010 cancers were responsible for 18.3% of PYLL in men and 48.1% in women. In years 1999-2010 PYLL rate in men decreased due to lung cancer (APC=0.75%) and stomach cancer (APC=1.2%). The increase in rate of PYLL was noted for colorectal cancer (APC=3.3%, p<0.05) and prostate cancer (APC=1.6%). In women, rate of PYLL increased due to lung cancer (APC=6.2%, p<0.05), colorectal cancer (APC=2.9%), breast cancer (APC=1.8%) and ovarian cancer (APC=0.15%). Rate of PYLL decreased due to cervical cancer (APC=4.3%, p<0.05) and stomach cancer (APC=1.5%). SUMMARY AND CONCLUSIONS: During the analysed period the highest increase of premature mortality was observed in colorectal cancer in both sexes and lung cancer in women, a slightly smaller increase was noted for breast cancer and prostate cancer. What is particularly important is the trend and a slight decrease of premature mortality rate caused by lung cancer in men and its significant decrease for cervical cancer as well as stomach cancer in both sexes.

The breast-conserving surgery of women with breast cancer in Podlaskie Voivodeship (Poland). Population study.

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