Meeting statement: Call to action for step-change in health behaviours.

Background: Enabling, supporting and promoting positive health-related behaviours is critical in addressing the major public health challenges of our time, and the multifaceted nature of behaviours requires an evidence-based approach. This statement seeks to suggest how a much-needed enhanced use of behavioural and cultural science and insights for health could be advanced. Study design and methods: and methods: Public health authorities of Europe and Central Asia and international partner organizations in September 2023 met in Copenhagen, Denmark, to discuss the way forward. Drawing on 1) country reporting to WHO, 2) interview study with public health authorities and 3) the meeting deliberations, this meeting statement was developed. Results: The meeting statement presents a joint call for step-change accelerated use of evidence-based approaches for health behaviours. Actionable next steps for public health authorities and international and regional development partners in health are presented. Conclusions: The way forward involves increased resource allocation, integration of behavioural insights into health strategies, advocacy through case and cost-effectiveness examples and capacity building.

Factors associated with satisfaction and perceived helpfulness of mental healthcare: a World Mental Health Surveys report.

BACKGROUND: Mental health service providers are increasingly interested in patient perspectives. We examined rates and predictors of patient-reported satisfaction and perceived helpfulness in a cross-national general population survey of adults with 12-month DSM-IV disorders who saw a provider for help with their mental health. METHODS: Data were obtained from epidemiological surveys in the World Mental Health Survey Initiative. Respondents were asked about satisfaction with treatments received from up to 11 different types of providers (very satisfied, satisfied, neither satisfied nor dissatisfied, somewhat dissatisfied, very dissatisfied) and helpfulness of the provider (a lot, some, a little, not at all). We modelled predictors of satisfaction and helpfulness using a dataset of patient-provider observations (n = 5,248). RESULTS: Most treatment was provided by general medical providers (37.4%), psychiatrists (18.4%) and psychologists (12.7%). Most patients were satisfied or very satisfied (65.9-87.5%, across provider) and helped a lot or some (64.4-90.3%). Spiritual advisors and healers were most often rated satisfactory and helpful. Social workers in human services settings were rated lowest on both dimensions. Patients also reported comparatively low satisfaction with general medical doctors and psychiatrists/psychologists and found general medical doctors less helpful than other providers. Men and students reported lower levels of satisfaction than women and nonstudents. Respondents with high education reported higher satisfaction and helpfulness than those with lower education. Type of mental disorder was unrelated to satisfaction but in some cases (depression, bipolar spectrum disorder, social phobia) was associated with low perceived helpfulness. Insurance was unrelated to either satisfaction or perceived helpfulness but in some cases was associated with elevated perceived helpfulness for a given level of satisfaction. CONCLUSIONS: Satisfaction with and perceived helpfulness of treatment varied as a function of type of provider, service setting, mental status, and socio-demographic variables. Invariably, caution is needed in combining data from multiple countries where there are cultural and service delivery variations. Even so, our findings underscore the utility of patient perspectives in treatment evaluation and may also be relevant in efforts to match patients to treatments.

The COVID-19 Crisis and the Incidence of Alcohol-Related Deaths in Poland.

BACKGROUND Identifying risk and protective factors for excessive alcohol consumption can inform targeted health policies, reducing the impact of potential mental health crises. This study examined the validity and reliability of COVID-19-related death data and explored the correlations among age, sex, residential status, alcohol abuse, and healthcare access. MATERIAL AND METHODS This analysis of Polish residents' mortality relies on individual data from the register of deaths maintained by Statistics Poland. This study examined deviations in the number of deaths between 2020 and 2021 by analyzing specific causes of death. RESULTS Alcohol abusers had increased COVID-19 risk factors compared to the general population. F10 values were 22% higher than expected in 2020, aligning with predictions for 2021. Higher mortality rates were observed in the first year of the pandemic. In 2020, women and rural residents were more affected (31% and 25% higher than expected, respectively), while men and urban residents were less affected (21% and 20% higher than expected, respectively). In 2021, the trend reversed, with men 2% higher than predicted and women 4% lower. Urban area residents had a 77% lower than expected value, while rural area residents were similar (8% higher). Overall mortality exceeded expectations in both 2020 (13% higher) and 2021 (23% higher). In 2021, alcohol-related non-mental health problems increased by more than 40% in standardized death rates (SDRs). CONCLUSIONS Alcohol-related deaths reflect the hidden effects of the pandemic. Measuring the pandemic's impact on global excess mortality is hindered by inconsistencies in COVID-19 death reporting.

Clustering of the Adult Population According to Behavioural Health Risk Factors as the Focus of Community-Based Public Health Interventions in Poland.

Effective lifestyle health promotion interventions require the identification of groups sharing similar behavioural risk factors (BRF) and socio-demographic characteristics. This study aimed to identify these subgroups in the Polish population and check whether local authorities' health programmes meet their needs. Population data came from a 2018 question survey on a random representative sample of 3000 inhabitants. Four groups were identified with the TwoStep cluster analysis method. One of them ("Multi-risk") differed from the others and the general population by a high prevalence of numerous BRF: 59% [95% confidence interval: 56-63%] of its members smoke, 35% [32-38%] have alcohol problems, 79% [76-82%] indulge in unhealthy food, 64% [60-67%] do not practice recreational physical activity, and 73% [70-76%] are overweight. This group, with an average age of 50, was characterised by an excess of males (81% [79-84%]) and people with basic vocational education (53% [50-57%]). In 2018, only 40 out of all 228 health programmes in Poland addressed BRF in adults; only 20 referred to more than one habit. Moreover, access to these programmes was limited by formal criteria. There were no programmes dedicated to the reduction of BRF exclusively. The local governments focused on improving access to health services rather than on a pro-health change in individual behaviours.

Development and evaluation of a risk algorithm predicting alcohol dependence after early onset of regular alcohol use.

AIMS: Likelihood of alcohol dependence (AD) is increased among people who transition to greater levels of alcohol involvement at a younger age. Indicated interventions delivered early may be effective in reducing risk, but could be costly. One way to increase cost-effectiveness would be to develop a prediction model that targeted interventions to the subset of youth with early alcohol use who are at highest risk of subsequent AD. DESIGN: A prediction model was developed for DSM-IV AD onset by age 25 years using an ensemble machine-learning algorithm known as 'Super Learner'. Shapley additive explanations (SHAP) assessed variable importance. SETTING AND PARTICIPANTS: Respondents reporting early onset of regular alcohol use (i.e. by 17 years of age) who were aged 25 years or older at interview from 14 representative community surveys conducted in 13 countries as part of WHO's World Mental Health Surveys. MEASUREMENTS: The primary outcome to be predicted was onset of life-time DSM-IV AD by age 25 as measured using the Composite International Diagnostic Interview, a fully structured diagnostic interview. FINDINGS: AD prevalence by age 25 was 5.1% among the 10 687 individuals who reported drinking alcohol regularly by age 17. The prediction model achieved an external area under the curve [0.78; 95% confidence interval (CI) = 0.74-0.81] higher than any individual candidate risk model (0.73-0.77) and an area under the precision-recall curve of 0.22. Overall calibration was good [integrated calibration index (ICI) = 1.05%]; however, miscalibration was observed at the extreme ends of the distribution of predicted probabilities. Interventions provided to the 20% of people with highest risk would identify 49% of AD cases and require treating four people without AD to reach one with AD. Important predictors of increased risk included younger onset of alcohol use, males, higher cohort alcohol use and more mental disorders. CONCLUSIONS: A risk algorithm can be created using data collected at the onset of regular alcohol use to target youth at highest risk of alcohol dependence by early adulthood. Important considerations remain for advancing the development and practical implementation of such models.

Managed Care after Acute Myocardial Infarction (MC-AMI) - Poland's nationwide program of comprehensive post-MI care improves prognosis in 2-year follow-up. A single high-volume center intention-to-treat analysis.

BACKGROUND: Managed Care in Acute Myocardial Infarction (MC-AMI) is a program introduced in Poland aimed at comprehensive, scheduled, and supervised care for AMI patients to improve longterm prognosis. AIMS: Our study aimed to compare 24-month mortality and the incidence of major cardiovascular events (MACE: a composite of death, recurrent MI, and hospitalization for heart failure) in a cohort of AMI patients treated in the MC-AMI era (intention-to-treat analysis) vs. similar population treated before the MC-AMI era. METHODS: We analyzed 2323 consecutive patients with AMI: 1261 patients enrolled in the MC-AMI era (study group) and 1062 patients treated 12 months before the MC-AMI era (control group). In the study group, 57% of patients participated in MC-AMI while 43% of patients remained under standard care. The patients were followed up for 24 months. Mortality and MACE were recorded. RESULTS: Treatment in the MC-AMI era was related to a 30% reduction in all-cause mortality and a 14% reduction of MACE although it was not related to the reduction of hospitalization for heart failure (HF) or AMI in 24 months. The 24-month survival rate was the highest in MC-AMI enrolled patients while patients treated in the MC-AMI era but not enrolled had a similar prognosis to those treated before the MC-AMI era. Multivariable Cox regression analysis revealed the MC-AMI era to be inversely associated with mortality in 24-month follow-up (hazard ratio [HR], 0.49; 95% confidence interval [Cl], 0.38-0.65; P <0.001). CONCLUSIONS: AMI treatment in the MC-AMI era reduces 24-month mortality and MACE. Moreover, AMI treatment in MC-AMI is inversely related to mortality, MACE, and hospitalization for HF. The effect is pronounced in patients enrolled in MC-AMI.

Perceived helpfulness of treatment for social anxiety disorder: findings from the WHO World Mental Health Surveys.

PURPOSE: To investigate the prevalence and predictors of perceived helpfulness of treatment in persons with a history of DSM-IV social anxiety disorder (SAD), using a worldwide population-based sample. METHODS: The World Health Organization World Mental Health Surveys is a coordinated series of community epidemiological surveys of non-institutionalized adults; 27 surveys in 24 countries (16 in high-income; 11 in low/middle-income countries; N = 117,856) included people with a lifetime history of treated SAD. RESULTS: In respondents with lifetime SAD, approximately one in five ever obtained treatment. Among these (n = 1322), cumulative probability of receiving treatment they regarded as helpful after seeing up to seven professionals was 92.2%. However, only 30.2% persisted this long, resulting in 65.1% ever receiving treatment perceived as helpful. Perceiving treatment as helpful was more common in female respondents, those currently married, more highly educated, and treated in non-formal health-care settings. Persistence in seeking treatment for SAD was higher among those with shorter delays in seeking treatment, in those receiving medication from a mental health specialist, and those with more than two lifetime anxiety disorders. CONCLUSIONS: The vast majority of individuals with SAD do not receive any treatment. Among those who do, the probability that people treated for SAD obtain treatment they consider helpful increases considerably if they persisted in help-seeking after earlier unhelpful treatments.

Health status and its socio-economic covariates in the older population in Poland - the assumptions and methods of the nationwide, cross-sectional PolSenior2 survey.

INTRODUCTION: Population ageing constitutes an increasing medical, social, and economic burden worldwide. Optimal senior policy should be based on well-assessed knowledge on the prevalence and control of age-related diseases, multimorbidity, disabilities, and their social determinants. The objective of this paper is to describe the assumptions, methods, and sampling procedures of the PolSenior2 survey, which was aimed at characterising the health status of old and very-old adults in Poland. MATERIAL AND METHODS: The project was conducted in the period 2018-2019 as a cross-sectional survey of a representative sample of people aged 60 years and over. Subjects were selected using three-stage stratified and proportional random sampling in seven equally sized (n = 850) age groups. The study protocol consisted of face-to-face interviews, specific geriatric scales and tests, and anthropometric and blood pressure measurements performed by well-trained nurses at participants homes as well as blood and urine sample laboratory tests. RESULTS: In the Polsenior2 study a group of 5987 subjects underwent the questionnaire parts of the survey, and almost all (n = 5823) agreed to blood or urine sample collection. CONCLUSIONS: In recent decades several studies focused on various aspects of elderly health and life conditions had been carried out in Poland and Central and Eastern Europe. However, none of them is so complex and has covered so many issues as PolSenior2, which is the largest study devoted to the health status of older persons in Poland and one of the largest and the most comprehensive in Europe. The results of the study will help to improve health policy targeted at the elderly population in Poland.

Perceived helpfulness of service sectors used for mental and substance use disorders: Findings from the WHO World Mental Health Surveys.

BACKGROUND: Mental healthcare is delivered across service sectors that differ in level of specialization and intervention modalities typically offered. Little is known about the perceived helpfulness of the combinations of service sectors that patients use. METHODS: Respondents 18 + years with 12-month DSM-IV mental or substance use disorders who saw a provider for mental health problems in the year before interview were identified from WHO World Mental Health surveys in 17 countries. Based upon the types of providers seen, patients were grouped into nine mutually exclusive single-sector or multi-sector 'treatment profiles'. Perceived helpfulness was defined as the patient's maximum rating of being helped ('a lot', 'some', 'a little' or 'not at all') of any type of provider seen in the profile. Logistic regression analysis was used to examine the joint associations of sociodemographics, disorder types, and treatment profiles with being helped 'a lot'. RESULTS: Across all surveys combined, 29.4% (S.E. 0.6) of respondents with a 12-month disorder saw a provider in the past year (N = 3221). Of these patients, 58.2% (S.E. 1.0) reported being helped 'a lot'. Odds of being helped 'a lot' were significantly higher (odds ratios [ORs] = 1.50-1.89) among the 12.9% of patients who used specialized multi-sector profiles involving both psychiatrists and other mental health specialists, compared to other patients, despite their high comorbidities. Lower odds of being helped 'a lot' were found among patients who were seen only in the general medical, psychiatrist, or other mental health specialty sectors (ORs = 0.46-0.71). Female gender and older age were associated with increased odds of being helped 'a lot'. In models stratified by country income group, having 3 or more disorders (high-income countries only) and state-funded health insurance (low/middle-income countries only) were associated with increased odds of being helped 'a lot'. CONCLUSIONS: Patients who received specialized, multi-sector care were more likely than other patients to report being helped 'a lot'. This result is consistent with previous research suggesting that persistence in help-seeking is associated with receiving helpful treatment. Given the nonrandom sorting of patients by types of providers seen and persistence in help-seeking, we cannot discount that selection bias may play some role in this pattern.

Factors determining adherence to guidelines and restrictions during the initial period of the COVID-19 pandemic in Poland before the vaccination rollout.

INTRODUCTION: In Poland, like in many other countries, guidelines and certain restrictions were introduced in order to reduce the impact of the pandemic and curb the spread of the virus. These related to such behaviours as washing and disinfecting hands, wearing face masks in designated places, keeping social distance and frequently ventilating rooms. However, not all people follow the guidelines, which can lead to both health and social ramifications. The key objective of this study was an in-depth analysis of how safety rules (SR) were complied with in Poland during the initial pandemic period before the vaccines were rolled out, as well as determining factors that could affect the compliance with SR. METHODS: The study was conducted in the form of a series of cross-sectional surveys using the CATI method on a representative Polish sample in 8 rounds of interviews. Random sampling was applied. The first round was carried out from 2 to 6 July 2020, the last from 17 to 21 August 2020. The authors' original survey questionnaire was used. Factors affecting the compliance with SR were analysed using the multivariate logistic regression method on a combined group of participants from all the study rounds. RESULTS: In total, 4,800 subjects participated in the study, of which 2,512 were women (52.3%) and 2,288 were men (47.7%). Compliance with guidelines was defined based on four survey questions relating to: disinfecting hands when not at home, not touching items with bare hands when not at home, wearing face masks or covering mouth and nose, as well as washing hands after coming back home. Two affirmative answers to these questions or wearing a face mask alone (covering mouth and nose) were interpreted as compliance with SR. SR were more frequently followed by women OR=1.234 95% CI (0.988-1.543), persons over the age of 65 OR=2.098 95% CI (1.409-3.122), people with university education OR=1.315 95% CI (0.950-1.820) and residents of large cities OR=2.179 95% CI (1.382-3.437). Factors that supported compliance with SR were older age, fear of contracting COVID-19 and knowledge of SR. DISCUSSION AND CONCLUSIONS: During the first wave of the pandemic, the SR compliance level was high. Nevertheless, the study identified social groups with a higher risk of non-compliance. This indicates a need for properly addressing communication to these groups, especially that, as was demonstrated, the knowledge alone of pandemic-related messages significantly increased the likelihood of following SR and restrictions. The study of infection-preventing behaviours and their context may provide essential information to guide public policies and communication strategies that would support these behaviours in order to control the spread of the virus more effectively.

Hospitalizations for COVID-19 in Poland: a study based on data from a national hospital register.

INTRODUCTION COVID­19 has been identified by the World Health Organization as a pandemic. Poland introduced extensive antiepidemic measures relatively early in order to slow down the spread of the disease. OBJECTIVES The study aims to present recent data on COVID­19 hospitalizations during the first months of the disease outbreak in Poland. PATIENTS AND METHODS This is a retrospective, population­based study conducted using hospital discharge records that included a diagnosis of COVID-19. Data were obtained from the National Institute of Public Health, where they had been originally collected for a Polish hospital morbidity study. They included 8840 hospitalization records from the period between February and September 2020. RESULTS Overall, there were 8252 records of patients hospitalized for COVID­19 for the first time, which accounted for 93% of all hospitalizations. The study group consisted of 4161 men (50.4%) and 4091 women (49.6%). Significantly more patients from urban than rural areas were hospitalized (21.8 per 100 000 vs 20.5 per 100 000; P <0.02). In the period subject to analysis, 1073 in­hospital deaths were observed (13% of all patients), 965 of which occurred during first­time hospitalizations (11.7% of all patients). In the study group, patients who died during hospitalization compared with those who survived hospitalization were significantly older, more frequently lived in urban areas, and had more comorbidities. CONCLUSIONS The findings of our study, especially the differences between survivors and nonsurvivors with COVID-19, may be helpful in recognizing patients requiring special medical care and preventive measures during hospitalization.

Observed and relative survival and 5-year outcomes of patients discharged after acute myocardial infarction: the nationwide AMI-PL database.

BACKGROUND: Long­term follow­up data from a large Polish acute myocardial infarction (AMI­PL) database are still unavailable. AIMS: This study aimed to assess the 5­year outcomes of patients discharged after hospitalization for AMI in Poland in relation to age. METHODS: The studywas based on the nationwide AMI­PL registry including data on the management and long­term outcomes of all patients admitted to hospitals with AMI (codes I21-I22 according to the International Classification of Diseases and Related Health Problems, 10th Revision [ICD ­10]), derived from the database of the obligatory healthcare payer in Poland.The current analysis included all patients after AMI who were discharged alive between the years 2009 and 2010 (n = 134 602). RESULTS: The median age of the study patients was 66.8 years, 62.8% of them were male, and 57.1% had ST­segment elevation myocardial infarction. Older patients, especially those at age ≥80 years, were less likely to receive invasive treatment during the index hospitalization and follow­up. There were 37 437 deaths during the follow­up, and the observed 5­year survival ranged from 0.921 in women at the age below 55 years to 0.383 in men older than 80 years. Relative survival, however, ranged from 0.94 to 0.68 in these age­sex groups. The mortality risk increased with age, was higher in men, in patients treated noninvasively, hospitalized for non-ST­segment elevation myocardial infarction, and discharged from non­cardiology wards. Patients were rehospitalized due to cardiovascular reasons in 63% of cases, heart failure in 17.9%, and AMI in 12.8%. CONCLUSIONS: More than 1 in 4 patients discharged after hospitalization for AMI died within 5 years. Age strongly affects the treatment and long­term outcomes of AMI patients. Our findings indicate the need for improvement in secondary prevention after AMI.

Findings From World Mental Health Surveys of the Perceived Helpfulness of Treatment for Patients With Major Depressive Disorder.

Importance: The perceived helpfulness of treatment is an important patient-centered measure that is a joint function of whether treatment professionals are perceived as helpful and whether patients persist in help-seeking after previous unhelpful treatments. Objective: To examine the prevalence and factors associated with the 2 main components of perceived helpfulness of treatment in a representative sample of individuals with a lifetime history of DSM-IV major depressive disorder (MDD). Design, Setting, and Participants: This study examined the results of a coordinated series of community epidemiologic surveys of noninstitutionalized adults using the World Health Organization World Mental Health surveys. Seventeen surveys were conducted in 16 countries (8 surveys in high-income countries and 9 in low- and middle-income countries). The dates of data collection ranged from 2002 to 2003 (Lebanon) to 2016 to 2017 (Bulgaria). Participants included those with a lifetime history of treated MDD. Data analyses were conducted from April 2019 to January 2020. Data on socioeconomic characteristics, lifetime comorbid conditions (eg, anxiety and substance use disorders), treatment type, treatment timing, and country income level were collected. Main Outcomes and Measures: Conditional probabilities of helpful treatment after seeing between 1 and 5 professionals; persistence in help-seeking after between 1 and 4 unhelpful treatments; and ever obtaining helpful treatment regardless of number of professionals seen. Results: Survey response rates ranged from 50.4% (Poland) to 97.2% (Medellín, Columbia), with a pooled response rate of 68.3% (n = 117 616) across surveys. Mean (SE) age at first depression treatment was 34.8 (0.3) years, and 69.4% were female. Of 2726 people with a lifetime history of treatment of MDD, the cumulative probability (SE) of all respondents pooled across countries of helpful treatment after seeing up to 10 professionals was 93.9% (1.2%), but only 21.5% (3.2%) of patients persisted that long (ie, beyond 9 unhelpful treatments), resulting in 68.2% (1.1%) of patients ever receiving treatment that they perceived as helpful. The probability of perceiving treatment as helpful increased in association with 4 factors: older age at initiating treatment (adjusted odds ratio [AOR], 1.02; 95% CI, 1.01-1.03), higher educational level (low: AOR, 0.48; 95% CI, 0.33-0.70; low-average: AOR, 0.62; 95% CI, 0.44-0.89; high average: AOR, 0.67; 95% CI, 0.49-0.91 vs high educational level), shorter delay in initiating treatment after first onset (AOR, 0.98; 95% CI, 0.97-0.99), and medication received from a mental health specialist (AOR, 2.91; 95% CI, 2.04-4.15). Decomposition analysis showed that the first 2 of these 4 factors were associated with only the conditional probability of an individual treatment professional being perceived as helpful (age at first depression treatment: AOR, 1.02; 95% CI, 1.01-1.02; educational level: low: AOR, 0.48; 95% CI, 0.33-0.70; low-average: AOR, 0.62; 95% CI, 0.44-0.89; high-average: AOR, 0.67; 95% CI, 0.49-0.91 vs high educational level), whereas the latter 2 factors were associated with only persistence (treatment delay: AOR, 0.98; 95% CI, 0.97-0.99; treatment type: AOR, 3.43; 95% CI, 2.51-4.70). Conclusions and Relevance: The probability that patients with MDD obtain treatment that they consider helpful might increase, perhaps markedly, if they persisted in help-seeking after unhelpful treatments with up to 9 prior professionals.

Changes in disease burden in Poland between 1990-2017 in comparison with other Central European countries: A systematic analysis for the Global Burden of Disease Study 2017.

BACKGROUND: Systematic collection of mortality/morbidity data over time is crucial for monitoring trends in population health, developing health policies, assessing the impact of health programs. In Poland, a comprehensive analysis describing trends in disease burden for major conditions has never been published. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides data on the burden of over 300 diseases in 195 countries since 1990. We used the GBD database to undertake an assessment of disease burden in Poland, evaluate changes in population health between 1990-2017, and compare Poland with other Central European (CE) countries. METHODS: The results of GBD 2017 for 1990 and 2017 for Poland and CE were used to assess rates and trends in years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs). Data came from cause-of-death registration systems, population health surveys, disease registries, hospitalization databases, and the scientific literature. Analytical approaches have been used to adjust for missing data, errors in cause-of-death certification, and differences in data collection methodology. Main estimation strategies were ensemble modelling for mortality and Bayesian meta-regression for disability. RESULTS: Between 1990-2017, age-standardized YLL rates for all causes declined in Poland by 46.0% (95% UI: 43.7-48.2), YLD rates declined by 4.0% (4.2-4.9), DALY rates by 31.7% (29.2-34.4). For both YLLs and YLDs, greater relative declines were observed for females. There was a large decrease in communicable, maternal, neonatal, and nutritional disease DALYs (48.2%; 46.3-50.4). DALYs due to non-communicable diseases (NCDs) decreased slightly (2.0%; 0.1-4.6). In 2017, Poland performed better than CE as a whole (ranked fourth for YLLs, sixth for YLDs, and fifth for DALYs) and achieved greater reductions in YLLs and DALYs than most CE countries. In 2017 and 1990, the leading cause of YLLs and DALYs in Poland and CE was ischaemic heart disease (IHD), and the leading cause of YLDs was low back pain. In 2017, the top 20 causes of YLLs and YLDs in Poland and CE were the same, although in different order. In Poland, age-standardized DALYs from neonatal causes, other cardiovascular and circulatory diseases, and road injuries declined substantially between 1990-2017, while alcohol use disorders and chronic liver diseases increased. The highest observed-to-expected ratios were seen for alcohol use disorders for YLLs, neonatal sepsis for YLDs, and falls for DALYs (3.21, 2.65, and 2.03, respectively). CONCLUSIONS: There was relatively little geographical variation in premature death and disability in CE in 2017, although some between-country differences existed. Health in Poland has been improving since 1990; in 2017 Poland outperformed CE as a whole for YLLs, YLDs, and DALYs. While the health gap between Poland and Western Europe has diminished, it remains substantial. The shift to NCDs and chronic disability, together with marked between-gender health inequalities, poses a challenge for the Polish health-care system. IHD is still the leading cause of disease burden in Poland, but DALYs from IHD are declining. To further reduce disease burden, an integrated response focused on NCDs and population groups with disproportionally high burden is needed.

Fruit and vegetable consumption and its contribution to inequalities in life expectancy and disability-free life expectancy in ten European countries.

OBJECTIVES: To assess to what extent educational differences in total life expectancy (TLE) and disability-free life expectancy (DFLE) could be reduced by improving fruit and vegetable consumption in ten European countries. METHODS: Data from national census or registries with mortality follow-up, EU-SILC, and ESS were used in two scenarios to calculate the impact: the upward levelling scenario (exposure in low educated equals exposure in high educated) and the elimination scenario (no exposure in both groups). Results are estimated for men and women between ages 35 and 79 years. RESULTS: Varying by country, upward levelling reduced inequalities in DFLE by 0.1-1.1 years (1-10%) in males, and by 0.0-1.3 years (0-18%) in females. Eliminating exposure reduced inequalities in DFLE between 0.6 and 1.7 years for males (6-15%), and between 0.1 years and 1.8 years for females (3-20%). CONCLUSIONS: Upward levelling of fruit and vegetable consumption would have a small, positive effect on both TLE and DFLE, and could potentially reduce inequalities in TLE and DFLE.

Smoking ban in public places and myocardial infarction hospitalizations in a European country with high cardiovascular risk: insights from the Polish nationwide AMI-PL database.

INTRODUCTION: Previous studies demonstrated a possible positive effect of a smoking ban in public places on cardiovascular outcomes. However, little is known about the influence of such regulations in Poland, a country with a high cardiovascular risk. OBJECTIVES: We aimed to evaluate the association of hospitalization rates for acute myocardial infarction (AMI) in Poland before and after the introduction of the smoking ban in public places in November 2010. PATIENTS AND METHODS: The Nationwide Acute Myocardial Infarction Database (AMI­PL) was searched for the cases of AMI that occurred between 2009 and 2014. The analysis considered sex, age (20-64 years vs 65 years or older), and the place of residence (rural vs urban area). There were no specific exclusion criteria. RESULTS: The overall average number of AMI hospitalizations in the years 2009-2010, 2011-2012, and 2013-2014 was 79 323, 80 783, and 77 356, respectively. Age­standardized rates of AMI hospitalizations in both sexes and age groups decreased only slightly in the first 2 years and were more visible in the years following the implementation of the smoking ban. In men, the decrease was observed in both age groups and almost in the whole country. In younger women, the decrease was not observed in towns with more than 100 000 inhabitants. In large towns (over 500 000 inhabitants), mostly a nonsignificant decrease occurred. CONCLUSIONS: After the introduction of the smoking ban, a marked decrease in age­standardized AMI hospitalizations was observed in long­term follow­up both in men and women as well as both in younger and older patients, but with differences regarding the place of residence.

Nationwide General Hospital Morbidity Study as a source of data about Polish population health

The objective of this article is description of the important source of data on hospitalised morbidity collected in Poland within the frameworks of public statistics, and also underlying the significance of the quality of data collected at the hospital level for the purpose of the practical application of them. The Nationwide General Hospital Morbidity Study has been conducted by the Department of Population Health Monitoring and Analysis of the NIPH-NIH for more than 40 years within the frameworks of the Programme of Statistical Surveys of Official Statistics. Since the year 2000, it has had a complete character, collecting individual data for all cases of hospitalisation in Poland within the scope compliant with the MZ/Szp-11 form, among others, sex, age, place of residence of a patient, data on hospital, information about the course of treatment (length of stay in hospital, principal diagnosis and comorbidity, applied medical procedures, the mode of admission and discharge). The collected data are anonymous. In the recent years, annually, more than 8 million of the cases of hospitalisation have been documented. Almost all obliged hospitals (96%) participate in the study. Some weak point is the completeness of submitted data, in particular, regarding information about the external causes of injuries and poisonings (in the year 2017, 27% of the required data were missing). Interestingly, a high level of missing data is generated by a comparatively small number of hospitals. Significant differences are observed in the quality of data depending on the voivodship of hospital location. The collected data render it possible to, among others, determine the frequency of hospitalisations due to particular causes taking under consideration the localisation of a hospital, and also the sex, age and the place of residence of patients, the analysis of the duration of hospital stay or in-hospital fatality. The aggregated results are reported to international databases (WHO, OECD, Eurostat), and support the administrative authorities of various levels. They are also a basis for numerous published scientific papers. The most important results of routine analyses are presented of the web page of the Study (http://www.statystyka1.medstat.waw.pl/).

Lung cancer survival and comorbidities in lung cancer screening participants of the Gdansk screening cohort.

BACKGROUND: In 2010, the World Health Organisation recommended implementation of screening programmes in four groups of diseases-neoplasms, cardiovascular diseases (CVD), diabetes mellitus (DM) and chronic obstructive pulmonary disease (COPD). It is due to the fact that they share the same, modifiable risk factors. METHODS: Between 2009 and 2011, 8637 heavy smokers (aged 50-75, smoking history >20 pack-years) were screened in the Pomeranian Pilot Lung Cancer Screening Programme (PPP) in Gdansk, Poland. We looked at 5-year follow-up and analysed the medical events and comorbidities of all participants. One health care provider in the Polish health care system provides a unique opportunity to gather most reliable data on all medical events in each person. RESULTS: In 52.0% of lung cancer screening participants CVD (33.5%), DM (26.0%) and COPD (21.0%) were diagnosed. Prevalence of these diseases is higher in lung cancer patients than in the non-cancer screening group (P < 0.0001). One hundred and seven (1.2%) lung cancers were diagnosed during PPP programme performance and another 382 cases (4.4%) in the 5-year follow-up, so the potential mean annual lung cancer detection rate is 0.77%. CONCLUSIONS: Lung cancer screening programme offers a great potential for joint screening of lung cancer, CVD, diabetes and COPD.

Variations in experience of social support and physical health among adult residents of Poland in urban versus rural areas

Background: A study reveals ­ against to common beliefs ­less support between rural area residents in comparison to town-dwellers and significantly higher support for healthy, not for poor health research participants. Objectives: The aim of our paper was comparing support from spouse/partner, relatives, friends and strangers among people with good and ill physical health. A next purpose was to find differences of social support and experience of social undermining in urban and rural residential settings. Material and methods: The study "Epidemiology of Mental Disorders and Access to Mental Health Care, EZOP ­ Poland" was carried out on random sample of 24 000 of Poland residents and a 50,4% response rate, 10 081 computerassisted personal interviews. Of those respondents, 4 000 constituted a sub-sample asked to complete the social networks and support section of the questionnaire. Data were analyzed by age, gender, residential setting and marital status for statistically significant differences in the percentage of functional and structural social support being reported, using the chi-squared test with a significance level of 0.05 used to reject the null hypothesis (H0 = lack of relationship between variables). Results: A majority of respondents maintain that in difficult life situations, family and a close network of friends and acquaintances make it possible to openly discuss problems and obtain help. However, respondents who rate their health as "poor" or "very poor" significantly less often than healthy individuals experience support coming from their relatives, friends, or strangers. In comparison to urban areas, the extent of social support in rural areas is significantly limited. The rural setting offers less support and even less opportunities for interaction with relatives, friends, acquaintances and strangers. Negative social factors­ low levels of trust, isolation from friends and family, lack of a social life, lack of a helpful neighborhood ­ are conditions significantly more often found in the countryside than in urban areas. Conclusions: Results obtained from the EZOP study shows that amount of social support received is higher in urban areas and among those who enjoy better physical health.

Trends in health inequalities in 27 European countries.

Unfavorable health trends among the lowly educated have recently been reported from the United States. We analyzed health trends by education in European countries, paying particular attention to the possibility of recent trend interruptions, including interruptions related to the impact of the 2008 financial crisis. We collected and harmonized data on mortality from ca 1980 to ca 2014 for 17 countries covering 9.8 million deaths and data on self-reported morbidity from ca 2002 to ca 2014 for 27 countries covering 350,000 survey respondents. We used interrupted time-series analyses to study changes over time and country-fixed effects analyses to study the impact of crisis-related economic conditions on health outcomes. Recent trends were more favorable than in previous decades, particularly in Eastern Europe, where mortality started to decline among lowly educated men and where the decline in less-than-good self-assessed health accelerated, resulting in some narrowing of health inequalities. In Western Europe, mortality has continued to decline among the lowly and highly educated, and although the decline of less-than-good self-assessed health slowed in countries severely hit by the financial crisis, this affected lowly and highly educated equally. Crisis-related economic conditions were not associated with widening health inequalities. Our results show that the unfavorable trends observed in the United States are not found in Europe. There has also been no discernible short-term impact of the crisis on health inequalities at the population level. Both findings suggest that European countries have been successful in avoiding an aggravation of health inequalities.