Ukraine war refugees - threats and new challenges for healthcare in Poland.

BACKGROUND: Between February 2022, when the war in Ukraine began, and April 1, 2022, the number of refugees to neighboring countries reached 4,137,842 people. The majority have fled to Poland. The main challenge for the health system in Poland in this situation is how to develop effective adaptation measures. AIM: The aim of this study is to describe threats and challenges to public health related in particular to infectious diseases and to identify the resources of the healthcare system that are necessary to meet the needs of the recent war refugees and the Polish population. METHODS: Scientific publications, statistical data from national and international organizations, information obtained from public institutions in Poland and Ukraine, and reliable sources of up-to-date information on the Internet were used. Key data on threats and challenges to public health were collected and presented. FINDINGS: Differences were observed between Poland and Ukraine in terms of immunization programmes and their implementation as well as in relation to the prevalence of selected infectious diseases. The increase in demand for healthcare resources in Poland was estimated on the basis of current indicators. Both the possibilities of counteracting epidemic threats related to the current situation and possible consequences for the availability of services and the health condition of all people currently staying in Poland were presented. CONCLUSION: European countries may experience public health threats due to the influx of war refugees. The data presented could be useful for European countries while developing effective strategies to mitigate public health issues.

Indirect effects of a 7 year PCV7/PCV13 mass vaccination program in children on the incidence of pneumonia among adults: a comparative study based on two Polish cities.

BACKGROUND AND OBJECTIVES: In 2006 the city of Kielce, Poland, introduced a mandatory PCV7 (replaced by PCV13 in 2011) vaccination program against S. pneumoanie for all children under 2 years old. At that time, the neighboring city of Ostrowiec Swietokrzyski had no such large-scale vaccination program in place. This created an opportunity to observe the results of the vaccination by comparing the incidence of pneumonia in these two cities. The aim of this study was to analyze how the incidence of pneumonia among adults was indirectly affected by the PCV7/PCV13 vaccination program in children during the 7 year follow-up period. METHODS: We performed a retrospective study. PCV7/PCV13 vaccinations were delivered according to a 2 + 1 schedule. The vaccination rate in the analyzed period amounted to almost 99%. The following age groups were analyzed: 30-49, 50-64 and 65+. The Cochran-Armitage test was used to investigate the significance of the observed trend in pneumonia morbidity. The significance of deviations from a linear trend was also tested. In addition, the importance of the trend (in the case of deviations from linearity) was confirmed with the use of the Mantel test. RESULTS: In the 65+ age group there was a decrease of 66.5% in the incidence of diagnosed pneumonia (p < 0.0001). This was followed by smaller, but statistically significant, declines in the other age groups: 30.75% in the 30-49 age group (p = 0.001) and 56.8% in the 50-64 age group (p < 0.0001). This decreasing trend continued for seven consecutive years of observation. In addition, we demonstrated a statistically significant higher rate of pneumonia in all age groups in the City of Ostrowiec Swietokrzyski. CONCLUSIONS: The results clearly indicate that the indirect effectiveness of the PCV7/PCV13 vaccine program, performed according to the 2 + 1 schedule and applied in Kielce, Poland, is statistically significant.

Indirect population impact of universal PCV7 vaccination of children in a 2 + 1 schedule on the incidence of pneumonia morbidity in Kielce, Poland.

The aim of this study was an analysis of the population effects of a seven-valent pneumococcal conjugate vaccine (PCV7) on pneumonia incidence rates in the 5-year follow-up period after the introduction in 2006 of a universal PCV7 vaccination programme in the city of Kielce, Poland. Vaccinations were carried out according to a 2 + 1 schedule. The vaccination compliance rate amounted to approximately 99 %. The age groups 0-2, 30-49, 50-65 and 65+ years were analysed. The Cochran-Armitage test was used to investigate the significance of observed trends in pneumonia morbidity. The significance of deviations from a linear trend was also tested. The importance of the trend was confirmed by the Mantel test. Between 2005 and 2010, the greatest decline, 82.9 % (2005, 25.31/1,000; 2010, 4.34/1,000), in pneumonia morbidity was observed for children <2 years of age. In the 65+ years age group, this amounted to 43.5 %. Lesser declines, but still of statistical significance, were observed for the other age groups: 16.5 % in the 30-49 years group and 40.4 % in the 50-64 years group. All reductions are statistically significant and confirmed by the Mantel test. Five years after the introduction of a universal PCV7 vaccination programme in Kielce, Poland, its effectiveness in pneumonia prevention has been demonstrated in both the <2 years of age group and indirectly for other groups.

Poland: health system review

The Health Systems in Transition (HiT) country profiles provide an analytical description of each health system and of policy initiatives in progress or under development. They aim to provide relevant comparative information to support policy-makers and analysts in the development of health systems and reforms in the countries of the WHO European Region and beyond. The HiT profiles are building blocks that can be used: to learn in detail about different approaches to the financing, organization and delivery of health services; to describe accurately the process, content and implementation of health reform programmes; to highlight common challenges and areas that require more in-depth analysis; and to provide a tool for the dissemination of information on health systems and the exchange of experiences of reform strategies between policy-makers and analysts in countries of the WHO European Region. This series is an ongoing initiative and material is updated at regular intervals.

Effects of ammonia and hepatic failure on the net efflux of endogenous glutamate, aspartate and taurine from rat cerebrocortical slices: modulation by elevated K+ concentrations.

Cerebrocortical minislices derived from control rats ("control slices") and from rats with thioacetamide (TAA)-induced hepatic failure showing moderate hyperammonemia and symptoms of hepatic encephalopathy (HE) ("HE slices"), were incubated with physiological saline in the absence or presence of 5 mM ammonium acetate ("ammonia"), at potassium ion (K+) concentrations ranging from 5 to 15 mM. The efflux of endogenous aspartate (Asp), glutamate (Glu) and taurine (Tau) to the incubation medium was assayed by HPLC. At 5 mM K+, perfusion of control slices with ammonia did not affect Glu and slightly depressed Asp efflux. Raising K+ concentrations in the incubation medium to 7.5 led to inhibition of Glu and Asp efflux by ammonia and the inhibitory effect was further potentiated at 10 mM K+. The inhibition was also significant at 15 mM K+. This suggests that, depression of excitatory neurotransmission associated with acute hyperammonemia is more pronounced under conditions of intense neuronal activity than in the resting state. HE moderately increased the efflux of Glu and Asp, and the stimulatory effect of HE on Glu and Asp efflux showed virtually no variation upon changing K+ concentration up to 15 mM. Ammonia strongly, and HE moderately, increased Tau efflux at 5 mM K+. However, both the ammonia- and HE-dependent Tau efflux decreased with increasing K+ concentration in the medium and was no longer significant at 10 mM concentration, indicating that intense neuronal activity obliterates the neuroprotective functions of this amino acid triggered by hyperammonemia.

Ammonia-induced extracellular accumulation of taurine in the rat striatum in vivo: role of ionotropic glutamate receptors.

Accumulation of taurine (Tau), glutamate (Glu) and glutamine (Gln) was measured in vivo in microdialysates of the rat striatum following a direct application to the microdialysis tube of 60 mM ammonium chloride which renders the final ammonia concentration in the extracellular space to approximately 5 mM. The following compounds were coadministered with ammonia to distinguish between the different mechanisms that may underlie the accumulation of amino acids: ion transport inhibitors, diisothiocyanostilbene-2,2'-disulfonate (DIDS) and furosemide, a Glu transport inhibitor L-trans-pyrrolidine-2,4-dicarboxylate (PDC), an NMDA receptor antagonist dizocilpine (MK-801) and an 2-amino-3-hydroxy-5-methyl-4-isoxazolepropionate (AMPA)/kainate (KA) receptor antagonist 6,7-dinitroquinoxaline-2,3-dione (DNQX). Ammonia stimulated Tau accumulation in the microdialysates to approximately 250% of the basal value. Furosemide did not significantly affect the stimulation by ammonia and DIDS only moderately depressed the effect. The ammonia-dependent Tau accumulation was increased by approximately 50% in the presence of PDC and reduced by approximately 35% in the presence dizocilpine and DNQX. In the microdialysates ammonia stimulated Glu and Gln accumulation somewhat less than Tau accumulation. Except for stimulation of Gln accumulation by DNQX, the effects were not modified by any of the cotreatments. The results are consistent with the assumption that ammonia stimulates Tau efflux mainly via activation of ionotropic Glu receptors.

The future of chronic diseases.

Major chronic diseases continue to be the main health scourge of the most developed countries, have only recently been retreating in frequency in the fledgling market economies, and are becoming dominant in many populous areas of the developing world. The descriptive evidence from the developments of the near past strongly suggests that much of the control outcomes have already been achieved with the existent imperfect causative knowledge. The continuation of desirable trends in major chronic diseases in some places like Central & Eastern Europe, is uncertain within the intermediate time range without gaining more etiological clues, among which the role of medical care is worthy of reconsideration. Other factors can grow in importance, like obesity, which may be freed from the suppressive influence of cigarette smoking to trigger major mass pathologies, like type 2 diabetes mellitus, arterial hypertension, some cancers etc. The role of social underpriviledge seems recalcitrant, although the part played by social share of biological risk agents may diminish in response to educational persuasion. The remotest destinies of some chronic diseases may depend on the mixture of external and genetic influences ending as predispositions towards some ailments, antecedents of which might have protected their carriers from dangers of the past unfriendly environment, like obesity (or diabetes) against famine, or hypertension against inefficient defense reaction. The resulting medium-range prediction of well-being for inhabitants of more developed world may not be forbidding, since increasing life expectancy needs not be synonymous with disability, and attaining old age does not require excessive sacrifice, beyond reducing number smoked, or preserving decent respiratory volumes.

Outdoor sulphur dioxide and respiratory symptoms in Czech and Polish school children: a small-area study (SAVIAH). Small-Area Variation in Air Pollution and Health.

OBJECTIVES: Air pollution has been linked to respiratory outcomes but controversy persists about its long-term effects. We used a novel technique to estimate the outdoor concentrations of sulphur dioxide (SO2) at small-area level to study the long-term effects on respiratory symptoms and disease in children. METHODS: As part of the international SAVIAH study, parents of 8,013 children aged 7-10 studied in Prague (Czech Republic) and Poznan (Poland) completed a questionnaire covering respiratory health, demographic and socio-economic factors and health behaviours (response rate 91%). This report is based on 6,959 children with complete data. Outdoor SO2 was measured by passive samplers at 80 sites in Poznan and 50 sites in Prague during 2-week campaigns. Concentrations of SO2 at each point (location) in the study areas were estimated from these data by modelling in a geographical information system. The mean of the estimated SO2 concentrations at children's homes and schools was used as an indicator of exposure to outdoor SO2. RESULTS: The prevalence of respiratory outcomes was similar in both cities. In the pooled data, 12% of children had experienced wheezing/whistling in the past 12 months; 28% had a lifetime prevalence of wheezing/whistling; 14% had a dry cough at night; and 3% had had asthma diagnosed by a doctor. The estimated mean exposure to outdoor SO2 was 80 (range 44-140) microg/m3 in Poznan and 84 (66-97) microg/m3 in Prague. After socio-economic characteristics and other covariates were controlled for, SO2 was associated with wheezing/whistling in the past 12 months (adjusted OR per 50 microg/m3 1.32, 95% CI 1.10-1.57), lifetime prevalence of wheezing/whistling (OR 1.13, 95% CI 0.99-1.30), and lifetime prevalence of asthma diagnosed by a doctor (OR 1.39, 95% CI 1.01-1.92). The association with dry cough at night did not reach statistical significance. CONCLUSIONS: In these two Central European cities with relatively high levels of air pollution, small-area based indicators of long-term outdoor winter concentrations of SO2 were associated with wheezing/whistling and with asthma diagnosed by a doctor.

Effects of ammonia in vitro on endogenous taurine efflux and cell volume in rat cerebrocortical minislices: influence of inhibitors of volume-sensitive amino acid transport.

Rat cerebrocortical minislices were incubated with physiological saline in the absence or presence of 5 mM ammonium acetate ("ammonia") and/or inhibitors of osmosensitive amino acid transport: 50 microM niflumic acid and 100 microM N-ethyl-maleimide for 60 min, with medium changes after 20 min and 40 min. The efflux of endogenous taurine, glutamate and glutamine was assayed by high-performance liquid chromatography, and steady-state cell volumes were monitored in the slices with the [14C]inulin method. In the absence of ammonia, niflumic acid abolished taurine efflux but did not affect glutamate or glutamine efflux at all time-points, and increased cell volume at 20 min and 60 min. N-Ethyl-maleimide increased taurine, glutamine and glutamate efflux at 20 min and 40 min, inhibited taurine and glutamine efflux at 60 min, and increased cell volume at 20 min. Ammonia strongly stimulated taurine (by 380% at 20 min), and only moderately glutamate (30% at 20 min) or glutamine efflux (76% at 20 min). Ammonia increased cell volume above the control level at all time-points. Niflumic acid inhibited, but did not abolish ammonia-dependent taurine and glutamine efflux, and did not change glutamate efflux. The effects of ammonia + niflumic acid on cell volume did not differ from the effects of each compound separately. N-Ethyl-maleimide inhibited ammonia-dependent efflux of all three amino acids except for stimulation of glutamate efflux at 20 min. N-Ethyl-maleimide + ammonia decreased the cell volumes more than did each compound separately. It is concluded that although ammonia-induced taurine efflux is accompanied by an increase in cell volume, the underlying mechanism is not simply a cell volume regulatory response normally observed in hypoosmotic stress. Increased efflux of taurine, which is an inhibitory amino acid and a cell membrane protectant, may serve to counteract the deleterious effects of increased excitatory transmission accompanying acute hyperammonemic insult.

[SO2 and NO2 air pollution measurement by passive monitors]. / Ocena zanieczyszczen powietrza (SO2 NO2) przy uzyciu monitorów pasywnych.

Air pollution concentration measurement in Poland are routinely carried on using aspiration methods. This technique required suitable measurement point preparation and its monitoring. During last years passive monitors are used more and more frequently for some air pollutants concentrations measurement. The above mentioned method is recommended when spatial differentiation of air pollution are analized. Results of such measurements carried of in the area of Poznan are presented in this contribution.

[The assessment of population exposure to atmospheric air pollution]. / Szacowanie narazenia ludnosci na zanieczyszczenia powietrza atmosferycznego.

The air pollution concentrations of SO2 and suspended particulate matter in 1993 in one Polish city Poznan and over entire Poland have been modeled and mapped. The data for Poznan were obtained during special epidemiological study by means of a dense network of passive samples and the data for Poland were obtained from the routine network operated by Sanitary Epidemiological Stations. The modeling employed the kriging method of ARC/INFO computer package. It was found that about 1/3 of Polish population was exposed to the SO2 and/or SPM level that exceeded annual recommended values. In Poznan 25% of children aged 8-9 years were exposed to SO2 level above 100 during heating season 1992/1993.

[Domestic factors and respiratory symptoms in children]. / Czynniki srodowiska domowego a wystepowanie objawów ze strony ukladu oddechowego u dzieci.

The purpose of the analysis was to evaluate an association between selected factors of home environment and respiratory symptoms (wheezing/whistling) and asthma diagnosed by physician in 4333 children of age 7-8 years in Poznan. The data were collected within the scope of the EU funded multinational SAVIAH study. It was found that presence of the symptoms as well as asthma were significantly associated with presence of damp spots and/or mould at home and disturbance by traffic fumes and/or noise at home. The association of respiratory symptoms with ETS and presence of pets was less clear.

[Studies of ambient air pollution and selected aspects of health status of children in Poznan: preliminary information]. / Badania zanieczyszczen powietrza i niektórych aspektów stanu zdrowia dzieci w Poznaniu--doniesienie wstepne.

Within the framework of international collaboration an epidemiological study has been carried out in Poznan with the objective to develop and assess new methodologies in environmental epidemiology in Poland. The network of passive samplers has been set up for estimation of SO2 and NO2 air pollution exposure, small area analysis methods and Geographic Information System will be used for assessment of the relationship of respiratory symptoms and air pollution while controlling for socioeconomic factors and household characteristic.

[Temporal and spatial analysis of hospitalization for selected diseases in Poland associated with certain environmental factors. I. Current trends in hospitalization for certain diseases]. / Czasowe i terytorialne zróznicowanie hospitalizacji wybranych chorób w Polsce w powiazaniu z niektórymi czynnikami srodowiska. CZ. I. Czasowe trendy hospitalizacji z powodu wybranych chorób.

In the present study of hospitalization rates during the period 1979-1990 for some of the diseases considered to be related to environmental contamination were analyzed. Selected diagnosis included malignant melanoma and other malignant neoplasm of skin, malignant neoplasm of bladder, myeloid and monocytic leukaemia, aplastic anaemia, chronic obstructive pulmonary disease and asthma, diseases of skin and subcutaneous tissue, spontaneous abortion and congenital anomalies. The performed analysis has shown that in 1979-1990 discharge rates had significant growing trends in the both urban and rural population in the case of malignant neoplasm of bladder, leukaemia, spontaneous abortion and congenital anomalies in infants. There were no significant trends in hospitalization of malignant melanoma and other malignant neoplasm of skin, aplastic anaemia and asthma.

[Temporal and spatial analysis of hospitalization for selected diseases in Poland due to certain environmental factors. II. Spatial analysis of environmental differences]. / Czasowe i terytorialne zróznicowanie hospitalizacji wybranych chorób w polsce w powiazaniu z niektórymi czynnikami srodowiska. Cz. II. Analiza zróznicowania terytorialnego.

The present study was aimed at assessment of a degree of regional differences in hospitalized morbidity in Poland for some of diseases considered to be related to environmental contamination and its relationship with general environmental characteristic of the regions. The performed analysis has shown that however in recent years there have been substantial differences in the discharge rates between provinces of Poland, these differences are not well explained by differences in general environmental factors. The possible reasons of these results have been discussed.

[Selected elements of health status of the Polish population in relation to other European countries in the light of the program "Health for all up to 2000"]. / Wybrane elementy stanu zdrowia lundnosci Polski na tle innych krajów europejskich w swietle celów strategii "Zdrowie dla wszystkich do roku 2000".

Total mortality from main causes of death (diseases of circulatory system, malignant neoplasms, injuries and poisoning) life expectancy at birth, infant and maternal mortality in Poland in the years 1970-1988 were analyzed on the basis of targets of the regional strategy for "Health for all by the year 2000" (HFA 2000). It seems that it isn't possible to achieve targets concerning mortality by the year 2000. However it is possible to decrease infant and maternal mortality. Standardization of health indicators to european population allows to compare health status of the polish population to other european countries. This comparison shows that situation in Poland is not optimistic.

[Injury and poisoning mortality rate among children and adolescents in Poland during the years 1980-1985]. / Zgony dzieci i mlodziezy w Polsce w latach 1980-1985 z powodu urazow i zatruc.

In 1980-1985 injuries and poisoning were the cause of 50 percent of death in Polish children. A slow decrease of mortality in girls and rural boys was observed in last years. In every age group injuries and poisoning mortality were higher in boys than girls. The difference between sexes increase with age and in age group 15-19 years mortality from these causes is four times higher in boys than in girls. In every age group mortality was also higher in rural young population then in urban. Asphyxia and suffocation were the main external cause of infant death. Starting from the age 1-4 the main cause of death were traffic accidents followed in older age by drowning and suicide.

[Exposure of schoolchildren and teachers to noise at school]. / Narazenie uczniów i nauczycieli na halas w szkole.

The factor of decisive influence on the acoustic climate in rooms is the inner noise, which is dependent in schools on the activity of children, overcrowding of classes and inadequate use of technical protective means. The inappropriate location of schools, although also important from the standpoint of acoustics, is a much lower source of noise than it is generally assumed. Particularly unfavourable acoustic conditions are in elementary schools with over 300 children in one shift. The spaces with the highest noise level include corridors, especially during recesses between lessons. The noise level in them is in the range of an equivalent sound A 60-95 dB, and the most frequent noise level is 80 dB. In a large part of schools the acoustic conditions in the corridors during recesses approach the critical values accepted for hearing protection in industrial plants, in some schools they are even exceeded. The situation is also unfavourable in other rooms such as doctor's office, director's room, reading rooms, rooms for teachers. These rooms are situated usually without taking into consideration of the acoustic conditions. This is particularly true of teachers' rooms which should give the teachers the possibility of resting before the next lesson. During lessons the noise level decreases in all rooms. However, the noisiest among them, corridors, classes situated near the hall for physical exercises and day-room, have still up to about 65 dB noise level. Generally speaking, in about 60% of rooms the acoustic conditions are below the recommended standard. The main cause, apart from overcrowding of schools, is low acoustic absorption ability of school rooms, and poor acoustic insulation ability of the doors in schools.