Alina Kowalska

Fractional exhaled nitric oxide (FeNO) may predict exercise-induced bronchoconstriction (EIB) in schoolchildren with atopic asthma.

BACKGROUND There is a need for the performance of exercise-induced bronchoconstriction (EIB) tests in the monitoring of childhood asthma control. We aimed to evaluate whether in children with atopic asthma, EIB can be predicted by one or more of the following parameters or by their combination: fractional exhaled nitric-oxide (FeNO), allergy profile, asthma treatment, total IgE serum concentration and eosinophil blood count (EBC). METHODS It was a retrospective, cross-sectional study. We evaluated data from medical documentation of children with atopic asthma who had performed standardized spirometric exercise challenge test. RESULTS One hundred and twenty six patients with atopic asthma, aged 5-18, were included in the analysis. There were two groups of patients: the EIB group (n=54) and the no-EIB group (n=72). The median FeNO level prior to exercise in the EIB group was 27.6 vs. 16.3 ppb in the no-EIB group (p=0.002). FeNO level higher than 16 ppb had the highest diagnostic value to confirm EIB. When using the FeNO level of >16 ppb, the sensitivity, specificity, negative predictive and positive predictive values for EIB were 83%, 46.9%, 74.2%, and 60%, respectively. In the EIB group, the degree of FeNO elevation did correlate positively with the absolute fall in FEV(1) (p=0.002; r=0.45). The FeNO value of >16 ppb, EBC value of >350 cell/mm(3) and allergy to house dust mites presented the highest odds ratios of EIB. However, the FeNO value of >16 ppb was the only independent odds ratio of EIB. CONCLUSIONS Elevated FeNO level increased the odds of EIB in asthmatic schoolchildren, independently of other asthma severity markers and the intensity of anti-asthma therapy. It seems likely that FeNO measurement may act as a screening tool and help to prevent under-diagnosis and under-treatment of exercise-induced bronchoconstriction in schoolchildren with atopic asthma.

Effects of Changes in Ownership of the Polish Hospital on the Patients' Opinion About Its Functioning

System changes in health care centers have been directed at introducing such marketing elements into the Polish health care system as managerial approach to managing the centers and contracting medical services and quality management. High quality of the medical services and patients’ satisfaction became the key factors deciding about “the brand” of a health care center. The aim of the work was to assess the effect of changes in ownership of the hospital on the patients’ opinion about its functioning. Patients’ satisfaction survey was carried out through an anonymous questionnaire among 2702 respondents before and 2795 respondents after the transformation of the hospital. Multivariate analysis of variance (MANOVA) was used to analyze the collected empirical material. The assessment of the functioning of the admission center and hospital wards was significantly higher among the respondents asked after the transformation of the hospital as opposed to the assessment before it. Transforming the public hospital in Poland into a commercial company helped improve its functioning in the opinion of patients. There is a need to carry out further systematic research into the patients’ satisfaction better adjust the hospital’s offer to the needs of the hospitalized people.

Smoking-related behaviours of pregnant women depending on their place of residence

OBJECTIVES Smoking is a commonly recognized risk factor of civilization diseases. Despite many educational programmes concerning harmful effects of tobacco smoking, this habit is still very popular. Particularly alarming is a high percentage of pregnant women who smoke. METHODS The aim of the study was to analyse the prevalence of smoking among pregnant women depending on their place of residence. The research was conducted in randomly selected 30 outpatient clinics for women in Łodź and 16 outpatient clinics in rural communes of the Łodź province. The epidemiological analysis included 400 women. Collected data were processed statistically using the descriptive methods and statistical inference. RESULTS It has been demonstrated that smoking in the past was more popular among city residents than countryside residents (58.2% and 47.9%, respectively). Women living in the city smoked almost three times more frequently during the whole pregnancy than the respondents from the countryside (13.4% and 4.3%, respectively). Furthermore, every fifth respondent living in the urban area (f=0.21) smoked over 10 cigarettes a day, and every fourth respondent from rural communes (f=0.24) smoked from 5 to 10 cigarettes a day. However, in the month preceding the research, pregnant women from rural areas smoked slightly more frequently as compared to the subjects from the city. In the group of pregnant women who smoked in the past or who smoke at present, regardless from their place of residence, every other woman did not breastfeed her baby. 6.1% of city residents and 4.3% of countryside residents declared that they smoked during the breastfeeding period. CONCLUSIONS Within the analysed population the influence of place of residence on the prevalence of active smoking, number of smoked cigarettes and giving up smoking during pregnancy and breastfeeding period has been evidenced.

Factors Influencing the Opinion of Patients Concerning the Functioning of the Polish Hospital Before and After Ownership Transformation

Studies of satisfaction among patients are a popular and frequently obligatory tool used in improving the quality of medical services worldwide. Becoming familiar with the opinion of the patients enables to adjust the venue to their expectations, thus contributing to the increase in its competitiveness. We aimed to study patients’ satisfaction understood as a tool used in increasing the quality of medical services; in addition, we assessed factors that affect a worse review patients gave about the functioning of this Polish hospital before and after its transformation into a commercial company. The study of satisfaction among patients was conducted using an anonymous questionnaire among 2702 respondents before and 2795 respondents after the hospital’s transformation. Multivariate logistic regression analysis was applied to statistically analyze the collected empirical material, where the dependent variable was a worse evaluation of respondents concerning the functioning of the hospital. It was demonstrated that both before and after the hospital’s transformation into a commercial company, it was education and conditions of housing of patients that determined their opinion about the functioning of the admission center and hospital wards. A higher level of education increases the risk of a worse evaluation of the admission center and hospital wards, whereas higher self-evaluation of housing conditions lowered the discussed risk. Factors that influence the opinion of patients concerning the functioning of the hospital are education, age, marital status, housing conditions of the respondents and also the number of stays at a given hospital, and a conscious choice of the facility in which a patient wished to be treated.