Publications by authors named "Joanna Zajac"

22 Publications

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What are the effects of teaching Evidence-Based Health Care (EBHC) at different levels of health professions education? An updated overview of systematic reviews.

PLoS One 2021 22;16(7):e0254191. Epub 2021 Jul 22.

Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa.

Background: Evidence-based healthcare (EBHC) knowledge and skills are recognised as core competencies of healthcare professionals worldwide, and teaching EBHC has been widely recommended as an integral part of their training. The objective of this overview of systematic reviews (SR) was to update evidence and assess the effects of various approaches for teaching evidence-based health care (EBHC) at undergraduate (UG) and postgraduate (PG) medical education (ME) level on changes in knowledge, skills, attitudes and behaviour.

Methods And Findings: This is an update of an overview that was published in 2014. The process followed standard procedures specified for the previous version of the overview, with a modified search. Searches were conducted in Epistemonikos for SRs published from 1 January 2013 to 27 October 2020 with no language restrictions. We checked additional sources for ongoing and unpublished SRs. Eligibility criteria included: SRs which evaluated educational interventions for teaching EBHC compared to no intervention or a different strategy were eligible. Two reviewers independently selected SRs, extracted data and evaluated quality using standardised instrument (AMSTAR2). The effects of strategies to teach EBHC were synthesized using a narrative approach. Previously published version of this overview included 16 SR, while the updated search identified six additional SRs. We therefore included a total of 22 SRs (with a total of 141 primary studies) in this updated overview. The SRs evaluated different educational interventions of varying duration, frequency, and format to teach various components of EBHC at different levels of ME (UG, PG, mixed). Most SRs assessed a range of EBHC related outcomes using a variety of assessment tools. Two SRs included randomised controlled trials (RCTs) only, while 20 reviews included RCTs and various types of non-RCTs. Diversity of study designs and teaching activities as well as aggregated findings at the SR level prevented comparisons of the effects of different techniques. In general, knowledge was improved across all ME levels for interventions compared to no intervention or pre-test scores. Skills improved in UGs, but less so in PGs and were less consistent in mixed populations. There were positive changes in behaviour among UGs and PGs, but not in mixed populations, with no consistent improvement in attitudes in any of the studied groups. One SR showed improved patient outcomes (based on non-randomised studies). Main limitations included: poor quality and reporting of SRs, heterogeneity of interventions and outcome measures, and short-term follow up.

Conclusions: Teaching EBHC consistently improved EBHC knowledge and skills at all levels of ME and behaviour in UGs and PGs, but with no consistent improvement in attitudes towards EBHC, and little evidence of the long term influence on processes of care and patient outcomes. EBHC teaching and learning should be interactive, multifaceted, integrated into clinical practice, and should include assessments.

Study Registration: The protocol for the original overview was developed and approved by Stellenbosch University Research Ethics Committee S12/10/262.

Update Of The Overview: Young T, Rohwer A, Volmink J, Clarke M. What are the effects of teaching evidence-based health care (EBHC)? Overview of systematic reviews. PLoS One. 2014;9(1):e86706. doi: 10.1371/journal.pone.0086706.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0254191PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8297776PMC
July 2021

Evaluating adults' health-related values and preferences about unprocessed red meat and processed meat consumption: protocol for a cross-sectional mixed-methods study.

F1000Res 2020 11;9:346. Epub 2020 May 11.

Iberoamerican Cochrane Centre, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain.

People need to choose from a wide range of foods, and in addition to availability and accessibility, people's values and preferences largely determine their daily food choices. Given the potential adverse health consequences of red and processed meat and the limited knowledge on individuals' health-related values and preferences on the topic, such data would be useful in the development of recommendations regarding meat consumption. We will perform a cross-sectional mixed methods study. The study population will consist of adult omnivores currently consuming a minimum of three weekly servings of either unprocessed red meat or processed meat. We will explore participants' willingness to stop or reduce their unprocessed red meat, or their processed meat consumption through a direct-choice exercise. This exercise will consist of presenting a scenario tailored to each individual's average weekly consumption. That is, based on a systematic review and meta-analysis of the best estimate of the risk reduction in overall cancer incidence and cancer mortality, we will ask participants if they would stop their consumption, and/or reduce their average consumption. We will also present the corresponding certainty of the evidence for the potential risk reductions. Finally, we will measure their meat consumption three months after the interview and determine if they have made any changes to their average consumption. The research protocol was approved by the ethics committees in Canada (Research Ethics Board, Dalhousie University), Spain (Comitè Ètic d'Investigació Clínica de l'IDIAP Jordi Gol), Poland (The Bioethics Committee of the Jagiellonian University), and Brazil (National Research Ethics Commission). The study is based on voluntary participation and informed written consent. Results from this project will be disseminated through publications and presentations.
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http://dx.doi.org/10.12688/f1000research.23593.2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8176263PMC
July 2021

Segmental Phase Angle and Body Composition Fluctuation of Elite Ski Jumpers between Summer and Winter FIS Competitions.

Int J Environ Res Public Health 2021 04 29;18(9). Epub 2021 Apr 29.

Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Kopernika 7 st., 31-034 Krakow, Poland.

(1) Background: The purpose of this study was to observe segmental phase angle (PhA) and body composition fluctuation of elite ski jumpers. (2) Methods: In the study, 12 professional ski jumpers took part. Body composition was estimated with segmental multi-frequency bioelectrical impedance analysis. Repeated ANOVA was used to check the parameters' variability in time. The symmetry between the right and left side of the body was verified with the -test for dependent samples. Pearson's linear correlation coefficient was calculated. (3) Results: The most stable parameter was body weight. An increase in the visceral fat area was noted, the fat-free mass dropped, and significant changes were noted in the internal and external cell water parameters. Parameters connected with water between the right and left side of the body were symmetrical. Significant correlation between PhA values and body parameters with regard to fat tissue and PhA values of the legs was noticed when PhA was measured at 50 kHz. (4) Conclusions: PhA could be considered as a ski jumper body symmetry monitoring tool. The described relationship may be useful for the assessment of body fat change, which, in the case of jumpers, is crucial. Moreover, our data suggest that segmental PhA evaluation could be a good solution for ski jumpers as a confirmation if lowered body mass and low BMI are still healthy and increase the chance for longer jumps and good performance.
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http://dx.doi.org/10.3390/ijerph18094741DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124535PMC
April 2021

Anti-cytokine targeted therapies for ANCA-associated vasculitis.

Cochrane Database Syst Rev 2020 09 29;9:CD008333. Epub 2020 Sep 29.

2nd Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland.

Background: Anti-neutrophilic cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) are a group of rare auto-inflammatory diseases that affects mainly small vessels. AAV includes: granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA). Anti-cytokine targeted therapy uses biological agents capable of specifically targeting and neutralising cytokine mediators of the inflammatory response.

Objectives: To assess the benefits and harms of anti-cytokine targeted therapy for adults with AAV.

Search Methods: We searched the Cochrane Central Register of Controlled Trials (2019, Issue 7), MEDLINE and Embase up to 16 August 2019. We also examined reference lists of articles, clinical trial registries, websites of regulatory agencies and contacted manufacturers.

Selection Criteria: Randomised controlled trials (RCTs) or controlled clinical trials of targeted anti-cytokine therapy in adults (18 years or older) with AAV compared with placebo, standard therapy or another modality and anti-cytokine therapy of different type or dose.

Data Collection And Analysis: We used standard methodological procedures expected by Cochrane.

Main Results: We included four RCTs with a total of 440 participants (mean age 48 to 56 years). We analysed the studies in three groups: 1) mepolizumab (300 mg; three separate injections every four weeks for 52 weeks) versus placebo in participants with relapsing or refractory EGPA; 2) belimumab (10 mg/kg on days 0, 14, 28 and every 28 days thereafter until 12 months after the last participant was randomised) or etanercept (25 mg twice a week) with standard therapy (median 25 months) versus placebo with standard therapy (median 19 months) in participants with GPA/MPA; and 3) infliximab (3 mg/kg on days 1 and 14, before the response assessment on day 42) versus rituximab (0.375g/m on days 1, 8, 15 and 22) in participants with refractory GPA for up to 12 months. None of the studies were assessed as low risk of bias in all domains: one study did not report randomisation or blinding methods clearly. Three studies were at high risk and one study was at unclear risk of bias for selective outcome reporting. One trial with 136 participants with relapsing or refractory EGPA compared mepolizumab with placebo during 52 weeks of follow-up and observed one death in the mepolizumab group (1/68, 1.5%) and none in the placebo group (0/68, 0%) (Peto odds ratio (OR) 7.39, 95% confidence interval (CI) 0.15 to 372.38; low-certainty evidence). Low-certainty evidence suggests that more participants in the mepolizumab group had ≥ 24 weeks of accrued remission over 52 weeks compared to placebo (27.9% versus 2.9%; risk ratio (RR) 9.5, 95% CI 2.30 to 39.21), and durable remission within the first 24 weeks sustained until week 52 (19.1% mepolizumab versus 1.5% placebo; RR 13.0, 95% CI 1.75 to 96.63; number needed to treat for an additional beneficial outcome (NNTB) 6, 95% Cl 4 to 13). Mepolizumab probably decreases risk of relapse (55.8% versus 82.4%; RR 0.68, 95% CI 0.53 to 0.86; NNTB 4, 95% CI 3 to 9; moderate-certainty evidence). There was low-certainty evidence regarding similar frequency of adverse events (AEs): total AEs (96.9% versus 94.1%; RR 1.03, 95% CI 0.96 to 1.11), serious AEs (17.7% versus 26.5%; RR 0.67, 95% CI 0.35 to 1.28) and withdrawals due to AEs (2.9% versus 1.5%; RR 2.00, 95% CI 0.19 to 21.54). Disease flares were not measured. Based on two trials with different follow-up periods (mean of 27 months for etanercept study; up to four years for belimumab study) including people with GPA (n = 263) and a small group of participants with MPA (n = 22) analysed together, we found low-certainty evidence suggesting that adding an active drug (etanercept or belimumab) to standard therapy does not increase or reduce mortality (3.4% versus 1.4%; Peto OR 2.45, 95% CI 0.55 to 10.97). Etanercept may have little or no effect on remission (92.3% versus 89.5%; RR 0.97, 95% CI 0.89 to 1.07), durable remission (70% versus 75.3%; RR 0.93, 95% CI 0.77 to 1.11; low-certainty evidence) and disease flares (56% versus 57.1%; RR 0.98, 95% CI 0.76 to 1.27; moderate-certainty evidence). Low-certainty evidence suggests that belimumab does not increase or reduce major relapse (1.9% versus 0%; RR 2.94, 95% CI 0.12 to 70.67) or any AE (92.5% versus 82.7%; RR 1.12, 95% CI 0.97 to 1.29). Low-certainty evidence suggests a similar frequency of serious or severe AEs (47.6% versus 47.6%; RR 1.00, 95% CI 0.80 to 1.27), but more frequent withdrawals due to AEs in the active drug group (11.2%) compared to the placebo group (4.2%), RR 2.66, 95% CI 1.07 to 6.59). One trial involving 17 participants with refractory GPA compared infliximab versus rituximab added to steroids and cytotoxic agents for 12 months. One participant died in each group (Peto OR 0.88, 95% CI, 0.05 to 15.51; 11% versus 12.5%). We have very low-certainty evidence for remission (22% versus 50%, RR 0.44, 95% Cl 0.11 to 1.81) and durable remission (11% versus 50%, RR 0.22, 95% CI 0.03 to 1.60), any severe AE (22.3% versus 12.5%; RR 1.78, 95% CI 0.2 to 16.1) and withdrawals due to AEs (0% versus 0%; RR 2.70, 95% CI 0.13 to 58.24). Disease flare/relapse and the frequency of any AE were not reported.

Authors' Conclusions: We found four studies but concerns about risk of bias and small sample sizes preclude firm conclusions. We found moderate-certainty evidence that in patients with relapsing or refractory EGPA, mepolizumab compared to placebo probably decreases disease relapse and low-certainty evidence that mepolizumab may increase the probability of accruing at least 24 weeks of disease remission. There were similar frequencies of total and serious AEs in both groups, but the study was too small to reliably assess these outcomes. Mepolizumab may result in little to no difference in mortality. However, there were very few events. In participants with GPA (and a small subgroup of participants with MPA), etanercept or belimumab may increase the probability of withdrawal due to AEs and may have little to no impact on serious AEs. Etanercept may have little or no impact on durable remission and probably does not reduce disease flare.
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http://dx.doi.org/10.1002/14651858.CD008333.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8094990PMC
September 2020

Health-Related Values and Preferences Regarding Meat Consumption: A Mixed-Methods Systematic Review.

Ann Intern Med 2019 11 1;171(10):742-755. Epub 2019 Oct 1.

Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), and CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain, and McMaster University, Hamilton, Ontario, Canada (P.A.).

This article has been corrected. The original version (PDF) is appended to this article as a Supplement.

Background: A person's meat consumption is often determined by their values and preferences.

Purpose: To identify and evaluate evidence addressing health-related values and preferences regarding meat consumption.

Data Sources: MEDLINE, EMBASE, Web of Science, Centre for Agriculture and Biosciences Abstracts, International System for Agricultural Science and Technology, and Food Science and Technology Abstracts were searched from inception to July 2018 without language restrictions.

Study Selection: Pairs of reviewers independently screened search results and included quantitative and qualitative studies reporting adults' health-related values and preferences regarding meat consumption.

Data Extraction: Pairs of reviewers independently extracted data and assessed risk of bias.

Data Synthesis: Data were synthesized into narrative form, and summaries were tabulated and certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Of 19 172 initial citations, 41 quantitative studies (38 addressed reasons for meat consumption and 5 addressed willingness to reduce meat consumption) and 13 qualitative studies (10 addressed reasons for meat consumption and 4 addressed willingness to reduce meat consumption) were eligible for inclusion. Thirteen studies reported that omnivores enjoy eating meat, 18 reported that these persons consider meat an essential component of a healthy diet, and 7 reported that they believe they lack the skills needed to prepare satisfactory meals without meat. Omnivores are generally unwilling to change their meat consumption. The certainty of evidence was low for both "reasons for meat consumption" and "willingness to reduce meat consumption in the face of undesirable health effects."

Limitation: Limited generalizability of findings to lower-income countries, low-certainty evidence for willingness to reduce meat consumption, and limited applicability to specific types of meat (red and processed meat).

Conclusion: Low-certainty evidence suggests that omnivores are attached to meat and are unwilling to change this behavior when faced with potentially undesirable health effects.

Primary Funding Source: None. (PROSPERO: CRD42018088854).
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http://dx.doi.org/10.7326/M19-1326DOI Listing
November 2019

Red and Processed Meat Consumption and Risk for All-Cause Mortality and Cardiometabolic Outcomes: A Systematic Review and Meta-analysis of Cohort Studies.

Ann Intern Med 2019 11 1;171(10):703-710. Epub 2019 Oct 1.

Dalhousie University, Halifax, Nova Scotia, Canada, and McMaster University, Hamilton, Ontario, Canada (B.C.J.).

This article has been corrected. The original version (PDF) is appended to this article as a Supplement.

Background: Dietary guidelines generally recommend limiting intake of red and processed meat. However, the quality of evidence implicating red and processed meat in adverse health outcomes remains unclear.

Purpose: To evaluate the association between red and processed meat consumption and all-cause mortality, cardiometabolic outcomes, quality of life, and satisfaction with diet among adults.

Data Sources: EMBASE (Elsevier), Cochrane Central Register of Controlled Trials (Wiley), Web of Science (Clarivate Analytics), CINAHL (EBSCO), and ProQuest from inception until July 2018 and MEDLINE from inception until April 2019, without language restrictions, as well as bibliographies of relevant articles.

Study Selection: Cohort studies with at least 1000 participants that reported an association between unprocessed red or processed meat intake and outcomes of interest.

Data Extraction: Teams of 2 reviewers independently extracted data and assessed risk of bias. One investigator assessed certainty of evidence, and the senior investigator confirmed the assessments.

Data Synthesis: Of 61 articles reporting on 55 cohorts with more than 4 million participants, none addressed quality of life or satisfaction with diet. Low-certainty evidence was found that a reduction in unprocessed red meat intake of 3 servings per week is associated with a very small reduction in risk for cardiovascular mortality, stroke, myocardial infarction (MI), and type 2 diabetes. Likewise, low-certainty evidence was found that a reduction in processed meat intake of 3 servings per week is associated with a very small decrease in risk for all-cause mortality, cardiovascular mortality, stroke, MI, and type 2 diabetes.

Limitation: Inadequate adjustment for known confounders, residual confounding due to observational design, and recall bias associated with dietary measurement.

Conclusion: The magnitude of association between red and processed meat consumption and all-cause mortality and adverse cardiometabolic outcomes is very small, and the evidence is of low certainty.

Primary Funding Source: None. (PROSPERO: CRD42017074074).
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http://dx.doi.org/10.7326/M19-0655DOI Listing
November 2019

Public media as a tool for dissemination of evidence-based information.

Int J Evid Based Healthc 2019 Jun;17 Suppl 1:S32-S33

Systematic Reviews Unit, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland.

The internet is becoming a more and more popular source of all kinds of information. The quantity of web pages that offer information and advice about health is increasing, though the quality is often not rising. The aim of the presented work is to describe advantages and difficulties connected with dissemination of evidence-based information in social media. Using Polish Facebook and Twitter profiles over the course of 2 years, we posted about 400 posts and tweets. We analysed types of topics and some strategies to broaden our audience. On basis of our results, we found that probably inconclusive results make review summaries unintelligible and not popular in public media, though the broad reach of posts in public media does not implicate that the message was understood. Even though numerous efforts were put into guidelines on how to write a proper plain language summary of the systematic review, there is still space for improvement.
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http://dx.doi.org/10.1097/XEB.0000000000000191DOI Listing
June 2019

Urinary 1-hydroxypyrene in occupationally-exposed and non-exposed individuals in Silesia, Poland.

Ann Agric Environ Med 2018 Dec 28;25(4):625-629. Epub 2017 Aug 28.

Jagiellonian University Medical College, Dep. Hygiene and Dietetics.

Introduction: The aim of presented study was comparison of urinary 1-hydroxypyrene concentration among coke plant workers (before and after working week) and among non-exposed individuals from the same area, taking smoking status into consideration.

Material And Methods: 647 coke plant workers and 206 individuals living in the same area were analysed with respect to urinary 1-OHP concentration and smoking status. Urinary samples were measured using high performance liquid chromatography (HPLC) with fluorescent detection. Concentrations were normalized with respect to creatinine concentration. For workers, two samples were collected before and after working week. Multiple regression was performed to distinguish and quantify the influence of cigarette smoking and occupational PAH exposition on the urinary 1-OHP levels.

Results: Average urinary 1-OHP concentration of samples collected before the working week was: 1.07 μg/g; after the working week: 2.36 μg/g and for control: 0.74 μg/g. The samples collected at the beginning of the working week were not suitable for assessment of the workers' background (non-occupational) exposition. Smoking cigarettes induced a rise in urinary 1-OHP level by 16%, on average (CI: 5% - 28%), and working for a whole working week at the coke plant made urinary 1-OHP levels, on average, 3.21 times higher (CI: 2.91 - 3.54).

Conclusions: Working at the coke plant increases significantly urinary 1-OHP concentration in comparison to non-occupationally exposed individuals, both for samples collected before and after the working week. Smoking remains a significant source of PAHs exposition, despite the fact that occupational exposure is greater. Health promotion programmes should address both the occupational health risks reduction and smoking prevention.
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http://dx.doi.org/10.26444/aaem/75940DOI Listing
December 2018

Overweight and obesity vs. simple carbohydrates consumption by elderly people suffering from diseases of the cardiovascular system.

Ann Agric Environ Med 2017 Dec 11;24(4):575-580. Epub 2017 May 11.

Department of Hygiene and Dietetics, MedicalCollege, Jagiellonian University, Krakow, Poland.

Introduction: Overweight and obesity belong to the alarming and constantly increasing problems of the 21st century among all age groups. One of the major factors enhancing these problems are simple carbohydrates commonly found in popular sweet drinks.

Objective: The aim of the study was to estimate the nutritional patterns of elderly people with diagnosed cardiovascular system diseases, and analysis of the relationship between consumption of simple carbohydrates and prevalence of overweight and obesity.

Material And Methods: From 233 individuals hospitalized in the Clinic of Cardiology and Hypertension in Krakow, Poland, a group of 128 elderly people was selected (66 women and 62 men). Actual food consumption for each individual was assessed using a 24-hour nutrition recall. BMI values was calculated for assessment of nutritional status. Statistical analysis was performed on two groups: one with BMI <25kg/m2 and other with BMI≥25kg/m2.

Results: Overweight was stated among 33.8% of women and 50% of men, obesity among 27.7% of women and 17.7% of men. Results indicated that consumption of products rich in sucrose was associated with overweight and obesity. People with overweight and obesity statistically more often ate sweet products comparing to those with proper weight: 46.2 g vs 33.8g. The growing world-wide epidemic of overweight and obesity is one of the main priorities of preventive medicine remains changing eating patterns As observed in this study, one additional spoon of sugar consumed daily increases the risk of being overweight or obese by about 14%.

Conclusions: Overweight and obesity was found among 60% of the examined elderly people. Correlation was found between rise in risk of obesity or overweight by about 14% with each additional spoon of sugar (5g) eaten every day.
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http://dx.doi.org/10.5604/12321966.1233555DOI Listing
December 2017

Dioxins: validation of food frequency questionnaire and intake in a group of adolescents.

Ann Agric Environ Med 2017 Sep 11;24(3):372-375. Epub 2017 May 11.

Department of Hygiene and Dietetics, Medical College, Jagiellonian University, Krakow, Poland.

Introduction: A lot of has been heard about dioxins and dioxins-like compounds. These molecules are typically connected in public awareness with affairs. The main source of dioxins for humans is food (90% of typical exposition); thus, assessment of dioxins intake and monitoring of levels of dioxins in food remain an important issue.

Objective: The aim of the presented work was checking the reproducibility of the authors' semi-quantitative food frequency questionnaire, focusing on products that may contain dioxins and related compounds among adolescents. The uptake of these compounds was also assessed using obtained data. For survey purposes, an album of food products from the questionnaire was constructed.

Material And Methods: A modified semi-quantitative food frequency questionnaire was constructed and distributed twice in a 2-week time span among 55, 15-year-old, students of secondary schools.

Results: The correlation coefficient for both declared frequencies and assessed amounts in the case of the majority of food items was above 0.70. The average assessed intake of dioxins and related compounds was 1.57pgWHO-TEQ/kg body weight per day, and 1.85 pgWHO-TEQ/kg body weight per day, during test and retest, respectively.

Conclusions: The modified semi-quantitative food frequency questionnaire is a reproducible tool that can be used for adolescents. Average intake in the analyzed group was lower than the Tolerable Daily Intake, but in contrast to other countries remains one of the highest intakes in a comparable age group. The main sources of dioxins exposition were fish (38%), and meat products.
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http://dx.doi.org/10.5604/12321966.1233558DOI Listing
September 2017

Relationship between dietary antioxidant index (DAI) and antioxidants level in plasma of Kraków inhabitants.

Adv Clin Exp Med 2017 May-Jun;26(3):393-399

The Regional Specialist Children's Hospital of St. Ludwig, Kraków, Poland.

Background: Some literature data indicate that antioxidant-rich food may significantly increase antioxidants in serum and decrease the oxidative stress but results are ambiguous.

Objectives: The aim of this study was to estimate the total antioxidant capacity of food intake among the inhabitants of Kraków, Poland on the basis of dietary antioxidant index (DAI) and evaluation the relation between DAI and the level of antioxidants in plasma.

Material And Methods: Examination included 70 (37 women and 33 men) non-smoking inhabitants of Krakow aged 46.4 ± 13.7 years. DAI was investigated on the basis of Food Frequency Questionnaire including 145 food items. DAI was measured using the method by Benzi and expressed as FRAP (mMol/L). In plasma samples total antioxidant status (TAS) expressed as FRAP and malondialdehyde (MDA) concentration as a marker of lipids peroxidation were measured.

Results: The mean value of DAI of all examined persons was 46.74 ± 25.5 mMol/L (in female group: 54.13 ± 27.7 mMol/L; in male group: 37.83 ± 19.5 mMol/L; p < 0.05). The highest contribution in total DWA value had fruits (48.7%) opposite to vegetables (9.3%). Statistically significant positive correlations between DAI and FRAP in plasma was found in all: r = 0.42 and in female: r = 0.54 groups (not significant in men group: r = 0.20). Statistically significant negative correlation of DAI with MDA (malonylaldehyde) in female (-0.49) and male (-0.51) groups.

Conclusions: The obtained results confirmed the hypothesis that the intake of antioxidants in daily diet (measured as DAI) might increase antioxidants defense (measured by TAC as FRAP) and decrease oxidative stress (measured by MDA concentration in plasma). The dietary modification towards higher consumption of antioxidants (especially in men) should be highlighted in prevention of diseases in which oxidative stress play considerable role.
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http://dx.doi.org/10.17219/acem/61834DOI Listing
October 2017

Occupational Exposure to Polycyclic Aromatic Hydrocarbons in Polish Coke Plant Workers.

Ann Occup Hyg 2016 Nov 12;60(9):1062-1071. Epub 2016 Sep 12.

1.Department of Hygiene and Dietetics, Jagiellonian University Medical College, 7 Kopernika Street, 31-034 Kraków, Poland.

Assessment of occupational exposure to polycyclic aromatic hydrocarbons (PAHs) is an urgent and important task to prevent workers' illnesses. 1-Hydroxypyrene is one of the most commonly used biomarkers. The presented study assessed exposure to PAHs molecules among 619 individuals, men working in coke plant. Average number of years spent on working posts in exposition to PAHs was 31.5 years with standard deviation = 5.3. About 35% were smokers with 14.7 cigarettes per day. For each individual, 1-hydroxypyrene concentration in urine samples was measured. Urine 1-hydroxypyrene concentration correlated with air PAHs concentration. Difference between smokers and non-smokers was statistically significant. The median value for post-shift samples was 1.3 µg g and for pre-shift sample concentration reached 0.3 µg g Maximal assessed concentration was 7.6 µg g among pre-shift samples and 27.8 µg g among post-shift samples. The most exposed working posts were coke oven workers and coal derivatives production workers. Results obtained in presented study are relatively low in comparison to other countries or other Polish results but for further improvement a regular measurement of any PAHs' biomarker should be included to standard periodic health examinations for coke plant workers.
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http://dx.doi.org/10.1093/annhyg/mew049DOI Listing
November 2016

Morphological Properties of Siloxane-Hydrogel Contact Lens Surfaces.

Curr Eye Res 2017 04 9;42(4):498-505. Epub 2016 Sep 9.

d Department of Materials Science , University of Milano Bicocca, Piazza dell'Ateneo Nuovo , Milano , Italy.

Purpose: The aim of this study was to quantitatively characterize the micromorphology of contact lens (CL) surfaces using atomic force microscopy (AFM) and multifractal analysis.

Materials And Methods: AFM and multifractal analysis were used to characterize the topography of new and worn siloxane-hydrogel CLs made of Filcon V (I FDA group). CL surface roughness was studied by AFM in intermittent-contact mode, in air, on square areas of 25 and 100 μm, by using a Nanoscope V MultiMode (Bruker). Detailed surface characterization of the surface topography was obtained using statistical parameters of 3-D (three-dimensional) surface roughness, in accordance with ISO 25178-2: 2012.

Results: Before wear, the surface was found to be characterized by out-of-plane and sharp structures, whilst after a wear of 8 h, two typical morphologies were observed. One morphology (sharp type) has a similar aspect as the unworn CLs and the other morphology (smooth type) is characterized by troughs and bumpy structures. The analysis of the AFM images revealed a multifractal geometry. The generalized dimension D and the singularity spectrum f(α) provided quantitative values that characterize the local scale properties of CL surface geometry at nanometer scale.

Conclusions: Surface statistical parameters deduced by multifractal analysis can be used to assess the CL micromorphology and can be used by manufacturers in developing CLs with improved surface characteristics. These parameters can also be used in understanding the tribological interactions of the back surface of the CL with the corneal surface and the front surface of the CL with the under-surface of the eyelid (friction, wear, and micro-elastohydrodynamic lubrication at a nanometer scale).
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http://dx.doi.org/10.1080/02713683.2016.1217546DOI Listing
April 2017

The Structure of Fats and Fatty Acid Consumption in Elderly People with Cardiovascular System Diseases.

Adv Clin Exp Med 2016 Jan-Feb;25(1):69-75

Faculty of Health Sciences Jozef, The Malopolska Higher Vocational School of J. Dietl in Kraków, Poland.

Background: Patients with cardiovascular system diseases having their origin in arteriosclerosis require special dietetic treatment. Among many nutritional components, fats in the diet (both their quantity and quality) play a very important role in primary and secondary prevention of these diseases.

Objectives: The aim of the study was the estimation of total fats participation (saturated fatty acids, mono- and polyunsaturated fatty acids and cholesterol) in the Daily Nutritional Ration (DNR) of elderly people with cardiovascular system diseases.

Material And Methods: The study included 128 persons (66 women and 62 men, mean age 73.2 ± 6.9) hospitalized in the 1st Clinic of Cardiology and Hypertension, UJCM in Kraków. Daily intakes of energy were estimated using the 24-h nutritional recall and Food Frequency Questionnaire.

Results: A higher consumption of fats and fatty acids was observed in men's diet than in women's diet. The percentage of energy from saturated fatty acids (10.6% M and W) was higher than dietary recommendations. The consumption of monounsaturated fatty acids was in accordance with nutritional recommendations. The participation in the diet of polyunsaturated fatty acids was insufficient versus the newest nutritional recommendations and was determined as 4.6% of energy in DNR in men and 4.1% of energy of DNR in women.

Conclusions: The excessive amount of saturated fatty acids together with the insufficient amount of polyunsaturated fatty acids in the diet are the result of the excessive consumption of products which are a source of animal fat and insufficient consumption of plant fat, fish and seafood.
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http://dx.doi.org/10.17219/acem/33842DOI Listing
June 2016

Dietary Patterns Seem to Influence the Development of Perfusion Changes in Cardiac Syndrome X Patients.

Adv Clin Exp Med 2015 May-Jun;24(3):453-62

Department of Hygiene and Dietetics, Jagiellonian University, Kraków, Poland.

Background: Cardiac syndrome X (CSX) is linked with changes in the heart's micro-vasculature, without significant changes in main coronary vessels. According to ESC 2013 stable coronary artery disease criteria, CSX was replaced by Microvascular Angina (MA). While no changes in main coronary vessels are present, most patients still suffer from angina-like chest pains, which significantly diminish their quality of life. CSX is recognized among other coronary diseases and is now considered to be a form of stable angina. In most CSX patients we can visualize perfusion changes in the left ventricle.

Objectives: Since it is well known that the kind of diet can greatly influence the development of coronary disease, our aim was to evaluate the influence of diet on the myocardial perfusion in the group of patients who were diagnosed of CSX. In addition, we tried to verify whether there is any correlation between dietary patterns and perfusion changes visualized in this group of patients.

Material And Methods: Toward this goal we screened for the presence of CSX a group of 436 women who suffered from angina-like symptoms and whose routinely performed angiography revealed no changes in coronary vessels. Out of these, 55 women with CSX diagnosis, completed questionnaires regarding their nutritional patterns and underwent both myocardial perfusion studies (MPI) and exercise tests.

Results: In the studied group dietary patterns were far from normal values, with the majority of women consuming too much protein, animal fats and sugars in their daily diet, and too low amounts of complex carbohydrates and oils. We were not able to find definite correlations between diet and perfusion changes; however, women whose diet included too high fat and protein intake, seemed to have worse perfusion pattern in MPI.

Conclusions: Nutritional pattern seems to have an impact on development of myocardial perfusion changes in CSX patients.
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http://dx.doi.org/10.17219/acem/34475DOI Listing
November 2015

The effects of cardiac rehabilitation on overall physical capacity and myocardial perfusion in women with microvascular angina.

Kardiol Pol 2016;74(5):431-8. Epub 2015 Sep 28.

Hygiene and Dietetics Department, Jagiellonian University Medical College, Krakow, Poland Nuclear Medicine Department, John Paul II Hospital, Krakow, Poland.

Background: Cardiac syndrome X (CSX) is linked with changes in microcirculation, without significant changes in main coronary vessels. According to European Society of Cardiology 2013 stable coronary artery disease (CAD) criteria, CSX was replaced by microvascular angina (MA). The main feature of MA should be regional myocardial ischaemia; however, there are several works on this subject which failed to demonstrate the presence of perfusion defects.

Aim: To determine the effect of non-pharmacological procedures (cardiac rehabilitation) in patients diagnosed with MA on changes in left ventricular perfusion as assessed by myocardial single photon emission computed tomography, along with potential related improvements in exercise capacity.

Methods: Toward this goal we screened for the presence of CAD in a group of 528 women, of whom 55 were not only diagnosed with MA but also agreed to participate in our study, which involved myocardial perfusion imaging (MPI) studies, during which exercise tests and cardiac rehabilitation were performed.

Results: Comparison of results obtained at the beginning of the study with data obtained after completion of a three month period of cardiac rehabilitation showed improvements in both exercise test parameters (length of test, metabolic equivalents, blood pressure control during extortion) and MPI parameters for the left ventricle (both at rest and stress, global and regional).

Conclusions: Cardiac rehabilitation is a very useful tool of choice in the treatment of patients with MA.
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http://dx.doi.org/10.5603/KP.a2015.0198DOI Listing
April 2017

Cardiac rehabilitation: a good measure to improve quality of life in peri- and postmenopausal women with microvascular angina.

Ann Agric Environ Med 2015 ;22(2):390-5

Department for Health Problems of Ageing, Institute of Rural Health in Lublin, Poland.

Cardiac Syndrome X (CSX) was considered a stable coronary syndrome, yet due to its nature, CSX symptoms often have a great impact on patients' Quality of Life (QoL). According to ESC 2013 stable coronary artery disease criteria, CSX was replaced by Microvascular Angina (MA).Unfortunately, most CSX or MA patients, after classical angina (involving main coronary vessels) has been ruled out, often do not receive proper treatment. Indications for pharmacological treatment of MA patients were introduced only recently. Another problematic issue is that scientists describing the pathophysiology of both CSX and MA stress a lack of a deeper insight into the multifactorial etiology of the source of pain associated with this disease. In the presented article we have attempted to study the influence of cardiac rehabilitation (3 months programme) on the QoL of patients recognized as suffering from MA, as well as to check if changes in myocardial perfusion in these patients at baseline and after completion of cardiac rehabilitation match changes in their QoL. Therefore, after screening 436 women for MA, we studied 55 of them who were confirmed as having MA and who agreed to participate in the study. Exercise tests, Myocardial Perfusion Imaging, and QoL questionnaires were studied at baseline and after completing 3 months period of cardiac rehabilitation. Results were subsequently compared, which showed a link between improved perfusion score in SPECT study and improved overall physical capacity, on one hand, and improved QoL score on the other. These results confirm that cardiac rehabilitation is a very useful treatment option for MA patients. It seems that training during cardiac rehabilitation is a very important factor (improved physical efficiency -> increase in self-belief), and that taking into consideration the multifactor pathophysiology of pain, it is connected with a better quality of life for MA patients.
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http://dx.doi.org/10.5604/12321966.1152100DOI Listing
April 2016

Prostate cancer in patients from rural and suburban areas--PSA value, Gleason score and presence of metastases in bone scan.

Ann Agric Environ Med 2014 ;21(4):888-92

Department for Health Problems of Ageing, Institute of Rural Health, Lublin, Poland.

Introduction: Prostate cancer is the second most common neoplasm among men both worldwide and in Poland. In prostate cancer, bone metastasis is related to a poorer prognosis. A diagnosis of metastatic bone disease is important in prostate cancer patients prior to therapy. Prostate specific antigen (PSA) serum value is used both as a screening tool and for staging of prostate cancer.

Aim: To evaluate whether there is a link between symptoms presented by patients, pain in particular, and the presence, number and location of bone metastases as assessed by bone scan scintigraphy in concordance with PSA values and Gleason scores.

Material: A group of 186 patients (aged: 68.38±6.16) diagnosed with prostate cancer, from rural and suburban areas of Małopolska province, that was directed for bone scan scintigraphy to the Nuclear Medicine Dept, John Paul II Hospital in Kraków.

Methods: Analysis of all laboratory findings (including PSA value) and a biopsy were performed. Then, bone scan scintigraphy was done with the use of methylene disphosphonate (MDP) labeled with Tc-99m.

Results: In patients with a Gleason value≤7 and a PSA value≤20 ng/ml, the cutoff value for a negative bone scan with a confidence interval of 0.95 was established at a PSA value below 10 ng/ml (p<0.01). Correlations were established between PSA value and presence of metastases in bone scan (r=0.45, p=0.05), the number of metastases (r=0.66, p<0.01), and their presence in particular body regions.

Conclusions: The correlation between PSA value and both presence and number of metastases confirms the usefulness of bone scan scintigraphy in prostate cancer staging. The cutoff value for negative bone scan with a 95% confidence interval was established at PSA=10 ng/ml.
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http://dx.doi.org/10.5604/12321966.1129953DOI Listing
August 2015

Salt caves as simulation of natural environment and significance of halotherapy.

Ann Agric Environ Med 2014 ;21(1):124-7

Lubuski College of Public Health, Zielona Góra, Poland.

Introduction: Human activity usually leads to a deterioration in air quality; therefore, searching for places that simulate an environment without pollution is important. Artificial salt caves play crucial role, as a kind of therapy, known as halotherapy, based on treatment in a controlled air medium that simulates a natural salt cave microclimate.

Objective: Evaluation of awareness about the existence of salt caves, basic knowledge about the purpose for their presence among people who bought salt caves sessions, and checking their subjective estimation of salt caves influence on their well-being.

Material & Methods: 303 inhabitants (18-51-years-old) of 3 randomly chosen cities of southern Poland were surveyed using a validated author's questionnaire. Both genders were represented in comparable numbers.

Results: It was be observed that knowledge about the existence of salt-caves is common - 94% of respondents. 96 persons bought at least 3 salt caves sessions. The majority of women, did this for therapeutic reasons (57%), and men for both therapeutic and relaxation reasons (both 39%). Both among women and men, the dysfunctions intended to be cured by sessions included problems with throat, larynx or sinus. Depression as a reason for buying sessions was mentioned only by women. In general, those who attended felt better after sessions in salt caves.

Conclusion: Besides the health benefits, people do not have free time for rest and activities in clean air; moreover, stress is inseparable from everyday life, and for that reasons salt caves become places that help to support a proper lifestyle.
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December 2014

Dietary acrylamide exposure in chosen population of South Poland.

Ann Agric Environ Med 2013 ;20(2):351-5

Department of Hygiene and Dietetics, Jagiellonian University, Medical College, Krakow, Poland.

Introduction: Acrylamide is used for wide range of industry purposes and it is produced in food during heating process. Foods with high acrylamide concentration include French fries, chips, bread crust, cereal, different baked goods. The electrophilic nature of acrylamide allows to interact with biological molecules. It is easily absorbed via the ingestion, inhalation or through the skin.

Objective: Evaluation of dietary exposure to acrylamide in chosen population with respect to different age groups in South Poland and assessment of health risk.

Material And Methods: Food consumption survey was conducted among 3 southern provinces in Poland. Studies involved 1470 participants. A semi-Quantitative Food Frequency Questionnaire was used. Consumption data of individuals were calculated into μg/kg(bw)/day. Statistics was calculated for both whole group and different age groups. MOE values were calculated.

Results: Average acrylamide intake was 0.85 ± 0.82 μg(acrylamide)/kg(bw) per day and calculated 95th percentile was 1.70 μg(acrylamide)/kg(bw)/day. In general total dietary exposure decreased with age from 1.51 μg(acrylamide)/kg(bw)/day for the youngest group (6-12 years old) to 0.67 μg(acrylamide)/kg(bw)/day for the oldest one (42-60 years old). The main contributor of acrylamide in diet in all age groups are bakery products. The MOE values calculated for average acrylamide exposure in diet was 212 and 365 for BMDL10 0.18 and 0.31 mg/kg(bw)/day.

Conclusions: Young population consume the highest amount of acrylamide thus any efforts should be done to rise their nutritional knowledge and to decrease intake of high acrylamide products (crisps and French fries). The need for promotion of knowledge how to decrease acrylamide level especially in home-made food regardless of age is necessary.
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January 2014

[Controversial issue in biotechnology--students' opinions].

Przegl Lek 2012 ;69(8):459-62

Zakład Higieny i Dietetyki, Uniwersytet Jagielloński, Collegium Medicum, Kraków.

Discovery of DNA structure gave the chance for creation organisms, that are called genetically modified organisms (GMO). Birth of Scottish sheep called Dolly in 1996 can be treated as a turning point in GMO issue. Next years have brought development of genetic techniques that help to insert genes that usually come from a different species and create organisms with modified features. The aim of such work is gaining or emphasis on specific desirable features, that leads to better quality of product. Such genetic changes can be controlled only in limited scope. This problem makes GMO-issue vivid and there are many opponents and proponents. The aim of our study was an assessment of knowledge connected with GMO and tendency to buy genetically modified food instead of natural one. 745 students from medical departments in south Poland took part in survey. Questionnaire was originally constructed and validated. Terms connected with biotechnology and GMO were, in general, well known. Only the term "genetically modified animals" for 50% of surveyed individuals were unknown. The majority does not prefer GMO food and does not assess GMO influence on humans health and natural environment positively. Moreover, interviewed people do not feel satisfied with the knowledge about GMO, that they have obtained from school or university.
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January 2013

Optical analogue of the spin Hall effect in a photonic cavity.

Opt Lett 2011 Apr;36(7):1095-7

School of Physics and Astronomy, University of Southampton, Southampton SO17 1BJ, UK.

We observe anisotropy in the polarization flux generated in a GaAs/AlAs photonic cavity by optical illumination, equivalent to spin currents in strongly coupled microcavities. Polarization rotation of the scattered photons around the Rayleigh ring is due to the TE-TM splitting of the cavity mode. Resolving the circular polarization components of the transmission reveals a separation of the polarization flux in momentum space. These observations constitute the optical analogue of the spin Hall effect.
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http://dx.doi.org/10.1364/OL.36.001095DOI Listing
April 2011
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