During the COVID-19 pandemic, an increasing number of infections and a need for medical consultations forced the society to implement remote forms of contact with patients. The aim of this study was to analyze the experiences and preferences of patients regarding the doctor-patient relationship. A quantitative study was conducted using the CAWI technique. The study involved 1011 adult patients who were consulted by their family physicians. The patients generally declared unfavorable changes regarding their access to medical services. While comparing the experiences before and during the pandemic, most patients (70.3%) revealed that they had difficulties accessing their family physicians. Many patients (83.1%) preferred a personal visit as a form of consultation. Identification of the constraints relating to the COVID-19 pandemic can contribute to optimizing the health care system, particularly the organization of remote medical consultations. 

Knowledge of primary and secondary colorectal cancer prevention among young people in Poland

Colorectal cancer-specific mortality in Poland exceeds the average for European Union countries. The aim of this study was to assess the knowledge about colorectal cancer and primary and secondary prevention. The original questionnaire was used in the study. 184 randomly selected respondents were included in the analysis (mean age 35 years). Only half of respondents knew the correct definition of screening test and only one-third of respondents correctly indicated the target group of Colorectal Cancer Screening Program in Poland. The main source of information about colorectal cancer was internet, rather than physicians and nurses. Lower knowledge of colorectal cancer was reported among respondents from small cities and villages, with less education and unemployed. The knowledge about colorectal cancer prevention is insufficient among polish population. Education seems to be an important part of health promotion, especially among people with low awareness of cancer risk factors and screening test.

Evaluation of the model of environmental treatment of persons with double diagnosis

The study presents the results of the evaluation of the community treatment model Together, we can do more, which is based on the assumptions of community psychiatry. The described model is an example of a form of assistance recommended by WHO for people with serious mental disorders. The evaluation of the treatment model was based on data obtained from therapists and family members of patients with dual psychiatric diagnosis (PDP). Formative evaluation (evaluation of the program implementation process) and summative evaluation (evaluation of results – e.g. in the form of obtained support) were performed. In terms of evaluating the goals and process of the program, the focus was on the size and type of support received by the patient. The outcome evaluation indicator was the assessment of the patient’s functioning in various areas of everyday life, outside the medical system. Self-care, establishing relationships with other people, the ability to use public institutions, mental state, including awareness of addiction/disease have improved. There was also a reduction in the burden on the family with the patient’s mental problems. The evaluation of the environmental treatment model showed significantly longer duration of specialist care than hospitalization. According to the Statistical Yearbook of the Healthcare Institution (2019), the average length of stay in a psychiatric ward in Poland fluctuates around 1 month. In the discussed model, the average duration of participation in the project by a person with PDP was 8 months, with a standard deviation of 5.4.

The data security of medical records – the legal and practical issues

The purpose of this article is to present selected legal provisions regulating the issue of keeping medical records in medical care providers – its scope and principles, as well as to indicate the legal aspects of the security of data aggregated as part of medical records. Specially that medical records are increasingly being kept in digital form. Assuming that the legal conditions in the national legislation are sufficiently defined, the key is- sue is, on the one hand, to indicate the practical conditions for ensuring the optimal (under given conditions) level of computerization of medical care providers and on the other hand – the related level of data security – from the IT point of view. This article, in addition to the conclusions from the analysis of the applicable legislation, presents practical observations related to the application of legal provisions in medical care providers, which are based on the knowledge and professional experience of the author. The point of reference is the assumption that the overriding element of activities for data security, especially about the health of patients, is the awareness of the “key user”, which is always almost every person in the medical facility staff.

The programs for open disclosure of adverse medical events to patients

The aim of this study is to present and compare programs for open disclosure of adverse medical events to patients by medical personnel. Australia, Canada, and the United States, based on apology laws, procedures, medical staff handbooks, training, and fair culture, have implemented solutions that focus on the needs of the patient after the adverse event. It has been proven that a proper patient communication process can reduce the number of claims brought against staff or medical institutions. However, there are barriers to communicating adverse events to patients. These are ingrained in the “deny and defend” strategy, which does not promote a culture of learning from mistakes. The paper also discusses the second victim syndrome, which is the second victim of an adverse event such as medical personnel experiencing emotional damage after an incident.

The use of the National Health Fund databases as a source of real-world evidence

Patient medical records and administrative healthcare databases are possible sources of real-world evidence (RWE), i.e., evidence on the potential benefits and risks of a medical product. RWE can complement the evidence from randomized clinical trials. The wide range of information collected by the National Health Fund (NFZ) and the Ministry of Health in Poland ensures the versatility of the data that cover almost all patients treated in Poland. In addition to administrative data (without detailed information about patients and their disease), electronic medical records of some patient groups can be obtained from special programs (e.g., KOS-Zawał) or the System of Monitoring Drug Programs (SMPT). Low usage (only 37 studies) but high usability of NFZ databases as a source of RWE were identified. Joint analysis of data from administrative databases and SMPT can increase the credibility of the study, but limits the study to only patients treated within the Drug Programs.

Methods and tools of Lean Management in hospital management – case studies

Lean Management is a management concept whose main goal is to support the management and employees in improving the entity. The concept of Lean Management is of particular importance in the healthcare sector. Its importance in the improvement of health care units resulted in the creation of a subdiscipline of management called Lean Healthcare. The main goal of the empirical research undertaken is to show the role and importance of selected Lean Management methods and tools in health care units. The main research method used in the research procedure was a case study of selected health care units that implemented Lean Management methods and tools in their facilities. The method of analyzing the content of documents of the surveyed units was also used. The most frequently used Lean Management methods and tools in the surveyed healthcare units include: Kaizen, Kanban, Just-in-Time, 5S, A3, Takt Time, Value Streams Mapping, Visual Management, Gemba, Pull system. The surveyed entities decided to implement them mainly due to the desire to eliminate the phenomenon of waste, improve the quality of services and improve the area of services provided. The research also showed that the LM methods and tools implemented by the surveyed units brought measurable organizational, operational, logistic, financial and image benefits. Lean Management in healthcare units brings measurable benefits and multi-range benefits. However, special attention should be paid to the barriers and difficulties that individuals in this sector may encounter in implementing LM methods and tools. The health care sector is specific, so implementing changes in the units representing it should take into account counteracting possible, identified implementation barriers.

Malnutrition among result from inappropriate eating behavior that leads to changes in body weight. Consuming excessive amounts of salt, sugar, carbonated drinks, alcohol or inactivity causes overweight or obesity. To prevent malnutrition, it is necessary to prevent nutrition and to motivate prohealth behaviors that should be targeted at a given group of society. Thanks to this, it may limit or even exclude the emergence of eating disorders, which intensify the increase in the incidence of civilization diseases. The aim of the article is an attempt to present selected elements of lifestyle. The survey was addressed to 3rd grade students from 2 public secondary schools (189 boys and 178 girls). A proprietary questionnaire entitled “My health – I care for them” was used for the study. The questionnaire included questions about the diet, forms of spending free time and participation in physical education classes at school. Watching TV is the most common form of spending free time (37% boys and 32% girls). Only 7% of girls and 18% of boys chose participation in sports as a form of spending their free time. 28% of boys and as much as 31% of girls admitted that they do not participate in physical education classes. The type of drinks consumed by students was significantly dependent on their gender. The sandwich is chosen by 31% of boys and 23% of girls. Fruit is declared by 28% of the surveyed girls and only 2% of boys. Research has shown that there are many abnormalities in the diet of adolescents. The widespread belief that a slim figure is an asset nowadays prompts many people to use many slimming diets or fasting, which when used excessively can pose a threat to the developing organism. The respondents also show insufficient physical activity. Students more and more often choose passive recreation, because physical activity does not give them as much satisfaction as playing on a computer.

Selected practical aspects of General Data Protection Regulation in public health

This article presents the characteristics of selected practical aspects related to the need to apply the provisions of the so-called General Data Protection Regulation (GDPR) in institutions classified as public health. The basic element of the considerations is the presentation of examples of violations of the provisions of the GDPR, and more broadly the provisions relating to the protection of personal data, which, observed in the daily functioning of selected public health institutions, may be an incentive to take preventive measures in all such institutions. At the same time, this paper presents potential remedies that may also take the form of so-called good practices. Being aware of the difficulties in applying the provisions of the GDPR, the authors, by presenting their observations, want to contribute to the discussion on the practical aspects of personal data protection in the area of public health, both in its practical and scientific terms.

The Dutch guaranteed Benefit Health Basket – an example for reformers

In the process of searching for nearly half a century of new possibly effective forms of satisfying the health needs of societies, which have been undertaken with limited success in all countries of the world, an exceptional position should be attributed to the experience in the Netherlands. There are many reasons: not only the success of the changes carried out, not only the concept of a guaranteed health benefits basket confirmed by practice, not only the rarely used mechanism of competition between payers, but above all the consistency in the long-term preparation of a comprehensive change in the health system. At the same time, the constant dialogue with the society was not neglected, which allowed it to treat the introduced changes as its own.

In this paper, the theme of medical neutrality is highlighted, in particular, the definition of the concept and principles are defined, and examples of medical neutrality violation through the prism of armed aggression in Ukraine are given. Medical neutrality is seen as a social agreement that obliges society to protect health workers both in time of war and peacetime, and obliges medical personnel to provide medical care to all, regardless of religion, race, ethnic origin, political affiliation or other characteristics. The internationally coordinated system for the observance of human rights is clarified, attention is focused on the guarantees enshrined in Protocol I regarding the provision of medical care, as well as on the international axioms of the protection of medical workers and guarantees of their professional activity in martial law conditions, defined in Protocol I.

The issue of legal assessment of the professional activity of medical workers in the territories in which the aggressor state has established or is trying to establish an occupation regime is revealed, and a fine line between the essence of the concept of medical neutrality and the professional activities of medical workers in the temporarily occupied territories is stated, which emphasizes the need for clarity and certainty in the presentation of legal norms to prevent human rights violations.

This publication is an analogue of the report on the review of the state of the health care system of Ukraine since the beginning of the war. This report was presented as a part of an international event—a special meeting on the topic “War in Ukraine and public health,” organized on May 22, 2022 by ASPHER (Association of Schools of Public Health in the European Region). The speech not only indicated the terrible consequences and the humanitarian crisis due to military aggression by Russia, but also partially considered multiple issues: 1) state of sanitary and epidemic wellbeing of Ukrainian citizens and threats to the health of the population during the war; 2) needs which can be met by organizations such as ASPHER to strengthen human resources for Ukraine in the field of public health; 3) steps which must be taken in the shortest possible time to strengthen the restoration of the Ukrainian healthcare system and ensure the proper state of sanitary and epidemic well-being of the population.

Since the beginning of the Ukrainian War, ASPHER has been mobilized to provide its best contribution to the search for an immediate and long-term response. The reason for this strong mobilization is that the present war represents a risk of the greatest magnitude to European Health and, inherently, to Public Health in the countries covered by ASPHER.

Efforts have been made in providing scientific and technical advice related to Public Health to reinforce closer cooperation between Schools of Public Health, in particular between those in peripheral countries to the theatre of military operations, and theoretical training, given the near absence of an educational offer from Schools of Public Health (SPH) in this area of knowledge. A Public Health War Roadmap is also under construction.

This article is essentially the closing speech of the Gdansk Meeting promoted by ASPHER together with the local School of Public Health, which seeks to express ASPHER’s position on the war in Ukraine and what, in its opinion, should be done by the SPH.

Key words: public health, Schools of Public Health, public health in wartime, Ukrainian war

Since February 24, 2022, the hybrid war between Russia and Ukraine has been transformed into a very severe and open military conflict, having dramatic humanitarian and public health consequences – first of all, for the Ukrainians, but also for the whole world, in various dimensions. The impacts of this war are complex, multidimensional and multilateral. This paper aims to characterize the selected major impacts of the ongoing war on public health, as well as to characterize the selected reactions of the international academic public health community, including especially the three organizations from Moldova, Poland and France. Several positive responses of the academic community to the unprecedented humanitarian and public health crises caused by the Russo-Ukrainian war have been described. These efforts should be continued, developed and modified to the dynamically changing situation. The already existing international cooperation platforms, networks and alliances should be used for that purpose.

Public health plays a crucial role in restoring, protecting and promoting health of affected populations in times of war and armed conflict. Even though health effects of war are well explored, the development of competencies to address the public health impact had received little attention in public health curricula. We suggest building upon the WHO-ASPHER Competency Framework originally designed to strengthen Public Health Services in the European Region. It provides an already established framework for Schools of Public Health and additional public health organizations and, at the same time, can be extended to understand and prevent the political, economic, social, and cultural determinants of war.

Euthanasia – characteristics of legal aspects in Poland and selected European countries

This article presents the characteristics of the legal aspects of euthanasia in Poland and in selected European countries. The key element of the considerations is the presentation of the legal regulation of euthanasia in Poland against the background – often detailed and precise solutions adopted in the European countries (specially EU), which define the legal conditions for carrying out this type of “medical services”. These solutions are presented from the point of view of the legal conditions for ensuring the legality of treatments falling within the concept of “euthanasia”, which in European legislation are most often classified as “assisted suicide” treatments and are associated with the provisions of the so-called “living wills”. The authors intended the article to be part of the discussion on potential changes in Polish legislation.

Background: The study originated from the authors’ coursework in health technology assessment and rational pharmaceutical policy.

Purpose: To respond to the question of whether there is a global problem of access to medications by providing differentiated backgrounds and possible solutions or mitigation strategies for boosting the population’s access to medications.

Method: Thematic content analysis (TCA) was performed on paper-based data. Findings: 39 documents were included, including 22 articles, eleven technical reports, two books, one book chapter, and three websites. Drug accessibility issues affect four major categories – essential, innovative, orphan, and highly-priced medicines. Access to these medications is nevertheless hampered for several reasons, including patents; prohibitive costs; fluctuating production; market unprofitability for rare diseases; and delays in innovative treatments, even in developed countries.

Conclusion: Efforts to boost drug access should target all sectors – public, private, and non-governmental – and should forge ties with pharmaceutical firms and key health care institutions.

* This study arose from the authors’ coursework “Health Technology Assessment and Rational Pharmaceutical Policy” for the European Public Health Master: Europubhealth+ Studies, which was funded by the European Union’s Erasmus+ Program. 

Conditions for introducing a new medical profession (physician assistant) in the polish health care system

Shortage of medical staff is a growing problem in most countries, also in Poland. There is a growing demand for medical staff in connection with longer life expectancy and on a macro scale, the aging of society. An important idea for reducing this problem is to introduce new medical professions. However, this issue arouses controversy and opinions on it are divided. The paper presents data on the number of physicians in Poland compared to other European countries and discusses selected proposals related to attempts to improve the situation in this area. Reference has also been made to the example of the United States, where physician assistants have been functioning for many years. Moreover, the current outline of a proposal for the occupation of a physician assistant in Poland has been presented, with particular emphasis on specialization in “surgical physician assistance”. The paper also presents the results of the author’s study on the attitude of primary care physicians towards new medical professions and refers to the opinions of the medical community in this respect, mainly from websites. Finally, the paper presents conclusions and recommendations for further actions related to the introduction of new medical professions in the country.

Analysis of the hierarchy of motivational factors in the work of nurses

Introduction: Employees incentive scheme is one of the main components of human resource management in any modern organization. A properly functioning incentive system enabling an effective motivation process allows to utilize the potential and commitment of employees, which directly affects the efficient functioning of a given facility. The aim of the study was to establish the hierarchy of motivational factors and the relationships that exist between them in the group of nurses working in one of the network of healthcare centers in the city of Kraków.

Materials and methods: The survey was conducted among 79 nurses working in several healthcare centers. The study uses the method of a diagnostic survey with the use of a research technique in the form of a questionnaire. The questionnaire contained demographics questions and the “Self assesment scale of work motivators” by Stefan Tokarski. Results: The study uses the terms “dominant motive” and “meaningless motive”.The research showed that the most numerous group of respondents chose “job security” as the dominant motive. At the lowest level in the hierarchy of respondents were “possibility of promotion” and “independence”. The research also uses the term “leading motive”, which was designated as the one with the highest score in the hierarchyof respondents’ motives, but not necessarily the dominant motive. Conclussions: Research has shown a relationship between seniority and the choice of the leading motive. Among the respondents, the group with work experience over 20 years showed significant leading motives. These included “job security”, “relationships with colleagues” and “earnings”. The remaining groups did not show any visible leading motives. The research also showed a relationship between education and the classification of motivators. The group with a master’s degree assessed the relations with their superiors significantly lower compared to other motivating factors.

Evidence based public health policy and the COVID-19 pandemic

Public health has always sought to use scientific findings in health-enhancing activities. At the end of the twentieth century, a program to use scientifically validated evidence in public health – evidence based public health (EBPH) – was formulated. Rigorous application of evidence was supposed to guarantee effective and efficient interventions. When the global threats of Covid 19 pandemic appeared, it seemed to be a great opportunity for EBPH to reaffirm its value. Societies, as well as governments, could have hoped that scientifically equipped public health would be able to cope well with the threat. However, reality has brought disappointment. It turned out that public health does not have enough confirmed evidence to support policymakers. In many situations, both politicians and medical doctors had to make quick and inevitably intuitive decisions, without documented evidence. The pandemic has forced the need to search for evidence more quickly, but it has raised the question of whether the procedure for validating evidence must be as rigorous as it had been recommended in the past. Under pressure emerging needs, a number of evidence-based recommendations have been prepared and offered to decisionmakers to be used.

The knowledge of young adults on the subject of dental erosion

Dental erosion is a result of the contact between tooth surfaces and acids, processes occur that result in progressive hard tooth tissue reduction. Its characterized by progressive and irreversible changes that not only affect the aesthetics of a tooth, but also oral health. Poor eating and hygienic habits, as well as some diseases, significantly increase the risk and rate at which erosion develops.

The purpose of this study was to evaluate the knowledge of young adults on the subject of dental erosion, and specifically to assess their knowledge about the nutritional factors that may predispose them to dental erosion.

The study involved 250 individuals between the age of 18–30 who were divided into two groups. The study was conducted in 2020 using a survey, and was then statistically analyzed using the STATISTICA PL 10 program (UJ license). Differences in the distributions between the two groups were verified using the chi-squared test and the non-parametric Mann-Whitney U test at the significance level ≤0.05.

In results 13.2% of participants declared that they experience dental erosion The study has evaluated the general knowledge of the young adults as being sufficient. Most of the young adults did not differentiate dental erosion from tooth decay, and had difficulty in answering questions on nutritional and hygienic risk factors. The groups did not differ from each other in terms of general knowledge about dental erosion. Both groups had a similar frequency of consuming high dental erosion products and drinks (sweetened carbonated beverages, citrus fruits, energy or isotonic drinks). The groups also differed in terms of reported symptoms and diagnosed conditions, in which tooth sensitivity and eating disorders significantly affected young adults with dental erosion.

The young adults showed many gaps in their knowledge of dental erosion. That is why education plays a key role in this area and is extremely important, especially in regards to nutritional factors and hygienic habits.

Knowledge of adult inhabitants of Małopolska on nutritional fac tors in the development of color ectal cancer

Most cases of colorectal cancer are related to lifestyle, including eating habits. The aim of the study was to assess the level of knowledge of the inhabitants of the Małopolskie Voivodeship regarding specific food ingredients and nutritional behaviors that are important in the development of colorectal cancer depending on selected socio-demographic factors, as well as the assessment of the nutritional status of the respondents.

The study was conducted among 144 adults, residents of Krakow and the village of Gródek nad Dunajcem. The analyzes included responses from 126 people (89 women and 36 men). The diagnostic survey method was used, while the research tool was the original questionnaire. The first part of the survey concerned selected nutritional behaviors of the studied group, while the second part assessed the knowledge of nutritional risk factors for colorectal cancer. In addition, data on lifestyle, socio-economic data and participation in screening tests for the diagnosis of the lower gastrointestinal tract in the year preceding the study were collected.

In the adopted assessment scale, the level of knowledge of the respondents differed significantly, taking into account the place of residence (p = 0.0363), where 41% of Krakow’s residents found it very good, while 43.8% of rural residents found it insufficient. People living in the city have almost three times greater chance of getting a higher level of knowledge than people living in the countryside. Also, the knowledge of the respondents who declared higher consumption of portions of fruit and vegetables was 2–3 times higher than those who consumed these products less frequently.

The level of knowledge on nutritional behaviors related to the development of colorectal cancer is insufficient among rural residents. People who demonstrate favorable nutritional behavior have greater knowledge about modifiable cancer risk factors.

The aim of the article is to present selected issues related to the impact of the pandemic on the universality of e-health services, as well as to show the readiness to use such services by the inhabitants of urban and rural areas in Poland. Several hypotheses are launched regarding the COVID-19 effect in relation to the implementation, use and access to e-health services and the skills needed to use them.

The article includes an analysis of the legal and social context accompanying organisational changes in the health care system caused by the presence of the COVID-19 virus, as well as an analysis of the results of quantitative research on the attitude of rural residents to such solutions. Data obtained in a study from the WE Patients Foundation provide some insight into the complexity of factors governing e-health use, showing less differences between city and rural areas than we hypothesised.

Corruption is commonly defined as the abuse of entrusted power for private gain. It is estimated that over 500 USD billion are lost every year due to corruption and that a 1-point change in the control of corruption indicator measured by the World Bank increases life expectancy by 0.44 years and reduces under-five mortality by 4.6 per 1,000 infants. Despite its global prevalence and critical impact on public and private services, corruption in the healthcare sector remains understudied. The present report aims to expand the knowledge on the paramount need to tackle corruption in healthcare by identifying the actors in the health system at risk to involving in corrupt practices, followed by defining health corruption from the governmental, non-governmental organisations, and societal perspectives, together with describing relevant corruption indicators from countries from the WHO European region. To conclude, this report presents a set of proposals and recommendations to address corruption in the healthcare sector.

The health programs in the perspective of the conditions of the health care system in Poland

This article presents the characteristics of health programs implemented from public funds in Poland which are based on generally applicable laws. The key element of the considerations is the presentation of the tasks of the public payer (National Health Fund) in the implementation of health programs. This issue is presented in the perspective of the conditions of the health care system in Poland.

Prezentowane wspomnienia o zmarłym 8 lutego 2022 r. Krzysztofie Kuszewskim stanowią wyraz uznania środowiska zdrowia publicznego dla Jego życiowej działalności, która wywarła duży wpływ na rozwój tej dziedziny w najnowszej historii nauk o zdrowiu w Polsce.

Cezary Włodarczyk, Janusz Opolski, Andrzej Koronkiewicz, Jacek Putz, Janusz Meder, Paweł Roszkowski, Paweł Goryński, Rafał Halik, Katarzyna Kwiatkowska, Magdalena Krysińska-Pisarek, Olga Partyka, Stanisława Golinowska, Andrzej Fal 

The paper presents the information on COVID-19 policy response in Italy inin the second half of 2020, when the second wave of the pandemic occurred. It builds on the authors previous report (1) that addressed the first wave of the COVID-19 pandemic. In Italy, from October till December, the number of SARS-CoV-2 infections increased significantly. However, the Italian government, unlike many other European governments, refrained from introducing a second nationwide lockdown.  The pandemic was managed through a system of localized interventions (on a regional and / or provincial basis) which significantly varied across the regions. At the end of December 2020, a national plan for vaccination against COVID-19 was approved. In February 2021, together with the change of government, a new public policy against the COVID-19 pandemic was formulated. 

Key words: COVID-19 pandemic, health policy, Italy, public health, policymakers

In a previous report we answered a number of questions by the editors about the Dutch strategic policy in the first half year of the SARS-CoV2 crisis. In the present paper we reply to a number of additional questions of the editors about the steps put by the Dutch policy during the second half of 2020, when the SARS-CoV2 and COVID-19 pandemic developed its second wave. Especially, the awareness of an upcoming second and third epidemic waves, the specific preventive actions and measures taken by the government and the changing compliance and trust of the public in the government’s strategy are described. Actions such as the Dutch test strategy, the division of regional vs national competences, partial and complete lockdowns, and cooperation with other member states and the (or their lack) are also briefly treated. Specific temporary and structural adjustments in the public health and health care system are mentioned.

No hard conclusions or qualifications about the adequacy of the Dutch public health and health care policy are drawn. Nevertheless, in retrospect it is clear that a straightforward, focussed and highly effective strategy in this unprecedented crisis by a new and dangerous and rapidly mutating virus is a great challenge for every country. Many things go well, but many more could or should have be done better. We have to learn, also from each other.

Key words:  COVID-19, health care systems,   lockdown, Netherlands, pandemic,  public health, public policy, SARS-CoV2

The Vaccinations during COVID-19 pandemics in Poland

When pandemics Covid 19 hit Poland, the people’s readiness to observe the recommended rules of rational healthy behaviour was partially hampered by the lasting activities of anti-vaccination circles which were appearing at grass root level and among parliamentary politicians. These activities were supported by a component the medical persons who provided an impression of professional authority. This situation to the growing scepticism in the face of rational sanitary recommendations, the fact what was revealed the social attitudes investigations. Decision-makers’ negligence who implemented many inappropriate legislative measures also contributed to the disappointing effects. Sometimes the authorities tried to withdraw partly from this mistake - obligatory masks wearing is an example - but such facts did not strengthen people’s willingness to follow recommendations. The authorities abandoned its concern of employees and clients health and refused to equip the management with the rights to check up their vaccination status. Following the same line the Government confirmed the Universities could not verify the students’ vaccination status or implement any restrictions for unvaccinated. The rectors trying to undertake any measures were criticised.

It is justified to assert that decision-makers’ mistakes contributed at least partially to smaller efficiency anti-pandemic interventions, than this was potentially possible.

Key words: anti-vaccination movements, face coverings, mobility restrictions, pandemics Covid 19, Poland, pandemic intervention, personal protection equipment, social attitudes

Assessment of the impact of the Covid-19 pandemic on the realization of rehabilitation services financed by NFZ in Poland in 2020.

 The National Health Fund finances rehabilitation services contracted in two scopes, therapeutic rehabilitation and health resort treatment. The aim of the study is to assess the impact of the Covid-19 pandemic on the realization of rehabilitation services financed by the National Health Fund in Poland in 2020 compared to the previous years (2016-2019). The paper also discusses the implementation of successive regulations regarding rehabilitation during Covid-19 pandemic in Poland in 2020. Based on the analysis, it was shown that the number of patients who benefited from rehabilitation services in Poland financed by the National Health Fund decreased by 17% in the case of services in the field of therapeutic rehabilitation in 2020 compared to 2019 (the largest decrease, amounting to 80%, was observed in the case of pulmonary rehabilitation provided in the conditions of a day center or ward) and by 50% in the case of health resort treatment services.

Key words: medical rehabilitation, National Health Fund, Covid-19, coronavirus, health services

Identification of key actors involved in the implementation of a regional functional model for hospital evaluation

The concept of Hospital-Based Health Technology Assessment (HB-HTA) is conducive to the rationalization of decisions made by the hospital management regarding the implementation of innovative medical technologies in hospital units.

This type of HTA is a bottom-up hospital initiative, but usually it is also supported systemically and involves other entities, such as: the Agency for Health Technology Assessment and Tariff System, the payer, or regional authorities. Providing support to the hospital in making the final decision on the implementation of innovative medical technology may include such aspects as: obtaining necessary funding for the implementation of technology, identification of the competitive potential of the planned project, or following the HB-HTA methodology in reporting.

The process of decentralization of hospital management in Poland induces scholars to carry out research and draw conclusions about the involvement of regional authorities, mainly voivodeship offices and their departments responsible for health issues, in the HB-HTA process.

The primary objectives of this paper are to present the results of research and analysis of the development and popularization of HB-HTA in Poland. These will be discussed in relation to the implementation of a regional functional model for hospital evaluation of innovative medical technologies and the creation of rules of cooperation between important institutions of sectoral (health) policy to support and develop HB-HTA at the regional (voivodeship) level, as well as the dissemination of knowledge, popularization of HB-HTA, and promotion of good practices.

Implementation of Hospital-Based Health Technology Assessment (HB-HTA) with the coordinating role of independent external organization

Hospital-Based Health Technology Assessment (HB-HTA) aims to support local decision-making on investing in new health technologies limited to the hospital level. The goal of this study was to prepare and present the strategic functional model of HB-HTA in Poland with coordinating role of an organization labelled as the independent external organization (NOZ). The stakeholders of the HB-HTA process were identified, together with their interests and relations among them, as well as the goals and consequences of health policy in area of implementation of HB-HTA in Poland. The conduct of HB-HTA process was presented, the tasks foreseen for NOZ, its possible organizational forms, barriers, and possibilities of development; as well as the overall capacity of this organization in area of HB-HTA. It is foreseen that the development of HB-HTA in Poland based on NOZ should take place within a positively inclined environment, having a generally positive impact on the health care system, positive prognoses, and opportunities for implementation of HB-HTAh.

The functional model of the Hospital-Based Health Technology Assessment (HB-HTA) with the coordinating role of the Agency of the Health Technology Assessment and Tariff Systems

The article presents the functional model of the HB-HTA (Hospital-Based Health Technology Assessment) project implementation with coordinating role of the Agency of the Health Technology Assessment and Tariff Systems.

The functional model of Hospital-Based Health Technology Assessment with coordinating role of the Polish National Health Fund

The article presents the concept and the conduct of the HB-HTA (Hospital-Based Health Technology Assessment) project implementation with coordi­nating role of the Polish National Health Fund. The main stakeholders of the HB-HTA process were identified, together with their interests and barriers in the area of the implementation of HB-HTA in Poland.

Mixed functional model HB-HTA with the coordinating role of the Regional Center for Investments supported by the Polish National Fund and Agency for Health Technology Assessment and Tariff System

The implementation of the strategic model for hospital health technology assessment in Poland requires the involvement of many stakeholders. HB-HTA fundamentally concerns hospitals and how they rationalize decision making in implementing innovative medical technologies. However, the need to obtain public funding after verifying the effectiveness of a given medical technology or to keep up with the evolving HB-HTA method­ology naturally requires the involvement of both the payer (NFZ) and the Agency for Health Technology Assessment and Tariff System in activities connected with the implementation and development of HB-HTA. An important aspect of the coordination of activities in relation to hospital HTA is also the support given to hospitals by regional authorities – competent health departments in voivodeship offices – by assessing HB-HTA reports prepared by the hospitals and indicating regional competitive potential of a given medical technology. This creates a hybrid/mixed system of insti­tutional support for innovative medical technologies implemented in hospitals.

This institutional plurality within HB-HTA is a clear asset, strengthening the hospital’s planned undertaking substantively and financially, especially when the assistance mechanisms undertaken are flexible, soft in nature, and allow hospital units to shape effective HB-HTA activities.

The Resolution of Public Health Committee Polish Academy of Science on Vaccination against COVID-19

Public health community worldwide encouraged by successes of former campaigns have always accepted vaccination as the most effective way to handle infectious diseases pandemics. Even before the outburst of SARS-CoV-2 pandemic in many countries mandatory vaccination against many diseases, especially child related had been implemented. From among 193 countries under study in as many as 105 (54%) such obligation existed and in 62 of them (59%) at least one form of punishment or harm for those opposing was involved. Following this sort of available solutions and facing COVID-19 pandemic disaster the authors on behalf of the Public Health Committee of the Polish Academy of Science recommend to the government implementation od mandatory vaccination against COVID-19 for all workers in sectors of health care, education and welfare.

Politicians and Experts – Poland and USA during pandemic COVID-19

During pandemic COVID-19, politicians responsible for developing strategies to combat the virus play a significant role and make key decisions in this regard. An important role is also played by national experts who advise and provide scientific knowledge to governments to ensure the highest possible level of security for the whole society. The analysis of Polish and American politicians and experts gives a comparison in terms of actions, opinions and positions taken. In both countries, important national expert institutions participated in the fight against the pandemic, and government advisory teams for the COVID-19 pandemic were established. There were numerous problems with both health systems and a lack of consistency between the recommendations of experts and politicians, which resulted in a loss of public confidence. This difficult situation in which all countries in the world find themselves may be a good lesson for future threats.

The importance of medical Staff competences influence on the effectiveness of healthcare

Limited financial and infrastructure resources, but above all, lack of staff, and at the same time increasing need and patients’ awareness is the leading problem that the health care sector in Poland is facing. Determining the dependence of medical staff competences and effectiveness of patients’ health care in health care units might be of high importance in the process of managing medical facilities. Determining these relations will allow proper measures to be taken aiming at increasing the effectiveness of patients’ health care and also improving functioning of the medical facilities. This paper looks into the issue of assessing the competences of medical staff. These competences were determined by their scope, systematization, core, and the role they might play in patient treatment and care in health care unites. The core of the analyzed competencies are knowledge and skills. Identification and reinforcement of these competences may have crucial influence on the quality and effectiveness of health care having its roots in adequate medical staff management at the medical facilities.

Waiting Times for Diagnosis and Treatment in Breast Cancer and the Impact of Measurement on the Improvement of the Standard of Services Provided

Mortality rates for malignant breast cancer are rising in Poland. This is a subject of growing concern and a focus of public debate about cancer care in Poland. The following paper presents a case study—an attempt to measure and analyze waiting times for diagnosis and treatment in breast cancer. The survey was carried out in one of the regional cancer care centers in Poland. The data were collected solely from hospital information systems.

The overall waiting time (mammography to treatment) was median 35,5 days. Waiting time since diagnosis (results of core needle biopsy to treatment) was median 27,5 days. The analysis has been conducted twice. In between the center implemented several organizational changes. They resulted in shortening of waiting time for mammogram description—from 4 to 1 day (median) also the waiting times for core needle biopsy result has been shortened—from 6 to 4 days (median). However, the overall waiting time has not changed significantly.

Fixed assets in public and private healthcare in 1999-2018

The presented article deals with the subject of fixed assets in healthcare: their gross value, condition and degree of wear, broken down into the public and private sectors. Above the value grew extremely strongly in the analysed period, particularly impressive in private healthcare. The financing of this growth seems to have the largest share of funds obtained from EU and the EEA Financial Mechanism and the Norwegian Financial Mechanism as well as from public payer funds. The rate of increase of funds in healthcare from other public sources is significantly lower than, for example, the rate of GDP growth, which may indicate the withdrawal of state structures from healthcare financing. The increase in the degree of wear of fixed assets, which took place in the analysed period, may cause some concern.

Remarks on COVID-19 Pandemic in Poland. A Health Policy Perspective

Occurrence of the COVID-19 Pandemic was totally unexpected, and governments of all countries were surprised. Pandemics always raises the feel­ing of fear and health policy is interested in such phenomena. In this specific case it was fully justified as COVID-19 was new and unknown. Every­where the populations found themselves in psychological position presented years ago by Ulrich Beck in book Risk Society. Influencing and shaping society’s emotions – both feelings of safety and feelings of fear had a fundamental importance for social behaviour.

In time when first information about COVID-19 came from China and Poland was still free from any infection, the government’s representatives tried to play down the seriousness of the virus and equated the COVID-19 to a seasonal flu. At that time, it could have been justified as an attempt to avoid panic. But with the first episodes of infections the tone of messages essentially changed, and the virus was presented as a lethal danger. Such a con­text was applied as a direct rationalization of general lockdown and a broad catalogue of restrictions in social contacts.

However, when The Presidential Election was approaching (with the act of balloting demanding presence of people in a polling station), the content of messages presented to the public changed again. In the new version the virus itself was shown as rather innocent and the pandemic was contained and under control. In this way all voters, including elderly people, were encouraged to take part in the election.

If lessons are to be drawn from the past, we might conclude that in time of a pandemic, the instrumental management of social emotions and feel­ings is not always the best way of communicating with the general public.

A Polish nurse during SARS-CoV-2 pandemic – various aspects of following a nursing profession

A nurse as well as a midwife belong to independent professions which inherently involve performing numerous tasks and functions in various areas and in various positions, which simultaneously requires from these professions respecting the rules of law. In health-threatening conditions, for example during a pandemic, especially when all social groups are exposed to danger and when danger arises unexpectedly, nurses become an im­portant link in the process of providing health security to everybody who needs it. In such situations nurses are obliged to perform their professional duties as well as possible and, at the same time, they have to tackle numerous family responsibilities. No matter if they take direct care of patients infected with SARS-CoV-2 virus or those possibly suffering from COVID-19, work as university lecturers teaching prospective nurses or hold mana­gerial positions, they always face professional difficulties and dilemmas or even real dangers. Although the challenges which nurses face during the pandemic tend to change week by week, nurses, with time, learn to respond to them for the sake of other people’s welfare.

In the absence of effective drugs that could be used in the treatment of infection caused by SARS-CoV-2, behavioral methods of preventing infection have become important in counteracting the epidemic, including wearing protective masks. A historical overview of the epidemic and the introduc­tion of the mask order allows an epidemic to be better understood not only as a biological event, but also as a social process. Many countries have enforced the wearing of masks in public despite conflicting opinions about whether their use could prevent transmission of the coronavirus from one person to another. In Poland, the content of the official message on the effectiveness of wearing masks was changing, ultimately introducing the obligation to cover the mouth and nose with masks or an element of clothing in generally accessible places.

Medical rehabilitation in Poland during the COVID-19 pandemic. Regulatory and organizational issues

The medical rehabilitation system in Poland includes various rehabilitation services, financed by various institutions, including the NFZ, ZUS, KRUS, PFRON and local governments. The aim of the study is to identify the most important problems and limitations of this system, especially in the context of the COVID-19 pandemic. The most important issues to be solved and proposed reforms of the medical rehabilitation system in Poland presented in recent years were identified. The impact of the COVID-19 pandemic on this system, providing rehabilitation services and problems related to the im­plementation of further legal regulations in the first months of the pandemic were discussed. One of the most important recommended changes is the implementation of the comprehensive care model and the activities aimed at coordinating various elements and levels of rehabilitation.

Activities of public health authorities to combat COVID-19 in selected European countries

The coronavirus pandemic has contributed to great changes in the functioning of modern societies, not just in the medical dimension. The percep­tion of the health care system and its employees has also changed.

The aim of the article is to analyze the approach of public authorities to combat the spread of SARS-CoV-2 virus in the following countries: Belgium, Bulgaria, Denmark, France, Germany, the Netherlands, Spain, the United Kingdom and Poland. The research material was information available on the website of the European Observatory of Health Systems and Policies (EOHSP) in a special section dedicated to issues related to the prevention of coronavirus pandemic (https://www.covid19healthsystem.org/mainpage.aspx).

The obtained results indicate that the crisis situation caused by the COVID-19 pandemic forced all countries to undertake diversified, non-standard efforts, i.e. the use of their own pharmaceutical sector for the production of disinfectants or acceleration of obtaining licenses by medical practition­ers. In terms of financing one of activity was generation of additional funds for healthcare systems that were financially heavily burdened in the pandemic era.

With more than 6.5 million known cases and nearly 195,000 deaths as of 9 September 2020, the United States has been gravely affected by the COVID-19 Pandemic. The nation’s response can only be described as inconsistent and ineffective. The role of the once preeminent US Centers for Disease Control has been undercut. The extent of infection and death can be attributed to the failure of many Americans to wear masks and maintain physical distance, appropriate behaviors which the nation’s political leadership has advocated to some degree but failed to adopt in practice.

Wśród licznych analiz dotyczących kryzysu zdrowotnego wywołanego pandemią COVID-19 autorzy poszukiwali takich, które pozwolą na ocenę rozwiązań instytucjonalnych. Postawili tezę, że istnienie dobrych instytucji (z odpowiednimi regulacjami, środkami i zapleczem eksperckim) stanowi niezbędny zasób umożliwiający szybkie, trafne i efektywne działania ochronne oraz lecznicze.

Autorzy zwrócili się do ekspertów z innych krajów, z którymi od wielu lat współpracują w dziedzinie zdrowia publicznego, aby tym razem, wykorzystując kompetencje w dziedzinie ochrony zdrowia, odpowiedzieli na pytania dotyczące zarządzania publicznego (governance) w pierwszym półroczu wybuchu pandemii (od stycznia do czerwca 2020), kiedy powszechnie zastosowano lockdown i stopniowo z niego wychodzono. Co szczególnie znaczące dla oceny zarządzania w sytuacji kryzysu zdrowotnego, zaproszeni do współpracy eksperci reprezentują kraje różnorodne pod względem: decentralizacji państwa, struktury społecznej, posiadanych zasobów, także organizacji ochrony zdrowia i tradycji politycznej w uzgadnianiu spraw spornych.

Raporty z Włoch, Holandii, Zjednoczonego Królestwa, Norwegii, Niemiec, Czech, Ukrainy oraz Kanady (w tym z prowincji Ontario) – załączone jako apendyks – uzupełniano bezpośrednimi konsultacjami. Analiza pozyskanych informacji oraz wymiana opinii stanowią przedmiot artykułu. W analizie porównawczej odwołujemy się także do polskich działań i rozwiązań. Polska perspektywa zarządzania publicznego jest wyrazem troski o zaniedbany obszar zdrowia publicznego. Artykuł wzbogacony jest refleksjami autorów oraz ogólnie sformułowanymi rekomendacjami.

Public governance of the health crisis in the first six months of the global COVID-19 pandemic. Comparative analysis based on the opinions of experts from selected countries

From among the numerous analyses of the health crisis caused by the COVID-19 pandemic, the authors looked for those that would enable assessment of institutional solutions. They put forward the thesis that good institutions (with appropriate regulations, means and expert support) constitute an essential resource enabling fast, accurate, and effective measures in terms of protection and therapy.

The authors turned to experts from other countries with whom they have been cooperating for many years in the field of public health and used their competences in the field to answer questions about public governance in the first six months of the pandemic outbreak (January to June 2020) when lockdowns were widely implemented and then gradually lifted. Particularly significant for the assessment of health crisis management, the experts chose countries that are diverse in terms of: state of decentralization, social structure, and resources available, as well as healthcare organization and political tradition in dispute resolution.

Reports from Italy, the Netherlands, United Kingdom, Norway, Germany, the Czech Republic, Ukraine, and Canada (with focus on Ontario) – attached as an appendix – were supplemented with direct consultations. The comparative analysis of the obtained information and the exchange of opinions are the subject of this article. In the comparative analysis, we also refer to Polish activities and solutions. The Polish perspective of public management signifies a concern for the neglected area of public health. This article is enriched with the authors’ reflections and generally formulated recommendations.

Since the beginning of the COVID-19 pandemic, Italy was one of the worst-affected European countries. The rapid surge of cases and the limited capacity of intensive care unit departments have posed a serious threat to the Italian national health system. In this paper we describe the first response and the main measures carried by Italian policy makers, as coordinated by a governmental committee of public health experts, which have succeeded in preventing the pandemic from turning into a disaster. Early closure of the school, quarantine measures and lockdown were put in place and the response of the population has been good overall.

Despite the Italian health care system of universal coverage is considered the second-best in the world, during phase 1, the Italian decentralisation and fragmentation of health services probably restricted timely interventions and effectiveness. In northern Italy, Lombardy, Emilia Romagna, Piedmont, and Veneto, which reported most of the Italian cases, carried out different strategies against COVID-19, with great differences in testing, quarantine, and public health procedures.

The improvement of the epidemiological situation has allowed an easing of the restrictive measures, with a progressive restarting of work activities. The government and technical-scientific bodies have prepared health strategies to support a possible second epidemic wave in the autumn.

The authorities’ first responses were the classification of COVID-19 as Group A-disease in the sense of the Law on Public Health, scaling up of regular crisis control structures, installation of an Outbreak Management Team OMT and a “National Operational Team-Corona”. COVID-surveillance is done by the RIVM (National Public Health Institute), and is based on data from Municipal Public Health Services (GGDs) supplemented with additional (inter)national sources. The OMT is the main advisory body regarding preventive measures and includes experts from relevant medical specialisms. Organisations of medical professionals gave separate advices. Sanctions to preventive measures can be fines and closure of accommodations. Initially, 80% of the population trusted the government’s messages and “intelligent lockdown” strategy. The Prime Minister’s addresses to the people were highly appreciated. However, at slow-down of the outbreak (May-June) society’s trust crumbled (“quarantine-fatigue”). The initial testing policy was very restricted and contrary to WHO’s adagium “Test, test, test!”. In June the Minister of Health announced that a capacity of 30.000 tests per day was achieved, to be scaled up to 70.000. The crises management’s primary concern was to increase the (ICU-)bed capacity and was achieved by transforming regular wards into COVID-care, setting-up external “Corona-wards” in hotels, and regional, interregional and crossborder spreading of COVID-patients. This focus on ICU-bed capacity was criticized, as half of the death cases and extreme equipment shortages occurred in other sectors (nursing homes, homecare, homes for the elderly, psychiatry, mental handicaps). Transformation of hospital wards also led to waiting lists for non-COVID care. End of June the government presented a step-by-step easing of the lockdown in which a fine-tuned epidemiological surveillance dashboard and the continuation of economical support for the economic sector are the backbones.

The outbreak of the COVID-19 pandemic has resulted in various public health responses around the globe. Due to the devolved powers of the United Kingdom, the response has been centralized but simultaneously greatly differing across England, Wales, Scotland, and Northern Ireland. The following article examines the governmental responses to the outbreak, the public health measures taken, data collection and statistics, protective equipment and bed capacity, the society’s response, and lastly, the easing of the lockdown restrictions. In terms of the governmental response, the COVID-19 pandemic was initially met with less urgenon/populacy and social distancing, along with the development of herd immunity, were first mentioned. As the virus continued to spread, the government started imposing stricter measures and a lockdown was implemented. Tests were conducted using a five pillar typology. The collection of information, particularly on COVID-19 associated deaths, varied across the United Kingdom and among the governmental organizations due to differing definitions. In term of hospital bed availability, the rate of hospitalizations was the highest from late March to early April of 2020. Temporary hospitals were constructed, however, they mostly went unused. The United Kingdom society was generally compliant in adapting to the lockdown and trust in the government rose. Nonetheless, as the lockdown progressed, trust in the government began to fall. After several months, the rate of infection decreased and the lockdown in the United Kingdom was lifted in accordance with ‘Our plan to rebuild: The United Kingdom Government’s COVID-19 recovery strategy’. The slogan ‘Stay at Home. Protect the NHS. Save Lives’ was replaced with ‘Stay Alert. Control the Virus. Save Lives’.

Pandemics sudden influx claimed reaction from national authorities to protect their societies and ensure an operative functioning of the public health care. This article explains how the Norwegian government reacted in this unpredictable situation, which lockdown option was chosen and what economic consequences the applied measures might bring. How to weight public health against economic offers and future downturn? Trade-offs are compound and it is too early to conclude which country has made the best choice.

The Czech Republic initially managed the outbreak of the novel coronavirus remarkably, with relatively few cases and low death rate. Its public health response was characterized by swift implementation of public health measures driven by an implicit precautionary principle, but also chaotic communication of measures and a lack of transparency in justifying individual policies. June and July 2020 have seen a rise in COVID-19 cases linked to two regional clusters but later associated with community transmission, which exposed weaknesses in the country’s test-trace-isolate system.

In this article, the governmental response to the COVID-19 pandemic in Ukraine is described, starting from the first detected cases, up until the summer of 2020. Pandemic caught Ukraine’s health care system in the midst of a reform. At the time of COVID-19 outbreak, the first steps of primary health care reform were already being implemented while the reform at the secondary health care level were about to started. However, changes of the political environment (due to the elections 2019), two changes of the Minister of Health (since the beginning of the pandemic), the absence of the general plan of action followed by the inconsistent political decisions, and the uncertainty in financing mechanisms of the secondary health care facilities, made the COVID-19 pandemic challenging for Ukraine. The Ukrainian government had difficulties in devoting additional recourses to medical facilities to protect medical professionals and provide treatment for patients. Instead, as a main intervention to combat COVID-19, the government implemented lockdown from 12 of March to 12th of May that only postponed the raise of infections, preserved lives. While the pandemic still had a highly negative impact on the economy, initial analysis indicate that lockdown could be considered effective from the economics point of view.

In late January 2020, the first COVID-19 case was reported in Canada. By March 5, 2020, community spread of the virus was identified and by May 26, 2020, close to 86,000 patients had COVID-19 and 6,566 had died. As COVID-19 cases increased, provincial and territorial governments announced states of public health emergency between March 13 and 20, 2020. This paper examines Canada’s public health response to the COVID-19 pandemic during the first four months (January to May 2020) by overviewing the actions undertaken by the federal (national) and regional (provincial/territorial) governments. Canada’s jurisdictional public health structures, public health responses, technological and research endeavours, and public opinion on the pandemic measures are described. As the pandemic unravelled, the federal and provincial/territorial governments unrolled a series of stringent public health interventions and restrictions, including physical distancing and gathering size restrictions; closures of borders, schools, and non-essential businesses and services; cancellations of non-essential medical services; and limitations on visitors in hospital and long-term care facilities. In late May 2020, there was a gradual decrease in the daily numbers of new COVID-19 cases seen across most jurisdictions, which has led the provinces and territories to prepare phased re-opening. Overall, the COVID-19 pandemic in Canada and the substantial amount of formative health and policy-related data being created provide an insight on how to improve responses and better prepare for future health emergencies.

The first positive case of COVID-19 in Canada was reported on January 25, 2020, in the city of Toronto, Ontario. Over the following four months, the number of individuals diagnosed with COVID-19 in Ontario grew to 28,263 cases. A state of emergency was announced by the Premier of Ontario on March 17, 2020, and the provincial health care system prepared for a predicted surge of COVID-19 patients requiring hospitalization. The Chief Medical Officer of Health and the Minister of Health guided the changes in the system in response to the evolving needs and science related to COVID-19. The pandemic required a rapid, concerted, and coordinated effort from all sectors of the system to optimize and maximize the capacity of the health system. The response to the pandemic in Ontario was complex with some sectors experiencing multiple outbreaks of COVID-19 (i.e. long-term care homes and hospitals). Notably, numerous sectors shifted to virtual delivery of care. By the end of May 2020, it was announced that hospitals would gradually resume postponed or cancelled services. This paper explores the impact of the COVID-19 pandemic on multiple health system sectors (i.e., public health, primary care, long-term care, emergency medical services, and hospitals) in Ontario from January to May 2020. Given the scope of the sectors contributing to the health system in Ontario, this analysis of a regional response to COVID-19 provides insight on how to improve responses and better prepare for future health emergencies.

Agency for Health Technology Assessment and Tariff System in health care system in Poland

Drug prices – theory and practice

The design, assessment, implementation, monitoring and evaluation of health policy programs

* Przygotowanie do wydania elektronicznego finansowane w ramach umowy 637/P-DUN/2019 ze środków Ministra Nauki i Szkolnictwa Wyższego przeznaczonych na działalność upowszechniającą naukę.

* Przygotowanie do wydania elektronicznego finansowane w ramach umowy 637/P-DUN/2019 ze środków Ministra Nauki i Szkolnictwa Wyższego przeznaczonych na działalność upowszechniającą naukę.

Literature search strategy for Health Technology Assessment Reports   

* Przygotowanie do wydania elektronicznego finansowane w ramach umowy 637/P-DUN/2019 ze środków Ministra Nauki i Szkolnictwa Wyższego przeznaczonych na działalność upowszechniającą naukę.

* Przygotowanie do wydania elektronicznego finansowane w ramach umowy 637/P-DUN/2019 ze środków Ministra Nauki i Szkolnictwa Wyższego przeznaczonych na działalność upowszechniającą naukę.

This paper describes the provision of long-term care across Europe based on data gathered in a desk research. The aim is: (1) to identify indicators of long-term care provision; and (2) to compare the provision of formal and informal care across the European countries. For this purpose, a narrative literature review was carried out to identify relevant indicators. Subsequently, a descriptive analysis was performed to analyse the indicator-related data. The results suggested that there are important differences in the long-term care provision in Europe. Long-term care is provided both at public and private institutions. The entitlement criteria vary among countries. In general, Western and Northern European countries have more generous provision of residential care compared to Eastern and Southern European countries. At the same time, informal care has different roles and it is extremely important in Eastern and Southern European countries. Among all countries, more than half have quality assurance regulations for residential care. However, most of the Southern and Eastern European countries lack information about the quality assurance regulations. In order to monitor the long-term care provision, it is recommended that European countries establish a reporting system to provide annual data. These annual data should be based on identical measurement mechanisms and standardised reporting structure to allow for comparison and improvements of long-term care systems.

* Przygotowanie do wydania elektronicznego finansowane w ramach umowy 637/P-DUN/2019 ze środków Ministra Nauki i Szkolnictwa Wyższego przeznaczonych na działalność upowszechniającą naukę.

Despite the growing interest in the sustainability of long-term care (LTC) systems, only a few studies have investigated the differences in the LTC financing across European countries. The objective of this paper is to describe the financing of LTC in Europe. For this purpose, we use indicators on LTC financing taken from international databases and reports. Desk research was carried out to identify relevant indicators. Hierarchical cluster analysis was used to identify typologies in LTC financing across the EU/EEA countries based on seven indicators selected. We found large differences in LTC financing across the EU/EEA countries in terms of total expenditure, the division of expenditure between the social and health care system, and in the role of in-kind and cash benefits. Four main financial models across the EU/EEA countries could be distinguished. Further, we identified some shortages in data reporting on the financing of LTC services. Some limitations and contradictions related to the indicators of LTC financing are highlighted. In particular, we stress the need for more comprehensive data to enable further cross-country comparisons and to provide valid input for policy.

* Przygotowanie do wydania elektronicznego finansowane w ramach umowy 637/P-DUN/2019 ze środków Ministra Nauki i Szkolnictwa Wyższego przeznaczonych na działalność upowszechniającą naukę.

The provision of good quality long-term care to citizens represents a challenge for many European countries due to tight public budgets and ongoing societal transitions. To gain insights on the future of long-term care in Europe, an explorative study was conducted consisting of a review of policy reports and qualitative study among country experts from Albania, Bulgaria, France, Germany, Lithuania, the Netherlands, Poland, Portugal, Ukraine, and the United Kingdom. For the purpose of the analysis, a conceptual framework was developed. Based on this framework, the method of qualitative directed content analysis was applied to extract and analyze information from the reports and study transcripts. The results suggest four key directions for long-term care development: a) integration, coordination and cooperation across structures and actors for better service quality; b) increased scope and scale of formal service provision; c) improved workforce planning and capacity building; d) use of e-health and information technologies. The exact direction is however dependent on the country-specific guiding principles, governance capacity and funding constraints. To adequately respond to current challenges, policy-makers need to acknowledge the interconnectedness of long-term care issues and approach them from a more holistic perspective.

* Przygotowanie do wydania elektronicznego finansowane w ramach umowy 637/P-DUN/2019 ze środków Ministra Nauki i Szkolnictwa Wyższego przeznaczonych na działalność upowszechniającą naukę.

End-of-life communication between the physician and the relative of dying nursing home residents

The aim of this paper was to summarize the current knowledge about the end-of-life (EOL) communication between the physician and the relative of dying nursing home (NH) residents. A review of literature showed that relatives of dying residents reported low satisfaction with quality of communication with a physician. The relatives complained they were not informed about the residents’ condition, did not understand the information provided by the physician and did not participate in the discussion about the residents’ wishes concerning medical treatment. In conclusion, (1) the concept of quality of EOL communication between the physician and the relatives of the dying NH residents still has no well-grounded foundation, (2) the number of tools for evaluation of EOL communication in the NH is limited, (3) physician-family communication is one of the most important aspects of care at the EOL, (4) many factors may influence it, but one of the most important is the availability of a physician in the NHs.

* Przygotowanie do wydania elektronicznego finansowane w ramach umowy 637/P-DUN/2019 ze środków Ministra Nauki i Szkolnictwa Wyższego przeznaczonych na działalność upowszechniającą naukę.

Population ageing has been affecting all countries across the European Union (EU). To address the challenges resulting from this process, a healthy ageing strategy has been proposed. Healthy ageing aims at keeping older people in good health and independent as long as possible, and thus, improves their wellbeing. The aim of this paper is to present the EU healthy ageing policy, based on a review of EU documents related to this concept. A method of narrative literature review using a snowball approach has been applied.
The results of the review show that healthy ageing is a broad concept which covers various issues, such as promoting health enhancing behaviour, disease prevention, changing the social perception of older people and providing conditions for the independent living of older people. Healthy ageing has often been dominated by active ageing strategies which are focused on increasing older people’s labour market participation and social involvement. The EU actions in the area of healthy ageing include: increasing awareness and encouraging relevant stakeholders to undertake actions to address the needs of older people (e.g. the 2012 European Year for Active Ageing and Solidarity between Generations), providing funds (e.g. Health Programmes) and providing platforms for cooperation and exchange of good practices (e.g. the European Innovation Partnership on Active and Healthy Ageing). 

* Przygotowanie do wydania elektronicznego finansowane w ramach umowy 637/P-DUN/2019 ze środków Ministra Nauki i Szkolnictwa Wyższego przeznaczonych na działalność upowszechniającą naukę.

The role of professional competences in matching the qualifications of medical professionals with the requirements of health care services

The aim of the article is to indicate the role of professional competences in adjusting the qualifications of medical workers to the requirements of the patients treatment process. The article presents the activities of EU and the Polish labour ministry aimed at increasing the role of competences in the labour market policy. It also shows exemplary connections of competences with tasks of family nurse, competence profile in 12 selected medical professions, social competences and personality traits, important for the performance of various medical services. Information on competences is contained in the “Information on occupations”, prepared by the Ministry of Family, Labour and Social Affairs. The analysis in the article leads to the conclusion, that not all descriptions of competences are adapted to the specificity of medical work. They must not be used as a benchmark for the development of competence profiles in a particular healthcare organization. 

Przygotowanie do wydania elektronicznego finansowane w ramach umowy 637/P-DUN/2019 ze środków Ministerstwa Nauki i Szkolnictwa Wyższego przeznaczonych na działalność upowszechniającą naukę.

Phenomenon. The process of career decision making by medical students has been the subject of many studies analyzing the choice. However, the studies have not analyzed determination of global priorities for the criteria of choice or alternatives regarding the choice of medical specialty. The goal of this paper is to determine the weights (priorities), factors and alternatives involved in the choice of specialty for year six medical students.

Approach. A sample of 202 final-year medical students at the Medical University was examined using Saaty’s Analytic Hierarchy Process. During interviews, the students used the Saaty’s scale to pair various factors influencing their choice of medical specialty. Analysis was performed to evaluate the crucial decisive criteria and various decisive models.

Findings. When choosing the medical specialty, the highest rank was given to “individual physician’s aptitude and expected professional attainment” (P = 0.4748), followed by “the features of the medical specialty” (P = 0.3636) and “the process of training for the specialty” (P = 0.1616). The most important sub-criteria were “intellectual qualities and competencies useful in practicing the specialty”, “place of work” and “opportunity to create one’s own medical practice”. A model of specialty choice was obtained. The most important criteria of choice were “opportunities for professional career in healthcare entities”, “place of work”, “opportunity to create one’s own medical practice” and “expected income”. 

Insights. Understanding the factors influencing choice of specialty enables workforce planning to meet local and national healthcare needs. It also helps optimize the profile of medical education courses offered by medical universities. The results obtained, although limited in their generalisability, may support organizing specific curricula and strategies to encourage the choice of specialties in short supply. 

Przygotowanie do wydania elektronicznego finansowane w ramach umowy 637/P-DUN/2019 ze środków Ministerstwa Nauki i Szkolnictwa Wyższego przeznaczonych na działalność upowszechniającą naukę.

Coordination as an element of modern medical care in oncology

The number of patients suffering from chronic diseases, including oncology, has been systematically increasing in recent years. There is a shortage of doctors and nurses in Poland, and the actions taken within the healthcare system, they focus primarily on securing typically medical needs. Staff in medical facilities are often unable to fully meet the needs of patients. For the treatment to be effective, it must be carried out with the participation of a patient who should experience the greatest comfort and sense of security during therapy. The patient should also have full knowledge about his condition and receive information enabling him to find himself in the health care system. Modern medical care should also include non-medical aspects of patient support. Numerous publications indicate the importance of comprehensive healthcare. It is not possible to build an optimal model of care for a chronically ill patient without strengthening medical staff. The experience of people who, since 2015, have been coordinating oncological treatment as part of their duties, indicates that treatment coordination must be formalized and assigned to a specific person should belong to the duties of this professional category in order to deprive this process of signs of randomness. Therefore, it becomes necessary, firstly, to model and define this function precisely, and secondly, to begin the systematic and comprehensive education of future coordinators. 

Przygotowanie do wydania elektronicznego finansowane w ramach umowy 637/P-DUN/2019 ze środków Ministerstwa Nauki i Szkolnictwa Wyższego przeznaczonych na działalność upowszechniającą naukę.

The reforms of the healthcare system (market economy of the sector) have changed the requirements for Poland’s hospital directors. Consequently, ever greater numbers of non-doctors have been appointed to these positions in recent years. One of the responses to this change in the requirements has been directors undertaking postgraduate studies in order to enhance their qualifications or by others to meet the requirements included in recruitment competitions to select a director. The research conducted in 2017 on a group of 137 directors found out that the majority of respondents completed at least one postgraduate course of study. The groups more often undertaking a course of study, or more than one course comprised women, non-doctors, especially those with an engineering education, and younger people. The studies most often chosen were in the field of healthcare management, which comprised 43% of all studies undertaken by the research group. Those least interested in postgraduate studies were doctors. 

Przygotowanie do wydania elektronicznego finansowane w ramach umowy 637/P-DUN/2019 ze środków Ministerstwa Nauki i Szkolnictwa Wyższego przeznaczonych na działalność upowszechniającą naukę.

The purpose of the paper is to identify and explore social determinants of health in women as compared to men. We used data from The Collaborative Research on Ageing in Europe (COURAGE in Europe) study. The study population consisted of 1,317 men and 1,921 women. The independent measure was Self-Rated Health (SRH) and the World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0), which incorporates both condition of health and disability. To find determinants of WHODAS 2.0. linear regression model was performed and in the case of SRH the proportional odds model was used. Analysis showed that women’s SRH was significantly related to age, level of education. household income, type of occupation and family background. There was a similar relation observed amongst the male results. The analysis of the results indicates that socio-economic status is one of the main determinants of peoples’ health. This relation was observed for both women and men. As analysis shows, the level of financial situation during childhood changes SRH especially among women. For men’s health a more important variable was mother’s occupation. 

Przygotowanie do wydania elektronicznego finansowane w ramach umowy 637/P-DUN/2019 ze środków Ministerstwa Nauki i Szkolnictwa Wyższego przeznaczonych na działalność upowszechniającą naukę.

The article presents the thesis that there is information available in the public sphere on the basis of which the situation in the Polish health system can be diagnosed. Such a diagnosis would make it possible to identify the problems experienced by patients as ailments and other problems which may lead to missing the chance of positive impact on the health condition. Since the study is focused on and confined to the diagnosis of problems, especially those perceived by patients as limiting, and leaves their explanation to be considered further, the range of sources is necessarily restricted. The following sources are indicated: WHO reports, European Health Consumer Index reports, Centre for Public Opinion Research (Pol. CBOS) reports, National Health Fund (Pol. NFZ) annual reports, WHC BAROMETER results and OECD documents. On this basis, it can be argued that a serious problem for the system is the multi-cause perception of the patients’ failure to meet their health needs, long waiting times for specialist consultation, diagnostic tests and hospitalisations, shortage of time and attention devoted to patients, issues of equal treatment of patients and – oftentimes – dissatisfaction with the functioning of the system. After formulating the outline of the diagnosis presented in this text, considerations were made aimed at explaining the revealed problems. 

The paper presents lists of Ten Threats to Global Health published by the World Health Organization in 2018 and 2019. The lists give health problems and emergencies which seriously menace the health and well-being of billions of people on earth. The threats and health challenges are commented in the text. The interested reader is referred to the concise and easily legible original documents which give core data about the threats, actions and responses.

Health inequities are defined as systematic differences in health that can be avoided by appropriate policy intervention, and for this reason are considered unfair and unjust. Health inequities are not solely related to access to health care services; they are caused by the unequal distribution of these determinants of health, including power, income, goods and services, poor and unequal living conditions, and the differences in healthdamaging behaviours that these wider determinants produce. They are defined as systematic differences in health that can be avoided by appropriate policy intervention and that are therefore deemed to be unfair and unjust.

To be able to devise effective action, we first need to understand the causes of these inequities in health. Health inequities are not solely related to access to health care services; there are many determinants related to living and working conditions, as well as the overall macro-policies prevailing in a country or region.

The differences in social and economic development are reflected in health inequities that can be seen both between and within countries. Furthermore, evidence shows that even in the more affluent countries health inequities are seen in all parts of Europe. In the WHO European Region the gap in life expectancy between countries is 17 years for men and 12 years for women.

Inequities in health are caused by the unequal distribution of these determinants of health, including power, income, goods and services, poor and unequal living conditions, and the differences in health-damaging behaviours that these wider determinants produce.

The experiences of various countries indicates that in order to narrow the health inequities countries have to improve living conditions including the provision of comprehensive welfare systems, and high-quality education and health services.

The Strategy Health 2020 developed and approved by the WHO European Region countries is focusing on reducing inequities in health, which are key strategic objectives of endorsed by the 53 Member States. It emphasizes the need to strengthen population-based prevention on the social determinants of health. Also, in 2009 the European Commission developed European Union (EU) Health Strategy Programme titled “Solidarity in health: reducing health inequalities in the European Union”. 

Przygotowanie do wydania elektronicznego finansowane w ramach umowy 637/P-DUN/2019 ze środków Ministerstwa Nauki i Szkolnictwa Wyższego przeznaczonych na działalność upowszechniającą naukę.

Dementia occurs with a frequency of 10–12% in the entire geriatric population and 33–50% in people over 90 years of age. The most common cause of dementia are: Alzheimer’s disease, rarely vascular dementia, dementia with Lewy bodies, frontotemporal dementia and Parkinson’s disease with dementia. There are no medicaments to prevent dementia and effectively treat it. The treatment only slows the progression and improves the quality of life of the patient and caregiver. Taking care of a patient with dementia burdens the caregiver. As the disease progresses, care time extends even to the entire day. Over 90% of caregivers in Poland are family carers. Over 90% of patients stay in their own home until death. The cost of care is high and increases with the duration of the disease. In the case of agitated patients, the cost is higher. Institutional care is more expensive than home care. In Poland, there are no good system solutions in care for a dementia patient. Caregivers do not receive proper support from the government and subordinate units. 

Przygotowanie do wydania elektronicznego finansowane w ramach umowy 637/P-DUN/2019 ze środków Ministerstwa Nauki i Szkolnictwa Wyższego przeznaczonych na działalność upowszechniającą naukę.

In recent years, the situation of child and adolescent psychiatry in Poland has dramatically deteriorated. 24-hour psychiatric wards dedicated to minors are overcrowded and it is almost exclusively patients who are a direct threat to their own health or life that are hospitalised. About 20% of children and adolescents have symptoms of various mental disorders, of which 10% (about  400,000) require specialist care. Depression is one of the most common health problems among children and adolescents and its prevalence increases with age and puberty. Depression can be chronic, with constant severity, or recurrent, when symptoms return in the form of mild, moderate or severe episodes. The mood disorders occurring in the developmental period carry many negative consequences in the emotional, social and educational functioning of the patient. They increase the risk of self-destructive behaviours, suicide, abuse of psychoactive substances, as well as later difficulties in many areas of life during adulthood. 

Penicillin, the first antibiotic introduced into clinical practice opened a new era in medicine. The ‘golden age’ of antibiotic discoveries in the 1950s, 60s and 70s significantly helped our fight against bacterial infections. In parallel with the introduction of new drugs, resistance strains were identified. This was, however, neglected because of the belief that pharmaceutical companies would continuously supply us with new products. In contrary, a pipeline of new antibiotics slowly dried out and in the 1980s we realized that the proportion of resistant bacteria was increasing faster than the supply of new antibiotics. New mechanisms of resistance emerged and multidrug and pandrug resistant bacterial strains started to spread globally. Antimicrobial resistance is recognized now as one of the greatest threats to public health worldwide. The WHO and EU as well as national agencies are calling for actions which should be immediately undertaken if we do not want to lose the battle. 

Przygotowanie do wydania elektronicznego finansowane w ramach umowy 637/P-DUN/2019 ze środków Ministerstwa Nauki i Szkolnictwa Wyższego przeznaczonych na działalność upowszechniającą naukę.

False information by vaccination movements as a challenge for public health

The analysis of the characteristics of refusals to carry out preventive vaccinations, both in historical and contemporary perspective, showed that the dissemination of false information by vaccination movements, had and has a significant impact on the level of vaccination in the scope of individual preventive vaccinations, e.g. against polio, tetanus and diphtheria and it is real public health challenge. It is necessary to analyze the nature of the message in terms of the sender’s intentions, i.e. to distinguish between misinformation and disinformation. Preparation of an appropriate communication strategy in public health in this regard, seems necessary and crucial in terms of maintaining a high level of confidence in preventive vaccinations, and thus population resistance in the case of infectious diseases. Type of research methodology/research approach used: literature analysis. 

Przygotowanie do wydania elektronicznego finansowane w ramach umowy 637/P-DUN/2019 ze środków Ministerstwa Nauki i Szkolnictwa Wyższego przeznaczonych na działalność upowszechniającą naukę.

In Poland, the issue of required preparation and professional status of people working in health promotion (HP) is not specified in detail and existing rules are not transparent. An important aspect of professionalization of the field should be strong embedding in the theoretical framework. Furthermore, the term "theory and evidence-based" used in relation to HP and health education (HE) interventions is getting popularity. This paper is a thematic draft which discusses several issues subjectively assessed as constitutive for the professionalization of the HP field. It presents: professions related to HP; fundamental differences between HP and HE; theoretical forms in HP; the importance of theory in HP; selected theoretical concepts on disease, health and health behaviors. Particular attention was paid to the concepts that were considered the key to understanding the philosophy and specificity of HP and therefore should be the starting point in acquiring essential competences to professional performance.

The paper presents the role of health education as an inseparable element of health promotion.  Both concepts refer to activities that aim to provide support for people to control the factors which may influence their health and to create a healthy environment.  The two concepts are different, however, there is a link between health education and health promotion, human health, which is emphasized as being the common focus of these activities. The relationship between health education and health promotion is discussed on the basis of the National Health Programme for 2016-2020 and one of the habitats of a health promoting school. It is also emphasised that taking care of one’s health is a lifelong process, which can be perceived in health education and health promoting activities.

In conclusion, it is stated that health education is a necessary tool for health promotion; their combination in various habitats and the areas of social life may induce a synergic effect, contributing to an increase in the effectiveness of the applied health activities.

The aim of the study was to assess correlations between the consumption of selected non-alcoholic beverages and the prevalence of tooth erosion among adults visiting dental practices in Krakow. Dental erosion in group 124 people aged 18-55 was assessed using BEWE, while oral dryness with a mirror test. FFQ was used to assess fluid intake, supplemented with questions regarding oral hygiene and socio-demographic factors.Dental erosion, mostly mild, was found in 38.7% of participants. Dry mouth (second and third degree in a mirror test)concerned 16.1% of subjects. Dental erosion was significantly more common (p=0.01) among participants with dry mouth. More frequent consumption of sweetened beverages as well as 100% juices (fruit, vegetable) correlated with dental erosion. Overall consumption of such beverages and also milk, as well as daily fluid intake was significantly higher among subjects with dental erosion.

Incorrect behaviors regarding the quality and quantity of drinks may contribute to tooth erosion among adults.

Incidence and mortality from measles in Ukraine – implication for preventive action

According to the definition of the World Bank and World Health Organization, health of the population is one of the main factors for the development of the economy and the social well-being of each country.  Several positive changes have recently occurred in the health care field of Ukraine. However, despite of that the state of health of this country's population is currently assessed as insufficient. Since independence in 1991 Ukraine has not reached such a level of measles virus elimination as the Member States of the European Union. The aim of this article is to analyze the level of morbidity and mortality due to measles and the state of measles vaccination in Ukraine. In 2018, 53 219 measles cases were registered in Ukraine (incidence rate - 125, 47 per 100,000). The situation compared to the previous year deteriorated significantly and was 12-fold. In 2018, 16 people died of measles - 12 children and 4 adults. The status of inoculation of children under one year of age was 91%, which was less by 2% compared to 2017, but twice as much as in 2016, where only 46% children aged less than 1 year were vaccinated. Indicators of the epidemiological situation in Ukraine in 2018 deteriorated to a large extent compared to 2017. Based on the current trends in measles vaccination and the frequency of its occurrence, it could be argued that the elimination of measles is very much at risk due to both migration and the rapid development of anti-vaccine movements.

Non-violent communication. How to use empathic communication in the delivery room?

The process of birth has become a medical procedure, the correctness of which is monitored by obstetricians and midwives. In a hospital setting, the needs of a woman giving birth are not always taken into account. Over the years, women have been pushed into areas of objective rather than subjective treatment in obstetric care. Despite significant positive changes in perinatal care in Poland, many women giving birth do not understand why they are experiencing harm and violence from medical personnel. At the same time, the movement of the humanization of midwifery, emphasizing the patient's subjectivity, strengthens the active role of the mother in the delivery room, opening the possibility of using new methods of communication. Non-violent communication, developed by Marshall Rosenberg, assumes communication based on the recognition of needs and emotions, and allows for the complete elimination or at least limitation of the possibility of violence in dialogue in any form, psychological or physical. The aim of the article is to show how the empathic reception of the interlocutor's message can be an alternative to the communication of the delivery tract that women recall. Base on the experiences of women giving birth, a simulation of "reversing traumatic perinatal experiences" will be created through a proposed change in the pattern of communication.

This article is to present the concept of the electronic prescription model, taking into account legal regulations and technical solutions. Nowadays important changes have happened. In 2018, a law package regarding e-prescriptions was introduced in Poland that creates a new tool (electronic prescription) in the Polish market. Homogeneous tools enabling the security and integrity of e-documents and the approval of electronic signatures and seals are particularly important for the operation of the e-prescription. To enable the transmission of e-prescriptions it is required to join basic information and communications technology (ICT) system that supports e-prescribing to the main electronic identification system called Identification Electronic Node. In order to implement the e-prescription model, the lanuching of electronic medical records is indispensable. In most EU countries the e-prescription is implemented with the interchange standard of medical records called Health Level Seven (HL7). In terms of identification and authentication in e-prescribing, the eIDAS regulation plays a significant role. The electronic prescription has long been used in many countries, among which Sweden was one of the earliest (Sjunet system). Patients, physicians, pharmacies and the state will all benefit from the implementation. Ultimately, prescribers would have to use tools that will make it possible to ensure the confidentiality, integrity and credibility of transactions.

According to estimated data, an average Polish hospital manages about 130 thousand pharmaceutical products. The main problem related to pharmacotherapy in hospitals is real-time access to up-to-date data, which determines the correct treatment process. This paper presents the results of research aimed at forecasting the outcome of implementing e-prescriptions in conjunction with barcode scanning on the time of response to a patient’s needs for pharmacotherapy. The research was conducted in two hospitals by means of a business process analysis and the BPMN 2.0 standard. The analysis was concentrated on the drug administration process, taking into consideration the labour and service times of the process. Special attention was given to evaluating the possibilities of getting real-time access to information regarding the type, location and inventory level of pharmaceutical products. The research proved that implementing e-prescriptions in conjunction with barcode scanning could lead to reductions of the average working and service time.

mHealth is seen as the next stage of developing applications for information and communication technologies in the area of health care. This paper presents the evolution of mHealth systems and the results of the latest analyses of the effectiveness of mHealth interventions. Intensive mHealth development results from the near universal access to mobile devices, primarily smartphones, and devices that use sensory technologies. The great interest in mobile applications is reflected in the offer of online stores, which already provide many thousands of programs that can be installed on a mobile phone. Of the many possible mHealth applications, those supporting chronic diseases care and health promotion activities are regarded as the most promising. The growing interest in the area of mHealth is proven by the large number of publications that present syntheses of the available evidence. Although studies aimed at assessing the usefulness and effectiveness of health applications quite often raise doubts about the methodological quality, the significance of the analyses is positive. However, problems in maintaining the involvement of health users in mHealth solutions may be a cause for concern.

Mobile health technologies and applications installed on smart devices still represent new and relatively understudied phenomena in Poland. At the same time, a multitude of applications and their accessibility cause the increase of opportunities for their use for health purposes.

The aim of the present study was to evaluate the interest in applications supporting health and healthy lifestyle as well as monitoring health and disease among 718 adult patients in primary health care. It was found that there is a considerable potential for the increase of future use of health applications. Women, young respondents, respondents who hold an undergraduate degree and assess their health status well were observed to be more likely to potentially use applications related to lifestyle, health monitoring and combating disease.

The aim of the paper is to identify key determinants of effective implementation of innovations in respect to assisted living ecosystems for the elderly. Desk-study as a method was used and EBSCO (including Medline), ScienceDirect, Open Knowledge Repository, and BazEkon databases were researched. The scope of ageing and its key economic and social consequences are portrayed at the beginning. Then main categories of seniors’ needs are presented. Consequently the main ways innovations and new technologies can respond to these needs are identified accompanied by senior citizens’ particular attitude toward new technologies, especially ICT. Then Gerontechnology is presented not only as an important social innovation, but also as a leverage for more effective implementation of innovations and modern technologies in active and assisted living for seniors. The article ends with identification of three key success factors for effective implementation of innovations and new technologies by independently living seniors.

The current challenge for healthcare systems is to assess the clinical and economic value of non-drug technologies. Attempts have been made to use Health Technology Assessment, a standard method used in many countries to assess and make decisions regarding the reimbursement of medicines. The use of health technology assessment for non-drug technology can be a challenge because of the lower availability of high-quality scientific evidence in comparison with drugs. In several European countries attempts were made to develop guidelines for the clinical and economic evaluation of non-drug technologies; we presented specific guidelines prepared by British and French HTA agencies: NICE and HAS, respectively. In the case of Poland, the role of the Agency for Health Technology Assessment and Tariff System (AOTMiT) is to assess and appraise all medical technologies and services claiming public money funding; most of these assessments concern drug technologies. Only 103 of 1,550 orders (6.6%) issued by the Ministry of Health, from 1^st January 2012 to 1^st July 2018, were related to non-drug technologies. The health services assessed by the AOTMiT include different non-drug medical technologies, both specialized medical devices as well as surgical interventions or diagnostic procedures or screenings. Orders for non-drug technologies issued by the Ministry of Health vary in scope and type of assessment.

This paper concerns the events that occurred in the span of thirty years – from the 1986 Ottawa Charter for Health Promotion to the 2016 Vienna Declaration supporting it. The purpose, however, is not to discuss the substance of these events, but what should be defined as their context, in particular the political one. The text is divided into two parts relating to both of the documents mentioned, where the content of the message about health promotion formulated at that time is presented, together with the context in which it was created and received, and – briefly – its consequences. With reference to the context of the Vienna document, the issue of post-truth era will be discussed in more detail. The analyses devoted to the two parts will include addressing two problems that affect the issues under consideration: the concept of Health in All Policies and the issue of the susceptibility of various social classes to the arguments presented in health promotion programmes.

The HealthCareEurope (HCEU) project as a support for the transparency and the recognition of qualifications in the health sector in Europe

The HealthCareEurope (HCEU) project funded by the European Commission (co-funded by Erasmus +) implemented from September 2015 to August 2018 involved 10 institutions from five European countries. The leader of the project was DEKRA Akademie GmbH (DE). The aim of the project was to develop tools to facilitate the transparency and recognition of migrant workers’ qualifications within the health care sector in Europe. As a part of the project, the Competence Matrix – Nursing was developed with additional tools to facilitate their transfer to European countries and combined with the Competence Matrix – Elderly Care creating the “Competence Matrix – Professional Care”. In the matrix the VQTS model was used, based on professional tasks in a specific area of work, progress of competence development and competence profiles. The results of the project could facilitate the nurses and elderly caregivers to move freely around the European labor market in terms of their qualifications. In the current process of qualifications recognition – diplomas/certificates confirming formal qualifications have been taken into account, but not qualifications obtained in non-formal and informal learning. The developed Competence Matrix – Professional Care complements these elements.

In January 2016 Polish nurses and midwives were granted new powers to prescribe medications and food of special purposes, as well as to issue referrals for several diagnostic tests and prescriptions for reimbursed medical products. The aim of this paper is to present the possibility to describe the process of prescribing medications using the international language of nursing practice ICNP®. International Classification for Nursing Practice (ICNP®) is a unified glossary of referential terms for nursing practice that is recommended by the most important medical and professional organisations in Poland and all over the world. Numerous ICNP® terms, which do not only meet international criteria but can – and should –become the primary communication tool for everyday nursing practice of Polish nurses and midwives are an alternative to often random, traditional and intuitive expressions describing nursing and midwifery activities related to widely understood process of prescribing medications. 

Some remarks on ratio legis of the so-called Polish standards for perinatal care

Author in the article presents the evaluation and legal relevance of Regulation of the Ministry of Health which regulates the standard of conduct and medical procedures for the delivery of health services in in the field of perinatal care provided to women during physiological pregnancy, physiological birth, confinement and infant care. It is indicated that the regulations containing the so-called standards of medical care during the perinatal period, may contribute to the improvement of organisation of the care provided to patient during pregnancy, delivery and to the newborn. However, the regulations should not include provisions which describe the standard of medical conduct. They cannot also exclude many of the factors which seriously and negatively affect the level of medical care during the perinatal period in Polish hospitals. 

Impact of the shift system of nurses’ work on their diet and physical activity

Nurses’ work in inpatient care often involves shift work. The shift system, especially working nights, disrupts habits and natural biological rhythms, is a hindrance to home and social life and has a detrimental effect on diet and physical activity. The aim of the study was to assess the influence of shift work on nurses’ dietary intake and physical activity. Using a diagnostic survey, the behaviours of nurses in one- and two-shift systems were compared. The results were processed using the Microsoft Excel and Statistica 10.0 software. The dietary habits and types of exercise did not differ significantly between nurses in the one-shift and two-shift systems. However, a slightly healthier lifestyle in terms of nutrition and exercise was exhibited by nurses in the one-shift system. It seems necessary to introduce health education among professionally active nurses in order to minimise potential problems arising from the style of work.

Incidence of occupational diseases at the territory under the authority of District Sanitary and Epidemiological Station in Bielsko-Biała

Introduction. The employees’ health condition depends to a large degree on occupational risks and occurrence of harmful physical, chemical and biological factors at work. These hazards are reflected in the incidence of occupational diseases. Purpose. Analysis of incidence of occupational diseases in 2004–2015 at the territory of the District Sanitary and Epidemiological Station in Bielsko- Biala.

Material and methodology. The source of information about occupational diseases in the city end District of Bielsko-Biała was data from individual occupational disease record sheets analysed in the Station. The analysis covered data on occupational diseases according to disease classification, gender, age and duration of exposure to harmful factors in the work environment.

Results. The noted reduction in occupational disease incidence on the territory of the Sanitary and Epidemiological Station in Bielsko-Biała during the period of 2004–2015 correlated with the general declining tendency in Poland. In the city end District of Bielsko-Biala dominated chronic diseases of the musculoskeletal and nervous system, pneumoconiosis, hearing loss and chronic disease of speech organ prevailed, which was related to a longstanding exposure to harmful factors in the work environment.

Conclusions. In the city and District of Bielsko-Biala the declining incidence tendency of occupational diseases is maintained. Analysing morbidity of particular occupational diseases in the city and District of Bielsko-Biala shows that dominating illnesses in this group are currently skin allergies, bronchial asthma, chronic diseases of the musculoskeletal and nervous system and hearing impairment

Risk assessment of aggression among patients applicant to medical centers

Risk assessment of aggression among patients applicant to medical centers Aim was to identify factors potentially increasing the risk of patient aggression. The study was conducted in medical centers in Poland on 244 patients. It was performed using an observation method with the Brøset Violence Checklist for measuring the risk of violent behavior, and the Overt Aggression Scale used in the case of subjects who displayed aggressive behavior. The participants were divided into categories according to the level of risk of aggression. A higher risk was observed among younger individuals, brought to medical centers by the police, those who came later in the day and under the influence of intoxicants. The patients whose risk of aggression was estimated as ≥ 2 points constituted 18.85%, out of whom 87.78% displayed overt aggression. Nursing staff is exposed to patient aggression. The use of the Brøset Violence Checklist can be recognized as an appropriate method of predicting aggressive behavior in patients.

Background. Deficiencies among nursing staff results in a lower quality of nursing care, thereby threatening patients’ safety. A potential way to deal with the problem of insufficient nursing care is to implement effective leadership. Universities play a key role in creating future leaders who are able to initiate changes in health care systems. As leadership education requires adequate support (including financial aid and mentoring), it is necessary to identify those who would most benefit from additional training by analyzing natural leadership competences. To date, the issue of nursing leadership, especially authentic leadership, in Poland has not been sufficiently described. This study aimed to assess the level of competence in authentic leadership in a group of nursing students in Poland.

Methods. A total of 99 students (93 women and 6 men) from the Nursing Division, Faculty of Health Sciences, Medical University of Warsaw were recruited, including 58 students in their first year of first cycle (54 women and 4 men) and 41 students in their second year of the masters program (39 women and 2 men). The average age was 26.17 years (min. 24, max. 47, SD: 5.630). Students were assessed using the pen and paper interview (PAPI) method, and an anonymous Authentic Leadership Questionnaire (ALQ). The ALQ comprises 16 statements rated using the Likert scale, ranging from 1 (totally disagree) to 5, in four dimensions: self-awareness, ethics/morality, balanced processing, and transparency in relationships. Data was analyzed using descriptive statistics. The reliability of the questionnaire measured by Cronbach’s alpha coefficient was 0.781.

Results. Only 24% of students had a high level of leadership competency (16–20 points) in the self-awareness dimension. Students achieved a low score (15 points or below) in the other dimensions (ethics/morality, balanced processing, and transparency in relations).

Conclusion. The overall level of leadership competency among the study group of nursing students in Poland was low. Nursing students with higher levels of authentic leadership competencies should be identified and given additional individual support from their home universities during their studies to provide future leaders for our health care system.

The health status of a population defined by deliberately chosen indicators can be treated as one of principal elements of the civilization progress constituted by the development of the public health area, i.e. improvement of particular indicators relating directly to the health of the population. Within different societies this process runs at different rates and has different priorities. The activities aiming at increasing its dynamics and rationalizing its targets may contribute to the civilization progress in its health dimension.

The paper is an attempt to apply a taxonomic method of international comparisons in order to set the population health development goals. The method is illustrated by the example of 28 EU countries. The health status of the populations of these countries has been operationalized in the set of six indicators. On the basis of applying the method some procedures of setting out the development perspective within the population health area is illustrated using the example of Poland.

Institutional determinants of cooperation between public health institutions and public television in the field of health education

The level of effectiveness of mass-media influence on population health is determined by a number of factors, some of which are barriers to effective communication, others support it. The aim of this article is an attempt to present elements of the process of  cooperation between representatives of public health institutions and public television, at the stage of creating health information and its dissemination. The analysis of this process, based, inter alia, on the findings and observations made within sociology and public health, will be aimed at identifying barriers to effective media impact in the field of health education, as well as remedies that can minimize potential failures.

Clinical picture of disease in letters to polish television (TVP). A reconstruction of popular thinking

The article seeks to characterize and interpret the “Kashpirovsky phenomenon”, which was part of the context of the first stage of the system transformation (1990–1993).The extent of the popularity of this healer and his ‘health sessions’ was a kind of challenge to medical sociologists (the ‘teletherapy’ was watched by 59% of adult Poles).The text shows changes in the picture of typical civilization diseases taking place against the backdrop of rapid, deep and radical social changes bringing with them a number of severely felt stressors at the time. It also describes the method used to analyze two collections of personal documents/letters/addressed to TVP (Polish Television) by viewers of Kashpirovsky’s programs; in the first stage there 1907 documents of this type, and 1311 in the second. The obtained results made it possible to discern the types and effects of somatic and psychosomatic changes described by the viewers (positive or negative), to register the types of diseases (ailments) that viewers expected to be cured, to interpret popular, commonsense knowledge about health and disease, inter alia: ‘lay etiological concepts’, ‘presumed causal relationships’ between their own illness and Kashpirovsky’s methods, and to describe thaumaturgic phenomena caused, in the opinion of the authors of the letters, by the healer, etc.

Although clinical trials are rarely of interest to medical sociologists, in the last decades there has been increased focus on the processes of medicalization as well on the social critical approach to these multidimensional phenomena by health sociologists. From the perspective of the sociology of illness, clinical trials could be perceived as a bridge between the ‘society of remission’ and ‘risk society’. Public opinion polls did not give a clear answer regarding the social attitudes and the level of social trust presented by Poles towards clinical trials although patients or healthy volunteers are the main subject of this research. Creating an atmosphere of social trust (using the role of mass-media) towards clinical trials (through social awareness, methods of investigation and using the results in everyday medical practice) gives a chance to create a new ‘quality of relations’ between scientific teams responsible for clinical trials and society.

The occurrence and morbidity of cancer increase with age. The aim of the study was to ascertain the beliefs of older people about the access to and quality of cancer care in Poland and to determine the impact of gender, age, education and SES variables on their beliefs. In 2012, a sample of 910 adult residents of Wrocław was studied by means of an interview questionnaire and quota sampling was applied.  This paper presents only the data obtained from two of the six age categories researched (N = 329; specifically the age categories: “55–64 years” and “65 and over”. It was established that more than half of the respondents evaluated the treatment conditions in hospitals negatively; most being critical of the access to the medical services for oncology. The results show a divergence between the assessment of the medical personnel’s instrumental function and the care received. Although 75% of seniors positively assess the competence of oncologists, 45.29% evaluate their interpersonal skills negatively.It was found that criticism of oncological care increases with the age of the respondents and their lower financial state.

Health communication, in the opinion of Tomasz Goban-Klas, is primarily a social practice in healthcare and a field for reflection and study. The changes occurring, at the semantic and at the tool level, result ever increasing interest of scientific circles’, especially in issues included in the field of communication involving the new telecommunications media: digital, online, and mobile. This paper presents the selected levels of health communication, the medial activity of patients and medical institutions that fall within the area of analysis/social practice. The aim is to present selected concepts of medical marketing strategies and the changes occurring in the profile of the modern patient, with particular regard to the development of a technically oriented communication process. Changes taking place in the management of communication in medicine create new opportunities as well as threats. In addition, they initiate changes, which are not universally approved, in the course of interaction previously regarded as the model for contact between the patient and medical staff. Changes in the understanding of the relationships between the physician and the patient result, among others, in the creation of successive levels of communication, areas of activity and the means of reaching potential clients, as evidenced by the use of virtual space. This are is being annexed with an increasingly greater scope, hence its observation and analysis seem to be an extraordinary challenge for social scientists. An overview of the selected problem area has been based on a selective review, literature search and analysis.

New medias online reality and process of building the identity of the people with Asperger syndrome. Sociological study

New media is a space in which neuroatipical individuals can exist. They can articulate their subjectivity and construct their identity. The analysis of the webblogs of people who define themselves as Asperger Syndrome diagnosed shows how either individual or collective identity is forming. Bloggers describing their everyday life show their perspective, which is not available to neurotipical (NT) people. Thanks to online memoirs, attempts can be made to reconstruct their identity projects and analysis of adaptation strategies.

Konferencja naukowa pod patronatem Ministra Zdrowia

Promocja zdrowia postawą zdrowia publicznego. Promocja zdrowia dla osób starszych

Narodowy Instytut Zdrowia Publicznego - Państwowy Zakład Higieny w Warszawie

Warszawa, dnia 8 września 2017 r.

Konferencja naukowa pod patronatem Ministra Zdrowia

Promocja zdrowia postawą zdrowia publicznego. Promocja zdrowia dla osób starszych

Narodowy Instytut Zdrowia Publicznego - Państwowy Zakład Higieny w Warszawie

Warszawa, dnia 8 września 2017 r.

Procreation plans and use of contraception by Poles in reproductive age

The paper attempts to show the relationship between reproductive plans of Poles in reproductive age and their use of methods of preventing pregnancy. There has been carried out a reinterpretation of the results of a sexuality study from 2011 of a representative sample of 3206 adult Poles. There have also been used some of the results obtained in the previous edition of the survey, realised in 2005. It has been established, among other things, that almost half of the respondents plan to have another child in the future; the reproductive plans of the respondents have been differed by many socio-demographic variables as well as variables describing being in a relationship and sexual activity of the respondents; nearly three quarters of respondents who started a regular sex life used some method of contraception; there has been a favourable change in the use of methods of preventing pregnancy – hormonal medicines and condoms are used more frequently; unreliable methods (natural methods and coitus interruptus) are still relatively frequently used; there has been a radical reduction in concerns about unplanned procreation.

In this paper, we investigate the significance of health in the fertility choices made by women in Poland. We use data from the first wave of the Polish “Generations and Gender Survey” (GGS-PL), which was conducted at the turn of 2010 and 2011. We verify whether women who are disabled or who experience health problems limit their childbearing intentions. In our analyses, we use four different indicators for health. Our results suggest that all four might be important when planning a child in the subsequent three-year period. Nevertheless, our multivariate analyses indicate that only women’s self-rated health remains significant, if age, parity and marital status are controlled for.

Przygotowanie do wydania elektronicznego publikacji - zadanie finansowane w ramach umowy Nr 780/P-DUN/2017 ze środków Ministra Nauki i Szkolnictwa Wyższego przeznaczonych na działalność upowszechniającą naukę.

There has been a lot of changes in the provision of care for women during the perinatal period and newborns since the early 90s past century. These changes are an example occurring in parallel to the process of medicalization and the tendency to demedicalization.

The aim of this paper is to analyse these changes from the perspective of the theory of medicalization. In this article we analyse three effects of medicalization: increasing number of unjustified medical interventions, ignoring the needs of childbearing women and reducing the role of midwives.

I assert that we observe two contradictory tendencies. On the one hand, the medicalization of perinatal care is promoted by physicians. On the other hand, the demedicalization has its advocates among women and midwives. The question then arises whether these tendencies are exclusive or they are an example of democratization in the field of perinatal care, which are increasingly influenced by active in civil society, various pressure groups.

Breastfeeding is the healthiest way to feed newborns and infants. Breast milk is a unique biological fluid, a source of nutrients, immune factors and bacterial flora. Although we know breast milk is one of the factors influencing bacterial flora of the newborn's gastrointestinal tract, the diversity of factors affecting the composition of the microbiota and the biological role of bacteria in human milk is poorly understood. There are several potential factors that influence the composition of the flora of breast milk: immunological disorder of the mother, her diet, antibiotic treatments, birth type, and lactation duration. Currently, there are three known hypothesis about how milk becomes colonized: bacterial transfer from the mother's intestines (endogenous road), colonization after exposure to the bacteria in the birth canal during delivery and the transfer of bacteria from the skin to the breast during breastfeeding. Further research is needed to confirm the validity of the presented hypotheses

Background: Stunting hinders the development of children around the world.

Objectives: Wehavecalculated the burden of disease attributable to protein and energy malnutrition (PEM) in Ghana and evaluated the impact of the modeled intervention to prevent stunting in Ghana.

Methods: A literature review was conducted to better understand the economic implications of stunting. The burden of PEM was measured in Disability-Adjusted Life Years (DALYs) and income lost. A culturally sensitive nutritional intervention was designed to prevent stunting in the target population. The comparator was no intervention. We performed cost-effectiveness, cost-utility, and cost-benefit analyses.

Results: The estimated income lost due to PEM in Ghana was over 70 bln2014 international dollars (I$). In 2014 the Ghana GDP per capita was I$4,548.00. The incremental cost-effectiveness ratio (ICER) per stunting case averted was I$2,573.72. The ICER per DALY averted was I$896.18. The cost-benefit ratio was 0.03.

Conclusion: Stunting causes a high burden to society in Ghana. The modelled backyard poultryintervention is very cost-effective in reducing stunting and it effects.

Economic and epidemiological aspects of the immunisation program against pertussis in Poland

The aim of this study is to evaluate the cost-effectiveness of vaccination against pertussis in epidemiological and economic terms. The estimation was based on available epidemiological data linked to an obligatory vaccination programme and morbidity in the Polish population. The economic evaluation included data on funds spent on the purchase of vaccines and the cost of outpatient and hospital treatment of patients spent from the state budget. The analysis of epidemiological data confirmed that the decrease in the level of vaccination of the population in combination with shortening the time of immunization resulted in an increase in the incidence of whooping cough. Economic analysis showed that the costs associated with the implementation of a vaccination program are lower than the direct costs of treatment of pertussis per patient. Vaccinations should be a fundamental tool in the fight against infectious diseases despite emerging reports of adverse events or evasion of vaccination. There are economic and epidemiological arguments for broadening the scope of vaccination against pertussis as well as extending the vaccination calendar by inclusion of currently recommended (not financed by the state) vaccines.

The chronic character of the disease has a significant impact on expenses borne by individual patients and by the health care system. Patients diagnosed with epilepsy need a long-term treatment, which is often expensive. In order to minimize the costs, doctors are increasingly turning to prescribing cheaper generic drugs. On the one hand, from an economic perspective, such a solution is cost-effective; on the other hand, the choice of an inadequate treatment may have serious consequences for the patient’s health. Patients using drugs with a narrow therapeutic index should be careful because of differences in bioequivalence of medicinal products. An inadequate alteration of the treatment for epilepsy, either by replacing the original drug with a generic one or by replacing one generic drug with another,  may adversely affect the patient’s condition. It is important, then, that therapeutic decisions should not be guided chiefly by considerations of cost reduction for the patient, but first of all by possible future health effects.

A System of Health Accounts (SHA), recently adopted by the European Commission as a statistical framework for reporting data and metadata on health care expenditure and financing have paved the path for systematic data collection in the field which is indispensable for ensuring transparency and accountability of health care system on the Member States' level and for adequacy of many health policy recommendations on the EU level. The purpose of this paper is therefore to present  selected aspects of the informative and analytical power of the core and extended accounting framework of the System of Health Accounts (SHA) in the context of health care system accountability with emphasis put on the role of the European Commission in straightening it among MS. A special attention is paid to one of the SHA newly developed analytical interfaces i.e. the ‘consumer health interface’ which has potential to be used for conducting multidimensional analyses of health spending by patient characteristics, including diseases and health conditions.

The purpose of this study was to identify the main health problems in Poland against global health problems using the latest Global Burden of Disease (GBD) study results. The burden of disease is assessed here in terms of: (i) time lost due to premature deaths and morbidity (expressed in Disability-Adjusted Life Years – DALYs measure) and (ii) national income lost due to disease in Poland. The study presents the estimates of total DALYs, Years of Life Lost (YLL) caused by deaths, Years Lived with Disabilities (YLD), both in total (due to all causes) and attributable to chronic non-communicable diseases (NCDs), in 2015. The economic value of time lost due to deaths and disability in Poland is measured using the method employed by the WHO Commission for Macroeconomics and Health, which makes the assumption that each DALY can be valued at between one and three annual GDPs per-capita for the country under study. In 2015 over 2.46 bln DALYs globally were lost due to all causes, of which 66.7% were due to NCDs and 18.2% were due to communicable diseases. Poland experienced over 11.3 mln DALYs in the year 2015, 81.9%of which were due to NCDs and 3.4% of which were due to communicable diseases. 68% of total DALYs globally and 41% in Poland were years of life lost due to deaths. 84% of the total years of life lost due to death in 2015 globally (69% in Poland) occurred under the age of 70 and are considered avoidable. Total income lost in Poland due to deaths in 2015 amounted to up to I$527 bln.

Diabetes mellitus is now recognized as a societal disease that significantly burden health care systems in highly developed as well as developing countries and constitutes a serious problem of public health world-wide. The aim of this study was to estimate the value of reimbursement of diabetes-related drugs in 2012 and 2013 and to analyze indirect costs generated by diabetes in Poland in 2012.

It was revealed that reimbursement of glucose test strips, antidiabetic drugs and insulins covered by the National Health Fund was as high as 1.3 billion PLN in 2012 and 1.5 billion PLN in 2013 and the dominant cost drivers were glucose test strips (49% of costs in 2012 and 52% of costs in 2013) and insulins (40% and 38% of total reimbursement costs due to diabetes, respectively).

Total indirect costs of diabetes type 1 and type 2 in 2012 were as high as 59 million PLN and 66,5 million PLN and absenteeism due to sick leave was a main cost driver (61% in diabetes type 1 and 95% in diabetes type 2, respectively).

In summary, costs associated with diabetes constitute a serious burden for the National Health Fund as well as for the Social Insurance Institution in Poland.

Objective: The main aim of the research was to investigate the costs of dementia in Romania based on the estimated average cost of each person with dementia in Bucharest.

Method: This was across-sectional, non-population based study, with a mix of “bottom-up” and “top-down” data collection methods, which adopted the Cost-of-Illness approach from a broad societal perspective. The study involved 31 carers of patients with dementia in two Bucharest clinics in 2013 and 2014: the PROMEMORIA Private Clinic and the “Sf. Luca” chronic disease hospital. Face-to-face individual interviews were conducted using a modified version of the Resource Utilisation in Dementia (RUD) questionnaire. The average direct and indirect costs of dementia per person in the study were estimated for the year 2013 and are presented for the three levels of disease severity – mild, moderate and severe.

Results: The mean carer age was 59.3 (SD = 13.3), with 77.4% of the participants being females. The average cost (direct and indirect) of dementia per person in the study ranged from 53,787 RON to 67,554 RON (depending on the hourly wage used for valuation of the caregivers’ time). Converted to the international dollar currency, using the purchasing power parity (PPP) of the US dollar in Romania in 2013, the average cost of dementia in the study accounted for between I$32,301 and I$40,583. The estimated total annual cost of dementia in Romania in 2013 was between I$9 bln and I$11 bln.

Introduction: The role of physician and nurse in the therapeutic team depends on the prevailing medical model of health: biomedical or holistic and functional.

Purpose: The theoretical basis of the therapeutic role of doctor - nurse - patient contact from a psychological perspective is the Functional Model of Health created by Helena Wrona-Polanska.

Material and Methods:141 people after bone marrow transplantation were examined at the Hematology Clinic of Jagiellonian University. To examination were used the questionnaires of stress, coping strategies, personal resources, and grading scales of health and anxiety.

Results:Analysis of the results revealed predictors of subjective health and difference between subjective and objective health.

Conclusions: Author's Functional Model of Health used in the analysis of nurses work shows the complexity of the physician - nurse - patient contact: instrumental function, cognitive function, emotional function as a basis of innovative educational program for physicians and nurses.

Knowledge of people’s health information needs and information behaviour can be used in planning health interventions in a way that they would meet people’s needs as accurately as possible and reflect how health information is acquired and processed.

The aim of the study presented in this paper was to analyze the usefulness of online forums as a source of scientific knowledge about people’s health needs and information behaviour, which could then be actively used in the area of public health.

Method. The content, a total of 1,575 entries, derived from two open forums devoted to depression in the years 2012–2015 was analysed using a set of mixed methods, including: a formal (quantitative) analysis of the material using the tools of computational linguistics (QDAMiner Simsat), inductive theme analysis EMIC, in the so-called hard variety, reinforced by elements of Awdiejew’s conversational grammar, and comparative method.

Results: Both health information needs and behaviour can be identified on Internet forums dedicated to health problems. Linguistic analysis of online forums can give very interesting results and clues that cannot be obtained using questionnaires or personal interviews. It seems, however, that it should never be the only method used in investigating this matter. Since there are several intervening factors that may distort reliability of findings, determining whether we are dealing with real or created needs or behaviour requires confirming the results of the linguistic analysis of the forums using other methods.

Direct-to-consumer advertising (DTCA) in which pharmaceutical companies market prescription drugs directly to consumers is legal in only two countries – the USA and New Zealand. This article describes legislative milestones of DTCA development in the USA which have given rise to the current legal framework.

The article shows the cultural background for DTCA expansion, outlining the fight of patients’ associationsfor better access to information about therapy and drugs and change in perceiving the role of the patient in the health care professional-patient relations. It presents arguments supporting the producers’ right to advertise their products.

Direct-to-consumer advertising in the USA is a controversial subject. Although based on only limited data, the existing research gives arguments both in favour and against direct-to-customer advertising. The article also presents the EU policy towards DTCA, considering the consequences of the existing DTCA ban in the EU.

Introduction:Current time perception becomes a metaphor of remarkable challenges and possibilities available for nursing and for academic institutions responsible for preparing next generations of nurses.

Methodology: Trends in vocational training of nurses will be presented on the basis of thematic review of the literature which allows indication of transformation directions in training nurses around the world as well as in Polish nursing. It will also enable comparison of these changes with the health needs of Polish people – both current and forecasted.

Results: In review, what draws attention is detailed and quite extensive analysis of usefulness of nurses training method in the conditions of high-fidelity simulation and accompanying conclusions that indicate its effectiveness in creating skills and knowledge of nursing students. At the same time, only a few studies show that this method forecasts safer care provided by the same students in clinic conditions.

In providing cultural safety in the process of globalization, the meaning of national minorities is emphasized and the transcultural training is expected from nursing.

Conclusions: Summing up, directions of changes in nursing training are based on indicators built on socio-demographic and psychosocial processes related both to single persons and whole communities. However, in nursing in Poland, the same process is related usually to biomedical indicators.

Practical implementations of selected classification of nursing diagnoses and interventions for Polish nursing

In nursing oriented on autonomous problem solving of care in nursing practice while taking into account the strengthening of the nursing profession and promoting quality of nursing care, the value of alternative classifications of diagnoses and nursing interventions should be considered: ICNP- International Classification for Nursing Practiceand NANDA-North American Nursing Diagnosis  Association.

The aim of this study is identification of assessment criteria significant for classification systems of nursing diagnoses and showing their practical value in classifications ICNP and NANDA.

Expert analysis of evidence gathered in literature indicates that classification system of NANDA fulfills majority of detailed criteria included in the structure of requirements for classification. In detailed reference of classifications NANDA and ICNP to conditions of Polish nursing practice, it requires further studies. It also calls for comparisons of possibilities and benefits of using those classifications with taking into account the stage of development, practical solutions developed and tradition of Polish nursing.

Nurses are the largest professional group in the health sector, mainly being frontline, 24 hours/7 days in a roll, 365 days a year. Nurses are frontline to coordinate care and empower patients and citizens. The present document is intended at guiding decisions about how public health services can be usefully deployed in the introduction and development of advanced roles for nurses. Advanced roles are seen as the way forward in order to improve access to care and patient outcomes, contain provider related costs and improve recruitment and retention rates through enhanced career prospects. In Poland many of nurses developed their skills to delivering high quality of care using the autonomy and independent practice in Primary Health Care. Introducing Advance Practice Nursing role it is a challenge which is new for polish health system and it is recommended by nursing authorities as Polish Nurses Association.

Determinants of professional satisfaction of nursing staff in Poland

Introduction and aim of the study. Professional satisfaction is one of the most important elements determining the quality of life of every human being. Its level can be determined by a number of different factors. The aim of this study has been to identify the most important ones in relation to the nursing environment in Poland.

Material and methods.A study has been conducted with a method of diagnostic survey using a standardized questionnaire in a group of 1066 economically active Polish nurses.

Results.Results of track modeling in the studied group testify to the fact that among Polish nurses the greatest impact on the level of professional satisfaction have: the company's image, the atmosphere in the workplace and performed tasks. The level of remuneration does not have a direct impact on the job satisfaction in studied environment. Instead, it has a significant impact on displeasure perceived by nurses.

Conclusions.Due to the fact that the level of professional satisfaction in a group of Polish nurses is significantly affected by parts characterized as real motivators, in order to raise its level managers should primarily skillfully choose management style from among those that are based on the thesis that the employee is the most important asset for any, viable and functional organization.

An effort-reward imbalance during shiftwork may result in occupational burnout of nurses. The aim of this study is to analyze the relationships between occupational burnout and stress in context of the attitude towards shiftwork and work satisfaction. Material and methods: The study included 250 nurses aged between 22 and 54 with an average of 12 years work experience. The following research methods have been used: Burnout Inventory (MBI), Effort – Reward Imbalance, Attitude Towards Shiftwork Scale (ATSS) and Manual for Minnesota Satisfaction Questionnaire. Results: The effort invested in work turned out to be the only significant predictor of emotional exhaustion. It explained up to 31% of variance in emotional exhaustion in the group of both low work satisfaction and negative attitude towards shiftwork. Conclusion: The study showed that more attention needs to be paid to efforts invested in work, as well as rewards, and the balance between rewards and efforts in the group of low work satisfaction and of negative attitude towards the shiftwork system.

Introduction: Present scientific research indicates that the occurrence of decubitus ulcers
of hospitalized patients is still a great medical problem , which has the influence on both,
the quality and cost of medical care. In Poland, for years, some actions have been taken within the scope of decubitus ulcers prevention and modern methods of their treatment.
The effectiveness of the mentioned activities can be influenced by early diagnosis
of decubitus ulcers risk and their occurrence.

Research aim:The aim of the research was the assessment of decubitus ulcers risk and their occurrence in the group of patients accepted for hospital treatment to conservative wards.

Material and method: The research comprised of 10,507 patients on admission day
for treatment to the following wards: Allergology, Gastroenterology, Geriatrics, Cardiology, Neurology, Rheumatology and Rehabilitation. To collect the data there were used: analysis
of medical records, Norton scale for decubitus ulcer’s risk and Torrance scale for assessment of ulcer’s degree. Data analysis was made on the basis of statistics “Statistica – version 8”.

Results:The risk of decubitus ulcers development was observed in 12% of all the patients accepted for treatment. The highest percentage of the risk of decubitus ulcers development was for patients accepted to Rehabilitation Ward (50%) and Neurology Ward (34%).
The presence of decubitus ulcers was confirmed at 7% of all examined, including above 3% on degree II/2^nd. The highest percentage (27%) of decubitus ulcers was confirmed of the patients accepted to Rehabilitation Ward.

Conclusions: The assessment of decubitus ulcer’s risk and their occurrence while accepting to hospital allows for early diagnosis and implementation of appropriate prophylactic procedures and treatment.

Assessment of readiness for discharge of patients with chronic diseases

Introduction: The most common cause of ineffectiveness in the treatment of chronic diseases is a lack of cooperation between the patient and the therapeutic team. An important factor that could change the situation is education of the patient, which would allow the patient to assume the role of an expert and become an active participant in the therapeutic process.

The main purpose of the study: The main purpose was to assess the readiness for discharge of hospitalized patients.

Material and methods: The study evaluated 325 chronically ill patients who were hospitalized. On the day of release from the hospital, the patients assessed their preparedness for discharge.  Results:Studies showed that in all analyzed aspects of readiness for discharge there are statistically significant differences depending on the type of diagnosed chronic illness in a patient. Conclusions:The readiness for discharge of patients hospitalized because of chronic disease is insufficient

Badania finansowane z grantu nr 980 na utrzymanie potencjału badawczego w 2015 roku Katedry i Zakładu Promocji Zdrowia CM Uniwersytet Mikołaja Kopernika w Toruniunt. Ocena przygotowania pacjentów przewlekle chorych do samoopieki

The functional condition and physical mobility among patients provided with  long-term institutional care

Introduction:The increase of dysfunction in the functional condition  and a decrease in physical mobility lead to independence limitation and  increased demand for health care services.

Aim  of the study:  The aim of the research was to evaluate the association between functional condition  and physical mobility and selected demographic variables of patients provided with  long-term institutional care.

Material and Methods:The study group consisted of persons provided with  long-term institutional care. The following standardized research tools were used in this study: the Cognitive Assessment Scale, the Edmonton Functional Assessment Tool  and  the Barthel Index.

Results:Studies have shown that with increasing dysfunction of the functional condition of mobility decreases patients. The analysis showed no significant correlation of functional condition with age and gender of the respondents.

Conclusions:The results indicate a need systematic assessment of  the functional condition of patients, which determines  adjustment of care to the capabilities and needs of the patients.

Rehabilitation and Geriatric Care Management in the Population 60+

Aging of the population in the highly developed countries brings an increasing interest in the organization of the geriatric care. Efforts are undertaken towards the development of a geriatric care management model which would fulfill the following criteria: continuity, complexity and availability. Such model would focus on the early diagnosis of health disorders, what should decrease the need for the hospitalization of persons at the advanced age and therefore reduce the cost of medical care. The calendar age not always corresponds to the biological age of a person, and there is no agreement as to what year of life should be considered as the border of an „old age” of the given person. Medical care should therefore be adapted to the individual needs of each patient. A goal of this report is to define rehabilitation and areas of functioning of aging persons which should be considered while developing strategies for the geriatric care management in the aging population

There were very different methods of health measurement and kinds of indicators used through the years, but a key objective of these indicators usage was, and still is, an improvement of health state. The complex, reliable, clear and standard methods of health measurement are needed to plan and introduce effective actions in health care. Despite many years of work on the indicators of health, the measure meeting all these conditions has not been constructed yet. At the beginning health indicators were mainly related to population health and communicable diseases. Currently, after a period of “medicalization” of measurement, a growing emphasis placed on indicators supporting the public health can be observed. In this article the development process of health measurement was briefly presented and some health indicators were described.