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Maintaining body balance is a complex function based on the information deriving from the vestibular, visual, and proprioceptive systems. The aim of the study was to evaluate quiet single stance stability in young adults with lumbar derangement syndrome (LDS) and in the control group of the healthy subjects. The second aim of this study was to determine whether pain intensity, degree of disability, and the level of physical activity can influence postural control in patients with LDS. It is important to underline that selecting a homogeneous group of LBP patients using, for example, mechanical diagnosis and therapy method and Quebec Task Force Classification, can result in an increased sensitivity of the study. The study included 126 subjects: 70 patients with LDS (37 women, 33 men) and the control group 56 healthy volunteers (36 women, 20 men). In case of multiple group comparisons for variables with normal distribution, ANOVA post hoc test was used or, as the nonparametric equivalent, Kruskal-Wallis test. In all these calculations, the statistical significance level was set to p < 0.05 . The stability index eyes open for the study group was 88.34 and for the control group 89.86. There was no significant difference in the level of postural control between the study and control groups ( p > 0.05 ). The level of stability index eyes closed (SI EC) for the study group was 71.44 and for the control group 77.1. SI EC results showed significant differences in proprioceptive control during single leg stance between the study and control groups ( p < 0.05 ). The level of pain intensity, the degree of disability, and physical activity level did not influence postural control in the study group with LDS. In summary, patients with LDS showed significantly worse proprioceptive control.

Background: According to the World Health Organization’s statistics, 7 of the 10 main causes of death in 2019 were noncommunicable diseases. Health indicators are measures used to evaluate public health system effectiveness and functioning. Monitoring mortality rates from leading causes, life expectancy and other health indicators is essential to address their causes and adapt health systems to react adequately. The aim of this study is to present the dependencies of selected health care indicators and health outcomes. Methods: Based on the literature review conducted, selected health indicators, along with healthcare system data, were analyzed using Pearson’s r correlation. The analyses included data from the Organization for Economic Cooperation and Development (OECD) presented in statistics and the Health at a Glance 2021 report and data collected as part of the preparation of the Financing Global Health 2020 report by the Institute for Health Metrics and Evaluation. Results: Health system resources are linked to health outcomes. The number of medical consultations, the number of nurses per patient or the level of financing of services under general health insurance are related to life expectancy and deaths due to causes that could have been avoided or treated. Conclusions: Life expectancy is positively correlated with access to general health insurance and public expenditure on healthcare. There is a need for all countries to provide their citizens with broad access to healthcare services.

(1) Background: Pancreatic cancer is the cancer with the third-highest mortality rate, and forecasts indicate its growing share in morbidity. The basis of treatment is inpatient chemotherapy and there is a strong focus on palliative care. (2) Methods: A literature review was conducted based on the rapid review methodology in PubMed and Cochrane databases. The search was supplemented with publications from the snowball search. Qualitative assessment of included publications was performed using AMSTAR2 modified scheme. (3) Results: The review included 17 publications, of which majority concerned direct costs related to the adopted treatment regimen. Most of the publications focused on comparing the cost-effectiveness of drug therapies and the costs of palliative treatment. Other publications concerned indirect costs generated by pancreatic cancer. They particularly focused on the economic burden of lost productivity due to sickness absence. (4) Conclusion: The increase in the incidence of pancreatic cancer translates into an increase in the costs of the health care system and indirect costs. Due to the significant share of hospitalization in the health care structure, direct costs are increasing. The inpatient treatment regimen and side effects translate into a loss of productivity for patients with pancreatic cancer. Among gastrointestinal cancers, pancreatic cancer generates the second largest indirect costs, although it has a much lower incidence rate than the dominant colorectal cancer. This indicates a significant problem of the economic burden of this cancer.

Pancreatic cancer is the malignant disease with the highest mortality rate, and it ranks third in the world after lung and colon cancer. Identified factors that increase the risk of developing pancreatic cancer include chronic pancreatitis, radiation therapy to the pancreatic area due to another cancer, diabetes mellitus, obesity, smoking, and age. The objective of this study was to present the current state of knowledge on the quality of life of patients diagnosed with pancreatic cancer, factors that determine QoL, and ways of coping with the disease. The low curability and low survival rates of pancreatic cancer significantly affect the quality of life of patients, often in the form of significant deterioration, especially in terms of mental changes, cognitive functions, and coping with the disease. Cognitive decline with comorbid depression is also typical for patients with this type of cancer. Research has shown that the health-related quality of life of patients with pancreatic cancer is low, so further research is needed to improve the situation in this area.

The 2019 worldwide sales of Orphan Drugs were estimated at $136 billion USD, which constituted 16% of the global pharmaceutical prescription market and is expected to grow by 12% in the next 5 years. A better understanding of Orphan Drug pricing may contribute to on-going discussions on Orphan Drug Act (ODA) corrections in US or modifications of price setting mechanisms in EU. The objective of the study was comparison and analysis of the prices of Orphan Drugs in US and EU. All drugs with Orphan Drug status were compared in the US and EU. For the US prices, the US Department of Veterans Affairs (VA) was sourced. The EU List Prices came from six EU countries: Denmark, France, Germany, Greece, Poland, Spain. We found US prices to be higher than the six selected EU countries. The average Price Ratio was 1.64. The prices across EU countries were more homogeneous, while the number of the reimbursed and therefore available to patient medicines varied and was correlated with GDP per capita r = 0.87. Considered implementation of the External Reference Price system in US may generate significant savings in the US but may result in upward pressure on pricing of Orphan Drugs in EU. Centralization of the Orphan Drugs pricing negotiations in EU may prevent such development and offer a win-win opportunity for all involved parties.

BackgroundHospital stay is associated with difficult circumstances, which may be accompanied by anxiety. Difficulty with initiation and continuation of breastfeeding may be commonly experienced in the hospital. Observed difficulties can be modified by sharing knowledge and involvement of midwives in the care of mothers and newborns. Breastfeeding is considered to be the ideal choice of nutrition and infant’s feeding, providing many benefits both for infants and their mothers. The aim of the study is to explore the role of the quality of breastfeeding assistance during delivery hospitalization and maternal anxiety for overall breastfeeding duration.Participants and procedureThe study included 858 women after labor from intentionally selected hospitals of Pomerania, discharged from hospital up to 15 days after birth. We used a questionnaire to collect data on the nursing assistance and the process of breastfeeding during patients’ stay in a hospital. In addition, we applied the State-Trait Anxiety Inventory (STAI) to measure the levels of state and trait anxiety.ResultsThe results showed a significant relationship between the level of maternal postpartum anxiety and duration of breastfeeding. Mothers (mostly after physiological labor) reported a significantly lower level of state anxiety in hospitals titled Baby Friendly. Additionally, a significant difference in breastfeeding duration depending on the hospital and mothers’ perception of receiving support from midwives was found.ConclusionsIt is reasonable to continue the activities increasing standards of medical personnel support and raising the midwives’ and mothers’ awareness of the importance of anxiety for breastfeeding duration.

Aim The aim of this study was to evaluate the quality of nursing care in psychiatric wards and compare it between hospitals of different types. Results Significant differences between hospitals were found in: personnel benevolence (p = 0,006219) and response to patient needs (p = 0,011446) as well as patients' sense of safety (p = 0,020042). In both hospitals, patients were equally dissatisfied with the quality of information concerning treatment side effects (p = 0,207804). In both hospitals patients were equally satisfied regarding the level of respect for their dignity and psychological support (p = 0,176928). Conclusion General patient perception of nursing care in psychiatry wards seems to be positive. Some tasks carried out by nurses in psychiatric care still require improvement, especially regarding providing information to patients.

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common disease that occurs all over the world. Models of care, initially accessed from the clinical point of view, must also be evaluated in terms of their economic effectiveness, as health care systems are limited. The Integrated Care Model (ICM) is a procedure dedicated to patients suffering from advanced COPD that offers home-oriented support from a multidisciplinary team. The main aim of the present study was to evaluate the cost-effectiveness of the ICM. MATERIAL AND METHODS We included 44 patients in the study (31 males, 13 females) with an average age 72 years (Me=71). Costs of care were estimated based on data received from public payer records and included general costs, COPD-related costs, and exacerbation-related costs. To evaluate cost-effectiveness, cost-effectiveness analysis (CEA) was used. The incremental cost-effectiveness ratio (ICER) was calculated based on changes in health care resources utilization and the value of costs observed in 2 consecutive 6-month periods before and after introducing ICM. RESULTS Costs of care of all types decreased after introducing ICM. Demand for ambulatory visits changed significantly (p=0.037) together with a substantial decrease in the number of emergency department appointments and hospitalizations (p=0.033). ICER was more profitable for integrated care than for standard care when assessing costs of avoiding negative parameters such as hospitalizations (-227 EUR), exacerbations-related hospitalizations (-312 EUR), or emergency procedures (-119 EUR). CONCLUSIONS ICM is a procedure that meets the criteria of cost-effectiveness. It allows for avoiding negative parameters such as unplanned hospitalizations with higher economic effectiveness than the standard type of care used in managing COPD.

Objectives The aim of the study is to determine the level of acceptance and differences in subjective perception of disease and the relation between the level of acceptance, perception, and demographic factors. Methods The study included 100 patients with COPD (Chronic Obstructive Pulmonary Disease) treated in two Pomeranian hospitals: Pneumonology and Allergology Department of Medical University of Gdansk and J.K. Lukowicz Specialist Hospital in Chojnice. Study participants have been divided into two groups: Group I consisted of patients with degree I and II of airways obturation assessed by spirometry: Group II consisted of patients with degree III and IV. The disease perception assessment and acceptance were evaluated respectively with use of The Brief Illness Perception Questionnaire (Brief IPQ) and Acceptance of Illness Scale (AIS). Results and conclusions There have been proven differences in the subjective perception of the disease in patients with COPD. The disease among patients with severe and very severe obturation degree is considered as life threatening. The colloquial idea about causes of COPD in half of the cases is the same as the medical knowledge about its etiology. Patients with mild and moderate obturation present good level of acceptance; patients in poorer health condition present medium level of illness acceptance.

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a commonly diagnosed condition in people older than 50 years of age. In advanced stage of this disease, integrated care (IC) is recommended as an optimal approach. IC allows for holistic and patient-focused care carried out at the patient's home. The aim of this study was to analyze the impact of IC on costs of care and on demand for medical services among patients included in IC. MATERIAL AND METHODS The study included 154 patients diagnosed with advanced COPD. Costs of care (general, COPD, and exacerbations-related) were evaluated for 1 year, including 6-months before and after implementing IC. The analysis included assessment of the number of medical procedures of various types before and after entering IC and changes in medical services providers. RESULTS Direct medical costs of standard care in advanced COPD were 886.78 EUR per 6 months. Costs of care of all types decreased after introducing IC. Changes in COPD and exacerbation-related costs were statistically significant (p=0.012492 and p=0.017023, respectively). Patients less frequently used medical services for respiratory system and cardiovascular diseases. Similarly, the number of hospitalizations and visits to emergency medicine departments decreased (by 40.24% and 8.5%, respectively). The number of GP visits increased after introducing IC (by 7.14%). CONCLUSIONS The high costs of care in advanced COPD indicate the need for new forms of effective care. IC caused a decrease in costs and in the number of hospitalization, with a simultaneous increase in the number of GP visits.

Introduction: ICM in COPD patients had been earlier proven to provide clinical benefits, manifested mainly by better compliance and milder course of disease. This study was designed to assess the economic effects of ICM in patients with severe COPD. Methods: Within a pilot project conducted between 2011 and 2014, 41 severe COPD patients were subjected to ICM including home support, to decrease the frequency of disease events and improve quality of life. Using the National Health Fund data, medical expenditures in these patients were compared in two consecutive 6-month periods: before and after implementing ICM. Results: After implementing ICM the average 6-month general costs decreased from 5627 PLN (1349 EUR) to 3576 PLN (856 EUR), COPD related costs from 3191 PLN (765 EUR) to 1741 PLN (418 EUR), and exacerbation-related costs from 2444 PLN (586 EUR) to 735 PLN (176 EUR). All cost benefit indicators confirmed high economic efficacy of ICM Conclusions: ICM decreases the costs of care in severe COPD patients, mainly by preventing exacerbations. ICM was financed by grant from Novartis and City Council of Gdansk.

Background: Clinical relevance of integrated care model in COPD is still a matter of controversy. Aim: The aim of the study was to asses if integrated care improve course of chronic obstructive pulmonary disease. Methods: The study was conducted in the group of 21 patients with advanced COPD subjected to integrated care (IC) program. Comparison between 6 months period of standard care (before) and 6 months of IC in relation to the number of exacerbations and emergency visits was performed. Results: In six months period of standard care before including patients in PMICPC 21 had severe exacerbations requiring hospitalization and 14 emergency visits were observed. In comparison, after 6 months of IC these results were 13 and 10, respectively. Calculated number need to treed (NNT) to avoid one severe exacerbation in 6 months period equals 2,6. Conclusion: IC seems to be an effective option for advanced COPD patient to improve the course of the disease. Project was supported by Novartis and Town Council Gdansk grants.