Analysis of the Effectiveness of Coordinated Care in the Management of Pharmacotherapy of Patients with Hypertension and Comorbidities in Primary Care-Preliminary Reports.

Hypertension (HTN) is the dominant cause of cardiovascular disease and premature death worldwide. Also in Poland, the number of people with HTN is steadily increasing. In order to improve care for patients with HTN and other chronic diseases, a pilot of the POZ PLUS coordinated-care model was introduced. The pilot ran from 1 July 2018 to 30 September 2021 at 47 facilities nationwide. The purpose of this study was to conduct a preliminary analysis of the effectiveness of this model of care. The study focused on the management of pharmacotherapy in patients with hypertension and other comorbidities. The study included a group of 90 patients with HTN. Fifty-nine people were in the coordinated-care study group and 31 in the control group. Data were collected from electronic medical records. The analysis showed a trend toward greater blood-pressure reduction in patients under coordinated care (-4 mmHg difference in systolic blood pressure between the second and first visits and -2 mmHg difference in diastolic pressure between the second and first visits, p = 0.180 and p = 0.156). This suggests the preliminary conclusion that coordinated care in the PCP plus model might have positively affected the outcomes of patients with HTN. Further studies on the subject are planned.

Evaluation of the Organisation of the COVID-19 Vaccination Process by the Teachers in a Region of Poland.

The aim of this study was to assess the organisational process of vaccination within the National Vaccination Programme against COVID-19 (NVP) in the professional group of teachers in Pomeranian Province, Poland. The main goal of the survey was to assess the quality of planning and executing of the NVP and to find a correlation between social and employment placements with the level of perception of chosen quality indicators of the NVP. The presented cross-sectional survey was conducted among 4622 teachers from all levels of education in public and non-public institutions who received the SARS-CoV-2 virus vaccination campaign with the vaccine from AstraZeneca as part of the NVP. The survey was conducted using an original, self-designed questionnaire prepared for this study and distributed to teachers in the form of an online survey via email. Bayesian logistic and linear regression were used to estimate the relationship between predictors and dependent variables. Age was the main factor associated with the performance assessment of the vaccination centre (log[BF] = 0.86-16.88), while gender was the main factor associated with the assessment of NVP (log[BF] = 3.15-10,6). The evaluation of the vaccination registration process (log[BF] = -7.01-50.26) and the evaluation of the information received on the management of post-vaccination reactions (log[BF] = -2.22-65.26) were significant parts of the NVP. It is crucial to tailor information messages to the age and gender of the recipients and to ensure the quality of the information provided by medical personnel, in particular the possible occurrence of vaccination reactions and how to deal with them.

Patients' Expectations and Preferences for the Organizational Conditions of the Colorectal Cancer Screening Programme in Poland: A Qualitative Analysis.

(1) Background: Colorectal cancer (CRC) is a serious health problem in Poland as well as many European Union countries. The study aimed to describe factors that, from the patient's perspective, could increase the attendance rate and regularity of participation in the colorectal cancer screening programme (SP); (2) Methods: The qualitative approach was applied. The study involved six focus interviews conducted with 24 respondents (12 women and 12 men) aged 40-49, who had at least one first-degree family member diagnosed with CRC and persons aged 50-65, living in five selected voivodships (provinces) of Poland. The collected data were thematically coded. Further, a comparative analysis was conducted, and aggregated statements were formulated; (3) Results: The inclusion of primary care clinics within the CRC SP organization was reported as a key factor in improving the attendance rate and regularity of patient participation in the programme. Particularly important factors included an invitation in the form of a personal letter or a phone call made by staff from primary care clinics; (4) Conclusions: Patients were confirmed to have clear expectations and preferences for the organizational conditions of the CRC SP. Preferences nature allows them to be treated as one of the potential criteria for selecting critical parameters of CRC SPs.

Adolescents' Perceptions and Attitudes towards Traditional and Electronic Cigarettes-Results of Focus Group Interviews.

There is general agreement among scholars and policymakers that efforts to reduce smoking and prevent nicotine use should be intensified and focused on the most vulnerable part of society-adolescents. Regardless of common knowledge about the health consequences of smoking, according to data from 2020, about 51% of children in Poland had their first contact with smoking at the age of 15 and older. The objective of this research is to investigate motivations to start smoking or vaping, patterns of using tobacco products, perceptions of smoking/vaping and smokers/vapers, as well as attitudes toward nicotine addiction. The broad aim is to reflect on youth perceptions of nicotine use. A qualitative approach has been applied, utilising focus-group interviews. The sample included six focus groups, consisting of smokers and non-smokers of both genders, situated in three different cities in Poland. The interviewees were adolescents ages 16-18, attending high schools, technical schools, or vocational education. Interviews were transcribed and further analysed using the thematic analysis approach. This research enhances previously reported results by revealing new insights into the strategies applied by adolescents to mitigate financial barriers arising from high costs of nicotine products, as well as highlighting methods used to avoid the traditional antismoking messages placed on packaging.

Community Cardiac Arrest as a Challenge for Emergency Medical Services in Poland.

The problem of cardiac arrest, particularly out-of-hospital cardiac arrest (OHCA), is the subject of continuous research. The aim of this study was to analyze the use of an automated external defibrillator (AED) during the resuscitation of an adult in public places in Poland between 2015 and 2020. A retrospective analysis of the selected documentation obtained from AED distributors, the medical records obtained from the emergency call center, and the emergency medical teams was conducted. During the analysis period, there were 100 cases of recorded and documented use of AEDs in OHCAs in public places. In 70% of the cases, defibrillation was performed with an AED. This result could be higher, but the study's methodology and limited access to data only allowed for this result. In Poland, there are no legal acts on the registration of automatic external defibrillators and their implementation. Appropriate registries should be introduced nationwide as soon as possible. Due to the inadequacy of the medical records of the emergency medical teams to record the use of automated external defibrillators by a bystander to an incident, changes to these documents should be pursued. Based on such a small cohort, it is not possible to conclude that the return of spontaneous blood circulation is correlated with the use of AEDs and public access to defibrillation PADs.

Possibilities of Using UAVs in Pre-Hospital Security for Medical Emergencies.

The term unmanned aerial vehicle (UAV) was post-applied in the 1980s to describe remotely piloted multi-purpose, unmanned, autonomous aircraft. The terms unmanned aircraft systems with data terminal connectivity (UAS) and remotely piloted aircraft systems (RPV, RPAS-military systems) are also used. This review aims to analyze the feasibility of using UAVs to support emergency medical systems in the supply and urgent care ranges. The implementation of drones in the medical security system requires proper planning of service cooperation, division of the area into sectors, assessment of potential risks and opportunities, and legal framework for the application. A systematic literature search was conducted to assess the applicability based on published scientific papers on possible medical drone applications in the field of urgent mode. The widespread applications of UAVs in healthcare are concerned with logistics, scope, and transportability, with framework legal constraints to effectively exploit opportunities for improving population health, particularly for costly critical situations.

Patient Management in the Emergency Department during a COVID-19 Pandemic.

In the wake of the COVID-19 pandemic, international action has been taken to prevent the spread of the disease. The aim of this study is to establish the impact of the COVID-19 pandemic on emergency department utilization patterns in Poland. It was established that age (among COVID-19 positive patients) has a large influence on the occurrence of a mental illness or disorder. It has been proven that the older the person (patients diagnosed with U07.1), the more often mental diseases/disorders are diagnosed (p = 0.009-0.044). Gender decides the course of hospitalization to the disadvantage of men (p = 0.022). Men diagnosed with U07.1 stay much longer in specialized long-term care units. Lower-aged patients have a shorter hospitalization time (up to the age of 29; p = 0.017). The COVID-19 pandemic has placed healthcare systems, their staff, and their patients in an unprecedented situation. Our study showed changes in the number and characteristics of patients visiting the ED during COVID-19. Despite the shift in the center of gravity of health system functioning to the treatment of SARS-CoV-2 infected patients, care must be taken to ensure that uninfected patients have access to treatment for cardiovascular, mental health, oncological, and other diseases.

An impact of economic slowdown on health. New evidence from 21 European countries.

BACKGROUND: The economic slowdown affects the population's health. Based on a social gradient concept, we usually assume that this detrimental impact results from a lower social status, joblessness, or other related factors. Although many researchers dealt with the relationship between economy and health, the findings are still inconsistent, primarily related to unemployment. This study reinvestigates a relationship between the economy's condition and health by decomposing it into macroeconomic indicators. METHODS: We use data for 21 European countries to estimate the panel models, covering the years 1995-2019. Dependent variables describe population health (objective measures - life expectancy for a newborn and 65 years old, healthy life expectancy, separately for male and female). The explanatory variables primarily represent GDP and other variables describing the public finance and health sectors. RESULTS: (1) the level of economic activity affects the population's health - GDP stimulates the life expectancies positively; this finding is strongly statistically significant; (2) the unemployment rate also positively affects health; hence, increasing the unemployment rate is linked to better health - this effect is relatively short-term. CONCLUSIONS: Social benefits or budgetary imbalance may play a protective role during an economic downturn.

Network of Automated External Defibrillators in Poland before the SARS-CoV-2 Pandemic: An In-Depth Analysis.

INTRODUCTION: Sudden cardiac arrest (SCA), which causes more than half of all cardiovascular related deaths, can be regarded as a common massive global public health problem. Analyzing out-of-hospital cardiac arrest (OHCA) cases, one of the key components is automatic external defibrillators (AEDs). AIM: The aim of this study was to analyze the use and distribution of AEDs in Polish public places. MATERIALS AND METHODS: The data were analyzed by using the Excel and R calculation programs. RESULTS: The data represents 120 uses of automatic external defibrillators used in Polish public space in the period 2008-2018. The analysis describes 1165 locations of AEDs in Poland. It was noted that the number of uses in the period 2010-2016 fluctuated at a constant value, with a significant rise in 2017. When analyzing the time of interventions in detail the following was noted: the highest percentage of interventions was observed in April, and the lowest in November; the highest number of interventions was observed on a Friday, while the least number of interventions was observed on a Sunday; most occurred between 12:00 to 16:00, and least between 20:00 to 8:00. CONCLUSIONS: The observed growth in the number of cases of AED use in public places is associated with the approach to training, the emphasis on public access to defibrillation, and, therefore, the growth of social awareness. This study will be continued. The next analysis would include 2020-2022 and would be a comparative analysis with the current research.

The Impact of Reflection on Death on the Self-Esteem of Health Care Workers.

BACKGROUND: The study was based on the Terror Management Theory. This theory assumes that self-preservation and awareness of imminent death create the potential to trigger fear. The "culture buffer" can protect people from fear, and it is composed of two factors: personal views on world issues and self-esteem. The aim of the study was to show that exposure to content that increases the availability of thoughts about death causes changes in medical personnel (doctors, nurses, and paramedics) in areas such as self-esteem, mood, sense of agency, and communion. METHODS: The research was experimental. Standardized psychometric tests were used, including the Rosenberg self-esteem scale (RSE), the University of Wales Institution of Science and Technology) Mood Adjective Check List (UMACL), scales measuring agency and communion, and an additional questionnaire containing two types of text. Respondents were divided into two text groups: A (exposed to increased availability of thoughts of death) and B (neutral). RESULTS: Reflection on death, triggered by the experimental manipulation of the independent variable (text version), did not modify mood (in groups of medical staff and students) or self-esteem of health care professionals but did modify scores on a single RSE item in the student's group. Moreover, age, income level, religious attitude, and belonging to a professional group had an impact on self-esteem, mood components, and other parameters but did not interact with the text group. Reflection on death modified the sense of agency and communion. CONCLUSIONS: Exposure to content increasing the availability of thoughts of death led to observable effects possible to observe in all groups only after taking into account an additional factor, which turned out to be the religious attitude of the respondents in the experiment. Specific tools should be selected or developed for the needs of research on respondents working in health care.

Management Decisions: The Effectiveness and Size of the Emergency Medical Team.

In Poland, often for economic reasons, the staffing of medical rescue teams is limited to the legally required minimum. This gives rise to problems related to the effectiveness and efficiency of medical rescue teams. A literature review did not find any sources addressing the issue of the verification of the effectiveness of paramedic teams depending on the personnel composition of units. The aim of the study was to analyze the effectiveness of resuscitation depending on the size of the medical rescue team, comparing the work of two- and three-person teams. In total, 100 two-person teams and an analogous number of three-person units were studied. Statistical analyses were performed using the IBM SPSS Statistics 24 package. The results showed that the assessment of the condition of the victim as well as the ability to assess the heart rhythm and monitor the condition during advanced measures were more effective in three-person teams; three-person teams also used oxygen more frequently during advanced life support (ALS). Most of the elements influenced the quality of resuscitation and it can be unequivocally stated that the work of three rescuers is more efficient and definitely more effective.

Searching for the Optimal Method of Financing Hospital Emergency Departments-Comparison of Polish and Selected European Solutions.

Hospital emergency departments are units of the State Medical Rescue system in Poland, which was established to help people in a state of a health emergency. The aim of this study is to develop an optimal method of financing emergency departments in Poland. The study used Polish data from 2016-2019 on the financing of services at the Clinical Emergency Department of the University Clinical Center in Gdansk. For benchmarking and mathematical modeling, data for the Czech Republic, Germany and Latvia was used. The results of the analysis shows significant differences, to the disadvantage of Clinical Emergency Department, between the potential contract values in the tested models and the actual amounts of funds transferred by the National Health Fund Pomeranian Voivodeship Branch for the activities of Clinical Emergency Department under the concluded contracts. The introduction of co-payment on the part of patients reporting to the emergency departments with minor ailments that do not require hospitalization generates financial revenues, but does not significantly improve the financial results of the analyzed ward. However, it may be educational for patients in terms of raising their awareness of the correct place to seek assistance in the event of a sudden illness.

Evaluation of Capillary Blood Gases in Medical Personnel Caring for Patients Isolated Due to SARS-CoV-2 in Intensive Care Units before and after Using Enhanced Filtration Masks: A Prospective Cohort Study.

The dynamically changing epidemiological situation caused by the SARS-CoV-2 virus is associated with the increased burden and fatigue of medical personnel. The aim of the study was to evaluate: (1) oxygen and carbon dioxide blood pressure and saturation levels in medical personnel caring for patients isolated due to SARS-CoV-2 in ICUs; (2) adverse symptoms reported by medical personnel after leaving the isolation zone. DESIGN: A Prospective Cohort Study. METHODS: The project was implemented in the first quarter of 2021. Medical personnel working with patients isolated due to SARS-CoV-2 in the ICU of three hospitals were eligible for the study. The participants of the study were subjected to two analyses of capillary blood by a laboratory diagnostician. RESULTS: In the studied group of medical personnel (n = 110) using FFP2/FFP3 masks, no significant differences (p > 0.05) were found between the parameters of geometric examination performed before and after leaving the isolation ward of the hospital. After working in the isolation ward, nurses reported malaise (somnolence, fatigue, sweating, dizziness) more often than paramedics (44% vs. 9%; p = 0.00002). The risk of ill-being in nurses was approximately nine times higher than in paramedics (OR = 8.6; Cl 95%: 2.7 to 26.8) and increased with the age of the subjects (OR = 1.05; Cl 95%: 1.01 to 1.08). CONCLUSION: FFP2/FFP3 filter masks did not worsen blood oxygenation in medical staff caring for patients isolated due to SARS-CoV-2 in the ICU. The presence of subjective symptoms such as fatigue may be due to lack of adequate hydration.

Analysis of the Way and Correctness of Using Automated External Defibrillators Placed in Public Space in Polish Cities-Continuation of Research.

Immediate resuscitation is required for any sudden cardiac arrest. To improve the survival of the patient, a device to be operated by witnesses of the event-automated external defibrillator (AED)-has been produced. The aim of this study is to analyze the way and correctness of use of automated external defibrillators placed in public spaces in Polish cities. The data analyzed (using Excel 2019 and R 3.5.3 software) are 120 cases of use of automated external defibrillators, placed in public spaces in the territory of Poland in 2008-2018. The predominant location of AED use is in public transportation facilities, and the injured party is the traveler. AED use in non-hospital settings is more common in male victims aged 50-60 years. Owners of AEDs inadequately provide information about their use. The documentation that forms the basis of the emergency medical services intervention needs to be refined. There is no mention of resuscitation performed by a witness of an event or of the use of an AED. In addition, Poland lacks the legal basis for maintaining a register of automated external defibrillators. There is a need to develop appropriate documents to determine the process of reporting by the owners of the use of AEDs in out-of-hospital conditions (OHCA).

Comparative Analysis of the Effectiveness of Performing Advanced Resuscitation Procedures Undertaken by Two- and Three- Person Basic Medical Rescue Teams in Adults under Simulated Conditions.

(1) Objective: Paramedics as a profession are a pillar of the State Medical Rescue system. The basic difference between a specialist and a basic team is the composition of members. The aim of the study was to benchmark the effectiveness of performing advanced resuscitation procedures undertaken by two- and three-person basic emergency medical teams in adults under simulated conditions. (2) Design: The research was observational. 200 two- and three-people basic emergency medical teams were analyzed during advanced resuscitation procedures, ALS (Advanced Life Support) in adults under simulated conditions. (3) Method: The study was carried out among professionally active and certified paramedics. It lasted over two years. The study took place under simulated conditions using prepared scenarios. (4) Results: In total, 463 people took part in the study. The analysis of the survey results indicates that the efficiency of three-person teams is superior to the activities performed by two-person teams. Three-person teams were quicker to perform rescue actions than two-person teams. The two-person teams were much quicker to assess the condition of victims than the three-person teams. The three-person teams were more likely to check an open airway. The three-person teams were more efficient in assessing the heart rhythm and current condition of victims. It was demonstrated that three-person teams were more effective during electrotherapy. The analysis demonstrated that three-person teams were significantly faster and more efficient in chest compressions. Three-person teams were less likely to use emergency airway techniques than two-person teams. The results indicate that three-person teams administered the first dose of adrenaline significantly faster than two-person teams. For the "call for help", the three-person teams were found to be more effective. (5) Conclusion: Paramedics in three-person teams work more effectively, make a proper assessment of heart rhythm and monitor when taking advanced actions. The quality of ventilation and BLS in both groups studied is insufficient. Numerous errors have been observed in two-person teams during pharmacotherapy.

Patient Safety Related to Microbiological Contamination of the Environment of a Multi-Profile Clinical Hospital.

Nosocomial infections pose a serious burden for hospitals, patients, and the entire society. The aim of the study was to assess the microbiological cleanliness of the hospital environment through quantitative and qualitative analysis of microbiological contamination of air and surfaces in inpatient treatment facilities, based on the example of a large clinical hospital in Poland. Data were collected between 2012 and 2018 in premises of a large teaching hospital in Gdansk using the sedimentation method and the impact method using the Aerideal apparatus (Biomerieux). In the analyzed clinical center, the microbiological cleanliness tests in most of the hospital rooms in the analyzed period showed an acceptable number of saprophytic microorganisms. Of all the tested samples, 1159 (21.8%) were positive, indicating the presence of microorganisms in the tested sample. Species potentially pathogenic for hospital patients were identified, constituting 20.8% of all positive samples (4.6% of all samples). Significantly higher proportion of microorganisms potentially dangerous to patients were isolated from sanitary facilities. Due to the potentially pathogenic microorganisms detected in the tested samples, the authors suggest that in the analyzed hospital, the areas requiring a specific level of microbiological purity should be designated and described, with [specifically] defined cleaning and disinfection protocols.

Adipokines and Obesity. Potential Link to Metabolic Disorders and Chronic Complications.

The World Health Organization (WHO) has recognized obesity as one of the top ten threats to human health. It is estimated that the number of obese and overweight people worldwide exceeds the number of those who are undernourished. Obesity is not only a state of abnormally increased adipose tissue in the body, but also of increased release of biologically active adipokines. Adipokines released into the circulating blood, due to their specific receptors on the surface of target cells, act as classic hormones affecting the metabolism of tissues and organs. What is more, adipokines and cytokines may decrease the insulin sensitivity of tissues and induce inflammation and development of chronic complications. Certainly, it can be stated that in an era of a global obesity pandemic, adipokines may gain more and more importance as regards their use in the diagnostic evaluation and treatment of diseases. An extensive search for materials on the role of white, brown and perivascular fatty tissue and obesity-related metabolic and chronic complications was conducted online using PubMed, the Cochrane database and Embase.

Organizational and Financial Analysis of Polish Tobacco Control Program in 2000-2018.

In accordance with the provisions of the WHO Framework Convention on Tobacco Control (FCTC), each country shall promote and strengthen public awareness of tobacco control issues (Article 12). Many parties to the FCTC have adopted national tobacco control programs to organize their tobacco control activities. The aim of our study was to analyze the organization and funding of the Polish Tobacco Control Program in years 2000-2018. Document analysis of The Program and reports from its implementation were performed in accordance to the Agency for Health Technology Assessment in Poland (AHTAPol) recommendations and the WHO FCTC guidelines for Article 12 implementation. Spending was also analyzed. The study showed both inadequate planning of and funding for Polish Tobacco Control Program. The Program was developed without use of best practices detailed in the WHO FCTC guidelines as well as in national guidelines prepared by AHTAPol. The experience of Poland shows that although earmarking tobacco taxes has existed in the law, it has been largely ineffective due to the poor Tobacco Control Program design and insufficient funding resulting from a poor execution of the earmarking law. This may be a warning to other countries to strive to create law, compliance with which can be verified and controlled.

Gaseous Pollutants and Particulate Matter (PM) in Ambient Air and the Number of New Cases of Type 1 Diabetes in Children and Adolescents in the Pomeranian Voivodeship, Poland.

The increase in type 1 diabetes mellitus (T1DM) incidence in children is worrying and not yet fully explored. It is suggested that probably air pollution exposure could contribute to the development of T1DM. The aim of the study was to investigate the relationship between the concentration of gaseous pollutants including, nitrogen dioxide (NO2), nitric oxides (NOx), sulphur dioxide (SO2), carbon monoxide (CO), and particulate matter (PM) in the air, and the number of new cases of T1DM in children. The number of new cases of T1DM was obtained from the Clinic of Paediatrics, Diabetology, and Endocrinology, Medical University of Gdansk. The number of children of 0-18 years old in Pomeranian Voivodeship was acquired from the Statistical Yearbook. The concentrations of PM10 absorbance, NO2, NOx, SO2, and CO were measured at 41 measuring posts, between 1 January 2015 and 31 December 2016. It was detected that the average annual concentration of PM10 was higher than the value acceptable to the WHO. Furthermore, the average 24-hour concentration of PM10 was 92 µg/m3 and was higher compared to the acceptable value of 50 µg/m3 (acc. to EU and WHO). Moreover, the number of new cases of T1DM showed a correlation with the annual average concentration of PM10 (ß = 2.396, p < 0.001), SO2 (ß = 2.294, p < 0.001), and CO (ß = 2.452, p < 0.001). High exposure to gaseous pollutants and particulate matter in ambient air may be one of the factors contributing to the risk of developing T1DM in children. Therefore, it is important to take action to decrease air pollutant emissions in Poland. It is crucial to gradually but consistently eliminate the use of solid fuels, such as coal and wood in households, in favour of natural gas and electricity. The development of new technologies to improve air quality, such as "best available techniques" (BAT) or renewable energy sources (water, wind, and solar generation) is of critical importance as well.