Search

Abstract Background Considering the rapid influx of Ukrainian migrants and war refugees into Poland, the knowledge of their health condition is becoming increasingly important for health system policy and planning. The aim of the study was to assess war-related changes in the frequency and structure of hospitalizations among Ukrainian migrants and refugees in Poland. Methods The study is based on the analysis of hospital admission records of Ukrainian patients, which were collected in the Nationwide General Hospital Morbidity Study from 01.01.2014 to 31.12.2022. Results In the study period, 13,024 Ukrainians were hospitalized in Poland, 51.7% of whom had been admitted to hospital after February 24, 2022. After the war broke out, the average daily hospital admissions augmented from 2.1 to 21.6 person/day. A noticeable increase in the share of women (from 50% to 62%) and children (from 14% to 51%) was also observed. The average age of patients fell from 33.6 ± 0.2 years to 24.6 ± 0.3 years. The most frequently reported hospital events among the migrants until 23.02.2022 were injuries (S00-T98) – 26.1%, pregnancy, childbirth and the puerperium (O00-O99) – 18.4%, and factors influencing health status and contact with health services (Z00-Z99) – 8.4%. After the war started, the incidence of health problems among migrants and war refugees changed, with pregnancy, childbirth and the puerperium (O00-O99) being the most common – 14.9%, followed by abnormal clinical and lab findings (R00-R99) – 11.9%, and infectious and parasitic diseases (A00-B99) – 11.0%. Conclusions Our findings may support health policy planning and delivering adequate healthcare in refugee-hosting countries.

Objectives: There are limited data on the impact of the COVID-19 outbreak in Poland on newborn health. The aim of the study is to show recent information on hospitalizations of newborns in Poland in the pre-pandemic and COVID-19 pandemic era.Methods: A retrospective, population-based study was conducted using data from hospital discharge records of patients hospitalized in 2017–2021.Results: The data on which the study was based consisted of a substantial number of 104,450 hospitalization records. Annual hospitalization rate was estimated to be 50.3–51.9 per 1,000 in 2017–2019, 56 per 1,000 in 2020 and it rose to 77.7 per 1,000 in 2021. In comparison to the pre-pandemic period, in the COVID-19 era, we observed significantly more hospitalization cases of newborns affected by maternal renal and urinary tract diseases (p < 0.001), syndrome of infant of mother with gestational diabetes (p < 0.001), maternal complications of pregnancy (p < 0.001). In the COVID-19 era, the prevalence of COVID-19 among newborns was 4.5 cases per 1,000 newborn hospitalizations.Conclusion: The COVID-19 pandemic outbreak could significantly contribute to qualitative and quantitative changes in hospitalizations among newborns.

Despite the growing prevalence of legionellosis in Poland and worldwide, little is known about the extent of public awareness regarding the seriousness of this disease and the appropriate preventive measures. The aim of this work is to assess the Polish adults’ knowledge, perceptions, and beliefs about legionellosis and its causative agents, risk factors, exposure, and other relevant facts. Data for this cross-sectional study were gathered via a questionnaire that was constructed and validated by the study investigators before commencing the survey, which lasted from January to March 2022. Knowledge, attitude and practice towards legionella were measured and quantified. One-way ANOVA and chi square tests were used to compare between demographic variables and the level of knowledge. Regression analysis was conducted to examine the predictors for higher knowledge among study participants. A total of 251 participants with a mean age of 28.26 ± 9.6 were enrolled in the current study. Over two thirds (74%) were females, with higher education (62%). Older age was associated with less knowledge about legionellosis (B = -0.049, p < 0.001), while higher education was associated with more knowledge (B = 1.656, p < 0.001). No significant differences were found between genders (p = 0.066). A knowledge gap was present for diagnostic tests regarding legionella. On the other hand, knowledge about prevention procedures was quite high among study participants. This study showed that overall knowledge about legionellosis in Polish adults was quite low. In particular, older age groups and the less educated are in need of more awareness of legionellosis disease. A knowledge gap was particularly present regarding how the disease is diagnosed. Awareness campaigns containing simple, easy-to-understand information could prove useful in combating the disease.

Abstract Congenital toxoplasmosis (CT) is a rare entity and it may pose a life-threatening risk for the newborns. The aim of the study was to evaluate the incidence and other selected factors of CT in Poland. Our study is a population-based study on CT patients in 2007–2021. The study was based on 1504 hospitalization records of first-time diagnosis of CT in newborns. In the study group, we observed 763 males (50.7%) and 741 females (49.3%). The mean and median age was 31 days and 10 days, respectively. Based on the hospital registry, the mean annual CT incidence was estimated to be 2.6 per 10,000 live births (95% CI 2.0–3.2 per 10,000 live births). The incidence of CT cases fluctuated over the years 2007–2021, with the highest incidence in 2010 and the lowest one in 2014. There were no statistically significant differences between the incidence of CT in relation to sex or place of residence. The periodic fluctuations in the number of cases of congenital toxoplasmosis indicates the need to develop effective prevention programs to effectively counteract the disease and its consequences.

Background: (1) Influence of comorbidities on life expectancy and treatment outcomes is one of the main concerns of modern rheumatology, due to their rising prevalence and increasing impact on mortality and disability. The main objective of our study was to analyze the time trends and shifts in the comorbidity profile and mortality over 10 years in the Polish population with ankylosing spondylitis (AS). (2) Data from 2011–2020 years were acquired from the General Hospital Morbidity Study in the National Institute of Public Health—National Institute of Hygiene (NIH-PIB) as ICD-10 codes. Based on ICD10 codes, we calculated the percentage shares for comorbidities, with the relative risk ratios and odds ratios. We analyzed the hospitalization rates and mortality from the overlapping conditions. Also, we analyzed age and sex related differences in the clinical manifestations of AS patients. (3) Results: From 53,142 hospitalizations of patients with AS, we found that the male population presented higher rates of cardiovascular (2.7% vs. 1.3% p < 0.001) and pulmonary conditions (1.2% vs. 0.8% p < 0.025). Inflammatory bowel diseases were more common in the female population than in males (2.3% vs. 1.7%, p < 0.001). In the years 2011–2020, we observed a decline in the number of hospitalized patients due to cardiovascular (p < 0.001) and respiratory system conditions (p < 0.001), yet the relative risk and odd ratios remained high. In the years 2011–2020, 4056 patients received biological treatment (7%). The number of initiated biological therapies correlated negatively with the number of reported hospitalizations due to ischemic heart diseases (IHD) (p < 0.031, r = −0.8). Furthermore, in the logistic regression model, we found strong collinearity between cardiovascular and pulmonary comorbidities (VIF = 14; tolerance = 0.1); also, the number of reported IHD’s correlated positively with the number of pulmonary infections (p < 0.031, r = 0.7) (4). Conclusions: Cardiopulmonary comorbidities are a main factor associated with increased mortality in patients with AS, especially in hospitalized patients. The mortality rates among patients with AS admitted to hospital due to other conditions other than movement disorders exceed the populational risk. The number of biologically treated patients correlated negatively with hospital admissions due to IHD.

Background The aim of the study was to assess the state of knowledge of Medical University of Warsaw (MUW) students on COVID-19, modes of transmission and preventive measures. Material and Methods The study was conducted in October 2020. The participants were all the students attending classes at MUW – 8922 persons. All had completed the online training “Work safety and hygiene during COVID-19.” To assess their state of knowledge an online questionnaire was made available on the MUW e-learning platform. The questionnaire comprised 4 parts: (1) awareness of rules of hand hygiene, (2) medical aspects of COVID-19, (3) preventing SARS-CoV-2 infection transmission in health care facilities, and (4) preventing infection transmissions in the society. Results The majority of students (93.9%) demonstrated a sufficient level of knowledge. The highest passing threshold was found on the medical programme (96.7% of students with satisfactory level of knowledge), dentistry (96.2%) and pharmacy (95.5%). The statistically significant factors that differentiated student results proved to be faculty (p < 0.001), study programme (p < 0.001), year of studies (p = 0.001), form of studies (p < 0.001). The participants most often showed full knowledge (100% correct answers in sub-area) of preventing infection transmissions in the society (93.3%) and medical aspects of COVID-19 (91.8%), less complete in terms of ways of preventing infection transmission in health care facilities (85.4%), and in particular hand hygiene rules (78.3%). All the variables characterizing academic status (study programme, faculty, year and form of studies) were statistically significant differentiating factors for students’ full knowledge in all of the 4 analyzed sub-areas, while students’ sex only in the sub-area of COVID-19 medical aspects. Conclusions There is a clear need for conducting systematic educational activities among students of all medical study programmes and assessing their level of knowledge in those areas that were identified as least frequently controlled, namely, hand hygiene and infection transmission in health care facilities. Med Pr. 2022;73(5):369–81

As defined by World Health Organization, a nosocomial infection or healthcare-associated infection is an infection occurring in a patient during the process of care in a hospital or other healthcare facility which was not present or incubating at the time of admission. This includes infections acquired in the healthcare facility but appearing after discharge, as well as occupational infections among healthcare workers of the facility. The Act of 5 December 2008 on preventing and combating infections and infectious diseases in humans defines healthcare-associated infection as “an infection that occurred in connection with the provision of health services, where the disease: did not occur at the time of providing health services during the incubation period or occurred after provision of health services, in a period not longer than the longest incubation period”. Healthcare providers and facilities owe a legal duty to ensure patient safety. In this article, important recent verdicts regarding nosocomial infections have been subject to legal analysis. They have been discussed in a broad context, including medical malpractice, guilt of doctors and healthcare facilities, the liability of doctors and healthcare facilities for damage caused during treatment and for violation of patient rights, causation and the burden of proof in trials and compensation for damage suffered.

The competitiveness of contemporary organisations is the foundation of their growth and market operation. Organisational culture, integrating the activities of an organisation with the environment in its own manner, determines the way it adapts to the conditions, and considerably impacts the competitive standing of a business. This is particularly important but, at the same time, increasingly difficult for entities operating on the health care market where goods of the highest order, namely saving life and improving health, are provided. The purpose of this article is to present a theoretical and practical discussion of the essence of the impact of organisational culture on building the competitive advantage of health care providers. The article features both a theoretical discussion based on a literature review and a practical discussion analysing the impact of organisational culture on the competitiveness of the health care provider Corten Medic. Both dimensions of the discussion reveal that organisational culture plays an essential role in building the competitive edge of a company and achieving success. In literature on the subject regarding enterprises operating in the health care sector, little attention is given to the links between organisational culture and the competitiveness of health care providers, although, as demonstrated by the results of this article, they may be highly significant, both for management as well as for patients. The article presents an attempt to define the essence and impact of organisational culture on establishing a competitive advantage.

Introduction Creating an impact on health is a long-term process that involves activities of public policy. In Poland, particular policies are formulated in documents at the central, regional and local levels. The presence of health issues in these documents can be a measure of the involvement of various sectors in health protection, and thus a measure of the implementation of health principle.in all policies. Objectives The aim of the study is to compare the health issues and health inequalities in policy documents. Material and methods Study methodology included an analysis and review of documentation. The review covered official documents of government bodies in which central, regional and local policies, accepted for the implementation in 2007–2013 and 2014–2020, were formulated. Results An analysis of 121 documents formulating development policies provided information about health issues and health inequalities in central, regional and local policies. Health inequality issues was identified in 12 health policy programmes implemented by the Ministry of Health. Conclusions Although health issues and health inequalities are present in all documents formulating public policies, they were given the biggest attention in the documents at the central level. It was observed that the level of health inequality representation in the strategies of provinces was very low, in the strategies of counties, it was marginal. Certain activities aiming at the increase in the awareness of health inequality should be undertaken.

Background Influenza vaccinations are recommended for medical staff as an effective and safe form of preventing influenza and its complications. The aim of the study was to assess the impact of selected educational and information interventions on the influenza vaccination coverage (IVC) in nursing personnel and their attitude towards this procedure. Material and Methods The study participants (N = 320) were randomly divided into 4 groups. Group 1 participated in stationary training, whereas group 2 participated in distance learning. Additionally, 2 subgroups were established in each of the groups above: 1 subgroup received a reminder about the vaccination in the form of a short text message, and the other group did not receive any such reminder. The IVC rate in each group was determined; the attitude towards influenza vaccination was measured using the health belief model. Results The highest IVC was obtained after stationary training followed by a reminder in the form of a short test message (36%). The reminder significantly affected IVC in the group attending stationary training (p 0.05, OR = 1.2, 95% CI: 0.51–2.83). Both stationary training and distance learning positively influenced the attitude towards influenza vaccinations. A major change in attitudes towards influenza vaccinations was observed only in the case of stationary training followed by a reminder in the form of a short text message (positive changes in perceived susceptibility and severity took place, perceived vaccination benefits increased, and perceived barriers were reduced). Conclusions Stationary training followed by a reminder in the form of a short text message is more effective in increasing the IVC rate compared to distance learning. It also promotes positive changes in attitudes to this prophylactic procedure, which is why it should be recommended for wider implementation. Med Pr. 2020;71(6):665–85

Introduction and objective Congenital cytomegalovirus (cCMV) infections are common worldwide. CCMV infected newborns are mostly asymptomatic at birth. However, cCMV remains the major infectious cause of congenital abnormalities in the developing foetus and newborns. The aim of the study was to provide recent data on cCMV in Poland. Material and methods Aretrospective, population-based study was conducted using data from hospital discharge records of patients hospitalized from 2009–2018. CCMV incidence rates were estimated on the basis of data taken from a Polish hospital morbidity study, carried out by the National Institute of Public Health. Results The study group consisted of 1,916 hospitalized patients with the first-time diagnosis of cCMV. Among them, 52% were patients up to 30 days of age. The median age was 28 days. The average annual incidence of cCMV was 48 per 100,000 live births (95% CI 23.5–73.4). A significantly higher cCMV incidence rate was observed in patients from more urban than rural regions of Poland (55 per 100,000 vs 39 per 100,000; P

When faced with a chronic disease such as rheumatoid arthritis, the patient attempts to cope with the stressful situation by applying coping strategies. The main aim of rheumatoid treatment is not only improving health but also increasing the quality of life. The research objective was to determine the relationship among socio demographic factors, duration of the disease and its associated ailments, attitude to the disease, self-assessment of one’s knowledge of RA, and the application of coping strategies in stressful situations by women with rheumatoid arthritis. The study involved 193 patients of the Clinic of Rheumatology and Systemic Connective Tissue Diseases, and the Rheumatology Unit of the Specialist Outpatient Clinic of the Independent Public Teaching Hospital No. 4 in Lublin, from November 2016 – June 2017. The Coping Orientations to Problems Experienced Inventory (COPE) Questionnaire and an author’s Original Questionnaire were used in the study. Analysis of variance (ANOVA) and Tukey’s range test were applied for statistical analysis. A p-value

Introduction and objective Occupational asbestos exposure is one of the major public health issues. Although asbestos use in Poland has decreased, asbestosis continues to remain an important health concern in the area of occupational medicine. The aim of the study is to perform a descriptive analysis of hospitalization cases in patients suffering from asbestosis in Poland. Material and methods The authors used hospital discharge records to conduct a retrospective, population-based study. To estimate the asbestosis hospitalization rate, data from the Nationwide General Hospital Morbidity Study conducted by the National Institute of Public Health were used. Events were defined as in-patient hospital discharges during 2006–2016. 1,101 hospitalization records of 764 patients were included in the study. Results In the study group of first-time hospitalized patients, the mean and median ages were 68.1 and 69 years, respectively; CI: 67.3–68.9; SD: 11.1, min-max:16–99 years. In this group, significant gender differences were observed (560 males vs. 204 female; P

The number of people who are afraid of vaccinations and who refuse to submit their children to them is constantly growing in Poland. Certain attempts are being made to change legal provisions regarding the obligation of preventative vaccinations. An important element of this discussion is an analysis of the current legal solutions included in judicial decisions. The aim of this paper is to present court judgements in cases regarding legal responsibility related to the obligation of preventative vaccinations issued by the Supreme Court, district courts, the Supreme Administrative Court and voivodship administrative courts. The subject of the judgments under discussion were, in particular, matters relating to the obligation to undergo mandatory vaccinations; legal sources of the obligation to undergo preventative vaccinations, included in the Announcement of the Chief Sanitary Inspector on the protective vaccine program; mandatory preventative vaccinations and the constitutional rights of citizens; administrative enforcement of the obligation to subject a child to mandatory preventative vaccinations, as interpreted by the state, and contraindications to vaccination; enforced fulfillment of the obligation to subject a child to preventative vaccination, and the legal effect of the refusal to subject a child to a pre-vaccination screening; the use of fines to enforce mandatory preventative vaccinations; administrative fines and criminal liability for failure to undergo vaccinations against infectious diseases; parental refusal to subject a child to mandatory vaccinations; civil liability for compensation; and nature and the enforcement of a parents’ obligation to subject children to protective vaccination. The administrative and criminal law measures provided for in the Act on enforcement procedure in administration, including fines, to enforce the statutory obligation of vaccination may be used to achieve this goal. This has been concluded in judgements which are valid.

Wstęp: Rynek ochrony zdrowia, podobnie jak inne sektory gospodarki oparty jest o konkurencyjność. Z uwagi na unikalność świadczonych usług (polegających na ratowaniu ludzkiego zdrowia i życia), konkurencyjność podmiotów leczniczych różni się od typowego wolnego rynku. Cel: Celem pracy była identyfikacja czynników konkurencyjności podmiotów leczniczych w czterech wyróżnionych obszarach konkurencyjności przedsiębiorstw – czynników zewnętrznych (makro- i mikrootoczenie) oraz czynników wewnętrznych (zasoby i aktywa). Wyniki: Czynniki makrootoczenia zostały pogrupowane na: polityczno-prawne, ekonomiczne, społeczne, technologiczne i demograficzne. Mikrootoczenie zostało podzielone na: konsumentów i konkurentów, uwzględniając ich intensywność oraz bariery wejścia na rynek oraz dostawców. Zasoby podzielono na: aktywa finansowe, infrastrukturę pomieszczeń oraz wyposażenie w sprzęt. Natomiast aktywa zostały scharakteryzowane w oparciu o elementy systemu organizacji, warunkujące ich sprawczość – strategię, style, kompetencje, pracowników, strukturę oraz kulturę organizacji. Podsumowanie: Dokonany przegląd i systematyzacja czynników wpływających na konkurencyjność podmiotów leczniczych umożliwia ocenę ich potencjału konkurencyjności w kontekście poszczególnych obszarów i scharakteryzowanych w nich kluczowych czynników sukcesu.

Background: Human respiratory syncytial virus (RSV) is responsible for infections mainly affecting the lower respiratory tract in infants and young children after the first exposure. The aim of the study is to show up-to-date information on RSV hospitalization cases in Poland in children aged < 5 years. Methods: A retrospective, population-based study was conducted using data from hospital discharge records of patients hospitalized from 2010–2020. Results: The study group consisted of 57,552 hospitalizations of RSV children. The mean and median ages were 232 (95% CI: 230–234) and 132 (IQR 63–271) days. The mean annual hospitalization rate for patients with RSV infection was estimated to be 267.5 per 100,000, and the highest was observed in children < 1 year (1132.1 per 100,000). The mean annual hospitalization rate was significantly higher in patients living in urban than rural regions (p < 0.001). A statistically significant increase in the number of hospitalizations was observed (p < 0.0001) during the analyzed period. The seasonal pattern was found with the highest rates of hospitalizations in the January–March period. Conclusions: The increasing RSV hospitalization rate requires further research and may be the basis for urgent healthcare measures. The results may be helpful in comparative analyses in the European and global context.

Background: Influenza constitutes a significant health care burden that can be related to an increased morbidity and mortality. The aim of the study is to show up-to-date information on influenza hospitalization cases in Poland in children aged p < 0.001). The age of patients living in urban regions was significantly lower than the age of patients living in rural regions (2.2 vs. 2.3 years; p < 0.001). A statistically significant increase in hospitalization was observed. Conclusions: The reported increasing trend in hospitalizations indicates the need to take focused measures. Presented data may be useful in comparative analyses in a European context.

Cerebral stroke is the third most frequent cause of death in the human population, and one of leading causes of long-lasting disability. Medical rehabilitation has proven to be an indispensable element in stroke management. The aim of this study is to evaluate the quality of life in patients after a cerebral stroke, before and after rehabilitation. This analysis was based on data obtained from an empirical study conducted on 70 people after a stroke. The research was performed with the use of an original survey questionnaire. Due to their conditions, respondents perceived varying degrees and extents of changes in their organisms and environments pertaining to their physical, psychological, social, and professional spheres of life. In the vast majority of the patients, applied rehabilitation had a positive influence on their quality of life. There was an improvement in their physical and psychological conditions, as well as in various other aspects of life, while the intensity of emerging disorders decreased.

Introduction Takayasu’s arteritis (TA) is a rare and potentially life-threatening granulomatous large-vessel vasculitis that involves mostly in the aorta and its proximal branches, and occurs most commonly in young females. This study measures the incidence and prevalence of TA, and assesses the gender distribution and territorial differences in the occurrences of this disease in Poland over a five-year period. To the best of our knowledge, this is the first evaluation of this rare disease in Poland based on a hospital morbidity database. Material and methods Analyses were performed with population-based administrative data obtained from a national hospital morbidity study carried out between January 2011 – December 2015 by the Polish National Institute of Public Health. Yearly incidence rates and prevalence of TA were calculated using the number of TA patients and corresponding census data for the overall Polish population. Results Data included 660 hospitalization records. The final study sample comprised 177 patients: 154 female (87%) and 23 male (13%) with first-time hospitalization for TA. The mean age was 45.4years (95% CI: 42.9–47.8; SD 16.8; range 4–81 years), median 47. The incidence rate of TA was estimated at 0.92 per million per year (95% CI: 0.68–1.16). Five-year TA prevalence was estimated to be 4,6 per million. Incidence rates of TA did not vary significantly between more urban and more rural regions. Conclusions The incidence of TA in Poland was similar or lower to data reported by other European countries. The study provides epidemiological data on TA in Poland that may be useful while comparing it with other geographical regions.

Introduction Several studies have suggested, that diabetes is very important factor of the risk of the chronic a renal disease. The paper aims to present a retrospective analysis of incidence of end-stage renal disease in subgroups of patients with and without diabetes in Poland. Material and methods For assessing this problem an electronic search was performed using Polish National Health Fund data base from 01.01.2011 until 31.12.2013 in general population and from 01.01.2012 until 31.12.2012 in 2 populations: with diabetes and without diabetes mellitus. Results The 43.70 % patients with end-stage renal disease was diabetic. The incidence rate in 2012 was: 292.48 ± 90.97 diabetic men / 100,000 diabetic population; 203.10 ± 90.97 diabetic women / 100,000 diabetic population; 23.44 ± 6.34 non-diabetic men / 100,000 non-diabetic population; 17.88 ± 6.33 non-diabetic women / 100,000 non-diabetic population. Conclusions The incidence rate of end-stage renal failure in diabetics was multiple times higher than the incidence rate in non-diabetics. The incidence rate of new ESRD cases in Poland estimated to be 36.17 per 100,000 of general populations in 2011, 35.28% in 2012 and 30.46 per 100,000 of general populations in 2013. In 2012, the incidence rate of new ESRD cases in male diabetics was 292.48 ± 90.97 per 100,000 of diabetes men population, and in women diabetics 203.10 ± 66.06 per 100,000 of diabetes women population. In the same 2012 year, the incidence of new ESRD cases in men non-diabetics was 3.44 ± 6.34 per 100,000 of non-diabetes, and in women non-diabetes 17.58 ± 6.33 per 100,000 of non-diabetes women population.

Introduction Paget’s disease (PDB) is a focal disorder of bone remodeling that occurs commonly in older people with decreasing prevalence reported in European countries. This disease is most often asymptomatic, but it can cause a variety of medical complications resulting in considerable morbidity and reduced quality of life. There is little information regarding the epidemiology of PDB in Poland. To the best of the authors’ knowledge, this is the first large epidemiological analysis of this disease in Poland. Objective The aim of this study was to analyze factors that may be related to the PDB epidemiology among hospitalized patients in Poland. Material and methods The analysis was conducted on the basis of population-based administrative data, taken from a Polish hospital morbidity study carried out by the National Institute of Public Health between January 2008 – December 2014. Results Analyzed data covered 662 hospitalization records. The final study sample comprised 94 (41.8%) male and 131 (58.2%) female patients with first-time hospitalizations for PDB, with a significant predominance of females (P

The meta-analysis presented in this article covered the efficacy of red clover isoflavones in relieving hot flushes and menopausal symptoms in perimenopausal and postmenopausal women. Studies were identified by MEDLINE (PubMed), Embase, and the Cochrane Library searches. The quality of the studies was evaluated according to Cochrane criteria. A meta-analysis of eight trials (ten comparisons) demonstrated a statistically significant reduction in the daily incidence of hot flushes in women receiving red clover compared to those receiving placebo: weighted mean difference (WMD—weighted mean difference) −1.73 hot flushes per day, 95% CI (confidence interval) −3.28 to −0.18; p = 0.0292. Due to 87.34% heterogeneity, the performed analysis showed substantive difference in comparisons of postmenopausal women with ≥5 hot flushes per day, when the follow-up period was 12 weeks, with an isoflavone dose of ≥80 mg/day, and when the formulations contained a higher proportion of biochanin A. The meta-analysis of included studies assessing the effect of red clover isoflavone extract on menopausal symptoms showed a statistically moderate relationship with the reduction in the daily frequency of hot flushes. However, further well-designed studies are required to confirm the present findings and to finally determine the effects of red clover on the relief of flushing episodes.

Introduction Systemic sclerosis (SSc) is a rare and potentially severe connective tissue disease, characterized by skin fibrosis and involvement of internal organs. Because of its rarity and heterogeneous clinical presentation, reliable epidemiological studies on SSc have been particularly difficult to carry out. Objectives The purpose of this study was to present SSc epidemiology among hospitalized patients in Poland. Material and Methods The analysis was based on population-based administrative data, taken from a Polish hospital morbidity study carried out by the National Institute of Public Health between January 2008 – December 2012. Results Analyzed data covered 9,049 hospitalization records. The final sample comprised 3,653 patients with first-time hospitalizations for SSc. The average age of the sample was 53 years (SD 16.2; range 0–91 years); 84% of patients were female and 16% male. Based on hospitalization registers, the average SSc incidence was estimated to be 1.9/100,000 per year and peak age of incidence was 55 years. The point prevalence was estimated to be 9.4/100,000 at the end of 2012. SSc was more common in females, with F:M ratio ranging from 6.2:1–4.6:1 depending on the year. Analysis of hospitalization trends revealed that overall numbers of SSc hospitalizations increased, while first-time hospitalizations decreased between 2008–2012. Clusters of higher incidence were observed in more rural regions vs. urban regions. Conclusions Estimated incidence of SSc in Poland was comparable to reported incidence in other European countries. Analysis of demographic factors and reports of clusters of higher incidence may suggest the existence of environmental risk factors for the development of SSc. These observations may require further research

Public health and primary health care are complementary strategies for sustaining the health of a society. There are many analyses in the literature on the subject that deal with the possibility of mutual support between public health and primary health care. There reports from many countries include studies of scientific institutions, presentations of specific solutions used by health protection administrations and self-government bodies, programs of study, and courses. However, this issue is rarely raised in Poland. The aim of this article is to present an up-to-date list of public health operations and to where there is room for primary health care activities. A binding list of public health operations was defined by the World Health Organisation (WHO) in 2012 under the name of Essential Public Health Operations (EPHOs). In order to define public health operations more precisely in this article, a questionnaire self-assessment tool for the evaluation of essential public health operations in the WHO European Region was used. Primary health care plays a significant role in the performance of public health operations (EPHOs), whereas the public health operations connected with health protection (EPHO 3), health promotion (EPHO 4) and disease prevention (EPHO 5), are mostly attributed to primary health care. Primary health care provides the information necessary for the performance of public health operations in the field of monitoring population health and well-being – in particular infectious and chronic diseases (EPHO 1), and for health care management and improvement of health care quality (EPHO 6).

Maximizing Health-Related Quality of Life (HRQoL) is one of the most important goals in the work of the family doctor. Providing a high quality of medical services (QMS) should be among the most important challenges in primary health care organizations (PHCOs). In practice, these two areas of activity require continuous improvement, and can complement each other and enhance their mutual impact on the health of patients. The objective of this article is to present selected areas of HRQoL and QMS improvement in the practice of a family doctor, which might contribute to patients’ health, to cost reduction, and to a beneficial reposition of a health center within the medical service market. The paper presents proposals for improving HRQoL and QMS through the use of data from questionnaires filled out by patients, through the cooperation of all the people involved in the delivery of medical services, through adaptation of the IT infrastructure to meet the needs of PHCOs, and through improvements in quality as the result of a process model. QMS is of great importance, especially for both consumers and providers of medical services, including PHCOs. Improvement in quality should be considered as operating on both HRQoL and QMS. This paper presents strategies for selected areas that may contribute to improving QMS, both with respect to the opinions of patients and the functioning of PHCOs.

Introduction Respiratory diseases constitute a public health priority worldwide. This is related to the increasing exposure to microorganisms, toxic factors, allergens, drugs and smoking, as the most important factors. Increasing costs of health promotion, prevention, diagnosis and treatment of respiratory tract diseases forces the search for effective strategies in the reduction of costs without making a significant impact of these activities on health results. Chronic obstructive pulmonary disease (COPD) is an example of these diseases with increasing incidence, which has few known modifiable factors and absorbs large medical and social costs. Objectives The aim of this study is to present the conception of cost driver analysis that could be useful in constructing a good combination of the EBM-based treatment with cost reduction decisions. Material and Methods Analysis of cost drivers was based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines and Polish recommendations of COPD diagnosis and treatment. The proposition of cost reduction strategy in COPD treatment was based on identification of cost drivers in value chain conception. Results and Conclusions An increasing incidence and treatment costs of COPD force the search for methods of costs reduction in health care. Identifying, evaluating and modifying the cost drivers with use of the value chain conception could be an effective method in achieving these objectives.

Aim of the study: Granulomatosis with polyangiitis (GPA) is a disease of unknown aetiology, with a variable course, and with the possibility of exacerbations associated with life-threatening organ damage. Data on the incidence of GPA in Poland are limited. Epidemiological analysis can provide a lot of information that contributes to more accurate knowledge about GPA. The objective of this study was to conduct an analysis of GPA incidence in Poland with comparison of results to selected European countries. An additional analysis was performed according to the distribution of gender, age and hospitalization structure in GPA patients. Material and methods: The estimation of GPA incidence was based on data taken from the Polish hospital morbidity registry of the National Institute of Public Health, in the scope of which data on all inpatients discharged from non-psychiatric hospitals in Poland are collected. Analysed data covered 1112 medical records taken from the first time of hospitalization records with diagnosis of GPA. The observation time ranged from December 2004 to December 2010. Results : The average annual incidence of GPA in Poland was estimated to be 4.9/million in the general population, 5.8/million in the adult population and 1/million in the population of patients below 18 years of age. The annual incidence in Poland was comparable to incidence data from other European countries. The analysis of hospitalizations showed that the GPA patients were most often hospitalized in pulmonary, nephrology and rheumatology departments. During the observation period hospitalizations ended with death in 80 patients and GPA as an underlying cause of death was reported in 60 cases. Conclusions : In this study GPA incidence in Poland was estimated. Analyses of the structure of hospitalizations suggested that symptoms from the respiratory tract, kidneys and joints could be leading symptoms in the early stage of GPA development.

Celem związanym z leczeniem reumatoidalnego zapalenia stawów(RZS) jest poprawa zdrowia w wymiarze fizycznym, społecznym i psychicznymoraz dbałość o jakość życia zależną od zdrowia. Celembadania była analiza jakości życia zależnej od zdrowia (health-relatedquality of life – HRQoL) pacjentów hospitalizowanych z powoduzaostrzenia RZS z uwzględnieniem chorób współistniejącychi wybranych parametrów biochemicznych. W badaniu brało udział 51osób, 42 kobiety i 9 mężczyzn. Średnia wieku wynosiła 62,5 roku (SD±12,6). Analizę HRQoL wykonano z użyciem kwestionariusza SF-36.Wyniki badania wykazały istotny statystycznie związek wybranychskal SF-36 z parametrami demograficznymi (starszy wiek, płeć żeńska),klinicznymi (czas trwania RZS, obecność choroby niedokrwiennejserca, osteoporozy, złamań patologicznych w przebiegu osteoporozy,choroby zwyrodnieniowej stawów, nowotworów złośliwych), biochemicznymi(OB, CRP, GFR, Hb, albuminy osocza) i wizualną skaląanalogową (visual analogue scale – VAS). Nie wykazano istotnegostatystycznie związku pomiarów HRQoL z takimi zmiennymi, jakobecność cukrzycy, stężenie białek osocza, wskaźnik aktywnościchoroby (DAS28), wskaźnik masy ciała (body mass index – BMI).Dodatkowo przeprowadzono analizę psychometryczną stosowanegoinstrumentu oceny HRQoL – SF-36, gdzie potwierdzono jego rzetelnośćoraz dobre parametry trafności, co wskazuje na przydatnośćtego instrumentu do oceny HRQoL u pacjentów z RZS. Otrzymanewyniki mogą być pomocne w dalszych badaniach nad HRQoL pacjentówz RZS i podejmowaniu decyzji ukierunkowanych na poprawęjakości życia.