Retaining Healing Hands: A Transnational Study on Job Retention Interventions for the Healthcare Workforce.

Healthcare organizations worldwide face challenges in retaining their healthcare workforce, with individual and organizational factors influencing their intentions to leave. This study conducted eight online co-creation workshops and four Delphi sessions to gain qualitative and in-depth insights into job retention interventions, involving healthcare workers, hospital managers, and policymakers. A thematic analysis was conducted, resulting in multiple interventions that were clustered in four pre-defined themes: professional and personal support, education, financial incentives, and regulatory measures. Professional and personal support interventions included regular interprofessional team meetings, leadership training programs, self-scheduling and sabbaticals, support for administrative and non-clinical work, and the provision of psychological counselling. Educational interventions encompassed facilitating development opportunities, periodic evaluations, onboarding, mentorship programs, and peer support groups. Financial incentives included the provision of competitive salaries, adequate infrastructure, extra benefits, transport possibilities, and permanent employment contracts. Regulatory measures addressed the need for complementary legislation across various levels, fixed healthcare worker-to-patient ratio, and instruments to monitor workload. To optimize retention strategies, healthcare organizations should tailor these interventions to address the unique factors influencing their workforce's intentions to leave within their specific context. The study concludes that combining personal and professional support, educational opportunities, financial incentives, and regulatory measures is necessary because there is no one-size-fits-all solution.

Cations impact radical reaction dynamics in concentrated multicomponent aqueous solutions.

Ultraviolet (UV) photolysis of nitrite ions (NO2-) in aqueous solutions produces a suite of radicals, viz., NO·, O-, ·OH, and ·NO2. The O- and NO· radicals are initially formed from the dissociation of photoexcited NO2-. The O- radical undergoes reversible proton transfer with water to generate ·OH. Both ·OH and O- oxidize the NO2- to ·NO2 radicals. The reactions of ·OH occur at solution diffusion limits, which are influenced by the nature of the dissolved cations and anions. Here, we systematically varied the alkali metal cation, spanning the range from strongly to weakly hydrating ions, and measured the production of NO·, ·OH, and ·NO2 radicals during UV photolysis of alkaline nitrite solutions using electron paramagnetic resonance spectroscopy with nitromethane spin trapping. Comparing the data for the different alkali cations revealed that the nature of the cation had a significant effect on production of all three radical species. Radical production was inhibited in solutions with high charge density cations, e.g., lithium, and promoted in solutions containing low charge density cations, e.g., cesium. Through complementary investigations with multinuclear single pulse direct excitation nuclear magnetic resonance (NMR) spectroscopy and pulsed field gradient NMR diffusometry, cation-controlled solution structures and extent of NO2- solvation were determined to alter the initial yields of ·NO and ·OH radicals as well as alter the reactivity of NO2- toward ·OH, impacting the production of ·NO2. The implications of these results for the retrieval and processing of low-water, highly alkaline solutions that comprise legacy radioactive waste are discussed.

Significance of Th17 and Treg in Treatment Efficacy and Outcome in Pediatric Acute Lymphoblastic Leukemia.

Acute lymphoblastic leukemia represents a malignant proliferation of lymphoid cells blocked at an early stage of cell differentiation. It is the most common cancer occurring in children. Despite favorable prognosis, the survival rate of patients with poor treatment response or relapse remains dismal. The interaction between leukemic cells and the tumor immune microenvironment is pivotal in mediating tumor progression. In this study we evaluated associations between Treg and Th17 lymphocytes and the clinical presentation of ALL pediatric patients to validate their value in monitoring treatment outcome. The peripheral blood and bone marrow aspirates from 35 pediatric patients with ALL and 48 healthy control subjects were selected for the experiment. We demonstrated the numbers of Th17 lymphocytes and Tregs were increased in the bone marrow of ALL patients at the moment of diagnosis compared to the healthy control group, with the latter significantly decreasing during the course of ALL treatment. Patients with lower Th17 were found to demonstrate higher risk of blasts prevalence in bone marrow at day 33. ALL patients with lower WBC demonstrated higher frequency of Tregs. In summary, we identified a significant role of Th17 and Treg lymphocytes in ALL of pediatric patients and their contribution to disease-related parameters.

Maternal diet during pregnancy and risk of allergic diseases in children up to 7-9 years old from Polish Mother and Child Cohort study.

BACKGROUND: The impact of maternal diet during pregnancy on the risk of allergic diseases in childhood is an increasing scientific and public health concern. We evaluated the associations of maternal type of diet and essential elements and vitamins intake during pregnancy with offspring allergic and respiratory outcomes. METHODS: The study population included 557 mother-child pairs from Polish Mother and Child Cohort (REPRO_PL). Based on the Food Frequency Questionnaire filled in between the 20th-24th week of pregnancy, overall maternal diet was evaluated as the difference between the Prudent Dietary Pattern (PDP) score and Western Dietary Pattern (WDP) score ((PDP-WDP) score) and maternal achievement of dietary recommendations (estimated average requirement, EAR) for essential elements and vitamins was assessed. Children's health examination at age of 1, 2, and 7-9 years covered the following symptoms: infections, wheezing/asthma, food allergy, allergic rhinitis, and atopic dermatitis. At age of 7-9 years, children underwent spirometry and skin-prick tests. RESULTS: Children of the mothers who were not achieving adequate intake of vitamin C during pregnancy had a higher risk of wheezing and having more than two infections within the first two years of life comparing to those who met EAR (OR = 2.6, p = 0.05, and OR = 2.3, p = 0.04, respectively). Inadequate intake of vitamin E during pregnancy was related to a higher risk of atopic dermatitis (OR = 2.7, p = 0.04), whereas inadequate intake of magnesium during pregnancy was associated with the risk of wheezing in the offspring at age of two years (OR = 3.7, p = 0.03). A lower (PDP-WDP) score during pregnancy (indicating unhealthier diet) was associated with a higher risk of infections (OR = 1.5, p = 0.007) but a lower risk of atopic dermatitis (OR = 0.7, p = 0.02) at age of 7-9 years. CONCLUSIONS: These results may contribute to the body of evidence for the impact of maternal diet during pregnancy for children's optimal health, however further studies are needed before drawing conclusions and recommendations for clinical practice.

Quality of Emulsions Based on Modified Watermelon Seed Oil, Stabilized with Orange Fibres.

The aim of the study was to evaluate emulsion systems prepared on the basis of blended fat in different ratios (watermelon seed oil and mutton tallow) stabilised by orange fibres and xanthan gum. Emulsions were subjected to stability testing by Turbiscan and were assessed in terms of mean droplet size, colour, viscosity, texture, skin hydration and sensory properties. The most stable systems were found to be the ones containing a predominance of mutton tallow in a fat phase. For these emulsions the lowest increase in mean particle size during storage was observed. The study also confirmed the synergistic effect of the thickeners used. The presented emulsions despite favourable physicochemical parameters, did not gain acceptance in sensory evaluation.

Study on the Incorporation of Oat and Yeast ß-Glucan into Shortbread Biscuits as a Basis for Designing Healthier and High Quality Food Products.

According to international health and food organizations and authorities, people should limit fat intake since fat is the most caloric component of food and it is often a source of unsafe saturated fatty acids (FA) and trans isomers. The greatest health benefits come from replacing shorts with dietary fiber molecules. The aim of the study was to determine the possibility of reducing shortening content, which has an undesirable profile of FA, by addition of ß-glucan molecules in shortbread biscuits. The effect of oat and yeast ß-glucan supplementation on physical and sensory quality of products with reduced fat content (max 15%) were studied. It was shown that the substitution of shortening by ß-glucan in shortbread biscuits is possible to a limited extent. Reduction in product energy value (up to 36 kcal/100 g) and content of undesirable FA (maximum 2.1 g/100 g) and increased of ß-glucan content, regardless of the type, caused deterioration of biscuits quality and affected changes during storage. The substitution of shortening by ß-glucan in food is a good way to improve nutritional value by increasing the amount of dietary fiber molecules, reducing calories, and amount of SFA in diets.

The risk of respiratory incidents in response to the increase of ozone concentration in the ambient air, in the Silesian Voivodeship, in 2016-2017.

INTRODUCTION: Due to the high level of urbanization and industrialization, Silesian Voivodeship remains a region with the poorest quality ambient air, especially in the winter season in which alarm levels are constantly being exceeded. However, in the summertime, there are observed short-term episodes of high ozone concentrations for which their impact on the population health is poorly documented. The aim of the study was to assess the risk of daily respiratory health problems related to an increased pollutants concentration typical for photochemical smog. MATERIAL AND METHODS: In the ecological type of study, secondary epidemiological data were used. They were obtained from the National Health Fund (NFZ) in Katowice and included the number of outpatient visits in primary health care and hospitalizations due to respiratory diseases (J00-J99) and selected acute respiratory incidents registered between 01/01/2016 and 31/08/2017 in the Silesian Voivodeship. RESULTS: In the summertime of both years (2016 and 2017), there were observed short-term episodes of photochemical smog in the study region. Obtained results show a significant increase in the risk of outpatient visits due to total respiratory diseases, and also due to acute pharyngitis, acute laryngotracheitis, bronchitis, and asthma in response to the increase in ozone concentration. Similarly, a significant increase in the risk of hospitalization for all respiratory diseases was found, however, it appeared with a delay of at least two to three weeks. In the case of hospitalization due to bronchitis statistically significant risk was observed 2-4 days after the increase in exposure. CONCLUSIONS: The occurrence of registered respiratory incidents was confirmed in response to the increase in ozone concentration, characteristic of the summertime in the Silesian Voivodeship.

Study on the Introduction of Solid Fat with a High Content of Unsaturated Fatty Acids to Gluten-Free Muffins as a Basis for Designing Food with Higher Health Value.

BACKGROUND: Shortenings are high in undesirable nutritionally saturated fatty acids. The aim of the study was to produce gluten-free muffins (GFM) of increased health quality and available to people intolerant to gluten, in which the shortenings were replaced with solid oleogels, consisting of 95% rapeseed oil. METHODS: The dough and baked products were subjected to physical, textural, and structural analyses. Moreover, the fatty acids composition, chemical quality of fats extracted from muffins, and color of the products were determined. The dough was also observed at 600× magnification in bright field and polarized light microscopy, and microtomographic analysis of the structure of GTM was performed. RESULTS: There was no effect of the type of lipids on physical properties, including water content in gluten-free muffins. However, the baked products differed in total porosity and brightness, as well as intensity of red and yellow colors. The use of rapeseed oil oleogels, instead of shortening in the muffin recipe, resulted in a decrease in the dietary undesirable SFA in lipid fractions (by approximately 40%), an increase in the content of MUFA (by approximately 30%), and an increase in the content of PUFA (by approximately 15%), with acceptable chemical quality. CONCLUSIONS: Research confirms the possibility of obtaining products with increased nutritional value available to consumers on a gluten-free diet.

Quality of Soybean Products in Terms of Essential Amino Acids Composition.

The content of protein, moisture content and essential amino acids in conventional and genetically modified soybean grain and selected soybean products (soybean pâté, soybean drink, soybean dessert, tofu) was analyzed in this paper. The following comparative analysis of these products has not yet been carried out. No differences were observed in the amino acid profiles of soybeans and soybean products. The presence of essential amino acids was confirmed except for tryptophan. Its absence, however, may be due not to its absence in the raw material, but to its decomposition as a result of the acid hydrolysis of the sample occurring during its preparation for amino acid determination. Regardless of the type of soybean grain, the content of protein, moisture content and essential amino acids was similar (statistically insignificant difference). Thus, the type of raw material did not determine these parameters. There was a significant imbalance in the quantitative composition of essential amino acids in individual soybean products. Only statistically significant variation was found in genetically modified and conventional soybean pâté. Moreover, in each soy product their amount was lower irrespective of the raw material from which they were manufactured. Therefore, the authors indicate the necessity of enriching soybean products with complete protein to increase their nutritional value.

Hospitalization and in-hospital mortality due to COVID-19 in the Silesian Voivodeship during the first year of epidemic.

INTRODUCTION: The Silesian Voivodeship is the region with the highest population density in Poland, three times higher than the national average. These are important circumstances that may favor the transmission of the SARS-CoV-2 virus and, due to the severe course of the disease in many patients, contribute to overloading the healthcare system. AIM: The aim of the study was to evaluate the temporal and territorial variability of hospitalized morbidity and in-hospital mortality in COVID-19 patients treated in the study region. MATERIAL AND METHODS: The research was an epidemiological descriptive study. Secondary epidemiological data were obtained from the registry of the Health Department of the Silesian Voivodeship Office in Katowice. Crude and standardized hospitalized morbidity rates, as well as COVID-19 in-hospital mortality, were calculated. Results were presented in particular poviats and subsequent months of the 2020 year. The capabilities of the ArcGIS 9.2 geographic information system and Statistica 13.3 software were used. RESULTS: The largest number of patients hospitalized due to COVID-19 and the number of deaths occurred in autumn and spring, in both periods in-hospital mortality was over 24%. The poviats with the highest standardized hospitalized prevalence rate were located in the southern part of the Silesian Voivodeship. The highest in-hospital mortality (exceeding 24%) was recorded in Gliwice, Myslowice, Tychy, Bytom and in the Lubliniec poviat. Older people (65+), usually with diagnosed comorbidities, including chronic respiratory and cardiovascular diseases, died more often. CONCLUSIONS: The highest number of patients and deaths due to COVID-19 occurred in autumn. A significant territorial diversification of hospitalized morbidity and in-hospital mortality was demonstrated, the worst situation concerned densely populated poviats and cities. Worse prognosis applied to older patients with comorbidities.

Impact of the Tumor Microenvironment on the Gene Expression Profile in Papillary Thyroid Cancer.

Transcriptome of papillary thyroid cancer (PTC) is well characterized and correlates with some prognostic and genotypic factors, but data addressing the interaction between PTC and tumor microenvironment (TME) are scarce. Therefore, in the present study, we aimed to assess the impact of TME on gene expression profile in PTC. We evaluated the gene expression profile in PTC and normal thyroid cells isolated by laser capture microdissection and in whole tissue slides corresponding to the entire tumor. We included 26 microdissected samples for gene expression analysis (HG-U133 PLUS 2.0, Affymetrix, currently Thermo Fisher Scientific USA): 15 PTC samples, 11 samples of normal thyrocytes, and 30 whole slides (15 PTC and 15 normal thyroid). Transcripts were divided into three groups: differentially expressed both in microdissected and whole slides, transcripts differently expressed in microdissected samples and not changed in whole slides, and transcripts differentially expressed in whole slides and not changed in microdissected samples. Eleven genes were selected for validation in an independent set of samples; among them, four genes differentiated only microdissected PTC and normal cells. Two genes (PTCSC and CTGF) were confirmed. One gene (FOS) was not confirmed by the validation, whereas EGR1 was also significant in whole slide analysis. The other seven genes (TFF3, FN1, MPPED2, MET, KCNJ2, TACSTD2, and GALE) showed differentiated expression in microdissected thyrocytes and in whole tumor slides. Most of identified genes were related to the tumor-microenvironment interaction and confirmed the crosstalk between TME and cancer cells.

Readiness for Voice Technology in Patients With Cardiovascular Diseases: Cross-Sectional Study.

BACKGROUND: The clinical application of voice technology provides novel opportunities in the field of telehealth. However, patients' readiness for this solution has not been investigated among patients with cardiovascular diseases (CVD). OBJECTIVE: This paper aims to evaluate patients' anticipated experiences regarding telemedicine, including voice conversational agents combined with provider-driven support delivered by phone. METHODS: A cross-sectional study enrolled patients with chronic CVD who were surveyed using a validated investigator-designed questionnaire combining 19 questions (eg, demographic data, medical history, preferences for using telehealth services). Prior to the survey, respondents were educated on the telemedicine services presented in the questionnaire while being assisted by a medical doctor. Responses were then collected and analyzed, and multivariate logistic regression was used to identify predictors of willingness to use voice technology. RESULTS: In total, 249 patients (mean age 65.3, SD 13.8 years; 158 [63.5%] men) completed the questionnaire, which showed good repeatability in the validation procedure. Of the 249 total participants, 209 (83.9%) reported high readiness to receive services allowing for remote contact with a cardiologist (176/249, 70.7%) and telemonitoring of vital signs (168/249, 67.5%). The voice conversational agents combined with provider-driven support delivered by phone were shown to be highly anticipated by patients with CVD. The readiness to use telehealth was statistically higher in people with previous difficulties accessing health care (OR 2.920, 95% CI 1.377-6.192) and was most frequent in city residents and individuals reporting a higher education level. The age and sex of the respondents did not impact the intention to use voice technology (P=.20 and P=.50, respectively). CONCLUSIONS: Patients with cardiovascular diseases, including both younger and older individuals, declared high readiness for voice technology.

Differences in Gene Expression Profile of Primary Tumors in Metastatic and Non-Metastatic Papillary Thyroid Carcinoma-Do They Exist?

Molecular mechanisms of distant metastases (M1) in papillary thyroid cancer (PTC) are poorly understood. We attempted to analyze the gene expression profile in PTC primary tumors to seek the genes associated with M1 status and characterize their molecular function. One hundred and twenty-three patients, including 36 M1 cases, were subjected to transcriptome oligonucleotide microarray analyses: (set A-U133, set B-HG 1.0 ST) at transcript and gene group level (limma, gene set enrichment analysis (GSEA)). An additional independent set of 63 PTCs, including 9 M1 cases, was used to validate results by qPCR. The analysis on dataset A detected eleven transcripts showing significant differences in expression between metastatic and non-metastatic PTC. These genes were validated on microarray dataset B. The differential expression was positively confirmed for only two genes: IGFBP3, (most significant) and ECM1. However, when analyzed on an independent dataset by qPCR, the IGFBP3 gene showed no differences in expression. Gene group analysis showed differences mainly among immune-related transcripts, indicating the potential influence of tumor immune infiltration or signal within the primary tumor. The differences in gene expression profile between metastatic and non-metastatic PTC, if they exist, are subtle and potentially detectable only in large datasets.

Prevalence of SARS-CoV-2 infection and risk factors in health care workers.

The COVID-19 pandemic verifies the preparation of medical care in individual countries in terms of the fluent of guaranteed medical services provided to the people in need. Due to the easy spread of SARS-CoV-2 virus when in direct contact with the patients, health care workers are at an increased risk of infection. Nurses and auxiliary staff, as well as medical doctors, were most frequently infected. The prevalence of infection depends on the adopted reporting method, including the diagnostic test used to recognize the infection, the nature of the work performed, but also on the gender, knowledge, and individual behavior of employees while performing their professional duties. It ranges from 5-30% depending on the country and the occupational group, and the highest rates were recorded in the initial phase of the pandemic. A review of the literature shows the lack of a uniform, transparent system of reporting infections in health care workers, which makes a reliable assessment of the epidemiological situation in this area difficult.

Overview of statistical methods for estimating the relative risk of delayed respiratory effect related to ambient air pollution exposure.

INTRODUCTION: The occurrence of smog episodes and their significant impact on human health have forced research focused on risk assessment. Over the years, methods of exposure measuring have been improved, as well as statistical models necessary to the biological response estimation including the risk of incidence or death. AIM: The aim of presented study is to review and evaluate possibilities of statistical methods of delayed respiratory health effects risk assessment related to ambient air pollution exposure. MATERIAL AND METHODS: The review of published data was carried using the PubMed platform from 1994 to the 2020 year. Over 80 references were include in the analysis identifying general characteristics, construction of models estimating the relative risk of respiratory incidents with delayed health effect, and modelling tools available in statistical packages R, SAS, and Statistica. RESULTS: Among various methods of health risk assessment, the Almon model, the Poisson model, and the Distributed Lag Non-Linear Models (DLNM) were most common used. Initially, the Poisson model was used, close to 60% of the cited works apply this method. The interest in the nonlinear modelling implementation has increased (34% of cited papers) in recent years. Mostly researchers used R or SAS statistical software. Usually, was calculated the relative risk of health effect related to short-term exposure (up to a week). About 75% of available papers concern measurements of relative risk in response to the concentration of pollution increase by unit=10 µg/m3. Other describe the risk associated with the exposure increasing by the interquartile range (IQR). CONCLUSIONS: Distributed Lag Non-linear Model DLNM is classified as the statistical tool recommended by researchers due to its flexibility in defining, simplicity in interpretation, and increasingly frequent applications to environmental epidemiology.

Spatial variability of SARS-CoV-2 infection in the Silesian voivodeship, Poland.

INTRODUCTION: SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and related to infection COVID-19 (coronavirus disease 2019) remain a new and global challenge for public health. Due to the location, specifics of employment, and the high density of population in the Silesia voivodeship it is appropriate to study the available epidemiological data in a region with a potentially higher risk of infection. MATERIAL AND METHODS: In the descriptive model of the study, data on the number of infected, hospitalized, and dead people due to SARS-CoV-2 infection were analyzed. The source of information was daily reports conducted by the Provincial Sanitary and Epidemiological Station in Katowice, in the period from March 5 to August 18, 2020. RESULTS: Results of antigenic molecular tests for SARS-CoV-2 infection in the Silesian voivodeship indicate that in the first half of 2020, the infection rate was approximately 5% and the symptomatic form of the disease was approximately 20%. CONCLUSIONS: The analysis of the frequency of infection and mortality in the poviats reveals a large variation in the occurrence of both phenomena, but the explanation of this difference is not possible due to the descriptive nature of the analysis and the secondary form of epidemiological data.

Sources of parental knowledge about the safety of vaccinations in Poland.

There has been a recent increase in the number of parents refusing vaccination for their children in many European countries, including Poland. This observation necessitates the need to understand parental knowledge in regard to mandatory vaccination of children in these countries. A cross-sectional survey was conducted in 2016 on 1239 parents or legal guardians of preschool and school children in the Silesian Voivodship (Poland) to evaluate their hesitancy in acquiescing to their children mandatory immunization and the relation to this habit in regard to the use of informational sources on children vaccination system in Poland. Medical doctors often provide the basic source of information about vaccination to parents. About one-third (29%) of the respondents from the survey deemed the qualification system for vaccination as either inadequate or bad. 16.9% of the respondents surveyed declared that information received from physicians regarding vaccinations were either incomplete or unconvincing. Results of multivariable analyses confirmed that respondents are less likely to seek information about mandatory vaccinations from medical professionals and more often to misjudged vaccination's qualification system. Participants who used less informative sources (e.g. leaflets) and those with a lower level of education were more likely to avoid vaccination. Greater emphasis on the quality of information provided by medical professionals is crucial in order to avoid doubts about vaccination and to create proper attitudes and adherence to vaccination schedules.

Association of breast cancer grade with response to neoadjuvant chemotherapy assessed postoperatively.

Currently, breast cancer chemotherapy response can be predicted based on various parameters, with common reporting of tumour grade and Ki67 proliferation index. We analysed their association with pathological complete response (pCR) in a multivariate approach. The study was carried out in a group of 353 patients, treated by preoperative chemotherapy and prospectively observed. In selected patients, parallel to routing core needle biopsy assessment, gene expression profile of tumour was analysed by oligonucleotide microarrays. Tumour parameters associated with pCR in univariate analysis were: tumour grade, nuclear grade, mitotic index, Ki67, oestrogen and progesterone receptor (all p < 0.0001), and triple-negative status (p = 0.0032). The highest increase of pCR chance was observed in patients with high-grade tumours and with Ki67 ≥ 20%. In multivariate analysis, only tumour grade and oestrogen receptor status were predictive for pCR independently of other variables, with high grade increasing the odds of pCR 2.42 fold, and high ER decreasing the chance of pCR 0.41 fold. Tumour grading reflects important biological features of breast cancer and is not inferior to proliferation markers, including Ki67. It should be taken into account in decision-making for preoperative chemotherapy in parallel to breast cancer biologic subtypes, because grade 3 tumours exhibit a higher proportion of pCR.

The Web-Based Randomized Controlled Intervention as the Enhancer of Cancer Prevention.

Background and Objectives: Cancer is an unresolved public health issue in society. With the advent of the internet and the development in the technological sector, access to basic health-related information has become more frequent among patients and healthy individuals. The aim of this study is to evaluate the impact of educational intervention on the participant's willingness to undergo selected medical procedures in case of suspected cancer. Materials and Methods: From 14 May 2015 to 13 November 2016, a total of 1118 who visited the Polish scientific website were enrolled in the 'Polish Online Randomized Intervention aimed at Neoplasm Avoidance' (PORINA) and randomized into two groups (educational and control). The original Cancer Knowledge Index (CKI) was used for the evaluation of participants' cancer-related knowledge. They were asked to declare whether they would consent to undergo selected medical procedures necessary for cancer diagnosis or treatment. Results: Most participants declared their readiness to undergo abdominal ultrasonography, computed tomography, and a nevi excision. The most noticeable changes were found for potential consent to undergo breast fine needle aspiration, mammography and gastroscopy. Conclusions: The level of oncological knowledge has an impact on individual decision to consent to particular medical procedures. Conducted educational intervention has significantly increased the readiness to undergo selected medical procedures.

Human biomonitoring as a tool for exposure assessment in industrially contaminated sites (ICSs). Lessons learned within the ICS and Health European Network.

BACKGROUND: the mixed and complex nature of industrially contaminated sites (ICSs) leads to heterogeneity in exposure and health risk of residents living nearby. Health, environment, and social aspects are strongly interconnected in ICSs, and local communities are often concerned about potential health impact and needs for remediation. The use of human biomonitoring (HBM) for impact assessment of environmental exposure is increasing in Europe. The COST Action IS1408 on Industrially Contaminated Sites and Health Network (ICSHNet) decided to reflect on the potential and limitations of HBM to assess exposure and early health effects associated with living near ICSs. OBJECTIVES: to discuss challenges and lessons learned for addressing environmental health impact near ICSs with HBM in order to identify needs and priorities for HBM guidelines in European ICSs. METHODS: based on the experience of the ICSHNet research team, six case studies from different European regions that applied HBM at ICSs were selected. The case studies were systematically compared distinguishing four phases: the preparatory phase; study design; study results; the impact of the results at scientific, societal, and political levels. RESULTS: all six case studies identified opportunities and challenges for applying HBM in ICS studies. A smart choice of (a combination of) sample matrices for biomarker analysis produced information about relevant time-windows of exposure which matched with the activities of the ICSs. Combining biomarkers of exposure with biomarkers of (early) biological effects, data from questionnaires or environmental data enabled fine-tuning of the results and allowed for more targeted remediating actions aimed to reduce exposure. Open and transparent communication of study results with contextual information and involvement of local stakeholders throughout the study helped to build confidence in the study results, gained support for remediating actions, and facilitated sharing of responsibilities. Using HBM in these ICS studies helped in setting priorities in policy actions and in further research. Limitations were the size of the study population, difficulties in recruiting vulnerable target populations, availability of validated biomarkers, and coping with exposure to mixtures of chemicals. CONCLUSIONS: based on the identified positive experiences and challenges, the paper concludes with formulating recommendations for a European protocol and guidance document for HBM in ICS. This could advance the use of HBM in local environmental health policy development and evaluation of exposure levels, and promote coordination and collaboration between researchers and risk managers.