Efficiency and Effectiveness of Patient Care Provided by Physicians in Rural and Urban Areas in Poland.

BACKGROUND The health sector in Poland is currently facing challenges such as limited financial resources, poor infrastructure, and insufficient human resources. To address these issues, increasing cost-effectiveness at the individual physician level has become essential. This study aimed to evaluate the efficiency and effectiveness of patient care at the level of individual primary health care physicians and to compare the performance of physicians working in urban and rural areas. MATERIAL AND METHODS Thirteen original effectiveness indicators were developed based on a literature review, expert consultations, and a pilot study at the Medical and Diagnostic Center in Siedlce. The indicators were used to evaluate the effectiveness of physicians and compare physicians' characteristics working in rural and urban areas. The study extracted data on physicians' characteristics and used the indicators to evaluate their effectiveness. RESULTS Physicians working in rural areas treated more patients due to staff shortages. However, physicians working in urban areas demonstrated greater effectiveness in performing routine and advanced health checks and mammograms. Despite this advantage, the average life expectancy of patients was higher among patients of physicians working in rural areas. CONCLUSIONS Five indicators developed in the study formed a scale, which is a step toward developing a uniform effectiveness indicator. Further research on consistently measuring effectiveness could significantly impact the development of sociometric research methodology. This study highlights the differences in efficiency and effectiveness of physicians working in rural vs urban areas and underscores the need for healthcare policymakers to consider these differences in addressing healthcare resource allocation.

Trends in Hospitalization Duration for Rare Diseases: A Retrospective Analysis of Sarcoidosis, Still's Disease, and Systemic Sclerosis in Poland (2009-2018).

BACKGROUND A rare disease is a health condition that rarely occurs in the population. It is estimated that up to 400 million people around the world suffer from a rare disease. This retrospective study aimed to investigate factors associated with length of hospitalization in 78 626 patients with sarcoidosis, 3294 patients with adults-onset Still's disease, and 35 549 patients with systemic sclerosis between 2009 and 2018 using data from the National Institute of Public Health in Poland. MATERIAL AND METHODS In this population-based study, we analyzed hospital discharge records of first-time and subsequent hospitalizations. To perform the statistical analyses, R software was used. RESULTS The average length of hospitalization over the selected period in the diseases was 5.39 days for sarcoidosis, 6.22 days for scleroderma, and 7.44 days for Still's disease, and was shorter for each of the diseases analyzed compared with the length of hospitalization for second and subsequent stays. There were no substantial differences in length of hospitalization between males and females. The average length of hospitalization increased with each additional comorbidity. CONCLUSIONS The study showed that hospitalizations for selected rare diseases do not cause a significant burden on the healthcare system. The results also showed that advanced age and comorbidities are important factors determining the length of hospitalization. The average length of hospital stay for selected rare diseases in Poland is not longer than the European Union (EU) average, so it can be assumed that the process of inpatient treatment in Poland is optimal.

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

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

Effectiveness of Antiepidemic Measures Aimed to Reduce Carbapenemase-Producing Enterobacteriaceae in the Hospital Environment.

Purpose: The objective of this study was to evaluate the effectiveness of hospital-based antiepidemic measures aimed at limiting the spread of symptomatic infections and colonization with carbapenem-resistant Enterobacteriaceae (CPE), mainly NDM-producing Klebsiella pneumoniae, with particular emphasis on microbiological screening tests. Methods: This retrospective study was based on data from 168 hospitals under the supervision of the Provincial Sanitary and Epidemiological Station in Warsaw, Poland, in 2016-2017. Analysis of the effectiveness of antiepidemic procedures focused on the type of implemented antiepidemic procedures, the number of microbiological screening tests per year, the geographic location of the hospitals (inside or outside Warsaw), the timing of the screening tests (on admission to hospital or 48 hours later), and the results of the screening tests. Results: Rates of proper isolation of patients infected or colonized with an alarm pathogen including NDM-producing K. pneumoniae increased from 38.0% in 2016 to 49.5% in 2017 (p > 0.05). The number of screening tests performed increased by 88% from 68319 in 2016 to 128373 in 2017. The number of epidemic outbreaks of symptomatic infections caused by NDM-producing K. pneumoniae decreased from 11 in 2016 to 7 in 2017 in hospitals in Warsaw, where microbiological screening tests were performed. The number of outbreaks in hospitals outside Warsaw, where the screening tests were not performed or were limited, increased from 8 in 2016 to 24 in 2017. Conclusion: Screening tests increase the chance of detecting colonization by CPE. The implementation of microbiological screening decreased the risk of epidemic outbreaks of symptomatic infections caused by CPE.

Immunogenicity of Split Inactivated Quadrivalent Influenza Vaccine in Adults with Obesity in the 2017/2018 Season.

BACKGROUND Obesity is associated with susceptibility to severe influenza infection and several disturbances of the immune response to the influenza vaccine. However, the effect of obesity on the immunogenicity of the influenza vaccine is not fully understood. Our objective here was to assess the immunogenicity of the split, inactivated quadrivalent influenza vaccine (QIV) in Polish adults with obesity. MATERIAL AND METHODS Fifty-three subjects with obesity aged 21-69 years were vaccinated with the QIV in 2017/2018 season. Antibody titers against the 4 vaccine strains were measured using the hemagglutination inhibition (HI) assay. The mean fold antibody increase (MFI), seroprotection rate (protection rate, PR), and seroconversion rate (response rate, RR) were calculated to assess vaccine immunogenicity. RESULTS The vaccine elicited a significant increase in the anti-HI titers against the QIV antigens. The MFI, PR, and RR for the QIV antigens also reached the required age-specific values, indicating the QIV meets current immunogenicity criteria. Individuals with class I and class II/III obesity had similar anti-HI titers, MFI, PR, and RR to each of the vaccine strains. Adults aged <60 years had similar anti-HI titers, MFI, PR, and RR to the QIV strains to those aged ≥60 years. CONCLUSIONS Our results indicate that the split virion, inactivated QIV is immunogenic in adults with obesity regardless of their degree of obesity and age (ie, <60 and ≥60 years).

Polish adolescents' right to confidential primary health care is not respected despite high public acceptance.

AIM: The right of underaged patients to confidential health care should be considered an inalienable human right. Access to such care is also advisable according to contemporary medical knowledge. The aim of this study was to verify the extent this right is exercised in Poland and to examine social attitudes towards this issue. METHODS: A sample of Polish school-age pupils and parents (n = 800) was surveyed using an online questionnaire. RESULTS: Only 4.2% of the surveyed adolescents were offered private time with a doctor during their last preventive visit (well-child visit), and this was more frequent for girls. At the same time, a very high level of acceptance for private time with a doctor was observed among Polish adolescents (90.8%) and their parents (84.3%). CONCLUSION: Our findings suggest serious deficiencies in the protection of adolescent patients confidentiality. It is necessary to change medical practice and adapt legal regulations to the provisions of the Convention on the Rights of the Child.

Influenza A (H1N1) and Respiratory Syncytial Virus (RSV) Coinfection in a Newborn Child: A Case Report.

This paper presents a case of coinfection of influenza A virus (H1N1) and respiratory syncytial virus (RSV) in a male newborn. On the first day of life, the newborn required passive oxygen therapy, followed by respiratory support with nasal continuous positive airway pressure (nCPAP) due to respiratory insufficiency. As the newborn's respiratory effort was intensifying, he was intubated. In the second day of life, a nasopharyngeal swab was taken yielding the presence of H1N1 and RSV in the RT-PCR test. The child was isolated and given oseltamivir and empirical antibiotic therapy, which improved his condition. Other newborns who initially stayed with the sick child in the post-delivery room did not obtain oseltamivir prophylactically as their nasopharyngeal swabs were negative. The child's parents denied the occurrence of influenza-like symptoms within 14 days of delivery, which suggests a transplacental transmission of the child's infection or asymptomatic course of infection in the parents. In conclusion, this report confirms the possibility of viral coinfections in newborns, which points attention to considering a panel of respiratory viruses in the diagnostics. Symptoms of influenza in newborns may be atypical, including a fever-free course. Oseltamivir treatment in newborns with influenza seems an effective therapeutic measure.

Safety and Impact on Training of the Influenza Vaccines in Elite Athletes Participating in the Rio 2016 Olympics.

OBJECTIVE: The aim of the study was to evaluate the safety and tolerance of influenza vaccines for the northern and southern hemispheres in Polish elite athletes participating in the Rio 2016 Olympics. DESIGN: Prospective, observational, cohort study. SETTING: Institutional level. PARTICIPANTS: Ninety-seven athletes vaccinated only with the northern hemisphere vaccine; 98 athletes received the southern hemisphere vaccine alone, whereas 39 athletes were vaccinated with both vaccines. INTERVENTIONS: The athletes were vaccinated with a trivalent, inactivated influenza vaccine recommended for the northern hemisphere 2015/2016 and then with the vaccine recommended for the southern hemisphere 2016. Athletes kept a diary of adverse events and effects (if any) on training for 6 days after vaccination. MAIN OUTCOME MEASURES: The percentage of general and local adverse events, number of lost or modified training sessions. RESULTS: Significantly more local adverse events (pain and redness) were found in the group immunized with the vaccine for the northern hemisphere. There were no differences in the frequency of general adverse events and influence on training between groups. Of total 273 athletes who had 1911 training days during 6 days after vaccination, 6 athletes (2.2%) lost 13 training days (0.7%) and 16 athletes (5.9%) had to modify 34 (1.7%) training days within first 2 days after vaccination. CONCLUSIONS: Athletes tolerated influenza immunization well. If they are going to travel to the other hemisphere during the influenza season, the use of the second influenza vaccine should be advised. Athletes should anticipate modification of trainings for 2 days after vaccination.

[What is the effect of social distancing on the course of COVID-19 epidemic?] / Jak dystansowanie spoleczne wplywa na rozwój epidemii COVID-19?

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

Patient care efficiency in primary healthcare - pilot study in Medical and Diagnostical Centre.

In Poland, there is a niche that can be filled with original research in the area of performance indicators of individual health care professionals. AIM: The aim of the study was the empirical verification of original effectiveness indicators and the identification of the degree of patient care effectiveness of selected primary health care professionals with the application of the developed indicators. MATERIALS AND METHODS: The study population consisted of physicians employed in the primary care in Medical and Diagnostic Centre (MDC) in Siedlce, Poland. The final study sample consisted of 29 respondents. 14 original indicators in three areas: structure, process and effect were developed and verified. RESULTS: The distribution of indicator values for the physicians included in the study demonstrated a diverse level of their effectiveness. The factor analysis performed for the 14 original indicators demonstrated that a highly reliable scale can be created out of 5 of the original indicators. CONCLUSIONS: In our pilot study we assessed the reliability of the designed tools. However, unfortunately, our research did not offer the opportunity to identify any dependencies of variables. A study on a larger sample of physicians would therefore be needed.

Prophylactic medical examination of 15/16 year old from the Warsaw Agglomeration. Evaluation of the implementation of standards in practice.

Prophylactic medical examinations - called well-child visit - are among the benefits guaranteed under basic health care. The prophylactic visit should include, among others: physical examination and an interview (with the adolescent and the parent), as well as individual pro-health education. AIM: The aim of the study was to answer the question whether preventive medical visits of 15/16 year olds from the Warsaw Agglomeration are carried out within the scope defined by the Minister of Health and in accordance with standards. MATERIALS AND METHODS: The course of well-child visit was evaluated on the basis of 359 anonymous questionnaires filled in by students from randomly selected 11 schools from the Warsaw Agglomeration. RESULTS: In 3.3% of the respondents, the doctor did not carry out any of the physical examinations asked in the questionnaire. The most often doctor auscultated chest organs (94.4% of respondents), the least frequently examined genitals in girls (2.1%). During the visit, the doctors raised less than 4 topics on average. The most frequent subjects of discussion were menstruation (80.0% of girls), chronic diseases in the adolescent's family (59.1%) and physical activity (51.0%); the rarest ones were depression and suicidal thoughts (3.1%), violence (1.9%) and the influence of the family on the patient's well-being (1.4%). The compatibility of the gender of the patient and the doctor increased the number of topics discussed. CONCLUSIONS: The confrontation of the data obtained by us with the content of the Minister of Health's regulation and the standards in force in Poland provides the basis for a negative assessment of the implementation of medical prophylactic examinations in the adolescents in the Warsaw Agglomeration.

Decreasing Vaccination Coverage Against Hepatitis B and Tuberculosis in Newborns.

The number of parents who refuse to vaccinate their children or present the so-called hesitant behavior, i.e., delay the moment of vaccination beyond the mandatory time, has increased in many developed countries. The purpose of this retrospective study was to evaluate the completeness and timeliness of vaccinations against hepatitis B (HBV) and tuberculosis (TB) in neonates in a single maternity hospital in Warsaw, Poland. We reviewed medical files of 14,785 children born in the hospital in 2015-2017 and calculated the proportion of newborns not vaccinated on time according to the Polish Immunization schedule that includes vaccination against HBV and TB in the first day of life. Newborns remained unvaccinated because of parental refusal (refusers) or decision for a delay (hesitants), or medical contraindications. The percentage of unvaccinated newborns in the 3 years was as follows: 7.3% in 2015, 6.7% in 2016, and 10.1% in 2017. Parental decisions rather than medical contraindications caused nonvaccination (4.4% vs. 2.9% in 2015, 4.7% vs. 2.0% in 2016, and 7.5% vs. 2.6% in 2017). The majority of refusals concerned both vaccinations (67.3% in 2015, 74.8% in 2016, and 68% in 2017). Among parents who refused only one vaccination, TB vaccination was refused more often than HBV (9.2% vs. 7.1% in 2015, 8.3% vs. 5.7% in 2016, and 5.9% vs. 2.7% in 2017). Similar trends were observed among the hesitants. In conclusion, it seems essential to implement effective educational and informative activities targeted to parents to reinforce positive attitudes toward vaccinations.

Nutritional Status and Dietary Patterns in Adults with Severe Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is associated with daytime sleepiness, obesity, and lifestyle and dietary changes. The potential role of diet in OSA has been largely unexplored. The aim of the study was to assess nutritional status and dietary patterns in OSA patients. The study was conducted in 137 adult patients (48 women and 89 men) aged 31-79 suffering from OSA. The following diagnostic procedures were undertaken: polysomnography, anthropometric measurements, and a dietary pattern questionnaire. We found that 128 (93.4%) patients were overweight or obese with the mean body mass index (BMI) of 33.2 ± 6.1 kg/m2 and weight of 98.0 ± 20.2 kg. The mean percentage of total body fat was 45.0 ± 5.5% in women and 32.5 ± 5.5% in men. Obesity was associated with the severity of OSA, expressed by apnea/hypopnea index. We further found that the waist-to-hip ratio in women, but the neck circumference or percentage of body fat in men, characterizes best the OSA patients. Referring to dietary habits, half of the patients consumed white bread on a daily basis, 35.8% of them had whole grain bread in the diet, and only 16.8% consumed fish at least two portions a week. A third of patients used butter as a spread for bread or a source of fat for cooking, 2.9% of them used soft margarine, and 20.4% used olive or canola oil. Fruits and vegetables were consumed by 60% and 38% of patients, respectively. Refined sugar and sweets were used by 31.4% of patients every day. We conclude that excessive body weight, which may portend the development of OSA, is characterized by different anthropometric variables in men and women. Further, improper dietary habits seem conducive to the gain in body weight and thus may be at play in the pathogenesis of OSA.

Impact of parental smoking on influenza and others respiratory infections in children.

BACKGROUND: The predisposition of cigarette smokers for the development of respiratory infections, including influenza, have been well documented. As well, those exposed to side stream smoke are prone to viral and bacterial infections of the respiratory tract. AIM: The study aimed to evaluate whether the prevalence of smoking parents is higher among children with respiratory tract infections, including influenza, in comparison to the general population. MATERIAL AND METHODS: Observational, cohort study. The authors surveyed a cohort of patients and their families, hospitalized in the Paediatric University Hospital in Warsaw during 2018 influenza season. Patients were diagnosed with influenza (using PCR) or other respiratory tract infections. A questionnaire on smoking habits was performed. RESULTS: Overall, 72 patients were included in the study, median age 2 years and 9 months (IQR: 1.4 - 7.2), influenza was diagnosed in 43% (n= 31) of patients. The percentage of regularly smoking parents in the whole cohort amounted to 33.3% (44 of 132) and was statistically significantly higher (p < 0.05) than in the general population (22.7%), whereas in the subgroup with influenza and non-influenza infections it reached 32.2% and 34.2%, respectively. CONCLUSIONS: The prevalence of smoking parents of children with acute respiratory tract infections is higher than in the general population: exposing children to tobacco smoke is one of the risk factors for acquiring influenza and others respiratory tract infections. Quitting smoking can decrease the risk of infectious diseases.

[Benzo(a)pyrene in atmospheric and indoor air, health hazards and possibilities of limitation]. / Benzo(a)piren w powietrzu atmosferycznym i wewnetrznym, zagrozenia zdrowotne i mozliwosci ograniczenia.

The work discusses the occurrence of benzo (a) pyrene in atmospheric air and indoor air, as well as health threats caused by this environmental pollution. The results of research conducted worldwide and in Poland were referred to. Poland belongs to the European Union country, where high levels of benzo(a)pyrene are recorded in both atmospheric air and indoor air (residential houses) exceeding 1ng/m3. Considering the fact that this pollution is highly carcinogenic one should strive to reduce the concentration of benzo(a)pyrene in the air in Poland, recognizing and eliminating its sources. Installation of dedusting equipment in residential areas is possible but expensive. This creates an inequality in the access to fresh air in the rooms. The World Health Organization strongly promotes measures to reduce emissions of benzo(a)pyrene. On the other hand, extensive information campaigns should be carried out to make the public aware of the exposure, its sources and options of prevention.

Lifestyle Intervention Program for Amelioration of Dysmetabolism in Overweight Women.

Overweight and obesity, a cluster of multiple risk factors for atherosclerosis such as elevated blood pressure, elevated glucose level, and dyslipidemia, increase the risk of all-cause mortality and cardiovascular morbidity and mortality. Physical activity and a proper diet are essential preventive measures. The aim of the study was to evaluate the effects of a two-month intervention program consisting of a low-caloric diet (1,500 kcal) and increased physical activity on the anthropometric parameters, body composition, resting metabolic rate, and maximum oxygen uptake. The study was conducted in 22 women aged 20-38 with diagnosed overweight or obesity. We found that after completing the eight-week-long intervention program, there were significant changes in body composition, consisting of a smaller proportion of body fat and increased lean body mass. Further, we observed a decrease in body weight by 4.3 ± 2.5 kg (p < 0.01), a reduction in waist and hip circumference of 2.6 ± 4.5 cm (p < 0.01) and 4.4 ± 2.9 cm (p < 0.01), respectively, and an increase in maximum oxygen uptake by about 5.2 ± 8.4 ml/kg/min (p < 0.01). We conclude that the intervention program consisting of counseling on diet and physical activity may be highly motivational for patients with excess body weight and care givers should give it a try before commencing more aggressive psychopharmacological therapies.

Epidemiology of Pulmonary Aspergillosis in Hospitalized Patients in Poland During 2009-2016.

Aspergillus is one of the most prevalent airborne fungal pathogens in the developed countries that may cause fatal invasive pulmonary aspergillosis in immunocompromised patients. The epidemiological information on aspergillosis in Poland is scarce. This retrospective, population-based study evaluated the incidence of pulmonary and other forms of aspergillosis, and also gender distribution and territorial differences in the occurrence of aspergillosis in hospitalized patients in Poland during 2009-2016. The incidence of aspergillosis was estimated on the basis of a dataset provided by hospital morbidity study carried out by the National Institute of Public Health. The data consisted of 4206 hospitalization records of 2338 patients, with some patients being hospitalized more than one time due to disease remissions. Significant gender differences were observed (1484 females vs. 2722 males, p < 0.001). No statistical differences were found for the place of residence. The average annual incidence rates for all forms of aspergillosis, invasive pulmonary aspergillosis, and other pulmonary aspergillosis were 13.8 per million (95% CI: 11.3-16.3), 4.0 per million (95% CI: 3.0-5.0), and 4.4 (CI: 3.5-5.2) per million, respectively. Over time, a significant increase in the rate of hospitalization were observed for all forms of aspergillosis (10.7 per million in 2009 vs. 15.7 per million in 2016, p for trend <0.005), invasive pulmonary aspergillosis (2.3 per million in 2009 vs. 5.0 per million in 2016, p for trend <0.001), and other pulmonary aspergillosis (3.6 per million in 2009 vs. 4.9 per million in 2016, P for trend <0.02). During the period analyzed 283 patients (12.0%) died while hospitalized and 224 of them (9.6% of all patients) died during the first-time hospitalization. We conclude that the incidence of aspergillosis is on the rise in hospitalized patients in Poland.

Factors Affecting Health-Related Quality of Life in Liver Transplant Patients.

This study seeks to evaluate the metabolic parameters such as body mass index (BMI), percentage of total body fat percentage (%BF), blood glucose, homeostatic index for quantification of insulin resistance and beta-cell function (HOMA-IR), sleep efficiency, and physical activity in liver transplant patients. The study group consisted of 24 male and 18 female patients, which enabled the inter-gender comparison. We found that a majority of patients had exceeded the norms for BMI and %BF. The excessive weight was distinctly accentuated in male patients. Only 40.5% of patients have a correct BMI and 21.4% of patients have a correct %BF. The indices of glucose metabolism were increased, pointing to enhanced insulin resistance. Resting energy expenditure and metabolic equivalent of task were characteristic of sedentary lifestyle, and they were lower in female patients. Almost 65% of patients had sleep efficiency below the desired 85% cut-off level. Further, sleep efficiency was decreasing with increasing BMI, %BF, and blood glucose level. In conclusion, liver transplant patients are characterized by excessive body mass and less physical activity and have a shortened sleep duration, all of which may lead to a worse glucose metabolism and increased disease risk and may also have an impact on quality of life.

Maternal Nutritional and Water Homeostasis as a Presage of Fetal Birth Weight.

Birth weight is a key determinant of perinatal outcomes which affect physical development and metabolic function. In this study, we evaluated the potential role of maternal body composition and nutritional status in programing fetal birth weight. This was a longitudinal study that included 29 pregnant women and their full-term newborns. Maternal dietary energy and fluid intake and body adipose tissue were assessed. In addition, we measured the serum content of copeptin, aldosterone, and angiotensin II in maternal and umbilical cord blood. The measurements were done across the three trimesters of pregnancy, on average, at 11.6 weeks, 18.3 weeks, and 30.2 weeks. Each newborn's birth weight was determined at the percentile line, using the World Health Organization (WHO) standards based on the gestational age, gender, and weight. We found no appreciable relation of fetal birth weight to the maternal dietary and fluid intakes, and the content of angiotensin II, aldosterone, or copeptin. However, birth weight correlated with increases in body adipose tissue in early pregnancy stages. Further, birth weight correlated positively with copeptin and adversely with angiotensin II in cord blood. We conclude that the present findings may be helpful in the assessment of a critical level of body adipose tissue in women of child-bearing age, above which the potential risk of macrosomia appears. The female population of child-bearing age needs a continual update on the nutritional knowledge to prevent modifiable maternal and fetal perinatal complications.

[Influenza vaccine coverage rates in Polish nurses]. / Wykonawstwo szczepien przeciw grypie u personelu pielegniarskiego w Polsce.

Medical personnel, including nursing staff, can become a source of influenza virus infections for their patients and co-workers. However, patients can infect the personnel, too. Therefore, influenza vaccinations are recommended for medical staff as an effective and safe form of preventing influenza and its complications. AIM: The aim of the study was to evaluate the current influenza vaccine coverage rate in nursing personnel and identify of incentives and disincentives for the performance of influenza vaccinations in nursing staff. MATERIALS AND METHODS: The cross sectional study was carried out a group of 770 nurses, using the research questionnaire, previously validated. RESULTS: The influenza vaccine coverage rate in the study group was 15%. The probability of having a vaccination this season and in the previous seasons was higher in medical staff working in out-patient health care (p <0.05, OR 5.15, 95% CI 3.33-7.96), with work experience >40 years (p <0 , 05, OR 6.93, 95% CI 2.04-23.78), dealing with chronic diseases (p <0.05, OR 1.57, 95% CI 1.00-2.46). The most important encouraging factor for influenza vaccination was that the employer paid for the vaccine available in the workplace, the desire to protect oneself from the disease, the belief in the safety and efficacy of the vaccine. The most important factor discouraging vaccination against influenza was the lack of reimbursement of the vaccine and the inconvenience of its implementation in the workplace, as well as doubts related to the safety and effectiveness of the vaccine. CONCLUSIONS: The influenza vaccine coverage rate is very low and certain activities should be undertaken to increase it. Measures taken to increase the influenza vaccine coverage rate for nursing staff should be targeted and include identified disincentives and incentives for vaccination.