Occupational activity and health of Warsaw inhabitants. Part I. Unemployment: a preliminary analysis.

BACKGROUND: The health deterioration of the unemployed is the serious challenge for the public health, especially of that health promotion programs for this group were not always effective. OBJECTIVES: The aim of the papers is to recognise initially the health effects of unemployment among Warsaw inhabitants in order to formulate recommendations for future more comprehensive research. MATERIAL AND METHODS: Out of the respondents who joint the program of social participation in health reforms, 23 the unemployed and 172 employed persons were included to the study. The eight indicators of health status and eight components of health security were assumed. RESULTS: As regards health status, compared to employed persons, relatively more of the unemployed perceived their health, physical and mental well-being as worse, they more frequently remained at home due to illness and were admitted to hospital, but relatively fewer of them visited physicians. As regards health security, relatively more the unemployed assessed their medical expenses as very high, used only public health care and well understood the information received from family doctor, but relatively fewer of them experiences difficulties in getting to physicians. The future retirement system they perceived dramatically poorly. However, not all visible differences reached the level of statistical significance. CONCLUSIONS: Despite the limitation of our findings due to a preliminary nature of the study, they confirmed unquestionable relationship between unemployment and health deterioration. The recommendations for future more extensive research were presented in detail.

Occupational activity and health of Warsaw inhabitants. Part II. Work in retirement age: a preliminary analysis.

INTRODUCTION: In the situation of rapid population ageing, it is necessary to encourage the older people to work longer. This requires a recognition of health conditions that cause the decision to continue working in retirement age. OBJECTIVES: The aim of the study was to determine differences in health status and health security between working and non-working retirees involved in the program of social participation in healthcare reform. MATERIAL AND METHODS. Of 406 participants of the program of social participation in healthcare reform, 161 non-working retirees and 21 working retirees were involved to analysis. Eight indicators of health status and eight components of health security were adopted. RESULTS: Our findings showed the weak relationship between health and the working continue in retirement age. The considerable differences between the groups were reported only for physical well-being; the working retirees felt better. They continued work despite the fact that most of them perceived their health poorly and almost all suffered from chronic diseases. The working in retirement age was related with financial and social benefits to a greater extent. The working retirees rarely reported financial problems, the medical expanses was less onerous for them, they had the great opportunity to use the private physician services, and they more often perceived social support. The negative effect of working in retirement age, however, was related with the lack of time to rest, more negative assessment of existing healthcare system and less satisfaction with health information received from family doctor. CONCLUSIONS: Our finding would indicate that health status influences the work in retirement age to a limited extend. Financial motivation and social factors seems to be the main determinants of working continue. The recommendations for future more extensive research were presented in detail.

Holistic measurement of well-being: psychometric properties of the physical, mental and social well-being scale (PMSW-21) for adults.

BACKGROUND: A holistic approach to health requires the development of tools that would allow to measure the inner world of individuals within its physical, mental and social dimensions. OBJECTIVES: To create the Physical, Mental and Social Well-being scale (PMSW-21) that allows a holistic representation of various dimensions of well-being in such a way as they are perceived by the individuals and how affected their health. MATERIAL AND METHODS: The study was conducted on the sample of 406 inhabitants of Warsaw involving in the Social Participation in Health Reform project. The PMSW-21 scale included: headache, tiredness, abdominal pain, palpitation, joint pain, backache, sleep disturbance (physical domain), anxiety, guiltiness, helplessness, hopelessness, sadness, self-dissatisfaction, hostility (mental domain), security, communicability, protection, loneliness, rejection, sociability and appreciation (social domain). The five criterial variables of health and seven of life experiences were adopted to assess the discriminative power of the PMSW-21 scale. RESULTS: The total well-being scale as well as its physical, mental and social domains showed high reliability (Cronbach a 0.81, 0.77, 0.90, 0.72, respectively). The analysis confirmed the construct validity. All the items stronger correlated with their own domain than with the others (ranges for physical: 0.41 - 0.55, mental: 0.49 - 0.80 and social: 0.31 - 0.50). The total scale demonstrate high sensitivity; it significantly differentiated almost all criterial variables. Physical domain showed high sensitivity for health as well as for negative life events variables, while the mental and social domains were more sensitive for life events. CONCLUSIONS: The analysis confirmed the usefulness of PMSW-21 scale for measure the holistic well-being. The reliability of the total scale and its domains, construct validity and sensitivity for health and life determinants were at acceptable level.

Responsiveness to the hospital patient needs in Poland.

BACKGROUND: The health system responsiveness, defined as non-medical aspect of treatment relating to the protection of the patients' legitimate rights, is the intrinsic goal of the WHO strategy for 21st century. OBJECTIVE: To describe the patients' opinions on treatment they received in hospital, namely: admission to hospital, the role of patient in hospital treatment, course of treatment, medical workforce attitude, hospital environment, contact with family and friends, and the efficacy of hospital treatment in respect to responsiveness to patient's needs and expectations (dignity, autonomy, confidentiality, communication, prompt attention, social support, basic amenities and choice of provider). MATERIAL AND METHODS: The data were collected in 2012 from 998 former patients of the randomly selected 73 hospital in Poland. RESULTS: Dignity: Over 80% of patients experienced kindness, empathy, care and gentleness, and over 90% of them had the sense of security in hospital, met with friendliness during the admission to hospital and never encountered inappropriate comments from medical staff. Autonomy: About 80% of patients accepted the active role of patients in hospital, they perceived they had influence on procedures related to hospitalization and course of treatment, and they felt medical staff responded to their requests and concerns. Over 90% of them had opportunity to communicate their concerns to medical staff and to discuss the course of treatment. On the other hand, the explanation of the reason for the refusal to meet their requests was given to only 23% of the patients interested. Confidentiality: 70-80% of patients declared the respect for privacy and confidentiality during collecting the health information and during medical examinations, and were not examined in presence of other people. Nevertheless, only 23% of patients examined so were asked of their consent. Communication: About 90% of patients declared they trusted their physician, received from him explanation regarding the course of treatment and information about further treatment after discharge from hospital, but physicians devoted the time and attention to only 70% of them. Prompt attention: Over 90% of patients perceived simplicity of the formalities of admission to hospital, and short waiting for treatment and additional tests in hospital (but only 50% received explanation of reason if they waited long). Nevertheless, 10% of them % of them perceived they waited for admission to hospital too long, and over 20% for admission to a ward as long. Social support: The unlimited direct and phone contact with family and friends was declared by 96% of patients. Basic amenities: The high percentage of patients assessed positively the marking in hospital (97%) and cleanliness of linen (89%), followed by the general indoor appearance room in which patient stayed, lack of noise (70-80%), hospital meals, furniture (60-70%), availability of personal hygienic articles (50-60%), cleanliness of hospital room, toilet, showers and bathtubs, and availability of soap (40-50%). Choice of provider: Only 41% of patients declared that they had influence on choice of the hospital. CONCLUSION: Responsiveness of Polish hospital patient needs is similar to that of the OECD countries of the lowest health system responsiveness. Compared to the Central European countries, the responsiveness in Polish hospitals is lower than that of Czech Republic and only slightly higher of those of Slovenia, Slovakia and Hungary.

Determining the use of health care services by obese inhabitants of Warsaw. A preliminary study.

BACKGROUND: The excessive use of health care services by obese people constitutes a serious financial burden to all highly developed countries. As yet however, this has not been recognised to be a problem in Poland. OBJECTIVE: To provide a preliminary analysis of Warsaw inhabitants in their use of and quality of received health care by comparing obese subjects with those of normal weight. MATERIALS AND METHODS: Study subjects were fifty three obese (BMI > 30) and one hundred eighty one normal weight (18.5 < BMI < 25) inhabitants of Warsaw, who had taken part in a study on social participation in health care reforms. The use of health care services covered: visits to public health care physicians, hospitalisation and visiting private physicians. Assessing health care quality was by evaluating overall the health care system and the family doctor as well as out-of-pocket treatment expenses and any difficulties in accessing physicians. RESULTS: Obese subjects perceived their health to be significantly worse than those of normal weight and significantly more of them never attended private practice. Consultation with public health physicians was also frequently, but not significantly, higher in the former whilst hospital admissions were the same in both groups. Obese subjects gave considerably lower general assessments of the quality of the health care system and more often perceived their medical expenses as being very high, nevertheless, both these differences were statistically insignificant. CONCLUSIONS: The obtained findings have allowed us to formulate new recommendations for future research. These will examine various uses of health care services by the obese, i.e. family doctors and other specialists of public primary health care, out-patient clinic physicians and private physicians (according to their defined specialisations), hospitals according to location and rehabilitation centres. Account will be taken of visiting frequency, admission waiting time for physicians, length of visits, amounts of prescribed medication, out-of-pocket payment for treatment and medication, frequency of surgical interventions, satisfaction with given treatments and physician attitudes towards obese patients. Moreover, the socioeconomic status of the obese will be investigated as a potential obstacle to using health care services.

Opinions of employees of the National Institute of Public Health--National Institute of Hygiene in Warsaw on influenza vaccination.

INTRODUCTION: Improving influenza vaccination coverage is an important action to prevent influenza epidemics and reduce the costs caused by the epidemics. Recognising the motives to be vaccinated or failure to vaccinate, especially among health care workers, is needed. OBJECTIVES: The aim of presented papers is: 1) recognising the influenza vaccination coverage among NIPH-NIH employees, 2) examining the determinants of decision be vaccinated/not vaccinated, 3) estimating the effectiveness of influenza vaccination in relation to sickness absence due to respiratory infection. MATERIAL AND METHODS: The study was carried out in NIPH-NIH by e-mail questionnaire. Out of 345 employees, 187 (54,2%) participated in the study. The questionnaire contained information on influenza vaccination and determinants that would potentially affect the decision to vaccinate. RESULTS: 18,7% of the participants was vaccinated in the previous epidemic season and the half of employees were vaccinated at least one time in the previous 10 seasons. Only every fourth family/occupational doctor encouraged their patients to vaccinate. The NIPH-NIH employees would be more likely to be vaccinated, if the employer has provided free vaccines. The estimation of influenza vaccination effectiveness in decreasing the sickness absence due to respiratory infection amounted 37%. CONCLUSIONS: Our findings confirmed that influenza vaccination contributes to noticeable decreasing of sickness absence. Providing free vaccination against influenza by employer could increase considerably the coverage.

The risk of overweight and obesity in chronic diseases among Warsaw inhabitants measured by self-reported method.

BACKGROUND: Obesity is well known cause of various diseases. However, there are only a few studies which enable to compare directly the magnitude of risk in different groups of chronic diseases. OBJECTIVES: The aim of presented paper was to identify a magnitude of the risk of chronic diseases attributable to overweight and obesity on the basis of data on weight and height self-reported by respondents. MATERIAL AND METHODS: The survey was conducted among 402 Warsaw inhabitants selected by non-random method. Overweight and obesity was measured by Body Mass Index (BMI) on the basis of the data of weight and height reported by respondents. According to WHO criteria the normal weight is defined as BMI 18.5 - 24.9 kg/m2, overweight as BMI 25.0 - 29.9 kg/m2, and obesity as BMI 30 kg/m2 or more. The following groups of chronic diseases were included: cancer, diabetes and other endocrine diseases, mental disorders, cardiovascular diseases, respiratory diseases, digestive diseases, arthritis and allergy disorder. RESULTS: Obesity measured by self-reported method was recognised as significant risk factor for diabetes (OR=9.6, CI: 2.0-152.8), respiratory diseases (OR=10.6, CI: 3,0-333,7), cardiovascular diseases (OR=5.2, CI: 1.9-108.3), arthritis (OR=6.3, CI: 2.4-266.7), digestive diseases (OR=3,8, CI: 1.3-83.6) and mental disorders (OR=5.8, CI: 1.5-29.1), while overweight significantly increased the risk of diabetes (OR=4.4, CI: 1.2-10.8), respiratory diseases (OR=3.2, CI: 1.4-22.2), cardiovascular diseases (OR=2.9, CI: 1.2-6.4) and arthritis (OR=3.0, CI: 1.1-9.6) CONCLUSIONS: Our findings showed that data on weight and height collected by survey method provide some information about the magnitude of the risk regarding particular groups of diseases attributable to overweight and obesity, nevertheless, underestimation of BMI calculated in this way should be taken into account.

[Willingness of Warsaw inhabitants to cooperate with health service. I. Opinions on health reforms]. / Gotowosc mieszkaniców Warszawy do wspólpracy ze sluzba zdrowia. I. Opinie o reformie zdrowia.

Social participation in undertaking public decisions is one of the main determinants of good governance. Recognizing to what extent people are ready to participate in the process of reforming health care as an active partners seems to be necessary. Therefore, in Health Promotion and Postgraduate Education Department of NIPH-NIH the study aimed at examining citizen's willingness to cooperate with health staff and gathering their opinions on health reform was carried out. The not-addressed questionnaires were conveyed to 1700 households in Warsaw and 402 correct completed were received. Our findings indicate that one of four Warsaw citizens was ready to participate jointly with health workers in health reform. The willingness was higher in women, older people, higher educated and pensioners. From perspective of their own health, respondents perceived the following issues as requiring a change in the time of health reform: easier access to specialist treatment (60,9%), changing the health insurance system (17,3%), reduction in medicines price (14,8%), improving the quality of medical services (14,0%), easier access to diagnostic tests (13,6%) and to primary care physicians (10,7%), improving the health and social security of old people (9,0%), easier access and wider range of preventive examinations (7,4%), facilitate the sanatorium treatment (4,1%) and rehabilitation (3,7%).

[Willingness of Warsaw inhabitants to cooperate with health service. II. Evaluation of health and retirement security]. / Gotowosc mieszkankców Warszawy do wspólpracy ze sluzba zdrowia. II. Ocena bezpieczenstwa zdrowotnego i emerytalnego.

Providing citizens with health security is one of the main challenges for health policy. For the effective modifying the health an social care system it is very important to recognize how citizens themselves perceived their health and retirement assurance. The article presents the analysis of assessment of health care system, out-of-pocket payments for treatment, and retirement system by Warsaw inhabitants in relation to demographic characteristics and health indicators. Data were collected using not-addressed questionnaire. Our findings indicated that women, people aged 30-64 years, those having vocational education and unemployed, the others out of work as well as employed more negatively assessed health care system in comparison to the other demographic groups. The youngest and oldest people, those having elementary education and those who were economically inactive relatively frequently declared bearing very high expenses for treatment. The retirement system was more negatively assessed by women, people under 45 years, unemployed and the others out of work. The analysis of the relationship between perceived health and out-of-pocket payments for treatment and selected health indicators showed that people, who positively assessed existing health care and declared low expenses for treatment, higher evaluated their health, less frequently stayed at home because of ill-health, less frequently were in contact with physician and rarely were treated in hospital. Such differences were not noted (except one) for retirement security.

[Willingness of Warsaw inhabitants to cooperate with health service. III. Use of different types of treatment]. / Gotowosc mieszkanców Warszawy do wspólpracy ze sluzba zdrowia. III. Korzystanie z róznych rodzajów leczenia.

BACKGROUND: The global economic crisis led to the need to reduce the public expenditure, including health care. In a situation of reduction of the publicly guaranteed benefits, some services may be available only in private physicians for particular patients. Therefore, there is a need to examine factors determining the use of both types of health care. OBJECTIVES: The aim of the study was to assess the association between the use of free treatment of general practitioner and the use of private physician services on one hand, and health and its disorders, assessment of physician, and expenditure on treatment of the Warsaw inhabitants on other hand. MATERIAL AND METHODS: The data were collected from 402 Warsaw inhabitants by not-addressed questionnaire elaborated in Health Promotion and Postgraduate Education Department of the National Institute of Public Health-National Institute of Hygiene. RESULTS: Our findings showed that the majority of respondents used the both types of health care. Males, people from the youngest and the oldest group, those having elementary education, students and unemployed were more likely to use only free treatment from general practitioner, whereas people aged 30-44 years, higher educated, employed and those depending on other people were more often treated only by private physicians. The beneficiaries of only private physician services higher evaluated their health, physically felt better, perceived stronger social support and rarely remained at home due to illness. Private physicians were evaluated more positively in comparison with general practitioner practicing in public health care, nevertheless, the difference was not large. With respect to their own financial situation, the people using private physician services did not find higher medical expenses than those using only the general practitioner of public health care. CONCLUSIONS. Our research indicates that uncontrolled development of private medical services market may increase inequality in access to health care, if not protected by appropriate access to public health care.

Determinants of self-rated health of Warsaw inhabitants.

BACKGROUND: Self-rated health is a one-point measure commonly used for recognising subjectively perceived health and covering a wide range of individual's health aspects. OBJECTIVE: The aim of our study was to examine the extent to which self-rated health reflects the differences due to demographic characteristics, physical, psychical and social well-being, health disorders, occurrence of chronic disease and negative life events in Polish social and cultural conditions. MATERIAL AND METHOD: Data were collected by non-addressed questionnaire methods from 402 Warsaw inhabitants. The questionnaire contained the questions concerning self-rated health, physical, psychical and social well-being, the use of health care services, occurrence of chronic disease and contact with negative life events. RESULTS: The analysis showed that worse self-rated health increased exponentially with age and less sharply with lower level of education. Pensioners were more likely to assess their own health worse then employed or students. Such difference was not found for unemployed. Compared to married, the self-rated health of divorced or widowed respondents was lower. Gender does not differentiate self-rated health. In regard to well-being, self-rated health linearly decreased for physical well-being, for social and, especially, for psychical well-being the differences were significant, but more complicated. Hospitalisation, especially repeated, strongly determined worse self-rated health. In contrast, relationship between self-rated health and sickness absence or frequency of contact with physician were lower. Chronic diseases substantially increased the risk of poorer self-rated health, and their co-morbidity increased the risk exponentially. The patients with cancer were the group, in which the risk several times exceeded that reported for the patients of other diseases. Regarding negative life events, only experience with violence and financial difficulties were resulted in worse self-rated health. CONCLUSIONS: Our findings confirmed the usefulness of self-rated health for public health research.

[Evaluation of usefulness of summarised and weighted scale of negative life events to examine the determinants of adolescent health]. / Porównanie przydatnosci sumarycznej i wazonej skali negatywnych zdarzen zyciowych do badania uwarunkowan zdrowia mlodziezy.

Numerous studies have shown that the occurrence of negative life events, especially in childhood and adolescence, increases the risk of developing mental and somatic disorders in future. The purpose of presented paper was to assess to what extent the severity of events determines health disorders and risk behaviours among adolescents. The study was conducted on a randomly selected sample of ten secondary school students in Warsaw in the three-year period. A questionnaire for data gathering was elaborated in Health Promotion and Postgraduate Education of the National Institute of Public Health - National Institute of Hygiene. The scale of negative life events consisted of 32 items covering: 1) changes in live and health of closed persons, 2) contact with the acts of a crime or incorrect, 3) problems concerning biological maturation, 4) interpersonal relations in the nearest surrounding, 5) financial and living conditions and 6) problems of learning. The average severity of events evaluated by the students was used to determine the weights of individual item. Weighted scale as well as summarised scale were applied to analysis. In addition, the questionnaire included questions on health, well-being, and risk behaviours and attitudes, as criterial indicators. Our study did not provide evidence that only the severity of negative life events determines the health disorders and taking risk behaviours. The both scales showed similar moderate correlation with most criterial indicators and explained 10% - 20% of variance of subjectively experienced health indicators (self-assessment of health status, physical, psychical and social well-being), 10% - 25% of risk behaviours and attitudes and only 1% - 7% of health disorders measured by objective indicators (sickness absence, staying at home or in hospital due to health disorders, contact with physician, taking medication). It seems that not the severity of negative life events but their cumulating determines health and behavioural negative effects.

[Depression, overweight and perceived body image among adolescents living in suburban areas]. / Depresja a nadwaga i postrzegany wyglad ciala wsród mlodziezy mieszkajacej na terenach podmiejskich.

The aim of the article is to explore the association between depression and overweight among adolescents living in suburban areas and to verify to what extend the acceptance of body image may be a mediating factor. The study was conducted on the sample of 322 students (girls--51.2%, boys--48.8%) aged 16 - 19 years attending two senior high schools in Radzymin. Overweight was measured by Body Mass Index (BMI) and according to WHO recommendations the following categories were established: BMI < 20--underweight, 20 < BMI < 25--normal weight, BMI > 25--overweight or obese. A question about the acceptance of body image contained four possible answers: I'm okay/I do not weight properly, but I accept myself/I do not accept myself, I'm too thin/I do not accept myself, I'm to thick. Beck Depression Inventory (BDI) was used for measure the level of depression. Unexpectedly, our investigations found association between depression and overweight only for boys. In turn, the girls, as expected, lower accepted their body image than boys. Moreover a considerable percents of girls whose weight was normal, and even those with underweight, perceived themselves as thick. The association between acceptance of body image and depression was confirmed only for girls. Our study suggests that the lack of acceptance of body image, especially by girls, to greater extend causes the appearance of depression than real overweight.

[School stress and health disorders of post-elementary school adolescents]. / Stres szkolny a zaburzenia zdrowia mlodziezy gimnazjalnej.

The aim of the study was to examine influence of school stress on level of health and health disorders in adolescence. The data were collected from students often post-elementary schools in Warsaw The investigation were carried on in two stages, when adolescents attended second grade (783 students aged 14-15 years), and in the next year, when they attended third grade (804 students aged 15-16 years). Four indicators measured severity of school stress: (1) change of school, (2) difficulties in learning, (3) lack of support from teacher (4) dislike to go to school. Seven indicators were accepted as indicators of the level of health and health disorders: (1) self-assessment of health status, (2) physical well-being, (3) psychical well-being, (4) sick absenteeism during the last month, (5) frequency of staying at home or in hospital during the last year due to health disorders, (6) frequency of being in contact with physician during the last year (7) frequency of intake medicines. The first three of them were assumed as subjective indicators, and the further four as objective indicators. The analysis found out that: (1) relatively more girls than boys experienced dislike to go to school, (2) students, who changed school, had difficulties in learning, had negative relation with teacher or dislike to go to school, in comparison to those, who did not notice these problems, in general, lower assessed their health and well-being and more frequently suffered from health disorders, (3) subjective indicators of health were much more associated with school stress than objective indicators. Simultaneously, the summarized rank scale of school stress was elaborated.

Health of Roma children in Vilnius and Ventspils.

According to the literature data, Roma health and living conditions in Central and Eastern Europe are poorer than of the rest of population. However, the more detailed information about Roma health is lacking. The aim of the study was to evaluate morbidity, health self-assessment, and prevalence of addictions among Roma children in Vilnius and Ventspils and to compare with health indicators of non-Roma children. PARTICIPANTS AND METHODS. A descriptive epidemiological study was carried out, anonymously questioning all volunteer Roma children - 59 in Vilnius (Lithuania) and 31 in Ventspils (Latvia) schools. Results were compared with identical study, carried out in five Vilnius schools (reference group, 640). RESULTS. The appliance rate of Roma children to doctor did not differ from reference group - half of all questioned children visited doctor 1-3 times during the last year. However, more Roma children (74.6% from Vilnius and 64.6% from Ventspils) considered their health as poor and very poor as compared to reference group (4.3%). The proportion of children indicating somatic symptoms often and very often did not differ statistically significantly among groups with exception of vomiting and nausea, which was most prevalent among Vilnius Roma and Ventspils Roma. The proportion of children indicating emotional symptoms often and very often differed significantly in all groups and was the biggest in Ventspils Roma group. The proportion of daily alcohol, drug users, and smokers was higher in Vilnius Roma and Ventspils Roma groups, although the differences among all three groups were not statistically significant. CONCLUSION. Although the morbidity of Vilnius Roma and Ventspils Roma groups did not differ from reference group, essential discrepancy was found in health self-assessment - more Roma children considered their health as poor and very poor.

[Evaluation of medical service quality by hospitalized patients]. / Ocena jakosci uslug medycznych przez pacjentów szpitali.

The study of patient satisfaction with health care in the time of reforming the health care system in Poland was undertaken in Public Health School of the Medical Centre for Postgraduate Education in collaboration with Mazovian Public Health Centre and Health Promotion and Postgraduate Department of the National Institute of Public Health-National Institute of Hygiene. A part of the study was to investigate the evaluation of quality of medical services by hospitalised patients. The data were obtained from randomly selected samples of 391 patients treated in five hospitals. The original questionnaire was elaborated in Public Health School of the Medical Centre for Postgraduate Education. The questionnaire contained the demographic information and twenty five core questions concerning general assessment of medical care quality in hospital, evaluation by patients the conditions and procedures of treatment, and patient satisfaction with care given them by hospital staff. Almost all or majority of hospitalised patients highly assessed general quality of medical care in hospital as well as conditions and procedures of treatment and hospital staff. Nevertheless, considerable percentage of them perceived the waiting for hospitalisation as long (11,2%), they were not asked for the acceptance on the presence of other persons in the time of the diagnostic procedures (49,7%), did not understand or understood not always the information about their health (23,2%), nothing knew about the drugs they used (10,4%), and were not able to define, whether they had or had not the confidence to physician (16,1%).

[Evaluation of patients' satisfaction level as a part of the quality of primary health care functioning]. / Ocena poziomu satysfakcji pacjentów jako element jakosci pracy podstawowej opieki zdrowotnej.

UNLABELLED: The study of patient satisfaction from primary health care is a part of the broader project focused on assessment of the quality of health care system in Poland in the time of reforms. THE AIM OF THE STUDY: To evaluate how Warsaw units of primary health care satisfy patients' needs concerning to accession, conditions and procedures of treatment and relations with staff. MATERIAL AND METHODS: The investigations were undertaken in Epidemiology and Health Promotion Department at Public Health School of the Medical Centre for Postgraduate Education in collaboration with Mazovian Public Health Centre and Health Promotion and Postgraduate Department of the National Institute of Hygiene. The data were obtained from randomly selected sample of 191 patients waiting on visits to general practitioner in primary health care units. The original questionnaire was elaborated in Public Health School of the Medical Centre for Postgraduate Education. The questionnaire consist of demographic information and twenty three core questions containing general assessment of primary health care, accession, conditions and procedures of treatment and relation to the staff. RESULTS: Majority of waiting patients highly evaluated quality of services given them. The patients only one aspect of the primary health care assessed negatively, less then 50% of them stated that general practitioner took into account their economical situation. CONCLUSIONS: (1) Collected data confirm the high level of patients' satisfaction with the units of primary health care. (2) Elaborated questionnaire seems to be useful measure for study of patients' satisfaction with health care services.

[Changes in adolescents' alcohol drinking in the time of accession to European Union: Polish and Lithuanian experiences]. / Zmiany w zakresie picia alkoholu przez mlodziez towarzyszace przystapieniu do unii europejskiej: doswiadczenia polski i litwy.

The greatest increase in the late nineties in adolescent's alcohol consumption in Europe were in the countries that were candidates for European Union. The aim of the papers is: 1) to examine the changes of adolescent's alcohol drinking in fife-year period preceding the accession of Poland to European Union and 2) to compare regular alcohol drinking and attitude toward alcohol drinking among Polish and Lithuanian adolescents. The surveys in 1999 and 2004 in Warsaw junior secondary schools and in 2004 in Vilnius junior secondary schools were carried out, and the data from 14-15 years old adolescents were obtained. The analysis confirmed significant increase in frequency of alcohol consumption as well as in more positive attitude toward usefulness of alcohol drinking. This process took place more dynamically among girls. The comparison of Warsaw and Vilnius samples showed that Lithuanian girls were more likely to drink alcohol regularly and Lithuanian adolescents were more likely to access higher the usefulness of alcohol drinking for coping with everyday troubles. The findings were widely discussed in respect to other studies and changes in alcohol control policy.

[Parents' unemployment, selected life conditions, adolescents' wellbeing and perceived health]. / Bezrobocie rodziców a wybrane warunki zycia, samopoczucie mlodziezy i postrzegane zdrowie.

Unemployment in Poland is one of the most negative outcomes of the economical transformations taking place in the last decade of the XX and first years of the XXI century. Therefore, the study on an influence of parents' unemployment upon adolescents' life conditions and health was undertaken in Health Promotion and Postgraduate Training Department of the National Institute of Hygiene. The data were collected from randomly selected sample of 783 students aged 14-15 years attending to ten private and public secondary schools (gymnasiums) in Warsaw. A part of the questionnaire elaborated in Health Promotion and Postgraduate Department covered information about negative life events, which had occurred in the previous year, also about a loss of the job by father or mother. The self-assessment of health, and physical and psychical wellbeing measured the perceived health. The study showed that significantly higher percentage of the students, whose father or mother had lost a job in the previous year, noticed also occurrence of father and mother health disorders, lack of support from father and mother, frequent quarrels between parents, too much of home duties, worsening a housing conditions, lack of possibilities to travel away on vacation and lack of own money. The differences were higher, if both the parents were unemployed. Moreover, the children of unemployed parents significantly lower assessed their health, and physical and psychical wellbeing. It is necessary to help immediately the students, whose parents are unemployed, with financial and psychological support in frame of the programmes of unemployment overcoming.

[Assessment of usefulness of visual analogue scale (VAS) for measuring adolescent attitude toward unhealthy behaviors]. / Ocena przydatnosci analogowej skali wizualnej (VAS) do mierzenia postawy mlodziezy wobec zachowan szkodliwych dla zdrowia.

In the last two decades the visual analogue scale has been more frequently used for measuring the psychosocial determinants of health, its disorders and unhealthy behaviours. In 1999 in Health Promotion Department of the National Institute of Hygiene multidimensional investigations on self-assessment of health and life style of adolescents were undertaken and evaluation of visual analogue scale usefulness for health promotion research was one of the aims of these investigations. The data were obtained from randomly selected sample of 682 schoolchildren aged 14-15 years attending to public and private schools of Warsaw. The questionnaire contained the questions about frequency of alcohol drinking, cigarette smoking, drug using and manifestation of aggression. Simultaneously, respondents were asked, how much these behaviours are usefully for coping with everyday events. The answers of usefulness of unhealthy behaviours were measured on tenth centimetre line from "not at all" to "completely". The study shows that adolescents who presented unhealthy behaviours more often are more likely to give higher value to these behaviours in coping with their problems. Moreover, adolescents' attitude toward unhealthy behaviours varies according to gender, kind of alcohol, frequency of being drunk, proposals to buy the drugs, carrying the weapon and frequency of injures from violence. The analyses confirm the usefulness of visual analogue scale for study on psychosocial and life style determinants of health.