Investment in the peace of mind? How private services change the landscape of maternity care in Poland.

For over two decades midwifery research advocated for the continuity of care and the ability to establish a relationship between care providers and care users as an important features of quality maternity services. In many countries, while unavailable through public services, continuity of care became commercialized and can be access as a private service. In Poland, private prenatal consultations and dedicated midwifery care allow women to access continuity and establish personal relationships with care providers. In this study, we explore, how accessing these private services, impact the rates of medical interventions and type of care women receive during labour and birth. We analyse data collected through an online questionnaire from 4402 first-time mothers in healthy pregnancy who had given birth in Poland between 2020 and 2021. We show that while private consultation did not translate into any significant differences in care, women who accessed private dedicated midwifery services experienced more attentive and less medicalized care, namely were more likely to give birth in vertical position, move freely during labour and less likely to experience emergency caesarean section. However, private dedicated midwifery care did not shield them from negative experience. While private care offers benefits for women who can afford it, it also contributes to inequalities in access to quality care and puts women with less social and financial resources in a vulnerable position. Efforts should be made to develop a more universal and equitable model of care that allows for building personal relationships between maternity care providers and women.

The Effect of a Single High Dose of Vitamin D on Serum Levels of Its Metabolites in the Elderly.

BACKGROUND: Vitamin D is a dietary micronutrient responsible for calcium and phosphorus metabolism and multiple extraskeletal actions. The assessment of vitamin D status is commonly based on measurement of 25(OH)D total concentration in serum. However, the usage of liquid chromatography with tandem mass spectrometry (LC-MS/MS) technique allows to reliably assess a panel of vitamin D metabolites in serum or plasma, which may help to investigate the metabolic paths of vitamin D, especially in populations at risk of deficiency. METHODS: A randomized, two-arms, open study was conducted on 58 patients (28 female and 30 male; aged from 61 to 96 years old). The primary aim was to assess the effects of a single, high, oral dose of vitamin D3 (120,000 IU) on serum 25(OH)D3, 25(OH)D2, 24,25(OH)2D3, 3-epi-25(OH)D3, 1,25(OH)2D3, 24,25(OH)2D3/25(OH)D3 ratio, and 25(OH)D3/3-epi-25(OH)D3 ratio concentration (measured by LC-MS/MS) at baseline, 3 days and 7 days after administration, compared to control group. The secondary aim was assessment of influence of percentage of fat tissue on serum metabolites of vitamin D and their changes after bolus dose. RESULTS: 56.6% study group attained a serum 25(OH)D3 concentration >30 ng/mL. All subjects, except for one patient achieved a serum 25(OH)D3 concentration >20 ng/mL after administration. No one exceed reference value of vitamin D (30-50 ng/mL). Among participants who received vitamin D3 there were significant increase in 25(OH)D3, 3-epi-25(OH)D3, 1,25(OH)2D3, 24,25(OH)2D3 on 3rd day after administration. 24,25(OH)2D3 concentration gradually grew, achieving the highest concentration on 7th day. The percentage increase of 25(OH)D3 was negatively correlated with baseline 25(OH)D3 (r = -0.688, p = 0.001). Positive correlation between percentage increase in 25(OH)D3 and a percentage increase serum concentration of 24,25(OH)2D3 (r = 0.954, p < 0.001), 3-epi-25(OH)D3 (r = 8.03, p < 0.001) and 1,25(OH)2D3 (r = 0.789, p <0.001) were found. None of the study participants developed hypercalcemia. The baseline concentration of analyzed metabolites of vitamin D in serum and their percentage increase were neither dependent on BMI nor percentage of fat tissue. CONCLUSIONS: High dose of vitamin D rapidly increases 25(OH)D3 concentration in the elderly patients. The response to the bolus of vitamin D includes activation of 3-epimerase, followed by production of 24,25(OH)2D3, which protects from excessive increase of active form of vitamin D.