Magdalena Prynda, Mikołaj Mazur, Patrycja Doroz, Olga Odrzywolska, Ali Aboud, Adrian Dyląg, Wojciech Niemczyk
{"title":"Barriers to dental treatment for patients on the autism spectrum disorder.","authors":"Magdalena Prynda, Mikołaj Mazur, Patrycja Doroz, Olga Odrzywolska, Ali Aboud, Adrian Dyląg, Wojciech Niemczyk","doi":"10.36740/WLek/207377","DOIUrl":"https://doi.org/10.36740/WLek/207377","url":null,"abstract":"<p><p>Individuals diagnosed with autism spectrum disorder (ASD) encounter significant obstacles when attempting to access dental care services. These obstacles are a result of their unique health requirements, behavioral challenges, and communication impairments. The primary challenges encompass a reliance on caregivers, challenges with adhering to proper oral hygiene practices, selective eating habits that contribute to dental caries, and an impaired capacity to communicate pain and health requirements. Furthermore, dental clinics frequently lack the capacity to accommodate individuals with ASD, exacerbating their stress during visits. A further salient issue pertains to the dearth of adequate staff training to address the needs of patients necessitating specialized care. The objective of this paper is to analyze these barriers and propose solutions that can increase the accessibility and quality of dental care for individuals with ASD, thereby improving their comfort and oral health.</p>","PeriodicalId":23643,"journal":{"name":"Wiadomosci lekarskie","volume":"78 7","pages":"1433-1437"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Oleksandra Yu Kushnir, Iryna M Yaremii, Kyrylo A Pantsiuk, Oleksandra O Kushnir, Kateryna M Yaremii, Kateryna V Vlasova, Olena V Vlasova
{"title":"Carbohydrate metabolism in the rats' liver under conditions of light and dark deprivation and correction by melatonin.","authors":"Oleksandra Yu Kushnir, Iryna M Yaremii, Kyrylo A Pantsiuk, Oleksandra O Kushnir, Kateryna M Yaremii, Kateryna V Vlasova, Olena V Vlasova","doi":"10.36740/WLek/205592","DOIUrl":"https://doi.org/10.36740/WLek/205592","url":null,"abstract":"<p><strong>Objective: </strong>Aim: This study aimed to investigate changes in carbohydrate metabolism in the liver of rats under light and dark deprivation and evaluate the effects of melatonin treatment.</p><p><strong>Patients and methods: </strong>Materials and Methods: Photoperiodic changes were simulated over two weeks: the natural equinox (March 16-29); the artificial equinox (12:12 light-dark cycle, 500 lux); constant light (24 hours, 500 lux) for dark deprivation; and constant dark (24 hours, 0-0.5 lux) for light deprivation. Forty-eight rats were divided into control and melatonin-treated groups (5 mg/kg daily for 14 days). Enzyme activities and glycogen content in the liver were measured using standard methods. Statistical analysis was performed using the Student's t-test.</p><p><strong>Results: </strong>Results: Glucose-6-phosphate dehydrogenase activity decreased by 18% under constant light but increased by 35% under constant dark compared to the equinox. Pyruvate kinase activity decreased by 17%, while glucose-6-phosphatase and lactate dehydrogenase activities increased by 9% and 20%, respectively, under constant light. Constant dark and melatonin treatment reduced glucose levels by 26% across all conditions, activated aerobic pathways, and increased glycogen content by 13% compared to the equinox.</p><p><strong>Conclusion: </strong>Conclusions: Melatonin treatment improved carbohydrate metabolism in the liver of rats under light and dark deprivation, suggesting its role in metabolic adaptation to altered photoperiods.</p>","PeriodicalId":23643,"journal":{"name":"Wiadomosci lekarskie","volume":"78 7","pages":"1361-1366"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aidyn G Salmanov, Dmytro V Shchehlov, Maryna Mamonova, Yevhenii E Shcheholkov, Viktor I Litus, Oleksandr V Burakov, Igor V Altman, Oleksandr P Kovalenko, Yaroslav E Kudelskyi, Oleh E Svyrydiuk, Mykhailo V Knyhin, Viktor A Yatsyk, Ihor M Bortnik, Nataliia O Serohina, Igor V Verbitskiy, Evgenii A Koichev, Anna Brodskaya
{"title":"Healthcare associated infections in patients with combat wounds and antimicrobial resistance of the responsible pathogens in Ukraine: results of a multicenter study (2022-2024).","authors":"Aidyn G Salmanov, Dmytro V Shchehlov, Maryna Mamonova, Yevhenii E Shcheholkov, Viktor I Litus, Oleksandr V Burakov, Igor V Altman, Oleksandr P Kovalenko, Yaroslav E Kudelskyi, Oleh E Svyrydiuk, Mykhailo V Knyhin, Viktor A Yatsyk, Ihor M Bortnik, Nataliia O Serohina, Igor V Verbitskiy, Evgenii A Koichev, Anna Brodskaya","doi":"10.36740/WLek/209517","DOIUrl":"https://doi.org/10.36740/WLek/209517","url":null,"abstract":"<p><strong>Objective: </strong>Aim: Aim this study was to estimate the prevalence and incidence of HAI in patients with combat wounds, and determine phenotypic and genotypic aspects of antimicrobial resistance of the responsible pathogens in Ukraine.</p><p><strong>Patients and methods: </strong>Materials and Methods: A multicenter observational cohort study based on HAIs and antimicrobial resistance surveillance data in Ukraine. Between June 21, 2022 and December 31, 2024, patients (aged 20-74 years) with combat wounds were admitted to civilian hospitals which are located in Kharkiv, Dnipro, Kherson, Zaporizhzhia, Odessa, and Kyiv, Ukraine. The criteria for HAIs were adapted from the CDC/NHSN. Antimicrobial susceptibility test used Kirby - Bauer disc diffusion antibiotic test according to the EUCAST.</p><p><strong>Results: </strong>Results: Among 7,324 patients with combat wound, 5,022 (68.6%) HAIs were observed. The most frequently reported HAI types were surgical site infections (27.3%), bone and joint infections (25.6%), skin and soft tissue infections (15.7%), bloodstream infections (9.7%), central nervous system infections (7.9%), and pneumonia (5.3%). In total, 88.9% isolates from patients with combat wounds were found to be MDROs. A significant number of the MDROs isolated from patients with HAIs had β-lactamase genes, including extended-spectrum β-lactamase (ESBL) (53.1%), OXA-type (32.9%), AmpC-type (35.7%), KPC-type (31.8%), and metallo-β-lactamases (51.4%) including IMP-type (18.5%), VIM-type (29.6%), and NDM-1 (34.7%).</p><p><strong>Conclusion: </strong>Conclusions: This study found a high prevalence of HAI in patients with combat wounds caused by MDROs, varying depending on the bacterial species, and antimicrobial group. The majority of MDRO isolates from patients with HAI carried β-lactamase genes.</p>","PeriodicalId":23643,"journal":{"name":"Wiadomosci lekarskie","volume":"78 8","pages":"1624-1634"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Oleksii V Tymoshenko, Zhanna H Domina, Valentyna H Bilyk, Inesa V Sheremet, Kateryna S Vasylenko, Svitlana Yu Gerasymenko, Yurii P Serhiienko
{"title":"Improving physical working capacity of high school students in the process of their functional training.","authors":"Oleksii V Tymoshenko, Zhanna H Domina, Valentyna H Bilyk, Inesa V Sheremet, Kateryna S Vasylenko, Svitlana Yu Gerasymenko, Yurii P Serhiienko","doi":"10.36740/WLek/209502","DOIUrl":"https://doi.org/10.36740/WLek/209502","url":null,"abstract":"<p><strong>Objective: </strong>Aim: To investigate the effectiveness of functional training implementation for improving the physical working capacity of high school students in physical education.</p><p><strong>Patients and methods: </strong>Materials and Methods: The research, which was conducted in 2024-2025, involved 176 high school students aged 16, of whom the experimental (EG) and the control (CG) groups were formed. Functional training was introduced into the physical education classes of the EG, while the CG high school students studied according to the existing program. The following indices were used to assess high school students' physical working capacity: Rufier index, Kerdo vegetative index, circulatory efficiency coefficient, Stange and Genchi tests.</p><p><strong>Results: </strong>Results: During the research period the EG revealed a significant (p ≤ 0.05-0.001) improvement in the Rufier index by 0.8 c. u. in boys and by 0.6 c. u. in girls, the Kerdo index - by 0.8 c. u. in boys and by 0.9 c. u. in girls, circulatory efficiency coefficient - by 175.8 c. u. in boys and 189.3 c. u. in girls, the Stange test - by 6.7 seconds in boys and 5.8 seconds in girls, the Genchi test - by 4.3 seconds in boys and 3.9 seconds in girls. At the end of the experiment, the EG high school students had all studied indicators significantly better than the CG's.</p><p><strong>Conclusion: </strong>Conclusions: The results of the conducted experiment prove the effectiveness of functional training implementation in physical education of high school students to improve their physical working capacity.</p>","PeriodicalId":23643,"journal":{"name":"Wiadomosci lekarskie","volume":"78 8","pages":"1496-1503"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zinovii Ozhogan, Andrii Krokhmal, Lidiia Miziuk, Vasyl Obidniak, Roman Ozhohan
{"title":"Complex diagnostics and prognostication of temporomandibular joints diseases using condylography.","authors":"Zinovii Ozhogan, Andrii Krokhmal, Lidiia Miziuk, Vasyl Obidniak, Roman Ozhohan","doi":"10.36740/WLek/209520","DOIUrl":"https://doi.org/10.36740/WLek/209520","url":null,"abstract":"<p><strong>Objective: </strong>Aim: To increase the efficiency of diagnosing diseases of the temporomandibular joint by assessing a set of condylographic indicators and developing prognostic algorithms for the course and an optimized program of dental care for patients.</p><p><strong>Patients and methods: </strong>Materials and Methods: A clinical retrospective cross-sectional comparative study was conducted with the participation of 470 patients with temporoman-dibular joint pathology aged 18-76 (33 ± 12.9) years. The comprehensive examination included palpation of the masticatory muscles and temporomandibular joint, condylography, computed tomography, teleradiography, occlusiography, analysis of mandibular mobility, modeling of the jaws in the articulator, as well as logical and statistical data processing using standard methods (p<0.05).</p><p><strong>Results: </strong>Results: The analysis of diagnostic and therapeutic approaches to patients with temporomandibular joint diseases allowed us to develop mathematical prognostic models and propose an examination program that takes into account the specifics of the development and course of the pathology. The algorithms for predicting the course of temporomandibular joint diseases based on complex clinical, condylographic and articulation methods were substantiated, which allowed to improve the dental care of patients.</p><p><strong>Conclusion: </strong>Conclusions: A modified program for diagnosing patients with the use of mathematical modeling (Wald's method of sequential analysis) was proposed to assess the probability of progression of temporomandibular joint diseases. Further research will focus on expanding the primary data base, improving mathematical models, testing individualized prognostic algorithms and evaluating their clinical effectiveness.</p>","PeriodicalId":23643,"journal":{"name":"Wiadomosci lekarskie","volume":"78 8","pages":"1649-1657"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Surgery to remove the plate from the distal radius with simultaneous reconstruction of the lacerated flexor pollicis longus tendon performed under WALANT: A case report.","authors":"Andrzej Żyluk, Ilya Kuryha, Marta Baranowska","doi":"10.36740/WLek/208441","DOIUrl":"https://doi.org/10.36740/WLek/208441","url":null,"abstract":"<p><p>The tendon rupture was caused by the protruded distal edge of the palmar plate inserted for fixation of the distal radial fracture 2 years earlier. The patient was a 28-year-old patient who had stopped bending the distal phalanx of his right thumb 2 months prior to the presentation. Performance of anaesthesia and operation is presented in details. The operation went smoothly, bleeding was minimal despite the relatively extensive wound, and the patient felt only little pain at the end of the operation.</p>","PeriodicalId":23643,"journal":{"name":"Wiadomosci lekarskie","volume":"78 8","pages":"1684-1691"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Valentyn V Bondarenko, Vasyl V Prontenko, Serhii V Rusanivskyi, Rostyslav M Radzievskyi, Vladyslav A Danylchenko, Dmytro V Shtanagei, Maksym V Pidoprygora
{"title":"Motor activity regimen and daily energy expenditure of cadets and employees in practical units.","authors":"Valentyn V Bondarenko, Vasyl V Prontenko, Serhii V Rusanivskyi, Rostyslav M Radzievskyi, Vladyslav A Danylchenko, Dmytro V Shtanagei, Maksym V Pidoprygora","doi":"10.36740/WLek/209499","DOIUrl":"https://doi.org/10.36740/WLek/209499","url":null,"abstract":"<p><strong>Objective: </strong>Aim: To conduct a comparative analysis of the motor activity regimen and daily energy expenditure of cadets and employees in police investigative units.</p><p><strong>Patients and methods: </strong>Materials and Methods: The research involved cadets of the 1st-4th training years (n = 86) and employees of police investigative units (n = 64). To establish the levels of motor activity and daily energy expenditure of cadets and employees in police investigative units, the Framingham method was used based on the registration of activities during the day.</p><p><strong>Results: </strong>Results: A significant difference in cadets' motor activity index and daily energy expenditure during their educational activities and police investigators during their service activities (p < 0.001) was found. It was found that during the day, the cadets consumed 2658.8 ± 39.6 kcal in the process of their educational activities with their motor activity index at 34.43 ± 0.32 points. The employees showed 2412.4 ± 35.1 kcal of daily energy expenditure with their motor activity index at 31.18 ± 0.29 points.</p><p><strong>Conclusion: </strong>Conclusions: The results obtained are due to the specifics of the educational activities of cadets and the peculiarities of the service activities of police inves-tigators, which are determined by an extended stay in a forced position and a low level of physical activity. The results of the conducted research should be taken into account when organizing the physical training of police investigators in the course of their service activities.</p>","PeriodicalId":23643,"journal":{"name":"Wiadomosci lekarskie","volume":"78 8","pages":"1470-1475"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tetiana V Kolomiichenko, Anatoliy V Kaminskiy, Igor L Kovalenko, Oksana Chayka, Valeriy V Konoplyanko
{"title":"Effectiveness of using ferning of the dried saliva crystallization to determine the fertile window in women with idiopathic infertility.","authors":"Tetiana V Kolomiichenko, Anatoliy V Kaminskiy, Igor L Kovalenko, Oksana Chayka, Valeriy V Konoplyanko","doi":"10.36740/WLek/205000","DOIUrl":"https://doi.org/10.36740/WLek/205000","url":null,"abstract":"<p><strong>Objective: </strong>Aim: To evaluate the effectiveness of determining the fertile window in women with idiopathic infertility based on the results of crystallization of saliva samples obtained using the Ovul portable device with a mobile application by comparing them with the results of urine test strips and folliculometry data.</p><p><strong>Patients and methods: </strong>Materials and Methods: The menstrual cycles of 42 women with idiopathic infertility were analyzed: Group I - 21 women who took drugs to induce ovulation, Group II - 21 women with natural menstrual and ovarian cycles. Ovulation was confirmed or excluded based on the results of the Ovul device, urine test strips, and folliculometry.</p><p><strong>Results: </strong>Results: Although ovulation detection using the Ovul device and urine test strips has 100% specificity, the sensitivity of the device is 97.4%and the accuracy is 97.6% (if the positive result is ovulation or the fertile window), while for urine test strips the sensitivity is 94.9% and the accuracy is 95.2% if we consider a positive result not only to be the same as the day of ovulation according to folliculometry, but also a positive result within the next 72 hours (mainly 12-24).</p><p><strong>Conclusion: </strong>Conclusions: Ovulation detection using the Ovul device is a highly accurate, 100% specific and highly sensitive method that can be used at home, will optimize diagnostics, make it more convenient and cheaper for patients who want to get pregnant or, on the contrary, who are trying to avoid pregnancy.</p>","PeriodicalId":23643,"journal":{"name":"Wiadomosci lekarskie","volume":"78 7","pages":"1220-1230"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ahmed J Mohammed, Atheer Mohammed Jasim Al-Zurfi, Shaden M H Mubarak
{"title":"Association of toll-like receptor 4 gene (Thr399Ile) polymorphism with type II diabetes mellitus patients.","authors":"Ahmed J Mohammed, Atheer Mohammed Jasim Al-Zurfi, Shaden M H Mubarak","doi":"10.36740/WLek/207378","DOIUrl":"https://doi.org/10.36740/WLek/207378","url":null,"abstract":"<p><strong>Objective: </strong>Aim: This study investigates the association of the TLR4 Thr399Ile (rs4986791) polymorphism with T2DM in Iraqi patients and its influence on clinical parameters.</p><p><strong>Patients and methods: </strong>Materials and Methods: A case-control study was conducted on 200 participants (100 T2DM cases and 100 healthy controls). Phenotypic analyses included fasting blood glucose, HbA1c, lipid profiles, and insulin sensitivity indices. Genotyping of the TLR4 Thr399Ile polymorphism was performed using PCR-RFLP. Statistical analyses were conducted using SPSS.</p><p><strong>Results: </strong>Results: The CT and TT genotypes were significantly more frequent in T2DM patients, associated with higher odds ratios (OR=2.40, p=0.003; OR=5.33, p=0.04, respectively). HDL levels were significantly lower in variant genotypes (p = 0.01). Other clinical parameters showed no significant genotype-specific differences.</p><p><strong>Conclusion: </strong>Conclusions: The TLR4 Thr399Ile polymorphism is significantly associated with increased T2DM risk and altered HDL levels in Iraqi patients, highlighting its potential as a genetic marker for early risk assessment.</p>","PeriodicalId":23643,"journal":{"name":"Wiadomosci lekarskie","volume":"78 7","pages":"1381-1388"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Оlena S Shcherbinska, Nadiia Ya Zhylka, Nataliia О Serohina, Oksana V Zhdanova
{"title":"The role of a family doctor in the formation of a healthy lifestyle of young people in Ukraine.","authors":"Оlena S Shcherbinska, Nadiia Ya Zhylka, Nataliia О Serohina, Oksana V Zhdanova","doi":"10.36740/WLek/205367","DOIUrl":"https://doi.org/10.36740/WLek/205367","url":null,"abstract":"<p><strong>Objective: </strong>Aim: Highlighting the main problems of forming a healthy lifestyle among the youth of Ukraine and determining the role of the family doctor in solving them.</p><p><strong>Patients and methods: </strong>Materials and Methods: The study used bibliosemantic, statistical, analytical methods and descriptive modeling. Data processing was performed using the Microsoft ® Excel ® software package (trial version); statistical processing of results was performed using the statistical analysis software package Statsoft ®Statistica ® ver. 10 (STA999K347156-W) and IBM ® SPSS 25.0 (trial version).</p><p><strong>Results: </strong>Results: According to the results of the study, numerous health problems associated with an unhealthy lifestyle are observed in Ukraine: physical inactivity, bad habits (use of alcoholic beverages and psychoactive substances, smoking), excessive communication on social networks, lack of safe sexual behavior skills. To increase the level of awareness of young people about a healthy lifestyle, we modeled the administration of services for the formation of a healthy lifestyle in the field of primary health care by a family doctor.</p><p><strong>Conclusion: </strong>Conclusions: One of the main links in the formation of a healthy lifestyle is the professional approach of this family doctor in the framework of performing his direct functions of eliminating habits and behavior that pose a risk to health and forming healthy lifestyle skills. Public administration should ensure the effectiveness of the family doctor in providing services for the formation of a healthy lifestyle through the process of collective adoption and implementation of strategic decisions.</p>","PeriodicalId":23643,"journal":{"name":"Wiadomosci lekarskie","volume":"78 5","pages":"1045-1051"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}