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Jaros&lstrok;aw Szyszka,1 Jakub Matuska,2,3 Bartosz Grzegorz Szyszka,4 Dariusz Walkowiak,5 El&zdot;bieta Skorupska6 1Department of Orthopaedic Surgery, Opolskie Center of Rehabilitation, Korfantow, Poland; 2Doctoral School, Poznan University of Medical Sciences, Poznan, Poland; 3Doctoral School, Rovira I Virgili University, Reus, Spain; 4Worcestershire Acute Hospitals NHS Trust, Worcester, England; 5Department of Organisation and Management in Health Care Poznan University of Medical Sciences, Poznan, Poland; 6Department of Physiotherapy, Poznan University of Medical Sciences, Poznan, PolandCorrespondence: El&zdot;bieta Skorupska, Department of Physiotherapy, Poznan University of Medical Sciences, ul. 28 Czerwca 1956 r. 135/147, Pozna&nacute;, 61-545, Poland, Email skorupska@ump.edu.plPurpose: Recent redefinitions of pain emphasize the importance of the previously overlooked recurrent low back pain (LBP). Understanding the direct medical cost for recurrent LBP cases based on the cost per visit is crucial economically. We aimed to compare the cost per visit for LBP and recurrent LBP, including the impact of gender and type of medical service, estimating the approximate annual cost of recurrent LBP.Patients and Methods: Data on LBP categorized according to ICD-10 codes (G54, G55, M45, M46, M47, M48, M49, M51, M53, and M54) from the Polish National Health Fund (NHF) and Opolskie Rehabilitation Center (OCR) were analyzed based on the recurrent state as outlined in the new chronic pain definition.Results: In OCR, a recurrent LBP was confirmed for 22.78% of patients, of which 59.72% were female (p< 0.001). The mean value of a single procedure for recurrent LBP was 110.56 EUR, it was significantly higher for males (135.35 EUR) than for females (92.94 EUR) (p=0.008). Recurrent LBP generated a higher cost per visit for medical services than LBP (p< 0.001), except for physiotherapy. Notably, males had a higher cost per visit in inpatient admissions, while females had a significantly higher cost per visit in physiotherapy services for both LBP and recurrent LBP. Moreover, recurrent LBP generated a statistically higher cost per visit for medical services than non-recurrent cases, except for physiotherapy. The average annual cost of LBP-related medical services in Poland was € 243,861,639.Conclusion: Recurrent LBP accounts for 5% of total direct LBP costs and has a higher cost per visit than LBP, excluding physiotherapy services. Gender significantly affected per-visit costs, with males having more inpatient admissions and females utilizing more physiotherapy services for both LBP and recurrent LBP.Keywords: cost analysis, recurrent low back pain, medical services, multidisciplinary care, biopsychical model of pain, ICD-11

OBJECTIVE: ApoE alleles have been shown to significantly correlate with vitamin K status, however, data concerning this phenomenon in cystic fibrosis (CF) are scarce. This study aimed to investigate the effect of ApoE polymorphism on vitamin K status in a unique group of CF patients who had never received vitamin K supplementation. PATIENTS AND METHODS: The study group consisted of 93 CF patients aged from 3 months to 32 years. Vitamin K status was assessed by the concentration of prothrombin induced by vitamin K absence (PIVKA-II) and the percentage of undercarboxylated osteocalcin (u-OC). The clinical status was evaluated in all patients. RESULTS: Fifty-four (65.1%) out of 83 patients had a pathological PIVKA-II concentration (≥2 ng/ml) and an abnormal percentage of u-OC (≥20%). There were no differences in the clinical parameters, including PIVKA-II concentration (p=0.7752) and u-OC percentage (p=0.8395), between patients with genotypes ApoE2/3, ApoE3/3 and ApoE3/4. Moreover, the frequency of vitamin K deficiency did not significantly differ in CF patients with ApoE2/3, ApoE3/3 and ApoE3/4 genotypes (66.7 vs. 69.9 vs. 80%, p=0.8411; 87.5 vs. 89.6 vs. 100%, p=1.000, respectively). CONCLUSIONS: The presence of the ApoE4 allele does not influence the vitamin K status in CF patients who have never received vitamin K supplementation. [ABSTRACT FROM AUTHOR]

Parenting a child with rare paediatric neurological diseases (RPNDs) severely affects parents' quality of life and the caregiver burden. Since mothers tend to be the primary caregivers more often, this study focuses on previously unexplored experiences of mothers of four RPNDs: 22q11.2 deletion syndrome (22q11.2DS), Angelman syndrome (AS), Dravet syndrome (DS) and Williams syndrome (WS). A cross-sectional survey of 302 mothers revealed that, while caring for RPND children seriously impacts well-being and stress in all mothers, there also exist some significant differences in diagnostic experiences, quality of life and the caregiver burden across conditions. DS and AS mothers reported difficulties in the access to and reimbursement for modern genetic testing and psychological support. DS and WS mothers were concerned over the impact of the delayed diagnosis on unnecessary hospitalisations and medication in their children. 22q11.2DS mothers felt more supported than others. While DS and AS mothers reported a greater burden in caregiving and reduced quality of life, WS mothers reported significantly lower burdens and higher scores across all quality-of-life domains. Mothers' financial well-being, employment status and early diagnosis significantly influenced their experiences. These findings underscore the need for tailored support for RPND mothers, with a focus on early diagnosis and financial and psychological help., Competing Interests: Declarations. Ethics approval and consent to participate: This study was performed in line with the principles of the Declaration of Helsinki. Ethics and research governance approval were obtained from the PUMS Bioethics Committee (KB – 228/24). Informed written consent was obtained from all individual participants in the study. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Current predictions of climate change impacts rely on conservative assumptions about a lack of adaptation, projecting significantly increased heatwave mortality. However, long-term studies have shown a decline in actual heatwave deaths, raising questions about the underlying mechanisms. We combined Eurostat weekly mortality data (baseline extracted via Seasonal-Trend decomposition by Loess and smoothed through Principal Component Analysis dimension reduction and reconstruction) with economic indicators, Copernicus temperature data since 1950, and ENTSO-E electricity demand data. Panel regression analyzed mortality patterns during weeks with daily temperatures exceeding 22 °C for 2000-2022. During the analyzed period, Europe outpaced climate change, with the capacity to tolerate an additional 1 °C rise every 17.9 years [95% CI 15.3-22.7]. Extending the temperature indicators beyond the prior 3 years did not enhance predictive accuracy, suggesting swift adaptations and historical climate lacked any predictive value. Additionally, increasing economic output, likely driven by infrastructural improvements, especially greater affordability of air conditioning, enabled tolerating each additional 1 °C due to a per capita GDP increase of 19.7 thousand euros [95% CI 14.6-30.3]. Consistently, the increase in cooling energy demand was the strongest in eastern Europe. The findings shed light on the mechanisms driving the observed reduction in heatwave mortality despite the warming climate trend, offering a more plausible basis for extrapolation than assuming a lack of adaptation. The model emphasizes the role of long term economic growth and addressing energy poverty., Competing Interests: Declarations. Competing interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2025. The Author(s).)

Objective: As digital natives appear to be the most suitable target group for technological innovations, we tested this notion by analyzing their attitude toward the implementation of telemedicine in Poland. Methods: An online survey was conducted from April to October 2021, yielding responses from 475 university students on their experience with teleconsultations, which are an essential part of telemedicine. Satisfaction-related questions were used to perform cluster analysis, and subsequently, clusters were compared based on significant differences in responses including sociodemographic and utilization patterns. Open-ended questions were analyzed to further gauge the rationale behind the demonstrated attitude. Results: The responses were polarized. In the cluster analysis, on one side were the "Skeptics" and "Enemies," who shared negative opinions on professionalism and convenience, differing only in their assessment of intangible skills. On the other side were the "Enthusiasts," who were satisfied in all categories; the "Indifferent," who lacked strong opinions; and the "Time-pressed," who, while openly admitting its drawbacks, were highly likely to continue using it due to its time-saving potential. Recurring concerns in open-ended questions focused on unreliable diagnoses and uncooperative administrative personnel. Conclusions: The reception was polarized. The split in answers suggests that administrative problems were limited to some providers, indicating they should be possible to overcome. There is a clear pattern that telemedicine is seen as an incomplete service. However, many would happily continue to use it due to its convenience and time-saving benefits.

Purpose: We aimed to analyze regional variations in the assignment of International Classification of Diseases, 10th Revision (ICD-10) codes to acute respiratory infections, seeking to identify notable anomalies that suggest diverse diagnoses of the same condition., Methods: We analyzed national weekly diagnosis data for acute respiratory infections (ICD-10 codes J00-J22) in Poland from 2010 to 2019, covering all 380 county-equivalent administrative regions and encompassing 292 million consultations. Data were aggregated into age brackets. We calculated the Kendall tau correlations between shares of particular diagnoses., Results: We found staggering differences across regions in applied diagnoses that persisted even after disaggregating the data into age groups. The differences did not seem to stem from different levels of health care use, as there was no consistent pattern suggesting variability in milder diagnoses. Instead, there were numerous pairs of strongly negatively correlated codes implying classification ambiguity, with the most problematic diagnosis being J06 (acute upper respiratory infections of multiple and unspecified sites), which was used almost interchangeably with a diverse range of others, especially J00 (common cold) and J20 (bronchitis)., Conclusions: To the best of our knowledge, this is the first study using observable anomalies to analyze regional coding variability for the same respiratory infection. Although some of these discrepancies may raise concerns about misdiagnosis, the majority of cases involving interchangeably used codes did not seem to substantially impact treatment or prognosis. This suggests that ICD codes may have clinical ambiguities and could face challenges not only in fulfilling their intended purpose of generating internationally comparable health data but also in their use for comprehensive government health planning., (© 2025 Annals of Family Medicine, Inc.)

Background: Despite the rise of research biobanks in the Middle East, they continue to struggle with the limited number of donors. Although qualified healthcare professionals may address it, the awareness of biobanks among future physicians is low. This paper assesses the attitudes towards research biobanks among Iranian medical students., Methods: 459 medical students completed an anonymous self-administered online questionnaire regarding the knowledge and attitudes of future physicians towards biobanking., Results: This study demonstrates that almost half of the students had not heard about biobanks, and one-third had mixed feelings about biobank research. The majority declared a willingness to share their biological material for biobank research and declared altruistic motivation. Students' willingness to donate was influenced by the type of tissues, the purpose of biobank research and trust in biobanks, which influenced their preference for a study-specific consent model. Students expressed concern over biospecimens' unethical or commercial use and data safety., Conclusion: This research shows that promoting knowledge about biobank-based research among future physicians in Iran is crucial., Competing Interests: Declarations. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. According to local legislation and national guidelines on research involving human subjects, ethical approval and research governance approval were not required. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Most children with a rare disease are cared for by their family members but parenting such a child is extremely demanding due to the complexity and severity of symptoms, with serious physical, emotional, social, and financial consequences for caregivers. Although religion may serve as a positive coping strategy, little is known about its role in helping caregivers manage the stress related to the burden of caregiving in Poland. Therefore, we surveyed 925 Polish family caregivers of children with rare diseases to understand the association between caregivers' religiosity and their caring experiences. The findings suggest that parents' religiosity is associated with a more positive caregiving experience, perceived quality of life, and experienced caregiving burden. While religious caregivers reported experiencing less distressing emotions and stressed the encouraging impact of their child's disease on their life more often, non-religious caregivers experienced role captivity and role overload more frequently. Since religion may serve as a source of strength and a protecting factor against mental health problems and the burden of caregiving, healthcare professionals should be aware of the importance of religious and spiritual care, and caregivers' religiosity should be considered an integral part of a holistic approach., Competing Interests: Declarations Conflict of interests The authors declare that they have no conflict of interest. Ethical Approval This study was performed in line with the principles of the Declaration of Helsinki. Ethics approval and research governance approval were obtained from the PUMS Bioethics Committee (KB –833/22, 22 October 2022). Informed Consent Informed consent was obtained from all individual participants included in the study., (© 2024. The Author(s).)

Background: Duchenne and Becker muscular dystrophies (DBMD) are rare progressive, X-linked diseases of muscle wasting characterised by the early onset and prognosis of premature death. The aim of this study was to evaluate the impact of providing care for a person with DBMD on caregivers' quality of life, perceived burden and financial well-being., Results: 202 Polish caregivers of a person with DBMD were included and completed a self-administered, computer-assisted online survey. Results show that DBMD affects the quality of life of caregivers who score significantly lower than the national average in every domain: 85.1% of DBMD caregivers scored below the national average in the physical health domain; in the environmental domain 83.7%; in the social relationships domain 82.2%; and in the psychological domain 72.3%. It also demonstrates that DBMD is a source of severe burden (mean score of 35.3). Finally, we report that while some dimensions of respondents' quality of life and perceived burden were associated with patients' age and caregivers' educational status, financial well-being was the most important predictor of respondents' quality of life and caregiving burden., Conclusions: To improve DBMD caregivers' quality of life and alleviate their burden, future intervention programs should promote resiliency and active coping and develop a social support system and respite care. Additionally, it is crucial to provide caregivers with adequate financial resources to fulfil their needs., Competing Interests: Declarations. Ethics approval and consent to participate: This study was performed in line with the principles of the Declaration of Helsinki. Ethics and research governance approval were obtained from the PUMS Bioethics Committee (KB – 228/24). Informed written consent was obtained from all individual participants in the study. Consent for publication: Not applicable. Competing interests: The authors declare that they have no conflict of interest., (© 2024. The Author(s).)

Objective: The aim of the study is to analyze the annual cycle of pediatric medically attended respiratory illnesses., Study Design: Data on 141 million pediatric respiratory visits from the years 2010-2019 were obtained from the Polish National Healthcare Fund. To identify underlying patterns and trends within the aggregated data, techniques like seasonal-trend decomposition using LOESS (STL) and principal component analysis (PCA) were applied., Results: A strongly recurring pattern was observed. Following the annual minimum in late summer, there was a sudden surge in upper respiratory infections in early September. Subsequently, overall visits declined gradually, while the share of lower respiratory infections increased, particularly during the influenza peaks from January to March. Afterwards, visits declined steadily, with an additional peak of tonsillopharyngitis noted in midsummer. Dimensionality reduction of diagnoses implied the existence of two major groups of co-occurring diagnoses, the proportions of which change over the year: one smaller but more severe, peaking during the influenza season, and the second dominating with lower severity. Age differences in diagnoses were observed, with babies showing upper respiratory infections likely diagnosed with the common cold rather than a more specific upper respiratory infection., Conclusion: While enhancing surveillance strategies is indeed a desirable long-term goal, it is worth noting that despite the variability observed in the onset of the influenza season, the infection cycles generally follow a relatively fixed pattern. This consistency provides a foundation for effective planning and underscores the potential for proactive measures to mitigate the impact of seasonal outbreaks., (© 2024 The Author(s). Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.)

Background: Over the past few years, several biobanks have been organized in the Republic of Kazakhstan (RoK). As research biobanks are becoming an increasingly important tool for precision medicine, they require competent biobankers who will help disseminate the idea of biobanking throughout the society and support donation for research purposes. This study aimed to assess the support for research biobanks among medical students (MSs) in Kazakhstan. Methods: This research includes data from an anonymous, self-administered online questionnaire regarding MSs' support for research biobanks in the RoK. Results: Only 212 (31.3%) MSs have heard of biobanks and 466 (68.7%) have not. Students who were biobank-aware held more positive views regarding biobanks, were more likely to support the idea of establishing a research biobank in Kazakhstan, and expressed a greater willingness to donate their biological material for research purposes. Students' awareness of biobanks was also associated with the respondents' motivations to donate. Students who were familiar with biobanks tended to be motivated by altruistic reasons more often, and those unfamiliar with biobanks tended to indicate selfish motives. Students' attitudes toward donation to various types of research and biobanks were influenced by their awareness of biobanks, any family history of genetic disease, experience of chronic disease, declared religiousness, hospitalization history, blood donor status, and year of study. Conclusion: Since MSs' awareness of research biobanks is low, there is an urgent need for biobank education in Kazakhstan.

Background: While conspiracy theories cover many different themes, medical conspiracy theories (MCTs) have become particularly prevalent in modern societies. As beliefs in MCTs can become a source of "infodemics", influence individual health behaviors and cause distrust in medical institutions and personnel, healthcare workers must find ways to overturn patients' conspiracy thinking. However, as the medical world is not free of these beliefs, in this study, we investigated beliefs in MCTs among medical and health science students and their association with reported health behaviors., Methods: Our sample was derived from a self-administered, anonymized, computer-assisted web survey conducted among 1,175 medical and health science students enrolled at the Poznan University of Medical Sciences, Poland., Results: From a set of twenty different MCTs, one-third of students rejected all of them, 18% believed in one, 15% in two, 10% in three, and 24% supported four or more conspiracy theories. In addition, many students were hesitant or unsure about MCTs. We also found that nursing and midwifery students were the most likely to believe in MCTs, while medical and dental students were the least supportive. Support for MCTs was higher among students in the early years of their studies and who declared themselves religious and conservative. This study also highlights the association between students' support for MCTs and their reported health behaviors, including avoiding vaccinations, using alternative medicine, taking vitamin C, or using social media as an essential source of health information., Conclusions: As medical and health science students are prone to conspiratorial thinking, they should be trained to act as a trusted and reliable source of medical information, to mitigate conspiratorial beliefs, and to act as role models for their patients and society, effectively shaping health behaviors in the population., (© 2024. The Author(s).)

Background : Caregiving experiences in rare diseases (RDs) vary based on factors such as specific clinical entity, disease severity, the child's age, and available support and resources, leading to challenges that significantly impact caregivers' lives. This study investigates whether caregivers of children with different RDs encounter varied aspects of care. Methods : This study was conducted as a self-administered, anonymous, computer-assisted online survey, focusing on the challenges of caregiving for children with RDs. Questions covered aspects such as information availability on RDs, diagnostic processes, modern treatment accessibility, family physicians and specialists, the impact of caregiving on personal life, family dynamics, and financial challenges. To achieve our study objectives, we categorized caregivers of children with RDs into two groups to compare various aspects of caregiving: caregivers of children with phenylketonuria (PKU) ( n = 175) and those caring for children with life-limiting rare diseases (LLRD) ( n = 226). Results: Caregivers of children with LLRD reported greater emotional challenges, personal sacrifices, and financial burdens compared to caregivers of children with PKU. Significant differences included heightened emotional distress, more frequent conflicts, and lower assessments of healthcare support among LLRD caregivers. Although family support ratings were similar between the groups, perceptions of financial concerns and interactions with the healthcare system varied significantly. Conclusions : This study, representing the inaugural systematic comparison of specific caregiver cohorts overseeing children with RDs across a substantial sample size, provides valuable insights. The findings lay a crucial foundation for precisely tailoring assistance and support initiatives to meet the unique needs of caregivers facing various RDs in diverse contexts.

Patients with phenylketonuria (PKU) must restrict their intake of phenylalanine, which can also affect the levels of other essential and non-essential amino acids due to inadequate supply. Therefore, our objective was to assess amino acids in serum samples from 20 PKU patients and compare them with results from 51 healthy subjects. A sample analysis was conducted using liquid chromatography-tandem mass spectrometry. We obtained levels of 28 substances, including amino acids, biogenic amines, carnitine, and acetylcarnitine. Kynurenine ( p = 0.000001), tyrosine ( p = 0.0002), asparagine ( p = 0.001), proline ( p = 0.012), and the kynurenine/tryptophan ratio ( p < 0.000001) were identified as features that differed between the studied groups, being significantly lower in patients with PKU. Glycine ( p = 0.000012), putrescine ( p = 0.0055), asymmetric dimethylarginine ( p = 0.01), creatinine ( p = 0.035) levels, as well as the total level of glucogenic amino acids ( p = 0.0018), and the ratios of putrescine/ornithine ( p = 0.003) and citrulline/ornithine ( p = 0.0043) were significantly higher in the PKU group. In conclusion, the amino acid profiles in patients with PKU differ significantly from those in healthy peers, with potential clinical implications. These findings confirm the importance of metabolic testing in clinical practice and highlight the necessity for adequate dietary monitoring and adjustment.

Background: Although biobanks have become fundamental to many research centers and contribute to medical development, they generate many ethical and legal issues that may discourage patients from donating., Materials and Methods: To understand patients' perception of ethical and legal issues related to biobanks we conducted a survey among 548 Polish patients with cancer., Results: While 93.1% of patients with cancer declared themselves willing to donate biospecimens left over after a medical procedure to a biobank, most opted for one-time consent or study-specific consent, blanket consent being less frequently preferred. Many patients believed that future use of previously collected tissues require second contact. Most patients preferred pseudonymization over anonymization of the data, and supported donors' right to withdraw informed consent at any given moment. Finally, while personal health information was the most expected form of compensation for donation, most patients suggested that all parties, including the biobank concerned, the sponsors of the research, and the donors, should own the rights to cancer tissues donated and profit from the biobank research. Patients' opinions on the ethical and legal issues related to biobank research were associated with age, sex, religiosity, education level, and place of residence., Conclusions: Since biobanks generate ethical and legal issues related to informed consent, data protection and storage, as well as the sharing of biosamples, tissue ownership, and profit sharing, that may discourage patients from donation, when asking a patient for a donation, healthcare professionals should communicate in a donor-centered manner and address patients' ethical and moral concerns related to donation and offer resources to help manage these concerns., (© The Author(s) 2024. Published by Oxford University Press.)

This study explores the experiences of Polish caregivers of children with rare disease (CRD) with health care and social services for CRD. A mixed-methods approach was employed, using an open-ended questionnaire with a convenience sample. Quantitative data presented through descriptive statistics, were complemented by thematic analysis applied to qualitative responses. Responses from 925 caregivers of 1002 children with CRD revealed that the duration of the diagnostic journey varied, spanning from 0 to 18 years, with an average time of 1.7 years. Similarly, the average number of physicians consulted before receiving the correct diagnosis was 4.8. The Internet was basic source of information about children's disease. Although caregivers were to some extent satisfied with the quality of health care for CRD, they complained at the accessibility of health care and social services, physicians' ignorance regarding RDs, the lack of co-ordinated care and financial and psychological support. To break the cycle of the diagnostic and therapeutic odyssey that may aggravate the condition of CRD, cause parental stress and financial burden there is a need to change our view on CRD from cure to family-oriented care. Multifaceted challenges and needs of CRD families should be prioritized., (© 2024. The Author(s).)

BACKGROUND Biobanks are legally regulated entities that acquire, store, prepare, preserve, test, analyze, and distribute defined biological material and related information and data from human sources. This study aimed to evaluate trust, support and willingness to donate personal data and tissue samples for biobanking from cancer patients attending oncology departments in Poznań, Poland. MATERIAL AND METHODS This study utilized data from questionnaire-based survey conducted from February to June 2023 among 548 patients from 2 Poznań hospitals equipped with oncology treatment units. The survey employed convenience sampling. Statistical analysis was carried out using JASP 0.18.3 and PQStat1.8.6., with significance levels set at 0.05. Descriptive statistics and logistic regression were utilized to present the results. RESULTS 92.2% of cancer patients supported the establishment of cancer research biobank in Poland, and 93.1% declared the willingness to share their cancer tissues for research purposes. Patients' willingness to donate was associated with biomedical research conducted by biobanks and types of biobank institutions. Most patients were willing to donate for research on cancer, genetic and autoimmune diseases or dementia, but were reluctant to participate in research on sexual identity, intelligence, aggression and for-profit research. Patients were willing to donate to biobanks managed by medical universities, public institutions, clinical hospitals and national biobanks but not to foreign and private biobanks. CONCLUSIONS Although patients' support for cancer biobank is high it is not unconditional as their willingness to participate in cancer-related research is associated with types of biomedical research conducted by biobanks and different types of biobank institutions.

Objectives: This study aimed to assess the biobank awareness among Polish pharmacy students and how it affects their support for biobank research., Methods: A survey among 366 pharmacy students enrolled at two Polish medical universities: the Poznań University of Medical Sciences and Medical University of Lublin was conducted., Results: Although most pharmacy students felt positivity about biobanking and expressed the willingness to donate their biospecimens for biomedical research, their awareness on research biobanks was low. Their willingness to participate was driven by the desire to benefit society, help advance science and develop new therapies. While students supported donation for most types of research, biobanks run by medical universities were the highest trusted research institutions. The primary factors associated with student's willingness to participate were religiosity and place of study. Notably, nonreligious students and those studying in Poznan exhibited more favourable attitudes toward donating for research and expressed greater support for the establishment of research biobanks in Poland., Conclusion: Since biobank awareness among future pharmacists is inadequate incorporating biobank competency domains into education and training of pharmacists is required., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Domaradzki, Majchrowska, Cielecka-Piontek and Walkowiak.)

The published data on the vitamin status of patients with phenylketonuria (PKU) is contradictory; therefore, this systematic review and meta-analysis evaluated the vitamin status of PKU patients. A comprehensive search of multiple databases (PubMed, Web of Sciences, Cochrane, and Scopus) was finished in March 2024. The included studies compared vitamin levels between individuals diagnosed with early-treated PKU and healthy controls while excluding pregnant and lactating women, untreated PKU or hyperphenylalaninemia cases, control groups receiving vitamin supplementation, PKU patients receiving tetrahydrobiopterin or pegvaliase, and conference abstracts. The risk of bias in the included studies was assessed by the Newcastle-Ottawa scale. The effect sizes were expressed as standardised mean differences. The calculation of effect sizes with 95% CI using fixed-effects models and random-effects models was performed. A p -value < 0.05 was considered statistically significant. The study protocol was registered in the PROSPERO database (CRD42024519589). Out of the initially identified 11,086 articles, 24 met the criteria. The total number of participants comprised 770 individuals with PKU and 2387 healthy controls. The meta-analyses of cross-sectional and case-control studies were conducted for vitamin B12, D, A, E, B6 and folate levels. PKU patients demonstrated significantly higher folate levels (random-effects model, SMD: 1.378, 95% CI: 0.436, 2.320, p = 0.004) and 1,25-dihydroxyvitamin D concentrations (random-effects model, SMD: 2.059, 95% CI: 0.250, 3.868, p = 0.026) compared to the controls. There were no significant differences in vitamin A, E, B6, B12 or 25-dihydroxyvitamin D levels. The main limitations of the evidence include a limited number of studies and their heterogeneity and variability in patients' compliance. Our findings suggest that individuals with PKU under nutritional guidance can achieve a vitamin status comparable to that of healthy subjects. Our study provides valuable insights into the nutritional status of PKU patients, but further research is required to confirm these findings and explore additional factors influencing vitamin status in PKU.

The relationship between temperature and mortality is well-established, with higher mortality rates occurring in moderate climates during winter. Studies on COVID-19 and influenza-related excess deaths often assume a sine-like wave pattern for baseline mortality. This study aims to assess the accuracy of this approximation in capturing the observed mortality pattern and explore its linkage with climate. Weekly mortality data from European regions (2000-2019) were modeled using the seasonal-trend decomposition procedure based on Loess. Cycles were grouped into clusters, and underlying trends were extracted using principal component analysis. Generalized linear models assuming a sine-like pattern were used to test predictive value. Cluster analysis divided the regional cycles approximately into continental and temperate climate regions, further subdivided into oceanic and Mediterranean. While the continental region exhibited a sine-like mortality pattern, it displayed modest deviations that compounded further south. The period of elevated winter mortality became shorter but more intense, while decreased summer mortality became more pronounced yet delayed. This study improves weekly estimations of excess mortality models by providing enhanced baselines. The deviation from the sine-like approximation mirrors the idealized outbreak pattern from epidemiological models with sharper surges and more gradual declines. The results point to winter infections, impacted by acquired immunity and weather conditions, as the primary drivers of fluctuations in mortality. In warmer regions, there is an apparent shift toward a lower number of overall infections within a compressed time span., (© 2024. The Author(s) under exclusive licence to International Society of Biometeorology.)

While biobanking is expanding globally, the empirical evidence concerning the impact of religion on future healthcare professionals' awareness and willingness to donate biospecimens for biobank research is lacking. To understand how medical students' religious beliefs can fuel their questions regarding how biospecimens would be stored, cared for, and used, we conducted a survey among 1500 medical students at Poznań University of Medical Sciences. Our findings suggest that, while both religious and nonreligious students supported the idea of biobanking of human biological material and were willing to donate for research purposes, nonreligious students felt more positive toward biobanking, supported the idea of establishing biobanks in Poland more often, and were more eager to donate most types of tissues and to participate in biobank research. Religious beliefs were also associated with medical students' perception of benefits and risks resulting from biobanking, perceived trust toward various biobank institutions, and preferred type of consent., (© 2023. The Author(s).)

Background: Since the biological material that remains after diagnostic and therapeutic procedures plays crucial role in biobank research, this study aims to explore cancer patients' views on the donation of biospecimens for research purposes., Methods: 548 oncology patients from two hospitals with oncology treatment units in Poznan, Poland, completed an anonymous, self-administered pen-and-paper questionnaire., Results: Although only 43.4% of patients had heard of biobanks, 93.1% declared themselves willing to donate. 71.1% of patients believed that doctors should ask patients to donate, and 60.9% that this should be done before the medical procedure. While 65% of patients were willing to donate any type of tissue that remained after a medical procedure, blood, saliva and hair were indicated most frequently. 40.5% of patients would donate their entire body after death and 21% would refuse. Patients' support for biobanks was mainly driven by the desire to support science, help advance cancer research and altruism. Some respondents expected health information or medical treatment. The most common barriers for donation were physical distance, repeated examinations, concerns over the privacy and confidentiality of data and the commercial or unethical use of samples. Patients' attitudes toward biobank donation seemed to be associated with age, education level, declared religiousness, a family history of genetically determined diseases and whether they were a blood donor., Conclusions: Although cancer patients' lack of biobank awareness had no effect on their affirmative attitudes towards biobank research, there is a need to further increase patients' support and overcome possible barriers that might hinder their willingness to donate., (© 2024. The Author(s).)

While the doctors' role in immunization is essential, their lack of knowledge or vaccine hesitancy may affect their ability to communicate effectively and educate patients about vaccination, vaccine hesitancy, and vaccine conspiracy theories. This, in turn, may hinder health policy aimed at fighting infectious diseases. Vaccine hesitancy is prevalent not only among the general population but also among healthcare workers; thus, this study is aimed at assessing future doctors' attitudes towards anti-vax conspiracy theories. A total of 441 medical students at Poznan University of Medical Sciences completed a web-based survey designed to explore their attitudes toward the six most prevalent anti-vaccine conspiracy theories. The survey showed that although over 97% of future doctors support vaccinations as an effective form of fighting infectious diseases, and 80% did not believe in any anti-vax conspiracy theory, a significant fraction of 20% of medical students either believed in at least one such theory or were unsure. It has also shown that male and younger students who had not received a flu vaccination and defined themselves as politically right-wing or conservative and religious were more likely to believe in anti-vax conspiracy theories. Our data suggest that, in order to overcome medical students' ambivalent attitudes towards anti-vax conspiracy theories, they should receive more education about the importance of vaccination in preventing disease and about effective ways to combat vaccine hesitancy and anti-vax conspiracy theories.

While low winter temperatures are associated with increased mortality, this phenomenon has been suggested to be most severe in regions with seemingly mild winters. The study aimed to establish a temperature-based formula that could elucidate the previously ambiguous regional differences in vulnerability to low temperature. European weekly mortality data (2000-2019) were matched with meteorological data to determine for each region vulnerability to temperature decrease and the optimal temperature with lowest mortality. Regression models were developed to generalize and explain these findings considering regional temperature characteristics. Optimal temperature could be predicted based on local average summer temperature (R 2  = 85.6%). Regional vulnerability to temperature decrease could be explained by combination of winter and summer temperatures (R 2  = 86.1%). Regions with warm winters and cold summers showed the highest vulnerability to decrease of temperature during winter. Contrary to theories about economic disparities Eastern Europe exhibited resistance comparable to Scandinavia. The southern edges of Europe demonstrated serious low temperature vulnerability to decreased temperatures, even if temperature was relatively high around 20 °C. This suggests that the observed connection primarily reflects the modulation of the length of respiratory virus infection seasons by climate conditions, counterbalanced by varying levels of acquired immunity and the presence of heatwaves eliminating the most frail individuals. Thus, relatively low vulnerability and a flat mortality cycle in countries with harsh climates paradoxically imply the presence of threats throughout the whole year., (© 2024. The Author(s).)

Background: Although physical, cognitive and behavioural manifestations of Williams syndrome (WS) affect every dimension of caregivers lives, no studies on the parental experiences of caring for a WS child have to date been carried out in Poland., Methods: In order to identify the challenges and needs of Polish carers of WS children a survey was conducted with 32 family caregivers who were supported by the Polish Williams Syndrome Association., Results: While caregivers were mostly challenged by their WS child's behaviours, health problems and mood swings, many parents experienced fatigue, intimacy problems with the partner and deterioration of mental health. They were also burdened by the lack of time for themselves and work restrictions resulting from caregiving responsibilities. Even though parents positively assessed quality of medical care for WS children, still many expressed their dissatisfaction both with the way the healthcare system for WS children works in Poland and complained about the doctors' lack of knowledge about WS, access to specialist care and lack of support from government and social institutions. Although many parents stressed positive impact of rising WS child, more than half experienced role captivity or role overload and felt not being understood by others. They also experienced variety of distressing emotions, including impatience, emotional lability, helplessness, anxiety and depression., Conclusions: Although many WS parents stressed the affirmative aspect of raising WS child this research shows that the burden of caring for such a child goes far beyond clinical aspects and seriously affects every aspect of parents' lives, including their mental health, daily lives, family, their professional and social lives. Because apart from the daily challenges related to caring for a WS child, parents' dealings with the healthcare system and support services represent major problems there is a the need for a bio-psychosocial approach to WS that should include not only WS children, but also their caregivers. WHAT THIS PAPER ADDS?: 1. It analyses the challenges and needs of parents caring for children with Williams syndrome; 2. It provides evidence that the impact of caring for WS children goes far beyond clinical aspects and seriously affects every aspect of parents' lives, including their mental health, daily lives, family, their professional and social lives; 3. It also shows that, apart from the daily challenges related to caring for a WS child, parents' dealings with the healthcare system and support services represent major problems. 4. Thereby, it highlights the importance of incorporating a bio-psychosocial approach to WS that should include not only WS children, but also their caregivers., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: We sought to assesses the impact of caring for children with ultra rare diseases (URDs) on family carers and to analyse the way these experiences differ among the caregivers of children diagnosed through prenatal or newborn screening, and those with symptom-based diagnosis., Methods: A total of 200 caregivers of 219 URDs children completed an on-line survey regarding the challenges and experiences of caregivers of URDs children., Results: The majority of URD caregivers felt burdened by their children's health problems, emotional and behavioural changes. 46.5% reported feelings of care overload, 43% coped poorly with the stress, and many experienced a variety of feelings of distress towards the role of caregiver. While most caregivers struggled with the diagnostic odyssey and were dissatisfied with the healthcare services for URD children, caregivers of children diagnosed through prenatal or newborn screening were significantly less burdened than the parents of children with symptom-based diagnoses., Conclusion: Although caregivers of URDs children experience physical and emotional strain, they are often neglected by the healthcare system. A bio-psychosocial approach to URDs should therefore also include family caregivers' physical and psychosocial needs. Apart from financial and emotional support, enhancing access to genetic testing and newborn screening should be prioritised., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (© 2023 The Authors. Published by Elsevier Ltd on behalf of European Paediatric Neurology Society. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).)

Introduction: This study aims to explore the opinions of female cancer patients regarding the donation of cancer and reproductive cells for reproductive and research purposes., Material and Methods: The study involved 373 female cancer patients from 2 hospitals with oncology departments in Poznan, Poland. They completed a pen-and-paper questionnaire-based survey., Results: While most female cancer patients declared their willingness to donate cancer tissues for fertility research (87.9%), they were reluctant to share their reproductive cells for research purposes (82.3%). Additionally, 88.2% of respondents were unwilling to donate embryos that remain after in vitro treatment for research purposes. Simultaneously, 57.1% of woman supported the preservation of fertility cells, 62.5% believed it should be ethically and legally regulated in Poland, and 74% believed it should be re-imbursed by the National Health Fund. Women's opinions were linked to their age, education, place of residence, family status, and declared religiosity., Conclusions: Because most female cancer patients expressed their willingness to share their reproductive cells for reproductive purposes and believed that the preservation of cells for fertility purposes should be reimbursed by the State, there is a need for doctors and nurses to inform patients about the available ways to preserve fertility. However, because donation of reproductive cells for biomedical research raises many concerns, healthcare professionals should be trained to discuss with patients the ethical and legal issues related to fertility preservation and biomedical research involving reproductive cells., Competing Interests: None., (Copyright © 2024 Termedia.)

Background: For a variety of reasons, raising a child with 22q11.2DS has significant psychosocial and financial repercussions for the family caregivers. Our aim was to identify and explain the expectations and concerns of Polish parents of 22q11.2DS children. An online survey was developed consisting of four sections: demographics, emotions experienced by caregivers while performing their duties, attitudes of the respondents about providing care, and finally different aspects of the caregivers' life satisfaction. The study was conducted with the support of the Polish 22q11 Association., Results: Forty-four caregivers of Polish origin completed the survey, all but one of whom were mothers. Thirty-four per cent (n = 15/44) declared full-time employment. According to 73% (n = 32/44) of those surveyed, the child's disease has not harmed their relationship with the partner. In spite of the fact that the median diagnosis time was 1.9 years (ranging from 0 to 12 years), the caregivers indicated that they had contacted on average 3.9 doctors before obtaining the right diagnosis (range 1-17). The Internet was the main source of information and knowledge about their child's disease for 93% of respondents (n = 41/44), while for 54% (n = 24/44) it was the association for people with 22q11DS. Only 26% rated as very good or good the support for caregivers offered by the central and local government or its agendas. The physicians' knowledge about 22q11DS was positively rated by 14% of respondents (n = 6/44). The most frequently chosen source of support for 66% of respondents (n = 29/44) turned out to be their families, and for 34% - a Facebook support group (n = 15/44). Asked how often they rated their quality of life (QoL) highly, none of our respondents chose the option "always", although 64% (28/44) gave the answer "often"., Conclusion: Our study is the first one in Poland to develop an online survey specifically for use with caregivers of paediatric patients with 22q11.2DS. Our respondents revealed that caring for 22q11.2 children entails a burden that extends far beyond clinical facets and has a significant impact on every dimension of the caregivers' lives, including their mental health, everyday activities, families, professional career and social lives. At the same time, caregivers are de facto left alone with the bureaucracy of the healthcare system., (© 2023. The Author(s).)

Objectives: This study was designed to determine the relationship between religion and healthcare practitioners' attitudes towards conscience clauses in Poland. Methods: We developed a survey assessing impact of religion on attitudes healthcare professionals towards the conscience clause. These questions were explored using a sample of 300 Polish healthcare professionals. Results: The results indicate that religiosity was a significant predictor of acceptance of conscience clauses. It also influenced healthcare practitioners' opinions on medical professionals that should be granted the right to conscience clauses and medical services that may be denied on moral grounds. There was also a significant relationship between healthcare practitioners' religiosity and their eagerness to use conscience clauses in a situation of moral conflict. Finally, religious healthcare practitioners were more concerned about the personal consequences of using this right in a medical environment. Conclusion: This study shows that at the same time, both religious and non-religious healthcare professionals believed that the Polish regulations regarding conscience clause are unclear and inaccurate, therefore leading to misinterpretation and abuse regulation of law., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2023 Czekajewska, Walkowiak and Domaradzki.)

Background: This study aims to accurately estimate influenza-associated deaths in Poland and their certified cause of death, due to significant discrepancies between official numbers and expected impact., Methods: Excess influenza-associated mortality in Poland from 2000 to 2019 was calculated using Seasonal-Trend Decomposition Procedure based on LOESS (STL), which can detect non-linear trends and non-sinusoidal cycles. Excess mortality was then used as an explanatory variable in a model predicting monthly fluctuations of officially recorded causes of death from 2010 to 2019., Results: A total of 142,000 conservative estimates of influenza-associated deaths were identified, representing 1.86% of overall mortality. Only 0.61% of influenza-associated deaths were officially recorded as influenza. Nearly half of certified influenza deaths were attributed to the seasonal baseline mortality, potentially doubling estimated impact based solely on influenza peaks. Influenza-associated deaths were frequently recorded as respiratory diseases (24.36%), with majority attributed to underlying conditions such as cardiovascular diseases (45.31%), cancer (9.06%), or diabetes (2.66%). Influenza-associated deaths were more commonly certified as nervous system diseases (1.84%) or mental disorders (1.04%), rather than influenza itself. There was a noticeable impact of influenza on secondary infections, such as meningococcal and gastrointestinal infections., Conclusion: These findings highlight the importance of improved estimation for informing public health policy decisions., Competing Interests: We declare no competing interests., (© 2023 The Authors. Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.)

Although biomedical research requires cooperation with a large number of donors, its success also depends on the input of healthcare professionals who play a crucial role in promoting biomedical research and influencing an individual's decision to donate one's biospecimens that are left over after a medical procedure. This work was aimed at investigating the correlation between medical and healthcare students' willingness to donate a biospecimen, the type of tissues to be donated, and the type of biomedical research to be conducted. A population survey among medical and healthcare students enrolled at the Poznan University of Medical Sciences was conducted on their attitudes toward the donation of human biological material for research purposes. A total of 1500 students responded and completed the survey. The questionnaire used multiple-choice closed-ended questions designed to explore medical and healthcare students' preferences for sharing particular types of tissues and donating to a particular type of biomedical research. It asked three questions: 1. Which type of tissue would people be willing to donate for research purposes? 2. Which organs would they be willing to donate after death? 3. What type of research would they be willing to donate to? While future healthcare professionals' beliefs regarding certain types of tissues and research can influence their willingness to donate for research purposes, many students tend to think about the body and biomedical research in terms of clusters. Consequently, their willingness to donate certain tissues for a particular type of research can affect their decision to donate other tissues. Our data suggest that cluster thinking with regard to donation can be a predictor of people's readiness to participate in the collection and management of biospecimens.

Background: During the Delta variant COVID-19 wave in Poland there were serious regional differences in vaccination rates and discrepancies in the enforcement of pandemic preventive measures, which allowed us to assess the relative effectiveness of the policies implemented., Methods: Creating a model that would predict mortality based on vaccination rates among the most vulnerable groups and the timing of the wave peak enabled us to calculate to what extent flattening the curve reduced mortality. Subsequently, a model was created to assess which preventive measures delayed the peak of infection waves. Combining those two models allowed us to estimate the relative effectiveness of those measures., Results: Flattening the infection curve worked: according to our model, each week of postponing the peak of the wave reduced excess deaths by 1.79%. Saving a single life during the Delta wave required one of the following: either the vaccination of 57 high-risk people, or 1,258 low-risk people to build herd immunity, or the isolation of 334 infected individuals for a cumulative period of 10.1 years, or finally quarantining 782 contacts for a cumulative period of 19.3 years., Conclusions: Except for the most disciplined societies, vaccination of high-risk individuals followed by vaccinating low-risk groups should have been the top priority instead of relying on isolation and quarantine measures which can incur disproportionately higher social costs. Our study demonstrates that even in a country with uniform policies, implementation outcomes varied, highlighting the importance of fine-tuning policies to regional specificity., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Walkowiak, Walkowiak and Walkowiak.)

While Polish studies focus on the symptoms, causes and treatment of people suffering from Dravet syndrome (DS), much less is known about the situation of the family caregivers of DS children. This study was designed to explore the experiences, daily challenges and needs related to caring for DS children. An anonymous self-administered online questionnaire was developed. The survey was completed by 75 family caregivers affiliated with the Association for People with Severe Refractory Epilepsy DRAVET.PL on Facebook. Most caregivers felt burdened by their children's reduced mobility (57.3%), mood swings (57.3%), lack of access to rehabilitation and medicine (56%) and healthcare expenses (50.7%). Caregivers also complained of a lack of time to themselves (76%) and work restrictions resulting from caregiving (72%). They consequently reported experiencing fatigue (84%), a deterioration of mental health (60%) and intimacy problems with their spouse/partner (53.4%). An important source of strain was a prolonged diagnostic odyssey and the constant struggle over the healthcare services for DS children. Since DS caregivers' problems and needs are often overlooked, they may be described as the forgotten people in DS. Healthcare professionals should be educated about the challenges related to caring for DS child, psycho-social status and coping resources of DS caregivers, and should focus on identification, monitoring and supporting caregivers' physical and mental well-being and needs.

Background: Over the last few decades biobanks have been recognised as institutions that may revolutionise biomedical research and the development of personalised medicine. Poland, however, still lacks clear regulations regarding the running of biobanks and the conducting of biomedical research. While the awareness of the general public regarding biobanks is low, healthcare professions and medical students also lack basic knowledge regarding biobanks, and such ignorance may affect their support for biobanks., Methods: This study is aimed at assessing the knowledge and attitudes of future healthcare professionals towards the donation of human biological material for research purposes and is based on a sample of 865 Polish medical students at Poznań University of Medical Sciences., Results: This research has shown that the awareness of medical students' regarding biobanks is low. It has also shown that while the majority of future healthcare professionals enrolled in this study supported the idea of biobank research and declared themselves willing to donate, still many students felt ambivalent about the biobanking of human biological material for research purposes and expressed concerns over biobanking research. While the primarily motivation to participate in biobank research was the desire to help advance science and to develop innovative therapies, the most common reason for a refusal was the fear that the government, insurance companies or employers, might have access to the samples. Concerns over unethical use of samples and data safety were also prevalent. More than half of students opted for a study-specific model of consent and only a few opted for broad consent., Conclusions: This research suggests that a lack of knowledge about biobanks, their role and activities may affect medical students' support for biobanks and their active participation in the collection and management of biospecimens for research purposes. Since in the future medical, nursing and pharmacy students will be involved in the collection, storage, testing and analysis of biospecimens from their patients, medical students in all professional fields should be trained regarding the concept, purposes and operational procedures of biobanks, as well as the ethical, legal and social implications of biobank research., (© 2023. The Author(s).)

Introduction: Clinical management of rare diseases often fails to acknowledge the challenges faced by caregivers. Whilst management of phenylketonuria (PKU) may not be considered as dire as other conditions, most studies primarily concentrate on clinical issues, dietary adherence, or the quality of life of the PKU patients, leaving caregivers in the background. The aim of the study was to evaluate the psychosocial effects of PKU on family caregivers., Methods: Between October 30th, 2022 and February 28th, 2023, we collected data from caregivers of children with PKU using an anonymous, self-administered, computer-assisted online questionnaire. The survey was distributed among to patients during their regular visits to five Polish PKU treatment centers., Results: A total of 159 Polish caregivers of children with PKU completed the survey. This research shows that while women caregivers were more likely to be unemployed due to their responsibilities for childcare (50.3% compared to 0% for men), and men caregivers were more likely to be employed full-time (93.8% compared to 40.6% for women), the former reported higher emotional engagement in caregiving (88.1% vs 56.3% respectively). Significantly, unemployed mothers reported higher levels of loneliness, helplessness, and emotional control problems, and lacked psychological/emotional support more often than employed mothers. This research also shows a statistically significant positive correlation between mothers' education level and financial situation ( p  < 0.05) and education level and professional activity ( p  < 0.01). Additionally, a significant positive correlation was found between perceived financial situation and feeling of happiness ( p  < 0.001), and between financial situation and professional activity (p < 0.001). Finally, a significant positive correlation was observed between feeling of happiness and professional activity ( p  < 0.05)., Conclusions: According to our findings, there is a link between subjective happiness, financial situation, and professional activity among female caregivers. The relationship between these factors goes beyond just the income earned from work. The results of our study imply that there could even be a therapeutic advantage for working mothers. It is crucial to recognize the emotional difficulties that employed mothers may experience while taking care of a child with PKU, and to provide them with the necessary assistance and resources to meet their needs. Additionally, our results may provide a foundation for redefining the support system for caregivers in Poland., Competing Interests: The authors declare that they have no conflict of interest., (© 2023 The Authors. Published by Elsevier Inc.)

In this study, we analyzed Polish COVID-19 vaccination data until January 2023 from the European Centre for Disease Prevention and Control to understand individual decision making during the milder Omicron wave. Our findings show a general decline in subsequent vaccine uptake. As the number of government-provided doses increased, completion rates among certain low-risk groups dropped to less than 1%. Elderly individuals, especially those aged 70-79, showed greater adherence but also exhibited decreased interest in subsequent boosters. Healthcare workers exhibited a dramatic shift in their attitude, disregarding the recommended schedule. The overwhelming majority opted out of receiving the second boosters, while the remaining individuals adjusted their timing based on infection trends or the availability of updated boosters. Two factors positively influenced vaccination decisions: societal influence and the availability of updated boosters. Lower-risk individuals were more likely to postpone vaccination until updated boosters were available. Our findings highlight that while Polish policy aligns with international guidelines, it fails to garner significant adherence from the Polish population. Previous studies have shown that vaccinating low-risk groups resulted in more sick days due to adverse events following immunization than the days gained by preventing infection. Consequently, we advocate for the official abandonment of this policy, as its practical abandonment has already taken place, and persisting in pretending otherwise only serves to erode public trust. Therefore, we propose a shift toward treating COVID-19-like influenza with vaccination for vulnerable individuals and those who have close contact with them before the season.

Background: Since the psychosocial implications of Dravet syndrome (DS) are much more serious and far-reaching than in other types of epilepsy, caring for a DS child seriously affects the entire family. This study describes the emotional experiences of family caregivers of DS children and evaluates the way caregiving affects their perceived quality of life., Methods: An anonymous, self-administered online questionnaire was sent to family caregivers of DS children through the online patient advocacy organization the Association for People with Severe Refractory Epilepsy DRAVET.PL. It focussed on the psychosocial impact of caregiving for DS children, the perceived burden of caregiving, caregivers' emotional experiences and feelings related to caregiving, and the impact of DS on the perceived quality of life., Results: Caregivers stressed that caring for a DS child is associated with a significant psychosocial and emotional burden that affects the entire family. Although most caregivers reported that it was the child's health problems and behavioral and psychological disorders that were the most challenging aspects of caregiving, they were also burdened by the lack of emotional support. As caregivers were profoundly engaged in caregiving, they experienced a variety of distressing emotions, including feelings of helplessness, anxiety and fear, anticipated grief, depression, and impulsivity. Many caregivers also reported that their children's disease disrupted their relationships with their spouses, family, and healthy children. As caregivers reported experiencing role overload, physical fatigue, and mental exhaustion, they stressed the extent to which caregiving for DS children impaired their quality of life, their social and professional life, and was a source of financial burden., Conclusions: As this study identified specific burden domains affecting DS caregivers' well-being family carers often need special attention, support, and help. To alleviate the humanistic burden of DS carers a bio-psychosocial approach focusing on physical, mental, and psychosocial interventions should include both DS children and their caregivers., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of the study was to collect and evaluate the opinions of representatives of Generation Z on their satisfaction with medical teleconsultation services during the COVID-19 pandemic in Poland. Methods: An online survey was conducted from April to June 2021. We received replies from 424 students. The research tools used comprised a validated Doctor-Patient Communication (DPC) questionnaire, the Telehealth Satisfaction Scale (TeSS), and a self-authored questionnaire. Results: About 60% of the respondents rated communication with a doctor during the remote visit as medium, with a DPC score value in the intermediate range (36-50). Only 7.5% of students rated DPC as high (DPC score over 50). Also, satisfaction with telemedicine measured by the modified Telehealth Satisfaction Scale was assessed as intermediate by 61.3% of respondents. DPC and satisfaction with telemedicine services are better assessed by students living in large cities and those who used paid telemedicine services. Conclusions: The need to improve the quality of DPC has been observed. Also, the functioning of telemedicine platforms, with the possibility of using images in teleconsultations would be welcome, with the concomitant leveling out of the disproportions in the quality of telemedicine services and DPC between urban and rural areas, as well as between commercial and noncommercial services. This could improve the service delivery process and, consequently, be beneficial for the competitiveness of telemedicine, which will be based on medical rather than organizational aspects.

Background: While healthcare professionals' right to invoke the conscience clause has been recognised as a fundamental human right, it continues to provoke a heated debate in Polish society. Although public discourse is filled with ethical and legal considerations on the conscience clause, much less is known about the attitudes of healthcare professionals regarding that matter. The aim of this study was therefore to describe the attitudes of Polish physicians, nurses and pharmacists towards the ethical and legal aspects of the conscience clause., Methods: We analysed a group of three hundred healthcare professionals: physicians, nurses and pharmacists in Poznan, Poland, using a standard questionnaire comprising of 29 questions about various ethical and legal aspects of the conscience clause and participants' personal experiences with the conscience clause. The study was conducted between January and March 2020., Results: This research shows that although most Polish healthcare workers support the right to invoke the conscience clause they differ significantly in their opinions on to whom and to what medical procedures the conscience clause should apply to. It also demonstrated that while the conscience clause is rarely invoked in Poland, most healthcare professionals declare that the current legal regulations in that sphere are unclear and inaccurate., Conclusions: While there is an urgent need to raise the awareness regarding the conscience clause among medical students and healthcare professionals and educate them about such issues, it is even more important to improve the legal system in regard to the CC so that it protects both HCPs' right to the CC and safeguards patients' rights to medical services., (© 2022. The Author(s).)

This study aims to analyse the experiences and motivations of volunteers who supported Ukrainian refugees who fled to Poland. Our study was conducted among 196 volunteers in Poznan, Poland who answered questions regarding their experiences with voluntary service during the current refugee crisis and the reasons they became involved in volunteer efforts. We found that although the Polish state had no prior experience in welcoming refugees on a mass scale, the Russo-Ukrainian War has resulted in the emergence of "spontaneous volunteers" who have offered their help and assistance to the flood of refugees sweeping in from its eastern neighbor. We also found that because many Polish citizens believe that helping those in need should not rest solely on the government there are two main motivations to volunteer: a general willingness to help and the willingness to volunteer on behalf of Ukrainian refugees. Finally, while this study highlights that in times of crisis, most people are primarily motivated by humanistic and democratic values, including altruism and public service, emotions also play an important role in influencing people's decision to engage in voluntary service., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Domaradzki, Walkowiak, Bazan and Baum.)

In this study, motivation for late (from 2021-W22, i.e., 24 July 2021) uptake of the first dose of the COVID-19 vaccine among adults in Poland and Lithuania is indirectly measured in order to avoid social-desirability bias or rationalisation in retrospect of prior decisions. Weekly vaccine uptake is modeled as if vaccine hesitant people were late adopters of a new product, with a fitted non-linear trend representing steadily decreasing interest. Before the analysed period, the vaccine uptake among Polish and Lithuanian adults was almost identical. Vaccination simply explainable by the trend was responsible for the vaccination of an additional 19.96% and 19.06% adults, respectively. The fear incurred by spikes in consecutive waves of infection motivated 3.20% and 3.89% more people, respectively, while the COVID-19 passport, introduced only in Lithuania, convinced an additional 13.98% of the overall population. The effect of the COVID passport was the biggest in the 18-24 age group, and the least visible among people aged 80 or more. In the latter group, other factors also had a limited impact, with merely 1.32% tempted by the one-time €100 payment offered to everybody aged 75 or more.

In comparison to Western European countries, Poland had a relatively lower percentage of its population diagnosed with COVID-19. Moreover, even the detected cases were not showing any pattern consistent with the expected chance of infection and were at best only remotely related to the severity of the illness that is known to increase with age. Instead, the crucial factor in detecting illness was whether the individual was likely to receive adequate compensation for being confined to their home, with employed women being the most likely to be diagnosed. In every Polish sub-region (powiat), in the 25-54 age group, the share of men diagnosed with COVID-19 was lower than that of women, with the missing share ranging from 8% to 36%. Based on the regression model (adjusted R² = 43.9%), there were relevant non-economic factors such as education, vaccination rate and increasing median age that were reducing this gap. However, the key factors, such as the share of population entitled to sick leave derived from employment rate, or the share of the self-employed population who were unlikely to receive adequate compensation, were related to economic incentives. It would seem that gender differences, in reaction to economic stimuli, widened the discrepancies, as the same factors were affecting women as well. While the testing rates in Poland, the lowest of all the EU countries, clearly played a role in creating the environment in which testing was perceived by the general population as somewhat optional, Polish citizens themselves through their actions aggravated the problem further, creating the impression of people receiving inadequate or no compensation for their time of self-isolation. In spite of well-intentioned government efforts to extend compensation to at least some groups, a significant share of the population clearly behaved as if they feared self-isolation more than the actual virus. Therefore, for both compliance and fairness purposes, both the severity of restrictions and the availability of compensation should be reconsidered.

Although national plans or strategies for rare diseases (RDs) have been implemented in many jurisdictions research show that one of the main barriers RD patients face during medical encounter is medical professionals' low level of knowledge and experience on the diagnosis, treatment and rehabilitation of RD patients. Consequently, there is a need to increase the standards of medical education in the field of RDs and to revise the undergraduate and postgraduate training programs. However, while studies on medical education in the field of RDs has been conducted in various countries across the both Americas, Asia or the European Union, still little is known about the awareness of RDs among healthcare professionals in the Republic of Kazakhstan. Thus, we conducted a survey among 207 medical students and 101 medical doctors from the West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan. The study was conducted between March and May 2021. The questionnaire assessed their knowledge about the number, examples, etiology and estimated frequency of RDs. It also evaluated respondents self-assessment of competence in RDs. Although the majority of respondents agreed that RDs constitute a serious public health issue both medical students and medical doctors showed insufficient knowledge on the etiology, epidemiology and prevalence of RDs, and many had problems with separating RDs from more common disorders. Moreover, they also lacked knowledge about and the central register of RD patients and reimbursement of orphan drugs in Kazakhstan. Finally, while almost half respondents declared having had classes about RDs during their studies most perceived their knowledge about RDs as insufficient or poor and felt unprepared for caring for RD patients. Additionally, although majority of respondents in both groups believed that all physicians, regardless of their specialization, should possess knowledge on RDs many respondents did not look for such information at all., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Walkowiak, Bokayeva, Miraleyeva and Domaradzki.)

In this study, regression models were created to explain the increase of COVID-19 vaccination rates in 378 Polish sub-regions. In order to trace the factors that could explain the willingness to delay vaccination, vaccination rates were compared for age groups of 20 years and more for 30 June 2020 and 31 January 2021. Initially high vaccination rates, rather than leading to the gradual exhaustion of the pool of those wishing to get vaccinated, were a very good predictor of the share of the remainder willing to do so, which increased the divergence between sub-regions in nominal vaccination rates. Support for Eurosceptic and anti-establishment parties was a strong predictor of persistent vaccine hesitancy. Ideological divergence from the mainstream appeared to reinforce vaccine hesitancy, and this relationship remained highly relevant even when controlling for possible time or spatial lag. Markers of social inclusion and social capital-voter turnout and employment rate-remained statistically significant even when controlling for time lag, thus implying clear relevance of trust in the public message. The share of the population with higher education remained a highly relevant factor as well, though in the 20-39 age bracket it predicted a higher vaccination rate, while in all older brackets it was a negative predictor-this implies that those people had already made up their minds. Delaying vaccination seems predominantly explainable by political views, as well as social exclusion and the historical specificity of sub-regions. On a regional level, there was actually a paradoxical Spearmans Rho correlation (0.641) between the share of population refusing mandatory vaccination for kids and the percentage of people receiving a COVID-19 vaccine, which further undermines the idea that overall observed vaccine hesitancy was in any meaningful way affected by anti-vaccine movements.

The issue whether official Polish COVID-19 death statistics correctly reflect the actual number of deaths is a contentious issue in public discourse and an important policy-wise question in Poland although it has not been the subject of thorough research so far. There had been clearly elevated excess mortality-5100 (death rate of 2.3 per 10,000) during the first wave, 77,500 (21.0 per 10,000) during the second one, and 48,900 (13.5 per 10,000) in the third. This study finds that during the second and the third pandemic wave, our data on excess mortality will match very well the somewhat belatedly officially reported COVID-19 deaths if we assume that only 60% of cases were officially detected. Based on principal component analysis of death timing, except for the age bracket below 40, where COVID-19 deaths calculated on the basis of our model explain 55% of excess mortality, for the remaining age groups, combined COVID-19 deaths explain 95% of excess mortality. Based on the share of excess mortality attributable to COVID-19 during the second wave, this infection in Poland caused the death of 73,300 people and not of 37,600 as officially reported. The third wave caused 46,200 deaths instead of the reported 34,700. The first wave was, indeed, as officially reported, very mild, and the number of excess deaths was too low to be used to calculate COVID-19 deaths directly. However, assuming that the detection rate remained comparable to the average in subsequent waves, we can set the number of deaths at 3500 instead of the reported 2100.

The first pandemic lockdown dramatically impacted many aspects of everyday life, including healthcare systems. The purpose of this study was to identify problems of patients with phenylketonuria (PKU) and their parents/caregivers during that time. We aimed to analyse potential differences in the self-reported compliance and characteristics of contacts with a doctor/dietitian before and during the pandemic lockdown and the perception of access to special food and opinions on remote contacts between a particular group of respondents. All participants ( n = 614) were asked to complete an online questionnaire that consisted of 31 questions on pandemic-related events and circumstances which may have directly or indirectly impacted health and treatment. The people who completed the survey were divided into three groups: parents of PKU children ( n = 403), parents of PKU adults ( n = 58) and PKU patients older than 16 years ( n = 153). The differences among the three analysed groups were found in the number of contacts, the way of contacting a doctor/dietitian during the pandemic and satisfaction with remote contact. Caregivers of children with PKU reported better therapy compliance, more frequent contacts with specialists and more satisfaction with remote visits than adult patients. We also observed a relationship between satisfaction from remote contact and self-reported frequency of contacts with a doctor/dietitian, as well as a relationship between satisfaction from remote contact and recommended blood Phe levels reported by both patients and caregivers. Travel time exceeding three hours from the respondents' location to their doctor was associated with higher odds of their recognition of remote contact as a method of PKU treatment only in the group of caregivers. In the caregiver groups, the reported worse access to low-Phe products during the lockdown was linked to the perceived difficulty of maintaining the diet. However, such a relationship was not found among patients. In conclusion, significant differences in the perception of the pandemic lockdown and its impact on health and treatment-related issues were found.