Respiratory differences in spontaneous and scripted speech among bilingual adults

This investigation explored respiratory differences between a speaker’s first language (L1) and second language (L2) during spontaneous and scripted speech in six adult bilingual speakers (two native bilingual speakers and four non-native bilingual speakers). Respiratory kinematic data using Respitrace respiratory inductance plethysmography and acoustic recordings were collected during five tasks: tidal breathing at rest, scripted speech in L1, spontaneous speech in L1, scripted speech in L2, and spontaneous speech in L2. Results indicated a significant interaction effect between proficiency and syllables produced during spontaneous speech, but no other significant differences were found among inspiratory/expiratory duration, task, proficiency or language. The data provides insight into how a higher cognitive-linguistic load of speaking in a second language may affect speech breathing and contributes to the existing pool of knowledge on monolingual cognitive-linguistic demands and speech breathing

Implementation of the 2011 Therapeutic Activity Act: Will commercialization improve the financial performance of Polish hospitals?

AbstractThe Therapeutic Activity Act that came into force on 1 July 2011 was aimed at achieving a large-scale transformation of public hospitals into Commercial Code companies. The change of the legal form, from a public entity to a for-profit company, was expected to improve the poor economic efficiency of the public hospital sector. However, the mere change of the legal form does not guarantee a better financial performance of hospitals and thus the success of the Act. In many cases, deep internal changes are needed to achieve improvements in the financial performance of particular hospitals. In addition, a set of other measures at the national and regional levels, such as the mapping of health needs of the population, have to accompany the legal transformations in order to improve the efficiency of the hospital sector. The recent slowdown in the rate of the transformations is another factor that renders the success of the Act uncertain

The 2015 emergency care reform in Poland: some improvements, some unmet demands and some looming conflicts

Between 2006 and 2015, the Act on the State Emergency Medical System was the key act governing the organization, financing and provision of emergency care in Poland. From the moment it entered into force, it had been heavily criticized. The critique focused, among others, on the lack of provisions allowing for emergency medical services (EMS) to be performed outside the EMS units, the lack of a separate Act regulating the profession of a medical rescuer and the lack of a separate professional organization representing medical rescuers. As early as 2008 a team of specialists was set up to work on amending the Act and these works resulted in the draft Act on the State Emergency Medical System that was submitted to public consultations on 19 August, 2014. This draft was further reworked in 2015 and was signed by the President on 25 September of the same year. The Act addressed some of the shortcomings of the EMS legislation that was previously in place. However, the new Act did not meet the key demands of medical rescuers; namely, it did not introduce a separate legal act regulating this profession nor established a professional organisation representing their interests. An analysis of the vested interests of various groups of medical professionals indicates that these interests are likely to have influenced the final legislative outcome. The Act, as well as its implementing executive regulation from April 2016, may reduce support of certain medical professional groups during the Act’s implementation as well as create tensions between these groups, especially between medical rescuers and nurses

The correlation between HTA recommendations and reimbursement status of orphan drugs in Europe

Background The aim of this study was to review and compare types of reimbursement recommendations for orphan drugs issued by eight European health technology assessment (HTA) agencies and the reimbursement status of these drugs in the corresponding countries. Separate calculations were also performed for three sub-groups: ultra-orphan drugs, oncology orphan drugs and other (non-ultra, non-oncology) orphan drugs. Results We reviewed drugs authorized by the European Medicine Agency (EMA) between 1 November 2002 and 30 September 2015. Among these, we identified 101 orphan drugs. Seventy-nine of them were assessed by eight European HTA agencies. The average rates of positive, conditional and negative reimbursement recommendations issued by these agencies were 55.7 %, 15.3 % and 29.0 %, respectively. On average, 21.2 % of EMA-authorized orphan drugs were reimbursed in the eight European countries studied: 49.0 % of those with positive, 53.6 % of those with conditional, and 16.0 % of those with negative reimbursement recommendations. In addition, 5.4 % of orphan drugs that had not been assessed by any of the eight HTA agencies were also reimbursed. The shares of oncology, ultra, and other orphan drugs that were assessed by HTA agencies were similar, with the lowest share observed in ultra-orphan drugs (72 %) and the highest in other orphan drugs (80 %). In terms of reimbursement, 20 % of oncology orphan drugs, 25 % of ultra-orphan drugs and 21 % of other orphan drugs were reimbursed. Conclusions Reimbursement of orphan drugs does not always correspond to the type of HTA recommendation. While the highest rate of reimbursement is observed (unsurprisingly) among drugs with positive or conditional recommendation, a high rate of reimbursement (11 %) is also observed among ultra-orphan drugs that had never been assessed by any HTA agency

The first attempt to create a national strategy for reducing waiting times in Poland : will it succeed?

The waiting lists package, proposed in March 2014, is the first attempt to create a national strategy to reduce waiting times for specialist care in Poland. The policy proposes a number of measures directed at primary, specialist ambulatory and hospital care with the goal of shifting patients to the lowest possible level of care. Initially, it has been welcomed by the patients and there has been, so far, no strong opposition against the reform from other stakeholders. However, this may be because there is some disbelief that the policy would actually be implemented (due to limited funding available for its implementation) and because some of the proposed changes are vague and have yet to be clarified. One stakeholder group that may obstruct the implementation of the reform, if they are not satisfied with the final shape of the proposed measures, is the primary care doctors. They are directly affected by the reform and enjoy a relatively strong bargaining position compared to other groups of medical professionals. Thus, the future of the reform remains uncertain

Support of Decision in Buildings Refurbishment with a Change of Utility

Construction objects, including buildings, are characterized by a long period of use resulting from the properties of structural and material solutions properly designed, constructed and operated. Practice shows that functional aging of buildings is faster than technical. Therefore, for these reasons and taking into account current socio-economic concepts (sustainable development, preservation of cultural heritage, economic, location reasons, etc.) buildings that have ceased to perform their current function are subject to renovation and / or refurbishment, enabling them to perform new functions compatible with social needs: public and commercial. The choice of new functions cannot be accidental. The decision-making process regarding the refurbishment of a building with a change of utility function is subject to high economic risk, which is why it should be carried out using a methodology that ensures a holistic approach. The paper proposes a methodology of functional and functional programming in the pre-investment phase of project preparation using multi-criteria analysis of the utility function selection. The methodology is illustrated by an example of the choice of function in the adaptation of a post-production building from public resources

The 2015 hospital treatment choice reform in Norway: continuity or change?

In several European countries, including Norway, polices to increase patient choice of hospital provider have remained high on the political agenda. The main reason behind the interest in hospital choice reforms in Norway has been the belief that increasing choice can remedy the persistent problem of long waiting times for elective hospital care. Prior to the 2013 General Election, the Conservative Party campaigned in favour of a new choice reform: “the treatment choice reform”. This article describes the background and process leading up to introduction of the reform in the autumn of 2015. It also provides a description of the content and discusses possible implications of the reform for patients, providers and government bodies. In sum, the reform contains elements of both continuity and change. The main novelty of the reform lies in the increased role of private for-profit healthcare providers

The 2014 primary health care reform in Poland: Short-term fixes instead of a long-term strategy

AbstractAt the end of 2013, the Minister of Health started legislative changes directly and indirectly affecting primary health care (PHC). The reforms were widely criticised among certain groups of medical professionals, including family medicine physicians. The latter mainly criticised the formal inclusion of specialists in internal diseases and paediatrics into PHC within the statutory health care system, which in practice meant that these two groups of specialists were no longer required to specialize in family medicine from 2017 in order to enter into contracts with the public payer and would be able to set up solo PHC practices—something over which family medicine physicians used to have a monopoly. They argued that paediatricians and internists did not have the necessary professional competencies to work as PHC physicians and thus assure provision of a comprehensive and coordinated PHC. The government’s stance was that the proposed measure was necessary to assure the future provision of PHC, given the shortage of specialists in family medicine. Certain groups of medical professionals were also supportive of the proposed change. The key argument in favour was that it could improve access to PHC, especially for children. However, while this was not the subject of the critique or even a policy debate, the proposal ignored the increasing health care needs of older patients—the key recipients of PHC services. The policy was passed in the Parliament in March–April 2014 without a dialogue with the key stakeholders, which is typical of health care (and other) reforms in Poland. The strong opposition against the reform from the family medicine specialists, represented by two strong organisations, may jeopardise the policy implementation in the future

What is being done to respond to the rise of chronic diseases and multi-morbidity in Czechia, Hungary, Poland, and Slovakia?

Although countries in central and eastern Europe (CEE) have relatively younger populations compared to the West, their populations are often affected by higher prevalence of chronic conditions and multi-morbidity and this burden will likely increase as their populations age. Relatively little is known about how these countries cater to the needs of complex patients. This Perspective piece identifies key initiatives to improve coordination of care in Czechia, Hungary, Poland, and Slovakia, including some pioneering and far-reaching approaches. Unfortunately, some of them have failed to be implemented, but a recent strategic commitment to care coordination in some of these countries and the dedication to rebuilding stronger health systems after the COVID-19 pandemic offer an opportunity to take stock of these past and ongoing experiences and push for more progress in this area

Clinical evaluation of postural posture of patients with previous stroke subjected to early rehabilitation

Introduction: Impairment disorders are often found in patients with stroke and impairment of motor and cognitive functions. This is a very serious complication because, by imposing a motor impairment, it aggravates the condition of disability and makes it difficult to conduct physical rehabilitation. The resulting neurological deficits due to stroke determine functional disorders. The possibility of locomotion is usually compromised, therefore the risk of falls increases significantly. The aim of the work is to present Postural Assesment Scale for Strock PASS with the postural stroke assessment scale, the impact of early rehabilitation of patients staying in the neurology ward. Material and methods: Postural examination was carried out among 17 people, of which 8 were women, and 9 were male. The study was divided into two stages. The first stage occurred immediately after the stroke and the second one before the patient was discharged from the ward. Research was carried out at the Biegański Specialist Hospital in Grudziądz in the Department of Neurology and Clinical Neuroimmunology and Impact Department. Conclusions: The results of the postural studies carried out in people with previous stroke subjected to early physiotherapy have a beneficial effect of the conducted therapy. There are positive changes between the first and the final examination of the patients