Factors associated with patient satisfaction with health care among Polish older people: results from the polish part of the COURAGE in Europe.

OBJECTIVES: The growing number of chronic conditions and functional limitations resulting from demographic changes and the aging of the population poses several challenges for health care and public health. Consequently, it plays a role in the assessment of the impact of diagnostic and treatment effects on patient satisfaction. The study aims to assess older patients' overall satisfaction with the medical care and healthcare system in Poland and to verify such factors as patient-doctor interactions, access to health care and other sociodemographic characteristics as possible determinants of patient satisfaction at the later stage of life. METHODS: The survey data represent the polish part of the cross-sectional COURAGE in Europe study. Satisfaction with hospital care, outpatient care, and the healthcare system in Poland was assessed. The indices for the psychosocial dimension of the patient-doctor relationships and access to hospital/outpatient care were developed based on patients' experiences as the possibility of talking about private matters, the clarity of explanations, the involvement in decision-making process, being treated respectfully, the duration of waiting and the ease of access to a preferred doctor or other healthcare professional. The ordered probit regression models were used. RESULTS: The psychosocial dimension of patient-doctor relationships was associated with the satisfaction with both hospital and outpatient care. Being treated with respect (very good experience vs. bad odds ratio [OR] = 8.1, 95% confidence interval [CI]: [1.9, 34.4]) and the possibility to talk about private matters with medical team (very good experience vs. bad OR = 3.5, 95% CI: [1.1, 10.4]) during the last stay in hospital were reflected in the higher satisfaction with the healthcare system. By contrast, the involvement of patients in the decision-making process (very good experience vs. bad OR = 3.6, 95% CI: [1.8, 6.7]) or access to outpatient health care (based on developed index OR = 1.02, 95% CI: [1.01, 1.02]) were found to be significant determinants of satisfaction with the healthcare system in Poland. Other factors associated with satisfaction with hospital stay were gender and changes in health conditions, whereas achieving the expected outcome was related to satisfaction with outpatient care, and the expenditure for medicines and medical services - to satisfaction with the heathcare system. CONCLUSION: The investigation confirms an important role of doctor-patient communication skills in improving older patient satisfaction and highlights the need for identifying the psychosocial dimension of patient-doctor relationships as an important part of health care.

Influence of Sociodemographic, Behavioral and Other Health-Related Factors on Healthy Ageing Based on Three Operative Definitions.

OBJECTIVES: Healthy ageing (HA) is a key concept and highly desirable phenomenon in every ageing and already old societies. The aim of our study was to evaluate the influence of socio-economic conditions as well as life-style and other health-related factors on the WHO definition of HA. DESIGN, SETTING, PARTICIPANTS: The study used cross-sectional data of the PolSenior Project - nationwide research evaluating different aspects of ageing in Poland - which included 4'653 respondents aged 65 years and over. MEASUREMENTS: Data were collected by trained interviewers in respondents' homes. Three definitions of HA including or not the participants' chronic conditions were analyzed. RESULTS: The prevalence of HA appeared as high as 17.6% if none or 1 chronic disease was present and 42.8% if no information about chronic diseases was taken into account. The association between known health predictors (age, marital status, education, income) and HA was observed. Moreover, HA appeared in relation with indicators of physical functioning and lifestyle. There was a strong concordance between HA and the fair self-rated health (OR = 1.87; 1.99, and 2.74 for the 1st, 2nd and 3rd definitions, respectively) and opposite relation with self-reported need for help (OR = 0.15; 0.15; and 0.13, respectively). CONCLUSIONS: The HA definition based on no functional activity limitations, no cognitive impairment, no depressive symptoms, no more than one disease and being socially active seems to be a useful approach of HA.

Factors determining changes in self-rated health in the Polish community-dwelling elderly.

Changes in self-rated health and its determinants have been analyzed in the group of 551 community-dwelling older age citizens of Krakow during the 12-year interval observation. Multidimensional model showed that changes in self-rated health between the studies have been significantly determined by such variables like age and self-evaluation of health status in the Ist study. Self-rated health was also less markedly decreased in men, who continued professional activity in the Ist study. Among variables analyzed in the IInd study it was age-related functional disability reported by men and reported chronic conditions that deteriorated self-rated health significantly. Changes in self-rated health between the Ist and the IInd study among women were determined by the same variables as in men (except for the continuation of professional activities in the Ist study). Significantly diminished scores were found in women with higher level of functional activity in the Ist study and greater independence in performing daily activities in the IInd study. Analysis of the summary effect of chronic diseases on self-rated health has shown significantly greater deterioration of self-rated health between the first and the second study related to the number of diseases reported in the Ist study.

Gender-related differences in self-rating of health and functional status of elderly people with ischaemic heart disease. Comparative study in 12-year period.

PURPOSE OF THE STUDY: The study aim is to present changes in the self-rating of health and functional status in performing activities of daily living, reported by the elderly persons with ischaemic heart disease (IHD), at the time interval of 12 years. Gender-related differences as well as socio-medical characteristics have been involved in the analysis changes. DESIGN AND METHODS: The study was carried out in 607 elderly respondents who participated in two surveys at the time interval of 12 years. The analysis of the functional ability in performing daily activities in both surveys was based on the ADL and IADL scales, self-rated health was based on the scale ranging from very poor to excellent health. RESULTS: It has been observed in the baseline survey that the respondents with IHD reported lower mobility, functional activity and scored their health lower than other respondents. Though females with IHD scored higher their functional ability than males with the same disease, decrease of their functional ability at the time interval between both surveys was three-fold higher compared to males with the same disease. The results of the second study demonstrated age-related level of self-coping with the activities of daily living (ADL scale) in females with IHD, while none of the factors from the baseline survey had influence on their functional independence (irrespective of IHD). Functional status in the second study of males with IHD has been influenced by age and presented in baseline study willingness to life, while in males who have not reported IHD, any factor coming from the 1st survey have not determined the level of independence in activities of ADL in survey II. Functional ability in males with IHD was affected in the IInd study, besides age, by the attitude denying weariness of life demonstrated in the baseline survey. None of the factors from the baseline survey determined self-coping with daily activities by the males without IHD as it was observed in the IInd study.

Nutrient intake patterns in gastric and colorectal cancers.

The purpose of the study was to present the dietary risk pattern in gastric and colorectal cancers, using the same methodological approach in a parallel hospital-based case-control study. In all, 180 cases of colorectal cancer and 80 cases of stomach cancer, confirmed histopathologically, were enrolled from the University Hospital in Cracow. A high intake of carbohydrates was associated with an increased risk of colorectal cancer (OR = 2.45). For stomach cancer, a moderate consumption of carbohydrates markedly increased relative risk (OR = 4.29), while a high intake of carbohydrates increased the risk by 8.73. The patterns of dietary risk factors related to intake of fats were definitively different in both cancer sites. The higher fat consumption was not associated with the higher risk of stomach cancer. A medium intake of fats increased the risk of colorectal cancer by 1.96 and that above 83 g/day by 2.20. In colorectal cancer, the significant protective effect of retinol, carotene and vitamin C has been evidenced, however, only carotene and vitamin E were inversely correlated with stomach cancer.

Risk of colorectal cancer from alcohol consumption at lower vitamin intakes. A hospital-based case-control study in Poland.

The purpose of the study was to assess the relation between the simultaneous exposure to alcohol and consumption of micronutrients that have protective properties against colorectal cancer. A hospital-based case-control study of colorectal cancer was carried out between January 1998 and November 1999 at the University Hospital in Krakow, Poland. In total, 180 incident cases of colorectal cancer, confirmed by histopathology, were recruited and an equal number of controls, individually matched by gender and age (+/-5 y), were chosen amongst patients with no history of cancer. A food-frequency questionnaire for 148 food items, combined with the quantity of foods eaten, was used to assess the normal dietary pattern. The data confirmed the reported inverse association between the intake of retinol, thiamine, or antioxidant micronutrients (vitamins C, E) and the occurrence of colorectal cancer. Alcohol intake was found to be an important risk factor for this cancer site, and the risk escalated in parallel with increased intake of retinol, carotene, vitamins C and E, but with high consumption of alcohol ran a noticeably high risk of colorectal cancer (OR= 6.79; 95% CI: 2.08-22.18). The risk was markedly lower, however, among alcohol drinkers who reported a high intake of micronutrients (OR = 1.35; 95% CI: 0.39-4.67). The data suggest that a combination of high consumption of alcohol and low intake of retinol and antioxidant vitamins may considerably increase the risk of colorectal cancer.

Combined risk assessment of physical activity and dietary habits on the development of colorectal cancer. A hospital-based case-control study in Poland.

The purpose of the study was to assess the importance of physical activity performed both in occupational settings and in leisure time on the risk of colorectal cancer, considering the possible confounding effects of dietary habits. The hospital-based case-control study was carried out in Poland. In total, 180 incident cases of colorectal cancer were recruited. An equal number of controls, individually matched by gender and age, were chosen from patients with no history of cancer. A food frequency questionnaire combined with quantity of foods eaten was used to assess the usual dietary pattern for 148 food items. The average physical load of the interviewed patients before the occurrence of disease was ascertained by self-assessment. The degree to which patients' recreational time was sedentary was measured by the number of hours spent watching TV. The adjusted risk of colorectal cancer was reduced by half in those active in leisure time (OR 0.45, 95% CI 0.24-0.84). The effect of occupational physical activity was of about the same order of magnitude in terms of risk reduction (OR 0.61, 95% CI 0.29-1.29) and both activities combined acted as independent protective factors. The protective effect of healthy nutrition appeared to be independent from that attributed to physical effort.

A clinico-epidemiological study on gastritis in gastric carcinoma and in non-cancerous gastric pathology in Poland.

To investigate the risk of gastric cancer development in subjects with atrophic and nonatrophic gastritis, we studied 221 consecutive gastric cancer patients and 7647 non-cancer subjects for whom endoscopic biopsy of the gastric mucosa was available. In gastritis patients, the relative risk (RR) estimates of gastric cancer were as follows: corpus atrophic gastritis RR = 8.7 (95% CI = 5.4-14.1), antral atrophic gastritis RR = 4.5 (2.4-8.1), chronic atrophic pangastritis RR = 7.6 (3.8-15.3), corpus nonatrophic gastritis RR = 1.6 (0.9-2.7), antral non-atrophic gastritis RR = 1.2 (0.7-2.3), and pangastritis RR = 1.3 (0.6-2.8). The latter was of borderline significance (p = 0.07). In peptic ulcer, a significant excess risk was calculated for subjects with either corpus atrophic gastritis (RR = 3.1 [2.5-3.9] or antral atrophic gastritis (RR = 3.5 [2.6-4.8]). For stomach polyps, the risk was significantly increased only in subjects with corpus atrophic gastritis (RR = 2.1 [1.3-3.5]). The risks for both peptic ulcer and polyps, however, were significantly increased in chronic atrophic pangastritis. A substantial excess risk of gastric cancer was found for atrophy in the corpus (RR = 20.9 [9.0-48.9]) and in the antrum (RR = 14.9 [5.3-41.9]). An increased risk of peptic ulcer was also confirmed in subjects with atrophy in the corpus (RR = 3.0 [1.3-6.9]) and in the antrum (RR = 4.9 [2.0-12.1]).

Health beliefs and health behaviours in subpopulation of stomach cancer families and in the control group.

The aim of the study was to assess the relation between health-related beliefs concerning the importance of risk factors in stomach cancer and positive health practices in eating habits. A multicentre hospital-based incident case-control study with 431 female stomach cancer cases aged less than 75 years and an equal number of age-matched controls without cancer has been carried out in Poland. The respondents were asked about their opinions on relevance in cancer prevention of such factors as protective role of raw vegetables and fresh fruit, consumption of fats, alcohol and coffee or using table salt. The data were compared with information on eating habits and diet behaviours in the reference group. It was shown in both groups that beliefs about the importance of raw vegetables and fresh fruit were closely associated with high frequency of everyday consumption of vegetables and fruit; however, statistically significant differences were found between cases and controls as regards the frequency of eating vegetables and fresh fruit at every meal. The same relation was observed between the belief in an unhealthy role of consumption of fats and using the animal fat in cooking. Univariate and multivariate analysis showed that a relation between beliefs and behaviours existed in the cases with the same demographic and social determinants.

Effects of Deomestic Gas Cooking and Passive Smoking on Chronic Respiratory Symptoms and Asthma in Elderly Women.

The purpose of the study was to assess the effect of indoor air pollution resulting from the use of gas stoves for cooking on women more than 65 years old, who may be more susceptible than younger women to the harmful effects of pollutants. A total of 1,544 women living in Cracow took part in a survey. The data were collected to standardized interviews dealing with respiratory symptoms (coughing, phlegm production, dyspnea on exertion), chronic chest diseases diagnosed by a doctor, active and passive smoking, educational level, type of cooking fuel used, and average time spent daily in cooking. Lung function was tested with a spirometer. Comparison of the prevalence of respiratory symptoms by daily duration of cooking of smokers with that of never-smokers showed more symptoms in smokers even in the low-exposure category. In multivariate analysis, the effects of duration of cooking with gas on asthma for the highest exposure category in terms of odds ratios (ORs) were 2.8 for the never-smokers and 2.4 for the smokers; however, passive smoking had no significant effect. As regards dyspnea on exertion, both gas cooking and passive smoking had significant effects in never-smokers (OR for gas cooking 7.2, for passive smoking 2.2). The OR for dyspnea due to cooking with gas in smokers was 3.1. Mean FVC and FEV&inf1; levels were not decreased among passive smokers or those who were subject to high levels of gas-cooking exposure.

Ventilatory lung function level as a predictor of survival among the elderly.

During a population survey in 1986/1987 among community-dwelling elderly in Cracow, aged 65 yrs and over, measurements of ventilatory lung function were carried out on 698 males and 1,211 females. The main objective of the study was to assess the importance of forced expiratory volume in one second (FEV1) as a predictor of survival experienced in this population group over a 6 year follow-up, in comparison with that of sociodemographic variables, smoking habit, chronic respiratory symptoms, hypertension, obesity and self-assessment of health. Statistical analysis of the relationship between mortality and chosen predictors has been performed with Cox proportional hazards statistical model. It was found that in addition to age, the FEV1 level was the most relevant and independent of age survival predictor among the elderly. In males, a reduction of FEV1 by 100 ml after allowing for age, showed a significantly higher risk of dying by 4%, (relative risk (RR) = 1.04; 95% confidence interval (CI) 1.01-1.06), and in females by 5% (RR = 1.05; 95% CI 1.05-1.09). Male current or ex-smokers displayed a higher mortality risk due to reduction of FEV1 (RR = 1.05; 95% CI 1.01-1.09) compared to lifetime nonsmokers (RR = 1.04; 95% CI 1.00-1.07); the corresponding RR values in women were 1.12 (95% CI 1.02-1.23) and 1.04 (95% CI 1.00-1.08), respectively. However, the differences found between the smokers and nonsmokers were not significant in either gender group. Other potential predictors considered, such as education, chronic respiratory symptoms, hypertension, self-assessment of health, or obesity, appeared to have been irrelevant in the multivariate analysis.

Lung function level as a valuable predictor of survival among the elderly. A 5-year community-based mortality study in Cracow.

The objective of the study undertaken among the elderly was to assess the strength and importance of health variable predictors (ventilatory lung function, blood pressure) in comparison with that of sociodemographic variables (age, sex, education), smoking habit, obesity and health self-assessment. The study covered a sample of elderly inhabitants of Cracow (698 males and 1211 females) who attended the mass screening X-ray clinic. The sample examined did not include patients of old people's homes or geriatric wards. Statistical analysis of the relation between mortality over a 5-year period and chosen predictors was carried out with Cox proportional hazards model. It was found that besides age, forced expiratory volume in 1 s (FEV(1)) level is the strongest survival predictor among the elderly. Subjects who had better FEV(1) by 500 ml showed significantly lower death risk, by 18% in males and 27% in females after allowing for age and height. The results obtained confirmed the expectation that ventilatory lung function is one of the strongest predictors of survival in the elderly. In the sample studied, the impact of education, smoking habit, obesity, health self-assessment on mortality was not significant. The effect of hypertension appeared to be relevant only in the female group.

Vodka consumption, tobacco smoking and risk of gastric cancer in Poland.

A multicentre hospital-based incident case-control study with 520 male gastric cancer cases aged < 75 years and an equal number of age- and sex-matched controls without cancer has been carried out in Poland to assess potential risks due to smoking and alcohol consumption. It was shown that after adjusting for socio-demographic and dietary confounders and vodka drinking, smoking cigarettes had no significant effect on risk. The estimated relative risk (RR) increased to 2.27 (95% confidence interval [CI] : 0.97-5.28) for intestinal cardia cancer for those who smoked cigarettes without filters. The RR for stomach cancer grew as the frequency and amount of vodka drunk increased. People drinking vodka at least once a week had about a threefold higher risk compared to non-drinkers (RR = 3.06, 95% CI : 1.90-4.95). The effect of vodka drinking on risk was particularly strong for non-cardia cancers of the intestinal type. Those who usually drank vodka before breakfast had an elevated risk (RR = 2.98, 95% CI : 1.60-5.53) which was also present in all the subgroups investigated. Cardia and non-cardia cancer showed differences with respect to the interaction between tobacco smoking and vodka drinking. For cancers of the cardia region the risk was low for non-smokers or those who drank small amounts of vodka. The risk for cardia cancer increased considerably for smokers of cigarettes without filters and vodka drinkers who consumed large amounts (RR = 3.70, 95% CI : 1.13-12.06). For the non-cardia region a uniform increase could be observed for vodka drinking regardless of cigarette smoking status.(ABSTRACT TRUNCATED AT 250 WORDS)

[On the need for training in environmental epidemiology]. / O potrzebach ksztalcenia w zakresie epidemiologii srodowiskowej.

The growing awareness and understanding of the fact that the maintenance of the health status of population is affected by environment, implements new objectives in undergraduate and postgraduate training of medical doctors and a necessity in producing a new generation of epidemiologists being able to solve environment health--related problems. While in Western European countries an intensive training in environmental epidemiology takes place, not much is done in this respect in our country. The training programs in environmental epidemiology should be based on the good recognition of the nature of the environmental hazards and local health needs. These requirements are urgent as one expects from medical doctors to-day, not only a proper understanding of relations between environment and health status of population, but also certain skills and ability to use epidemiologic methods in everyday clinical practice.

Dietary practices in households as risk factors for stomach cancer: a familial study in Poland.

In the framework of a nationwide case-control study of risk factors for stomach cancer, a household survey was conducted on those food habits at the family level which were considered relevant for stomach cancer. The practices of 741 case and 741 control households were compared and relative risks calculated by the unconditional maximum likelihood method. For each household, the person responsible for cooking completed the survey. Respondents to the household survey were 35% of the cases and 40% of the controls of the case-control study and otherwise other household members. Case households relied more frequently on their own gardens as a major source of vegetables and fruit, and they cooked their vegetables more often than control households. The vegetable and fruit consumption during the summer period per family member was significantly less in case households compared to control households. The difference in per capita vegetable and fruit consumption between case and control households persisted, but was considerably less pronounced when the consumption of the index person (case or control) was subtracted from the household consumption. The consumption of mainly wholemeal bread showed a relative risk (RR) of 0.18 (95% CI 0.07-0.44) compared with mainly white bread consumption, whereas frequent frying and stewing of meat was associated with an increased risk compared to boiling of meat (RR = 2.06, 95% CI 1.48-2.87). No association with risk was found for long-term refrigerator use or other storage modalities.(ABSTRACT TRUNCATED AT 250 WORDS)

[Tobacco smoking and alcohol consumption as risk factors for stomach cancer in different locations and histologic types]. / Palenie tytoniu i spozywanie alkoholu a ryzyko wystepowania raka zoladka o róznym umiejscowieniu i typie histologicznym.

A multicancer hospital based case-control study involving interviews with 741 incident male and female gastric cancer cases under the age of 75 years and an equal number of age and sex matched controls has been carried out in Poland. Smoking cigarettes without filter increased the risk for intestinal cancer in the cardia part of the stomach (OR = 3.72, 95% CI: 1.35-10.23). Relative risk of the intestinal type of cancer in the distal part of the stomach was augmented with the increasing frequency and amount of vodka drinking. Subjects who drank vodka at least once a week had about 4.5 times the risk of intestinal cancer of the gastric corpus compared to non-drinkers (RR = 4.45, CI: 2.26-8.75). The relative risk of intestinal carcinoma in the distal stomach due to vodka drinking among those who used to drink vodka on an empty stomach was also elevated (RR = 3.28, CI: 1.33-8.13), but the effect of years of vodka drinking habit failed to show significant association with gastric cancer. A weak interaction effect between smoking and vodka drinking was found for intestinal cardia cancer. Diffuse type gastric carcinoma or mixed type carcinoma were not significantly related to smoking or vodka drinking habits.

Dietary risk factors in intestinal and diffuse types of stomach cancer: a multicenter case-control study in Poland.

A hospital-based, multicenter, case-control study has been performed in Poland covering 741 incident stomach-cancer cases (520 males and 221 females) and the same number of controls. All stomach-cancer diagnoses were evaluated for histologic type according to the Lauren criteria. Fifty-one percent were of the intestinal type, 35 percent of the diffuse type, and 8.5 percent of the mixed type. The frequency of consumption of individual food items and several food groups was analyzed and the association of various foods with stomach cancer risk was evaluated after controlling for sex, age, occupation, education, and residency. Increased consumption of sausages was related significantly to gastric cancer risk, whereas increased consumption of cheese products, nonwhite bread, vegetables, and fruit was associated with decreased risk. A particularly strong decrease in risk was associated with consumption of radishes and onions. When consumption of fruits and vegetables, sausages, nonwhite bread, and cheese were introduced simultaneously in a multivariate model, independent effects were found only for fruit and vegetables, sausages, and nonwhite bread. The use of table salt, the frequency of eating hot meals, and an irregular eating pattern were also associated with increased risk, while additional consumption of fruit between meals showed reduced risk. If a reduction in vegetable and fruit consumption took place after marriage, an increased risk for stomach cancer was found, whereas augmented consumption of these food items after marriage decreased the risk. Separate risk models were calculated for stomach cancer of the intestinal and diffuse types, but both histologic varieties showed the same pattern of associations with dietary risk factors.

[Effect of parental longevity and smoking on the pulmonary function in elderly persons]. / Znaczenie dlugowiecznosci rodziców oraz wplyw palenia tytoniu na czynnosc pluc w wieku podeszlym.

The significance of smoking habits and long age of parents on lung function in a large population of elderly people (559 males and 1073 females) living in the city of Cracow were analyzed. The lung function parameters correlated negatively with age of analyzed subjects (males and females). Mean values of FVC in men from long living families were 400 ml higher in comparison with other subjects, while the mean FEV1 was 330 ml higher. Such differences were not seen in females. Smoking also affected negatively lung function in the analyzed subjects. Chronic cough and sputum production did not hamper lung function, if such variables as age, height and smoking habits were not included in the analysis.

Functional status of the lower extremities in elderly males. A community study.

The purpose of this study was to evaluate the functional status of the lower extremities (FSL) of elderly males from the community and to compare it with the self-assessment of health status (SHS) and ventilatory lung function based on measurement of forced expiratory vital capacity (FVC). The material covered a group of 559 males, age 65-89 years, who are residents of Krakow. The FSL was measured by the length of standing time on one leg (ST). There was a very strong declining trend in the ST with age in the elderly. The ST correlated significantly inversely with age (r=-0.32) and positively with FVC (r=0.29). The FSL was also associated strongly with the SHS score, while body-mass index (BMI) and occupational category (OC) appeared to have insignificant effect. The results of the study suggest that the ST may be used as a crude indicator of the general fitness of the elderly.

The analytic epidemiologic study on occupational factors and stomach cancer occurrence.

A multicenter hospital based case-control study involving 562 incident male gastric cancer caused under the age of 75 years and an equal number of age matched controls has been carried out. The study aimed at examining occupational factors in the development of stomach cancer after accounting for confounding variables such as dietary habits and alcohol consumption. The interviews with case and control series covered detailed questions on frequency of consumption of various dietary items and socio-demographic characteristics. The results of the study showed that manual workers in industry and farmers run the higher risk of stomach cancer compared with non-exposed clerical workers. Some job categories like painters, tanners and millers displayed the highest relative risk (RR: 3.4) and this higher risk could not be explained by differences in dietary habits or alcohol consumption. The results of the study are discussed against background of possible occupational hazards present in particular environmental settings.