Diabetes in Poland - public health challenges and opportunities

Introduction and objective: Diabetes, with its medical complications and societal consequences, is one the most difficult concerns for modern society. The purpose of this narrative review is to characterize the selected public health challenges and opportunities resulting from diabetes in Poland, as well as to identify public health measures that may be adopted to lower the diabetes burden in Poland. Review methods: This narrative review is based on the literature about diabetes in Poland. Scientific papers on diabetes published between 1 January 2010-31 January 2023, available in the PubMed database, were identified using a combination of the following key words: 'diabetes', 'Poland', 'public knowledge', 'management' and 'costs'. Particular attention was paid to the following diabetes-related issues: (1) current and forecast prevalence of diabetes in Poland, (2) diabetic care before and after the COVID-19 pandemic onset, (3) public knowledge of diabetes and diabetes risk factors, and (4) public health interventions to reduce the diabetes burden at the population level. Abbreviated description of the state of knowledge: A continuous growth of both the incidence and the prevalence of diabetes is predicted. Due to insufficient public awareness of diabetes risk factors and symptoms, and the health-debt caused by COVID-19 pandemic, a further rise in the number of diabetic complications is expected, as well as an increase in public spending on health care and social insurance systems. Summary: Public health interventions targeted at preventing diabetes and its complications should not be confined to reducing complications and improving diabetes care, but also include a wide range of initiatives aimed at addressing the fundamental causes of diabetes. Future study should look at the cost-effectiveness of such initiatives in order to mobilize different stakeholders and society.

[Covid-19 and cancers: how to do better in a crisis?]

COVID-19 AND CANCERS: HOW TO DO BETTER IN A CRISIS? The occurrence of the Sars-CoV-2 pandemic has profoundly disorganized the care pathways. The situation of oncology quickly appeared as specific because of the high and frequent risk of loss of chance, limited by the he mobilization of screening and care actors, as well as the deployment of a dedicated crisis organization. However, the persistence of a decrease in the activity of surgical removal of esophageal and gastric cancers still raises questions and prompts to remain vigilant and active. The experience of the Covid-19 pandemic has allowed practices to evolve in the long term, for example the better consideration of the immunodepression of cancer patients. Crisis management has highlighted the need for management based on updated indicators and the need to improve information systems in this respect. These elements have been integrated into the ten-year cancer control strategy, which includes actions dedicated to crisis management.

Creation and implementation of the SIENMECRO chronic patient drug delivery system: qualitative study

Introduction: Faced with the pandemic produced by SARS-CoV-2, the Peruvian government implemented several measures such as the temporary closure of primary care facilities and the health system implemented various policies and strategies;one of them was to create and implement the Drug Delivery System for Chronic Patients (SIENMECRO) project. Background: To describe the creation and implementation process of SIENMECRO project. Methods: Qualitative case study that involved reviewing existing documentation such as texts and videos and conducting in-depth interviews with officials and collaborators involved since the preparation of SIENMECRO proposal. Results: SIENMECRO project emerges as a positive initiative with the aspiration of promoting an integrated health system that addresses the health reality from the social determinants of health, due to patients' difficulties to go to their controls and to receive their treatment. Although there was no comprehensive plan for the implementation and control of the project, it was essential to cover the need for health care for a vulnerable segment of the population, avoiding their transfer and preserving the health of the people most likely to suffer complications from COVID-19 infection. Conclusions: It is an initiative where the health system takes a more proactive role for the benefit of the population, implementing the use of technology of the information and communication in health care, articulating with the various providers and bringing services closer to the most vulnerable citizens.

Special Issue: COVID-19, part 3. (Special Issue: COVID-19, part 3.)

This special issue contains 63 articles focusing on the oral manifestations of COVID-19. The articles offer a comprehensive overview of the current knowledge on the subject, encompassing the epidemiology, clinical presentation, diagnosis, and management of oral lesions associated with COVID-19. Additionally, the articles explore the potential role of the oral cavity in COVID-19 transmission, along with the impact of the pandemic on oral health care delivery.

A Novel Approach to Locating Community Clinics to Promote Health Care Accessibility and Reduce Health Disparities in Baltimore, Maryland.

Baltimore, Maryland's entrenched racial residential segregation renders the city's world-class medical facilities and services inaccessible to many Black residents living in its most divested neighborhoods. Arguing the need for post-pandemic health care facilities to address health inequities as a practice of care-giving, this article describes a project funded by the National Institutes of Health (NIH) to define a novel, transdisciplinary methodology for identifying ideal vacant sites for conversion into community clinics in Baltimore's most vulnerable neighborhoods. Positioning architecture as a social determinant of health, this paper suggests ethical and methodological reorientations toward a compassionate approach to clinic design and placement.

Patients' satisfaction with teleconsultations during the COVID-19 pandemic in the Kingdom of Bahrain

Background: The SARS-CoV-2 pandemic led to the restructuring of traditional clinical activity;hence, globally, 58% of countries implemented the use of telemedicine to meet their healthcare needs. Background: To examine patients' satisfaction with telemedicine medical service and experience at the level of primary care in the Kingdom of Bahrain. Methods: A retrospective cross-sectional study was conducted on 335 patients who used teleconsultations in January 2022 in primary care. A validated questionnaire was modified to assess patients' satisfaction with teleconsultation medical services and experience during the COVID-19 pandemic. Results: A total of 315 responses were included in the final analysis (response rate 94%). Almost all expressed extreme satisfaction with the medical service as they were able to easily explain their medical problem over the phone and fully understood their illness after the consultation. They were also satisfied with the ability of the doctor to understand their problem, explain their treatment, and provide appropriate management over the phone. Over 90% were satisfied with the consultation time that it does not require transportation and would like to use it in the future. Sharing private or personal information over the phone received the lowest satisfaction rate (77.5%). Conclusion: The overall satisfaction expressed by respondents of this survey with the teleconsultation medical service and experience is very high. Such a result confirms that patients have a positive attitude towards telemedicine services in primary care and are willing to use it again and, therefore, must be adopted as a proactive strategy to ensure long-term sustainability.

Digital health innovations for non-communicable disease management during the COVID-19 pandemic: a rapid scoping review

ObjectiveTo identify and summarise the digital health interventions (DHIs) implemented for non-communicable disease (NCD) management for COVID-19. DesignRapid scoping review. Three reviewers jointly screened titles-s and full texts. One reviewer screened all excluded records. Data were mapped to WHO DHI Classification and narratively summarised. Data sourcesPubMed, CENTRAL, CINAHL, EMBASE. Eligibility criteria for selecting studiesPeer-reviewed primary research published between 1 November 2019 and 19 September 2021 on DHI for NCD management during the COVID-19 pandemic. Reviews, editorials, letters, commentaries, opinions, conference s and grey literature were excluded. ResultsEighty-three studies drawn from 5275 records were included. A majority of the studies were quantitative in design. Forty per cent of the DHIs were implemented in the Americas. Nearly half of these DHIs targeted mental health conditions. A majority of the interventions were delivered remotely and via telephones. Zoom (26.5%), email (17%) and WhatsApp (7.5%) were the top three platforms for care delivery. Telemedicine, targeted client interventions, personal health tracking and on-demand information services for clients were the most frequently implemented interventions. Details regarding associated costs, sustainability, scalability and data governance of the DHI implementations were not described in the majority of the studies. ConclusionWhile DHIs supported NCD management during the COVID-19 pandemic, their implementation has not been equitable across geographies or NCDs. While offering promise towards supporting the continuum of care during care delivery disruptions, DHIs need to be embedded into healthcare delivery settings towards strengthening health systems rather than standalone parallel efforts to overcome system level challenges.

[Translated article] Efficacy and marginal cost of treatment with tocilizumab in COVID-19 patients.

OBJECTIVE: To describe the marginal cost and survival of patients treated with tocilizumab in a university hospital under real-life conditions and to evaluate factors that could influence costs and health outcomes will be evaluated. METHODS: Observational, single-center, retrospective study of a cohort of adult patients infected with SARS-COV2 treated with tocilizumab. The 1 year restricted mean survival time was analyzed in life-years gained (LYG). The influence of sex, age and severity on patient survival was evaluated. The marginal cost/LYG and marginal cost/survivor ratios were calculated. RESULTS: 508 patients (66 ±â€¯13 years; 32% women) were included. Seventeen percent were admitted to the ICU. Overall survival was 77%. Age older than 71.5 years (HR = 1.08; 95% CI 1.07-1.10; p < 0.001) and ICU admission at initiation of treatment (HR = 2.01; 95% CI 1.30-3.09; p = 0.002) were identified as risk factors. The total budgetary impact of tocilizumab in the period analyzed was 206,466 euros. The patients with the highest cost per unit of health outcome were those admitted to the ICU and those over 71.5 years, with a marginal cost/LYG of €966 and a marginal cost/survivor of €1136. CONCLUSION: The efficiency of treatment with tocilizumab is associated with the age and severity of the patients. The figures are lower in all subgroups than the thresholds usually used in cost-effectiveness evaluations. The results of the present study suggest that early first dose of tocilizumab is an efficient strategy.

Implementation of Blockchain Technology Could Increase Equity and Transparency in Organ Transplantation: A Narrative Review of an Emergent Tool.

In the last few years, innovative technology and health care digitalization played a major role in all medical fields and a great effort worldwide to manage this large amount of data, in terms of security and digital privacy has been made by different national health systems. Blockchain technology, a peer-to-peer distributed database without centralized authority, initially applied to Bitcoin protocol, soon gained popularity, thanks to its distributed immutable nature in several non-medical fields. Therefore, the aim of the present review (PROSPERO N° CRD42022316661) is to establish a putative future role of blockchain and distribution ledger technology (DLT) in the organ transplantation field and its role to overcome inequalities. Preoperative assessment of the deceased donor, supranational crossover programs with the international waitlist databases, and reduction of black-market donations and counterfeit drugs are some of the possible applications of DLT, thanks to its distributed, efficient, secure, trackable, and immutable nature to reduce inequalities and discrimination.

INFLUENCE OF DEATH ANXIETY ON THE PREVENTIVE PRACTICES OF HEALTHCARE PROFESSIONALS DURING COVID-19 OUTBREAK

OBJECTIVES: To ascertain the degree of death anxiety in healthcare professionals and their preventive practices during the ongoing pandemic and to find correlations between these two variables. METHODS: This cross-sectional study was conducted on healthcare professionals working in Combined Military Hospital, Lahore, Pakistan, from July 2020 to February 2021. A descriptive online questionnaire was distributed to measure demography, death anxiety using Collette-Lester Fear of Death Scale Revised and preventive practices using the prevention section of WHO European Region COVID-19 survey tool and guidance. Data were analyzed using SPSS version 24. RESULTS: Out of 136 subjects, 65 (47.8%) were male and 71 (52.2%) were female. Median (IQR) age of the participants was 28 (26-40) years. Median total degree of death anxiety was 83 (66-107). The four subscales showed Median (IQR) scores as follows: your own death 18 (12-27), your own dying 20 (15-27), the death of others 23 (18-28), and the dying of others 22 (16-29). Death anxiety was mild in 55 (40.4%), moderate in 65 (47.8%) and high in 16 (11.8%) participants. Significant association of female gender (p=0.002), experience of death of a patient (p=0.001) or loved one (p=0.001) was found with death anxiety. Zero participants recorded a high preventive practice score. CONCLUSION: A significant proportion of healthcare professionals suffered from undiagnosed moderate levels of death anxiety. The level of preventive practices amongst healthcare professionals was moderate to low. Death anxiety had no correlation with preventive practices. Further study is required to investigate the reason behind these unconventional findings. © 2022, Khyber Medical University. All rights reserved.

The COVID-19 Mortality Rate and its Related Factors in Fars Province

Background: The outbreak of COVID-19 has become the current crisis in most countries. Therefore, paying attention to the consequences and determinants of COVID-19. Mortality can lead to better control of the condition. This study aimed to investigate the COVID-19 mortality rate and its demographic and health determinants in Fars province. Methods: This research was conducted using a quantitative method. For this purpose, available data for selected counties in Fars province were analyzed. The COVID-19 mortality rate was considered a dependent variable. In addition, the variables of literacy rate, urbanization rate, elderly population ratio, unemployment rate, the ratio of the active hospital, ratio of pre-hospital emergency stations, the ratio of centers for primary health care, and the ratio of active hospital beds were considered independent variables. Results: Findings showed that the variables of the elderly population ratio, urbanization rate, and unemployment rate had a direct relationship with the COVID-19 mortality rate. The findings also indicated that the COVID-19 mortality rate in the 45-49 age range begins to accelerate and peaks between 95 and 99 years old. In addition, the literacy rate was inversely related to the COVID-19 mortality rate. The results also showed an inverse relationship between all the selected health variables and the dependent variable. Conclusion: Improving the economic situation, specifically reducing the unemployment rate, emphasizing public education of the people, as well as improving the medical and health facilities, can facilitate the response to pandemics. © 2023 Authors. All rights reserved.

The Uptake of Telemedicine in Obstetric Care During the Early Acute Phase of the Coronavirus 2019 Pandemic.

Introduction: The early acute phase of the coronavirus disease 2019 pandemic created rapid adaptation in health care delivery. Methods: Using electronic medical record data from two different institutions located in two different states, we examined how telemedicine was integrated into obstetric care. Results: With no telemedicine use prior, both institutions rapidly incorporated telemedicine into prenatal care (PNC). There were significant patient-level and institutional-level differences in telemedicine use. Telemedicine users initiated PNC earlier and had more total visits, earlier timing of ultrasounds, and earlier diabetes screening during pregnancy compared with nonusers. There were no significant differences in delivery mode or stillbirth associated with telemedicine use at either institution. Conclusions: Rapid adoption of obstetric telemedicine maintained adequate prenatal care provision during the early pandemic, but implementation varied across institutions.

All children left behind: drug adherence and the COVID-19 pandemic

We study the effect of the COVID-19 pandemic on chronic disease drug adherence. Focusing on asthma, we use a database that tracks the vast majority of prescription drug claims in the U.S. from 2018 to 2020. Using a difference-in-differences empirical specification, we compare monthly drug adherence in 2019 and 2020 for the set of chronic patients taking asthma medication before the onset of the pandemic. We find that the pandemic increased adherence for asthmatic adults by 10 percent. However, we find a sustained decrease in pediatric drug adherence that is most severe for the youngest children. By the end of 2020, drug adherence fell by 30 percent for children aged 0 to 5, by 12 percent for children aged 6 to 12, and 5 percent for children aged 13 to 18. These negative effects are persistent regardless of changes in medical need, socioeconomic factors, insurance coverage and access to health services. We provide suggestive evidence that the observed pediatric changes are likely driven by parental inattention.

[Interinstitutional Command Mexico: organizational decision-making in the face of COVID-19]

Background: The third wave of COVID-19 in Mexico produced a high demand for hospital care, which is why it was created a multidisciplinary group to optimize decision-making: the Interinstitutional Command for the Health Sector (COISS, according to its initials in Spanish). So far, there is no scientific evidence of the COISS processes or their effect on the behavior of epidemiological indicators and the hospital care needs of the population in the context of COVID-19 in the entities involved. Objectives: To analyze the trend on epidemic risk indicators throughout the COISS group's management in the third wave of COVID-19 in Mexico. Material and methods: Mixed study: 1) non-systematic review of information from technical documents issued by COISS, 2) secondary analysis of open-access institutional databases through the description of healthcare needs of cases notified with COVID-19 symptoms, and an ecological analysis by each Mexican state on the behavior of hospital occupancy, RT-PCR positivity, and COVID-19 mortality in two-time points. Results: The COISS activity in identifying states with epidemic risk generated actions aimed at a reduction in hospital occupancy of beds, positivity by RT-PCR, and mortality from COVID-19. Conclusions : The decisions of the COISS group reduced the indicators of epidemic risk. Continuing the work of the COISS group is an urgent need. Conclusions: The decisions of the COISS group reduced the indicators of epidemic risk. Continuing the work of the COISS group is an urgent need. Copyright © 2023 Revista Medica del Instituto Mexicano del Seguro Social.

[Factors associated with the duration of SARS-CoV-2 infection in healthcare professionals at a second-level public hospital in the Community of Madrid (Spain) during the sixth wave.]

OBJECTIVE: The incidence of COVID-19 infections among health professionals during the sixth wave has suffered an exponential increase, mainly due to the rapid community transmission caused by the Omicron variant. The main objective of the study was to evaluate the time to negativization in COVID-positive health professionals during the sixth wave, according to the PDIA result;and secondarily, to evaluate the possible influence of other factors (previous infection, vaccination, sex, age, job position) on the time to get negative status. METHODS: A descriptive, longitudinal, observational and retrospective study was carried out at Infanta Sofia University Hospital (Madrid, Spain). Made from the registry of the Occupational Risk Prevention Service of suspected or confirmed cases of SARS-COV-2 infection in health professionals, during the period between November 1, 2021 and February 28, 2022. Bivariate comparisons were made using Mann Whitney, Kruskal Wallis or Chi-square test (or exact test) according to variables. Subsequently, logistic regression (explanatory model) was performed. RESULTS: The cumulative incidence of SARS-COV-2 infection in health professionals was 23.07%. The mean time to become negative was 9.94 days. Only the history of previous SARS-COV-2 infection had a statistically significant influence on the time to negativization of PDIA. The variables vaccination, sex and age had no effect on the time to negativization of PDIA. CONCLUSIONS: Professionals with a history of COVID-19 infection present lower times of negativization than those who had not have the disease. The results of our study confirm the immune escape of the vaccine against COVID-19, since more than 95% of those infected had received a complete vaccination schedule.

Reason for Consultation and Waiting Time in Public Health Establishments during the COVID-19 pandemic, Peru 2020.

Objective: Identify whether the reason for care influences the waiting time in the health facility in the PeruvianpopulationduringtheCOVID-19 pandemic,according to analysis by ENAHO2020. Material(s) and Method(s): Cross-sectional study with secondary analysis of data from the ENAHO of the Institute of Statistics and Informatics (INEI) done in year 2020. For the analysis, regarding the reason for going to the health facility, symptoms were considered compatible with COVID- 19 and other acute symptoms. Result(s): Data of 1363 participants were analyzed No association was found between reason for consultation and waiting time. In the multivariate analysis found an association with female sex (PR: 2,97;IC: 1,09 - 1,54), being attended in centers of Ministerio de Salud (MINSA) establishment (PR:2,18;CI: 1,02 - 1,59)) and be attended by a doctor (PR: 6,52;IC: 1,53 - 2,21). Conclusion: Variables that have association with longer waiting time were female sex, MINSA as establishment of attendance and profesional of attendane is the doctor.Copyright © Colegio Medico del Peru. All rights reserved.

[The many challenges of population health and healthcare in Suriname since 1975]

Suriname inherited a weak colonial health system after political independence in 1975. In the decades that followed, political and economic developments have had an undeniable influence on the health situation and healthcare in Suriname, as well as on the (feasibility of the implementation of) plans to reform the healthcare system. The Surinamese health outcomes are not only particularly unfavorable compared to the Netherlands, but also compared to other states in the Caribbean region. Some national determinants strongly related to the implementation of effective health measures contribute to this: a low GDP, low control on corruption, sparsely populated areas and high ethnic diversity. The enormous impact of the COVID-19 pandemic in Suriname appears to have been the tipping point for a renewed relationship with the Netherlands. Almost 50 years after political independence, the Surinamese Ministry of Health, with the support of funding and expertise from the Netherlands, is embarking on an ambitious program to restore the health system.

[The many challenges of population health and healthcare in Suriname since 1975]

Suriname inherited a weak colonial health system after political independence in 1975. In the decades that followed, political and economic developments have had an undeniable influence on the health situation and healthcare in Suriname, as well as on the (feasibility of the implementation of) plans to reform the healthcare system. The Surinamese health outcomes are not only particularly unfavorable compared to the Netherlands, but also compared to other states in the Caribbean region. Some national determinants strongly related to the implementation of effective health measures contribute to this: a low GDP, low control on corruption, sparsely populated areas and high ethnic diversity. The enormous impact of the COVID-19 pandemic in Suriname appears to have been the tipping point for a renewed relationship with the Netherlands. Almost 50 years after political independence, the Surinamese Ministry of Health, with the support of funding and expertise from the Netherlands, is embarking on an ambitious program to restore the health system.

A cross-sectional study of unlocking childhood cancer services during COVID-19 pandemic: a pediatric oncology tertiary care center's experience from a developing country

Introduction: The global coronavirus disease 2019 (COVID-19) pandemic has made the provision of cancer care services a challenging task all over the world, even in developed countries. Multiple studies have already reported increased rate of diagnostic delays, interruptions in radiotherapy and chemotherapy administration, and shortage of health care personnel to deliver these services. Background: The aim of this study was to analyze the impact of strategies used to deliver uninterrupted childhood cancer services at our center during the COVID-19 pandemic. Materials and Methods: This is a cross-sectional study of the children less than 18 years of age admitted at our center between March 2020 and September 2021 to assess the effect of strategies adopted to provide uninterrupted cancer services during the COVID-19 pandemic. All the children with cancer who were managed during the study period were included in the study. The children who had treatment interruptions/lost to follow-up prior to onset of COVID-19 were excluded from the study. The primary outcome was to measure the effect of COVID-19 on delivery of cancer care services. The secondary outcome was to assess whether the strategies followed at our center helped to reduce diagnostic delays or loss to follow-up during the COVID-19 pandemic. Results: Out of total 1,490 admissions, 199 children were managed during the study period. Among the 199 children managed, 124 of them were newly diagnosed, 75 had ongoing treatment, 16 children relapsed, 13 children received palliative care, and 6 families were lost to follow-up. Out of 1,471 tests done, only 16 children and 6 caregivers tested COVID-19 positive during routine screening. Thirty-five underwent surgery and 23 received radiotherapy during this period. Among 199 children, 143 (71.8%) received financial support for hospital expenses, 23 (11.5%) received travel support, 20 (10%) were provided free accommodation, and 15 (7.5%) received home delivery of oral chemotherapy and pain medications. A total of $86,989.05 was supported for diagnostic investigations, COVID-19 testing, chemotherapy, and supportive care;$1,144.90 for travel support;and $17,010.94 was waived off by hospital administration to support the poor families. Conclusion: The shared care model, support from nongovernmental organizations and hospital administration, and utilization of local resources productively and effectively helped to avoid diagnostic delays and treatment interruptions, and provide uninterrupted pediatric cancer care services at our center.