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Community and Family-Focused Public Health and Sustainable Development: 2nd Edition

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 38215

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Guest Editor
Department of Health Sciences, Calisia University-Kalisz, Nowy Swiat Street 4, 62-800 Kalisz, Poland
Interests: health behaviour; adolescent health; public health
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Health Sciences Faculty, Calisia University-Kalisz, Nowy Swiat Street 4, 62-800 Kalisz, Poland
Interests: health inequalities; reproductive health; environmental and rural health; public health

Special Issue Information

Dear Colleagues,

The Special Issue “Community and Family-focused Public Health and Sustainable Development: 2nd Edition”, is a part of the renowned International Journal of Environmental Research and Public Health, and is continue 1st part on the special issue at the same title. This Special Issue encompasses applications in novel aspects connected with sustainability issues in community and family-focused public health studies. Contributions with a significant impact on solving public health problems at the family and community level are particularly welcome. All types of scientific papers, including review articles, qualify for publication, as long as they fall under this Special Issue’s remit and are relevant to audiences worldwide. Currently, the term 'family health' is most commonly used in aspects of mother and child health, and reproductive health. It is rare for family health to include the family as an important context for health development, including all family members and the family’s social environment. We therefore particularly encourage authors of scientific research covering issues of the impact of the family and the environment in which the family lives and functions on its members’ health presently and in the future. In addition, we are especially interested in scientific reports on social, economic, and health inequalities in the context of achieving sustainable development goals.

Prof. Dr. Wioletta Zukiewicz-Sobczak
Prof. Dr. Paulina Wojtyla-Buciora
Prof. Dr. Andrzej Wojtyla
Guest Editors

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Keywords

  • public health
  • poverty
  • inequality
  • sustainable development
  • family health
  • community health
  • public health
  • social health
  • spatial planning
  • management

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Related Special Issue

Published Papers (11 papers)

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Research

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14 pages, 1670 KiB  
Article
Influence of Public Sports Services on Residents’ Mental Health at Communities Level: New Insights from China
by Liu Lu and Wei Wei
Int. J. Environ. Res. Public Health 2023, 20(2), 1143; https://doi.org/10.3390/ijerph20021143 - 9 Jan 2023
Cited by 2 | Viewed by 2418
Abstract
It is generally believed that sports play an important role in healing and boosting mental health. The provision of public sports services is important for enhancing residents’ physical fitness and mental health, and for promoting their satisfaction with government public services. To build [...] Read more.
It is generally believed that sports play an important role in healing and boosting mental health. The provision of public sports services is important for enhancing residents’ physical fitness and mental health, and for promoting their satisfaction with government public services. To build and strengthen a high-quality sports service-oriented society, it is important to explore whether community public sports services influence residents’ mental health. To explore this phenomenon, the study gathered data from China and employed multi-level regression models to meet the study objective. The results show that the residents’ age difference is 0.03, and the average daily exercise time is 0.02, which is significantly correlated with residents’ mental health. The results show that the lower the availability and greening of sports facilities, and the fewer rest facilities there are, the higher the mental distress of residents may be. Conversely, the improvement of the greening and availability of sports facilities can facilitate the promotion of residents’ mental health levels. Moreover, it was found that the mental health of residents is mainly and positively affected by the cleanliness of sports facilities. The street environment affects mental health and is attributed to the damage to sports facilities. Neighborhood communication also improves residents’ mental health, and trust between neighbors has the greatest impact on reducing mental distress. Finally, the study proposes that the government should propose strategies to optimize the provision of community public sports services in the study area to boost both social and mental health benefits. Full article
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11 pages, 330 KiB  
Article
Influence of Selected Indicators of Healthcare System Functioning Evaluation on the Health Result
by Olga Partyka, Monika Pajewska, Aleksandra Czerw, Katarzyna Sygit, Kamila Kmieć, Oleh Lyubinets, Mateusz Niemiec, Mateusz Kaczmarski, Izabela Gąska, Grzegorz Juszczyk, Edyta Krzych-Fałta, Tomasz Banaś, Dariusz A. Kosior, Andrzej Deptała, Artur Kotwas, Ewa Bandurska, Weronika Ciećko and Elżbieta Cipora
Int. J. Environ. Res. Public Health 2022, 19(21), 14618; https://doi.org/10.3390/ijerph192114618 - 7 Nov 2022
Cited by 2 | Viewed by 2220
Abstract
Background: According to the World Health Organization’s statistics, 7 of the 10 main causes of death in 2019 were noncommunicable diseases. Health indicators are measures used to evaluate public health system effectiveness and functioning. Monitoring mortality rates from leading causes, life expectancy and [...] Read more.
Background: According to the World Health Organization’s statistics, 7 of the 10 main causes of death in 2019 were noncommunicable diseases. Health indicators are measures used to evaluate public health system effectiveness and functioning. Monitoring mortality rates from leading causes, life expectancy and other health indicators is essential to address their causes and adapt health systems to react adequately. The aim of this study is to present the dependencies of selected health care indicators and health outcomes. Methods: Based on the literature review conducted, selected health indicators, along with healthcare system data, were analyzed using Pearson’s r correlation. The analyses included data from the Organization for Economic Cooperation and Development (OECD) presented in statistics and the Health at a Glance 2021 report and data collected as part of the preparation of the Financing Global Health 2020 report by the Institute for Health Metrics and Evaluation. Results: Health system resources are linked to health outcomes. The number of medical consultations, the number of nurses per patient or the level of financing of services under general health insurance are related to life expectancy and deaths due to causes that could have been avoided or treated. Conclusions: Life expectancy is positively correlated with access to general health insurance and public expenditure on healthcare. There is a need for all countries to provide their citizens with broad access to healthcare services. Full article
17 pages, 1025 KiB  
Article
Comparison of US and EU Prices for Orphan Drugs in the Perspective of the Considered US Orphan Drugs Act Modifications and Discussed Price-Regulation Mechanisms Adjustments in US and European Union
by Paweł Żelewski, Michał Wojna, Katarzyna Sygit, Elżbieta Cipora, Izabela Gąska, Mateusz Niemiec, Mateusz Kaczmarski, Tomasz Banaś, Beata Karakiewicz, Artur Kotwas, Paulina Zabielska, Olga Partyka, Monika Pajewska, Edyta Krzych-Fałta, Ewa Bandurska, Weronika Ciećko and Aleksandra Czerw
Int. J. Environ. Res. Public Health 2022, 19(19), 12098; https://doi.org/10.3390/ijerph191912098 - 24 Sep 2022
Cited by 1 | Viewed by 5442
Abstract
The 2019 worldwide sales of Orphan Drugs were estimated at $136 billion USD, which constituted 16% of the global pharmaceutical prescription market and is expected to grow by 12% in the next 5 years. A better understanding of Orphan Drug pricing may contribute [...] Read more.
The 2019 worldwide sales of Orphan Drugs were estimated at $136 billion USD, which constituted 16% of the global pharmaceutical prescription market and is expected to grow by 12% in the next 5 years. A better understanding of Orphan Drug pricing may contribute to on-going discussions on Orphan Drug Act (ODA) corrections in US or modifications of price setting mechanisms in EU. The objective of the study was comparison and analysis of the prices of Orphan Drugs in US and EU. All drugs with Orphan Drug status were compared in the US and EU. For the US prices, the US Department of Veterans Affairs (VA) was sourced. The EU List Prices came from six EU countries: Denmark, France, Germany, Greece, Poland, Spain. We found US prices to be higher than the six selected EU countries. The average Price Ratio was 1.64. The prices across EU countries were more homogeneous, while the number of the reimbursed and therefore available to patient medicines varied and was correlated with GDP per capita r = 0.87. Considered implementation of the External Reference Price system in US may generate significant savings in the US but may result in upward pressure on pricing of Orphan Drugs in EU. Centralization of the Orphan Drugs pricing negotiations in EU may prevent such development and offer a win-win opportunity for all involved parties. Full article
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14 pages, 476 KiB  
Article
Self-Assessment of Physical Fitness and Health versus Motivational Value of Physical Activity Goals in People Practicing Fitness, Football, Martial Arts and Wheelchair Rugby
by Katarzyna Kotarska, Celina Timoszyk-Tomczak, Leonard Nowak, Katarzyna Sygit, Izabela Gąska and Maria Alicja Nowak
Int. J. Environ. Res. Public Health 2022, 19(17), 11004; https://doi.org/10.3390/ijerph191711004 - 2 Sep 2022
Cited by 3 | Viewed by 2035
Abstract
The aim of the study was to determine the relationship between self-assessment of physical fitness and health, and the motivational role of physical activity goals in people, depending on their sports discipline. The study included 470 men and 218 women, aged 18–45, from [...] Read more.
The aim of the study was to determine the relationship between self-assessment of physical fitness and health, and the motivational role of physical activity goals in people, depending on their sports discipline. The study included 470 men and 218 women, aged 18–45, from western and southern Poland. The respondents practiced sports recreationally (fitness—F), competitively (football—FB, martial arts—MA), and for rehabilitation and sports purposes (wheelchair rugby—R). The standardized questionnaire for the motivational role of physical activity goals (Inventory of Physical Activity Objectives, IPAO) by Lipowski and Zaleski and the authors’ questionnaire on lifestyle were used. In the statistical analyses, non-parametric statistics were used. Individuals with very high and high self-assessment of their physical fitness and very good self-assessment of health achieved higher scores on the motivational value scale, time management, motivational conflict and multidimensionality of physical activity goals (p < 0.05). Respondents who assessed their health as very good achieved lower results on the perseverance scale, compared to those who assessed their health as good or poor. Self-assessment of physical fitness had a positive, high and moderate correlation with the self-assessment of health in people practicing wheelchair rugby, fitness, football and martial arts (r = 0.61; r = 0.52; r = 0.41; r = 0.40, respectively). Correlations were found between the motivational role and time management in people practicing fitness (r = 0.81), football (r = 0.66) and martial arts (r = 0.45), and multidimensionality of goals in those practicing fitness (r = 0.65) and martial arts (r = 0.42) Wheelchair rugby players scored the highest on all KCAF scales (except for motivational conflict). Self-assessment of physical fitness of wheelchair rugby players and fitness practitioners was negatively correlated with time management (r = −0.68; r = −0.49), multidimensionality of goals (r = −0.51; r = −0.49) and motivational values (r = −0.43; r = −0.43). The demonstrated relationships indicated that there was a need to strengthen the self-esteem and motivation for physical activity, promoting perseverance, the ability to focus on the implementation of one’s goals and prioritizing the goals among people practicing various sports disciplines. Full article
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9 pages, 683 KiB  
Article
The Sense of Coherence and Health Behavior of Men with Alcohol Addiction
by Mateusz Curyło, Marlena Rynkiewicz-Andryśkiewicz, Przemysław Andryśkiewicz, Marcin Mikos, Dariusz Lusina, Jan W. Raczkowski, Grzegorz Juszczyk, Artur Kotwas, Katarzyna Sygit, Kamila Kmieć, Elżbieta Cipora, Mateusz Kaczmarski, Tomasz Banaś, Łukasz Strzępek, Andrzej Śliwczyński, Jan Krakowiak, Jakub Świtalski, Olga Partyka and Aleksandra Czerw
Int. J. Environ. Res. Public Health 2022, 19(14), 8650; https://doi.org/10.3390/ijerph19148650 - 16 Jul 2022
Cited by 1 | Viewed by 2856
Abstract
Introduction: Alcohol dependence is one of the world’s major health challenges. The salutogenic concept of health developed by Antonovsky focuses on the search for resources and factors supporting health. Its basic concept of the sense of coherence (SOC) focuses on strengthening the global [...] Read more.
Introduction: Alcohol dependence is one of the world’s major health challenges. The salutogenic concept of health developed by Antonovsky focuses on the search for resources and factors supporting health. Its basic concept of the sense of coherence (SOC) focuses on strengthening the global orientation of the patient, and creating permanent internal resources that translate into the improvement of pro-health behavior, including the fight against alcoholism. Objective: The objective of this study was to determine the correlation between individual factors and the SOC as well as the influence of the SOC concept on pro-health behavior of people addicted to alcohol. Materials and methods: The study group consisted of 110 men undergoing treatment in an addiction treatment ward. To check the level of the SOC, two standardized questionnaires, Antonovsky’s “SOC-29 Life Orientation Questionnaire” and Juczyński’s “Health Behaviour Inventory”, were used. The correlation coefficient between the sociodemographic variables was checked using the Pearson’s r test. Results: A positive correlation was found with the intensity of pro-health behaviors for three sociodemographic variables. In people aged 43–65 (r = 0.299; p = 0.030), people with primary/vocational education (r = 0.276; p = 0.015), and respondents living in rural areas (r = 0.303; p = 0.028) a greater SOC was associated with pro-health behaviors. Conclusions: Individuals addicted to alcohol are characterized by a low SOC and a low level of pro-health behaviors. Strengthening the internal level of the SOC can constitute an element of addiction therapy when introducing health education to prepare the patient for independent life in sobriety. Full article
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14 pages, 531 KiB  
Article
The Intensity of the Health Behaviors of People Who Practice Wheelchair Basketball, Wheelchair Rugby and Para-Rowing
by Maria Alicja Nowak, Marek Kolbowicz, Michalina Kuska, Katarzyna Sygit, Marian Sygit, Leonard Nowak and Katarzyna Kotarska
Int. J. Environ. Res. Public Health 2022, 19(13), 7879; https://doi.org/10.3390/ijerph19137879 - 27 Jun 2022
Cited by 2 | Viewed by 2175
Abstract
Sports serve people with disabilities as a form of rehabilitation. Sporting activity is a health-promoting behavior choice and a chance to achieve the best possible sports results. The aim of this study was to evaluate the intensity of health behaviors in people practicing [...] Read more.
Sports serve people with disabilities as a form of rehabilitation. Sporting activity is a health-promoting behavior choice and a chance to achieve the best possible sports results. The aim of this study was to evaluate the intensity of health behaviors in people practicing wheelchair basketball, wheelchair rugby and para-rowing. The study encompassed 176 athletes with disabilities, aged 19 to 49 (mean age 34.41 ± 8.56), from all over Poland. Men accounted for 83.5% of the respondents. They all had a significant degree of disability and used wheelchairs in their daily lives. The authors used Juczyński’s Health Behavior Inventory (HBI) and the authors’ own survey questionnaire. Nonparametric tests were used. A greater intensity of health behaviors in general (HBI—point score) and in four categories (correct eating habits—CEH, preventive behaviors—PB, positive mental attitude—PMA, health practices—HP) was observed in rugby and basketball players (compared with para-rowers). Disabled rowers achieved the poorest results. Polish Champions scored better results in preventive behaviors (PB) and weaker results in positive mental attitude (PMA)compared with those practicing amateur sport. Respondents who trained every day and had the longest weekly exercise time (>360 min) achieved the highest results in HBI in general and in all categories compared with those who trained once a week for less than 120 min a week. Respondents with higher education, those in a better financial situation, those who were employed and married, and those who were rural residents displayed a greater intensity of health-related behaviors. People in a more difficult financial situation, who had less education, who were cohabiting, and who lived on only a pension presented more preventive behaviors. There is a need for systemic health education aimed at people with disabilities who practice various sports disciplines. Full article
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22 pages, 1204 KiB  
Article
Changes in Attitudes toward Tobacco Smoking and Factors Associated with Quitting in 9-Year Observation of PURE Poland Cohort Study
by Katarzyna Połtyn-Zaradna, Piotr Psikus and Katarzyna Zatońska
Int. J. Environ. Res. Public Health 2022, 19(11), 6564; https://doi.org/10.3390/ijerph19116564 - 27 May 2022
Cited by 2 | Viewed by 1656
Abstract
(1) Background: This study aims to examine changes in tobacco smoking prevalence in the PURE Poland cohort study over the 9-year follow-up period. Moreover, it attempts to identify socio-demographic factors that affect changes in attitudes towards tobacco smoking. (2) Methods: The PURE Poland [...] Read more.
(1) Background: This study aims to examine changes in tobacco smoking prevalence in the PURE Poland cohort study over the 9-year follow-up period. Moreover, it attempts to identify socio-demographic factors that affect changes in attitudes towards tobacco smoking. (2) Methods: The PURE Poland cohort study—baseline was performed in 2007–2010 and covered 2036 participants, including urban (59.4%) and rural (40.6%) residents of Lower Silesia, Poland. The following study reports the results of 1690 participants who took part in both the baseline (2007–2010) study and 9-year follow-up (2016–2019). (3) Results: There was a 3.5% decrease in current smokers during the analyzed period (from 20.2% at the baseline study to 16.7% in the 9-year follow-up). Living in rural area increased the likelihood of being a current smoker by more than 1.5-fold (OR = 1.65 CI = 1.26–2.14) and decreased the likelihood of being a former smoker (OR = 0.70 CI = 0.57–0.86). In the 9-year follow-up period, more women were current smokers than men (17.2% vs. 16.0%) and women had lower chances of being former smokers than men (OR = 0.77 CI = 0.62–0.95). People with a primary education had 1.5-fold higher likelihood of being a current smoker (OR = 1.45 CI = 1.03–2.05). Nearly 11% significant increase in the percentage of current smokers was observed in the oldest age group (1.9% in the baseline study vs. 12.6% in the follow-up period). (4) Conclusions: The results obtained during 9 years of observation indicate the necessity of intensifying anti-tobacco programs especially targeting women, elderly population, people with lower level of education, rural residents, and the unemployed. Full article
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Review

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11 pages, 593 KiB  
Review
Quality of Life in Patients with Pancreatic Cancer—A Literature Review
by Elżbieta Cipora, Aleksandra Czerw, Olga Partyka, Monika Pajewska, Anna Badowska-Kozakiewicz, Marta Fudalej, Katarzyna Sygit, Mateusz Kaczmarski, Edyta Krzych-Fałta, Anna Jurczak, Katarzyna Karakiewicz-Krawczyk, Sylwia Wieder-Huszla, Tomasz Banaś, Ewa Bandurska, Weronika Ciećko, Dariusz Artur Kosior, Piotr Kułak and Andrzej Deptała
Int. J. Environ. Res. Public Health 2023, 20(6), 4895; https://doi.org/10.3390/ijerph20064895 - 10 Mar 2023
Cited by 6 | Viewed by 3563
Abstract
Pancreatic cancer is the malignant disease with the highest mortality rate, and it ranks third in the world after lung and colon cancer. Identified factors that increase the risk of developing pancreatic cancer include chronic pancreatitis, radiation therapy to the pancreatic area due [...] Read more.
Pancreatic cancer is the malignant disease with the highest mortality rate, and it ranks third in the world after lung and colon cancer. Identified factors that increase the risk of developing pancreatic cancer include chronic pancreatitis, radiation therapy to the pancreatic area due to another cancer, diabetes mellitus, obesity, smoking, and age. The objective of this study was to present the current state of knowledge on the quality of life of patients diagnosed with pancreatic cancer, factors that determine QoL, and ways of coping with the disease. The low curability and low survival rates of pancreatic cancer significantly affect the quality of life of patients, often in the form of significant deterioration, especially in terms of mental changes, cognitive functions, and coping with the disease. Cognitive decline with comorbid depression is also typical for patients with this type of cancer. Research has shown that the health-related quality of life of patients with pancreatic cancer is low, so further research is needed to improve the situation in this area. Full article
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12 pages, 363 KiB  
Review
Nutritional Treatment of Patients with Colorectal Cancer
by Agata Lewandowska, Urszula Religioni, Aleksandra Czerw, Andrzej Deptała, Beata Karakiewicz, Olga Partyka, Monika Pajewska, Katarzyna Sygit, Elżbieta Cipora, Kamila Kmieć, Anna Augustynowicz, Dominika Mękal, Michał Waszkiewicz, Agnieszka Barańska, Daniela Mináriková, Peter Minárik and Piotr Merks
Int. J. Environ. Res. Public Health 2022, 19(11), 6881; https://doi.org/10.3390/ijerph19116881 - 4 Jun 2022
Cited by 17 | Viewed by 7791
Abstract
Colorectal cancer is one of the most common cancers in Europe and the world. Cancer treatments have side effects and cause significant deterioration of the patient’s nutritional status. Patient malnutrition may worsen the health condition and prevent the deliberate effects of the therapy. [...] Read more.
Colorectal cancer is one of the most common cancers in Europe and the world. Cancer treatments have side effects and cause significant deterioration of the patient’s nutritional status. Patient malnutrition may worsen the health condition and prevent the deliberate effects of the therapy. The aim of this review was to describe the available data about clinical nutrition in colorectal cancer patients. A large proportion of colorectal cancer patients suffer from malnutrition, which negatively affects the survival prognosis, quality of life, and oncological therapy. Therefore, monitoring nutritional status during the treatment is essential and can be used to arrange proper nutritional therapy to enhance patient responses, prevent side effects, and shorten recovery time. The principles of nutrition during anticancer therapy should mainly consider light and low-fat foods, the exclusion of lactose and gluten-containing foods in certain cases, or the introduction of special dietary products such as oral nutrition supplements and it should be tailored to patients’ individual needs. Full article

Other

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20 pages, 529 KiB  
Systematic Review
Interventions to Increase Patient Safety in Long-Term Care Facilities—Umbrella Review
by Jakub Świtalski, Katarzyna Wnuk, Tomasz Tatara, Wojciech Miazga, Ewa Wiśniewska, Tomasz Banaś, Olga Partyka, Katarzyna Karakiewicz-Krawczyk, Justyna Jurczak, Mateusz Kaczmarski, Grażyna Dykowska, Aleksandra Czerw and Elżbieta Cipora
Int. J. Environ. Res. Public Health 2022, 19(22), 15354; https://doi.org/10.3390/ijerph192215354 - 21 Nov 2022
Cited by 6 | Viewed by 4385
Abstract
Introduction: Patient safety in long-term care is becoming an increasingly popular subject in the scientific literature. Organizational problems such as shortages of medical staff, insufficient numbers of facilities or underfunding increase the risk of adverse events, and aging populations in many countries suggests [...] Read more.
Introduction: Patient safety in long-term care is becoming an increasingly popular subject in the scientific literature. Organizational problems such as shortages of medical staff, insufficient numbers of facilities or underfunding increase the risk of adverse events, and aging populations in many countries suggests that these problems will become more and more serious with each passing year. The objective of the study is to identify interventions that can contribute to increasing patient safety in long-term care facilities. Method: A systematic review of secondary studies was conducted in accordance with the Cochrane Collaboration guidelines. Searches were conducted in Medline (via PubMed), Embase (via OVID) and Cochrane Library. The quality of the included studies was assessed using AMSTAR2. Results: Ultimately, 10 studies were included in the analysis. They concerned three main areas: promoting safety culture, reducing the level of occupational stress and burnout, and increasing the safety of medication use. Promising methods that have an impact on increasing patient safety include: preventing occupational burnout of medical staff, e.g., by using mindfulness-based interventions; preventing incidents resulting from improper administration of medications, e.g., by using structured methods of patient transfer; and the use of information technology that is more effective than the classic (paper) method or preventing nosocomial infections, e.g., through programs to improve the quality of care in institutions and the implementation of an effective infection control system. Conclusions: Taking into account the scientific evidence found and the guidelines of institutions dealing with patient safety, it is necessary for each long-term care facility to individually implement interventions aimed at continuous improvement of the quality of care and patient safety culture at the level of medical staff and management staff. Full article
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15 pages, 1692 KiB  
Perspective
Optimization of the Use of Hospital Beds as an Example of Improving the Functioning of Hospitals in Poland on the Basis of the Provincial Clinical Hospital No. 1 in Rzeszow
by Sławomir Porada, Katarzyna Sygit, Grażyna Hejda and Małgorzata Nagórska
Int. J. Environ. Res. Public Health 2022, 19(9), 5349; https://doi.org/10.3390/ijerph19095349 - 28 Apr 2022
Viewed by 2343
Abstract
An efficient health care system combines maximum accessibility with high-quality treatments, as well as cost optimization of individual health care facilities throughout the entire system. In hospitals, the critical element is the number of beds within individual wards, which generates costs and, at [...] Read more.
An efficient health care system combines maximum accessibility with high-quality treatments, as well as cost optimization of individual health care facilities throughout the entire system. In hospitals, the critical element is the number of beds within individual wards, which generates costs and, at the same time, affects the capacity to serve patients. The aim of this article is to discuss the restructuring and optimization of hospital bed occupancy in a healthcare facility in the Podkarpackie voivodeship. The analysis covers the years 1999–2018. In the indicated period, the analyzed healthcare institution restructured the number of beds based on a forecast of the demand for services, which resulted in positive cost effects, without limiting patients’ access to diagnostic and therapeutic care. The analyzed facility took part in a common trend of optimizing cost-effectiveness and efficiency of hospital operations in Poland. Full article
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