Phylodynamic evolution of HIV-1 A6 sub-subtype epidemics in Poland.

The human immunodeficiency virus type 1 (HIV-1) A6 sub-subtype is highly prevalent in Eastern Europe. Over the past decade, the dissemination of the A6 lineage has been expanding in Poland. The recent Russian invasion of Ukraine may further escalate the spread of this sub-subtype. While evolutionary studies using viral sequences have been instrumental in identifying the HIV epidemic patterns, the origins, and dynamics of the A6 sub-subtype in Poland remain to be explored. We analyzed 1185 HIV-1 A6 pol sequences from Poland, along with 8318 publicly available sequences from other countries. For analyses, phylogenetic tree construction, population dynamics inference, Bayesian analysis, and discrete phylogeographic modeling were employed. Of the introduction events to Poland, 69.94% originated from Ukraine, followed by 29.17% from Russia. Most A6 sequences in Poland (53.16%) formed four large clades, with their introductions spanning 1993-2008. Central and Southern Polish regions significantly influenced migration events. Transmissions among men who have sex with men (MSM) emerged as the dominant risk group for virus circulation, representing 72.92% of migration events. Sequences from migrants were found primarily outside the large clades. Past migration from Ukraine has fueled the spread of the A6 sub-subtype and the current influx of war-displaced people maintains the growing national epidemic.

Hip Fracture Incidence Over Twenty Years in Poland: The HiPoL Study.

INTRODUCTION: In the previous report, we noted a significant increase in hip fracture incidence in the local study area. The aim of the study was the continuous observation of hip fracture incidence in the local community over the last 20 years and to estimate their projection for the next 30 years. METHODS: Medical records of the patients aged 50 years and older in the period 2002 - 2021 (local data - area of the district Tarnowskie Góry and the city of Piekary Slaskie) with diagnosis ICD-10: S72.0; S72.1; and S72.2 (only the fragility fractures) were taken into analysis. RESULTS: 2,723 fragility hip fractures in the local area were registered (72 % in women). The increase in the rate was constantly observed, even during the COVID - 19 pandemic. The incidence rate ratio for the local population increased to 1.41. The incidence rate in 2021 was for the total population 230.2 (men 151.3; women 294.2). For comparison in 2002, it was 129.0 (men 48.8; women 192.4). In 2050 the number of fractures according to our new estimation will increase. CONCLUSIONS: The number of fragility hip fractures in Polish men and women aged over 50 years in the local population increased. The epidemiological situation is still worsening. Therefore, especially due to the reduction of orthopedic beds and the aging population phenomenon the situation will be tragic to our patients.

Assessment of physical activity levels and back pain among poles and Portuguese in the further year of the COVID-19 pandemic - a pilot study.

BACKGROUND: The vast majority of people have experienced the problem of back pain at least once in their lives for a variety of reasons. It is well known that regular physical activity at a moderate level has a number of health benefits regardless of age or gender with positive effects on the musculoskeletal, cardiovascular, respiratory or nervous systems improving fitness levels. During the pandemic, Poland experienced one of the longest periods of school lockdown in Europe. In Portugal, this period was considerably shorter. The aim of this study was to determine the level of physical activity and back pain as well as relationship between physical activity and back pain in a group of Polish and Portuguese students in the following year the COVID-19 pandemic. METHODS: The study was conducted via the Internet among students from Poland and Portugal (398 respondents - 229 from Poland and 169 from Portugal) in October 2022. In the pilot study, the International Physical Activity Questionnaire and The Oswestry Disability Index and Neck Disability Index questionnaires were used to assess the level of back pain. RESULTS: There are no statistically significant differences in the level of physical activity and pain complaints of respondents from the two countries. At least half of the students do not report any pain complaints (median in some groups being 0). In the Portuguese men, there is a correlation between the level of physical activity and the Neck Disability Index score (p = 0.0304). CONCLUSIONS: The following year, after the pandemic COVID-19 was declared, the prevalence of back pain among students in Poland and Portugal is still significant.

Childhood vaccination among Polish immigrants in Norway: a qualitative study.

BACKGROUND: Confidence in childhood vaccination is high in Norway and the Norwegian Childhood Immunization Programme (NCIP) achieves high overall coverage rates. However, lower coverage has been observed for some immigrant groups, including Polish immigrants who represent the largest immigrant group in Norway. Anti-vaccine sentiments and increased refusal of mandatory childhood vaccination has been on the rise in Poland, but it is unknown whether such attitudes also apply to Polish immigrants in Norway, as they experience a different vaccination policy and perhaps also different attitudes to vaccines. This qualitative study aims to explore attitudes towards childhood vaccination in Norway among Polish immigrants. METHODS: We interviewed 15 Polish parents living in Norway in 2022. We recruited the participants by purposive sampling and analyzed the interviews by reflexive thematic analysis. RESULTS: Three themes were identified: views of childhood vaccination, vaccine hesitancy, and differences in childhood vaccination between Poland and Norway. Overall, the participants favored childhood vaccination and viewed most of the vaccines included in the NCIP as safe and reliable. Human papilloma virus, meningococcal and pneumococcal vaccines were declined by some of the parents. Comparisons of childhood vaccination in Poland and Norway was evident in many of the interviews, especially among parents whose children had received vaccines in both countries. The participants were well acquainted with the NCIP, favored voluntary childhood vaccination, and the majority expressed a high level of trust in Norwegian health authorities. CONCLUSIONS: Polish immigrants to Norway generally expressed positive views about childhood vaccination. Non-vaccination was related to lack of knowledge and/or unfamiliarity with certain vaccines and not with anti-vaccine sentiments or conspiracy theories. The study highlights how parents' knowledge, in combination with norms and trends from both birth country and country of residence, influence parents' decision making about vaccination.

Refugees' right to health: A case study of Poland's disparate migration policies.

Poland has faced two waves of migration: the first was of irregular asylum seekers, which led to the humanitarian crisis on the eastern EU-Belarusian border since 2021; the second was of Ukrainians fleeing the Russian invasion. Although there are noticeable differences between these situations, and between the different reactions of the Polish authorities, it is possible to juxtapose them in terms of the right to health. The normative content of refugee and human rights law is the starting point for reconstructing the meaning of the terms 'refugee' and 'right to health'. A refugee is a person who needs international protection because of a well-founded fear of harm, which is not limited to persecution as defined by the Refugee Convention but also includes situations of international and non-international armed conflict. The right to health, which includes, inter alia, entitlements to a 'system of health protection' and 'underlying determinations of health', is reconstructed on the basis of human rights law and refugee and migration law. There are no legal and moral grounds to grant the right to health differentially to different groups of refugees. Nondiscriminatory health policy requires that refugees have the same access to health care as nationals, although their specific health needs resulting from past experiences and refugee situation require special treatment, that is, an appropriate refugee health policy. The broad understanding of the underlying determinants of health demonstrates the importance of overall migration policy for refugees' health, which can jeopardise the fragile good of refugee health.

How COVID-19 has changed the utilization of different health care services in Poland.

BACKGROUND: The COVID-19 pandemic has affected health care systems in many ways, including access to and the use of non-COVID services. The aim of the study was to assess the impact of the pandemic on the utilization of different public health care services in Poland. METHODS: The aggregated data on health care users and provided services for the years 2015/2016-2021 were used to analyse the changes in health care utilization during the pandemic and deviations from pre-pandemic utilization trends. Quantitative analysis was complemented with qualitative descriptions of the changes in principles of health care provision during the pandemic. RESULTS: The results show a considerable drop in the provision of most health care services in 2020 that in some cases disturbed pre-pandemic utilization trends and was not made up for in 2021. The most significant decrease has been observed in the field of preventive and public health services, as well as rehabilitation. The provision of these services was put on hold during the pandemic. CONCLUSIONS: The accumulated COVID-19-related "health debt" urgently calls for government actions to strengthen disease prevention and health promotion in Poland.

Good weather for a ride (or not?): how weather conditions impact road accidents - a case study from Wielkopolska (Poland).

This study offers a likely assessment of extreme meteorological events' impact on human perceptivity, frame of mind or even health during driving which might have had a consequence as a car accident. Research covered an analysis of car accidents during period 2010-2019 in the Wielkopolska (Poland) and four indices like maximum daily temperature, maximum value of humidex, difference between maximum temperatures observed from day to day and also difference between mean atmospheric pressure at the sea level observed from day to day. A distributed lag nonlinear model (DLNM) approach was used to obtain the relationship between these indices and car accidents. Our finding evidence that the "good weather for a ride" conditions are actually generating an increased risk of accidents. For indices related to high temperature, i.e., maximum temperature and humidex, it was possible to identify the critical values by which the risks of car accidents were the highest.

Large hospital outbreak caused by OXA-244-producing Escherichia coli sequence type 38, Poland, 2023.

In February 2023, Escherichia coli sequence type (ST) 38 producing oxacillinase 244 (OXA-244-Ec ST38) was detected from three patients in a hospital in western Poland. Overall, OXA-244-Ec ST38 was detected from 38 colonised patients in 13 wards between February and June 2023. The outbreak was investigated on site by an infection control team, and the bacterial isolates were characterised microbiologically and by whole genome sequencing. We could not identify the primary source of the outbreak or reconstruct the transmission sequence. In some of the 13 affected wards or their groups linked by the patients' movement, local outbreaks occurred. The tested outbreak isolates were resistant to ß-lactams (penicillins, cephalosporins, aztreonam and ertapenem) and to trimethoprim-sulfamethoxazole. Consistently, apart from bla OXA-244, all isolates contained also the bla CMY-2 and bla CTX-M-14 genes, coding for an AmpC-like cephalosporinase and extended-spectrum ß-lactamase, respectively, and genes conferring resistance to trimethoprim-sulfamethoxazole, sul2 and dfrA1. Genomes of the isolates formed a tight cluster, not of the major recent European Cluster A but of the older Cluster B, with related isolates identified in Germany. This outbreak clearly demonstrates that OXA-244-Ec ST38 has a potential to cause hospital outbreaks which are difficult to detect, investigate and control.

Inventory study on completeness of tuberculosis case notifications in Poland in 2018.

BackgroundEvaluating tuberculosis (TB) notification completeness is important for monitoring TB surveillance systems, while estimating the TB disease burden is crucial for control strategies.AimWe conducted an inventory study to assess TB reporting completeness in Poland in 2018.MethodsUsing a double-pronged inventory approach, we compared notifications of culture-positive TB cases in the National TB Register to records of diagnostic laboratories. We calculated under-reporting both with observed and capture-recapture (CRC)-estimated case numbers. We further compared the notifications by region (i.e. voivodship), sex, and age to aggregated data from hospitalised TB patients, which provided an independent estimate of reporting completeness.ResultsIn 2018, 4,075 culture-positive TB cases were notified in Poland, with 3,789 linked to laboratory records. Laboratories reported further 534 TB patients, of whom 456 were linked to notifications from 2017 or 2019. Thus, 78 (534 - 456) cases were missing in the National TB Register, yielding an observed TB under-reporting of 1.9% (78/(4,075 + 78) × 100). CRC-modelled total number of cases in 2018 was 4,176, corresponding to 2.4% ((4,176 - 4,075)/4,176 × 100) under-reporting. Based on aggregated hospitalisation data from 13 of 16 total voivodeships, under-reporting was 5.1% (3,482/(3,670 - 3,482) × 100), similar in both sexes but varying between voivodeships and age groups.ConclusionsOur results suggest that the surveillance system captures ≥ 90% of estimated TB cases in Poland; thus, the notification rate is a good proxy for the diagnosed TB incidence in Poland. Reporting delays causing discrepancies between data sources could be improved by the planned change from a paper-based to a digital reporting system.

Factors of pre-war educational migration: an investigation of polish medical and dental students in Ukraine.

BACKGROUND: Low admission rates at Polish medical universities led many students to study abroad. Ukraine provided an appealing option for years. The purpose of the study is to investigate the most important factors that motived Polish students enrolled at I. Horbachevsky Ternopil National Medical University in Ukraine to pursue medical and dentistry studies in lower middle-income countries, just before the outbreak of the war. It has become incredibly important to determine crucial economic and non-economic factors. METHODS: The paper draws on a quantitative survey (N = 94) conducted among medical and dental students from Poland who had studied at I. Horbachevsky Ternopil National Medical University in Ukraine using a semi-structured questionnaire. To test whether there was a relationship between the importance of the motives, Pearson's chi-square independence test was employed. RESULTS: The study found the key economic and non-economic factors for pursuing Ukrainian studies were rejection from Polish tuition-free programs, lower Ukrainian tuition and living costs compared to Poland and to other European Union countries. Determining reasons for choosing Ternopil University were recruiter and friend recommendations and its prestige among Ukrainian medical schools. Gender influenced the ranking of motives. CONCLUSION: The article examines the unique pre-war educational migration from Poland to Ukraine - occurring counter to typical flows from lower to higher a lower income country. The study showed that universities should strengthen recruiting efforts and highlight competitive tuition and living costs to attract international students, especially from relatively more developed nations.

Changes in Hospital Admissions of Patients with COPD in Poland: A 14-Year Nationwide Analysis (2006-2019).

Poland is a country with a high burden of COPD and its risk factors. This population-wide and geospatial study on COPD in Poland, aimed to analyze changes in hospitalizations of patients with a diagnosis of COPD between 2006 and 2019 as well as to identify changes in the demographic characteristics of patients hospitalized with COPD. This is a retrospective analysis of hospital discharge records of patients with a diagnosis of COPD (ICD-10 code J44 and age 40 and over), hospitalized in Poland between 2006 and 2019. Data were analyzed separately for all patients hospitalized with COPD (primary and secondary diagnosis), for patients admitted due to COPD (primary diagnosis) and patients hospitalized with COPD as a comorbidity (secondary diagnosis). Between 2006 and 2019, a total of 1,663,420 hospital admissions of patients with COPD were reported. Between 2006 and 2019, the annual number of patients hospitalized due to COPD decreased by 53.8%, including 57.3% among men and 46.6% among women. The number of patients hospitalized with COPD as comorbidity increased by 35.8%. The lowest hospital admissions rate was in north-western Poland and the highest in north-eastern Poland. Among patients admitted due to COPD, the percentage of women increased from 32.6% to 37.7%. The percentage of patients admitted due to COPD and living in rural areas decreased from 51.2% in 2006 to 40.8%in 2019. This study provided data on changes in sociodemographic characteristics of hospitalizations of patients with a diagnosis of COPD, including overall reduction in COPD admissions but an increase in COPD burden among women.

No Country for Sick Men: The Political Determinants of Health Policy in Poland.

The objective of this paper is to explain the political factors determining the relatively weak performance of the Polish health care (HC) sector. This can be treated as a critical case due to several reasons: first, the Poles as patients belong to the most unsatisfied ones in the European Union (EU), second, Poland spends on its HC-related expenditures one of the lowest shares of the GDP among the OECD countries, third, the number of doctors per 1000 inhabitants remains at the lowest European level, and the life expectancy in Poland is one of the lowest in the EU and is decreasing. The Authors argue that the policy inertia in the HC sector in Poland is determined by the group of inter-related political factors that effectively block the development of any positive trajectory in the Polish HC reforms. Of the various determinants analyzed the most significant appeared to be the post-communist legacy of the organization of the HC system, which combined with a short-term approach by politicians and weak decision-making processes in HC policy, makes any changes difficult to implement.

Ticks and spirochetes of the genus Borrelia in urban areas of Central-Western Poland.

Due to the extensive use of green urban areas as recreation places, city residents are exposed to tick-borne pathogens. The objectives of our study were (i) to determine the occurrence of ticks in urban green areas, focussing on areas used by humans such as parks, schools and kindergartens, and urban forests, and (ii) to assess the prevalence of Borrelia infections in ticks in Zielona Góra, a medium-sized city in western Poland. A total of 161 ticks representing the two species Ixodes ricinus (34 males, 51 females, 30 nymphs) and Dermacentor reticulatus (20 males, 26 females) were collected from 29 of 72 (40.3%) study sites. In total, 26.1% of the ticks (85.7% of I. ricinus and 14.3% of D. reticulatus) yielded DNA of Borrelia. The difference in the infection rate between I. ricinus and D. reticulatus was significant. Among infected ticks, the most frequent spirochete species were B. lusitaniae (50.0%) and B. afzelii (26.2%), followed by B. spielmanii (9.5%), B. valaisiana (7.1%), B. burgdorferi sensu stricto, (4.8%) and B. miyamotoi (2.4%). No co-infections were found. We did not observe a correlation in the occurrence of Borrelia spirochetes in ticks found in individual study sites that differed in terms of habitat type and height of vegetation. Our findings demonstrate that the Borrelia transmission cycles are active within urban habitats, pointing the need for monitoring of tick-borne pathogens in public green areas. They could serve as guidelines for authorities for the proper management of urban green spaces in a way that may limit tick populations and the potential health risks posed by tick-borne pathogens.

Ethical values held by nursing students. Comparative study in two country.

INTRODUCTION: Ethical values are a guideline for behavior in certain situations. They take on particular importance in patient care. Ethical values depend on many factors including culture. The aim of this study is to compare the ethical values of nursing students. METHODS: A cross-sectional study design was used. A total of 463 students participated in the survey, including 191 from Poland and 272 from Turkiye. The study was conducted from April to June 2022. For the purposes of this study was used Ethical Values Scale (IEVS). The criteria for excluding participants from the study were nursing student status and consent to participate in the study. RESULTS: The IEVE total score for all respondents was 68.20 and the median was 68. In the individual subscales: Love-Respect 34.76 (median 35), Justice-Honesty 21.29 (median 21) and Cooperation 12.14 (median 12). Polish students' total IEVS score average was 70.48 ± 6.81 and Turkish students' IEVS total score average was 66.61 ± 9.65. There is a statistically significant difference between the total score average on the IEVS of students from the two countries (p < 0.001). CONCLUSION: Students in both countries generally demonstrate high ethical standards. There are noticeable differences between the responses of students from Poland and Turkiye.

Navigating work and motherhood: exploring the link between career orientation and childbearing motivations in emerging adulthood.

BACKGROUND: Difficulties in reconciling work and family life are recognised as one of the major reasons for women delaying or even forgoing childbearing. Nonetheless, there are different mechanisms through which women's engagement in the labour market can impact their choices regarding having children. The current study focuses on the relationship between women's career orientation and the childbearing motivation of young, childless women. Additionally, we examine the moderating effect of women's self-esteem. METHODS: Questionnaires to assess women's childbearing motivation, career orientation (career commitment and career centeredness), and self-esteem were administered online to Polish childless women aged 18-25 (N = 358). Multivariate regression was performed to verify how professional aspirations determine childbearing motivation. Moderation analysis included self-esteem in the equation. RESULTS: Women's desire to be employed over their life course (career commitment) was associated with perceiving childbearing as less strenuous. However, women who placed a higher value on professional development perceived more costs and barriers related to parenthood. Women with higher self-esteem demonstrated a generally more negative view of childbearing, yet their perceived costs of having children increased along with rising professional aspirations. CONCLUSIONS: Our results demonstrate that career aspirations are a highly complex construct, and their relationship to childbearing motivation may differ depending on how women perceive their future in the labour market. The mere desire to engage in professional work is not detrimental to childbearing motivation, but the anticipated costs of having children become greater the more a woman is career-centred and the lower her self-esteem.

Health status in selected post-communist European countries: a comparative study between Poland and Albania.

OBJECTIVES: The aim of this analysis was to compare selected health status indicators of the Albanian and Polish populations, pertinent to two former communist countries in Central and Eastern Europe (CEE). METHODS: This analysis was based on the estimates related to the Global Burden of Disease (GBD) 2019 study, reported by the Institute for Health Metrics and Evaluation (IHME). For Poland, IHME uses data mainly from the Central Statistical Office of Poland, whereas for Albania the information is based on the reports from the National Institute of Statistics. RESULTS: In 2019, life expectancy at birth was slightly higher in Albania compared to Poland (78.5 years vs. 78.1 years, respectively). Mortality rate from noncommunicable diseases was similar in both countries (about 520 deaths per 100,000 population). In 2019, the main risk factor for the overall mortality in both countries was the high systolic blood pressure. In Albania, high systolic blood pressure accounted for almost 32% of deaths from all causes, whereas in Poland it accounted for only 21% of all deaths. The second main risk factor in Albania concerned the dietary factors which were responsible for almost one in four deaths. In Poland, the second main risk factor for all-cause mortality concerned tobacco which was responsible for one in five deaths. The third leading risk factor in Albania was tobacco (responsible for one in five deaths), whereas in Poland it concerned the dietary risks (responsible for about 19% of the all-cause mortality). CONCLUSIONS: This analysis provides useful information about the current health status of two populations pertinent to the former Communist Bloc in CEE. While health indicators can provide important information about the differences in health status between populations, it is important to interpret these indicators in the context of the specific challenges and limitations facing each country.

First molecular detection of Brachyspira hampsonii on pig farms in Poland.

Nowadays, the three strongly beta-haemolytic spirochaetes, Brachyspira hyodysenteriae, Brachyspira suanatina and Brachyspira hampsonii are thought to be causative agents of swine dysentery, an economically devastating disease of grow-finish pigs characterised by severe mucohaemorrhagic diarrhoea. B. hyodysenteriae has been reported in most leading swine-producing regions. B. suanatina and B. hampsonii have been successfully recovered from faecal samples collected in a few countries only. The present study was performed in March 2023 on faecal samples originating from nine Polish finisher farms with 6,000 to 18,000 animals in a location. Samples were obtained from 40 diarrhoeic finishers. Nucleic acid extracted from the samples was analysed using multiplex PCR for Brachyspira spp. From a total of nine sample populations examined in our study, the genetic material of B. hampsonii was identified in two. To the best of our knowledge, this is the first report on molecular detection of B. hampsonii on pig farms outside North America, Belgium and Germany. Our research highlights the need for increased focus directed on laboratory testing strategies, the lack of which may perplex swine practitioners and severely hinder a definite diagnosis.

Evaluation of potentially toxic elements and microplastics in the water treatment facility.

The potentially harmful effects of consuming potentially toxic elements (PTEs) and microplastics (MPs) regularly via drinking water are a significant cause for worry. This study investigated PTEs (Cd, Cu, Cr, Ni, Pd, Zn, Co), MPs, turbidity, pH, conductivity, and health risk assessment in the water treatment plant in Kielce, Poland. Zn had the highest concentrations throughout the water treatment facility, whereas Cd, Pb, and Co had lower concentrations (< 0.1 µg/L). The order of the concentrations among the specified PTEs was like Zn˃Cu˃Ni˃Cr˃Cd˃Pb and Co. The minimum turbidity was 0.34, and the maximum was 1.9 NTU. The range of pH in water samples was 6.51-7.47. The conductivity was 1,203-1,445 ms in water samples. These identified MPs were categorized into fiber and fragments. The color of these identified MPs was blue, red, black, green, and transparent. The minimum and maximum size of the MPs was 196 and 4,018 µm, while the average size was 2,751 ± 1,905 µm. The average concentration of MPs per liter of the water treatment plant was 108.88 ± 55.61. The elements listed are C, O, Na, Mg, Al, Si, K, Ca, and Ti. Fe and Zn were the predominant elements seen using EDX. HQ values of the PTEs were less than one for adults and children. The human health risk associated with all detected PTEs revealed that the HQ values exhibit a satisfactory degree of non-carcinogenic adverse health risk. HI values for adults and children age groups were less than one. In most water treatment samples, the carcinogenic value exceeds the threshold value of 10-6. The PTEs and MP concentrations in drinking water should be periodically monitored to minimize consumers' environmental pollution and health risks.

An educational approach to develop intercultural nursing care for refugees from Ukraine: A qualitative study.

AIM: To describe how nurses and nursing students in Poland and the United States perceive the practice of intercultural care of refugees from Ukraine. BACKGROUND: Millions of Ukrainian citizens sought safety in other countries when Russia invaded Ukraine in February 2022. INTRODUCTION: Nurses in Poland and the United States are positioned to provide nursing care for refugees from Ukraine yet lack intercultural knowledge, skills, and attitudes to meet refugee needs. METHODS: This education-focused qualitative description study was conducted in Spring 2023. Eighteen MSN and BSN students from one university in Poland and one university in the United States completed an international virtual exchange course that concentrated on the health and well-being of refugees from Ukraine. Students' reflection papers generated the data for this study. Content analysis was used to systematically structure the data, and themes were inductively derived for an initial understanding of intercultural care for refugees. The COREQ guidelines were followed for reporting study findings. RESULTS: Major themes were troubled communication, overlooked trauma-informed care, and compromised vaccine status. Language differences, a gap in nursing knowledge, and cultural variations impeded intercultural care. DISCUSSION: To address intercultural care for refugees from Ukraine, macro- and microlevel factors should be considered. Healthcare facilities need certified interpreters or adequate language-access technology for nurses. Nursing programs might evaluate content on trauma-informed care and cultural competency to meet the needs of war-affected refugees. Leaders from Ukrainian refugee communities could partner with nurses to deliver culturally relevant information to increase vaccine uptake. IMPLICATIONS: Nurses should advocate for inclusion of the WHO competency standards of care for refugees in healthcare policies with emphasis on communication and evidence-informed practice. Placing Ukrainian community leaders on health councils could bridge the gap between refugees and mainstream society.

External quality monitoring facilitates improvement in already well-performing stroke units: insights from RES-Q Poland.

INTRODUCTION: The Registry of Stroke Care Quality (RES-Q) is used in Poland for quality monitoring by numerous hospitals participating in the Angels Initiative. Our aim was to assess the degree of improvement in highly stroke-oriented centres that report cases to the RES-Q each year. MATERIAL AND METHODS: This retrospective analysis included Polish stroke units that from January 2017 to December 2020 contributed to the RES-Q at least 25 patients annually. RESULTS: Seventeen out of 180 Polish stroke units reported patients each year (2017, n = 1,691; 2018, n = 2,986; 2019, n = 3,750; 2020, n = 3,975). The percentage of ischaemic stroke patients treated with alteplase remained stable (26%, 29%, 30% and 28%, respectively). The door-to-needle time progressively decreased, from a median 49 minutes to 32 minutes. The percentage of patients treated ≤ 60 minutes and ≤ 45 minutes significantly increased (from 68% to 86% and from 43% to 70%, respectively), with no change observed between 2019 and 2020. Despite a general improvement in dysphagia screening (81%, 91%, 98% and 99%), screening performed within the first 24h from admission became less frequent (78%, 76%, 69% and 65%). In-hospital mortality significantly increased (11%, 11%, 13% and 15%), while the proportion of patients discharged home remained stable. CONCLUSIONS: Quality-oriented projects facilitate the improvement of stroke care, even in centres demonstrating good baseline performance. Polish stroke units that consistently reported cases to the RES-Q demonstrated improvement in terms of door-to- -needle time and dysphagia screening. However, there is still a need to shorten the time to dysphagia screening, and carefully monitor stroke unit mortality following the COVID-19 pandemic.