Effect of the PCV 10 vaccination on community-acquired pneumonia hospitalisations after four years of its introduction into the Polish National Immunisation Programme: Follow-up study

BACKGROUND

Vaccination against pneumococci is currently the most effective method of protection against pneumococcal infections. The aim of the study was to analyse changes in hospitalisations and in-hospital deaths due to pneumonia before (2009-2016) and after (2017-2020) the introduction of PCV 10 vaccinations in the National Immunisation Programme in Poland.

METHODS

Data on hospitalisations related to community acquired pneumonia (CAP) in the years 2009-2020 were obtained from the Nationwide General Hospital Morbidity Study. Analyses were made in the age groups: <2, 2-3, 4-5, 6-19, 20-59, 60+ years in 2009-2016 and 2017-2020.

RESULTS

Overall, there were 1,503,105 CAP-related hospitalisations in 2009-2020, 0.7% of which were caused by Streptococcus pneumoniae infections. Children <2 years of age were the most frequently hospitalised for CAP per 100,000 population, followed by patients aged 2-3, 4-5 and 60+ years. In the years 2009-2016, the percentage of CAP hospital admissions increased significantly, and after the year 2017, it decreased significantly in each of the age groups (p<0.001). In the years 2009-2016, a significant increase in hospitalisations for Streptococcus pneumoniae infections was observed in the age groups <2, 2-3 and 4-5 years (p<0.05). A significant reduction in hospitalisations was observed in the age groups <2, 20-59 and 60+ in 2017-2020 (p<0.05). In the years 2009-2020, there were 84,367 in-hospital deaths due to CAP, 423 (0.5%) of which due to Streptococcus pneumoniae, with patients mainly aged 60+.

CONCLUSIONS

Implementation of the PCV vaccination programme has effectively decreased the incidence of CAP hospitalisations, including children <2 years of age. The group that is most at risk of death are persons aged 60+. The results of our study can be useful in evaluating the vaccine efficacy and benefits, and they can be an essential part of public health policy. Effective prevention strategies for CAP should be implemented in different age groups.

Hospitalizations of patients with herpes zoster in Poland during 2012-2021: A population-based study

INTRODUCTION

The varicella-zoster virus (VZV) is an infectious agent that causes both chickenpox and herpes zoster/shingles (HZ). This infection can take various clinical forms, result in permanent complications, and be a marker of immunosuppression, e.g. in the course of a neoplastic disease. The aim of this study is to analyze epidemiological trends in hospitalization and hospital mortality rate among HZ patients in Poland (2012-2021).

METHODS

Our study is a population-based, retrospective analysis of hospital discharge records of patients with HZ. Data were obtained from the National Institute of Public Health in Poland, and they covered the period from 2012 to 2021. All hospitalization records with primary or secondary ICD-10 B02 code diagnosis were included in the study.

RESULTS

We analyzed the total number of 23,432 hospital discharge records of HZ patients in 2012-2021. The study group consisted of 22,169 (94.6 %) hospitalization records of first-time diagnosis of HZ in hospitalized patients: 9,309 males (42 %) and 12,860 females (58 %). In this group, 70.3 % were patients over 60 years old. The mean and median age was 64 and 69 years, respectively. The mean annual first-time hospitalization rate for HZ was estimated to be 5.8 per 100,000 person-years (95 % CI: 4.8-6.7 per 100,000 person-years). The hospitalization rate for HZ was similar during 2012-2019. There was a significant decrease in hospitalizations in 2020-2021 in comparison with the previous years (R2 = 0.42, p < 0.05). Women showed a higher hospitalization rate than men (p < 0.001). Urban residents had a higher hospitalization rate than rural residents (p < 0.001). In the analyzed period, 246 deaths were recorded (1.1 % of all hospitalized HZ patients) -119 males and 127 females.

CONCLUSIONS

The HZ-related number of hospitalizations and mortality in Poland are relatively low, but HZ is still a significant health problem. Risk factors include female gender, older age and residence in urban areas.

Newborn Hospitalizations Before and During COVID-19 Pandemic in Poland: A Comparative Study Based on a National Hospital Registry

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.

Ukrainian migrants' and war refugees' admissions to hospital: evidence from the Polish Nationwide General Hospital Morbidity Study, 2014-2022

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.

Congenital toxoplasmosis among hospitalized infants in Poland in the years 2007-2021: study based on the national hospital registry

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.

Health promotion and disease prevention registries in the EU: a cross country comparison

BACKGROUND

Health promotion and disease prevention programme registries (HPPRs), also called 'best practice portals', serve as entry points and practical repositories that provide decision-makers with easy access to (evidence-based) practices. However, there is limited knowledge of differences or overlaps of howe current national HPPRs in Europe function, the context and circumstances in which these HPPRs were developed, and the mechanisms utilised by each HPPR for the assessment, classification and quality improvement of the included practices. This study prepared an overview of different approaches in several national HPPRs and the EU Best Practice Portal (EU BPP) as well as identified commonalities and differences among the core characteristics of the HPPRs.

METHODS

We conducted a descriptive comparison - that focused on six European countries with existing or recently developed/implemented national HPPR and the EU BPP -to create a comparative overview. We used coding mechanisms to identify commonalities and differences; we performed data management, collection and building consensus during EuroHealthNet Thematic Working Group meetings.

RESULTS

All HPPRs offer a broad range of health promotion and disease-prevention practices and serve to support practitioners, policymakers and researchers in selecting practices. Almost all HPPRs have an assessment process in place or planned, requiring the application of assessment criteria that differ among the HPPRs. While all HPPRs collect and share recommendable practices, others have implemented further measures to improve the quality of the submitted practices. Different dissemination tools and strategies are employed to promote the use of the HPPRs, including social media, newsletters and publications as well as capacity building workshops for practice owners or technical options to connect citizens/patients with local practices.

CONCLUSIONS

Collaboration between HPPRs (at national and EU level) is appreciated, especially regarding the use consistent terminology to avoid misinterpretation, facilitate cross-country comparison and enable discussions on the adaption of assessment criteria by national HPPRs. Greater efforts are needed to promote the actual implementation and transfer of practices at the national level to address public health challenges with proven and effective practices.

Clustering of the Adult Population According to Behavioural Health Risk Factors as the Focus of Community-Based Public Health Interventions in Poland

Effective lifestyle health promotion interventions require the identification of groups sharing similar behavioural risk factors (BRF) and socio-demographic characteristics. This study aimed to identify these subgroups in the Polish population and check whether local authorities' health programmes meet their needs. Population data came from a 2018 question survey on a random representative sample of 3000 inhabitants. Four groups were identified with the TwoStep cluster analysis method. One of them ("Multi-risk") differed from the others and the general population by a high prevalence of numerous BRF: 59% [95% confidence interval: 56-63%] of its members smoke, 35% [32-38%] have alcohol problems, 79% [76-82%] indulge in unhealthy food, 64% [60-67%] do not practice recreational physical activity, and 73% [70-76%] are overweight. This group, with an average age of 50, was characterised by an excess of males (81% [79-84%]) and people with basic vocational education (53% [50-57%]). In 2018, only 40 out of all 228 health programmes in Poland addressed BRF in adults; only 20 referred to more than one habit. Moreover, access to these programmes was limited by formal criteria. There were no programmes dedicated to the reduction of BRF exclusively. The local governments focused on improving access to health services rather than on a pro-health change in individual behaviours.

Health Care Organization in Poland in Light of the Refugee Crisis Related to the Military Conflict in Ukraine

BACKGROUND

Poland is witnessing a migration crisis caused by the ongoing military conflict in Ukraine. In addition to housing and necessities, 1.8 million Ukrainians that had taken refuge in Poland must have access to medical care. We aim to propose a strategy for implementing the changes in the Polish health care system in response to the Ukrainian refugee crisis.

METHODS

A literature review on organizational changes in the functioning of health care systems during the migration crises worldwide in recent years and brainstorming in order to develop a strategy for implementing changes in the Polish health care system in response to the Ukrainian refugee crisis.

RESULTS

The proposed strategy for implementing the changes in the Polish health care system is based on building health care resilience and adaptation to different crises. The operational objectives of organization-related activities are: (1) preparation of medical facilities to provide help for refugees, (2) development and implementation of the communication system, (3) implementation of available digital solutions, (4) organization of the diagnostic and medical services, (5) and implementation of changes in the management of medical facilities.

CONCLUSIONS

Urgent reorganization is required to respond to an unavoidable increase in the demand for health care services.

Participation in Population Health Interventions by Older Adults in Poland: Barriers and Enablers

BACKGROUND

The participation of older adults in population health interventions constitutes a key factor in their physical, mental and social health. The aim of this study was to determine variables considered as enablers and barriers to participation in health programmes.

METHODS

The conceptual framework of the study was developed and population health interventions were operationalised as health programmes. A total of 805 older adults participated in a questionnaire survey. The questionnaire included questions about socio-demographic, health and social connectedness-related factors as well as participation in population health interventions/programmes. Multiple logistic regression was used to examine the relationship between respondents' characteristics and participation in the intervention.

RESULTS

Participation in health programmes was declared by 316 respondents. The enablers of participation were general practitioner's affability (OR = 2.638 [1.453-4.791], p = 0.001), three or more social activities (OR = 3.415 [1.477-7.894], p = 0.004), taking part in support groups (OR = 4.743 [1.255-17.929], p = 0.022) and involvement in Universities of the Third Age (OR = 2.829 [1.093-7.327], p = 0.032). The barriers were primary education (OR = 0.385 [0.215-0.690], p = 0.001), infrequent general practitioner's appointments (OR = 0.500 [0.281-0.888], p = 0.018) and lack of social activity (OR = 0.455 [0.299-0.632], p < 0.001).

CONCLUSION

The enablers of participation appeared to solely include variables regarding health service utilisation, patient experience and social activity, i.e., interpersonal and community relationships, not intrapersonal factors.

Knowledge about the COVID-19 and ways of its prevention among Medical University of Warsaw students

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.

Promoting implementation of “Good and Best Practices” through Health Promotion and Prevention Registries

Health promotion and disease prevention programme registries can play an important role in increasing transparency of “good/ best Practices” and promoting their implementation. In the EU, there are different approaches to how registries seek to support the implementation of practices. However, there is limited knowledge of the extent to which there are informative differences or overlaps in the mechanisms chosen for accreditation, capacity building and implementation. This presentation focuses on six national registries in the EU (Finland, Germany, Italy, Netherlands, Poland, Slovenia) and the European Public Health Best Practice Portal. Information was obtained through a working group on Good/ Best Practice Portals, established in 2019. Information on the process of adding good/best practices to the registry and on measures that promote implementation was gathered and evaluated through a descriptive case comparison. The comparison suggests that implementation can be promoted through different approaches for capacity building measures and incentives for implementation. The latter included funding resources, titling/awarding of practice and professional feedback in only a few registries. Registries may be useful not only for transparency of good and best Practices but also for implementation through capacity building and several incentives. The information provided in this presentation may be informative in guiding development of similar resources elsewhere and a starting point for discussion on how to support best the implementation of good/ best practices.

The way from stakeholders’ needs research to the public health policy and practice

The implementation of the project “ProfiBaza” was the unique opportunity to effectuate a data set with the possibility to showcase for the first time in Poland which public health (PH) interventions are taken and whether they cover population health needs. In order to be forethoughtful to this challenge, the needs of stakeholders within the health system were investigated. Particularly, considering the widely recognised knowledge-practice gap in the PH field. We would like to demonstrate the results of a needs analysis related to: the accessibility assessment of the information about PH interventions; the need of establishing a good practices database regarding health promotion and disease prevention; the possibility to use research findings in PH practice. All those would be presented from the perspective of researchers, politicians, decision makers and PH institutions. This research was conducted as a questionnaire-based survey and focus group interviews. Researchers were asked to assess the compatibility between the PH research and the population health needs. The group of health sector decision makers were questioned about the usage of the information available in the ProfiBaza for the process of evidence-based decision making; local government politicians - to assess their readiness to implement health programmes, use the good practices database and build partnerships for health while representatives of various sectors - to assess the need of initiating a knowledge translation platform via the launched ProfiBaza system. The results of the research demonstrate that there is a need for: solidified collaboration between different types of PH stakeholders, mobilization, coordination, sharing experiences, creating networks of cooperating institutions, which will enable the effective response to emerging challenges and opportunities and to counteract the phenomenon of dispersion of efforts in improving health and reducing social inequalities in health.

Hospitalizations of Ukrainian Migrants and Refugees in Poland in the Time of the Russia-Ukraine Conflict

BACKGROUND

In the face of a sudden influx of several million migrants and war refugees from Ukraine to other European countries, knowledge about the health of Ukrainian citizens becomes increasingly important. The aim of the study is to identify the main health problems of hospitalized Ukrainian citizens residing in Poland in the period from 2014 to June 2022.

METHODS

This study is based on hospitalization data of Ukrainian patients in Poland taken from the Nationwide General Hospital Morbidity Study.

RESULTS

The study group covered 8591 hospitalization records. We observed two hospitalization peaks, one in patients aged 0-5 and the other one in those aged 20-35. After the official outbreak of the war, 2231 Ukrainian citizens were hospitalized in Poland. At this time, the most often reported principal reasons for the hospitalizations of adult women were diseases related to pregnancy, childbirth and the puerperium, whereas in groups of adult men diseases were related to injury, poisoning and certain other consequences of external causes, and in children and adolescents diseases were infectious and parasitic diseases.

CONCLUSIONS

Our findings may have implications for healthcare policies and service provision to newly arrived migrants and war refugees in target European countries.

Congenital herpes simplex virus infection among hospitalized infants in Poland

INTRODUCTION AND OBJECTIVE

Congenital herpes simplex virus infection (cHSV) is a rare entity and may pose a life-threatening disease for the newborns. Due to the public health and clinical importance of cHSV infection in infants, the recent data on this disease in Poland should be investigated. The aim of the study was to evaluate the incidence and other factors related to cHSV.

MATERIAL AND METHODS

The study is retrospective, population-based that utilised the hospital discharge records of cHSV patients. Data were obtained from National Institute of Public Health NIH - National Research Institute in Warsaw, Poland, covering the period 2014-2019.

RESULTS

The study group consisted of 1,573 cHSV newborns (841 males and 732 females). Among this group, 70.1% were infants up to 90 days of age and 3.6% were neonates up to 28 days of age. The mean and median age was 98 days (95% CI: 94.5-101.8, SD 74) and 70 days (IQR: 53-104), respectively. Based on the hospital registry the overall average cHSV incidence over the study period was estimated to be 69 per 100,000 live births. The number of cHSV infection fluctuated over the years 2014-2019 with a significant decreasing trend from 2015-2019 (P<0.01). A significantly higher cHSV incidence was observed among patients from urban than rural areas of Poland (88 vs 40/100,000 live births; P<0.001).

CONCLUSIONS

CHSV incidence may be related to multifactorial conditions for the occurrence of this disease. Further studies on changes in the incidence of cHSV are needed.

Dichotomy of lay people and health professionals perception of physical activity is a challenge for activity education and promotion within primary health care - a qualitative study

INTRODUCTION

According to the WHO, healthy adults aged 18-64 should perform at least 150 min of moderate-intensity aerobic physical activity (PA), or at least 75 min of vigorous-intensity PA, throughout the week, or an equivalent combination of moderate and vigorous activity. These recommendations should be promoted and involved in primary health care (PHC) staff daily practice. Tailoring the education message depends on peoples' perspective on PA, but in Poland there is no research on the subject.

OBJECTIVE

The aim of the study was to explore and compare the perception of lay people (LP) and health professionals (HP) of PA to find similarities and differences in their perspective - as this may have an impact on PHC-based education on PA (favourable or unfavourable).

MATERIAL AND METHODS

Six mini FGIs were carried out. Research sample consisted of 16 LP from urban settings and 10 HP (doctors, nurses).

RESULTS

LP and HP appreciated PA as important and considerably controllable health determinant. LP attributed the main gains of PA to psycho-social benefits, and HP strictly to diseases risk reduction. Both groups had difficulties in defining PA and doubts abounded about PA and exercise. Optimal dose (volume) of PA was generally unclear and the WHO recommendation were unknown. HP seemed to be more eager than LP to appreciate simple forms of PA, e.g. walking. Barriers to PA perceived by LP were described in terms of 'real life' factors (sportswear, access, job), and HP mostly by cognition (knowing, judging) and social status. LP preferred positive, rewarding motivation for PA, but HP one that was negative and fear-based.

CONCLUSIONS

Referring to activity, LP and HP were like travellers in parallel universes. This created challenges in PHC-based education. Some suggestion for PA education were given. More qualitative and quantitative research are needed.

Financing of Immunization Programs by Local Government Units in Poland as an Element of Health Policy

Introduction: The scope and schedule of immunization in Poland is regulated by the Immunization Programme prepared and announced by the State Sanitary Inspector. There are two kinds of vaccines: compulsory vaccines, financed by the state budget at the disposal of the Minister of Health, and vaccines recommended by the central health authorities but financed by local governments within health policy programmes. Compulsory vaccines cover people up to 19 years of age and individuals at higher risk of infections. The public health programmes organized and financed by local governments play an important role in infectious disease control in the country. Objective: The objective of this study is to analyse health policy programmes including immunization programmes, which were developed, implemented and financed by local government units of all levels in Poland between 2016 and 2019. Material and Methods: This analysis covers data compiled by voivodes and submitted to the Minister of Health as annual information on public health tasks carried out by local government units. From the aggregate information, data on all health policy programmes conducted by individual local government units between 2016 and 2019, including immunization, were extracted and analysed. The data were obtained pursuant to the provisions of the act on access to public information. Results: In the analysed period, local government units implemented a total of 1737 health policy programmes that financed the purchase of vaccines, qualification tests for immunization and carrying out immunization by authorized medical entities. Among the vast majority of programmes, promotional activities were also implemented. Conclusions: In Poland, local governments are deeply engaged in the immunization of their citizens by organizing and financing specific health care programmes. These programmes are an essential addition to the state financial resources in infectious disease control. This engagement expresses local government maturity regarding the health needs of the population and public health measures. Communes are the most engaged units among all levels of local governments. It is probably due to close mutual communication between the people and local governments. The growing awareness of the important role of HPV immunization in the prevention of cervical cancer among local government units is reflected in the increase in the number of girls vaccinated against HPV and the increase in financial resources allocated for primary HPV prevention. The decrease in the number of people vaccinated against pneumococci may result from including pneumococcal vaccines in the compulsory immunization schedule.

[What is the effect of social distancing on the course of COVID-19 epidemic?]

COVID-19 pandemic challenged both public health specialists and authorities to implement non-pharmaceutical interventions aimed at limiting the spread of SARS-CoV-2 infections. The concept of social distancing is about limiting contacts between people, which breaks virus transmission chains, delays the increase in the number of infected people in the population and prevents overloading of health care systems. Many countries, including Poland, implemented a number of interventions aimed at limiting the number of infections and slowing down the tempo of the pandemic's spread. These are, among others, mass-scale testing, isolation of infected individuals, hand hygiene, breath etiquette and wearing mascs. Apart from these, a number of restrictions were enforced to ensure social distancing, such as closing down schools and universities, forbidding organising large parties and mass gatherings, limiting travels and use of public transport, increasing awareness of the public opinion on the necessity to stay at home, up to even introducing full lockdown with only the right to go out to buy food and medication or use the health care system. These interventions were gradually introduced in particular countries, in different ways, to a greater or lesser extent. Their effectiveness is largely influenced by the socio-economic and cultural factors, the nature of political and healthcare systems as well as the operating procedures used during their implementation. The implemented social distancing strategies prove to be effective, especially when combined with such actions as mass-scale testing, tracking contact chains, isolation and quarantine. The current work aims at making an overview of selected social distancing strategies and assessing their effectiveness in slowing down COVID-19 epidemic.

Cerebrovascular diseases in Poland-inconsistent seasonal patterns of hospitalisation and mortality

Background

A seasonal variation in the incidence of cerebrovascular diseases still remains inconsistently evidenced. Herein, we analyse the monthly patterns of two health phenomena: hospital admissions and deaths due to these diseases.

Methods

We identified 69 511 cases of hospital admissions and 14 956 deaths due to cerebrovascular diseases (ICD10: I60-I69 and G45) among the inhabitants of five Polish voivodeship capitals in 2004-13. The method of time series analysis (exponential smoothing with linear trend and monthly additive seasonality) was applied to calculate the monthly specific seasonal indices. The monthly variation in an in-hospital fatality and nonhospital deaths were also analysed.

Results

A summer season reduction in number of cases was observed for hospital admissions and deaths. Interestingly, the winter season effect is much more complex, mainly due to the contribution of December, when a high mortality is accompanied by a substantial decrease in the hospitalisation level. This unique discrepancy was observed for all the studied cities. Moreover, this month is characterised by a notably high in-hospital fatality. However, neither the number of non-hospital deaths nor the average length of hospital stay or the kind of hospitalised diseases evidenced that cerebrovascular problems were more serious in December than in any other month.

Conclusion

The obtained results confirmed a seasonal variation in cerebrovascular diseases among the inhabitants of Polish cities. Habitual and administrative limitations in hospital activities observed every December do not seem indifferent from the patient health's perspective since they may lead to a low hospitalisation level and a high in-hospital fatality.

Trends in Hospitalization of Children with Bacterial Pneumonia in Poland

AIM

The aim of the study was to evaluate the hospitalization trends in children aged 0-6 suffering from bacterial pneumonia in the years 2007-2011 in Poland.

METHODS

The data pertained to the hospitalized patients diagnosed with the diseases registered as J13-J15 according to ICD-10.

RESULTS

In the years 2007-2011, the hospitalization rate increased from 16.3/10,000 to 44.1/10,000 for boys and from 13.8/10,000 to 33.0/10,000 for girls. The most frequently hospitalized children were between 1 and 2 years of age (90.6/10,000 for boys and 58.0/10,000 for girls in 2011). The average length of stay (LOS) of the investigated children fell from 10.1 days in 2007 to 8.2 days in 2011. The longest stays were recorded for the youngest children, under 2 years of age (from almost 11 days in 2007 to around 9 days in 2011).

CONCLUSION

Bacterial pneumonia is a serious problem of public health and especially babies are at high risk of this disease. Given the effects of vaccinations against Streptococcus pneumoniae conducted all over the world and to a limited extend in Poland as well, further steps towards vaccinating children against pneumococci should be taken in Poland.

Public health physicians and dentists in Poland: results from public health workforce pilot study

BACKGROUND

Monitoring public health workforce is one of the essential functions of the public health system.

OBJECTIVE

The aim of the study was to identify the specialities for physicians and dentists related to public health in the years 1951-2013, and analyse of available data on physicians and dentists certified as public health specialists (PHS) in 2003-2015.

MATERIAL AND METHODS

The historical analysis covers a relevant regulations of a minister in charge of health. The data on PHS were obtained from the Centre of Medical Exams and included: the number of specialists and their demographic characteristics, professional background, spatial distribution. Density was also calculated.

RESULTS

The public health specialty was introduced in 1999. Before there were specialties in disciplines related to public health. In the years of 2003-2015, 360 physicians and dentists were certified as PHS. The majority of them had former background in another discipline, mostly related to clinical medicine. The average age of specialists was 47.2. Currently, the average age of specialists is ca. 57.6 years, with a prevalence of people aged 61-70 years (36.9%). PHS tend to be older than specialists in other disciplines. Over three fourths of PHS were certified in 2004. With the exception of that year, the public health specialist title was annually obtained by an average of 9 persons. The density of PHS in Poland was 0.94 per 100 thousand inhabitants, ranging between 0.16 and 3.12 in a given voivodeship.

CONCLUSIONS

The analysis has revealed numerous obstacles in estimation of the number of PHS and indicated a lack of relevant mechanisms aimed at workforce development. A relevant policy for developing public health workforce is urgently needed.

[Issues in conducting health education of patients by primary care physicians]

INTRODUCTION

Patients' health education involves forming their knowledge, attitudes and skills as well as exercising impact on their behaviour in order to maintain or improve one's health. Here, a special role is to be played by primary care physicians.

AIM OF THE STUDY

to estimate conditioning factors and frequency of undertaking health education of patients by primary care physicians.

MATERIALS AND METHODS

A survey study was executed with 800 family physicians, with 520 respondents actually returning the questionnaire (response rate--65%). The instrument contained questions concerning socio-demographic and professional situation of physicians, their health state, health behaviours and undertaking health education to patients in their own professional practice. The assessment of the strength of relationships between characteristic features and attitudes of physicians and their undertaking health education to patients was conducted with multinomial logistic regression.

RESULTS

Almost 60% of the respondents declare undertaking health education of patients. Facilitating factors here are family medicine specialization (OR=1.68 [1.11-2.53]), workload of under 50 hours a week (OR=1.67 [1.14-2.43]), living in a town under 100,000 inhabitants (OR=1.56 [1.08-2.27]), staying married (OR=1.55 [1.03-2.33]) and being on a diet (OR=3.22 [1.78-5.85]). Those physicians who work in their profession less than 10 years undertake health education significantly less frequently than their colleagues with a longer work experience (OR=0.57 [0.36-0.90]).

CONCLUSIONS

Many physicians (40.1%), especially young inhabitants of cities, do not undertake health education of patients at all. A considerable obstacle in undertaking educational activities seems to be physicians' excessive workload. Those physicians who declare undertaking health education of patients use the knowledge acquired during specialization training (family medicine) or work experience connected with the length of work in the profession. Thus, in order to intensify and optimise primary care physicians' activities with respect to health education of patients it is essential to include this topic in the curricula ofpre- and post-diploma courses as well as family medicine specialty training.

[Generalized self-efficacy in relation to anti-health behaviours of general practitioners exemplified by smoking]

The purpose of the present work is to make an assessment of generalized self-efficacy of general practitioners and to investigate its relationship with socio-demographic factors and undertaking risky behaviours taking smoking as an example. The participants of the research encompassed 500 general practitioners aged 27-75 living in Poland. The participants' level of generalized self-efficacy was measured first, then, the relationship between generalized self-efficacy, socio-demographic variables and GP's attitudes towards smoking was investigated. The averaged level of GP's generalized self-efficacy was 29.425 +/- 3.64, which is within high referential values. There have been statistically significant relationships between self-efficacy and sex of the participants (men achieved higher scores than women). There have been no significant differences found in the perception of self-efficacy in terms of age and marital status. Statistically significant relationships between generalized self-efficacy and smoking were found only with general practitioners addicted to smoking and smoking every day (in this group, the GSES score was 29.34; SD = 3.60, while in the non-smokers' group the score is significantly higher and is 31.19; SD 4.23). When implementing protective actions related to smoking special attention needs to be devoted to the psychological resources stimulating pro-health activity, including generalized self-efficacy.