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

BACKGROUND: Vaccination against pneumococci is currently the most effective method of protection against pneumococcal infections. The aim of the study was to analyse changes in hospitalisations and in-hospital deaths due to pneumonia before (2009-2016) and after (2017-2020) the introduction of PCV 10 vaccinations in the National Immunisation Programme in Poland. METHODS: Data on hospitalisations related to community acquired pneumonia (CAP) in the years 2009-2020 were obtained from the Nationwide General Hospital Morbidity Study. Analyses were made in the age groups: <2, 2-3, 4-5, 6-19, 20-59, 60+ years in 2009-2016 and 2017-2020. RESULTS: Overall, there were 1,503,105 CAP-related hospitalisations in 2009-2020, 0.7% of which were caused by Streptococcus pneumoniae infections. Children <2 years of age were the most frequently hospitalised for CAP per 100,000 population, followed by patients aged 2-3, 4-5 and 60+ years. In the years 2009-2016, the percentage of CAP hospital admissions increased significantly, and after the year 2017, it decreased significantly in each of the age groups (p<0.001). In the years 2009-2016, a significant increase in hospitalisations for Streptococcus pneumoniae infections was observed in the age groups <2, 2-3 and 4-5 years (p<0.05). A significant reduction in hospitalisations was observed in the age groups <2, 20-59 and 60+ in 2017-2020 (p<0.05). In the years 2009-2020, there were 84,367 in-hospital deaths due to CAP, 423 (0.5%) of which due to Streptococcus pneumoniae, with patients mainly aged 60+. CONCLUSIONS: Implementation of the PCV vaccination programme has effectively decreased the incidence of CAP hospitalisations, including children <2 years of age. The group that is most at risk of death are persons aged 60+. The results of our study can be useful in evaluating the vaccine efficacy and benefits, and they can be an essential part of public health policy. Effective prevention strategies for CAP should be implemented in different age groups.

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

BACKGROUND: The participation of older adults in population health interventions constitutes a key factor in their physical, mental and social health. The aim of this study was to determine variables considered as enablers and barriers to participation in health programmes. METHODS: The conceptual framework of the study was developed and population health interventions were operationalised as health programmes. A total of 805 older adults participated in a questionnaire survey. The questionnaire included questions about socio-demographic, health and social connectedness-related factors as well as participation in population health interventions/programmes. Multiple logistic regression was used to examine the relationship between respondents' characteristics and participation in the intervention. RESULTS: Participation in health programmes was declared by 316 respondents. The enablers of participation were general practitioner's affability (OR = 2.638 [1.453-4.791], p = 0.001), three or more social activities (OR = 3.415 [1.477-7.894], p = 0.004), taking part in support groups (OR = 4.743 [1.255-17.929], p = 0.022) and involvement in Universities of the Third Age (OR = 2.829 [1.093-7.327], p = 0.032). The barriers were primary education (OR = 0.385 [0.215-0.690], p = 0.001), infrequent general practitioner's appointments (OR = 0.500 [0.281-0.888], p = 0.018) and lack of social activity (OR = 0.455 [0.299-0.632], p < 0.001). CONCLUSION: The enablers of participation appeared to solely include variables regarding health service utilisation, patient experience and social activity, i.e., interpersonal and community relationships, not intrapersonal factors.

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

INTRODUCTION: According to the WHO, healthy adults aged 18-64 should perform at least 150 min of moderate-intensity aerobic physical activity (PA), or at least 75 min of vigorous-intensity PA, throughout the week, or an equivalent combination of moderate and vigorous activity. These recommendations should be promoted and involved in primary health care (PHC) staff daily practice. Tailoring the education message depends on peoples' perspective on PA, but in Poland there is no research on the subject. OBJECTIVE: The aim of the study was to explore and compare the perception of lay people (LP) and health professionals (HP) of PA to find similarities and differences in their perspective - as this may have an impact on PHC-based education on PA (favourable or unfavourable). MATERIAL AND METHODS: Six mini FGIs were carried out. Research sample consisted of 16 LP from urban settings and 10 HP (doctors, nurses). RESULTS: LP and HP appreciated PA as important and considerably controllable health determinant. LP attributed the main gains of PA to psycho-social benefits, and HP strictly to diseases risk reduction. Both groups had difficulties in defining PA and doubts abounded about PA and exercise. Optimal dose (volume) of PA was generally unclear and the WHO recommendation were unknown. HP seemed to be more eager than LP to appreciate simple forms of PA, e.g. walking. Barriers to PA perceived by LP were described in terms of 'real life' factors (sportswear, access, job), and HP mostly by cognition (knowing, judging) and social status. LP preferred positive, rewarding motivation for PA, but HP one that was negative and fear-based. CONCLUSIONS: Referring to activity, LP and HP were like travellers in parallel universes. This created challenges in PHC-based education. Some suggestion for PA education were given. More qualitative and quantitative research are needed.

Monitoring of community-acquired pneumonia hospitalisations before the introduction of pneumococcal conjugate vaccine into Polish National Immunisation Programme (2009-2016): A nationwide retrospective database analysis.

PURPOSE: Community-acquired pneumonia (CAP) is a common infection with significant morbidity and mortality. In January 2017, Poland introduced pneumococcal conjugate vaccine (PCV) into their national immunisation programme to protect children against invasive pneumococcal disease. This study was designed to investigate pneumonia-related hospitalisation rates and trends from 2009 to 2016 prior to the introduction of nationally funded PCV vaccination. METHODS: Using national public statistic data available from the National Institute of Public Health - National Institute of Hygiene, annual hospitalisation rates for pneumonia were analysed, categorised by aetiology and age (<2, 2-3, 4-5, 6-19, 20-59, 60+ years). Trends over time were assessed, as well as in-hospital mortality. RESULTS: The overall hospitalisation rate due to pneumonia varied between 325.9 and 372.2/100,000 population. Higher rates of hospitalisation were seen in older adults and children ≤5 years. Trends were observed when analysing hospitalisations by pneumonia aetiology within age groups: between 2009 and 2016, Streptococcus pneumoniae hospitalisations significantly increased for children aged <2, 2-3, and 4-5 years, from 5.3 to 12.4, 5.2 to 8.2, and 1.9 to 4.6/100,000 population respectively. Whereas hospitalisations due to Haemophilus influenzae pneumonia decreased significantly from 7.8 to 1.8 and 4.8 to 1.9/100,000 children aged <2 and 2-3 years respectively. The numbers of in-hospital deaths increased from 5578 in 2009 to 8149 in 2016, with >85% of deaths in the 60+ age group. CONCLUSIONS: This is the first national study of pneumonia hospitalisations in Poland, providing the baseline data from which to investigate the impact of the change in vaccination policy on pneumonia hospitalisations in Poland.

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

Background: Monitoring public health workforce is one of the essential functions of the public health system. Objective: The aim of the study was to identify the specialities for physicians and dentists related to public health in the years 1951-2013, and analyse of available data on physicians and dentists certified as public health specialists (PHS) in 2003-2015. Material and Methods: The historical analysis covers a relevant regulations of a minister in charge of health. The data on PHS were obtained from the Centre of Medical Exams and included: the number of specialists and their demographic characteristics, professional background, spatial distribution. Density was also calculated. Results: The public health specialty was introduced in 1999. Before there were specialties in disciplines related to public health. In the years of 2003-2015, 360 physicians and dentists were certified as PHS. The majority of them had former background in another discipline, mostly related to clinical medicine. The average age of specialists was 47.2. Currently, the average age of specialists is ca. 57.6 years, with a prevalence of people aged 61-70 years (36.9%). PHS tend to be older than specialists in other disciplines. Over three fourths of PHS were certified in 2004. With the exception of that year, the public health specialist title was annually obtained by an average of 9 persons. The density of PHS in Poland was 0.94 per 100 thousand inhabitants, ranging between 0.16 and 3.12 in a given voivodeship. Conclusions: The analysis has revealed numerous obstacles in estimation of the number of PHS and indicated a lack of relevant mechanisms aimed at workforce development. A relevant policy for developing public health workforce is urgently needed.

Is there the gap in public health literature in Europe?

INTRODUCTION AND OBJECTIVE: The growing expectations for the effectiveness of public health increase the demand for scientific literature, concerning research, reviews and other forms of information. The bibliographic databases are of crucial importance for researchers and policy makers. The objective of this study is to estimate the supply of scientific literature related to public health in selected European countries, which are available to a wide range of users. MATERIALS AND METHODS: Analysis of the number of bibliographic records on topics related to public health was based on searches in Ovid MEDLINE (R) in May and June 2011. According to MeSH terms, 11 keywords and names of 13 European countries were used in the search. Publications from the years 2001-2010 were analyzed. A number of publications indexed under 'public health', and related to selected countries were compared with the size of the population of those countries, GDP, total expenditure on health and burden of disease (DALYS's). RESULTS: The most popular topic was 'health policy', whereas the topics 'occupational health' and 'environmental health' were less prevalent. There were no significant changes in the number of publications in 2001-2010. The number of articles indexed under 'public health' had significant positive correlation with national GDP, expenditure on health and population size, and negative with DALY's. CONCLUSIONS: According to the criteria accepted in this study, the Nordic countries--Finland, Sweden and Norway--were very productive in this respect. Poland and other Central European Countries were less productive.

Associations and foundations in the field of health care and their role in the health system of Poland.

The article presents data on associations and foundations active in health care field in Poland, on the basis of a review of research done by Klon/Jawor Association and the Central Statistical Office. The article also applies to the issue of cooperation between NGOs and governmental adminstration in the health area and identifies lacking information that is necessary for better planning of national health policy. In Poland there are about three thousand associations and foundations whose main focus is the health care. In 2010, they accounted for about 7% of all non-governmental organizations. Results of representative nationwide surveys from 2008 and 2010 indicate that the NGO's active in the field of health care have, in most cases, legal form of associations. Almost half of the organizations declared national or international scope of action. Headquarters of most organizations were mainly in the cities, and only, one in twenty in the village. Most organizations were located in the mazowieckie province and a significant fraction of them was in Warsaw itself. Organizations were stood out by a relatively large number of personnel on the background of the entire NGO sector. Half of the organizations employed paid workers, the majority also collaborated with volunteers who were not members of the organization. More than a third of organizations dealt with the rehabilitation, therapy and long-term care, and about 1/3 dealt with prevention, health promotion and education, and blood donations. World Health Organization indicates the need for systematic collection of data about the role of the nongovernmental sector in health. In Poland, legal regulations require the public institutions and organizations to cooperate with NGOs to achieve health objectives. In spite of relevant data on NGOs in the field of health care in Poland, the necessary information to assess their potential are still lacking. Recognition of the capacity and limitations ofNGOs could enable better planning of national health policy.

The role of non-governmental organizations in the social and the health system.

The article presents the definitions, objectives, fields and tasks of non-governmental organizations in social life, health system and health policy. In addition, the article addresses the issue of effectiveness and quality of NGOs' activity. The term "NGOs" (Non-governmental Organizations) includes different categories of entities that operate not to obtain financial gain, and also do not belong to the government sector. Non-governmental Organizations' fields of activity were described in the International Classification of Non-Profit Organizations (ICNPO). NGOs are an integral part of a democratic society. Sociological sciences emphasize their importance in enhancing social integration, implementation of the principle of subsidiarity, building civil society, social dialogue and participatory democracy. The main tasks of NGOs in the health system are providing services and health advocacy. Provision of services includes medical, social and psychological services as well as, integration activities, care and nursing, material and financial support, educational and information services and training. Health advocacy is a combination of individual and social actions designed to gain political commitment, policy support, social acceptance and systems support for a particular health goal or program. An important task carried out by NGOs is participation in the formation of health policy. The increasing role of NGOs in providing social services and the participation in political processes, result in the need to confirm the validity and credibility of their operation. One of the ways could be to introduce the mechanisms to assess quality and efficiency, such as registration as a part of a legal system, self-regulatory activities (card rules, codes of ethics), certification, participation in networks, monitoring and audit.

[The role of science in policy making--EuSANH-ISA project, framework for science advice for health]. / Rola nauki w podejmowaniu decyzji politycznych--projekt EuSANH-ISA, struktura doradztwa nauki w kwestiach zdrowotnych.

Governments and other authorities (including MPs) should be well informed on issues of science and technology. This is particularly important in the era of evidence-based practice. This implies the need to get expert advice. The process by which scientific knowledge is transmitted, along with proposals how to solve the problem, is called science advice. The main aim of the article is to discuss the issue of science advice--definitions, interaction between science and policymaking, and its position in contemporary policies. The second aim is to present European Science Advisory Network for Health (EuSANH), EuSANH-ISA project, and framework for science advice for health which was developed by participants. Furthermore, the role of civil society in decision-making process and science advice is also discussed. Interaction between scientists and policy-makers are described in terms of science-push approach (technocratic model), policy-pull (decisionistic) and simultaneous push-pull approach (pragmatic). The position of science advice is described in historical perspective from the 50s, especially in the last two decades. Description relies to USA, Canada and UK. Principles of scientific advice to government (Government Office for Science, UK) are quoted. Some important documents related to science advice in EU and UN are mentioned. EuSANH network is described as well as EuSANH-ISA project, with its objectives and outcomes. According to findings of this project, the process of science advice for health should follow some steps: framing the issue to be covered; planning entire process leading to the conclusion; drafting the report; reviewing the report and revision; publishing report and assessing the impact on policy.

[Salutogenesis--new approach to health and disease]. / Teoria salutogenezy--nowe podejscie do zdrowia i choroby.

A. Antonovsky is the creator of salutogenesis. The theory was built on the ground of many, different sciences connected with health. The article presents salutogenic assumptions including the main factors that determine health and disease i.e. stressors, generalised resistance resources and sense of coherence. Interactions between individuals, environment and culture were presented. Complexity of individual and population health and quality of life was stressed. Salutogenesis and health promotion links were indicated.

[Self-efficacy in health behaviour models for health education]. / Wlasna skutecznosc w modelach zachowan zdrowotnych oraz w edukacji zdrowotnej.

This article presents the overview of self-efficacy theory, description of self-efficacy measurement scale and meaning of self-efficacy in health behaviour change models. Health behaviour impact on health and quality of life of individuals and populations is direct. Shifting health behaviour into pro-health direction is multi-conditioned process and composes of complexity of phenomena involved. Health education strategies which include self-efficacy will be more effective when people will be convinced about their ability to change their own health behaviours. Self-efficacy ought to be included in planning, implementation and evaluation of health education strategies, so their outcomes are much improved. In pursuit of health behaviour change, health education should be integrated into the health system: health care, rehabilitation, prevention and health promotion.

[The Tallinn Charter: health systems for health and wealth]. / Systemy zdrowotne dla zdrowia i dobrobytu--Karta z Tallina.

The article presents main issues of Tallinn Charter (2008) that concerns functioning health systems, theirs influence on health and wealth of society. Health systems are diverse, but share common set of functions. Theirs effective performance contribute, not only to improving health, but also to participation in labour market and socioeconomical development of country.