Socioeconomic correlates and biochemical profiles of smokers in Poland: a cross-sectional study.

INTRODUCTION: Epidemiological studies have shown a fairly constant association between the socioeconomic status and smoking. However, associations between smoking and the biological indicators of health status have not been well described yet. OBJECTIVES: This study aimed to determine the relationship among smoking, biochemical risk factors, and sociodemographic characteristics in the Polish population. PATIENTS AND METHODS: A survey was carried out in a representative sample of Polish residents aged 18 to 79 years. A total of 2413 randomly selected subjects participated in the survey. Logistic regression analysis as well as parametrical and nonparametrical tests were performed. RESULTS: Significantly higher cholesterol, apolipoprotein B, and potassium levels were observed in smoking women and men compared with the nonsmoking population. Significantly lower bilirubin levels were noted in smoking individuals. Higher C­reactive protein and lower creatinine levels were reported only in the smoking male population compared with nonsmokers. There was a significant inverse gradient in the relationship between income and smoking. Single women and men were at greater risk of being smokers (odds ratio [OR], 1.9 and 2.39, respectively). Individuals from small towns (less than 50 000 inhabitants) were at significantly greater risk of smoking compared with those living in rural areas (OR, 1.45 and 1.64 in women and men, respectively). CONCLUSIONS: We found differences regarding socioeconomic characteristics and major biochemical parameters between smokers and nonsmokers in Poland. However, it is difficult to establish which associations are causal for cardiovascular risk owing to the cross­sectional design of this study.

Cost-Effectiveness of an Obesity Management Program for 6- to 15-Year-Old Children in Poland: Data from Over Three Thousand Participants.

BACKGROUND: Obesity and overweight, including childhood obesity and overweight, pose a public health challenge worldwide. According to the available research findings, long-term interventions focusing on dietary behavior, physical activity, and psychological support are the most effective in reducing obesity in children aged 6-18 years. There are limited studies showing the financial effectiveness of such interventions. OBJECTIVE: The objective of the present study was to evaluate cost-effectiveness of the 6-10-14 for Health weight management program using pharmacoeconomic indicators, i.e., cost-effectiveness analysis using the incremental cost-effectiveness ratio. METHODS: We used anthropometric data of 3,081 children included in a 1-year-long intervention with a full financial cost assessment. RESULTS: The cost of removing a child from the overweight group (BMI >85th percentile) was PLN 27,758 (EUR 6,463), and the cost of removing a child from the obese group (BMI >95th percentile) was slightly lower, i.e., PLN 23,601 (EUR 5,495). Given the obesity-related medical costs calculated in the life-long perspective, these results can be considered encouraging. At the same time, when comparing the total costs per participant with the costs of other interventions, it can be noted that they are similar to the costs of school programs containing more than 1 type of intervention. CONCLUSIONS: The 6-10-14 for Health program can be considered cost-effective. As a result of committing financial resources in the approximate amount of EUR 1,790 per child, around half of the children participating in the program have improved their weight indicators.

Cost-Effectiveness Analysis of Integrated Care in Management of Advanced Chronic Obstructive Pulmonary Disease (COPD).

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common disease that occurs all over the world. Models of care, initially accessed from the clinical point of view, must also be evaluated in terms of their economic effectiveness, as health care systems are limited. The Integrated Care Model (ICM) is a procedure dedicated to patients suffering from advanced COPD that offers home-oriented support from a multidisciplinary team. The main aim of the present study was to evaluate the cost-effectiveness of the ICM. MATERIAL AND METHODS We included 44 patients in the study (31 males, 13 females) with an average age 72 years (Me=71). Costs of care were estimated based on data received from public payer records and included general costs, COPD-related costs, and exacerbation-related costs. To evaluate cost-effectiveness, cost-effectiveness analysis (CEA) was used. The incremental cost-effectiveness ratio (ICER) was calculated based on changes in health care resources utilization and the value of costs observed in 2 consecutive 6-month periods before and after introducing ICM. RESULTS Costs of care of all types decreased after introducing ICM. Demand for ambulatory visits changed significantly (p=0.037) together with a substantial decrease in the number of emergency department appointments and hospitalizations (p=0.033). ICER was more profitable for integrated care than for standard care when assessing costs of avoiding negative parameters such as hospitalizations (-227 EUR), exacerbations-related hospitalizations (-312 EUR), or emergency procedures (-119 EUR). CONCLUSIONS ICM is a procedure that meets the criteria of cost-effectiveness. It allows for avoiding negative parameters such as unplanned hospitalizations with higher economic effectiveness than the standard type of care used in managing COPD.

Ocena gminnego programu ochrony zdrowia psychicznego. / Ocena gminnego programu ochrony zdrowia psychicznego.

OBJECTIVES: The aim of this article was to assess the structure of municipal Mental Health Program. METHODS: The subject of the analysis was the Gdansk Mental Health Program for the years 2016-2023. The program was verified through comparison with the model of health policy program, developed by the Agency for Health Technology Assessment and Tariff System. Particular attention was paid to the presence of all recommended components of a program and the precise definition of terminology, especially the formulated goals, expected results and efficiency measures. RESULTS: The evaluated program does not contain required components of the health policy program. Unfortunately, this affects its quality. The document reveals a lack of estimation of the program implementation costs. The main goals and specific objectives do not meet the SMART criteria. Among the measures of effectiveness included in the program, the product indicators of quantitative nature have the largest share. Additionally, there is a lack of information on how to measure quality results and determine impact indicators. Regarding the evaluation, the assessment of the quality of services, their effectiveness and durability of the intended effects were not taken into account. CONCLUSIONS: Structural recommendations for mental health programs are needed. They would increase the effectiveness of the planned activities. Such effect could be achieved by use of criteria for health policy programs expressed in the Act of 27 August 2004 on health care benefits financed from public funds. Mental health programs would benefit if they were consulted by public health specialists.

Impact of Integrated Care Model (ICM) on Direct Medical Costs in Management of Advanced Chronic Obstructive Pulmonary Disease (COPD).

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a commonly diagnosed condition in people older than 50 years of age. In advanced stage of this disease, integrated care (IC) is recommended as an optimal approach. IC allows for holistic and patient-focused care carried out at the patient's home. The aim of this study was to analyze the impact of IC on costs of care and on demand for medical services among patients included in IC. MATERIAL AND METHODS The study included 154 patients diagnosed with advanced COPD. Costs of care (general, COPD, and exacerbations-related) were evaluated for 1 year, including 6-months before and after implementing IC. The analysis included assessment of the number of medical procedures of various types before and after entering IC and changes in medical services providers. RESULTS Direct medical costs of standard care in advanced COPD were 886.78 EUR per 6 months. Costs of care of all types decreased after introducing IC. Changes in COPD and exacerbation-related costs were statistically significant (p=0.012492 and p=0.017023, respectively). Patients less frequently used medical services for respiratory system and cardiovascular diseases. Similarly, the number of hospitalizations and visits to emergency medicine departments decreased (by 40.24% and 8.5%, respectively). The number of GP visits increased after introducing IC (by 7.14%). CONCLUSIONS The high costs of care in advanced COPD indicate the need for new forms of effective care. IC caused a decrease in costs and in the number of hospitalization, with a simultaneous increase in the number of GP visits.

Factors Associated With Quitting Among Smoking Pregnant Women From Small Town and Rural Areas in Poland.

INTRODUCTION: Smoking rates among women in Poland are high, and access to specialized smoking cessation services in rural areas are limited. The aim of this study was to assess factors related to quitting among pregnant women who smoke in rural areas of Poland. METHODS: Data were collected during interviews conducted by midwives among 4512 women at various stages of their pregnancy. The interviews took place in small towns with populations having less than 8000 residents, located within 12 out of 16 voivodships (provinces). We used exhaled carbon monoxide to verify self-reported smoking status. RESULTS: Overall, 38% of women interviewed (n = 1578) smoked before they found out they were pregnant. Among these women, 33% quit just after they had become aware of their pregnancy. The main predictors of early quitting were: higher educational attainment among pregnant women (adjusted odds ratio [AOR] 3.21; 95% confidence interval [CI] = 1.81-5.68), secondary educational attainment among their partners (AOR 1.63; 95% CI = 1.06-2.48), and not having children (AOR 1.71; 95% CI = 1.31-2.24). The main barriers to early quitting were: living with at least one current smoker (AOR 0.55, 95% CI = 0.39-0.76), being single (AOR 0.45; 95% CI = 0.29-0.71), and having both parents smoke cigarettes (AOR 0.67; 95% CI = 0.46-0.97). CONCLUSIONS: A modest proportion of women included in this study quit after they became aware of their pregnancy. However, women faced multiple barriers to quitting, including the smoking status of their family members. The factors identified in the study can inform the design of tailored interventions for pregnant women in rural areas. IMPLICATIONS: Smoking rates among women in Poland are high, and access to specialized smoking cessation services in rural areas are limited. This study found that women were motivated to quit smoking, and many quit after they had become aware of their pregnancy. However, women faced multiple barriers to quitting, including the smoking status of their family members. The factors identified in the study can inform the design of tailored interventions for pregnant women in rural areas.

Attempt to eliminate health inequalities in Poland arising at the time of political and economic transformation: Polish 400 Cities Project.

AIM: Epidemiological data show that citizens of small towns and villages have presented worse trends in cardiovascular mortality during the political, social and economic transformation in Poland during past 15 years than citizens of large towns. To try to eliminate these inequalities the Polish 400 Cities Project (P400CP), a large educational and interventional project, was prepared. The project consists of two arms: medical and social interventions. MATERIAL AND METHODS: The main aim of the medical screening intervention in P400CP is to increase detection and control of cardiovascular risk factors in inhabitants of 418 small cities (<8000 inhabitants) and surrounding villages, particularly in men and people of lower education. In 2003 and 2004 the P400CP covered 123 cities. All together, 36 696 subjects aged between 18 and 98 years were examined. In all participants, blood pressure (BP), anthropometric measurements, laboratory tests and questionnaire interviews were performed. The social arm of P400CP is one of multi-level educational intervention. Modern techniques of social psychology and marketing were involved to increase participation in interventions. RESULTS: Only 12.5% of all subjects had normal BP, cholesterol (<190 mg/dl) and glucose (<100 mg/dl in whole capillary blood) levels. During the first screening visit 65.5% of all examined subjects had BP>/=140 mmHg or >/=90 mmHg. The fasting glucose level was increased in 19% of women and 26% of men. Almost two-third of all subjects had a total cholesterol level above the norm. CONCLUSIONS: The prevalence of cardiovascular risk factors in participants of the screening programme P400CP in small towns in Poland was very high. High prevalence and low control of risk factors in participants of the P400CP confirm the decision to target this programme at citizens of small towns and villages.

[Prevention and health promotion programmes on websites of the Polish health insurance funds]. / Programy profilaktyki i promocji zdrowia prezentowane w serwisach internetowych kas chorych.

OBJECTIVE: The aim of our study was to evaluate the content and presentation of prevention and health promotion programmes on websites of the Polish health insurance funds. DESIGN: A systematic review of the content of official websites of all 17 national health insurance funds was done. RESULTS: Information on health care programmes was given on 12 websites, In four cases information can be described as sufficient and in only one case the programme was described in detail. Health insurance funds in Poland make extensive use of the Internet to communicate with contractual service providers. However, there is much to be done concerning communication with the patients.

[Health situation in poviats and cities with poviats status of Pomerania voivodeship--model studies]. / Sytuacja zdrowotna w powiatach i miastach na prawach powiatu województwa pomorskiego--badania modelowe.

The results of model study on the health status estimation of poviats and cities with poviats status population of Pomeranian voivodeship based on synthetic measures are presented. The measures were the elements of multidimensional comparative analysis. In the research the health status of population was estimated thoroughly from many points of view depending on different criteria. The criteria were representing as followed: economy, demography, social welfare, ecology and health service system. The model study was based on statistical data of poviats and cities with poviats status of Pomeranian voivodeship using prepared scheme of observations. Regarding to the obtained results of synthetic measures estimation, the objects were ranked and belonging to a determined group was defined. In the last part of the research the results of model study are described.

[Evaluation of human resources management in selected health care organizations in Pomerania voivodeship as far as workers motivation is concerned]. / Ocena zarzadzania zasobami ludzkimi w zakresie motywacji pracowników w wybranych zakladach opieki zdrowotnej województwa Pomorskiego.

The success of management in any organization in market-oriented environment is impossible without the proper management of human resource. The statement is true also in health care, where the internal market was imposed as a result of reforms. W scanned 44 medical organization of few different types, i.e. hospitals, clinics, nurses homes etc. In most of the organization there were no financial motivational bonus (38% of health care organizations) or only the basic bonus (40%). The system of personnel activities evaluation does not exist in 58% of scanned hospitals and clinics, and in 20% of the evaluation was conducted only occasionally. The system of employees evaluation existed only in one of each five of studied units. To improve the quality of personnel management it is necessary to improve communication inside the organizations. Only one in three of scanned facilities was marked as good or very good.

[Health services provided for victims of traumas and accidents in the Gdansk metropolitan area]. / Swiadczenia medyczne udzielane ofiarom urazów i wypadków w aglomeracji Gdanskiej.

Traumas and accidents are one of three main treats of public health. There are many research works on the topic, but only some of them concentrate on the issue of organization of the services and cost of hospitalisation. In our research we have analysed individual patients' documentation in the clinic of traumatic surgery of the main regional hospital. We were searching for the reason of hospitalisations and delivered services during the stay in hospital ward. There are three main reason of hospitalisation: transportation accidents (25%), acts of violence (20% of the man and 7% of the women) and home accidents (7% of treated man and 28 of treated women). The background of diagnoses were classic radiograms. In addition to this ultrasonography was carried out in 16% of patients and computer topography in 12% of patients.

[Health status evaluation in cities of the Silesia Voivodship--model studies]. / Ocena sytuacji zdrowotnej ludnosci miast na prawach powiatu w województwie slaskim--badania modelowe.

This paper presents the synthetic measure of health evaluation, which was used for model studies on populations of cities with poviat status in Silesia Voivodship. The study describes theoretical foundations for applying multidimensional comparative analysis in evaluation of the people health status. The range of entrance variables has been defined and selected. They have represented the following: demographic and economic variables, health needs variables, social variables and health service supplies variables. The examined cities have been assessed by means of the partial criteria and on the basis of the synthetic measure. According to the obtained results the examined cities were ranked and classified to a determined group. The results of model studies were also given.

[Evaluation of health status in the Silesia Voivodship--model studies]. / Ocena sytuacji zdrowotnej ludnosci powiatów województwa slaskiego--badania modelowe.

Silesia Voivodship is one of the most polluted areas in Europe. Especially Upper Silesia Region is recognized as ecologically ruined area according to the European Union standards. Very high degree of environmental degradation in Silesia Voivodship is connected with the industrialization. This region is the most polluted area in Poland. Gas and dust air pollution of this region has the highest level in Poland. The quality of the environment and its present status has got undoubtedly negative influence on the health of inhabitants. The paper presents the results of model studies of health status based on multidimensional comparative analysis using statistical data of Silesia Voivodship population. In the research different groups of factors were taken into account: demographic, economical, social and medical care service system. The studied objects were ranked according to the obtained measure of synthetic health status estimation. According to this, the poviats were included in the determined groups. Moreover, the advantages and disadvantages of the used method have been discussed.

[Spatial differentiation in financing medical services under universal health insurance selected segments of services]. / Przestrzenne zróznicowanie finansowania swiadczen zdrowotnych w systemie powszechnego ubezpieczenia zdrowotnego. Wybrane segmenty uslug.

After the universal health insurance has been started in Poland, patients believed that access to the health care system financed by the sick fund could be improved. It is generally known that there is a kind of relationship between both the access to the health care system and quality of medical system, and amount of money to be paid for that. There are 17 separate and independent sick funds in Poland. In this work the authors try to find how sick funds spend their financial resources in selected segments of medical services. The strongest influence of sick fund is in the region where its headquarter is located. If each sick fund has different amount of money to spend for a single patient and the right to divide funds according to its policy, the authors expect regional differentiation in financing medical services (according to the district). The data used in the work came from Urzad Nadzoru nad Ubezpieczeniami Zdrowotnymi (UNUZ) and Glówny Urzad Statystyczny (GUS). As a result their is no doubt that public money from the medical insurance is regionally significantly differentiated and each sick fund, spending money resources, creates its own medical policy in the examined segments of services.