Zinc and Its Antioxidant Properties: The Potential Use of Blood Zinc Levels as a Marker of Cancer Risk in BRCA1 Mutation Carriers.

BRCA1 mutations predispose women to breast and ovarian cancer. The anticancer effect of zinc is typically linked to its antioxidant abilities and protecting cells against oxidative stress. Zinc regulates key processes in cancer development, including DNA repair, gene expression, and apoptosis. We took a blood sample from 989 female BRCA1 mutation carriers who were initially unaffected by cancer and followed them for a mean of 7.5 years thereafter. There were 172 incident cases of cancer, including 121 cases of breast cancer, 29 cases of ovarian cancers, and 22 cancers at other sites. A zinc level in the lowest tertile was associated with a modestly higher risk of ovarian cancer compared to women with zinc levels in the upper two tertiles (HR = 1.65; 95% CI 0.80 to 3.44; p = 0.18), but this was not significant. Among those women with zinc levels in the lowest tertile, the 10-year cumulative risk of ovarian cancer was 6.1%. Among those in the top two tertiles of zinc level, the ten-year cumulative risk of ovarian cancer was 4.7%. There was no significant association between zinc level and breast cancer risk. Our preliminary study does not support an association between serum zinc level and cancer risk in BRCA1 mutation carriers.

Blood Lead Level as Marker of Increased Risk of Ovarian Cancer in BRCA1 Carriers.

BRCA1 mutations substantially elevate the risks of breast and ovarian cancer. Various modifiers, including environmental factors, can influence cancer risk. Lead, a known carcinogen, has been associated with various cancers, but its impact on BRCA1 carriers remains unexplored. A cohort of 989 BRCA1 mutation carriers underwent genetic testing at the Pomeranian Medical University, Poland. Blood lead levels were measured using inductively coupled plasma mass spectrometry. Each subject was assigned to a category based on their tertile of blood lead. Cox regression analysis was used to assess cancer risk associations. Elevated blood lead levels (>13.6 µg/L) were associated with an increased risk of ovarian cancer (univariable: HR = 3.33; 95% CI: 1.23-9.00; p = 0.02; multivariable: HR = 2.10; 95% CI: 0.73-6.01; p = 0.17). No significant correlation was found with breast cancer risk. High blood lead levels are associated with increased risk of ovarian cancer in BRCA1 carriers, suggesting priority for preventive salpingo-oophorectomy. Potential risk reduction strategies include detoxification. Validation in diverse populations and exploration of detoxification methods for lowering lead levels are required.

Social marketing in gynecological cancers prevention after the COVID-19 pandemic.

OBJECTIVES: Assessment of the development and description of the characteristics of social marketing in Poland and the United States with regard to the prevention of gynecological cancers and achievements of these countries. MATERIAL AND METHODS: Collective case study based on an analysis of five social campaigns in Poland and five social campaigns in the United States that were focused the gynecological cancers prevention. RESULTS: In the United States, there are more materials available on social campaigns dedicated to the prevention of gynecological cancers, and there are more public organizations that are involved in health promotion activities than in Poland. As opposed to American campaigns, Polish social campaigns did not cover all types of gynecological cancer. The study revealed that Facebook is the most commonly used social media platform by the social campaign organizers. CONCLUSIONS: Social marketing tools still have not been fully implemented in the prevention of gynecological cancers either in Poland or in the United States. However, social marketing in the US seems to be more effective in gynecological cancers prevention than Poland.

Efficiency and Effectiveness of Patient Care Provided by Physicians in Rural and Urban Areas in Poland.

BACKGROUND The health sector in Poland is currently facing challenges such as limited financial resources, poor infrastructure, and insufficient human resources. To address these issues, increasing cost-effectiveness at the individual physician level has become essential. This study aimed to evaluate the efficiency and effectiveness of patient care at the level of individual primary health care physicians and to compare the performance of physicians working in urban and rural areas. MATERIAL AND METHODS Thirteen original effectiveness indicators were developed based on a literature review, expert consultations, and a pilot study at the Medical and Diagnostic Center in Siedlce. The indicators were used to evaluate the effectiveness of physicians and compare physicians' characteristics working in rural and urban areas. The study extracted data on physicians' characteristics and used the indicators to evaluate their effectiveness. RESULTS Physicians working in rural areas treated more patients due to staff shortages. However, physicians working in urban areas demonstrated greater effectiveness in performing routine and advanced health checks and mammograms. Despite this advantage, the average life expectancy of patients was higher among patients of physicians working in rural areas. CONCLUSIONS Five indicators developed in the study formed a scale, which is a step toward developing a uniform effectiveness indicator. Further research on consistently measuring effectiveness could significantly impact the development of sociometric research methodology. This study highlights the differences in efficiency and effectiveness of physicians working in rural vs urban areas and underscores the need for healthcare policymakers to consider these differences in addressing healthcare resource allocation.

Health Care Organization in Poland in Light of the Refugee Crisis Related to the Military Conflict in Ukraine.

BACKGROUND: Poland is witnessing a migration crisis caused by the ongoing military conflict in Ukraine. In addition to housing and necessities, 1.8 million Ukrainians that had taken refuge in Poland must have access to medical care. We aim to propose a strategy for implementing the changes in the Polish health care system in response to the Ukrainian refugee crisis. METHODS: A literature review on organizational changes in the functioning of health care systems during the migration crises worldwide in recent years and brainstorming in order to develop a strategy for implementing changes in the Polish health care system in response to the Ukrainian refugee crisis. RESULTS: The proposed strategy for implementing the changes in the Polish health care system is based on building health care resilience and adaptation to different crises. The operational objectives of organization-related activities are: (1) preparation of medical facilities to provide help for refugees, (2) development and implementation of the communication system, (3) implementation of available digital solutions, (4) organization of the diagnostic and medical services, (5) and implementation of changes in the management of medical facilities. CONCLUSIONS: Urgent reorganization is required to respond to an unavoidable increase in the demand for health care services.

Assessment of Hospital Volume in the Surgical Management of Endometrial and Ovarian Cancer: A Polish Population-Based Study.

BACKGROUND Surgery is a cornerstone in management of ovarian and endometrial cancer. The European Society of Gynecological Oncology introduced quality indicators to improve management of these cancers. The optimal annual number of surgeries per unit was established for high-quality surgical treatment. MATERIAL AND METHODS The database of the National Health Fund on surgical management of endometrial and ovarian cancer was analyzed. Patients treated between 2017 and 2020 were included. Departments where patients underwent surgery were divided according to number of surgeries performed per year in endometrial cancer: ≥80, 79-50, 49-20, 19-0; and ovarian cancer: ≥100, 99-50, 49-20, 19-0. Optimal number of surgeries per center was defined as at least 100 and 80 surgeries per year in ovarian and endometrial cancer, respectively. RESULTS Totally, there were 22 325 surgeries in 316 units and 10 381 surgeries in 251 units due to endometrial and ovarian cancer, respectively. Most surgeries in endometrial cancer (n=15 077; 67.5%) and ovarian cancer (n=9642; 92.88%) were performed in departments that did not meet optimal criteria in number of surgeries. Between 2017 and 2019, an increasing trend in number of surgeries per year in endometrial and ovarian cancer was found. In 2020, there was a decrease in the number of surgeries by 7.8% (n=453) and 8.6% (n=234) in endometrial and ovarian cancer, respectively. CONCLUSIONS In Poland, surgical treatment of ovarian and endometrial cancer is decentralized. Most cancer patients underwent surgery in low-volume general gynecologic departments. The COVID-19 pandemic impaired cancer management, leading to a decreased number of surgeries.

Patient care efficiency in primary healthcare - pilot study in Medical and Diagnostical Centre.

In Poland, there is a niche that can be filled with original research in the area of performance indicators of individual health care professionals. AIM: The aim of the study was the empirical verification of original effectiveness indicators and the identification of the degree of patient care effectiveness of selected primary health care professionals with the application of the developed indicators. MATERIALS AND METHODS: The study population consisted of physicians employed in the primary care in Medical and Diagnostic Centre (MDC) in Siedlce, Poland. The final study sample consisted of 29 respondents. 14 original indicators in three areas: structure, process and effect were developed and verified. RESULTS: The distribution of indicator values for the physicians included in the study demonstrated a diverse level of their effectiveness. The factor analysis performed for the 14 original indicators demonstrated that a highly reliable scale can be created out of 5 of the original indicators. CONCLUSIONS: In our pilot study we assessed the reliability of the designed tools. However, unfortunately, our research did not offer the opportunity to identify any dependencies of variables. A study on a larger sample of physicians would therefore be needed.

An evaluation of the construction of the device along with the software for digital archiving, sending the data, and supporting the diagnosis of cervical cancer.

Cervical cancer is still an important cause of mortality among women in a number of countries. There are effective methods of prevention and early diagnosis, but they require well-trained medical professionals including cytologists. Within this project, we built a prototype of a new device together with implemented software using U-NET and CNN architectures of neural networks (ANN), to convert the currently used optical microscopes into fully independent scanning and evaluating systems for cytological samples. To evaluate the specificity and sensitivity of the system, 2058 (2000 normal and 58 abnormal samples) consecutive liquid-based cytology (LBC) samples were analysed. The observed sensitivity and specificity to distinguish normal and abnormal samples was 100%. We observed slight incompatibility in the evaluation of the type of abnormality. The use of ANN is promising for increasing the effectiveness of cervical screening. The low cost of neural network usage further increases the potential areas of application of the presented method. Further refinement of neural networks on a larger sample size is required to evaluate the software.

Effectiveness of Healthcare Coordination in Patients with Chronic Respiratory Diseases.

Coordination of healthcare effectively prevents exacerbations and reduces the number of hospitalizations, emergency visits, and the mortality rate in patients with chronic respiratory diseases. The purpose of this study was to determine clinical effectiveness of ambulatory healthcare coordination in chronic respiratory patients and its effect on the level of healthcare services as an indicator of direct medical costs. We conducted a retrospective health record survey, using an online database of 550 patients with chronic respiratory diseases. There were decreases in breathing rate, heart rate, and the number of cigarettes smoked per day, and forced vital capacity (FVC) and forced expired volume in 1 s (FEV1) increased after the implementation of the coordinated healthcare structure. These benefits were accompanied by increases in the number of visits to the pulmonary outpatient clinic (p < 0.001), diagnostic costs (p < 0.001), and referrals to other outpatient clinics (p < 0.003) and hospitals (p < 0.001). The advantageous effects of healthcare coordination on clinical status of respiratory patients above outlined persisted over a 3-year period being reviewed.