The impact of legal and organizational regulations on the nutritional behavior of patients-consumers of spa treatment services in Poland.

Health resort treatment facilities, regardless of the ownership status (public, private), most often carry out their activities based on contracts with the Polish public payer of the health care system, therefore the operation of sanatoriums is a fully-fledged element of the health care system, such as inpatient treatment, outpatient treatment and basic health care. The system designed in this way is designed to improve the organization of benefits, including by incorporating new useful organizational and legal tools. Thus, health education, along with its nutritional aspect, which is its inseparable part, is a perfect example of how to positively influence the behavior of consumers of spa treatment services. The structure of the study included the desk research method related to the consolidation and processing of information on applicable legal regulations and an individual in-depth, structured interview, using an original interview scenario. Based on the deliberate selection of the sample, 14 interviews were conducted. The interlocutors were representatives of the management of spa treatment facilities, academics and representatives of non-governmental organizations. The interview included functional and organizational, financial, competence and substantive aspects related to the implementation of nutritional education in spa treatment facilities in Poland. The use of a structured interview with experts made it possible to present the area of health education, including nutrition, in a broad light of the knowledge and experience of health care practitioners and theorists. Opinions were obtained on the optimal methods of assessing the effectiveness of education in the conditions of spa treatment and a set of system and organizational recommendations. Reporting of the results was presented using the COREQ checklist. It is justified to consider broadly understood health education in spa treatment facilities as a kind of wholesome health service, which may constitute effective systemic support for health policy and, consequently, increase the importance of prophylaxis and improve the health condition of the population. Such a legislative change will force organizational changes that may ultimately lead to a change in eating habits. Moreover, it is highly useful to use the potential of paramedical professionals, including dieticians, health educators and health promotion specialists.

Does Maternal Obesity Affect Preterm Birth? Documentary Cohort Study of Preterm in Firstborns-Silesia (Poland).

In addition to low birth weight and intrauterine growth restriction, prematurity is a major problem in modern neonatology. The etiology of premature delivery is multifactorial, but maternal obesity has been indicated as an important risk factor for preterm birth. This study aimed to assess the relationship between early pregnancy body mass index (BMI) and the risk of preterm delivery according to gestational age. In the cohort of 2794 firstborns, preterm deliveries accounted for 9.1%. Of all deliveries, 16, 48, and 189 were classified as extremely preterm, very preterm, and moderately preterm deliveries, respectively. The risk of extremely, very, and moderately preterm deliveries increased with the increasing BMI, with the highest overweight and obesity-related risk for extremely and very preterm delivery. The rate of extremely and very preterm delivery among normal-weight women (BMI 18.5 ≤ 25) was 1.8%, while that among overweight and obese women (BMI ≥ 25) was 2.36%. The rate of all preterm deliveries (22 ≤ 37 weeks) was 8% for normal-weight women and 10.3% for overweight and obese women. Compared with normal-weight women, the adjusted odds ratio (95% CI) for preterm delivery in overweight and obese women was 1.33 (0.98-1.79). In Poland, being overweight and obese during pregnancy was associated with an increased risk of preterm delivery, especially extremely and very preterm delivery. This relationship should be assessed in other populations.

Selected Organizational and Managerial Aspects of Health and Nutrition Education of Various Types of Consumers of Spa Treatment Services in Poland.

Consumer education, including nutrition education, understood as a process based on scientific principles, is becoming a very effective element in influencing the health of the population in the modern world. This work is based on direct research carried out in 2016-2018 in the form of a questionnaire interview among patients-consumers of educational services in spa treatment facilities. The research sample was N = 1000 (600 people were tested with the use of PAPI (Paper and Pencil Interview), and 400 people with the use of CAWI (Computer-Assisted Web Interview)) and concerned a representative group of spa patients in Poland. In addition, as a supplement, a direct survey was conducted in the form of a Computer-Assisted Telephone Interview with managers of spa treatment facilities (N = 50). Consumers of spa treatment services differ from each other, and types can be distinguished based on their professional activity status and the type of entity that pays for their stay in the spa, and, using cluster analysis, the status of professional activity in relation to their education level. The nutritional education system is based on highly specialized medical personnel. At the same time, it does not use the available assessment tools based on proven monitoring and evaluation indicators. Health education, which also includes nutritional education, apart from disease prevention, is the basic tool for health promotion in spa treatment conditions, enabling the introduction of a permanent change in the patients' lifestyles, the additional advantages of which are low costs and relatively high efficiency. In the course of the study, several useful patient profiles were also distinguished, thanks to which it is possible to select dedicated educational methods for selected groups of recipients.

Global Elderly Migrations and Their Impact on Health Care Systems.

Demographic transitions that occur in decreased dynamics of natality and rising number of elderly in population structures constitute a challenge for all national economies. Another global phenomena are large-scale migration processes driven by intensification of globalization process, development of technologies, and telecommunications. Although both these phenomena were vastly addressed in many ways in scientific literature, a notifiable fact is that there are only few researches that would investigate them in connection and consider migration of older people and its consequences, especially for health systems. Despite the fact that generally the likelihood of migrations reduces along with age, in some countries a higher share of migrants older than 65 years in reference to the entire group of migrants are being observed. It is the more essential that groups of seniors represent an increasing percentage of people. There are also differences in between standard reasons for migrations in young people and the factors affecting migrations in elderly ones. Many variables can influence migration decisions among older people, and they can be affected by seniors' health conditions, levels of health care within the target countries they migrate to, and the living standards. Such factors as population aging, reduced fertility, and international migration have affected the changes in demographic profiles of many countries. The consequence of migration decisions in the group of seniors is, among others, the impact on health care systems of single nation states, which are more and more important elements of economic, social, and financial systems.

Mapping Health Needs to Support Health System Management in Poland.

In Poland, following the example of other EU countries, the first maps of health needs prepared by the Ministry of Health were presented in 2016. The maps constitute a foundation for rational decision-making in the management of health care resources, being potentially useful for all actors in health system. This refers in particular to the institutions responsible for distribution of funds and contracting health service, but also for decision-makers, who determine the scope of funds to be utilized in the health system, or the structure of benefits provided to patients. Service providers are also addressees of the maps, to give them a basis for planning future activities. The article presents a structured assessment of the current state of affairs, based on recent experience and sets out likely directions for the development of health needs in mapping in Poland in the future. We discuss the criticism addressed toward maps by representatives of various groups acting in health care. It includes the lack of recognition of some of the key health needs, or wrong emphases, where much more attention is paid to the recognition of current resources in the health system, instead of making prognoses regarding the future developments of health needs. Nonetheless, we find that this instrument is potentially of high usability, in case of elimination of the existing weaknesses.

Health Promotion Development in the Spa Treatment. Perspectives for the European Countries Learned from Poland's Experiences.

The main aim of the paper is to outline the perspective for future developments of the spa treatment in light of demographic transitions characterized by the increasing number of seniors, as well as changing expectations and health needs of younger population. We made a systematic review of literature referring to the experience of Poland, and similar experiences of other countries in Central Europe. Based on the existing knowledge we conclude that spa treatment should become one of the preferred directions of development of health systems in European countries. Moreover, we state that a desirable direction to modify the therapeutic paradigm used in spa treatment is to put a far-reaching greater emphasis on the provision of innovative health promotion, which is justified by both its effectiveness, and strongly good foundation for its provision in spas. For this purpose it is necessary to extend the specialized health sector personnel with qualified health educators, which will enable an effective implementation of health promotion actions and their proper alignment to the specific target groups. Developing this category of specialists will also enable other professionals to concentrate on therapeutic activity fitting their competence.

Using New Instruments of Clustering Policy in the Health Care System. The Case of Poland.

The issue of clusters as a form of organization of market entities has recently attracted an increasing attention of health care management theoreticians and practitioners. In our opinion the existing theoretical basis gives a foundation for considering clusters as a source of potential for increasing the effectiveness of health policy and health care organizations. It can be assumed that in case of health care clusters there is a possibility of interregional diffusion of innovation, based on ventures undertaken on the health care market, increasing not only the potential of the entities in the cluster, but also of its surroundings and subcontractors. It is possible to realize the idea of a flexible health care implemented regionally with the use of modern techniques of communication, knowledge transfer and high specialization. Nonetheless, in case of Poland the potential of clustrification remains untapped, being characterized by a limited actions of public and private bodies, marginal role of non-profit sector organizations and limited engagement of R&D sector. This is because a general distrust in the cluster formula, and the lack of relevant knowledge among local officials and health business leaders. For this reason the process of clustrification among health care entities requires external support through the increased efforts to create a system of legal and tax preferences for cluster initiatives and provision of organizational support in terms of know-how, targeted particularly at bodies and individuals, who may act as cluster leaders.

The Systemic Changes to Improve Efficiency in Polish Primary Health Care.

Primary health care is an important part of any health care system. In highly developed countries it secures the population's most elementary health needs, with particular emphasis on preventive care and early intervention. Polish PHC model is currently undergoing a thorough transformation, associated with the need to adapt to standards designated based on the WHO's criteria, and with reference to the experience of other European countries. The paper describes the process of changes being carried out, in the context of previous experiences of reform relating to the sphere of organization, processes and efficiency. A review and systematization has been made, with regard to the undertaken activities in the field of deregulation and change of legal provisions, which are aimed at achieving the improvement of the efficiency of treatment and resource allocation. A set of recommendations based on expert's discourse have also been provided, with respect to future directions of Polish PHC transformation.

The organization and financing of cervical cancer prevention carried out by midwives in primary health care.

OBJECTIVE: The main objective of the project was the evaluation of the organizational and financial aspects of midwives in primary health care (PHC), functioning under The Population Program for the Early Detection of Cervical Cancer two years after the implementation of new law regulations, which enable this occupational group to collect cytological material for screening. MATERIAL AND METHODS: Under this project, the data of the Program's Coordinating Centre, affecting midwives' postgraduate education in the field of pap smear tests, was taken into analysis. Furthermore, The National Health Fund (NFZ) reports on contracts entered in the field of the discussed topics, taking into consideration the value of health services performed within the Program in respect of ambulatory care and primary care units. RESULTS: NFZ concluded contracts for the provision of PHC service with 6124 service providers in 2016, including the contracts in the field of providing health services under the cervical cancer prevention program by PHC midwifes, which were entered into by 358 institutions (5.85%). The value of the basic services under the Program, carried out under NFZ contracts in 2014, amounted to approx. PLN 12.3 million, while the value of services performed by PHC midwives represented only 0.38% of this sum. CONCLUSIONS: The introduction of legislative changes, allowing PHC midwives to collect cytological material for screening, did not cause, in the period of the observation on a national scale, the expected growth of availability of basic stage services within the cervical cancer prevention program.

[Treatment costs of malignant cervical cancer in Poland in 2011-2012--the case of Silesian Voivodeship]. / Koszty leczenia nowotworów zlosliwych szyjki macicy w Polsce w latach 2011-2012 na przykladzie województwa slaskiego.

OBJECTIVES: As far as health economics is concerned, it is hard to determine the only useful tool which would disclose the actual costs associated with cancer. We analyzed hospitalization costs, which create the highest rate among all malignant cervical cancer-related medical costs. The main aim of the study was to evaluate the real costs of medical treatment in the case of patients diagnosed with cervical cancer based on the group with the primary and coexisting diagnoses. MATERIAL AND METHODS: The analyzed data from 2011-2012 were obtained from the Silesian branch of the National Health Fund, which financed medical expenses due to the diagnosis of cancer in health facilities which have the agreement for such treatment. RESULTS: A total of 4 540 hospitalization-related health benefits were realized, with the final total cost was PLN 8 766 547, in the presented group of 2261 patients. The most popular procedures in patients with the diagnosis from the C53 group, included chemotherapy together with oncological hospitalization (over 62%). The vast majority of the realized procedures were treatments of the reproductive system (38%) and teleradiotherapy (about 31%). CONCLUSIONS: Lack of efficient procedures of data collection for cancer advancement hinders the economic analyses, which should constitute the foundation for the discussion about cost effectiveness of selected procedures. Adequate methods for the monitoring of direct and indirect costs associated with cervical cancer treatment ought to be created.

Nutritional education in the primary prevention of osteoporosis in perimenopausal and postmenopausal women.

Osteoporosis affects millions of people in the whole world and brings about far-reaching physical and psycho-social consequences for patients and financial ones for the health care system, and therefore it is classified as one of public health problems and treated as a social disease. Women belong to the increased osteoporosis illness risk group due to lower top bone mass reached earlier in life as compared to men and due to hormonal changes occurring in the menopausal period, which affect loss of the bone mineral density (BMD). Limitation of the osteoporosis-related financial and social costs increase requires efficient preventive actions on the level of early, primary, secondary or tertiary prevention. At all the four osteoporosis prevention phases, the crucial role is played by health education and nutrition education, the latter being the key element of the former one. The nutritional education purpose is to acquaint patients with nutrition recommendations that are the basic element of the osteoporosis prevention and to make them change their nutrition habits, which will improve their osseous metabolism. The education should be based on results of the latest scientific researches and focus on recommendations relating to proper supplementing of calcium and vitamin D, simultaneously including all the other nutrition components, necessary to decrease the osteoporosis risk. The primary prevention oriented to a specific group at risk for osteoporosis, including peri- or postmenopausal women, should be provided in cooperation with the different levels' medical professionals and it should focus on causing positive changes in patients both as regards nutrition habits and physical activities.

Consumer behavior in OTC medicines market.

UNLABELLED: Over-the-counter (OTC) drugs are pharmaceuticals sold without a medical prescription. The goal of the paper was to evaluate the awareness in the studied group of people concerning purchasing and usage of the OTC drugs. The essence of the research was to determine whether factors as: education, income, type and place of work influence purchase and use of OTC drugs. MATERIAL AND METHODS: Four equal groups (100 people each) were studied by an anonymous questionnaire. Two occupational groups: nurses and people working outside the medical sector, and also 2 student groups--from medical and non-medical schools living in Silesia. Respondents answered 47 questions. Data received from the questionnaire were statistically analyzed by means of the Chi2 test (p < 0.05). RESULTS AND CONCLUSIONS: More than half of the respondents use OTC drugs. The respondents mainly buy the medicines in pharmacies. People connected with medical sector more often take pharmacists' advice and opinion than people from non-medical sector. The majority of the respondents are not familiar with chemical composition of the OTC drugs they take. Among them medical staff and medical schools students are to be found.

[Differentiation of the premature mortality caused by the cardiovascular diseases in the chosen districts of the Upper Silesia region]. / Zróznicowanie zjawiska przedwczesnej umieralnosci z powodu chorób ukladu krazenia w wybranych powiatach województwa slaskiego.

Environmental factors are a significant cause of many civilization-related diseases, including diseases of the circulatory system which have been the main causes of death in Poland for years. The aim of the research was evaluation of the intensity and changes in premature deaths due to diseases of the circulatory system in the population of the Upper Silesia Region at the beginning of the XXI century within particular districts. For the needs of the analysis, the premature deaths are represented by deaths before the age of 65 years. The premature death date was calculated as a quotient of the number of total deaths, which occurred before the age of 65 years and the number of inhabitants at the ages from 0-64 years in given districts. The research was planned as an analysis of secondary epidemiological data obtained from the State Office of Statistics. The results were prepared using the Statistics v.6.0i program and have been placed in tables and graphs separately for general and premature deaths. Deaths due to diseases of the circulatory system are still the main causes of death both for the crude and the premature ones in districts selected for research. The worst health situation can be noted in Katowice where both the rate of crude and premature deaths has considerably risen. The diseases of the circulatory system are the most frequent causes of death among women who begin suffering from heart diseases on average several years later then men. Such an alarming health situation in the population of Silesia requires organized preventive actions such as introduction of prevention and promotion health programs on a mass scale.