Analysis of changes in cancer health care system in Poland since the socio-economic transformation in 1989

Background: The transformation period in Poland is associated with a set of factors seen as 'socio-economic stress', which unfavourably influenced cancer treatment and slowed down the progress of the Polish cancer care in the 90's. These outcomes in many aspects of cancer care may be experienced till today. The results of the international EUROCARE and CONCORD studies based on European data prove evidence that there is a substantial potential for improvement of low 5-year survival rates in Poland. Since high survivals are related to notably efficient health care system, therefore, to improve organization and treatment methods seems to be one of the most important directions of change in the Polish health care system. Till today, cancer care in Poland is based on a network outlined by Professor Koszarowski in the middle of the last century, and is a solid foundation for the contemporary project of the Comprehensive Cancer Care Network (CCCN) proposed in the frame of CanCon Project. Objective: Analysis of the structure of health care system and the changes introduced within the network of oncology in Poland since the beginning of the post-commuinist socio-economic transformation in 1989. Materials and Methods: This study was conducted based on the CanCon methods aimed at reviewing specialist literature and collecting meaningful experiences of European countries in cancer care, including the main legal regulations. Results: The analysis provided evidence that the political situation and the economic crisis of the Transformation period disintegrated the cancer care and resulted in low 5-year survival rates. A step forward in increasing efficiency of the cancer treatment care was a proposal of the 'Quick Oncological Therapy' together with one more attempt to organize a CCCN. With this paper the Authors contribute to the CanCon Project by exploration, analysis and discussion of the cancer network in Poland as an example of existing net-like structures in Europe as well as by preparation of guidelines for constructing a contemporary CCCN. Conclusions: (1) 'Socio-economic' stress adversely affected the efficiency of oncological treatment, both by reducing safety and slowing down the development of modern oncology. (2) Changing the current system into the contemporary form - CCCN could be an important step forward to optimise the oncological health care in Poland. (3) Introduction of the mandatory monitoring of organizational changes with the use of health standardized indicators could allow for the assessment of the effectiveness of implemented solutions and their impact on better prognosis for cancer patients. (4) Optimising the organization of the health care system is possible only by implementing necessary legislative corrections.

Epidemiology of eye diseases and infrastructure of ophthalmology in Poland.

ADMISSION: Untreated eye diseases are the leading cause of blindness in the world. Most people suffering from visual impairment is in the age group above 50 years of age. As many as 82% of people in this group is suffering from eye diseases. OBJECTIVE: The aim of this work was to present the epidemiology of eye diseases and state of infrastructure of ophthalmology in Poland. MATERIAL AND METHODS: Based on data by WHO prepared review of world and Polish literature on issues in the field of ophthalmology and epidemiology of eye diseases. On the analysis developed epidemiological situation of the most common eye diseases--cataract, glaucoma and AMD--leading to loss of vision in Poland. Using databases CSIOZ, the Central Statistical Office and WHO listed infrastructure resources of ophthalmology in Poland. RESULTS: The main eye diseases leading to blindness indicated cataract, glaucoma and macular degeneration. In 80% of cases, vision loss can be avoided by early detection and treatment. CONCLUSIONS: Prevention and early detection is an essential tool for reducing the incidence of blindness, especially in elderly.

Food supplement-related risks in the light of internet and RASFF data.

OBJECTIVE: Based on legal acts and RASFF information, this paper aimed at evaluating available facts on food supplements in comparison to the most popular data accessible via Internet for future and present consumers. MATERIAL AND METHODS: Having analyzed legal acts and RASFF (Rapid Alert System for Food and Feed) database, the authors attempted to verify what kind of information on food supplements may be found by an Internet user, using the first webpage of Google.pl. This search engine was used in this study as it gained the highest popularity among Internet users. It was decided that exclusively search results displayed on the first webpage would be subject to analysis as 91.5% of Internet users limit their search to the first 9-10 results. Internet was searched using the following two terms: 'supplement' and 'supplements' as well as terms suggested by Google. pl. Subsequently, the results were subject to qualitative and quantitative analyses. RESULTS: On the Internet, the most frequently searched terms were: 'supplements' (243 000 000), 'supplement' (9 290 000), 'supplements shop' (8 200 000). Having analyzed the content of particular websites, information on certain products, given by their manufacturers may be found. Then, data on supplement itself were provided, i.e. what is a supplement and when it should be used. Expert articles (written by physicians, dieticians, pharmacists) on a risk resulting from these products, including therapeutic indications or the presence of unauthorized substances were identified considerably less frequently. No warnings regarding the necessity of purchasing the products in legal and verified places were found. CONCLUSIONS: There is a necessity of systemic education of consumers on reasonable use of food supplements. It is also advisable to consider the organization of alert system whose objective would be to monitor adverse reactions caused by an intake of food supplements or novel food launched into the country. To obtain reliable information on the composition and effects of food supplements, potential consumer should contact physician or dietician. Additionally, complementary information, using different sources with an example being health-related portals, presenting articles written by physicians or pharmacists, may be also searched.

A framework for scientific advice on health: EuSANH's principles and guidelines.

BACKGROUND: Society expects politicians to make sound decisions by bringing the best evidence to bear on the health problems in question. Performing this task requires access to independent sources of sound scientific advice. The European Science Advisory Network for Health (EuSANH) is a network of national science advisory bodies in Europe which are active in the field of health and provide independent scientific advice to their authorities. The EuSANH addressed this question in a European project. METHODS: Guidelines and principles for producing sound advice have been formulated after international comparative evaluations and extensive discussions among participants of the EuSANH-ISA project with input from international experts. RESULTS: A framework for scientific advice on health has been produced. CONCLUSIONS: This framework will ensure a uniform approach and thus opens possibilities for collaboration between science advisory bodies.

Public health research in Horizon 2020. Results of the work of Independent Expert Group of the European Commission.

The recommendations of Independent Expert Group of European Commission on the future public health research priorities for Horizon 2020 funding stream in 2014-2020 are herewith presented. The group was commissioned in September 2012 by DG Research & Innovation of (DG-RTD) of European Commission.

"Health 2020"--new framework for health policy. Part I.

The paper presents the new framework for health policy adopted in September 2012 during the 62nd session of World Health Organization (WHO) Regional Committee for Europe as the strategy "Health 2020". Four priority areas for policy action as well as prerequisites for achieving two interlinked strategic objectives; improving health for all and reducing health inequalities as well as improving leadership and participatory governance for health are presented and discussed.

"Health 2020"--new framework for health policy. Part II.

The papers continues presentation of the new framework for health policy related to "Health 2020" strategy adopted in September 2012 unanimously by all member countries of EURO Region during the 62nd session of the World Health Organization Regional Committee for Europe. Four priority areas for action are presented.

The scope and results of selected epidemiological studies conducted at the National Institute of Hygiene in the years 1945-1989.

The authors present the first article in the series concerning the scope ofresearch, scientific, practical, educational and other achievements of the National Institute of Hygiene (PZH) since 1945. This article is limited to discussing selected studies conducted in the field of epidemiology until the year 1989. The selection was based on PZH annual reports on the accomplishment of planned objectives and the literature positins listed in these reports, as well as other documents. The criterion for selection was how the scope of the research matched the epidemiological situation within a historical context. The authors chose research that yielded practical results which made an impact on the epidemiological situation, particularly concerning infectious diseases in Poland. The significance of epidemiological research of non-infectious diseases was also stressed. In addition, research that was considered by scientists in Poland and abroad as contributing to the development of medical methodology was included in the selection.

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.

[Initiative of introducing the applications of genetics for public health purposes in Poland]. / Inicjatywa wprowadzenia zastosowan genetyki dla potrzeb zdrowia publicznego w Polsce.

An integration of scientific associations involved in public health and genetics to apply genetics achievements might create new perspectives of public health and health promotion in Poland and allow to apply genomic applications that are currently in transition from research to public health practice. Activities might enable to undertake preventive actions as population screening programs based on genome-based knowledge and technologies as targeted preventive interventions. The achievements in the field of public health genetics or genomics have been taking place in several countries and have begun to have an impact on population health status.

[The role of science in policy making--EuSANH-ISA project, framework for science advice for health]. / Rola nauki w podejmowaniu decyzji politycznych--projekt EuSANH-ISA, struktura doradztwa nauki w kwestiach zdrowotnych.

Governments and other authorities (including MPs) should be well informed on issues of science and technology. This is particularly important in the era of evidence-based practice. This implies the need to get expert advice. The process by which scientific knowledge is transmitted, along with proposals how to solve the problem, is called science advice. The main aim of the article is to discuss the issue of science advice--definitions, interaction between science and policymaking, and its position in contemporary policies. The second aim is to present European Science Advisory Network for Health (EuSANH), EuSANH-ISA project, and framework for science advice for health which was developed by participants. Furthermore, the role of civil society in decision-making process and science advice is also discussed. Interaction between scientists and policy-makers are described in terms of science-push approach (technocratic model), policy-pull (decisionistic) and simultaneous push-pull approach (pragmatic). The position of science advice is described in historical perspective from the 50s, especially in the last two decades. Description relies to USA, Canada and UK. Principles of scientific advice to government (Government Office for Science, UK) are quoted. Some important documents related to science advice in EU and UN are mentioned. EuSANH network is described as well as EuSANH-ISA project, with its objectives and outcomes. According to findings of this project, the process of science advice for health should follow some steps: framing the issue to be covered; planning entire process leading to the conclusion; drafting the report; reviewing the report and revision; publishing report and assessing the impact on policy.

[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.

[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.

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.

Hospitalisation of people with obesity in Poland in years 1985-2007.

AIM: The aim of this study was to analyse hospitalisation trends of obese people in Poland in the period of 1985-2007. METHODS: The data comes from a nationwide database created in 1979 in the framework of General Hospital Morbidity Study by the Centre for Monitoring and Analyses of Population Health in The National Institute of Public Health - National Institute of Hygiene in Warsaw. The analysis took into account age, gender, and place of residence (urban/rural) of hospitalised persons. For this analysis hospitalisation rates have been used (number of people hospitalised due to obesity during the year per unit of analysed population). RESULTS: Analysis has shown a systematic increase in the number of people hospitalised due to obesity. The majority of all admitted patients were women of whom those between the ages of 10-19 were treated most frequently. Because of obesity urban inhabitants were more often hospitalised than those coming from rural areas. In the analysed period of 23 years the hospitalisation span has been reduced by about 50%; it may be due to the trend of shortening treatment time, as well as to high costs of treating obese patients. CONCLUSIONS: Systematic increase in the prevalence of overweight and obesity in the Polish population reflects a problem growing for decades, manifested in the increase in the number of people hospitalised due to obesity.

[Position of health at international relations. Part I. Structural dimensions of health]. / Pozycja zdrowia w stosunkach miedzynarodowych. Cz. I. Zdrowie jako struktura.

In the article, the health is perceived as complex, multidimensional concept and not as absence of disease. This is consistent with public health perspective, where public health is regarded as public as well as political activity. It aims to solve health and social problems, depends on analysis of phenomena, needs the negotiations and relies on making decision on feasible directions of changes--what, why, how, where, when and by whom should be done. Public health policy developed as a result of international relations, and UN family fora especially, is regarded as significant for creating of health position. The aim of this article was: (1) the analysis of selected concepts and definitions related to structural dimensions of health, used in UN international arrangements; (2) an attempt to explain the evolution of health structure notions at worldwide agenda. The UN main bodies, programmes and funds working on the health field are mentioned and voting rules in UN General Assembly and World Health Assembly are reminded. The following structural dimensions were considered: (a) well-being, (b) human rights, (c) everyday resource, health potential, (4) equity. All were explored in WHO Constitution, Universal Declaration of Human Rights, International Covenant on Economic, Social and Cultural Rights, Ottawa Charter for Health Promotion and numerous WHA and UN GA resolutions, decisions as well as other documents. Some remarkable differences in English and Polish language versions and meanings were pointed out. It was argued that present perception of structural dimension of health is strongly derived from the preamble of the WHO Constitution adopted and signed on 22 July 1946 by the representatives of 61 States. It is an evidence of the strength of this document and wisdom of its authors. The greater progress is associated. with concepts and notion of organizational dimensions of health perceived as action and processes leading to health. Long-term efforts to strengthen the image of health was compared to positioning known in marketing as creating an identity in the minds of a target market.

[Position of health at international relations. Part II. Organizational dimensions of health]. / Pozycja zdrowia w stosunkach mii dzynarodowych. Cz. II. Zdrowie jako proces.

The aim of this article was: (1) the analysis of some concepts and definitions related with "set up of health", used in UN international arrangements; (2) an attempt to explain the evolution of organizational dimensions of health at worldwide agenda. The following organizational dimensions of health were discussed: (a) health for all, (b) health promotion, intersectoral and multisectoral actions, health in all policies, (c) health development, health as an element of human development, (d) investment for health, (e) health diplomacy and (f) mainstreaming of health. The analysis was based on World Health Assembly and UN General Assembly resolutions as well as supranational reports and statements available through conventional channels, not grey literature. It is apparent that some of notions are not in common use in Poland, some seems to be unknown. It was argued that some general and discreet thoughts and statements concerning organizational aspects of health were expressed in the preamble of WHO Constitution. Nevertheless they are not comparable with later propositions and proceedings. The first modern concepts and notions related as process were developed at late seventies. They originated from efforts to realize a vision of health for all and formulate national policies, strategies and plans of action for attaining this goal. The turning point was in 1981, when WHA adopted Global Strategy for Heath for All by the Year 2000. Since then one can observe considerable progress and new concepts came into existence, more and more precise and better reflecting the sense of health actions. The evolution of organizational dimensions of health was described in the context of brand positioning. It was assumed that first step of positioning was concentrated on structural dimensions of health. That served to awareness raise, attitudes change and motivation to action. That made a foundation to the next step--positioning based on process approach to health. Among others the following processes are described: (a) health for all, (b) health promotion, health in all policies, (c) health development, (d) health diplomacy, and (e) mainstreaming of health.

[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.