Prevention programmes in primary health care - 8 aspects of their effective implementation

INTRODUCTION: Primary health care (PHC) is an optimal setting for the purpose of primary and secondary prevention. Health education, vaccinations, screening may be successfully introduced to the PHC settings. Consequently, it would ensure better access to services and their accessibility for all social groups. OBJECTIVE: The purpose of this paper was to determine factors which have an impact on the implementation of prevention programmes in the PHC settings as well as actions which improve the effectiveness of such programmes in Europe and worldwide with a special attention paid to the prevention programmes concerning chronic infectious diseases. MATERIAL AND METHODS: A review of literature was conducted in PubMed using the following key words: primary care/general practice, prevention, screening, implementation. A total of 540 articles published in 1976-2016 were subject to analysis. RESULTS: Having developed prevention programmes in the PHC settings, it should not be forgotten that it would be an additional task for medical personnel. It would be of importance to allocate adequate funds which would allow for an optimal execution of the programme ­ adequate time for visit, adequate number of visits, time for education of patients, follow-up visits, monitoring of the execution of the programme and care over diagnosed patients. Prevention programme must be accompanied by education (especially education of medical personnel). Effective execution of the prevention programmes is favoured by the following factors: simple inclusion criteria, less invasive diagnostic tests, support programmes and the presence of workers which are appointed for such a purpose. FINDINGS: Execution of preventive programmes in the PHC settings is feasible. Furthermore, there is an evidence which suggests that they may be effectively executed there.

Factors associated with hepatitis C prevalence differ by the stage of liver fibrosis: A cross-sectional study in the general population in Poland, 2012-2016.

BACKGROUND & AIMS: There is a considerable burden of hepatitis C in Europe related to the lack of prompt diagnosis. We aimed to estimate the prevalence and related risk factors of HCV infections by the stages of liver fibrosis, using non-invasive methods, to understand testing needs in Poland. METHODS: A cross-sectional study was conducted in 2012-2016 adopting a stratified random sampling of primary health care units followed by systematic sampling of patients within each unit. Study participants filled a questionnaire and donated blood for laboratory HCV testing. Additionally, the results of liver function tests and platelet count were collected to calculate APRI and FIB-4 scores. Cases were classified according to the level of fibrosis: 'significant fibrosis' (APRI≥0.7 or FIB4≥1.45) and 'no significant fibrosis' (APRI<0.7 and FIB4<1.45). RESULTS: Of 21 875 study participants, 102 were HCV-RNA positive. Prevalence of HCV infections and significant fibrosis was estimated at 0.47% (95% CI 0.38% - 0.57%) and 0.12% (0.08% - 0.17%), respectively. Cases with significant fibrosis accounted for 51.6% (33.4%-69.9%) in men and 34.4% (17.3%-51.4%) in women. There was no correlation between the HCV prevalence and age. Blood transfusion prior to 1992 strongly predicted significant fibrosis as did the history of injecting drug use (IDU) and ever having an HCV-infected sexual partner in men and caesarean sections in women. Factors associated with HCV infection without significant fibrosis were tattooing in men and younger age in women. We acknowledge limited possibility to study the associations between IDU and ever having HCV-infected sexual partner, given small sample sizes for these exposures. CONCLUSIONS: As no clear birth cohort affected by HCV could be identified, risk factor-based screening in the general population should be considered, taking into account the association between the increased risk of liver fibrosis and the history of transfusion prior to 1992 and caesarean sections.

What affects response rates in primary healthcare-based programmes? An analysis of individual and unit-related factors associated with increased odds of non-response based on HCV screening in the general population in Poland.

OBJECTIVES: Response rate in public health programmes may be a limiting factor. It is important to first consider their delivery and acceptability for the target. This study aimed at determining individual and unit-related factors associated with increased odds of non-response based on hepatitis C virus screening in primary healthcare. DESIGN: Primary healthcare units (PHCUs) were extracted from the Register of Health Care Centres. Each of the PHCUs was to enrol adult patients selected on a random basis. Data on the recruitment of PHCUs and patients were analysed. Multilevel modelling was applied to investigate individual and unit-related factors associated with non-response. Multilevel logistic model was developed with fixed effects and only a random intercept for the unit. Preliminary analysis included a random effect for unit and each of the individual or PHCU covariates separately. For each of the PHCU covariates, we applied a two-level model with individual covariates, unit random effect and a single fixed effect of this unit covariate. SETTING: This study was conducted in primary care units in selected provinces in Poland. PARTICIPANTS: A total of 242 PHCUs and 24 480 adults were invited. Of them, 44 PHCUs and 20 939 patients agreed to participate. Both PHCUs and patients were randomly selected. RESULTS: Data on 44 PHCUs and 24 480 patients were analysed. PHCU-level factors and recruitment strategies were important predictors of non-response. Unit random effect was significant in all models. Larger and private units reported higher non-response rates, while for those with a history of running public health programmes the odds of non-response was lower. Proactive recruitment, more working hours devoted to the project and patient resulted in higher acceptance of the project. Higher number of personnel had no such effect. CONCLUSIONS: Prior to the implementation of public health programme, several factors that could hinder its execution should be addressed.

Hepatitis C in Poland in 2014

INTRODUCTION: . Currently, hepatitis C (HCV infection) is one of the public health priorities worldwide. It is associated with a considerable improvement of methods undertaken to eliminate this disease. Due to the predominance of chronic infections of long asymptomatic course, the number of cases detected in successive years does not reflect the actual dynamics of the epidemiological situation of hepatitis C. To a large extent, it depends on current testing practices. The modifications in the provisions on the notification of diagnosed cases may also have an effect on the number of HCV infections registered in successive years. OBJECTIVE: This article aims at evaluating the epidemiological situation of HCV infections in Poland in 2014 in reference to the data from previous years. MATERIAL AND METHODS: Analysis of epidemiological situation of hepatitis C in Poland was carried out on a basis of aggregated data from routine surveillance system published in annual bulletin "Infectious diseases and poisonings in Poland". Data on hepatitis C mortality from the Demographic Surveys and Labour Market Department of the Central Statistical Office were also employed. RESULTS: In 2014, a total of 3 076 HCV infections (incidence ­ 7.99 per 100,000) meeting 2005 definition were registered. Compared to 2013 and median as of 2008-2012, there was an increase of the incidence by 14% (2 705; 6.03) and 34% (2 294; 5.85), respectively. In 2014, a total of 3 551 (9.23) HCV infections meeting 2009 definition were reported (the definition was modified in 2014). Compared to 2013 (2 268; 6.86), it was an increase by 35%. In 2014, 241 deaths due to hepatitis C were registered which is the highest mortality noted so far. CONCLUSIONS: In recent years, a burden resulting from undiagnosed or untreated HCV infections is on the increase. It is demonstrated by increasing hepatitis C mortality and increasing trend of incidence according to 2005 definition (presence of symptoms). Increase of incidence according to 2009/2014 definition may be associated with the fact that laboratories were obliged to report positive test results for HCV since 2014.

Hepatitis C in Poland in 2013.

INTRODUCTION: Since 1997, hepatitis C (HCV infection) is registered separately in epidemiological surveillance in Poland. Having considered the predominance of chronic infections of long-term asymptomatic course, the number of infections detected in successive years and registered in surveillance system does not reflect the actual dynamics of hepatitis C epidemiological situation. To a large extent, it is dependent on current HCV testing practices. Furthermore, it may also result from modifications introduced to the regulations of HCV case notification. OBJECTIVE: This article aims at evaluating the epidemiological situation of hepatitis C in Poland in 2013 with the reference to the data from previous years. MATERIALAND METHODS: Epidemiological situation of hepatitis C in Poland was analyzed on a basis of aggregated data from routine surveillance system published in annual bulletin "Infectious diseases and poisonings in Poland in 2013"(Czarkowski MP et al. Warsaw: NIPH-NIH and CSI, 2013). Data on hepatitis C mortality was derived from the Demographic Surveys and Labour Market Department of the Central Statistical Office. RESULTS: In 2013, a total of 2,705 (incidence 7.03 per 100,000) HCV infections meeting 2005 definition were reported in Poland, including 35 co-infections with HCV and HBV (1.3%). Having compared to 2012, there was an increase in incidence by 15% (2,359; 6.12). In 2013, 2,641 cases (6,86) meeting 2009 definition were registered. Compared to 2012, it was an increase by 16% (2,268; 5.89). In 2013, 175 HCV fatal cases were reported, of whom only 2 were due to the acute stage of disease. CONCLUSIONS: In recent years, a societal burden resulting from undiagnosed or untreated chronic HCV infections is on the increase. It is demonstrated by high HCV mortality and increasing trend of incidence of symptomatic chronic hepatitis C (2005 definition) and hospitalizations.

Hepatitis C in Poland in 2012.

INTRODUCTION: In Poland, an estimated 2 000 HCV infections are reported annually, of which chronic stage of infections predominates (>95%). It is estimated that seroprevalence of anti-HCV and prevalence of active infections in the general population amount to ca 0.95% (more than 320 000 persons) and 0.6% (230 000 persons), respectively. The alarming finding is that approximately 90% of persons diagnosed with HCV infection are unaware of the condition and consequently hepatitis C virus may be transmitted to their contacts. OBJECTIVE: The objective of the present article is to determine the epidemiology of HCV infections in Poland in 2012 comparing to the preceding years. MATERIAL AND METHODS: The assessment of epidemiological situation of HCV infections in Poland was based on the analysis of aggregated data from the State Sanitary Inspection, published in "Infectious diseases and poisonings in Poland in 2012" (Czarkowski MP et al. "Infectious diseases and poisonings in Poland in 2012" Warsaw, NIPH-NIH and CSI). The data on mortality due to hepatitis C, which was obtained from the Demographic Surveys and Labour Market Department of Central Statistical Office, were also employed. RESULTS: In 2012, Poland reported 2 292 HCV infections, meeting 2005 definition (incidence 5.95), of which 1.4% were co-infections with HCV and HBV (33 cases). Compared to the data of 2011, the incidence was slightly lower (2 338; 6.07). Given 2009 definition, a total of 2 265 cases were reported (5.88), which constituted an increase of 3.5% compared to the data from the previous year (2 241; 5.82). Overall, 217 fatal cases due to hepatitis C were reported in 2012, of whom only 9 (4%) were due to acute stage of infection. CONCLUSIONS: Compared to the data from 2011, the epidemiological situation of hepatitis C in Poland has not changed significantly. The alarming fact is the increasing number of deaths due to hepatitis C. Probably, it suggests delayed diagnosis of HCV infections. Thus, it is a necessity to promote early diagnosis of HCV infections which can prevent life and health-threatening sequelae of hepatitis C.

Hepatitis C in Poland in 2011.

BACKGROUND: Low percent of diagnosed HCV infections is an important public health problem in Poland. Registered trends of HCV incidence compared to prevalence data allow to interpret the diagnosis rate in different groups. AIM: To assess epidemiological situation of hepatitis C in Poland in 2011 in comparison to preceding years. METHODS: The descriptive analysis was based on data retrieved from routine mandatory surveillance system. Case classification according to 2005 definition and 2009 definition was verified on a basis of individual case reports. RESULTS: In total there were 2151 hepatitis C cases meeting the 2005 case definition registered in 2011 (incidence 5.58 per 100,000) and the increasing trend observed since 2009 was continued. With respect to the estimated number of prevalent cases the diagnosis rate was 78 per 10,000. This indicator was lower for the rural areas, for the age group 30-49 and varied significantly across regions. The increasing trend of mortality is also of note (2009--137 deaths; 2010--167, preliminary data for 2011--191, mortality 0.5 per 100,000) CONCLUSIONS: The increasing hepatitis C incidence may be a result of intensification of testing activities. Low indicator of diagnosis rate and the increasing mortality call for improvement in access to diagnosis and treatment.

[Meningitis and encephalitis in Poland in 2010]. / Zapalenia opon mózgowo--rdzeniowych i zapalenia mózgu w Polsce w 2010 roku.

INTRODUCTION: Annually 2 000-3 000 cases of meningitis and encephalitis are notified to the Polish surveillance system. The leading etiologic agents of the bacterial infections are: N. meningitidis, S. pneumoniae, H. influenzae type B and L. monocytogenes. The most common causes of bacterial infections in children are: E. coli, S. agalactiae and H. influenzae type B. The viral infections are mainly caused by the following pathogens: Echovirus, Coxsackie virus group A and B. The agents responsible for the viral infections are also: arboviruses, Herpes simplex virus and mumps virus. OBJECTIVES: The objectives of the present article are to analyze the epidemiology of meningitis and encephalitis in Poland in 2010 and to present the information on the vaccines used to prevent the discussed infections. MATERIAL AND METHODS: The analysis was based on the data retrieved from the questionnaires used for the surveillance purposes, aggregated data on meningitis and encephalitis published in "Infectious diseases and poisonings in Poland in 2010", aggregated data on the vaccination coverage published in "Vaccinations in Poland in 2010", "Case definitions for the infectious diseases used for the surveillance purposes in 2009-2011" and Polish Immunization Programme for 2010. RESULTS: In 2010, Poland reported 3 063 neuroinfections--nearly 22% more than in 2009. The incidence rate was 8.03 cases per 100 000 population. From the analysis of data transpired that of the notified cases, 1 619 were of viral etiology, 846--were bacterial and 598 of other or unknown origin. Given the bacterial infections of determined etiology, the leading pathogenic agent was S. pneumoniae (180 cases), following by N. meningitidis (146 cases) and Haemophilus influenzae typu B (11 cases). Among confirmed cases of the viral infections, the predominant were tick-borne encephalitis cases (294). CONCLUSIONS: Compared to the data from 2009, the epidemiologic situation of the meningitis and encephalitis in Poland in 2010 has not changed significantly.