European trends in ovarian cancer mortality, 1990-2020 and predictions to 2025.

INTRODUCTION: Over the last decades, ovarian cancer mortality in Europe has been decreasing, but disparities in trends were observed. In this paper, we analysed ovarian cancer mortality trends in Europe over the period 1990-2020 and predicted the number of deaths and rates by 2025. METHODS: We extracted population and death certification data from ovarian cancer in women for 31 European countries, between 1990 and 2020 from the World Health Organization database. We computed age-standardised mortality rates (ASMR) per 100,000 women-years, based on the world standard population. We also obtained predictions for 2025 using a joinpoint regression model and calculated the number of avoided deaths over the period 1994-2025. RESULTS: Over the observed period, mortality from ovarian cancer showed a favourable pattern in most countries. In the EU-27, rates declined by 5.9% from 2010-2014 to 2015-2019, reaching an ASMR of 4.66/100,000. During the same period, the decline in ovarian cancer mortality was more pronounced in the EU-14 countries (-7.0%) compared to Transitional countries (-2.1%). Declines were also observed in the United Kingdom, to reach an ASMR of 5.29. Decreases in mortality from ovarian cancer are predicted until 2025, to 4.17/100,000 for the EU-27. CONCLUSIONS: Favourable trends in ovarian cancer mortality are expected to persist in Europe and can be mainly attributed to the increased use of oral contraceptives in subsequent generations of European women. Decreased use of menopausal Hormone Replacement Therapy and improved diagnosis and management may also have played a role.

A Spatio-Temporal Analysis of the Health Situation in Poland Based on Functional Discriminant Coordinates.

The aim of this study was to investigate if the provinces of Poland are homogeneous in terms of the observed spatio-temporal data characterizing the health situation of their inhabitants. The health situation is understood as a set of selected factors influencing inhabitants' health and the healthcare system in their area of residence. So far, studies concerning the health situation of selected territorial units have been based on data relating to a specific year rather than longer periods. The task of assessing province homogeneity was carried out in two stages. In stage one, the original spatio-temporal data space (space of multivariate time series) was transformed into a functional discriminant coordinates space. The resulting functional discriminant coordinates are synthetic measures of the health situation of inhabitants of particular provinces. These measures contain complete information regarding 8 diagnostic variables examined over a period of 6 years. In the second stage, the Ward method, commonly used in cluster analysis, was applied in order to identify groups of homogeneous provinces in the space of functional discriminant coordinates. Sixteen provinces were divided into four clusters. The homogeneity of the clusters was confirmed by the multivariate functional coefficient of variation.

Perinatal Outcomes in a Population of Diabetic and Obese Pregnant Women-The Results of the Polish National Survey.

Obesity and diabetes increase the risk of complications during gestation and at delivery. The aim of this study was to compare the perinatal outcomes in the populations of diabetic and obese Polish women, based on the results of a national survey performed in years 2012 and 2017, as well as to determine the risk factors of the gestational diabetes mellitus (GDM). Questionnaires from 6276 women were collected. Obese women constituted 5.5% and 7.5% of study population in years 2012 and 2017, respectively. Among women whose pregnancies were complicated by diabetes mellitus, GDM constituted the most common type of glucose intolerance during both time periods (2012: 89% vs. 2017: 85.6%). In the group of obese women an insignificant increase in the rate of induced deliveries was noted (2012: 9.9% vs. 2017: 11.7%), whereas the fetal birth-weight decreased significantly (2012: 3565 g vs. 2017: 3405 g, p < 0.05). In the group of diabetic pregnant women the percentage of cesarean sections, labour inductions and fetal birth defects was characterized by an insignificant upward trend. Risk of GDM was significantly increased in women aged over 35 years-(2012: OR 1.9 (95% CI: 1.1-2.9) and 2017: OR = 2.1 (95% CI: 1.5-2.9), p < 0.05-, as well as in overweight women-2012: OR 1.8 (95% CI: 1.2-2.7) and 2017: OR 2.6 (95% CI: 1.9-3.4), p < 0.05-during both analysed time periods. Based on the study results, it is necessary to develop population-based programmes to prevent obesity and to introduce and enforce the rules of appropriate screening for glucose tolerance disorders during pregnancy.

The effect of active and passive maternal smoking before and during pregnancy on neonatal weight at birth.

INTRODUCTION: Smoking during pregnancy is a risk factor for adverse pregnancy outcomes. Data on the correlation between passive maternal smoking and pregnancy outcomes remain limited. We investigated the effect of active smoking and environmental tobacco smoke (ETS) during pregnancy on neonatal birthweight, including the risk for low birthweight (LBW). MATERIAL AND METHODS: The study was conducted between 2010 and 2012. A group of 8625 women were surveyed during postpartum hospitalization. Outcome measures included mean birthweight of newborns. Additionally, odds ratios with confidence intervals were calculated to investigate the risk for LBW in active and passive smoking groups of mothers. RESULTS: Lower birthweight (46 g - 307 g; p < 0.05) and a higher risk for LBW (OR = 1.35, 95% CI: 1.05-1.75; p < 0.05) were observed in all infants born to smoking mothers. A negative effect of ETS in pregnancy on the reduction of mean birthweight was also found. Additionally, we analyzed the cumulative effect of active and passive smoking on neonatal birthweight. A statistically significant reduction in neonatal weight at birth was found in a group of women who smoked actively and passively during pregnancy (130 g; p < 0.05). CONCLUSIONS: Smoking is associated with decreased birthweight and in a group of active smoking mothers increased risk for LBW. This effect is dose-dependent and is also present in a group of women who smoked before pregnancy. There is also a cumulative effect of active smoking and ETS causing decreased neonatal birthweight and increased risk for low birthweight.

European trends in breast cancer mortality, 1980-2017 and predictions to 2025.

BACKGROUND: Breast cancer mortality in European women has been falling for three decades. We analysed trends in mortality from breast cancer in Europe over the period 1980-2017 and predicted number of deaths and rates to 2025. METHODS: We extracted death certification data for breast cancer in women for 35 European countries, between 1980 and 2017, from the World Health Organisation database. We computed the age-standardised (world standard population) mortality rates per 100,000 person-years, by country and calendar year. We obtained also predictions for 2025 using a joinpoint regression model and calculated the number of avoided deaths over the period 1994-2025. RESULTS: The mortality rate declined from 15.0 in 2012 to 14.4 in 2017 per 100,000 women (-3.9%) for the European Union (EU)-27. This fall was greater in the EU-14 (-5.2%), whereas rates rose in the transitional countries during this period by 1.9%. Mortality rate predictions across Europe are expected to reach relatively uniform levels in 2025. During the studied period, favourable trends in mortality emerged in most countries, with the greatest decrease in Denmark, whereas Poland and Romania showed an upward trend. The largest predicted decrease in breast cancer mortality was estimated for the United Kingdom (12.2/100,000 women in 2025), leading to the estimated avoidance of 150,000 breast cancer deaths over the period 1994-2025 and 470,000 in the EU-27. CONCLUSIONS: Favourable trends in breast cancer mortality were observed in most European countries, and they will continue to fall in the coming years. Less favourable patterns were still observed among the transitional countries than other European areas.

Functional Analysis of the Differences in the Dimensions of Two Types of Boiled and Steamed Rice Grains.

The study tested how the cooking process can change the dimensions of rice grains. The impact of set times of cooking or steaming process on the characteristics such as length, width, and height of two varieties of rice, namely, long-grain white and parboiled, was investigated. The measurements of the dimension characteristics obtained at different times of the cooking process were converted to functional data. Different methods of multivariate functional data analysis, namely, functional multivariate analysis of variance, functional discriminant coordinates, and cluster analysis, were applied to discover the differences between the two varieties and the two heat treatment methods.

Patterns of Alcohol Consumption in the PURE Poland Cohort Study and Their Relationship with Health Problems.

(1) Background: Alcohol is a leading risk factor of premature morbidity and mortality. The objective of this study was to investigate the patterns of alcohol consumption in the PURE Poland cohort study baseline. (2) Methods: A Polish cohort was enrolled in the baseline study in 2007-2010. The study group consisted of 2021 adult participants of urban and rural areas from the Lower Silesia voivodeship in Poland (747 men and 1274 women). (3) Results: In the overall study population, 67.3% were current drinkers, 10.3% were former drinkers, and 22.4% were abstainers. Current use of alcohol products was more prevalent in men (77.2%), people living in urban areas (73.0%), and people with a higher level of education (78.0%). The percentage of current drinkers decreased with increasing age (from 73.4% in 30- to 44-year-olds to 48.8% in participants aged 64 and more). The majority of participants (89.2%) declared a low level of alcohol intake. The chance of high level of intake of alcohol was four times higher in men than in women (OR 4.17; CI 1.64-10.6). The majority of participants (54.6%) declared most frequent consumption of low-alcohol drinks (beer, wine) and 21% declared most frequent consumption of spirits. Current drinkers had almost 1.5-fold higher odds of diabetes and cardiovascular diseases (CVD) than never drinkers (OR 1.49, CI 1.03-2.17; OR 1.66, CI 1.27-2.18, respectively). Former drinkers had higher odds for hypertension and CVD than never drinkers (1.73, CI 1.05-2.85; OR 1.76, CI 1.22-2.53, respectively). (4) Conclusions: In our cohort study, we observed several socio-demographic factors differentiating the patterns of alcohol consumption. The preventive programs should focus predominantly on men, people aged <45 years, and those with a higher level of education.

Physical activity patterns in third trimester of pregnancy - use of pregnancy physical activity questionnaire in Poland.

INTRODUCTION: Adverse pregnancy outcomes are less common among physically active women, and children born to such mothers are less likely to be at risk for macrosomia, obesity and metabolic diseases in the future. OBJECTIVES: The aims of the study were to establish physical activity (PA) patterns among pregnant women in the third trimester, and to determine the attitudes of prenatal care providers to maternal PA during pregnancy. MATERIAL AND METHODS: The study was conducted in 2017 using surveys from the Polish Pregnancy-related Assessment Monitoring System program (Pol-PrAMS). The study included 3,451 postpartum women. The Pregnancy Physical Activity Questionnaire was used to investigate their PA. This part of Pol-PrAMS study was completed by 2,744 postpartum women who were subjected to statistical analysis. RESULTS: Sedentary or light physical activity comprised 75% of the overall PA in the third trimester of pregnancy (mean values of energy expenditure: 67 and 93.3 MET-h/week, respectively). Household or caregiving activities accounted for almost 50% of all activities and were the most common PA types (mean energy expenditure: 105 MET-h/week). Restriction of PA in pregnancy was reported by over 60% of the women, most often due to concerns over proper foetal development. Over 85% of prenatal care providers either did not address the issue of PA with the future mothers at all, or recommended PA restriction. CONCLUSIONS: Sedentary and light-intensity PA are the two predominant types of physical activity in the third trimester. The most energy-consuming tasks involve household and caregiving activities. Restriction of activity was reported by the majority of the respondents. Prenatal care providers either did not address the matter of PA in pregnancy or recommended PA restriction.

Correlation between the single, high dose of ingested baclofen and clinical symptoms.

INTRODUCTION AND OBJECTIVES: Baclofen is a drug used mainly to treat muscle spasticity. Its overdose can lead to life-threatening clinical symptoms, including acute respiratory failure requiring mechanical ventilation. The aim of this study was to assess the prevalence of selected clinical symptoms associated with baclofen poisoning comparing to an ingested dose. MATERIAL AND METHODS: 60 cases of oral baclofen poisoning were analyzed. Gender, age distribution, and correlation between the dose of ingested baclofen were studied, as well as and following clinical parameters: degree of altered consciousness, heart rate, blood pressure, presence of acute respiratory failure, duration of mechanical ventilation, and presence of psychotic symptoms. RESULTS: The study found statistically significant correlations between dosage of ingested baclofen and presence of acute respiratory failure, as well as duration of mechanical ventilation. No statistically significant correlations were found between the dose of ingested baclofen and presence of hypertension, bradycardia, acute psychotic symptoms, or level of consciousness disturbance. However, it was found that patients who suffered from hypertension, bradycardia, and altered mental status ingested a larger dose of baclofen. CONCLUSIONS: There is a statistically significant correlation between the dose of ingested baclofen and the presence of acute respiratory failure, and duration of mechanical ventilation. Patients who have taken a single dose of baclofen of 200 mg, or higher, should be managed in centres able to provide continuous monitoring of life functions. Those with a higher level of a single dose of baclofen ingestion (>500 mg), should be hospitalized in a Toxicology Unit or Intensive Care Unit able to provide airway support and mechanical ventilation.

Trends in smoking among secondary school and high school students in Poland, 2009 and 2011.

OBJECTIVES: To determine the age and the most common circumstances for smoking initiation along with smoking rates and to evaluate smoking trends for secondary and high school students in Poland during 2009 and 2011. MATERIAL AND METHODS: In 2009, a pilot study was conducted in districts of Poland on high school students and their parents. For statistical analysis, correctly completed questionnaires from 999 students and 667 parents were qualified for use. After the pilot study, a nationwide study of secondary school students and their parents was also conducted in 2009. For statistical analysis, correctly completed questionnaires were used from 9360 students and 6951 from their parents. The research tool was a questionnaire developed by the Chief Sanitary Inspectorate. These studies were then compared to the nationwide research study from 2011. Questionnaires were obtained from a survey of 3548 students from secondary schools and 4423 of those from high schools. RESULTS: Smoking initiation usually begins at ages 12-15 years. Rates of secondary school student smoking at least once in their lifetime were about the same level in the surveyed years (2009 - 9%, 2011 - 11%), whereas rates of high school student smoking increased (2009 - 15%, 2011 - 24%). Moreover, 34% of secondary school student smoked less than once a week, whereas in 2009, only 8% of students had done so. For high school students, a 1/2 smoked every day; similar to 2009. Students usually smoked in parks, on streets or any other open space areas. CONCLUSIONS: From analyzing the smoking trends over the survey period it can be concluded that the problem of smoking increases with respondent age. Int J Occup Med Environ Health 2017;30(5):763-773.

Monitoring risk behaviour in adolescent pupils regarding consumption of psychoactive substances.

Introduction. Taking psychoactive substances constitutes a significant problem for Public Health, particularly in preventing drug abuse and addiction. Objectives. To estimate the amount and incidence of drug consumption in middle and high school pupils, including the circumstances in which drug taking first started, and to determine pupils' knowledge about the consequences of taking psychoactive substances and designer drugs (DDs). Materials and methods. A randomised study was conducted throughout Poland on 9,360 pupils attending middle school (junior high school) in 2009 and 7,971 pupils from middle and high school pupils in 2011. The survey consisted of a questionnaire devised by the Chief Sanitary Inspectorate (GIS) and the replies obtained were subject to the relevant statistical analyses. Results. Drug taking was found to have increased between 2009-2011, especially among those attending high school; proportionally rising from 4% - 11%. The numbers who had ever taken designer drugs were 3% for middle school pupils and 4% from high school. Conclusions. 1) Adolescent drug consumption has increased, particularly in those of older age and in boys. 2) Despite the only brief interval for which designer drugs were legal, they have gained high popularity among the young. 3) Adolescents have insufficient knowledge about the dangers of using DDs. 4) Faced with the growing threat of a dynamic designer drug market, appropriate counter-measures in education and prevention are therefore necessary.

Absorbed power distribution in the whole-body system of a tractor operator.

INTRODUCTION AND OBJECTIVE: Many people are exposed to vibration (WBV) in their occupational lives. The biodynamic responses of the human body in sitting conditions have been widely measured under whole-body vibration (WBV). The measures are most often expressed in terms of force-motion relations at the driving-point, namely, mechanical impedance, apparent mass and absorbed power, and flow of vibration through the body, such as seat-to-head and body segments vibration transmissibility. The absorbed power is a measure of the energy absorbed by the subject due to the external forces applied to the system. MATERIALS AND METHODS: The body behaves like a vibrating physical system with distributed energy-storage elements (masses, springs) and energy-dissipation elements (dampers). The total quantity of power can be divided into 2 components - one real and one imaginary. The real component reflects the energy-absorbing part of the system, due to the transformation of friction into heat within the tissues. The imaginary component reflects the energy-storing part of the system which does not consume any vibration energy. RESULTS: The seated human is modeled as a series 4-DOF dynamic models. After introduction of the excitation, the response in particular segments of the model can be analyzed. As an example, the vibration power dissipated in an operator's body segments has been determined as a function of the agricultural combination operating speed 1.4 - 2.75 ms(-1). CONCLUSIONS: The concept of absorbed power as a measurement for evaluation of WBV exposure opens a new area for research. The important character of absorbed power is that it has physical significance and therefore can be measured as well as computed analytically. The absorbed power relates to dissipation of energy attributed to relative motions of the visco-elastic tissues, muscles and skeletal system, which under prolonged exposures could lead to physical damage in the musculoskeletal system. A structural model of the human operator allows determination of the dynamic characteristics of the model, and study of the energy flow between the elements of the model.

Alcohol consumption in Polish middle and high school pupils--has this rapidly increased during 2009-11?

INTRODUCTION: The dynamic rise of alcohol consumption in adolescents is a matter of serious concern, requiring frequently updated monitoring. By such means, it is possible to optimise preventative measures for dealing with this problem. OBJECTIVE: To estimate the magnitude/amount and frequency of alcohol consumed by middle and high school pupils in Poland, including the circumstances when alcohol was first drunk. MATERIALS AND METHODS: A randomised survey was performed throughout Poland on middle school (junior high school) pupils, (n=9360) in 2009, followed by both middle and high school pupils in 2011 (n=7971). The questionnaire was devised by the Polish Chief Sanitary Inspectorate (GIS). RESULTS: A strikingly sharp increase in alcohol consumption (29%) was observed in subjects between 2009 - 2011. In the latter year, 1 month prior to survey, respectively, 50% and 71% of middle school and high school pupils drank alcohol, and correspondingly, 36% and 63% of these pupils ever became intoxicated/drunk. CONCLUSIONS: 1) Adolescent alcohol consumption increases with age and is highest in girls. Monitoring as well as in-depth analysis thus becomes necessary. 2) Systematic monitoring and analysis of changing healthy lifestyle behaviour should be used for taking the necessary corrective action. This should happen concurrently and consist of planned health education programmes, including health promotion.

Assessing physical activity and sedentary lifestyle behaviours for children and adolescents living in a district of Poland. What are the key determinants for improving health?

INTRODUCTION: Adequate levels of physical activity throughout an individual's life ensure an optimal state of health. Only 30% of adolescents and 10% of adults perform sufficient physical activity to facilitate proper physical, psychological/mental and emotional development. OBJECTIVE: Determining physical activity behaviour in children and adolescents through surveying the opinions of school pupils and parents, in order to lend support for optimised educational programmes designed to promote healthy lifestyle behaviour, as well as establishing consistent answers. MATERIALS AND METHODS: A randomised survey was conducted on two groups of n=1100 pupil subjects, each attending elementary or secondary school, with the former in Classes 5 and 6, whereas the latter were aged between 16-19 years old; in both instances parents were also included in the survey. All subjects came from the Kalisz District in western-central Poland, and were divided into those living in the city of Kalisz and those in the surrounding rural areas. RESULTS: It was found that 87%, 96% and 89% of elementary, middle and secondary school pupils, respectively, participated in Physical Education (PE) lessons. The numbers of pupils who daily, or almost daily, spent time on a computer, were 52%, 60% and 70%, respectively, for elementary, middle and secondary schools, and likewise 70%, 62% and 48% for watching TV. CONCLUSIONS: It is vital that education programmes with a focus on a healthy lifestyle are introduced and targeted at teenagers in order to promote physical activity during the crucial time of the body's development. The period of maturing into adulthood is particularly crucial for acquiring the right knowledge, convictions, skills and attitudes that help shape a pro-healthy lifestyle in later years.

Prevalence of antibodies against selected zoonotic agents in forestry workers from eastern and southern Poland.

INTRODUCTION AND OBJECTIVE: Due to the nature of their work, foresters are exposed to many infectious pathogens from the wildlife reservoir. The primary aim of this study was to assess their contact with these pathogens. MATERIAL AND METHODS: Sera and antibodies, mainly of IgG class against selected infectious factors, collected from a group of 216 employees of National Forests from eastern and southern Poland, were investigated. RESULTS: Antibodies to Anaplasma phagocytophilum were detected in 64 sera (29.6%), to Bartonella spp. in 133 sera (61.6%), to Babesia microti in 50 sera (23.1%), and to Coxiella burnetii in 14 sera (6.4%); 7 sera (3.2%) were positive to Francisella tularensis. In studies of diseases not carried by ticks positive results were found in 28 sera (12.9%) to Toxocara canis, 13 sera (6.0 %) to Trichinella spiralis, and in 7 sera (3.2%) to Echinococcus granulosus. Antibodies to Hanta viruses were detected with antigens from Puumala and Dobrava/Hantaan strains in both IgM and IgG class. In 9 foresters, positive results were found, including one positive result to 2 antigens, 5 to Dobrava/Hantaan antigen and 3 to Puumala antigen. CONCLUSION: Frequently higher percentages of positive results were found in people working utdoors, and in men when compared with women.

LC-Q/TOF mass spectrometry data driven identification and spectroscopic characterisation of a new 3,4-methylenedioxy-N-benzyl cathinone (BMDP).

The recent increase in the sell and abuse of substituted cathinones has developed the requirement for fast and reliable screening methods for these compounds in legal high products. This paper shows an example of the successful application of liquid chromatography-high resolution quadrupole time-of-flight mass spectrometry to detection and identification of a new synthetic cathinone 3,4-methylenedioxy-N-benzylcathinone (BMDP) in legal high samples. It discusses the mass spectrometric, the nuclear resonance spectroscopic and infrared spectroscopic data of BMDP. BMDP was first seized in United Kingdom in 2010, it was also seized in Poland in winter of 2010. The structure elucidation of the drug was carried out by high resolution product ion spectrometry after collision induced dissociation, and the product ion spectrometry after electron ionisation and one and two-dimensional (1)H NMR and (13)C NMR spectroscopy supported the findings.

Influence of prenatal physical activity on the course of labour and delivery according to the new Polish standard for perinatal care.

INTRODUCTION: Prenatal physical activity has been increasingly recommended in recent years as the fundamental condition of physiological pregnancy and birth by health promoting organizations throughout the world. OBJECTIVE: To determine the influence of prenatal physical activity on the course of labour and delivery. The practical purpose was to present prenatal physical activity as an effective tool in the implementation of the new Polish standard for perinatal care. BRIEF DESCRIPTION OF THE STATE OF KNOWLEDGE: Reviewed publications report either a positive impact or no impact of physical activity on selected parameters of labour and delivery. The most frequently cited benefits of physical exercise during pregnancy include: shorter delivery, less frequent need for anesthesia, reduced risk of operative births, a lower rate of induction of labor, amniotomy, episiotomy and perineum lacerations, and improved neonatal outcome. CONCLUSIONS: A review of the literature shows that regular prenatal physical activity can help reduce medical interventions during labour, without having negative consequences for either the mother or the foetus. It should be an important tool to implement the Polish standard for perinatal care. There is a need to promote regular prenatal physical activity among women, medical personnel, and physical education staff. Detailed instructions for designing prenatal exercise programmes should be included in the new guidelines for physical activity during pregnancy, both in Poland and abroad. To support or negate the hypothesis of the positive effects of physical activity on the course of labour and delivery, well-designed research trials should be conducted with the properly structured prenatal exercise programmes in the intervention groups.

Nutrition-related health behaviours and prevalence of overweight and obesity among Polish children and adolescents.

INTRODUCTION: An adequate mode of nutrition is among the most important environmental factors affecting the development of Man and maintenance of a good health status. An improper selection of nutrients and irregular consumption of meals may lead to overweight and obesity. OBJECTIVE: The characteristics of health behaviours of the examined population of schoolchildren, with consideration of nutrition and body weight disorders. A comparison of the opinions of schoolchildren and their parents concerning health behaviours. Development of guidelines for educational programmes carried out in the place of residence of the population of schoolchildren and their parents. MATERIALS AND METHOD: The survey covered a randomised group of schoolchildren attending elementary and secondary schools in the Kalisz Province and province of the city of Kalisz. The study was conducted in May and June 2009, in a randomly selected representative group of 1,100 boys and girls from classes V and VI of elementary schools, and 1,100 secondary school adolescents aged 16-19 and their parents. The studies of schoolchildren attending elementary and secondary schools were compared with the all-Polish studies of junior high school adolescents in the school year 2006-2007. RESULTS: The respondents most often consumed 3-4 meals; however, as many as 26% of junior high school adolescents and 27% of secondary school adolescents admitted that they consume only one meal daily. The schoolchildren show inadequate nutritional habits concerning an insufficient consumption of fruits, vegetables and fish, in favour of high calorific meals and sweet snacks and drinks. Parents improperly assess the body weight of their children and perceive them as slimmer, which is not confirmed by the BMI value for age and gender. CONCLUSIONS: Systematic monitoring and analysis of changes in the health behaviours of adolescents should be a basis for planning health education and promotion programmes. Educational programmes concerning various aspects of health should be implemented in an organized and complementary way, directed not only at schools, but also at entire families and local communities. Knowledge, beliefs, skills and attitudes towards health acquired during the period of adolescence decide about life style in adulthood.