Prevalence of Obesity among Polish Primary Care Population Considered Healthy.

Obesity is a complex disease with numerous health complications, influenced by factors such as genetics, lifestyle, mental health, societal impact, economic status, comorbidities, and treatments. This multicenter study included adults aged ≥35 years referred to a CVD prevention program, where sociodemographic data, anthropometric examinations, laboratory tests, and HLPCQ responses were collected. The study analyzed 1044 patients with a mean age of 47.9 years. Among them, 22.2% (232 patients) were diagnosed with obesity. These patients exhibited higher blood pressure, non-HDL cholesterol, triglycerides, and glucose levels (all p < 0.001). A comparative analysis showed that obese patients had significantly lower scores in healthy dietary choices, dietary harm avoidance, daily routine, organized physical exercise, and overall HLPCQ scores. These results indicate that individuals considered healthy were actually living with obesity and its associated complications. Consequently, family physicians should proactively identify patients at risk of obesity using existing programs. The Polish healthcare system urgently needs systemic solutions, including effective health promotion and the creation of obesity prevention programs at an early stage of adult life. These measures are essential to address the growing obesity epidemic and improve public health outcomes.

Self-medication of adults and children in Poland - results from outpatient health care physicians online questionnaire.

Introduction: In Poland, the area of self-medication requires scientific and organizational evaluation. So far, no solutions sanctioning self-medication have been introduced. Therefore, the aim of this study was to recognize and analyze the practical experience of outpatient physicians regarding self-medication of their patients, as well as self-medication of children by their caregivers. Methods: This study enrolled 386 participants and used a Computer-Assisted Web Interview that was disseminated online from 4th of July 2023 to 23rd of August 2023. The survey was addressed to outpatient healthcare physicians working in Poland. Results: In doctors' perspective the main three reasons for choosing self-medication in Poland were: taking advice from other people - family members or friends (59.1%), finding information regarding treatment online (52.9%) and ability to self-medicate in this kind of symptoms/disease (51.6%). Among adult patients, in 72.1% of cases, an independent decision to start antibiotic therapy was made. Such a decision occurred in 39.8% of pediatric patients. Children caregivers were more likely to visit the physician immediately with symptoms than in the case of adult patients (42.2% vs. 22.1%, p < 0.001). Conclusions: Self-medication in Poland requires educational and organizational support at various levels - both social (information campaigns, school education), the healthcare system (increasing the role of medical professionals, including pharmacists), and finally in the area of legislation. Two areas seem to be particularly alarming - the use of antibiotics by adults and children and the mental health of both populations.

Association between Symptoms of Depression and Generalised Anxiety Disorder Evaluated through PHQ-9 and GAD-7 and Anti-Obesity Treatment in Polish Adult Women.

Obesity impacts mental health greatly. Psychological factors may influence the effectiveness of its treatment. This study aimed to compare symptoms of generalised anxiety disorder and depression among adult women across different weight categories. The study sample comprised 1105 adult women. The computer-assisted web interview (CAWI) utilising the seven-item Generalised Anxiety Disorders Scale (GAD-7) and the nine-item Patient Health Questionnaire (PHQ-9) was used. Both GAD-7 and PHQ-9 scores correlated positively with BMI (r = 0.121, p < 0.001 and r = 0.173, p < 0.001, respectively) and negatively with age (r = -0.106, p < 0.001 and r = -0.103, p < 0.001, respectively). Patients undergoing treatment with semaglutide scored lower for both anxiety symptoms (8.71 ± 6.16, p = 0.013) and depression symptoms (9.76 ± 6.37, p = 0.013). Women who underwent bariatric surgery screened less frequently for anxiety (8.03 ± 6.27, p = 0.002) but not for depression. An interdisciplinary approach involving mental health professionals within the therapeutic team can comprehensively address factors contributing to obesity development and treatment outcomes. Further investigation of semaglutide's use is needed due to the promising evidence suggesting a positive effect on decreasing the severity of depression and anxiety symptoms to assess the direct or indirect character of this influence.

The impact of lifestyle, measured with the HLPCQ questionnaire on the prevalence of metabolic syndrome in Poland: a multicenter study.

Metabolic syndrome is one of the most common health problems for people around the world. The aim of our study was to assess the prevalence of metabolic syndrome among adults without prior diagnosis of cardiovascular disease, diabetes, and chronic kidney disease. We also plan to assess the influence of certain lifestyle components on prevalence of metabolic syndrome. The study involved cardiovascularly healthy patients undergoing lab tests, measurements, and the HLPCQ questionnaire (The Healthy Lifestyle and Personal Control Questionnaire). The data were used to diagnose metabolic syndrome. Out of 1044 patients from 10 primary care facilities, 23.3% met the metabolic syndrome criteria, showing a strong link with increased blood pressure, cholesterol, and fasting glucose. Lower scores in the Organized physical exercise subscale of the HLPCQ questionnaire were noted in those with metabolic syndrome. Comparing the subscale of HLPCQ questionnaire, the lower results in Organized physical exercise subscale were found among the participants with metabolic syndrome, both male and females. Metabolic syndrome, a significant risk factor for cardiovascular disease, should be screened for actively, even in apparently healthy populations. Results obtained in our study from analysis of HLPCQ show that screening for metabolic syndrome should be preceded by prevention based on regular physical activity and proper eating habits.

Is Obesity a Cause for Shame? Weight Bias and Stigma among Physicians, Dietitians, and Other Healthcare Professionals in Poland-A Cross-Sectional Study.

Weight bias and weight stigma pose significant challenges in healthcare, particularly affecting obesity management practices and patient care quality. Our study evaluates their prevalence and impact among healthcare professionals in Poland. Using the Fat Phobia Scale and custom questions, we surveyed 686 professionals via Computer-Assisted Web Interview (CAWI). Results reveal a moderate level of explicit weight bias (mean score: 3.60 ± 0.57), with significant variations across professional groups: physicians (3.70 ± 0.48), dietitians (3.51 ± 0.48), and others (3.44 ± 0.77). Common feelings towards individuals with obesity include willingness to help (57.0%) and compassion (37.8%), yet 29.9% perceive obesity as shameful. The results also vary depending on the respondent's sex or BMI. These findings underscore the need for evidence-based interventions to mitigate weight stigma and enhance understanding of obesity among healthcare professionals.

Teleconsultation as a Modern Form of Health Care Service in the Case of Poland: Assessment of Its Potential Use from the Perspective of Health Care Providers and Patients.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has facilitated access to health care services through telemedicine in Poland, where it has not been a common approach so far. Therefore, the aim of this study was to evaluate telemedicine as a form of health care provision in the Polish health care system. Methods: An online questionnaire was distributed to 2,318 patients and health care workers. Questions included telemedical services usage, attitude toward telemedical consultations, who should decide about the nature of the consultation, advantages and disadvantages of telemedicine, the possibility of teleconsultations remaining available after the pandemic, and the subjective perception of overuse of remote consultations by doctors. Results: In general, respondents approved of teleconsultations (3.62 on 1-5 scale) but specific clinical situations gained higher and lower scores-among the highest ranking were prescription renewal (4.68), interpretation of examination results (4.15), and treatment continuation/follow-up (3.81). Among least ranking were consulting children 2-6 years old (1.93) and children younger than 2 years old (1.55) as well as consulting acute symptoms (1.47). Health care workers rated their general attitude significantly higher than nonhealth care workers toward telemedicine consults (3.91 vs. 3.34, p < 0.001) and toward 12 out of 13 specific clinical situations and settings (p < 0.001). The only exception was "consulting acute symptoms," which received exactly the same rating within both groups (1.47, p = 0.99). Most respondents agreed that teleconsultations should remain an option for contacting a physician regardless of the epidemic situation. Each group declared that they should be the one to decide about the consultation form. Conclusions: Results of this study could help optimize and facilitate telemedical consultation usage after the COVID-19 pandemic.

Beneficial effects of SARS-CoV-2 vaccination resulting from the COVID-19 pandemic with regard to the uptake of influenza virus, pneumococcal, and herpes zoster adult vaccination - a narrative literature review.

INTRODUCTION AND OBJECTIVE: Analysis of factors influencing COVID-19 vaccination coverage in various countries raised the question whether the recent pandemic affected the vaccination rates of other pathogens in adults. Therefore, the aim of this review article was to analyse the literature to find potentially beneficial effects of the introduction of the large-scale vaccinations resulting from the COVID-19 pandemic, with regard to the influenza virus, pneumococcal and herpes zoster adult vaccinations, in order to identify factors and strategies to increase the uptake of these vaccines. REVIEW METHODS: The review of the literature was based on scientific articles indexed in the PubMed Database published between 2022-2023, during the COVID-19 pandemic. Data search was performed from 24-30 July 2023. BRIEF DESCRIPTION OF THE STATE OF KNOWLEDGE: It was found that the COVID-19 pandemic has had a beneficial effect on the acceptance and coverage of influenza and pneumococcal vaccination in the vulnerable elderly populations, and among healthcare workers in the case of influenza. Furthermore, the COVID-19 outbreak affected the designs of vaccine clinical trials, resulting in a lower frequency of age-related exclusion criteria, broadening the group of vaccine recipients. SUMMARY: Acceptance of COVID-19 vaccination increased willingness to accept other vaccines. The attitude to vaccination is a personal decision-making process based on previous experience and interpersonal interactions, greatly affected by information and recommendation from medical professionals. The COVID-19 pandemic vaccination implementation opened new opportunities to develop prevention efforts and build vaccination strategies in middle-income countries.

Weight stigma and fat phobia in Poland - attitudes towards people living with obesity and the level of knowledge about obesity among the social media internet respondents and medical professionals.

Introduction: Obesity often subjects individuals to stigmatization, impacting self-esteem, contributing to depression, social isolation, and even exacerbating weight gain. Our research aimed to evaluate weight stigma, fat phobia, their expressions, and obesity-related knowledge among social media internet respondents and medical practitioners in Poland. Methods: Conducted through Computer-Assisted Web Interview (CAWI), our study employed the Fat Phobia Scale (FPS) and tailored questions, analyzing 1705 questionnaires. Results: The respondents averaged a score of 3.60 ± 0.62 on the FPS. Interestingly, men exhibited higher stigma levels than women. Variables like BMI, residency, and interactions with people having obesity did not significantly impact stigma levels. Approximately 74.0% of respondents found individuals with obesity less attractive than those with normal weight, while 32.2% identified obesity as a cause of shame. Only 69.1% were aware of the BMI-based obesity diagnosis criterion. Conclusion: Given limited knowledge of Poland's weight stigma landscape, our research yields crucial insights for shaping social campaigns and enhancing educational initiatives in obesity management for healthcare professionals. Further studies will be instrumental in addressing patient and practitioner needs effectively.

Maladaptive Eating Behaviours, Generalised Anxiety Disorder and Depression Severity: A Comparative Study between Adult Women with Overweight, Obesity, and Normal Body Mass Index Range.

(1) Background: Causes of obesity are multifactorial and include genetic predisposition as well as behavioural, psychological, social, and hormonal influences. We aimed to compare adult women with normal weight, overweight, and obesity, with a focus on maladaptive eating behaviours, the presence of generalised anxiety disorder, and the severity of depression. Additionally, we explored the context of anti-obesity pharmacotherapy and the status of bariatric surgery. (2) Methods: The sample was composed of 1105 adult women. The following measures, through the Computer-Assisted Web Interview (CAWI), were used in the present study: the Three Factor Eating Questionnaire (TFEQ-R18), the 7-item Generalised Anxiety Disorders Scale (GAD-7), and the 9-item Patient Health Questionnaire (PHQ-9). (3) Results: All domains of the TFEQ-R18 had correlations with Body Mass Index (BMI). There was a weak negative association between BMI and Cognitive Restraint (r = -0.172, p < 0.001) and a weak positive relationship between BMI and Uncontrolled as well as Emotional Eating (r = 0.165, p < 0.001; r = 0.191, p < 0.001, respectively). Women who screened positive for anxiety scored lower in the Cognitive Restraint domain (10.11 ± 3.58, p = 0.042) and higher in the Uncontrolled Eating (12.69 ± 6.04, p < 0.001) and Emotional Eating (5.29 ± 2.75, p < 0.001) domains. Similarly, women screening positive for depression had lower scores in Cognitive Restraint (9.88 ± 3.61, p < 0.001) and higher scores in Uncontrolled Eating (12.64 ± 6.09, p < 0.001) and Emotional Eating (5.31 ± 2.71, p < 0.001). A significant association between liraglutide and semaglutide administration and Cognitive Restraint was observed. (4) Conclusions: Individualised treatment for obesity should consider the existing and confirmed association between maladaptive eating behaviours and generalised anxiety disorder, as well as the severity of depression influencing the BMI altogether. The use of anti-obesity pharmacotherapy needs further exploration because the evidence for the use of liraglutide and semaglutide in terms of positive associations with eating behaviours is encouraging.

Assessment of primary care physicians' knowledge of chronic kidney disease in Poland.

Chronic kidney disease (CKD) affects 10-15% of the adult population worldwide and is a major societal problem. A latent course of the disease and little alarming, gradually increasing symptoms usually do not cause concern in patients and diagnostic vigilance in physicians. CKD is most often diagnosed in its end-stage when treatment options are extremely limited. This study aims to assess the knowledge of CKD among primary care physicians (PCPs) in Poland. A CAWI survey was conducted based on an authors' own questionnaire that consisted of two parts. The first part concerned patients' socioeconomic data while the second part consisted of nine single- and multiple-choice questions assessing knowledge of the criterion for diagnosis, risk factors, diagnostic evaluation, and course of CKD. A total of 610 physicians took part in the survey, including 502 (82.3%) who fully completed the questionnaire. Women accounted for 83.1% of the study group. The mean age of the study group was 37.4 ± 10.1 years. Specialists or resident physicians in family medicine accounted for 79.9% of respondents and 93.8% of physicians are those who mainly work in primary care settings. In the knowledge test, the mean score obtained by physicians was 6.5 ± 1.3 out of possible 9, with only 2.4% of respondents answering all questions correctly. According to the survey, 78.4% of respondents correctly indicated the criterion for the diagnosis of CKD, while only 68.9% identified a test for increased urinary albumin loss as the one of the greatest diagnostic values in the early stages of CKD. More than half, 63.1%, of physicians selected the correct set of answers in the multiple-choice question regarding CKD risk factors. Despite a fairly high level of knowledge among family medicine physicians regarding the causes, risk factors and course of CKD, there is a need for further education and an increase in the factual information held by this professional group, especially that the vast majority of PCPs declare a desire to expand their knowledge and believe that this will help them in their daily clinical practice.

Mental Health Interest and Its Prediction during the COVID-19 Pandemic Using Google Trends.

This study aimed to analyze and predict interest in mental health-related queries created in Google Trends (GT) during the COVID-19 pandemic. The Google Trends tool collected data on the Google search engine interest and provided real-time surveillance. Five key phrases: "depression", "insomnia", "loneliness", "psychologist", and "psychiatrist", were studied for the period from 25 September 2016 to 19 September 2021. The predictions for the upcoming trend were carried out for the period from September 2021 to September 2023 and were estimated by a hybrid five-component model. The results show a decrease of interest in the search queries "depression" and "loneliness" by 15.3% and 7.2%, respectively. Compared to the period under review, an increase of 5.2% in "insomnia" expression and 8.4% in the "psychiatrist" phrase were predicted. The expression "psychologist" is expected to show an almost unchanged interest. The upcoming changes in the expressions connected with mental health might be explained by vaccination and the gradual removal of social distancing rules. Finally, the analysis of GT can provide a timely insight into the mental health interest of a population and give a forecast for a short period trend.

Association of Adiponectin, Leptin and Resistin Plasma Concentrations with Echocardiographic Parameters in Patients with Coronary Artery Disease.

The imbalanced network of adipokines may contribute to the development of systemic low-grade inflammation, metabolic diseases and coronary artery disease (CAD). In the last decade, three classic adipokines-adiponectin, leptin and resistin-have been of particular interest in studies of patients with CAD due to their numerous properties in relation to the cardiovascular system. This has directed our attention to the association of adipokines with cardiac structure and function and the development of heart failure (HF), a common end effect of CAD. Thus, the purpose of this study was to analyse the associations of plasma concentrations of adiponectin, leptin and resistin with parameters assessed in the echocardiographic examinations of CAD patients. The presented study enrolled 167 Caucasian patients (133 male; 34 female) with CAD. Anthropometric, echocardiographic and basic biochemical measurements, together with plasma concentrations of adiponectin, leptin and resistin assays, were performed in each patient. Adiponectin concentrations were negatively associated with left ventricular ejection fraction (LVEF) and shortening fraction (LVSF), and positively associated with mitral valve E/A ratio (E/A), left ventricular end-diastolic volume (LVEDV), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter LVESD, and left atrium diameter (LAD). Resistin concentrations were negatively associated with E/A. Leptin concentrations, although correlated with HF severity assessed by the New York Heart Association (NYHA) Functional Classification, were not independently associated with the echocardiographic parameters of cardiac structure or function. In conclusion, adiponectin and resistin, but not leptin, are associated with the echocardiographic parameters of cardiac remodelling and dysfunction. These associations suggest that adiponectin and resistin might be involved in mechanisms of cardiac remodelling or compensative response. We also suggest the possible benefits of adiponectin and resistin level measurements in the monitoring of patients with CAD.

Oral Health Related Behaviors in Relation to DMFT Indexes of Teenagers in an Urban Area of North-West Poland-Dental Caries Is Still a Common Problem.

Caries has a negative influence on health and is still a public health problem among children and adolescents in Poland. The aim of this study was to analyze the association of dietary habits, oral hygiene behaviors and the frequency of usage of dental services with the dental caries index in teenagers in North-West Poland. The study enrolled 264 children (147M/117F) aged 15. Participants filled out a questionnaire regarding age, sex, frequency of visits to the dentist, dietary habits and oral hygiene behaviors, and the Decayed Missing Filled Teeth Index (DMFT) was calculated. Caries was found in 88.6% of subjects. The lower or no caries experience group (DMFT ≤ 5) comprised of 180 subjects, while higher caries experience (DMFT > 5) was found in 84 teenagers and was significantly inversely associated with tooth brushing after the last meal (OR = 0.45; 95% CI:0.21-0.97; p = 0.04) and the daily use of dental floss (OR = 0.12; 95% CI:0.01-0.92; p = 0.04). There is an emerging need for the implementation of effective caries prevention and recovery programs in Poland. Health promotion focusing on oral hygiene behaviors should be disseminated more widely because lower caries experience was demonstrated in teenagers declaring healthy oral habits. Another important need is the development of multi-sectorial actions aiming at the improvement of dietary habits.

The Association between Lifestyle Choices and Schizophrenia Symptoms.

Due to poor eating habits, insufficient physical activity, and nicotine use, schizophrenia patients are at increased risk of lifestyle diseases. Factors contributing to unhealthy behaviors include lower socioeconomic status and level of education as well as social isolation. Schizophrenia manifestations such as amotivation, apathy, and cognitive deficits can further hinder development of proper health habits. The aim of this study was to assess the possible association between lifestyle-related choices and schizophrenia symptoms severity. This observational study enrolled 106 patients with schizophrenia (42 Males/64 Females), 18-69 years (mean: 41.89 ± 9.7 years). Mean duration of schizophrenia was 14.61 ± 9.7 years. Multiple significant correlations were found between patients' lifestyle and their biochemical laboratory parameters (lipid profile and fasting glucose). Most importantly, a significant link emerged between presented habits and schizophrenia symptom severity. There were also significant gender differences in the intake of sweets and sweet beverages. Quite unexpectedly, a behavioral shift towards more healthy lifestyle choices was observed after completion of questionnaires on lifestyle and health habits. There are clear benefits to systematic provision of educational interventions concerning physical activity and proper eating habits to schizophrenia patients. These simple preventive measures could significantly improve both mental and physical health outcomes in schizophrenia patient populations.

Evaluation of hyperhomocysteinemia prevalence and its influence on the selected cognitive functions in patients with schizophrenia.

There is evidence that hyperhomocysteinemia may be associated with the development of schizophrenia and cognitive impairment. Therefore, the aim of this study was to analyze the relationship between cognitive functions and normal homocysteine concentrations vs. hyperhomocysteinemia in schizophrenia patients before and after supplementation with vitamins B6, B12 and folate. An 8-week prospective, non-randomized study enrolled 122 adult patients with schizophrenia (67F/55M, mean age 43.54 ±â€¯11.94 years). Homocysteine concentrations were measured in all individuals and afterwards hyperhomocysteinemia patients (n = 42) were divided into two subgroups: treated with oral vitamins supplementation (B6 - 25 mg/d, B12 - 20 µg/d, folate - 2,5 mg/d) (n = 22) and without supplementation (n = 20). The assessment of schizophrenia symptoms severity in study group was performed using the Positive and Negative Syndrome Scale (PANSS). Cognitive functions were evaluated using the Stroop test and the Trail Making Test (TMT). We observed a higher prevalence of hyperhomocysteinemia in schizophrenia patients (34.4%) in comparison to the general population. Individuals with schizophrenia and coexisting hyperhomocysteinemia had worse performance on the Stroop and the TMT tests as well as higher PANSS scores. In these patients, supplementation with vitamins effectively decreased the homocysteine concentrations to the normal values, however there was no statistically significant improvement in the PANSS and cognitive test scores, except a significant decrease in the number of the Stroop test errors. We conclude that significant results obtained in this study show that there is a relationship between homocysteine blood concentration and schizophrenia severity. Moreover, homocysteine concentration lowering might be beneficial in schizophrenia patients with hyperhomocysteinemia in terms of cognitive functions improvement.

IL17A and IL17F genes polymorphisms are associated with histopathological changes in transplanted kidney.

BACKGROUND: Interleukin 17 is a proinflammatory cytokine involved in immune response after allograft transplantation. IL-17 family of proinflammatory cytokines includes IL-17A and IL-17F. Previous studies have demonstrated that the rs2275913 IL17A and the rs11465553 IL17F gene polymorphism are associated with kidney allograft function. Because of the association between these polymorphisms and post-transplant immune response, we assume that these single nucleotide polymorphisms may affect morphological structure of transplanted kidney. The aim of this study was to examine the association of rs2275913 IL17A and rs2397084, rs11465553 and rs763780 IL17F gene polymorphisms with histopathological changes in transplanted kidney biopsies such as: glomerulitis, tubulitis, arteritis, cell infilitration and fibrosis. METHODS: The study enrolled 82 patients after renal graft transplantation in whom a kidney biopsy was performed because of impaired graft function. The rs2397084 T > C (Glu126Gly), rs11465553 G > A (Val155Ile) and rs763780 T > C (His167Arg) polymorphisms within the IL17F gene and the rs2275913 A > G (- 197 A > G) polymorphism within the IL17A gene promoter were genotyped using TaqMan genotyping assays on a 7500 FAST Real-Time PCR System (Applied Biosystems, USA). RESULTS: There was a significant association between the rs2275913 IL17A gene polymorphism and the grade of tubulitis, which was more severe among patients with the A allele, compared to recipients with the GG genotype (GG vs. AG + AA, P = 0.02), and with the grade of arteriolar hyaline thickening and mesangial matrix increase, which were more severe among patients with the G allele compared to recipients with the AA genotype (AA vs. AG + GG, P = 0.01 and P = 0.04, respectively). Tubular atrophy and interstitial fibrosis were more severe among individuals with the C allele at the rs763780 IL17F gene polymorphism (TT vs. TC, P = 0.09 and P = 0.017, respectively). However, it should be taken into account that the statistical significance was achieved without correction for multiple testing, and no significant association would remain significant after such correction. CONCLUSIONS: The results of this study may suggest a possible association between the rs2275913 IL17A and rs2275913 IL17A gene polymorphisms and some histopathological changes in transplanted kidney biopsies.

Alcohol Drinking Pattern Is Associated with Demographic Features of Primary Health Care Patients in Poland: A Cross-Sectional Study.

BACKGROUND The Optimizing Delivery of Health Care Interventions (ODHIN) project focused on the implementation of screening and brief intervention for hazardous and harmful alcohol consumption in primary health care. The aim of the present study was to investigate whether alcohol drinking pattern is associated with demographic features of primary health care patients in Poland and if it is possible to identify groups at highest risk for hazardous and harmful drinking. MATERIAL AND METHODS The study enrolled 8805 adult (mean age 54.98±16.94, M/F - 3581/5224) patients reporting to 30 general practitioners working in 10 primary health care units located in urban and partially rural areas in Poland. The shortened, 3-item version of the Alcohol Use Disorders Identification Test (AUDIT-C) was the screening tool used. RESULTS Place of residence was significantly associated with higher odds of hazardous and harmful drinking diagnosis, referred to as AUDIT-C (+). Age and sex were significantly associated with AUDIT-C (+) and suspicion of alcohol dependence, referred to as AUDIT-C ³8 scores. Logistic regression revealed that males had 5-fold higher odds for hazardous and harmful drinking diagnosis and almost 28-fold higher odds for suspected alcohol dependence compared to females. CONCLUSIONS Demographic features are associated with drinking pattern of primary health patients in Poland. Young males and those inhabiting rural areas are at highest risk of being hazardous or harmful drinkers and of being alcohol dependent. There is a growing need for development of national guidelines to address the prevention of alcohol-related health problems by general practitioners.

Impact of practice, provider and patient characteristics on delivering screening and brief advice for heavy drinking in primary healthcare: Secondary analyses of data from the ODHIN five-country cluster randomized factorial trial.

BACKGROUND: The implementation of primary healthcare-based screening and advice that is effective in reducing heavy drinking can be enhanced with training. OBJECTIVES: Undertaking secondary analysis of the five-country ODHIN study, we test: the extent to which practice, provider and patient characteristics affect the likelihood of patients being screened and advised; the extent to which such characteristics moderate the impact of training in increasing screening and advice; and the extent to which training mitigates any differences due to such characteristics found at baseline. METHODS: A cluster randomized factorial trial involving 120 practices, 746 providers and 46 546 screened patients from Catalonia, England, the Netherlands, Poland, and Sweden. Practices were randomized to receive training or not to receive training. The primary outcome measures were the proportion of adult patients screened, and the proportion of screen-positive patients advised. RESULTS: Nurses tended to screen more patients than doctors (OR = 3.1; 95%CI: 1.9, 4.9). Screen-positive patients were more likely to be advised by doctors than by nurses (OR = 2.3; 95%CI: 1.4, 4.1), and more liable to be advised the higher their risk status (OR = 1.9; 95%CI: 1.3, 2.7). Training increased screening and advice giving, with its impact largely unrelated to practice, provider or patient characteristics. Training diminished the differences between doctors and nurses and between patients with low or high-risk status. CONCLUSIONS: Training primary healthcare providers diminishes the negative impacts that some practice, provider and patient characteristics have on the likelihood of patients being screened and advised. Trial registration ClinicalTrials.gov. Trial identifier: NCT01501552.

Delivery of Brief Interventions for Heavy Drinking in Primary Care: Outcomes of the ODHIN 5-Country Cluster Randomized Trial.

PURPOSE: We aimed to test whether 3 strategies-training and support, financial reimbursement, and an option to direct screen-positive patients to an Internet-based method of giving brief advice-have a longer-term effect on primary care clinicians' delivery of screening and advice to heavy drinkers operationalized with the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) tool. METHODS: We undertook a cluster randomized factorial trial with a 12-week implementation period in 120 primary health care units throughout Catalonia, England, Netherlands, Poland, and Sweden. Units were randomized to 8 groups: care as usual (control); training and support alone; financial reimbursement alone; electronic brief advice alone; paired combinations of these conditions; and all 3 combined. The primary outcome was the proportion of consulting adult patients (aged 18 years and older) receiving intervention-screening and, if screen-positive, advice-at 9 months. RESULTS: Based on the factorial design, the ratio of the log of the proportion of patients given intervention at the 9-month follow-up was 1.39 (95% CI, 1.03-1.88) in units that received training and support as compared with units that did not. Neither financial reimbursement nor directing screen-positive patients to electronic brief advice led to a higher proportion of patients receiving intervention. CONCLUSIONS: Training and support of primary health care units has a lasting, albeit small, impact on the proportion of adult patients given an alcohol intervention at 9 months.