The need of prenatal public health initiatives in Poland

The author emphasizes the achievements of the Polish Gynecological Society in the field of improving the health indicators concerning perinatal mortality among infants during the last two decades in Poland. Attention is paid to the contribution of the members of the Society to organizational change in Polish health care after 1990, which resulted in the improvement of the care of mother and child. It is also underlined that the members of the Society contributed to the creation of early detection system of breast and cervical cancer in Poland. However, it is noteworthy that in ‘Polish Gynecology’ – the publication of the Polish Gynecological Society – the number of reports devoted to risky health behaviors of women during periconceptional period and pregnancy is scarce. The author draws attention to the percentage of women who smoke cigarettes and consume alcohol before and during pregnancy. Emphasis is also placed on the problem of nutritional disorders (mainly pathological methods of dieting) among Polish women during the reproductive period and in the first weeks of pregnancy (before the pregnancy is confirmed). These aspects may result in epigenetic changes shaping the phenotype of the offspring. The author refers to the Barker’s theory of Developmental Origins of Adult Diseases and warns that the abovementioned health behaviors of women may bring about negative effects for the offspring and future generations, namely susceptibility to chronic diseases: arterial hypertension, obesity, type 2 diabetes and metabolic syndrome. Negative effects for the health of offspring may also result from low level of physical activity of women before and during pregnancy. The author concludes that it is necessary to intensify the efforts of the Polish Gynecological Society in the areaof prenatal public health

Diabetes and depression : a combination of civilization and life-style diseases is more than simple problem adding : literature review

The article presents a review of current medical and psychological literature published between 2000 - 2010, with the use of the PubMed database, concerning the occurrence of anxiety and depression in diabetic patients, with particular consideration of those aff ected by complications. Anxiety and fear are the most frequent emotional disorders among diabetic patients. Depression occurs in approximately 30% of patients with diabetes. Both diabetes and depression belong to so called ‘life style’ or ‘civilization diseases’. Numerous studies have confi rmed that the course of depression in patients with diabetes is more severe, and the relapses of depression episodes are more frequent. The studies show that diabetic patients experience various types of psychosocial and emotional problems due to which the monitoring of own state of health is not the priority in life. In the process of treatment of both sole diabetes and concomitant anxiety and depression it is important to adjust and motivate patients to apply widely understood therapeutic recommendations. The treatment of depression syndrome in the course of diabetes does not have to lead to improvement in glycaemic control. The following factors infl uencing the therapeutic eff ect should be mentioned: duration of diabetes, presence of complications, and the eff ect of the drugs applied on body weight, or possibly initial diabetes management. It seems, therefore, that the patient education model based on the provision of knowledge concerning diabetes and its complications, methods of treatment, principles of nutrition and health-promoting life style, may be insuffi cient, at least for patients with depression. The results of a review of reports shows that an optimum treatment of diabetes, in accordance with the current state of knowledge, requires from physicians a special consideration of psychological and psychiatric knowledge for the 2 following reasons: 1) eff ectiveness of therapy to a high degree depends on the proper behaviour of a patient; 2) considerably more frequent, compared to the total population, occurrence of the symptoms of emotional disorders negatively aff ect the course of diabetes

Risk factors for work-related eczema and urticaria among vocational students of agriculture

Introduction and objective. Farmers are at high risk of occupational skin diseases which may start already during vocational training. This study was aimed at identification of risk factors for work-related skin diseases among vocational students of agriculture. Materials and method. The study involved 440 students (245 males, 195 females aged 17–21 years) in 11 vocational schools which were at least 100 km from each other. The protocol included a physician-managed questionnaire and medical examination, skin prick tests, patch tests, total IgE and Phadiatop. Logistic regression model was used for the identification of relevant risk factors. Results. Work-related dermatoses were diagnosed in 29 study participants (6.6%, 95%CI: 4.3–8.9%): eczema in 22, urticaria in 14, and co-existence of both in 7 students. Significant risk factors for work-related eczema were: history of respiratory allergy (OR=10.10; p<0.001), history of eczema (itchy rash) provoked by wet work and detergents before entering the school (OR=5.85; p<0.001), as well as history of contact dermatitis to metals, rubber or cosmetics prior to inscription (OR=2.84; p=0.016), and family history of any skin disease (OR=2.99; p=0.013). Significant risk factors for work-related urticaria were: history of allergic rhinitis and asthma prior to inscription (OR=7.29; p=0.006), positive skin prick tests to work place allergens (OR=4.65; p=0.002) and to environmental allergens (OR=3.79; p=0.009), and positive Phadiatop test (OR=3.61; p=0.013). Conclusions. Work-related skin diseases are common among vocational students of agriculture. Atopy, past history of asthma, allergic rhinitis, and eczema (either atopic, allergic or irritant) are relevant risk factors for work-related eczema and urticaria in young farmers, along with family history of any skin disease. Positive skin prick tests seem relevant, especially in the case of urticaria. Asking simple, aimed questions during health checks while enrolling students into agricultural schools would suffice to identify students at risk for work-related eczema and urticaria, giving them the chance for selecting a safer profession, and hopefully avoiding an occupational disease in the future

Is there the gap in public health literature in Europe?

Introduction and objective: The growing expectations for the effectiveness of public health increase the demand for scientific literature, concerning research, reviews and other forms of information. The bibliographic databases are of crucial importance for researchers and policy makers. The objective of this study is to estimate the supply of scientific literature related to public health in selected European countries, which are available to a wide range of users. Material and Methods: Analysis of the number of bibliographic records on topics related to public health was based on searches in Ovid MEDLINE ( R) in May and June 2011. According to MeSH terms, 11 keywords and names of 13 European countries were used in the search. Publications from the years 2001–2010 were analyzed. A number of publications indexed under ‘public health’, and related to selected countries were compared with the size of the population of those countries, GDP, total expenditure on health and burden of disease (DALYS’s). Results: The most popular topic was ‘health policy’, whereas the topics ‘occupational health’ and ‘environmental health’ were less prevalent. There were no significant changes in the number of publications in 2001–2010. The number of articles indexed under ‘public health’ had significant positive correlation with national GDP, expenditure on health and population size, and negative with DALY’s. Conclusions: According to the criteria accepted in this study, the Nordic countries – Finland, Sweden and Norway – were very productive in this respect. Poland and other Central European Countries were less productive

Difficulties in funding of VA-ECMO therapy for patients with severe accidental hypothermia

Background: Severe accidental hypothermia is defined as a core temperature below 28 Celsius degrees. Within the last years, the issue of accidental hypothermia and accompanying cardiac arrest has been broadly discussed and European Resuscitation Council (ERC) Guidelines underline the importance of Extracorporeal Rewarming (ECR) in treatment of severely hypothermic victims. The study aimed to evaluate the actual costs of ECR with VA-ECMO and of further management in the Intensive Care Unit of patients admitted to the Severe Accidental Hypothermia Centre in Cracow, Poland. Methods: We carried out the economic analysis of 31 hypothermic adults in stage III-IV (Swiss Staging) treated with VA ECMO. Twenty-nine individuals were further managed in the Intensive Care Unit. The actual treatment costs were evaluated based on current medication, equipment, and dressing pricing. The costs incurred by the John Paul II Hospital were then collated with the National Health Service (NHS) funding, assessed based on current financial contract. Results: In most of the cases, the actual treatment cost was greater than the funding received by around 10,000 PLN per patient. The positive financial balance was achieved in only 4 (14%) individuals; other 25 cases (86%) showed a financial loss. Conclusion: Performed analysis clearly shows that hospitals undertaking ECR may experience financial loss due to implementation of effective treatment recommended by international guidelines. Thanks to new NHS funding policy since January 2017 such loss can be avoided, what shall encourage hospitals to perform this expensive, yet effective method of treatment

Psychosocial aspect of quality of life among working and unemployed nurses and midwives

Objective The objective of the study was to explain differences in the subjective evaluation of the psychological and social aspects of quality of life in a group of working and unemployed nurses and midwives. Material and Methods The survey was conducted in a group of 620 professionally-active and inactive people (315 nurses and 305 midwives), selected by random stratified-systematic sampling. The tool used to gather empirical material was the standardized questionnaire WHOQoL-100. Results Professionally-active nurses evaluated the mental domain less favourably (M=12.33), compared with unemployed nurses (M=12.73), and the difference between average values was statistically significant (p=.043). It is also worth noting that in the group of midwives there were significant differences in each discussed domain. The unemployed respondents evaluated more positively the overall quality of life (M=14.29; p=.005) and the mental domain (M=12.85; p=.009), while the social domain was evaluated less favourably by the professionally-active midwives (M=12.73; p=.022). Conclusions Paradoxically, those who were unemployed made slightly more positive evaluations in comparison with the professionally active. Professional work is not a factor preferably affecting the quality of life and its psychosocial dimension. The higher quality of life of the unemployed respondents may result from the buffering impact of social support

Psychosocial aspect of quality of life among working and unemployed nurses and midwives

Objective The objective of the study was to explain differences in the subjective evaluation of the psychological and social aspects of quality of life in a group of working and unemployed nurses and midwives. Material and Methods The survey was conducted in a group of 620 professionally-active and inactive people (315 nurses and 305 midwives), selected by random stratified-systematic sampling. The tool used to gather empirical material was the standardized questionnaire WHOQoL-100. Results Professionally-active nurses evaluated the mental domain less favourably (M=12.33), compared with unemployed nurses (M=12.73), and the difference between average values was statistically significant (p=.043). It is also worth noting that in the group of midwives there were significant differences in each discussed domain. The unemployed respondents evaluated more positively the overall quality of life (M=14.29; p=.005) and the mental domain (M=12.85; p=.009), while the social domain was evaluated less favourably by the professionally-active midwives (M=12.73; p=.022). Conclusions Paradoxically, those who were unemployed made slightly more positive evaluations in comparison with the professionally active. Professional work is not a factor preferably affecting the quality of life and its psychosocial dimension. The higher quality of life of the unemployed respondents may result from the buffering impact of social support

Problemy finansowania terapii pozaustrojowej VA-ECMO oraz leczenia chorych w głębokiej przypadkowej hipotermii

BACKGROUND: Severe accidental hypothermia is defined as a core temperature below 28 Celsius degrees. Within the last years, the issue of accidental hypothermia and accompanying cardiac arrest has been broadly discussed and European Resuscitation Council (ERC) Guidelines underline the importance of Extracorporeal Rewarming (ECR) in treatment of severely hypothermic victims. The study aimed to evaluate the actual costs of ECR with VA-ECMO and of further management in the Intensive Care Unit of patients admitted to the Severe Accidental Hypothermia Centre in Cracow, Poland. METHODS: We carried out the economic analysis of 31 hypothermic adults in stage III-IV (Swiss Staging) treated with VA ECMO. Twenty-nine individuals were further managed in the Intensive Care Unit. The actual treatment costs were evaluated based on current medication, equipment, and dressing pricing. The costs incurred by the John Paul II Hospital were then collated with the National Health Service (NHS) funding, assessed based on current financial contract. RESULTS: In most of the cases, the actual treatment cost was greater than the funding received by around 10000 PLN per patient. The positive financial balance was achieved in only 4 (14%) individuals; other 25 cases (86%) showed a financial loss. CONCLUSION: Performed analysis clearly shows that hospitals undertaking ECR may experience financial loss due to implementation of effective treatment recommended by international guidelines. Thanks to new NHS funding policy since January 2017 such loss can be avoided, what shall encourage hospitals to perform this expensive, yet effective method of treatment.  BACKGROUND: Severe accidental hypothermia is defined as a core temperature below 28 Celsius degrees. Within the last years, the issue of accidental hypothermia and accompanying cardiac arrest has been broadly discussed and European Resuscitation Council (ERC) Guidelines underline the importance of Extracorporeal Rewarming (ECR) in treatment of severely hypothermic victims. The study aimed to evaluate the actual costs of ECR with VA-ECMO and of further management in the Intensive Care Unit of patients admitted to the Severe Accidental Hypothermia Centre in Cracow, Poland. METHODS: We carried out the economic analysis of 31 hypothermic adults in stage III-IV (Swiss Staging) treated with VA ECMO. Twenty-nine individuals were further managed in the Intensive Care Unit. The actual treatment costs were evaluated based on current medication, equipment, and dressing pricing. The costs incurred by the John Paul II Hospital were then collated with the National Health Service (NHS) funding, assessed based on current financial contract. RESULTS: In most of the cases, the actual treatment cost was greater than the funding received by around 10000 PLN per patient. The positive financial balance was achieved in only 4 (14%) individuals; other 25 cases (86%) showed a financial loss. CONCLUSION: Performed analysis clearly shows that hospitals undertaking ECR may experience financial loss due to implementation of effective treatment recommended by international guidelines. Thanks to new NHS funding policy since January 2017 such loss can be avoided, what shall encourage hospitals to perform this expensive, yet effective method of treatment.