The subject of the article are the contextual determinants of the formula of the therapeutic relationship in medicine with regard to the proportions between paternalism and partnership. The article was inspired by the results of two recent editions of the Organisation for Economic Co-operation and Development (OECD) “Health at a Glance” studies of 2015 and 2017; in their light, Poland ranks at the bottom of ratings concerning patient satisfaction with communication with doctors. According to these studies, the therapeutic relationship in medicine in Polish society appears to be petrified in the paternalist formula, not sufficiently taking into account the autonomy and agency of patients. Based on the analysis of the determinants of a broader tendency, described in Western studies, consisting in the wider development of partnership relationships between doctors and patients, the study will show individual barriers, social ones, including structural and institutional, as well as clinical barriers to implementation in medical practice of the partnership model of therapeutic relationships in medicine, which assumes the active involvement of patients in clinical decision-making as well as in the processes of medical treatment.
Michał Skrzypek, Agnieszka Momora and Renata Krzyszycha
The current epidemiological situation in Poland is characterized by prevalence of cardiovascular diseases (CVD) as the main cause of mortality. In the paper the current state of knowledge on the importance of glycemic index (GI) and glycemic load (GL) in CVD prevention is presented, taking into consideration the latest recommendations on CVD prevention. In a nutrition strategy based on consumption of low GI/GL foods, the target of the intervention is the profile of dietary carbohydrates which is treated as a modulator of glycemic response. In the light of the current state of research, there is no reason to treat GI/GL values as markers of pro-health qualities of the dietary plan recommended in CVD prevention to individuals with normal glucose homeostasis. However, the preventive potential of diets characterized by low GI/GL deserves a more extensive application in patients with glucose homeostasis disturbances, including those with prediabetes and insulin resistance syndrome. Taking into account the relations between abnormal carbohydrate metabolism and a risk of developing diabetes, followed by CVD, the benefits of low-glycemic diets in individuals with impaired glucose homeostasis can indirectly result in lowering the risk of CVD. It is reasonable to conduct further clinical studies on the relevance of low GI/GL diets in preventive cardiology.
Michał Skrzypek, Lucyna Pachocka, Karolina Goral and Adamina Partycka-Skrzypek
The subject of the article is the present status of the profession of dietitian in the Polish healthcare system, taking into account the analysis of the current legislation in force that defines the principles of employment of dietitians and the practice of the dietitian in Poland in the context of relevant provisions of the EU law, with emphasis on the position of dieticians in the health-care systems of selected European Union countries. The study advances the thesis that the current status of the profession of dietitian in Poland reflects its incomplete professionalization manifested in the lack of legal regulations on the principles of its practice that are applied in the case of other medical professions. A consequence of the present, comparatively low status of the profession of dietitian in Poland is, inter alia, the hindered availability of professional clinical dietetics counseling under public health insurance, as well as the practice of the profession as a business activity by individuals whose professional qualifications are not subject to verification by professional regulatory bodies. This produces a risk to patients, arising from the fact that interventions not verified by the EBM paradigm are nevertheless implemented as part of dietary counseling.
Karolina Goral, Justyna Siwiela-Tomaszczyk, Renata Krzyszycha and Michał Skrzypek
The objective of the study is a critical analysis of the selected alternative diets used in the treatment of obesity inconsistent with the recommended standards, from the perspective of clinical dieticians, based on up-to-date guidelines for dietary management of obesity. Attention was paid to the assumptions of the selected alternative diets, some physiological mechanisms related with their use, as well as the deficit of data pertaining their distant effectiveness and safety. In the context of the current epidemiological situation concerning the prevalence of obesity, it is justifiable to undertake actions aimed at the professionalization of dietary management in obesity, consisting in the application of the treatment methods based on data generated in the EBM paradigm, with a simultaneous indication and criticism of dietary pseudo-therapies with unconfirmed curative value which, in addition, do not guarantee the reduction of the risk of metabolic complications of obesity.
Bogdan Szponar, Agnieszka Marzec and Michał Skrzypek
All human senses participate in the sensory evaluation of food, which means that such features as taste, flavour, appearance, or texture determine the acceptance and choice of a dish. Seeking to satisfy consumer requirements and offer a dish or food with the desired organoleptic features, the food industry initially used a wide range of food additives compensating for the loss of colour, taste or flavour of the dish. At present, with an increase in consumers’ awareness and nutrition knowledge, departure is observed from the use of food additives to the benefit of using modern technologies in the food industry. The progress in food science, concerning especially, the phenomena taking place during the storage or processing of food, gives direction to the application of modern technical solutions or materials, and also provides guidelines within the area of gastronomic technology concerning the shaping of not only organoleptic features of the dish, but also activities aiming at the preservation of pro-health potential of food. This issue becomes even more important in the context of increasing epidemics of chronic non-communicable diseases (NCD) in contemporary western societies, in the etiopathogenesis of which, health behaviours play a crucial role. The subject of the report will be analysis of the current state of knowledge in the area of food and nutrition sciences, concerning the possibility of using modern gastronomic technologies in order to preserve or enhance the pro-health potential of food, possible to use within the primary and secondary prevention of NCD.
Agnieszka Marzec, Michał Skrzypek and Zbigniew Marzec
The subject of the study is to present the issues of dietary supplements from the perspective of public health, taking into account definitional problems, the scale of the phenomenon in Poland and the look at the problem in question from the sociomedical perspective emphasizing the use of dietary supplements as a form of self-care. The study also discusses selected legal regulations in Poland and the EU on marketing and trading in dietary supplements. The article also presents, from the perspective of pharmaceutical sciences, the proposals for classification of dietary supplements and selected issues concerning safety of their use. The subject of a part of the present analysis is also the recent data showing the wide popularization of the phenomenon of polypragmasia consisting in simultaneous use of dietary supplements and OTC pharmaceutical agents with prescription drugs in Poland.