Care In Poland Research Articles

EXPERIENCE OF GROWING UP IN INSTITUTIONAL FOSTER CARE – RESEARCH REPORT

The article is devoted to the functioning of adolescent pupils of the “House of Return” in Białystok. Its aim is to show the experience of growing up in an orphanage from the pupils’ perspective. The first part of the text presents theoretical assumptions regarding the experience of growing up, organization of foster care in Poland, growing up in its institutional form and the process of deinstitutionalization. The second part of the article presents methodological assumptions of the research and the results regarding growing up in institutional foster care. Qualitative research using the method of individual cases was carried out in May 2021 with the charges of the “House of Return” in Białystok. The concept of qualitative data analysis by Matthew B. Miles and A. Michael Huberman was used to analyze the empirical material. In the light of the research, the charges function properly in the care and education centre for children and young people, the experience of growing up in an orphanage is not a trauma for them, but they have difficulties with establishing close relationships, they lack a significant adult, and are also not very self-reliant.

Informal care for adults: a comparison of Time Use Surveys of 2004 and 2013

The aim of this paper is to describe daily patterns and changes in time use of people dealing with elderly informal care in Poland. Based on Time Use Survey 2004 and 2013 we show that with increasing population of adults requiring care the profile of average caregiver also changes. We observe more caregivers. More often they are women and more often are retired. In consequence average time spent on caregiving also increases. We conclude that this trend will continue and therefore both market and state suppy of the caregiving services is required.

Regulacje prawne w zakresie szczepień ochronnych przeciwko COVID-19 – problemy wybrane

Undoubtedly, the end of 2019 will be recorded in the annals of modern human history as a time which resulted in an unprecedented event. This is because this year, the global epidemic of the SARS-CoV-2 virus broke out. This virus, on the other hand, leads to the development of an acute infectious disease of the respiratory tract, known as COVID-19. Therefore, the state of epidemic threat that was initially introduced in Poland, and then transformed into the current epidemic state, requires a particular reaction from the state authorities and also, it would seem, an appropriate response to the situation by the citizens themselves. In such exceptional circumstances, the obligation arises for the state to protect the life and health of its citizens, both in the area of enacting the relevant law and its implementation. However, there is a remedy for the growing number of new cases of COVID-19 and deaths in this context, namely the possibility of performing preventive vaccinations against this disease. This article aims to analyze and evaluate the legal regulations on preventive vaccinations against COVID-19 introduced in Poland. In this regard, reference is made to the basic assumptions used in the constitutional model of health care inPoland. In this context, the principle of equal access to health care services financed from public funds and the constitutional exceptions to the principle of equal access to benefits, such as children, pregnant women, disabled and elderly people are discussed, as well as the principle of the active role of the state in combating epidemic threats. These considerations are complemented by an outline of the statutory and sub-statutory solutions in the health care model. The analysis also covers legal solutions adopted with regard to the COVID-19 epidemic, and presents the distribution of SARS-CoV-2 vaccines as well as restrictions, orders and bans in connection with the epidemic. In addition, the compliance of the distribution of SARS-CoV-2 vaccines with the constitutional model of health protection is assessed, with the criteria for assessing this distribution in the context of establishing the state of the epidemic being singled out.

The impact of the COVID-19 pandemic on urological care in Poland - Post-COVID resilience scenarios and recommendations for healthcare system: A national population-based modelling study.

IntroductionOur aim was to assess the time required to recover the hypothetical surgical capacity of urological procedures that were suspended due to lockdowns caused by the SARS-CoV-2 outbreak in 2020 and 2021 in Poland, to indicate the most affected procedures, and to estimate the recovery time after a likely fourth lockdown.Material and methodsThe data aggregates contained the number of patients who underwent specific urological procedures classified in the ICD-9, performed from January 2009 to October 2019, acquired in granulation per month and per single voivodeship, and obtained by healthcare providers such as hospitals, ambulatory units, and primary care facilities. Using the model, we obtained the time required to discharge the excessive load on the healthcare system and the median wait time in the post-lockdown period. We validated the model based on the data aggregates from March to October 2020.ResultsLeaving the capacity of the most affected procedures unaltered, or increasing it by 20%, would not reduce the backlog of patients waiting to receive care after the third lockdown. The consequences of a feasible fourth lockdown would cause the necessity of a post-lockdown increase in capacity by more than 50%.ConclusionsThe availability of the most affected procedures will never achieve the pre-pandemic state without increasing the hypothetical surgical capacity of urological procedures that were suspended due to lockdowns caused by the SARS-CoV-2 outbreak. These procedures require taking special steps to unblock the urological healthcare system and allow patients continuous access to treatment.

Green Care in Poland. Essence, limitations and development opportunities with the kujawsko-pomorskie province as an example

Abstract An ageing society has triggered the development of new intervention mechanisms and the engagement of both state and non-governmental institutions. It can be said that, for each group of persons, place-of-residence and social-structure-specific social security models must be designed. In Poland, such innovative actions include the initiative of launching care farms, known as green care. This article presents the results of the current study and observations of the operation of such farms in the kujawsko-pomorskie province. The study mostly involved the use of qualitative methods: interviews with carers, a covert participant observation and the analysis of the opinions of the psychologist coordinating the care farm therapy. The study shows that the idea of green care is quite easily implemented in the rural areas of Poland, with plenty of potential clients and farms which, with sometimes inconsiderable investment inputs, can be adapted to welcome that specific group of guests. However, one must note many barriers, especially a lack of permanent sources of green care financing, in many places a profound distrust of the local community for changes and innovations, and uncertainty regarding the continued care prospect, which can result in an even greater social withdrawal of the clients and an abandoning of the efforts by the carers and farm owners for a further operation to be continued.

The Problem of Smog-Particle Removal in Large Cities—Experimental Analysis of Some Filtration Materials

Air pollution is a significant problem in city centers. According to public health care in Poland, there is a need for local authorities to propose good purification solutions in both outdoor and indoor conditions. The main objective of this study is the development of an appropriate filtration system for public transport, especially for buses and bus stops. Firstly, the authors justify the need for air filtration in the capital of Poland, Warsaw. The average concentration level of PM10 and PM2.5 dust particles in large Polish cities is presented. In addition, it is underlined that PM2.5 dust particles are carriers for coronavirus COVID-19 and easily inhaled by humans. In the next step, the authors introduce an experimental stand used in the examination of different filtration baffles. The filtration efficiency is defined and calculated according to experimental examinations. In these experiments, an antismog cover for air-conditioning split systems, an H13 HEPA filter and a three-stage filtration baffle (active carbon + F5 filter + EPA11 filter) were taken into consideration, and the efficiency of filtration under pressure-drop conditions and the influence of moisture were ascertained. The best filter setup was thereby determined to be the three-stage filtration baffle, being the most efficient in cleaning air on account of having the smallest mass concentration of PM2.5. This indicates that three-stage filtration is the most suitable air-filtration method for public transportation in cities where air pollution is a serious concern.

Prevalence of Chronic Polypharmacy in Community-Dwelling Elderly People in Poland: Analysis of National Real-World Database Helps to Identify High Risk Group.

Introduction: Multimorbidity often comes with age, making elderly people particularly prone to polypharmacy. Polypharmacy, in turn, is a risk factor for adverse drug reactions, drug-drug interactions, non-adherence to medication, negative health outcomes, and increased healthcare services utilization. The longer the exposure to polypharmacy is, the higher the risk of these consequences is. Therefore, a detailed assessment of the prevalence and drivers of chronic polypharmacy in the elderly is particularly important. Aim of study: To find out the prevalence of chronic polypharmacy in the elderly population of Poland, and to characterize the subgroup with the highest risk of this problem, using real-world data. Methodology: A retrospective analysis of data on dispensation and healthcare services utilization held by the national payer organization for the year 2018. Chronic polypharmacy was defined as possession, as a result of dispensation, of five or more prescribed drugs within 80% of each of the consecutive 6 months. Results: Chronic polypharmacy was found in 554.1 thousand patients, i.e. in 19.1% of the national 65+ cohort. On average, those patients were 76 years old, and 49.3% of them were female. The vast majority (68.6%) continued their polypharmacy for the period of the whole year. There was a marked variation in geographical distribution of chronic polypharmacy with the highest value of 1.7 thousand per 100,000 inhabitants in the Łódź Voivodeship. Patients exposed to chronic polypharmacy filled prescriptions from 4.5±2.36 healthcare professionals. The average number of drugs they used was 8.3±3.84 DDD per patient per day. The most often prescribed drugs were Metformin, Atorvastatin and Pantoprazole. The average annual hospitalisation rate in those patients was 1.03±2.4. Conclusion: This study was the first of this kind involving a nationwide assessment of chronic polypharmacy in Polish elderly people. We found that this problem affected one fifth of Polish older adults and it remains stable due to its direct relation to chronic conditions. Thus, our results confirm that this phenomenon is highly important for the national health policy and requires relevant interventions. The planned introduction of pharmaceutical care in Poland is expected to help in solving the problem.

Real-World Data from a Multi-Center Study: Insights to Psoriatic Arthritis Care.

Introduction: Real-world data indicate disparities in biologic access across Europe. Objectives: To describe the national structure of PsA care in Poland, with a particular focus on the population of inadequate responders (IRs) and difficulties associated with biologic therapy access. Methods: A pool of rheumatologic and dermatologic care centers was created based on National Health Fund contract lists (n = 841), from which 29 rheumatologic and 10 dermatologic centers were sampled randomly and successfully met the inclusion criterium. Additionally, 33 tertiary care centers were recruited. For successful center recruitment, one provider had to recruit at least one patient that met the criteria for one of the four pre-defined clinical subgroups, in which all patients had to have active PsA and IR status to at least 2 conventional synthetic disease-modifying drugs (csDMARDs). Self-assessment questionnaires were distributed among physicians and their patients. Results: Barriers to biologic DMARD (bDMARD) treatment are complex and include stringency of reimbursement criteria, health care system, logistic/organizational, and personal choice factors. For patients who are currently bDMARD users, the median waiting time from the visit, at which the reimbursement procedure was initiated, to the first day of bDMARD admission was 9 weeks (range 2–212; 32% < 4 weeks, 29% 5–12 weeks, 26% 13–28 weeks, 13% with >28 weeks delay). Out of all inadequate responder groups, bDMARD users are the only group with “good” therapeutic situation and satisfaction with therapy. Patient satisfaction with therapy is not always concordant with physician assessment of therapeutic status. Conclusions: Despite the fact that over a decade has passed since the introduction of biologic agents, in medium welfare countries such as Poland, considerable healthcare system barriers to biologic access are present. Out of different IR populations, patient satisfaction with treatment is often discordant with physician assessment of disease status.

An Integrated Model of Environmental Care for a Patient Discharged from the Emergency Department - A Comparative Analysis of Meeting the Needs of Emergency Department Patients and General Practice Patients

IntroductionThe development of an environmental care model taking the comprehensive coverage of the needs of patients receiving a stay at home care after being discharged from the Emergency Department (ED) into account may be effective in the prevention of subsequent hospitalisation in the ED. The aim of the study was to determine the level of satisfying the needs of the emergency department patients (EDPs) and general practice patients (GPPs) as well as the factors corresponding to a high level of satisfaction of needs in both groups.Theory/MethodsA cross-sectional study was conducted among 200 EDPs and 200 GPPs. The modified version of the Camberwell Assessment of Need Short Appraisal Schedule, Health Behaviour Inventory, Generalized Self – Efficacy Scale, Patients Satisfaction Questionnaire and an original questionnaire were used.Results. EDP patients showed a lower level of met needs measured by the Camberwel Index than the GPP (M=0.75 EDP vs. M=0.80 GPP, p=0.008). In both groups, a high level of satisfaction of the needs (above the median) more often co-occurred with: high values of a positive mental attitude (rs=0.53, p&lt;0.001 GPP vs. rs=0.30, p=0.010 EDP), a high generalized sense of self-efficacy (rs=0.44, p&lt;0.001 GPP vs. rs=0.35, p=0.010 EDP), high values of health practices (rs=0.49, p&lt;0.001 GPP vs. rs=0.17, p=0.020 EDP), the number of medications taken daily below the median (rs= -0.38, p&lt;0.001 GPP vs. rs= - 0.41, p&lt;0.001 EDP), good and very good material status of families (rs= 0.30, p&lt;0.001 GPP vs. rs= 0.35, p&lt;0.001 EDP), the number of chronic diseases lower or equal to the median (rs= -0.23, p=0.001 GPP vs. rs= - 0.46, p&lt;0.001 EDP), secondary and higher education (rs= 0.27, p&lt;0.001 GPP vs. rs= 0.35, p&lt;0.001 EDP), high level of patient satisfaction with GP’s services (rs=0.38, p&lt;0.001 GPP vs. rs=0.18, p=0.010 EDP), GP’s visit at a patient’s home (rs=0.20, p=0.005 GPP vs. rs=0,14, p=0.042 EDP).Discussions. In 1991, health and social care in Poland were separated into two separately administered and managed bodies. Certainly, there is a view that the health and social care systems are ill-prepared and under-equipped to meet the needs of the growing population of older adults.ConclusionsA comprehensive model of environmental care for patients discharged from the ED should include: their sociodemographic factors, health profile, level of health behaviours, generalized self-efficacy and quality indicators of health care provided by GP and primary care nurses. Lessons learned. ED’s nurses should conduct a screening based on the examination of the level of satisfying the needs of the patients being discharged. The results should be passed on to the primary care physician and social welfare units.LimitationsThis research was conducted on a small research sample and only in one ED.Suggestions for future research. Currently, in most countries healthcare coordinators use evaluation systems where health and physical needs are prioritized rather than psychological or social needs. A short, easy and practice tool, which will take the complexity of patients' needs and the above-mentioned elements of the environmental care model into account should be developed.

“I knew there has to be a better way”: Women’s pathways to freebirth in Poland

BackgroundEach year a small number of women decide to birth at home without midwifery and medical assistance despite the availability of maternity services in the country. This phenomenon is called freebirth and can be used as a lens to look into shortcomings of maternity care services. AimBy exploring women’s pathways to freebirth, this article aims to examine the larger context of maternity services in Poland and identify elements of care contributing to women’s decision to birth without midwifery and medical assistance. MethodsA qualitative methodology was used employing elements of ethnographic fieldwork, including digital ethnography. Semi-structured interviews with twelve women who freebirth, analysis of online support groups, secondary sources of information and elements of participant observation were used. FindingsWomen’s decisions to freebirth were born out of their previous negative experiences with maternity care. Persistent use of medical technology and lack of respect from maternity care providers played a major role in pushing women away from available Polish maternity services. While searching for a better environment for themselves and their babies for the subsequent births, women experienced a rigidity of both mainstream and homebirth services and patchy availability of the latter that contributed to their decisions to freebirth. ConclusionsFreebirth appears to be a consequence of inadequate maternity services both mainstream and homebirth rather than a preference. Women’s freebirth experiences can be used to improve maternity care in Poland and inform similar contexts globally.

Impact of Social, Economic, and Healthcare Factors on the Regional Structure of Antibiotic Consumption in Primary Care in Poland (2013-2017).

Antibiotic resistance is one of the most important public health threats worldwide. Antimicrobial misuse and overuse are well-recognized risk factors for the resistance emergence and spread. Monitoring of antibiotic consumption (AC) is an important element in strategies to combat antibiotic resistance. As a result of AC surveillance in Poland, regional differences in AC levels were observed. This study aimed to characterize the regional AC in the period 2013–2017 in primary care in Poland and to assess the possible determinants that influence the AC at the regional level. The study analyzed relationships between AC and its factors (grouped in three different categories: demographic, economic, and related to the organization of healthcare). Data covered AC in primary care in 5 years period (2013–2017) from all 16 Polish voivodeships. The AC primary care data were sales data, expressed in defined daily doses (DDD) according to the WHO methodology. The yearly data on demographic, economic, and related healthcare factors were downloaded from the Central Statistical Office of Poland. Standard statistical parameters were used to characterize the AC. Non-standardized regression coefficients were used to estimate the quantitative dependence of variables. The strongest correlation was demonstrated with factors related to employment, female reproductive activity, mobility of the population, the number of outpatient consultations, and the number of dentists. A correlation was also found between population mobility and density. Recognized risk factors for increased AC should be a priority for interventions implementing and disseminating rational antibiotic policy.

Spatial concentration of local government expenditures on family foster care in Poland

This article presents local government expenditures on family foster care in terms of their spatial concentration. The main aim of the study is to capture regional differences in the financing of family foster care in Poland. The location quotient and the shift-share analysis were applied in the study. The spatial disparities in the functioning of social assistance, in terms of foster family care, in Poland have been detected. These differences are caused by higher revenues for budgets, resulting in major additions to social benefits.

STUDY OF ADOLESCENTS' AWARENESS OF THE EFFECTS OF SMOKING IN ORDER TO INCREASE THE EFFECTIVENESS OF CANCER PREVENTION

In Poland and the world, cancer is a serious health problem. There are the second cause of death in total and the first cause of death before the age of 65 in Poland. The paper presents some research results concerning the understanding of the level of knowledge of adolescents about lung cancer. An attempt was made to answer the question: Do young people have basic knowledge about lung cancer? The following hypotheses were made: Students believe that they influ-ence whether they will develop lung cancer. Adolescents have a basic knowledge of lung cancer. The obtained results allowed for the formulation of conclusions. The main goal of the work is to find out about the level of knowledge of young people about lung cancer.To improve the situation of lung cancer in society, numerous social organizations and associations take part in social campaigns dedicated to all citizens, regardless of age and sex. Some postulates, the introduction of which could increase the health security of the state and eliminate some environmental threats, such as passive smoking, will be presented below. These postulates have the overarching goal of changing the model of lung cancer prevention and care in Poland. The changes should be comprehensive - from prevention (primary and secondary), through diagnostics and treatment, post-treatment care (including rehabilitation and psycho-oncological care), to observation aimed at detecting and treating complications of the disease and anti-cancer therapy as well as early detection of possible recurrence of the disease. Given that smoking is becoming a bad habit of the younger age group than the study, it would be worthwhile to expand the age range and conduct such research among children, for example, from the age of 7 years. At this age, children are more receptive to and aware of health hazards.

Expenditure on health care in Poland compared to selected countries in 2010–2019

The aim of the study is to evaluate healthcare from the perspective of healthcare expenditure between 2010–2019. The author examined how the level of healthcare expenditure as a share of GDP, as well as per capita developed in the 2010–2019 period. Expenditure on health care grew for most of the 1999–2010 period, but nevertheless stabilized at a level below 7% of GDP in year 2010 and were one of the lowest in OECD countries, also lower than the compared reference countries (Czech Republic, Slovakia, Hungary). The author explored the topic of healthcare expenditure in the consecutive decade (2010–2019) and made comparisons of international expenditures with those of OECD countries, and in particular with reference countries. Additionally, on the basis of some selected analyzes, he confirms the fact known in health economics that an appropriate level of expenditure on healthcare has a positive impact on the health status of the population and the quality of healthcare offered in a country.

What is the level of satisfaction with maternity care in Poland? A cross-sectional study

Background: A positive experience of childbirth, as outlined by the WHO, consists of giving birth to a healthy child, and meeting the expectations of the woman based on her beliefs, previous experiences, and cultural conditions. Aim of the study: To evaluate the mother’s satisfaction with childbirth, satisfaction with the expectations of giving birth, and the care received during and after birth. Material and methods: This study used a questionnaire for data collection that was validated by a panel of experts using the Delphi method. The Chi-square, Mann-Whitney U and Kruskal-Wallis rank tests with post-hoc comparisons were used for the analysis. Correlations were examined using the Spearman’s R test. Results: For the whole study group (n = 444), the mean score for satisfaction with childbirth was 3.83 (± 1.25), and the assessment of care during childbirth (n = 444) and care in the maternity unit (n = 427) were 4.11 (± 1.12) and 3.60 (± 1.22), respectively. Satisfaction with childbirth in the whole study group was significantly correlated with emotional support (r = 0.55, p &lt; 0.001) and communication with staff (r = 0.53, p &lt; 0.001) during delivery, provision of intimacy (r = 0.44, p &lt; 0.001), pain relief (r = 0.43, p &lt; 0.001), contact with the newborn after birth (r = 0.43, p &lt; 0.001), support for breastfeeding (r = 0.37, p &lt; 0.001), and accommodation and sanitary conditions during delivery (r = 0.37, p &lt; 0.001). The largest statistically significant differences regarding fulfillment of the women’s expectations were observed between groups describing their childbirth as frightening and painful, and groups describing their childbirth as expected, positive and pleasant. Conclusions: Women had a worse opinion of care after childbirth compared to care during childbirth, which may be due to the lack of expectations concerning emotional support and assistance in breastfeeding that were reported by the respondents.

Can Elderly People Afford Long-Term Care? Financing Long-Term Care in Poland and the Financial Resources Available to Beneficiaries

Purpose: This paper aims to assess long-term care (LTC) spending in Poland broken down into public financing and beneficiaries' contributions, which depend on the financial resources available to them. By focusing on individual expense items from the people's perspective requiring care, the author takes stock of the range of care services on offer relative to the financial resources available to those in need. Design/Methodology/Approach: The study examines expenditures on LTC in the West Pomeranian Region of Poland in three social care systems. Out of the list of such expenditures correlated with the financial resources available to the elderly, particular focus is placed on residential LTC services provided in comprehensive care systems. Findings: The levels of expense relative to the average disposable income of pensioners vary widely, revealing the problem of older adults having insufficient financial resources to self-finance their LTC in Poland. The variance results from system design and the principles that govern care financing. The cost of some residential LTC services is charged to beneficiaries, meaning they are required to pay for them out of their pocket, while other services are co-financed at fixed rates that vary depending on the income of the respective beneficiaries. Practical Implications: The paper outlines the essential characteristics of a new LTC financing scheme that could be designed and rolled out in Poland based on research. The main idea is to establish a new dedicated source of care service funding and a new fund-collecting entity. Originality/Value: The proposed method of LTC financing in Poland provides an opportunity to resolve insufficient care funding partially. It is necessary and crucial to identify a new source of funding that would feed into the system, given especially that Polish society is aging rapidly. The discussion covers multiple solutions, some of them taken from the LTC systems of other countries, and reviews viable concepts.

Opinion survey on the profession of a physiotherapist in Poland

IntroductionDespite numerous activities of the National Chamber of Physiotherapists, there are reasons that question the organization of physiotherapy in Poland. Public services are particularly criticized, which is alarming, because physiotherapy that functions well within the public health service is essential for maintaining the optimal efficiency of the entire system.PurposeDetermining the current opinion on the profession of a physiotherapist and the process of physiotherapy in Poland, taking into account the differences between reimbursed services and those provided in non-public entities.Material and methodThe method of diagnostic survey distributed with the use of social networks was used. The study group included 164 people (53F, 111M).ResultsThe quality of private services was statistically significantly (p &lt;.0001) assessed better on a five-point scale (4.74 [SD = 0.44]) than reimbursed services (3.1 [SD = 1.20]). Comparing the opinion on commercial services with those provided under public health care, significant (p &lt;.0001) differences were also noted in other assessed aspects in favor of private physiotherapy, which was assessed as good. Public health services were rated averagely.ConclusionsPublic health care physiotherapy is rated worse than commercial services.People who have undergone physiotherapy financed by the National Health Fund would be less willing to start physiotherapy again if necessary than people with experience from private physiotherapy offices.Activities optimizing the work system of physiotherapists can improve the opinion about physiotherapy in public health care in Poland, giving measurable health and economic benefits in the long term.

Health Care Providers’ Perceptions of Quality of Childbirth and Its Associated Risks in Poland

ObjectiveTo describe Polish maternity care providers’ cognitive frames of quality of childbirth and how they relate to providers’ perceptions of childbirth using Baranowska’s model of quality of care. DesignMixed-methods, cross-sectional. SettingTwenty-four hospitals and outpatient clinics that provide maternity care located in two central districts of Poland. ParticipantsObstetricians or resident physicians in obstetrics (n = 50) and midwives (n = 676) who were actively engaged in the provision of maternity care. MethodsParticipants completed a survey that included two tasks. The first was a sentence completion technique that we used as a projective method to investigate participants’ preconceived attitudes about quality of childbirth. Depending on the number of perspectives (as in Baranowska’s model) included in the statements, participants’ perceptions were categorized as strongly narrowed (zero perspectives), narrow (one perspective), intermediate (two perspectives), or holistic (three perspectives). In the second task, we asked participants to choose one statement out of three that best represented their beliefs about childbirth. ResultsParticipants had mostly intermediate (n = 436, 60%) or narrow (n = 183, 25%) perceptions of quality of childbirth. Those with less work experience tended to have more encompassing perspectives. More than half of the participants perceived childbirth as a physiologic process requiring no medical interventions (n = 385, 53%). Only 9% (n = 65) of the participants reported that childbirth is always associated with great risk. There was a main effect of work experience on the number of perspectives included in the definition of quality of childbirth with F(2, 720) = 5.532, p = .004. Participants with less work experience included more perspectives in their statements. There were no statistically significant differences in the perception of quality of childbirth between obstetricians and midwives, with F(1, 724) = .000, p = 0.991, or between participants from different workplaces, with F(3, 719) = 1.742, p = .157. ConclusionOnly a small share of participants had holistic perceptions of quality of childbirth consistent with Baranowska’s model. This may not only contribute to the medicalization of maternity care in Poland, but it also contrasts with participants’ declarations that childbirth is a physiologic process with no need for medical interventions. Considering the greater rates of medical interventions in maternity care in Poland, the latter finding requires further research.

A Pilot Study on the Quality of Sexual Life of Patients Receiving Home Palliative Care in Poland

Background: Quality of life, physical, psychic, and social functioning assessments in patients suffering from chronic, progressive, and incurable diseases are one of the most significant aims of the palliative care home teams. Sexuality and intimacy can be one of the most important elements of a person’s life, even at the end of it. Unfortunately, there is very little interest in this topic among medical staff of palliative care units. The objective of the study: The aim of this study was to assess the health status, the quality of life, the quality of sexual life, and the recognition and resolution of sexual problems by the palliative care team in adult patients in the advanced stage of terminal illness, who were receiving home palliative care. Research methods: The study involved 342 adult patients in the advanced stage of incurable, progressive disease, covered by home palliative care in 15 facilities in Poland. A generic EuroQoL 5-Dimension 3-Level health and quality of life assessment questionnaire and a questionnaire developed by the researchers, including questions about sexual problems, were used in this prospective study. Results: The presented results are the part of the more extensive study. The assessment of health status and quality of life of the study patients showed that the evaluation was the lowest for performing ordinary daily activities. The quality of sexual life after diagnosis in more than half of the study patients has worsened. Almost half of the respondents felt that the palliative care team did not recognize or address their sexual concerns. Patients indicated nurses and physicians as the members of the palliative care team most helpful in identifying and addressing sexual concerns. Conclusions: Members of the palliative care team should receive training in communication with patients concerning their sexual life, their needs and expectations and have knowledge about options for obtaining specialized sexological care. It is necessary to prepare and validate simple tools that will facilitate the initiation of appropriate communication between patients and members of the medical staff. It will be important to conduct more detailed and targeted research on sexuality and intimacy in the Polish palliative care patient population.

Private Services and the Fragmentation of Maternity Care in Poland

ABSTRACT As a result of reforms aimed at adjusting it to the market economy, the Polish health care system has become a complicated mix of public and private services. Using as an example maternity services, I show how private services allow a subtle process of patient selection to emerge, contributing to the fragmentation of public care. The process of selection is based on social relations formed between health care providers and patients through the use of private services. This has a negative impact on women who do not have the social or financial resources to engage in private services. W wyniku reform mających na celu dostosowanie do gospodarki rynkowej, opieka zdrowotna w Polsce przekształcona została w skomplikowaną mieszaninę usług publicznych i prywatnych. Na podstawie świadczeń położniczych, pokazuję, w jaki sposób prywatne usługi zdrowotne stały się „oknami” pozwalającymi na subtelną selekcję pacjentów. Selekcja ta oparta jest na relacjach społecznych nawiązywanych pomiędzy lekarzem/położną a pacjentką przy okazji korzystania z prywatnych usług i prowadzi do fragmentaryzacji opieki publicznej. Proces ten szczególnie negatywnie wpływa na kobiety, których zasoby społeczne i finansowe nie pozwalają na korzystanie z prywatnych usług zdrowotnych.