Anna Augustynowicz

The impact of individualised nutritional therapy according to DASH diet on blood pressure, body mass, and selected biochemical parameters in overweight/obese patients with primary arterial hypertension: a prospective randomised study

BACKGROUND AND AIM The aim of the study was to assess the impact of individualised nutritional intervention based on the DASH diet (Dietary Approaches to Stop Hypertension) on the nutritional status, blood pressure, and selected biochemical parameters of obese/overweight patients with primary arterial hypertension. METHODS A total of 131 participants were randomised to the DASH intervention group (DIG; n = 69, 33 males) or the control group (CG; n = 62, 32 males). A three-month nutritional intervention was carried out in the DIG group, while the control group received only standard recommendations. Body weight, height, waist and hip circumference, body composition, blood pressure, serum glucose, and insulin and leptin concentrations were measured at the baseline and after the intervention. RESULTS Sixty-four (92.8%) participants in the intervention and 62 (100%) in the control group completed the study. In the DIG group a significant decrease in body mass, systolic and diastolic blood pressure, body fat content, fasting glucose, insulin, and leptin concentrations were observed in comparison to the control group (p < 0.05). CONCLUSIONS The DASH dietary intervention provides significant benefits to overweight/obese patients with primary hyper¬tension.

Refusal to take a sick leave as an estimate of the phenomenon of presenteeism in Poland

Introduction Absenteeism and presenteeism are two main phenomena related to health problems and professional activity. Presenteeism is the involvement in a professional activity despite being ill. The purpose of the current study is to estimate the prevalence of presenteeism in Poland on the basis of medical records and to explore associations between presenteeism and patients’ age, gender and type of medical problem. Another purpose is to provide estimates of the length of sick leave if it was accepted. Results The amount of patients who refused to take a sick leave was 27.4%. There was a minor relationship between the refusals and gender (slightly higher in men) as well as strong effects of the age of patients (periods of sick leave were longer in older patients) and ICD-10 diagnosis (largely in acute diseases of the upper respiratory tract). The estimated number of days spent on sick leave in the group of patients that refused to take it, assuming that they made a different decision and complied to it, was in the range between 5 and 10 days. Discussion The prevalence of presenteeism in Poland is relatively high. Since the largest proportion of refusals took place in the case of potentially contagious diseases, the negative impact on productivity may be even higher. Even though the relationship between presenteeism and wages remains unclear, the remarkable increase of wages in Poland within the last 20 years may explain the propensity to work despite being ill. Further research needs to consider the simultaneous use of medical records and self-measured productivity loss. Materials and Methods The current study is based on data from medical records concerning 550,360 patients aged 19–64. Associations between refusals to take a sick leave and patients’ age, gender, as well as diagnosis in terms of ICD-10 (International Statistical Classification of Diseases and Related Health Problems), were tested. Linear regression analysis on the data acquired from the patients who accepted to take a sick leave were further used to estimate the possible length of sick leave in the group of patients that refused to take it.

Breast cancer and cervical cancer prevention programmes carried out by local government units in Poland in 2009–2014

Background In 2014 the standardised incidence rate for breast cancer in Poland reached 51.6/100,000, while the mortality rate reached 14.8/100,000. The incidence rate for breast cancer in the EU was 106.6/100,000, the mortality rate – 22.4/100,000. In 2014 the incidence rate for cervical cancer in Poland was 8.8/100,000, the mortality rate – 4.5/100,000. The incidence rate in the EU was 11.3/100,000 and the mortality rate – 3.7/100,000. Objective The aim of the paper was to establish the number of health policy programmes concerned with breast cancer and cervical cancer in women carried out in 2009–2014 by local government units, with specification of the type of programme, type of local government units that carried out the programmes and the costs of implementation of the programmes. Methods The study was based on a desk research. The analysis covered data included in annual reports submitted by voivodes to Minister of Health, concerning health policy programmes implemented by local government units in 2009–2014. Results The greatest number of programmes concerned with prevention of breast cancer and cervical cancer were implemented in municipalities, followed by counties and finally – self-governed voivodeships. The number of programmes concerned with primary prevention was three times smaller (656) than the number of programmes concerned with secondary prevention (2,229). The greatest number of primary prevention programmes were implemented in Dolnośląskie, Wielkopolskie and Mazowieckie Voivodeships, and the greatest number of secondary prevention programmes – in Wielkopolskie, Mazowieckie and Zachodniopomorskie Voivodeships. Conclusion It was found that the number of programmes implemented by particular local government units and the financial resources employed in the implementation of the programmes were different. It is probable that some of the initiatives of local government units related to secondary prevention coincide with the actions undertaken under the National Programme for Fighting Cancer. The entities that carry out breast cancer and cervical cancer prevention programmes need to coordinate their actions.

Health needs in local government policies in Polandin the context ofanti-smoking health policy programs

BACKGROUND According to the World Health Organization (WHO), every year tobacco smoking kills around 5.4 million people worldwide. Tobacco smoking is a major risk factor for cardiovascular diseases, respiratory diseases and cancer. In Poland, an average of 67,000 people die every year on account of smoking. OBJECTIVES The aim of the study was to evaluate the health security guaranteed by local governments based on an analysis of health policy programs associated with tobacco consumption, which were conducted in Poland from 2009 to 2014 by local governments. MATERIAL AND METHODS The study was based on desk research. The data was sourced from the annual reports submitted to the Minister of Health, concerning the health policy programs which were carried out. The analysis covered programs which name, objective or description of tasks indicated that they concerned tobacco smoking. RESULTS The largest number of programs was completed in the West Pomeranian, Warmian-Masurian and Masovian voivodeships. The smallest number of programs were completed in Kuyavian-Pomeranian, Łódź and Opole voivodeships. The greatest number of programs were carried out by municipalities, followed by counties and county towns, and finally by self-governments of the voivodeships. The number of preventive programs was significantly greater than the number of other types of programs. The majority of programs were aimed at children; there were fewer programs dedicated to adults. The expenditure on the programs was the highest in self-governments of the voivodeships, while the lowest was in municipalities. CONCLUSIONS The steady growth in the number of anti-smoking programs completed 2009-2014 was one of the factors that reduced tobacco smoking. In view of the mortality rates due to cardiovascular diseases, the inhabitants of Lublin and Warmian-Masurian voivodeships had their health needs addressed most efficiently. In the case of mortality rates due to tracheal, bronchial and lung cancer, the health needs of the inhabitants of Warmian-Masurian and West Pomeranian voivodeships were addressed most efficiently.

Prevention of Overweight and Obesity among Children and Youth in Local Government Health Policy Programs in between 2009-2015

Background: Overweight and obesity are among the so-called epidemics of the 21st century. An increasing number of children and youth are also affected by them. According to the forecasts of the “Institute of Mother and Child”, over the next decade each year the number of overweight children will increase by 400 thousand, including approximately 80 thousand obese children. Overweight and obesity are particularly dangerous for children at preschool and school age as it increases the risk of numerous diseases as well as physical and emotional problems.Objective: The objective of this article is to present implementation of health policy programs concerning prevention and treatment of overweight and obesity among children and youth between 2009-2015 by local government units.Methods: The study was conducted based on desk research. Databases of the Ministry of Health prepared by each voivodeship containing information about implemented health policy programs with regards to overweight and obesity among children and youth were used.Results: Between 2009-2015, local government units at all levels implemented 215 health policy programs concerning overweight and obesity among children and youth. Most programs were implemented by municipalities and counties. The costs incurred by counties and voivodeships were significantly higher than costs incurred by municipalities. Most programs were implemented in the West Pomeranian, Silesian and Masovian Voivodeships. The most common activities included consultations with a dietician, group trainings for children within school classes and various competitions concerning healthy diet and physical activity. The Podlaskie and Świetokrzyskie Voivodeships implemented the smallest number of programs.Conclusion: Programs implemented by local government units were poorly adjusted to the actual health needs of children and youth in terms of prevention and treatment of overweight and obesity. Local government units indicated insufficient engagement in prevention and treatment of overweight and obesity among children and youth. Programs implemented by local government units is have not any casual relationship on obesity prevalence. An insufficient number of program participants were observed. It demonstrates the need to evaluate the activities aimed at fighting overweight and obesity among children and youth. The number of health policy programs should be increased and the forms of program implementation should be more attractive-this will allow more people to be included in the activities.

Preventive healthcare and health promotion in local governments based on the example of health policy programmes concerned with cardiovascular diseases implemented in Poland in 2009–2014

BACKGROUND Cardiovascular diseases (CVD) are the cause of over 4.3 million deaths in the World Health Organisation European Region and around 1.9 million deaths in the European Union member states alone. They are also the number-one cause of death in Poland. In 2010 CVDs accounted for 46% of all deaths, and in 2013 - 45.8%. AIM The aim of the study was to evaluate the performance of the tasks of local government units in the area of preventive healthcare and health promotion on the basis of health policy programmes concerning CVD. METHODS The study was based on a desk research. The data included in the annual reports submitted to the Minister of Health concerning completed health policy programmes concerned with CVD, was used. RESULTS A total of 795 programmes were completed in 2009-2014. The greatest number of programmes were completed by municipalities followed by counties. The costs incurred by voivodeships in connection with the programmes were significantly higher compared to the costs paid by municipalities and counties. Diagnostic programmes accounted for 74% of the overall number of programmes, and preventive programmes made up only 24%. The greatest number of programmes were completed in Mazowieckie and Swietokrzyskie voivodeships. The smallest number of programmes were completed in Lubelskie, Lubuskie, and Podlaskie voivodeships. CONCLUSIONS Insignificant involvement of local government units can be seen in the fight against CVD. Particular types of local government units demonstrate a varied degree of involvement in the performance of health policy programmes. The small number of preventive programmes points to the fragmentary completion of tasks concerned with preventive healthcare and health promotion. Some of the voivodeships failed to properly address the health needs of local communities in respect of CVD. More programmes need to be completed, and they need to cover more people. Some guidelines should be developed for local government units concerning their involvement in the fight against CVD.

The use of coercive measures in the entities holding the long-term care for the elderly

w artykule przedstawiono podstawy prawne i zasady zastosowania przymusu bezpośredniego w podmiotach sprawujących opiekę nad osobami w wieku podeszłym. stosowanie przymusu bezpośredniego w domach pomocy społecznej przeznaczonych dla osób z zaburzeniami psychicznymi następuje na zasadach określonych w przepisach ustawy o ochronie zdrowia psychicznego. Przymus bezpośredni stosuje się wobec osoby z zaburzeniami psychicznymi tylko wtedy, gdy osoba ta dopuściła się zamachu przeciw życiu lub zdrowiu własnemu lub innej osoby lub też przeciw bezpieczeństwu powszechnemu, w sposób gwałtowny niszczy lub uszkadza przedmioty znajdujące się w otoczeniu, poważnie zakłóca lub uniemożliwia funkcjonowanie podmiotu leczniczego lub jednostki organizacyjnej pomocy społecznej. Jednocześnie wprowadzono ograniczenia w zakresie stosowania wszystkich form przymusu bezpośredniego przez wskazanie, jaki rodzaj środka może być zastosowany w określonych sytuacjach. środki przymusu bezpośredniego to: przytrzymywanie, przymusowe podanie leków, unieruchomienie, izolacja. szczególną uwagę zwrócono na brak uregulowań prawnych dotyczących stosowania przymusu bezpośredniego w podmiotach leczniczych. Chodzi tu o pacjentów zakładów opiekuńczo-leczniczych oraz pielęgnacyjno-opiekuńczych, ale również o pacjentów oddziałów szpitalnych innych aniżeli oddział psychiatrii. w tym przypadku podstawą ich zastosowania będą regulacje zawarte w ustawie o zawodach lekarza i lekarza dentysty oraz przepisy kodeksu karnego. w celu udzielenia niezbędnej pomocy medycznej lekarz mając do czynienia z pacjentem z zaburzeniami psychicznymi o podłożu somatycznym może zastosować środek przymusu bezpośredniego. Słowa kluczowe: podmiot leczniczy, dom pomocy społecznej, przymus bezpośredni, osoba w wieku podeszłym.

Health needs as a priority of local authorities in Poland based on the example of implementation of health policy cancer programmes

Introduction In developed countries, malignant tumours are the second most common cause of death after cardiovascular diseases. The estimates made by epidemiologists indicate that the incidence and death rate for malignant tumours all over the world, Poland included, will probably grow in the decades to come, specifically among patients who are over 65. The aim of the study was to evaluate how local government units address the health needs of citizens on the basis of an analysis of health policy programmes concerning malignant tumours completed in Poland in 2009–2014. Material and methods The study was based on desk research. The data included in the annual reports submitted to the Minister of Health concerning completed health policy programmes were used. Results The most programmes were completed in the Wielkopolskie and the Mazowieckie voivodeships, whereas the fewest were completed in the Kujawsko-Pomorskie and the Podlaskie voivodeships (χ2(15) = 2121.81, p < 0.001). The most programmes were completed by municipalities, followed by counties and, finally, self-governed voivodeships (Q(2) = 1967.90, p < 0.061). The majority of programmes concerned breast cancer and cervical cancer. There was no increase in the activity of local government units in terms of the number of implemented programmes, and a decreasing size of the population covered by the programmes. Conclusions There is a very high degree of differentiation in the involvement of particular voivodeships in fighting cancer regarding the number of implemented health programmes. There are various degrees of involvement of particular types of local government units in the implementation of programmes in the field of cancer. The repeatability of actions undertaken at the local and national level may indicate limited effectiveness of the policy to fight cancer. It is necessary to implement more programmes in the field of oncological diseases and to increase the population covered by these programmes.

Socio-demographic factors and self-healing of pain phenomenon in Poland

Introduction. Self-healing applies to the use of non-prescription drugs, as well as nutritional supplements, and herbal plant products for the treatment of diseases and symptoms diagnosed single-handedly. The aim of this study is to evaluate the impact of socio-demographic factors on the phenomenon of self-healing pain among Poles. Material and method. The study involved 218 randomly selected respondents, 159 women and 59 men. The tool was a questionnaire designed for the study. Collected data were analyzed using cross tables. Results. During six months before the start of the study 90% of respondents used the analgesics. Women declared that they took pain medication several times a month, three times more often than men. The type of pain for which respondents most frequently used the self-treatment is varied by gender as well as age and type of professional activity of the studied group. The most important factor in the purchase of the drug among the oldest patients is usually the pharmacists advice (47.1% of the group), and among the youngest respondents - previous use of the drug (62.5%). About 70% of respondents admit that they use the Internet to obtain information about medicines. Conclusions. The most important element in the development of responsible self-treatment is education, in terms of both responsible consumption of analgesics, and the use of appropriate sources concerning the treatment of these diseases.