Analyzing the dynamics of meningococcal vaccinations initiatives by local government units in Poland (2017-2021) - Scope, challenges and recommendations.

INTRODUCTION: Meningococcal vaccinations are recommended by Polish public health authorities but lack coverage under health insurance, prompting Local Government Units (LGUs) to implement local health policy programs. This study examines the effectiveness and impact of LGU-driven meningococcal vaccination initiatives in Poland between 2017 and 2021. MATERIAL AND METHODS: A retrospective analysis utilized data from reports on local public health interventions submitted annually to the Ministry of Health in Poland. The study focused on the number of meningococcal vaccination programs, their scope, the vaccinated population, and associated program costs. Additionally, nationwide data on meningococcal disease incidence and vaccine uptake were analyzed. RESULTS: Within LGUs programs, 48,617 individuals received meningococcal vaccinations, constituting approximately 10% of all vaccinations in Poland during the study period. Notably, cities with poviat rights spearheaded programs covering 54% of the total participants. The total cost incurred by these initiatives amounted to EUR 2,553,661. CONCLUSIONS: While LGUs activities positively contributed to increased meningococcal vaccination rates, the overall engagement of local governments remains limited. The findings underscore the importance of expanding local government involvement in meningococcal vaccination programs to address public health needs effectively. Improved collaboration and increased funding may enhance the reach and impact of these initiatives.

The Usage of Cryopreserved Reproductive Material in Cancer Patients Undergoing Fertility Preservation Procedures.

BACKGROUND: Many cancer treatment methods can affect fertility by damaging the reproductive organs and glands that control fertility. Changes can be temporary or permanent. In order to preserve the fertility of cancer patients and protect the genital organs against gonadotoxicity, methods of fertility preservation are increasingly used. Considering that some patients ultimately decide not to use cryopreserved reproductive material, this review analysed the percentage of post-cancer patients using cryopreserved reproductive material, collected before treatment as part of fertility preservation. METHODS: A systematic search of studies was carried out in accordance with the Cochrane Collaboration guidelines, based on a previously prepared research protocol. The search was conducted in Medline (via PubMed), Embase (via OVID), and the Cochrane Library. In addition, a manual search was performed for recommendations/clinical practice guidelines regarding fertility preservation in cancer patients. RESULTS: Twenty-six studies met the inclusion criteria. The studies included in the review discussed the results of cryopreservation of oocytes, embryos, ovarian tissue, and semen. In 10 studies, the usage rate of cryopreserved semen ranged from 2.6% to 21.5%. In the case of cryopreserved female reproductive material, the return/usage rate ranged from 3.1% to 8.7% for oocytes, approx. 9% to 22.4% for embryos, and 6.9% to 30.3% for ovarian tissue. In studies analysing patients' decisions about unused reproductive material, continuation of material storage was most often indicated. Recovering fertility or death of the patient were the main reasons for rejecting cryopreserved semen in the case of men. CONCLUSION: Fertility preservation before gonadotoxic treatment is widely recommended and increasingly used in cancer patients. The usage rate is an important indicator for monitoring the efficacy of these methods. In all of the methods described in the literature, this indicator did not exceed 31%. It is necessary to create legal and organizational solutions regulating material collection and storage and to create clear paths for its usage in the future, including by other recipients.

Respecting the Patient's Right to Information in Hospital Wards in Poland - Socio-Economic Determinants of Patients' Opinions.

Background: Implementation of the patient's statutory right to information is one of determinants the quality and safety of medical services. The patients' opinions survey is an element of patient-centric care, which is now one of the most important things in modern healthcare. The main aim of the work is to examine patients' opinions on the observance of patients' right to information in the hospital and quality of healthcare in the hospital. A secondary objective was to examine the impact of socioeconomic variables on patients' opinions. Materials and Methods: The study was based on the Computer-Assisted Web Interview (CAWI) questionnaire, carried out in March 2022. The sample included 801 persons. Respondents were patients hospitalized within a maximum of 12 months. The questionnaire contained closed questions about the quality of medical care, observance of the patient's right to information. Results: Probability of referral was measured using the Net Promoter Score (NPS). Respondents answered the question about the recommendation on a scale from 0 to 10. People who rated the hospital ward at 10 and 9 are promoters, people who rated the hospital ward at 8 and 7 are neutral people. In turn, people who rated the hospital ward at 6, 5, 4, 3, 2, 1 or 0 are critics, ie people who will not recommend the hospital to their relatives. Most patients in hospital wards were the detractors (37%). The percentage of promoters was only 1% lower (36%) than that of the detractors. Patients was rated medical and nursing staff at a similar level with regard to the observance of the patient's right to information. Conclusion: Most statistically significant differences in the assessment of medical care in the hospital ward were associated with such sociodemographic variables as age and income. People aged 55-64 and 65+ rated most of the analyzed aspects better.

Workplace Interventions for Type 2 Diabetes Mellitus Prevention-an Umbrella Review.

PURPOSE OF REVIEW: Type 2 diabetes mellitus (T2DM) is a chronic disease that may lead to severe complications. The main methods of preventing or delaying the onset of T2DM include lifestyle changes. The purpose of this study is to identify and evaluate the effectiveness of workplace interventions aimed at preventing type 2 diabetes. An umbrella review was conducted in accordance with the Cochrane Collaboration guidelines. Searches were performed in Medline (via PubMed), Embase (via OVID), and Cochrane Library databases. The quality assessment of the included studies was performed using the AMSTAR2 tool. RECENT FINDINGS: The final analysis included 7 studies. The majority (4 of 7) of the studies included in the review focused on workplace interventions based on the guidelines of the US Diabetes Prevention Program (DPP) or other similar programs. The method of decreasing the risk of type 2 diabetes among employees are programs consisting of multiple approaches aimed at improving parameters associated with diabetes, i.e., body weight, and therefore BMI, reduction, and reducing blood glucose levels, as well as HbA1c levels through educational approach and lifestyle changes. The results of those studies point to multicomponent interventions as more effective than single-component interventions. An effective workplace intervention aimed to reduce the risk of type 2 diabetes among employees is a multicomponent program consisting of elements such as educational activities, interventions targeting dietary changes and increased physical activity.

COVID-19 control measures in correctional facilities of selected countries - A literature overview.

INTRODUCTION: The COVID-19 pandemic is one of the most significant public health challenges for this generation. Governments have been forced to undertake different measures to constrain the spread of the virus and protect the people. Restrictive and other measures have also been taken in correctional facilities to control the epidemiological situation. OBJECTIVE: The aims of this review are: 1) to contribute to knowledge by providing an overview of anti-COVID-19 measures that have been undertaken by the proper authorities in a few selected countries to control the epidemiological situation in prison; 2) to demonstrate proposals made in this respect by international organizations and scientific institutions and 3) to complete the most important bibliographical items for further studies. REVIEW METHODS: A literature review was carried out of international scientific and grey literature published between 30.01.2020 and 30.07.2021 (with some exemptions). In every correctional system in the countries under scrutiny, the proper authorities introduced many measures to control the epidemiological situation from the very beginning of the pandemic. SUMMARY: The COVD - pandemic impacts almost all aspects of social and individual life. Governments were forced to undertake different measures to constrain the spread of the virus. Restrictive and other measures also had to be taken in correctional systems, where more than ten million people are held worldwide. The measures introduced differed regarding details such as time, scope and range, but were generally similar to solutions proposed by organisations such as the WHO or CDC. In most countries, the discussion regarding the reform of the legal system have been observed. One of the most discussed issues was the problem of decarceration.

COVID-19-Infections and Immunization of Inmates in Penitentiary Institutions in Poland in 2021.

Susceptibility to infection and the risk of a severe course of the disease caused by SARS-CoV-2 among inmates are greater than in the general population. Therefore, it is extremely important to control infections in penitentiary institutions and to vaccinate as many inmates as possible. The objectives of the study are to present the number and percentage of inmates quarantined, infected with the SARS CoV-2 virus, and vaccinated against COVID-19 in 2021, and to describe the rules and organization of immunization. The information presented in the study was obtained from the Ministry of Justice in the form of access to public information. In 2021, 2065 cases of SARS CoV-2 infection were detected among inmates, and 5707 people were quarantined. The waves of infections among inmates in Poland ran parallel to those in the general population. Immunization of inmates began at the turn of February and March 2021. It took place in accordance with the provisions of the National COVID-19 Immunization Program. The program ensured equality of the inmates' population with the group to which individual inmates belong in the community. In 2021, nearly half of the inmates were covered by the full vaccination course. Inmates were vaccinated immediately after the vaccines were made available. There have been cases of refusals among inmates. There are no data that could determine the magnitude of the phenomenon and its exact causes.

Civil Lawsuits as an Indicator of Adverse Outcomes in Healthcare.

The financial burden of adverse healthcare outcomes in Poland still remains unknown. The objective of the study was to estimate the cost of adverse healthcare outcomes in the Polish healthcare system. Cost calculation was performed on the basis of civil cases completed in Polish courts against doctors and healthcare entities. The research material consisted of 183 civil cases completed by a final judgment in 2011-2013. The case study was conducted in five out of forty-five district courts across the country. Out of 183 reviewed cases, 73 complaints ended up with favorable judgments (39.9%). The average value of the subject matter of the dispute was USD 78,675. The total expected value of lawsuits in the 183 reviewed cases was USD 11,299,020. The total amount awarded in 73 judgments from medical facilities to injured patients was USD 2,653,595, which on average means USD 36,351 per case. The average amount of awarded compensation was USD 33,317 per case. The average compensation amount in the analyzed cases was USD 11,724. The average one-time annuity for a patient was USD 11,788. The estimated costs of negative healthcare outcomes amounted to USD 8,000,000 per year.

Health Security: Definition Problems.

The link between security and health is not a discovery. Despite the widespread recognition of the social importance of health security, there is no single common definition of this concept. The study's objective was to search, analyse and evaluate possible original propositions to define the concept of "health security" in Polish professional literature published from 10 January 2017 to 31 March 2022. The research method was a scoping review performed in five stages according to H. Arksey and L. O'Malley. Ultimately, the study criteria were met by four studies. The proposed definition of health security in these papers failed to solve this problem and raised further questions and doubts. It is urgent to start a discourse on the meaning of the concept of "health security" with the broadest possible participation of representatives of various scientific disciplines, but taking into account the knowledge and practice of public health. It seems that it will be impossible to avoid the following questions: what is health security nowadays? What is health security as a personal issue? What are the necessary steps to achieve the consensus? Is it worthwhile to consider it on the international level?

The Role of Soy Isoflavones in the Prevention of Bone Loss in Postmenopausal Women: A Systematic Review with Meta-Analysis of Randomized Controlled Trials.

The aim of the report was to determine the effects of soy isoflavones on lumbar spine, femoral neck, and total hip bone mineral density (BMD) in menopausal women. MEDLINE (PubMed), EMBASE, and Cochrane Library databases were searched for articles published in English during 1995-2019. Studies were identified and reviewed for inclusion and exclusion eligibility. Weighted mean differences (WMD) were calculated for each study and were pooled by using the random effects model. Eighteen randomized controlled trials were selected for meta-analysis. Different types of soy phytoestrogens, i.e., genistein extracts, soy isoflavones extracts, soy protein isolate, and foods containing diverse amounts of isoflavones were used in the studies. The analysis showed that daily intake of 106 (range, 40-300) mg of isoflavones for 6-24 months moderately but statistically significantly positively affects BMD, compared with controls: lumbar spine WMD = 1.63 (95% CI: 0.51 to 2.75)%, p = 0004; femoral neck WMD = 1.87 (95% CI: 0.14 to 3.60)%, p = 0.034; and total hip WMD = 0.39 (95% CI: 0.08 to 0.69)%, p = 0.013. Subgroups analyses indicated that the varying effects of isoflavones on BMD across the trials might be associated with intervention duration, racial diversity (Caucasian, Asian), time after menopause, form of supplements (especially genistein), and dose of isoflavones. Our review and meta-analysis suggest that soy isoflavones are effective in slowing down bone loss after menopause.

Nutritional Treatment of Patients with Colorectal Cancer.

Colorectal cancer is one of the most common cancers in Europe and the world. Cancer treatments have side effects and cause significant deterioration of the patient's nutritional status. Patient malnutrition may worsen the health condition and prevent the deliberate effects of the therapy. The aim of this review was to describe the available data about clinical nutrition in colorectal cancer patients. A large proportion of colorectal cancer patients suffer from malnutrition, which negatively affects the survival prognosis, quality of life, and oncological therapy. Therefore, monitoring nutritional status during the treatment is essential and can be used to arrange proper nutritional therapy to enhance patient responses, prevent side effects, and shorten recovery time. The principles of nutrition during anticancer therapy should mainly consider light and low-fat foods, the exclusion of lactose and gluten-containing foods in certain cases, or the introduction of special dietary products such as oral nutrition supplements and it should be tailored to patients' individual needs.

Falsified Medicines Directive in a Secondary Care Environment-Impact on Supply Chain.

The Falsified Medicines Directive (FMD) and the Delegated Regulation (DR) impact the pharmaceutical supply chain. Ahead of the deadline for implementation, in February 2019, every entity of the supply chain had to adapt its operations to the regulatory requirements to be compliant with the directive. This paper analyzes the supply chain of a hospital pharmacy and the impact of the FMD implementation. Furthermore, a cost analysis was performed demonstrating that the FMD increases expenditure in the secondary care environment dispensing operations. Governments should be aware that this regulation will certainly impact public healthcare institutions in the long term.

Resilient Health and the Healthcare System. A Few Introductory Remarks in Times of the COVID-19 Pandemic.

People across the globe are facing increasingly complex public health emergencies that are responsible for the loss of life, economic and social problems with unprecedented damage and costs. For some sociologists, our society is even "a risk society" and our time is highly violative. Emergencies of different origin: stemming from natural environmental disasters, such as floods, hurricanes, intense drought, technical accidents, social unrest and last but not least-outbreaks of infectious diseases. This decade started with one of the most significant pandemics in the history of man-kind-COVID-19. Hence, the problems of resilient health and healthcare systems have become urgent. Especially since SARS-CoV-2 may cause long-term health threats and recurrent crises. It is very important to have a common language. So far, definitions and concepts of health and healthcare resilience differ substantially and are seldom clearly defined. The aim of this paper is to describe how health and healthcare system resilience is defined to either uncover, recall, or in combination, its concept and prepare an introductory conceptual review as a preliminary step for further studies.

Pain Management Strategies among Cancer Patients. Normalization of the CSQ (The Pain Coping Strategies Questionnaire) Form.

INTRODUCTION: Cancer is associated with chronic pain, which significantly reduces the quality of life. The level of pain depends on the dominant pain management strategy that the patient uses. OBJECTIVE: This study seeks to evaluate the application of the Pain Coping Strategies Questionnaire among cancer patients and develop norms allowing differentiation of patients with diagnosed cancer in terms of pain management strategies. MATERIAL AND METHODS: The study involved 1187 patients diagnosed with malignant cancer, who are under outpatient care of the Maria Sklodowska-Curie Institute-Oncology Center in Warsaw. The study used the Pain Coping Strategies Questionnaire (CSQ) elaborated by A.K. Rosentel and F.J. Keefe. RESULTS: Socioeconomic variables and medical factors affect pain management strategies chosen by patients. The area most strongly differentiated by the studied variables is praying/hoping. Factors that have the greatest impact on the choice of pain management strategies for cancer patients include education, income, and radiation therapy. Sten standards were developed to determine the severity of pain management strategies used in the low-average-high categories. CONCLUSIONS: The CSQ questionnaire should be used in cancer patients, and the result of the strategy used can be a prognostic factor for the expected effects of therapy. Knowledge of the variables most strongly affecting patients' choice of strategies that are not conducive to strengthening health attitudes and the ability to determine the severity of pain management strategies on standard scales allows us to focus psychotherapeutic activities on patients who need support most.

Patients' Opinions on the Quality of Services in Hospital Wards in Poland.

INTRODUCTION: Patient opinion surveys have become a widely used method for assessing key aspects of the functioning of medical facilities and, thus, of the functioning of the entire health care system. They are a prerequisite for developing patient-centered care and an essential component of quality improvement programs. In many countries, including Poland, patient opinion surveys are written into the accreditation standards of medical institutions. Patient's readiness to recommend a hospital is a recognized indicator of the quality of patient-centered care. In a report on strategies for improving the quality of health care in Europe published in 2019 by WHO and the OECD (Organisation for Economic Cooperation and Development), patient's readiness to recommend a hospital was cited as one of the basic indicators of 'patient centeredness' along with patient satisfaction. Therefore, as well consideration of the quality of medical care, a patient recommendation index was also used in the study presented in this paper. The index was based on the answers to questions about the patient's readiness to recommend a hospital ward to family and friends. AIM: The aim of the study was to investigate patients' opinions on the quality of services in particular hospital wards. A patient opinion survey can be used to improve the quality of services and monitor the effects of health-related activities, identify areas that need improvement, motivate medical staff and prevent their burnout, build a trusting relationship with patients, and compare the quality of health care in various facilities. MATERIAL AND METHODS: The study was carried out in March 2022. The patient opinion survey was conducted using the CAWI (Computer-Assisted Web Interview). The sample selection was purposive. The respondents were patients with a history of hospitalization. The sample selection used an algorithm for the random selection of patients who met the criteria for the sample. The inclusion criterion was hospitalization in the 12 months prior to the study. A standardized questionnaire was used that was aimed at the assessment of the quality of medical care and the patient's rights to information. Additionally, the survey contained questions about the demographic characteristics of the respondents. RESULTS: A total of 38% of patients with a history of hospitalization expressed criticisms. The majority of statistically significant differences were observed when differentiating respondents according to age. Elderly persons significantly more often declared having been treated with respect and interest. They also rated more highly the meals served in the hospital, effective pain treatment, and respect for the patient's dignity and intimacy during diagnosis and treatment. Younger persons assessed all these aspects of hospitalization less favorably. CONCLUSIONS: Variables including age and the level of income had a statistically significant influence on the opinion of the respondents. Elderly persons assessed most aspects of the quality of care in a hospital ward more favorably. There were a similar number of "promoters" (36%) and "detractors" (38%) of the quality of hospital services. Detractors mainly pointed to long waiting times for hospital admission, the poor quality of medical and nursing care, and unappealing meals. The promoters emphasized the high quality of medical and nursing care and the favorable conditions of the accommodation. Regular patient satisfaction surveys are helpful in identifying areas in which the functioning of a medical entity requires changes.

COVID-19 - Infection prevention in prisons and jails in Poland.

INTRODUCTION AND OBJECTIVE: Due to the specificity of conditions in penitentiary establishments, there is an increased risk of rapid spread of SARS-CoV-2 virus infections. In addition, there is a high prevalence of non-communicable chronic diseases among inmates, which increases the risk of the severe course of COVID-19. The objectives of the study are to present the number and percentage of officers and employees of the Prison Service (PS), and inmates quarantined and infected with the SARS-CoV-2 virus in the period from March to the end of December 2020, as well as to present solutions aimed at limiting the transmission of SARS-CoV-2 virus. MATERIAL AND METHODS: Information on the number of PS officers, employees and inmates quarantined and infected, as well as information on the solutions introduced by the Prison Service Management Bard,was obtained from the Ministry of Justice pursuant to the provisions of the Act on Access to Public Information. RESULTS: From1 March 2020 - 31 December 2020, the number of cases of infection detected among PS officers and employees was 3,666, and among inmates - 599. 97.7% of all cases among PS officers and employees and 93.8% among inmates were reported in the last 3 months of the year. CONCLUSIONS: The rapid introduction of solutions aimed at limiting the transmission of the SARS-CoV-2 virus and proper monitoring of the epidemic in penitentiary establishments resulted in a low number of infections in the period from March to the end of December 2020. Infections among PS officers and employees, as well as inmates, seem to be parallel to the epidemiological situation in the population of the entire country. Further analysis of the epidemic will confirm the impact of the measures taken on the incidence of COVID-19 among PS officers, employees and inmates.

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

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

Creating healthy and active life for the elderly in programmes conducted by rural and urban-rural communes in Poland.

BACKGROUND: In Poland, between 1989 and 2018 the number of the elderly increased by over 3.9 million. Demographic changes justify a senior policy focussed on the longest possible social, professional and family activity of the elderly. Directions of undertaken actions should include health policy programmes aimed at creating conditions healthy and active life of the elderly. The programmes should be particularly important in rural areas as the health of rural and urban residents differs. The study presents programmes for creating conditions for a healthy and active life of the elderly run by rural and urban-rural communes in 2012-17. METHODS: The study was conducted on the basis of existing data analysis. Data from the summary information prepared by voivodes and provided to the Minister of Health about implemented health policy programmes were used. Data on programmes concerning a healthy and active life for the elderly conducted by rural and urban-rural communes between 2012 and 2017 were extracted from the aggregate information. RESULTS: Between 2012 and 2017, 354 programmes were implemented, the most in 2016, and the least in 2015. There were 171 000 people participating in the programmes. The total cost was USD 2 491 664. CONCLUSION: It can be presumed that in 2016 communes implemented more diagnostic and therapeutic programmes than in 2017. A small number of programmes and a small involvement of financial resources in communes with the largest number of the elderly may indicate marginalization of the importance of an active and healthy life for the elderly.

Self-government HPV vaccination programmes in Poland, 2009-2016.

INTRODUCTION: Cervical cancer is the fourth neoplasm in women with respect to incidence. In Poland, both cervical cancer incidence and corresponding mortality are gradually decreasing. Despite these improvements, the epidemiological situation significantly deviates from European standards. Poland has one of Europe's lowest five-year survival rates at 54.1% for patients diagnosed in 2000-2002, compared to the European mean value of 62.1%. OBJECTIVE: The aim of this study is to present health policy programmes related to HPV vaccinations run by local self-government units in 2009-2016. MATERIAL AND METHODS: The research is based on analysis of already existing data developed by provincial governors and annual information reviews on health-policy programmes implemented by local self-government units presented to the Ministry of Health. All the programmes that included HPV vaccinations have been subjected to analysis. RESULTS: In 2009-2016, local government units implemented a total of 1,204 health policy programmes that covered HPV vaccinations. Under these programmes, 2.05% of girls aged 10-14 were vaccinated. Percentage-wise, these were communes that contributed the most financially to the HPV vaccination programmes, whereas the counties the least. CONCLUSIONS: Local self-government's programmes covering HPV vaccinations conform with the trends outlined in strategic documents on fighting neoplastic diseases. It is possible that the availability of HPV vaccination was limited for girls living in rural communes. Differences in the number of programmes, number of vaccinated girls and the financial outlays allocated for the implementation of HPV vaccination programmes in particular provinces, may be determined by the epidemiological situation in a given region, measured by the incidence rate of cervical cancer.

Selected factors determining outsourcing of basic operations in healthcare entities in Poland.

BACKGROUND: In light of insufficient financial resources allocated to the functioning of the health care system in Poland, healthcare entities undertake several restructuring measures aimed at cost reduction, improvement of effectiveness and optimisation of operations. One of the elements of this restructuring is outsourcing. OBJECTIVE: The objective of the study is to determine the significance of selected factors determining the outsourcing of basic operations in healthcare entities in Poland. METHODS: The research tool was the authors' questionnaire. The study was conducted at healthcare entities using the CAWI method in 2018. The outsourcing of laboratory diagnostics, diagnostic imaging and medical personnel was examined. RESULTS: Out of 750 healthcare entities, 241 outsource medical personnel, 484 outsource laboratory diagnostics, 445 outsource imaging diagnostics. The use of outsourcing primarily results from the excessively high cost of maintaining own employees, the desire to gain access to the top-quality knowledge and technology as well as the need for financial savings. CONCLUSIONS: The scale of outsourcing of medical personnel may be greater than it results from the obtained study results. Excessively high costs of maintaining own employees as the most important reason for using outsourcing is a consequence of high personnel costs occurring in the case of establishing cooperation on the basis of an employment relationship.

Prevention of overweight and obesity undertaken by local government units in Poland.

BACKGROUND: Based on the estimates of World Health Organization (WHO), in European Union countries overweight or obesity affects more than 60% of men and over 50% of women. According to the nationwide European Health Interview Survey (EHIS) survey conducted in 2014, in Poland over 62% of men and nearly 46% of women carried excess weight in 2014. OBJECTIVE: The objective of the paper is to present health policy programmes aimed at prevention of overweight and obesity developed, implemented and funded by local government units (self-governments of voivodeships, counties, municipalities) in Poland in 2010-2016. METHODS: The study was based on a desk research. It covered data from two sources, i.e. data included in annual reports formulated by voivodes and submitted to Minister of Health concerning all health policy programmes implemented by local government units and data published online as part of reviews of draft programmes by the Agency for Health Technology Assessment and Tariff System (AOTMiT). RESULTS: In the period under review local government units implemented a total of 333 overweight and obesity prevention programmes. 18 programmes were reviewed by AOTMiT. Most programmes have been implemented in the Zachodniopomorskie and Mazowieckie Voivodeships, whereas the least in the Podlaskie, Lubelskie and Kujawsko-Pomorskie Voivodeships. Around 99% of municipalities, 97% of counties and 86% of self-governments of voivodeships did not complete any overweight and obesity prevention programmes in the period under review. CONCLUSION: Insufficient engagement of local government units in the prevention of overweight and obesity - one of the primary objectives of the National Health Programme for 2007-2015 and 2016-2020. Differences in terms of the number of programmes implemented by particular types of local government units and the financial resources employed in the implementation of the programmes. Failure to fulfil the statutory obligation to obtain a review from AOTMiT. Failure to address the actual health needs of local communities related to overweight and obesity prevention by some of the voivodeships.