The abstract should provide a summary of the HiT in no more than 250 words The Box provides an example from the Philippines HiT, 2011 Philippines HiT abstract Consistent with its commitment to the Alma Ata in 1978, the Philippine Government adopted the Primary Health Care (PHC) approach in 1979 to achieve health for all Filipinos by year 2000 The promulgation of the Local Development Code (RA 7160) in 1991 was in line with the community participation ideals of PHC (1992-1999) as it devolved responsibility for health care was devolved to Local Government Units The Health Sector Reform Agenda was introduced in 2005 to address problems in health care delivery at local level brought about by the devolution proves Issues of poor accessibility, inequities and inefficiencies of the health system have been the target of health reforms over the last 30 years Hospital, public health, financing, local health system and regulatory reforms comprised the HSRA approach In 2005, the DOH streamlined the reform program to ensure access and availability of essential and basic health packages by reducing the four reform areas, namely: 1) designating providers of basic and essential health service package in strategic locations; 2) assuring the quality of both basic and specialized health services; and 3) intensifying the current efforts to reduce the public health threats brought about by endemic, vaccine-preventable and priority diseases Although studies have yet to be done on the impact of reforming health service delivery, implementation of strategies to improve the hospital services and public health programs have shown some positive gains However, huge disparities in health outcomes across income groups and geographic areas and challenges in ascertaining physical and financial access to health services as evidenced by high out-of-pocket expenditures, concentration of physical and human resources for health in urban areas and migration of health professionals still exist The focus of future developments in health should be towards providing universal health care for Filipinos, starting with improving access of the poor and vulnerable to health services Source: APO, Philippines HiT Vol 1 No 2 2011

https://www.euro.who.int/__data/assets/pdf_file/0018/231516/HiT-Estonia.pdf

Health systems in transition.

In some diseases, a very important role is played by the ability of bacteria to form multi-dimensional complex structure known as biofilm. The most common disease of the oral cavity, known as dental caries, is a top leader. Streptococcus mutans, one of the many etiological factors of dental caries, is a microorganism which is able to acquire new properties allowing for the expression of pathogenicity determinants determining its virulence in specific environmental conditions. Through the mechanism of adhesion to a solid surface, S. mutans is capable of colonizing the oral cavity and also of forming bacterial biofilm. Additional properties enabling S. mutans to colonize the oral cavity include the ability to survive in an acidic environment and specific interaction with other microorganisms colonizing this ecosystem. This review is an attempt to establish which characteristics associated with biofilm formation—virulence determinants of S. mutans—are responsible for the development of dental caries. In order to extend the knowledge of the nature of Streptococcus infections, an attempt to face the following problems will be made: Biofilm formation as a complex process of protein–bacterium interaction. To what extent do microorganisms of the cariogenic flora exemplified by S. mutans differ in virulence determinants “expression” from microorganisms of physiological flora? How does the environment of the oral cavity and its microorganisms affect the biofilm formation of dominant species? How do selected inhibitors affect the biofilm formation of cariogenic microorganisms?

https://link.springer.com/content/pdf/10.1007%2Fs10096-013-1993-7.pdf

The virulence of Streptococcus mutans and the ability to form biofilms.

Survival of women with cancers of breast and genital organs in Europe 1999-2007: Results of the EUROCARE-5 study

This analysis of the Estonian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health system performance. Without doubt, the main issue has been the 2008 financial crisis. Although Estonia has managed the downturn quite successfully and overall satisfaction with the system remains high, it is hard to predict the longer-term effects of the austerity package. The latter included some cuts in benefits and prices, increased cost sharing for certain services, extended waiting times, and a reduction in specialized care. In terms of health outcomes, important progress was made in life expectancy, which is nearing the European Union (EU) average, and infant mortality. Improvements are necessary in smoking and alcohol consumption, which are linked to the majority of avoidable diseases. Although the health behaviour of the population is improving, large disparities between groups exist and obesity rates, particularly among young people, are increasing. In health care, the burden of out-of-pocket payments is still distributed towards vulnerable groups. Furthermore, the number of hospitals, hospital beds and average length of stay has decreased to the EU average level, yet bed occupancy rates are still below EU averages and efficiency advances could be made. Going forwards, a number of pre-crisis challenges remain. These include ensuring sustainability of health care financing, guaranteeing a sufficient level of human resources, prioritizing patient-centred health care, integrating health and social care services, implementing intersectoral action to promote healthy behaviour, safeguarding access to health care for lower socioeconomic groups, and, lastly, improving evaluation and monitoring tools across the health system.

Estonia: health system review.

In Poland, like in other European countries and in accordance with the global trend, the number of computer users and people who have access to the Internet has increased considerably. The study investigates trends and patterns of Polish health-related Internet use over a period of seven years. The main objective of the study was to estimate the change in the proportion of the population using Internet for health purposes and to show the potential trend in perceptions and preferences of Polish citizens in this respect as well as factors affecting their use. The study was based on three national surveys that were conducted in 2005, 2007, and 2012. A total of 3027 adult citizens were selected randomly from the Polish population. A sample collection was carried out by Polish opinion poll agencies by computer-assisted telephone interviews. The subjects were asked to respond to general questions about their Internet use and their Internet use for health-related purposes, as well as to express their opinions about various sources of medical information, frequency, and the need for direct communication with health professionals via the Internet and other interactive forms of online activities. The proportion of the Polish population that used the Internet for health-related purposes increased significantly (41.7% in 2005, 53.3% in 2007, and 66.7% in 2012). The Internet has become an important source of health information for almost half of Polish citizens, overtaking television, radio, press, and courses or lectures in the ranking list. As the medium matures, the use of interactive, health-related online services has also increased remarkably. However, while the main users of the Internet are certainly younger people, the largest growth potential has been observed among the elderly. The profile of the most likely Internet user and the citizen for whom the Internet is an important source of health information has been determined. The Internet offers enormous opportunities, particularly for providing and improving consumer information services with regard to health care. A sharply increasing trend regarding Internet use, Internet use for health purposes, and the interactive use of the Internet related to health has been observed among Polish citizens.

/pdf/trends-in-the-use-of-the-internet-for-health-purposes-in-3wsm640rfh.pdf

Trends in the use of the Internet for health purposes in Poland.

Since the successful transition to a freely elected parliament and a market economy after 1989, Poland is now a stable democracy and is well represented within political and economic organizations in Europe and worldwide. The strongly centralized health system based on the Semashko model was replaced with a decentralized system of mandatory health insurance, complemented with financing from state and territorial self-government budgets. There is a clear separation of health care financing and provision: the National Health Fund (NFZ) the sole payer in the system is in charge of health care financing and contracts with public and non-public health care providers. The Ministry of Health is the key policy-maker and regulator in the system and is supported by a number of advisory bodies, some of them recently established. Health insurance contributions, borne entirely by employees, are collected by intermediary institutions and are pooled by the NFZ and distributed between the 16 regional NFZ branches. In 2009, Poland spent 7.4% of its gross domestic product (GDP) on health. Around 70% of health expenditure came from public sources and over 83.5% of this expenditure can be attributed to the (near) universal health insurance. The relatively high share of private expenditure is mostly represented by out-of-pocket (OOP) payments, mainly in the form of co-payments and informal payments. Voluntary health insurance (VHI) does not play an important role and is largely limited to medical subscription packages offered by employers. Compulsory health insurance covers 98% of the population and guarantees access to a broad range of health services. However, the limited financial resources of the NFZ mean that broad entitlements guaranteed on paper are not always available. Health care financing is overall at most proportional: while financing from health care contributions is proportional and budgetary subsidies to system funding are progressive, high OOP expenditures, particularly in areas such as pharmaceuticals, are highly regressive. The health status of the Polish population has improved substantially, with average life expectancy at birth reaching 80.2 years for women and 71.6 years for men in 2009. However, there is still a vast gap in life expectancy between Poland and the western European Union (EU) countries and between life expectancy overall and the expected number of years without illness or disability. Given its modest financial, human and material health care resources and the corresponding outcomes, the overall financial efficiency of the Polish system is satisfactory. Both allocative and technical efficiency leave room for improvement. Several measures, such as prioritizing primary care and adopting new payment mechanisms such as diagnosis-related groups (DRGs), have been introduced in recent years but need to be expanded to other areas and intensified. Additionally, numerous initiatives to enhance quality control and build the required expertise and evidence base for the system are also in place. These could improve general satisfaction with the system, which is not particularly high. Limited resources, a general aversion to cost-sharing stemming from a long experience with broad public coverage and shortages in health workforce need to be addressed before better outcomes can be achieved by the system. Increased cooperation between various bodies within the health and social care sectors would also contribute in this direction. The HiT profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services, and the role of the main actors in health systems; they describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis.

Poland health system review.

Background This single-centre study investigated factors influencing death in coronavirus disease 2019 (COVID-19) patients treated in an intensive care unit (ICU). Methods Data of 113 consecutive patients with a severe form of COVID-19 infection, who completed their ICU stay in a large COVID-19-dedicated hospital in the Silesian Region of Poland during one year of the pandemic (between 10 March, 2020 and 10 March, 2021), were reviewed. Comprehensive comparison of all available ICU pre-admission, admission and treatment variables was performed. Variables that independently influenced ICU death were identified. Results ICU mortality in the whole group was 64.6%. Mean age was higher in non-survivors (64.6 ± 9.5 vs. 60.0 ± 12.8 years, P = 0.036), but the distribution of sex and body mass index was similar in both groups. Non-survivors had a marginally higher mean Charlson Comorbidity Index (5.9 ± 3.6 vs. 4.5 ± 4.1 points, P = 0.063), and significantly higher mean Clinical Frailty Score (4.8 ± 1.5 vs. 3.9 ± 1.4 points, P = 0.004), admission APACHE II score (22.9 ± 7.9 vs. 19.1 ± 7.8 points, P = 0.017) and SAPS II score (62.1 ± 18.1 vs. 54.0 ± 16.7 points, P = 0.023). Factors that independently influenced ICU death were limited to: admission total protein < 50 g L–1 (OR = 11.5, P = 0.002), procalcitonin level > 2.0 ng mL–1 (OR = 11.3, P = 0.026) and lactate level > 2.0 mmol L–1 (OR = 4.2, P = 0.003) as well as Clinical Frailty Score ≥ 5 points (OR = 3.1, P = 0.021). Conclusions The presence of low total protein, frailty and increased procalcitonin and lactate levels at ICU admission are associated with ICU death in patients with severe COVID-19 infection.

/pdf/factors-influencing-death-in-covid-19-patients-treated-in-1w71ait8.pdf

Jaroslaw Madowicz

Papers

Poland health system review.

Factors influencing death in COVID-19 patients treated in the ICU: a single-centre, cross-sectional study