Epidemiology of physical inactivity in Poland: prevalence and determinants in a former communist country in socioeconomic transition.

OBJECTIVES: The aim of this study was to identify physical activity patterns and determinants of physical inactivity in a representative sample of Polish adults. STUDY DESIGN: A cross-sectional analysis of 14 769 randomly selected individuals (52.7% women and 47.3% men) aged 20-74 years participating in the National Polish Health Survey, WOBASZ (2002-2005). METHODS: Sociodemographic and lifestyle details were collected. Assessment of physical activity was based on selected questions from the CINDI Health Monitor Questionnaire. RESULTS: Approximately 35% of Polish adults are not physically active in leisure time, whilst 39.5% declare sufficient level of leisure-time physical activity. Leisure-time inactivity is significantly less likely in persons aged <35 years, those with university education and those living in rural areas. Almost 48% of men and 28.4% of women employed full- or part-time report highly active work, whilst sedentary work is reported by 42.7% of women and 30.2% of men. Low occupational activity is more prevalent in young adults, persons with university education and those living in large urban areas. Nearly 67% of the entire working population report no active commuting. CONCLUSIONS: There is a need to promote various forms of physical activity, with special attention on active commuting and leisure-time activities across both genders and all age groups. Public health policies and programmes should focus on substantial differences between various sociodemographic groups.

Age and hypertension related changes in genotypes of MTHFR 677C>T, 1298A>C and PON1 -108C>T SNPs in men with coronary artery disease (CAD).

The phenotypes of CAD related to arterial hypertension co-occurrence were analysed in 174 male patients and 117 control men for the associations with the polymorphisms of the MTHFR gene (677C>T and 1298A>C) and the PON1 gene (-108C>T) in relation to age at diagnosis (less or equal and more than 50 years). We noted the increased frequency of the three MTHFR genotypes: CC/AC, CT/AA and CC/CC in the CAD group (65.5%) in comparison to the control group (45.3%), corresponding to the 2.3-fold increased risk of CAD for men with these genotypes (95%CI (1.4-3.7); p=0.0005). The higher increase in risk of CAD was noted for the younger men (OR=3.6; 95%CI(1.6-8.3); p=0.002) and lower for the older (OR=1.8; 95%CI(1.0-3.4); p=0.03). In the normotensive men the greater impact on CAD risk had the homozygous genotypes; the 2.3-fold higher risk was associated with MTHFR CC/AC, CC/CC and TT/AA genotypes (95%CI(1.2-4.4); p=0.01). After adjustment for age, the association between CAD and MTHFR was significant only for the younger normotensive men (OR=2.8; 95%CI (1.0-8.0); p=0.04). Additionally, we found that the younger part of the control group was characterized by higher frequency of the low expression PON1 -108T allele and PON1 -108TT genotype (0.54 and 31.9% respectively) in comparison to the older men (0.41 and 17.1% respectively; p=0.03).

Arterial distensibility, intima media thickness and pulse wave velocity after renal transplantation and in dialysis normotensive patients.

AIM: Structural and mechanical properties of the arterial wall are altered in patients with renal failure. The ageing process of the arterial wall appears to be accelerated in patients with end-stage renal failure. The mechanisms responsible for reduced arterial compliance and distensibility in dialysis patients and renal transplant recipients without hypertension remain to be evaluated. METHODS: Thirty-five normotensive dialysis patients (D), 35 normotensive renal transplant recipients (T) and 35 healthy volunteers (N) matched for age, sex and blood pressure as controls were enrolled into the study. The arterial blood pressure of all patients was < 140/90 mmHg. The dialysis patients and renal transplant recipients were eligible for the study if the serum creatinine level was < 2 mg/dL. In all subjects, fasting concentrations of serum creatinine, total cholesterol, HDL-cholesterol, LDL-cholesterol and hemoglobin and glucose were determined at enrollment to the study. Blood pressure was measured using an automatic sphygmomanometer. Pulse wave velocity (PWV) was evaluated using non invasive automatic Complior device. The vessel wall properties of the left common carotid artery were studied using multigate pulsed Doppler system. With this method, the end-diastolic diameter (d) and the systolic increase of vessel diameter (distension DELTAd) were measured. From these data the relative systolic increase of vessel diameter (DELTAd/d) and the arterial wall distensibility coefficient (DC) were calculated. RESULTS: Systolic blood pressure (SBP) and central pulse pressure (CPP) were significantly higher in T than in D and N group, respectively 138 +/- 18 mmHg and 59 +/- 16 mmHg vs 128 +/- 13 mmHg and 49 +/- 12 mmHg and 132.12 mmHg and 51 +/- 10 mmHg. The d did not change significantly between all groups. The distension DELTAd was significantly lower in patients group D and T, respectively 466 +/- 38 microm and 511 +/- 37 microm than in controls. Similarly DELTAd/d was in these groups significantly lower than in healthy volunteers, respectively D 6.33 +/- 0.5%, T 6.9 +/- 0.4% vs N 9.15 +/- 0.5%. DC was also significantly lower in D and T than in N groups, respectively D 17.91 +/- 1.5 10-3/kPa and T 18.92 +/- 1.3 10-3/kPa and N 24.28 +/- 0.51-3/kPa. Significant differences were found in the increase of the intima-media thickness (IMT) of carotid artery for dialyzed patients and renal transplant recipients in contrast to the control group, but there were no differences between the patients. PWV in both patient groups was statistically significant higher than in control group correspondingly D 11.1 +/- 1.03 m/s and T 13.3 +/- 1.13 m/s, N 9.4 +/- 0.89 m/s. There was a significant correlation between the change of DC, PWV and CPP in T group (n = 35; r = -0.43; P < 0.01 and n = 35; r = 0.48; P < 0.05). In the T group also an important correlation between PWV and IMT complex (n = 35; r = 0.49, P < 0.001) was found. CONCLUSIONS: The elastic and structural properties of arterial wall in dialysis patients and renal recipients are decreased. End-stage renal disease accelerates arterial stiffening despite of arteriosclerosis and hypertension. Renal transplantation does not reverse loss of elastic and morphologic properties of arteries found in patients with end-stage renal insufficiency.

[Insulin binding to erythrocyte receptors in patients with essential hypertension]. / Wiazanie insuliny przez receptory insulinowe erytrocytów chorych na nadcisnienie tetnicze pierwotne.

Recently many researchers have described the presence of insulin resistance and hyperinsulinemia in a substantial number of patients with essential hypertension. Reduced insulin binding to the receptors may play important role in development of insulin resistance in these patients. The study was aimed to assess the value of insulin binding to erythrocyte receptors in the patients with essential hypertension and compare to values in healthy persons. Additional purpose was the evaluation of insulin degradation by erythrocytes in patients with essential hypertension. 23 patients with essential hypertension (BMI 22.7 +/- 3.2) and 21 healthy persons (with BMI value 23.3 +/- 2.9) were studied. In all examined individuals the blood glucose and blood insulin concentrations were determined, insulin binding to erythrocyte receptors and insulin degradation by erythrocytes were measured by the method of Gambhir and al. Insulin concentration was significantly higher in patients with essential hypertension than in healthy subjects. We demonstrated a statistically significant positive correlation between body weight and insulin concentration in blood serum only in healthy people. Insulin binding to the receptors of red blood cells was significantly stronger (p < 0.001) in healthy persons than in patients with essential hypertension (0.972 +/- 0.395 pg 10(11) RBC and 0.446 +/- 0.14 pg 10(11) RBC respectively). In patients with hypertension insulin binding to receptors of red blood cells does not depend on body weight and insulin concentration in blood serum. Values of insulin degradation by erythrocyte in patients with essential hypertension and healthy persons were not significantly different. It seems that decreased insulin binding to insulin receptors is an important mechanism of insulin resistance patients with essential hypertension.

Acetylsalicylic acid (aspirin) test for the diagnosis of renovascular hypertension.

OBJECTIVE: To determine whether the administration of acetylsalicylic acid (ASA, also known as Aspirin) differentiates patients with renovascular hypertension from those with essential hypertension, in order to provide a simple alternative to more expensive forms of diagnosis for this condition. DESIGN: Trial of ASA test in patients with previously diagnosed essential and renovascular hypertension. SETTING: Inpatient department of an academic health sciences centre in Poznan, Poland. PATIENTS: Forty patients with essential hypertension and 21 patients with renovascular hypertension. INTERVENTIONS: Patients were given an intravenous injection of ASA (10 mg/kg body weight), blood pressure was measured and blood was sampled and assayed for plasma renin activity (PRA) before and 30 minutes after the injection. RESULTS: ASA infusion in patients with renovascular hypertension resulted in a decrease in PRA from 15.2 (standard deviation [SD] 12.4) ng/mL per hour to 7.2 (SD 9.8) ng/mL per hour, whereas in patients with essential hypertension the initial PRA was significantly lower before ASA administration and did not change afterward. In patients with renovascular hypertension, the mean systolic, diastolic and arterial pressure decreased significantly (p < 0.001) after ASA infusion, but these did not change in patients with essential hypertension. Based on the criterion of 4 mm Hg as a detectable decrease in mean blood pressure, the sensitivity of the ASA test was 95.0% and the specificity 82.5%; its positive predictive value was 74% and its negative predictive value 97%. CONCLUSION: The precise measurement of blood pressure during the ASA test may provide a useful method of differentiating between patients with renovascular and essential hypertension.

Structural and electrochemical examinations of PACVD TiO2 films in Ringer solution.

The conditions for obtaining titanium dioxide from the substrates titanium tetrachloride and oxygen and applying this to a surgical stainless steel of the type 316L by the plasma assisted chemical vapour deposition method have been determined. It was established that, during the process, titanium dioxide anatase is created, Crystallizing in a tetragonal lattice. During exposure of the 316L steel with the titanium dioxide coating, in Ringer's solution, protective properties of this covering improve. After 120 h the coating adopts superior barrier characteristics. Titanium dioxide covering increases the resistivity of steel of the type 316L to pitting corrosion and general corrosion. Any damage or partial removal of the coating does not cause an increased galvanic corrosion of the substrate.

[Controversy about using calcium antagonists for treatment of coronary disease and hypertension]. / Kontrowersje wokól stosowania antagonistów wapnia w niewydolnosci wiencowej i nadcisnieniu tetniczym.

Calcium antagonists are widely used in therapy of hypertension and angina pectoris. Their advantage is good efficacy, relatively few and not dangerous side effects and first of all lack of bad metabolic effects (hypokalemia, hyperuricemia, hyperinsulinemia and hyperlipoproteinemia). In contrast to beta-blockers and diuretics, which decline mortality from myocardial infarctions and strokes there are not similar information concerning calcium antagonists. Two meta-analysis from 1995 unexpectedly suggest, that some preparations of calcium antagonists increase mortality from myocardial infarctions and strokes. In our paper we discuss possible pathogenetic (harmful) mechanisms, pay attention to each class of calcium antagonists and time of action of the particular drugs. Short acting nifedipine formulation should be withdrawn from chronic hypertension and angina pectoris therapy. Ongoing multicenter trials in several European countries and in USA will decide the usefulness of other calcium antagonists preparations.

Intravenous aminophylline increases the degree of saturation of urine with calcium phosphate and struvite.

This study was designed to assess the effect of i.v. treatment with aminophylline (AMPH) on the risk of calcium phosphate and struvite stone formation. We administered AMPH in doses of 4 mg/kg body weight in 15-min i.v. infusions to 60 infants with clinical symptoms of obstructive bronchitis with dyspnoea. During 3 hours after infusion we observed a significant increase in urine saturation with brushite, octocalcium phosphate and struvite. This rise in urine saturation may increase the risk of kidney stone formation.

Comparison of the serum insulin and endothelin level in patients with essential and renovascular hypertension.

To evaluate whether a relationship exists between insulinaemia (increased in essential hypertension) and endothelin level, we determined insulin and endothelin-1-like (ET-1-Li) immunoreactivity in blood serum by radioimmunoassay (RIA) in essential (EH, n = 64) and renovascular (RVH, n = 36) patients with hypertension and in healthy subjects (controls, n = 44). The trials were carried out in fasting patients and after an oral glucose tolerance test (OGTT, 75 g). Each group of subjects had similar body mass index (BMI) values. The mean values of insulin level were significantly (P < 0.0001 in every case) elevated in patients with essential hypertension compared with renovascular and control subjects during the whole OGTT. There was no significant difference in insulin level between subjects with renovascular hypertension and controls. ET-1-Li immunoreactivity levels were significantly increased (P < 0.005 fasting; P < 0.01 after 1 and 2 h) throughout the whole test in the essential hypertensive group compared with controls; in renovascular hypertensive patients 2 h after glucose administration the analogous difference was not statistically significant (P < 0.05 fasting; P < 0.01 after 1 h). In all the investigated groups the mean value of ET-1-Li immunoreactivity increased and decreased in parallel to the changes in insulin concentration during the OGTT. The ET-1-Li level was positively correlated with insulin concentration with a statistical significance for patients with essential hypertension 1 h after load (r = 0.6578, P < 0.05). The border of the significance level correlation was obtained in essential hypertensive patients 2 h after load (r = 0.5227, P = 0.06) and in controls 1 h after glucose administration (r = 0.5465, P = 0.054). Our results indicate a mutual connection between insulinaemia and an endothelin set; their relevance for the pathogenesis of hypertension requires further research.

[Clinical characteristics of patients with hypertension resistant to antihypertensive drug therapy]. / Charakterystyka kliniczna chorych z nadcisnieniem tetniczym opornym na leczenie hipotensyjne.

Two groups of hypertensive patients: 137 responsive (on one or two drugs) and 162 resistant on antihypertensive treatment in the similar age were compared. Resistant patients (on three or more drugs) characterize by significantly higher body weight and BMI, longer history of hypertension, more frequent hypertension prevalance in family members and lower education. Level of triglycerides in resistant on antihypertensive treatment patients was significantly higher than in responsive patients. Insulin level in blood in 31 patients with essential hypertension was significantly higher than in 36 healthy persons and 20 patients with renovascular hypertension and resistant on antihypertensive therapy. In 14 patients with essential hypertension resistant to treatment insulin level one hour after oral glucose load was significantly (p < 0.01) higher than in 16 patients with essential hypertension responsive to antihypertensive treatment.

Result of oral intake of glucose by healthy subjects and patients with essential hypertension on the binding and degradation of 125I-insulin by erythrocyte receptors.

The work presents the results of researches of binding and degradation of 125I-Insulin by erythrocyte receptors in the patients with essential hypertension and healthy patients after glucose intake. In order to obtain full representation of the pattern of changes the serum IRI and glucose concentrations were assayed. Binding and degradation of 125I-Insulin by erythrocyte receptors were determined with the method described by Gambhir (1977), modified by the authors. The modification consisted in usage of constant concentrations of iodized insulin (0.9 pg/0.1 ml) and bovine insulin (2.4 I.U./0.1 ml). Before administration of glucose and in 30, 60 and 120 minutes after, venous blood was collected from ulnar vein. All examined persons were in sitting position during the trial of glucose intake. Obtained results show, that blood insulin level in the patients with essential hypertension is statistically significantly higher than in healthy persons of similar anthropometric characteristics. Binding of 125I-Insulin to erythrocyte receptors in fasting state is statistically significantly lower. Degradation after glucose intake in the patients shows decreasing tendency, while in healthy persons--growing tendency.

[Activity of pyrimidine 5'nucleotidase (py5'Nd) of erythrocytes in essential hypertension]. / Aktywnosc nukleotydazy 5'pirymidynowej (Py5'Nd) krwinek czerwonych w nadcisnieniu tetniczym pierwotnym.

Activity of pyrimidine 5'nucleotidase was measured in hemolysate of erythrocytes of healthy persons and patients with essential hypertension. Cytidine 5'monophosphate (CMP) and uridine 5'monophosphate (UMP) were used as the substrates for evaluation of activity of so called I-isoenzyme and uridine 3'monophosphate (U3'MP) was used as a substrate for the II isoenzyme of Py5'Nd. It was found that the activity of Py5'Nd I was lower in hypertensives (26.8 mU/gHb (CMP)) and 69.3 mU/gHb (UMP) in comparison with normotensives (62.3 and 117.4 mU/gHb respectively) (p < 0.05). The activity of Py5'Nd II did not differ between studied groups. Possible metabolic consequences of decreased activity of Py5'Nd are discussed.

[Excretion of beta-2-microglobulin in hypertension]. / Wydalanie beta-2-mikroglobuliny w nadcisnieniu tetniczym.

The study aimed at evaluating an excretion of beta 2-microglobulin with the urine of hypertensive patients. Thirty patients with mild-to-moderate hypertension (diastolic blood pressure 14.26 +/- 0.86 kPa) and 13 patients with severe hypertension (diastolic blood pressure 17.8 +/- 1.7 kPa) were included into the studies. Significantly increased beta 2-microglobulin excretion with the urine was noted in both groups with the highest values in patients with severe blood hypertension. Moreover, significant correlation between tubular reabsorption of beta 2-microglobulin and diastolic blood pressure was noted in both groups. Increased excretion of beta 2-microglobulin in the arterial hypertension may be due to an increased glomerular filtration of this protein and/or decreased reabsorption in proximal tubule.

[Arterial hypertension refractory to hypotensive treatment]. / Nadcisnienie tetnicze nie poddajace sie leczeniu hipotensyjnemu.

Lack of normalization of arterial pressure in spite of treatment of hypertension is most frequently caused by irregular and incomplete taking of hypotensive drugs or by erroneous medical instructions (drug interactions). "True" resistance to 3 simultaneously administered hypotensive drugs in optimal doses may be caused by secondary hypertension. In a part of cases of refractory essential hypertension an increased insulin concentration is found. In the paper the importance is discussed of "resistance" to insulin in the development of hypertension.

[Value of oxypurines and uric acid in plasma, renal excretion of oxypurines and uric acid as well as plasma adenosine deaminase and AMP deaminase activity in patients with essential hypertension]. / Stezenie oksypuryn i kwasu moczowego w osoczu krwi, nerkowe wydalanie oksypuryn i kwasu moczowego oraz aktywnosc dezaminazy adenozyny i dezaminazy AMP w surowicy krwi chorych na nadcisnienie tetnicze samoistne.

Serum uric acid and oxypurines (hypoxanthine and xanthine) renal excretion of uric acid and oxypurines as well as plasma adenosine deaminase activity and AMP deaminase activity were studied in 18 patients with essential hypertension and in 17 healthy subjects. The aim of the study was to evaluate uric acid production rate in essential hypertension. Serum uric acid was significantly higher (7.04 +/- 2.03 mg% = 370.5 +/- 106 mumol/l; p < 0.01) in essential hypertension in comparison with control group (5.2 +/- 1.0 mg% = 275.0 +/- 51.9 mumol/l) and plasma oxypurines were increased insignificantly. Impairment of fractional excretion of uric acid (p < 0.05) was found in patients with essential hypertension. Plasma adenosine deaminase activity and plasma AMP deaminase activity did not differ in the studied groups. Increased production of uric acid does not contribute the incidence of hyperuricemia in essential hypertension. The results suggest that tubular defect of oxypurines excretion similar to that of uric acid exists in patients with essential hypertension.

[Osteoporosis in insulin dependent diabetes]. / Osteoporoza w przebiegu cukrzycy insulinozaleznej.

A case of female patient with non-compensated diabetes mellitus is presented. Pathological bone fractures caused by the diabetic osteoporosis were produced in the relatively short period of time. An emphasis is on the role of pathogenetic factors leading to the diabetic osteoporosis, prevention and treatment of this disease are discussed.

[Aluminum in chronic renal failure]. / Glin w przewleklej niewydolnosci nerek.

In the paper below are presented the undesirable effects of aluminium in patients with chronic renal failure. Until now aluminum treatment has been used to reduce the level of phosphates in blood serum or in haemodialysis a this group of patients. The toxic activity is a result of cumulation of the element in organism, mainly owing to limited elimination through kidneys, but also as a consequence of disturbed absorption in digestive tract or intravenous infusion of blood serum and albumins. It can be expressed by several clinical syndromes, especially dialysis, encephalopathy, osteomalacia, microcystic++ anaemia, more rarely calcinosis and increased general morbidity and mortality rate. The diagnosis of suspected toxic activity of aluminium in patients with uraemia is based mainly on estimation of concentration of this ion in blood serum and aluminium deposits in skeletal system and skin. The effective treatment consist in intravenous infusions of deferoxamine in a dose 2 g 3 times a week for a long time.

[Hydrochlorothiazide, allopurinol and magnesium oxide in the treatment of recurrent calcium urolithiasis]. / Hydrochlorothiazyd, allopurinol i tlenek magnezowy w leczeniu nawrotowej wapniowej kamicy moczowej.

The study aimed at presenting own experience in prevention of new urinary calculi in 18 patients with metabolically active calcium urolithiasis treated with hydrochlorothiazide in daily doses of 100 mg (group I) for 2 years, and in 6 patients with the same disease treated with magnesium oxide in daily doses 300 mg twice a day (group II) for average period of 10 months. In 9 patients a new calculus was formed during the treatment with hydrochlorothiazide, in 7 patients no recurrence was noted, and in 2 remaining patients the results were controversial (coral calculus). Therefore, patients were subdivided into group Ia (failure of hydrochlorothiazide therapy), and group Ib (no recurrence noted). Hydrochlorothiazide did not lead to the stable decrease in the saturation of the urine with calcium oxalate in group Ia whereas in group Ib (without recurrence of urolithiasis) the content of calcium oxalate in the urine was significantly lower than that in group Ia after a 2-year treatment with hydrochlorothiazide (p < 0.01) Recurrence of the disease was seen only in one patient of group II, i.e. treated with magnesium oxide. The treatment of the recurrent calcium urolithiasis is justified and efficient in those patients in whom therapy decreases the content of calcium oxalate in the urine.