Operation of Mental Health Centres (CZP) in Poland during the SARS-CoV-2 pandemic. / Funkcjonowanie Centrów Zdrowia Psychicznego (CZP) w Polsce w czasie pandemii wywolanej wirusem SARS-CoV-2.

OBJECTIVES: The aim of the study is to characterise the changes in the operation of the Mental Health Centers (CZPs) in Poland during the SARS-CoV-2 pandemic. METHODS: Changing the concept of psychiatric care and moving towards a community model under the CZPs is, inter alia, no need to present and implement strictly defined schedules by service providers, which allows to respond to the current needs of patients and allows for the adaptation of the conditions and methods of providing psychiatric care services in Poland during pandemic. RESULTS: On the basis of the experiences from the pandemic period, recommendations were presented the aim of which is improving work organisation of the CZPs in Poland. CONCLUSIONS: A new map of mental health services' organisation following the peak of the pandemic in Poland is urgently needed. Well-functioning community care fosters good understanding of patients' needs, which means that even in a situation of, for instance, there is no element of surprise and there are known channels and methods of reacting to an emergency situation. The pilot CZPs quickly and easily adapted their response methods to the changing or new needs/new circumstances. As part of the activities in the field of psychiatric care reforms in Poland, it seems appropriate, at the present stage, to use all observations and information on the operation and organisation of work of entities that were included during pandemic in the CZP pilot programme in order to continuously improve the functioning of a new model of mental healthcare.

The prevalence of depression in children and adolescents under 18 years of age treated for mental disorders in Poland between 2005 and 2016.

Introduction: The prevalence of depression in Polish children and adolescents under 18 years of age treated for mental disorders has increased in the last few years in Poland. The purpose of this study was to examine the prevalence of major depression in a population of Polish children and adolescents under 18 years of age treated for mental disorders, stratified by sex and place of residence, in the years 2005, 2009, 2014, and 2016. Material and methods: We analysed the psychiatric treatment data of children and adolescents under the age of 18 years in Poland compiled by the Institute of Psychiatry and Neurology in Warsaw for these years. Results: Major depression was moderately prevalent among children and adolescents treated in all evaluated types of mental health facilities, with a prevalence in this population ranging from 0.8% in 2005 to 4.3% in 2016. The rates of young patients with mood disorders increased from 3.1% in 2005 to 7.0% in 2016. Risk factors for developing major depression in our research group were: being female and living in an urban area. Conclusions: Our findings suggest the need to increase the service capacity for children and adolescents as well as to intensify preventive measures to improve the mental health status of this age group.

Asthma as a social problem requiring systemic solutions in Poland.

Introduction: Due to its physiopathology and chronic character, asthma constitutes a considerable burden to health care and public health. Aim: The main aim of this study was to determine and present the problems of patients diagnosed with asthma and to suggest solutions to meet the individual and public expectations. Material and methods: The study included 18,874 patients and was part of the System for the Prevention and Early Detection of Allergic Diseases in Poland. The study method was a questionnaire based on the European Community Respiratory Health Survey (ECRHS) and International Study of Asthma and Allergies in Childhood (ISAAC). Results: Nearly 90.1% of patients aged 6-7 years reported periodic difficulty in breathing, with over three episodes per week (3.6 in adults, 3.6 in women, 3.1 in men, 3.3 in urban residents, and 4.6 in rural residents) of reported asthma attacks interrupting patients' sleep. Recent asthma attacks were reported mainly by women living in urban areas. Conclusions: Health problems of asthma patients have a measurable impact on the need to introduce systemic solutions, to ultimately minimize the risk of complications for the individual as well as to minimize the social burden of chronic asthma in Poland.

Prevention of perennial allergic rhinitis in the conception of coordinated healthcare in Poland.

Introduction: The primary prevention is intended to prevent the development of diseases, secondary prevention aims to limit disease progression, and tertiary prevention involves reducing disease-associated symptoms. The purpose of this study was to assess the use of selected forms of secondary prevention by patients diagnosed with perennial allergic rhinitis. Moreover, this paper presents the ways in which the adopted organizational solutions could be utilized as part of coordinated healthcare to benefit patients with perennial allergies. Material and methods: The study population comprised 18,617 respondents, 4783 of whom (including patients allergic to Dermatophagoides pteronyssinus and Dermatophagoides farinae) were qualified to undergo a medical examination. The study used ECRHS and ISAAC questionnaires adapted for Europe. Results: Nearly 20% of patients diagnosed with chronic allergic rhinitis used preventive measures against house dust mites; this is in contrast with 13% in the control group (p = 1.358e-07). The secondary preventive measures most commonly used in the study group were, in descending order of frequency, mattress protectors and anti-dust-mite spray. Undertaking preventive measures was most common among study participants with higher education and residents of large cities. Conclusions: The proportion of patients diagnosed with a dust-mite allergy, who undertook preventive measures against perennial allergic rhinitis, was relatively low. Building, maintaining, and continual strengthening the doctors' relationship with chronic allergy patients may shift the nature of healthcare services more towards preventive measures, for the implementation of which the patient will be co-responsible under the coordinated healthcare system.

Factors Associated with Attitudes towards Seasonal Influenza Vaccination in Poland: A Nationwide Cross-Sectional Survey in 2020.

We aimed to assess attitudes towards the influenza vaccine and factors associated with a willingness to vaccinate against seasonal influenza in Poland during the COVID-19 pandemic (flu season 2020/2021). This cross-sectional questionnaire-based study was carried out between 5 and 15 November 2020 on a representative nationwide sample of 1052 individuals aged 18+ in Poland. Of the respondents, 5.5% (95% CI: 4.3-7.0%) declared that they had already got vaccinated against influenza and 13.4% (95% CI: 11.4-15.6%) declared a willingness to vaccinate against influenza during the 2020/2021 season. Out of nine different factors analyzed in this study, only three were significantly associated with attitudes towards influenza vaccination. Participants aged 75 years and over (OR = 5.82; 95% CI: 2.63-12.85), as well as participants aged 60-74 years (OR = 2.43; 95% CI: 1.30-4.54), compared to those aged 19-29, had significantly higher odds of having a positive attitude towards seasonal influenza vaccination. Respondents who define themselves as completely religious unbelievers (OR = 4.34; 95% CI: 1.79-10.55), as well as Internet users (OR = 2.12; 95% CI: 1.30-3.47), had higher odds of having a positive attitude towards influenza vaccination. Despite the COVID-19 pandemic, the percentage of adults in Poland who already got vaccinated or declared a willingness to vaccinate against influenza remains low. This also applies to high-risk groups.

Measurement of health care services in long-term residential mental health care institutions. / Pomiar uslug zdrowotnych w placówkach psychiatrycznej dlugoterminowej opieki stacjonarnej.

This study concerns measuring the quality of health services in long-term residential mental health care. The issue of measuring the quality of health services has been limited to services at residential health care centers (ZOL). The aim of the study is to propose measures associated with the provision of services in long-term residential mental health care. Currently, there are no tools for measuring the psychiatric services provided. The consequence of that isthat the monitoring-supervisory-control mechanism that should ensure the required level of quality of services provided in this area of psychiatric care is inefficient. The aim of the deliberations made in this study is presenting an appropriate set of measures to assess the performance of aresidential health care provider, taking into account the specificity of long-term mental health care (ZOL). The application of the Team Patient Functioning Scale allows for the specification of the changes occurring in the patient's functioning and comparing them at time intervals, and indirectly causes the Team Patient Functioning Scale to be used to draw conclusions about the aggravation, stabilization, or regression of the illness, and to prove the effectiveness of the therapeutic team. The presented results of the application of the proposed measures may constitute a reference base - as a benchmark - for the improvement and development of the quality of health services for patients in residential health care centers in Poland.

The use of nasal over-the-counter agents in the evaluated Polish population. The underrated role of the pharmacist in patient education on medical treatment in patients with allergic rhinitis.

INTRODUCTION: The goal of treatment in allergic rhinitis is a complete elimination of symptoms or achieving significant clinical improvement. The role of the pharmacist has been receiving particular attention in terms of the initial diagnosis and treatment of allergic rhinitis patients and their sufficiently early referral to a specialist in case of persistent symptoms. AIM: This study attempted to estimate the rates of nasal OTC use in patients diagnosed with allergic rhinitis. MATERIAL AND METHODS: Study population was 18,578 subjects (4,192 patients diagnosed with AR and 14,386 healthy controls): children aged 6-7 years, adolescents aged 13-14 years, and adults aged 20-44 years. We used translated and validated versions of ECRHS and ISAAC questionnaires. RESULTS: The rates of nasal decongestant use in the allergic rhinitis group were 60.4% in children, 50.7% in adolescents, and 43.0% in adults, with these figures significantly higher than in the control group (p < 0.05). The most common nasal agent was Oxymetazoline and Xylometazolini hydrochloridum 0.1%. CONCLUSIONS: Over a half of the evaluated allergic rhinitis patients used nasal decongestants, which poses a potential risk of uncontrolled side effects. There is an urgent need to introduce patient education on medical treatment.

Effectiveness of health-promoting activities in the area of general hearing screening tests in newborns in Poland.

INTRODUCTION: An analysis of the impact of health promotion efforts as part of the Polish Universal Neonatal Hearing Screening Program demonstrated diagnostic efficacy. The health promotion efforts had been efficiently implemented via a proper execution of this long-term Program by the Great Orchestra for Christmas Charity (WOSP) foundation. OBJECTIVE: The aim of the study was to demonstrate the impact of health promotion efforts by public benefit organizations by analyzing the WOSP foundation's involvement in the Program in Poland during 2003-2015. MATERIAL AND METHODS: Statistical data for 2003-2015 were obtained from the database of the Department of Otolaryngology and Laryngeal Oncology at Poznan University of Medical Sciences. The analyzed data included the rates of hearing-impairment detection (phase 1), diagnosis (phase 2), and treatment (phase 3) in the newborns included in the Program, as well as the documentation of expenditures based on WOSP's foundation annual financial reports. RESULTS: A total of 4,672,704 newborns were screened from 2003-2015, which amounted to approximately 360,000 screened patients per year. During the analyzed 12 years of the Program, the mean proportion of children who underwent screening was 96.1%, with an observable, gradual increase in the number of children undergoing diagnostic assessments (phase 2) for a suspected hearing impairment, with the largest amount of money having been allocated to the Program implementation and expended in its early stages. The total cost of financing the Program by the year 2015 was 51,841,712 PLN. CONCLUSIONS: The Polish Universal Neonatal Hearing Screening Program resulted in an improvement in the quality in the screening test, ensured more thorough diagnostics, and shortened the time needed to implement the appropriate treatment.

Organizational model for the management of patients with chronic allergic conditions.

INTRODUCTION: Allergic conditions present a serious problem for the Polish population. The most common form of allergy is allergic rhinitis. Due to its chronic nature and a complex pathophysiological mechanism the allergic rhinitis could be associated with others comorbidities. That is why it is a poses a considerable bio-psychosocial problem both for the affected individual patient and for the healthcare system. AIM: To identify organizational factors and analyse their effect on patients with chronic allergic conditions. MATERIAL AND METHODS: The study group comprised 9,370 respondents (including 1,967 patients with allergic rhinitis (AR), 372 patients with self-reported bronchial asthma (BA1), and 351 patients with physician-diagnosed bronchial asthma (BA2)) aged from 20 to 44 years, some of whom were additionally examined (skin pick tests) in an outpatient setting. The findings obtained in the outpatient subgroup (n = 4,783) were analysed in more detail. The study was based on translated and validated ECRHS and ISAAC questionnaires. RESULTS: Over a half of the evaluated patients with AR visited a specialist due to their symptoms. Some respondents neither visited their doctor regularly nor had regular check-ups, which undoubtedly affected their quality of life. CONCLUSIONS: The authors propose an organizational model incorporating the position of a healthcare educator (HE) as a coordinator in the process of managing chronic allergic conditions in adult patients within the Polish healthcare system. Adult patient education by the HE would include introducing the principles of secondary and tertiary prevention in order to improve the quality of life in patients with chronic allergic conditions.

The effect of selected risk factors, including the mode of delivery, on the development of allergic rhinitis and bronchial asthma.

INTRODUCTION: Cesarean section affects the process of colonization by bacteria transferred from the mother's skin and hospital bacteria, which in turn contributes to development of allergic conditions. AIM: To assess selected risk factors, including the mode of delivery, parity, and the role of genetic factors for the development of allergic rhinitis and bronchial asthma. MATERIAL AND METHODS: The study was conducted in 18,617 respondents aged 6-7, 13-14, and 20-44 years who completed the ECRHS II and ISSAC questionnaires. Thirty percent of the study population underwent complementary assessments in the form of skin-prick tests, serum IgE levels, lung function tests, and peak nasal inspiratory flow (PNIF). The study is a part of the Epidemiology of Allergic Disorders in Poland (ECAP) study conducted in 8 areas in Poland (Warsaw, Lublin, Bialystok, Gdansk, Poznan, Wroclaw, Katowice, Krakow, and two rural areas - Zamosc and Krasnystaw counties). RESULTS: Respondents diagnosed with allergic rhinitis were at a significantly higher risk of inheriting the allergic condition if their mother (OR = 2.17; 95% CI: 1.98-2.39, p = 2.00 × 10-16) or father (OR = 2.20; 95% CI: 1.96-2.47; p = 2.00 × 10-16) suffers from this allergy. Conversely, in the group diagnosed with bronchial asthma, the highest risk of an inherited allergy was observed in situations where maternal (OR = 2.00; 95% CI: 1.57-2.55; p = 1.69 × 10-5) or paternal (OR = 1.94; 95% CI: 1.42-2.66; p = 3.61 × 10-5) grandparent was affected. Moreover, the risk of developing allergic rhinitis depended on the mode of delivery: i.e. it was higher for a Cesarean section (OR = 1.20; 95% CI: 1.01-1.43; p = 0.04) than vaginal delivery (OR = 0.88; 95% CI: 0.78-0.99; p = 0.03). The higher the number of siblings, the lower the risk of allergic rhinitis. CONCLUSIONS: Allergy risk factors, especially those predisposing to allergic rhinitis, include not only genetic factors but also the mode of delivery: vaginal delivery or Cesarean section.

Functioning of the various forms of mental health care in Poland in the years 2010-2013. Organizational, economic and financial aspects. / Funkcjonowanie jednostek w róznych formach opieki psychiatrycznej w Polsce w latach 2010­2013. Analiza organizacyjna i ekonomiczno-finansowa.

OBJECTIVES: The main objective of the study was to verify the hypothesis about the high growth rate of expenditure on the provision of mental health in the past few years. High dynamics of the expenditure increase will result in the development of a model of community psychiatry and a gradual move away from the hospital psychiatric treatment towards mental health care in the open system, including the community one. METHODS: This research is based on data on the implementation of services for mental health care in the framework of agreements with the National Health Fund, which has been collected in the NFZ IT system. Some information is from 2010, which was adopted as the base date for the implementation of the principles of the National Mental Health Program in 2011. The data from the implementation of individual benefits in 2013 were used for the comparison. In addition, other selected organizational, economic and financial elements of the psychiatric care system were analyzed. RESULTS: In 2013, compared to 2010, increased the number of mental health care organizations: outpatient mental health clinics (an increase of 37 clinics), outpatient mental health day hospital wards (an increase of 25 wards) and community psychiatric treatment teams (an increase of 74 teams). The largest increase in the value of contracts (approx. 150%) was related to community treatment teams. CONCLUSIONS: Between 2010 and 2013 there was an increase in the value of cleared contracts in psychiatric care, in general and in each of the three forms of psychiatric care (i.e., in day wards, outpatient mental health clinics and in community teams). The highest increase in investments included community treatment teams, to a lesser extent day wards and outpatient clinics. The adopted organizational, economic and financial solutions in the mental health care system are in line with the objectives of the National Mental Health Program, including the assumed structure of Mental Health Centers.

Healthcare model with use of information and communication technology for patients with chronic disease.

INTRODUCTION AND OBJECTIVE: The healthcare system is positioned in the patient's environment and works with other determinants of the treatment. Patient care requires a whole system compatible to the needs of organizational and technical solutions. The purpose of this study is to present a new model of patient-oriented care, in which the use of information and communication technology (ICT) can improve the effectiveness of healthcare for patients with chronic diseases. MATERIAL AND METHODS: The study material is the process of healthcare for chronically ill patients. Knowledge of the circumstances surrounding ecosystem and of the patients' needs, taking into account the fundamental healthcare goals allows us to build a new models of care, starting with the economic assumptions. The method used is modeling the construction of efficient healthcare system with the patient-centered model using ICT tools. RESULTS: We present a new systemic concept of building patient's environment in which he is the central figure of the healthcare organization - so called patient centered system. The use of ICT in the model of chronic patient's healthcare can improve the effectiveness of this kind of care. The concept is a vision to making wide platform of information management in chronic disease in a real environment ecosystem of patient using ICT tools. CONCLUSIONS: On the basis of a systematic approach to the model of chronic disease, and the knowledge of the patient itself, a model of the ecosystem impacts and interactions through information feedback and the provision of services can be constructed. ICT assisted techniques will increase the effectiveness of patient care, in which nowadays information exchange plays a key role.