Trajectories of primary health care utilization: a 10-year follow-up after the Swedish Patient Choice Reform of primary health care.

BACKGROUND: In January 2010, the choice reform was instituted in Swedish primary health care establishing free entry for private primary health care providers and enabling patients to choose freely among primary health care centers. The motivation behind the reform was to improve access to primary care and responsiveness to patient expectations. Reform effects on health care utilization have previously been investigated by using subgroup analyses assuming a pattern of homogeneous subgroups of the population. By using a different methodological approach, the aim of this study was to, from an equity perspective, investigate long term trends of primary health care utilization following the choice reform. METHOD: A closed cohort was created based on register data from Region Skåne, the third most populated region in Sweden, describing individuals' health care utilization between 2007-2017. Using a novel approach, utilization data, measured as primary health care visits, was matched with socioeconomic and geographic determinants, and analyzed using logistic regression models. RESULTS: A total of 659,298 individuals were included in the cohort. Sex differences in utilization were recorded to decrease in the older age group and to increase in the younger age group. Multivariable logistic regression showed increasing utilization in older men to be associated with higher socioeconomic position, while in women it was associated with lower socioeconomic position. Furthermore, groups of becoming high utilizers were all associated with lower socioeconomic position and with residence in urban areas. CONCLUSION: The impact of demographic, socioeconomic and geographic determinants on primary health care utilization varies in magnitude and direction between groups of the population. As a result, the increase in utilization as observed in the general population following the choice reform is unevenly distributed between different population groups.

The Chemical and Biological Properties of Nanohydroxyapatite Coatings with Antibacterial Nanometals, Obtained in the Electrophoretic Process on the Ti13Zr13Nb Alloy.

The risk of an early inflammation after implantation surgery of titanium implants has caused the development of different antimicrobial measures. The present research is aimed at characterizing the effects of nanosilver and nanocopper dispersed in the nanohydroxyapatite coatings, deposited on the Ti13Zr13Nb alloy, and on the chemical and biological properties of the coatings. The one-stage deposition process was performed by the electrophoretic method at different contents of nanomaterials in suspension. The surface topography of the coatings was examined with scanning electron microscopy. The wettability was expressed as the water contact angle. The corrosion behavior was characterized by the potentiodynamic technique. The release rate of copper and silver into the simulated body fluid was investigated by atomic absorption spectrometry. The antibacterial efficiency was evaluated as the survivability and adhesion of the bacteria and the growth of the biofilm. The cytotoxicity was assessed for osteoblasts. The results demonstrate that silver and copper increase the corrosion resistance and hydrophilicity. Both elements together effectively kill bacteria and inhibit biofilm growth but appear to be toxic for osteoblasts. The obtained results show that the nanohydroxyapatite coatings doped with nanosilver and nanocopper in a one-stage electrophoretic process can be valuable for antibacterial coatings.

Infectious diseases in Poland in 2019.

OBJECTIVE OF THE WORK: The article reviews the main problems of the epidemiology of infectious diseases in Poland. It is an introduction to the Epidemiological Chronicle presented annually in the Epidemiological Review. MATERIAL AND METHODS: The data contained in this article come from the reports of the State Sanitary Inspectorate collected as part of routine epidemiological surveillance. Information on deaths comes from the reports from Statics Poland. RESULTS AND THEIR DISCUSSION: Based on the basic materials, this text presents data on infectious diseases of particular importance due to high incidence, such as influenza and other respiratory infections, or due to increasing trends, such as C. difficile infections, and Lyme disease. Particular attention was paid to diseases against which vaccinations are used and to non-endemic diseases imported from abroad. In the epidemiological characteristics of individual diseases, reference was made mainly to the data on the number of cases, incidence and deaths included in Table 1.

Infectious diseases in Poland in 2018.

OBJECTIVE OF THE ARTICLE: The introductory text to the Epidemiological Chronicle (EC) of the Epidemiological Review contains data on the incidence of infectious and parasitic diseases in Poland in 2018 compared to 2017 data and medians from 2012-2016. It is a general overview of the epidemiological situation of infectious and parasitic diseases in Poland. With regard to selected diseases, widening and deepening picture is in the content of remaining articles of the epidemiological chronicle. MATERIAL AND METHODS: The source data for this article are mainly individual reports submitted by doctors to the County Sanitary/Epidemiological Stations. The basic material of this study is the data published in the bulletins "Infectious diseases and poisoning in Poland in 2018" and "Immunization in Poland in 2018", as well as data published in the reports "Influenza and suspected influenza in Poland in 2018". Data on deaths due to infectious diseases come from the summaries of the Demographic Research Department of the Central Statistical Office. RESULTS AND THE DISCUSSION: As in previous years, the highest incidence was recorded in the category of upper respiratory tract infections and, but to a much lesser extent, gastrointestinal infections. For at least two decades, there has been a shift in the profile of gastrointestinal infections characterized by an increase in viral infections compared to bacterial infections. Regarding healthcare associated infections, rotavirus infections predominate among children and C. difficile infections among adults. The later creates a serious, growing problem, largely related to the use of antibiotics, but also to fecal-oral transmission. Among infectious diseases, C. difficile caused the highest number of deaths in 2018. Viral infection of the liver continues to be an important problem. Apart from hepatitis B and C, this also applies to hepatitis A, which took the form of an epidemic in 2017. In 2018, the incidence decreased by more than a half, but still the number of cases was about thirty times higher than for the median from 2012-2016. Despite declining tendency for many years, the incidence of tuberculosis still remains above the numbers recorded in the developed countries of Western Europe. In other disease groups, there was no marked increase in risk compared to previous years.

Tetanus in Poland in 2017

INTRODUCTION: In the last decade, the number of tetanus cases in Poland has not exceeded 20 cases. Since 1984, neonatal tetanus has not been reported. OBJECTIVE OF THE WORK: The aim of the study is to present the data of epidemiological surveillance of tetanus in 2017 in a historical perspective, taking into account the role of protective vaccination and a reference to activities for the elimination of neonatal tetanus on a global scale. SUMMARY AND CONCLUSIONS. Tetanus is an infectious disease acquired in the environment and associated with wound pollution. Few cases of illness in Poland are associated with non-compliance with recommendations for booster vaccinations. MATERIAL AND METHODS: The material of the study are individual reports on tetanus sent to the Department of Epidemiology, NIZP-PZH and the bulletin "Infectious diseases and poisoning in Poland in 2017. The historical data is based on earlier Polish and foreign studies. RESULTS: In 2017, 11 cases of tetanus were reported. Four men and seven women got sick. One man died in the age > 69.

Infectious diseases in Poland in 2017

OBJECTIVE OF THE WORK: The article contains an overview of epidemiological surveillance data on infectious diseases in Poland in 2017 with reference to data from 2016 and median from 2011-2015. This is another introductory article to the systematically conducted Epidemiological Chronicle of Epidemiological Review presenting the current epidemiological situation of selected infectious diseases. In justified cases, eg by cross-border threats, the study includes references to the epidemiological situation in other countries. MATERIAL AND METHODS: The source data for this study are the applications of doctors to the State Sanitary Inspection, which in the form of summary lists or individual notifications are forwarded to the Department of Epidemiology of Infectious Diseases and Surveillance of NIPH-PZH and after being prepared they are included in the bulletins "Infectious diseases and poisoning in Poland in 2017 "and" Protective vaccinations in Poland in 2017". Data on deaths due to infectious diseases come from a list of the Department of Demographic and Labor Market Research of the Central Statistical Office. RESULTS AND THEIR DISCUSSION: Discussion of epidemiological data begins with the most prevalent diseases in Poland, which are upper respiratory tract infections and gastrointestinal infections. In the area of upper respiratory tract infections, attention is drawn to the increase in the number of reported cases in recent years, which may be at least partly related to the development of computerization of reports. The profile of gastrointestinal infections acquired in the non-hospital environment has been changing in recent years towards a clear predominance of infections with viral etiology in relation to bacterial infections. Regarding healthcareassociated infections, rotavirus infections predominate among children, and among adults, C. difficile infections constitute a serious, growing problem, which is largely associated with the use of antibiotics. Viral liver infections are still an important problem. B and C, and in 2017 also hepatitis A, which took the form of an epidemic. In other groups of diseases, there was no clear increase in threats compared to previous years. Despite a steady decline in incidence, tuberculosis has been the disease causing the highest number of deaths among infectious diseases for many years. In 2017, the highest number of deaths was caused by C. difficile infection.

Genital Chlamydia trachomatis infections in young adults - a school-based bio-behavioural study in urban areas, Poland, 2012 to 2015.

Context and AimOne of the most common sexually transmitted pathogens disproportionately affecting young people is Chlamydia trachomatis (CT). This study aimed to assess prevalence of CT among sexually active students (aged 18-19 years) in their final years of high school education in Warsaw and Krakow. Methods: The sample was selected from 61 clusters, each cluster representing one school. We described city, sex, type of school and their association with CT prevalence. To account for non-responders we applied inverse probability weighting. Results: Our study population consisted of 3,136 young adults eligible for CT screening, of whom 2,326 reported having had sexual intercourse within past 12 months. Of the 950 students who agreed to be tested, 39 were infected with CT. Weighted prevalence of CT was 3.9% (95% confidence interval (CI): 2.7-5.1); however, prevalence in the students in Warsaw (6.6%; 95% CI: 3.5-12.4) was six times higher (prevalence ratio (PR) = 5.9; 95% CI: 2.0-17.3) than in Krakow (1.1%; 95% CI: 0.5-2.6). In both settings, female students attending vocational-technical schools were most affected; the prevalence in this group was more than five times higher (PR = 5.2; 95% CI: 1.7-15.6) compared with female peers in high schools and more than three times higher (PR = 3.3; 95% CI: 1.0-10.7) compared with male peers attending vocational-technical schools. Conclusion: Our study suggested prevalence of CT infection among young people in Poland comparable with the European average, supporting implementation of a CT control programme as recommended in international guidelines.

Tetanus in Poland in 2016

THE PURPOSE of the STUDY: The purpose of the study was to provide data on tetanus incidence in 2016 in the basic categories of epidemiological surveillance. MATERIAL AND METHODS: The study is based on the individual forms of tetanus cases submitted to the NIZP-PZH Epidemiology Department and the data of the bulletin "Infectious Diseases and Poisoning in Poland in 2016. RESULTS: The number of tetanus cases in 2016 was 12, exactly as it was in the previous year 2015. Among the infected people there were six men and six women. Among the infected people two men and one women died. All the fatalities were in the age groups of 70 and older. SUMMARY AND CONCLUSIONS: The environmental nature of tetanus infections makes the immunity of individual exposed persons the basic preventive tool, which underlines the role of individual vaccinations.

Infectious diseases in Poland in 2016

OBJECTIVE OF THE ARTICLE: This is for the year 2016 subsequent annual analysis of the situation of infectious and parasitic diseases in Poland as part of the Epidemiological Chronicle of the Epidemiological Review. Its purpose is to summarize the collective incidence of infectious diseases and to indicate potential threats to the health of populations from communicable diseases occurring in Poland. MATERIAL AND METHODS: The basic source of epidemiological information for this summary is a summary of data from reports of the State Sanitary Inspection, contained in the annual bulletins "Infectious diseases and poisoning in Poland in 2016" and "Protective Vaccination in Poland in 2016" (1, 2). Supplementary sources are detailed assessments of the epidemiological situation of selected infectious diseases that make up the socalled Epidemiological Chronicle. Data on deaths were obtained from materials of the Department of Demographic and Labor Market Research of the Central Statistical Office regarding deaths from infectious and parasitic diseases registered in Poland in 2015 and in earlier years. RESULTS AND THEIR DISCUSSION: The most numerous group among infectious diseases subject to epidemiological surveillance are upper respiratory tract infections classified as "influenza and influenza - like disease". In 2016, the number this category cases was 4 316 823 (11 233.9 / 100 000). In relation to incidence in 2015, it was an increase of 12.4%, and in relation to the median from 2010-2014 by 196.5%. In 2016, the incidence of intestinal infections of salmonellosis etiology increased compared to the previous year by 16.0%, and in relation to the median from 2010-2014 was higher 19.1%. This is a deviation from the downward trend of these infections observed over last decades. A serious epidemiological problem is the high incidence of infection caused by Clostridium difficile. In 2016, 8 716 (22.7 / 100,000) of these cases were reported, which resulted in 540 deaths. In comparison with the previous year, it was a non-significant decline in incidence by 2.8%, but in comparison with the median from 2010-2014 it was an increase of 56.4%. In 2015, the high incidence of norovirus induced intestinal infection persisted. 3 706 cases were reported (9.64/ 100 000), which is significantly higher than in 2015 (by 2%), but in relation to the median from 2010-2014 it was an increase of 136.6%. Among viral intestinal infections in children, rotavirus infections are still a particularly important problem. Despite the decrease in incidence in comparison with 2015 by 37.3%, the number of cases in 2016 was 21 258 (55.3 / 100,000), which is a serious epidemiological problem. A high percentage of these incidents were infection related to the medical care. In the group of infections and intestinal intoxication, which cause diarrhea in children under 2 years, in 2016 there was a decrease from the previous year of 11.7%, but in relation to the median from 2010-2014 it was an increase of 25.7%. In 2016 number of reported cases of pertussis was 6 828 (17.8 / 100 00), which represented a rise in incidence compared to the previous year by 37.9%, and compared to the median from 2010-2014 by as much as 225%. The year 2016 was another year of decreasing the incidence of rubella. 1105 cases were reported (2.88 / 100 000), what in comparison with the previous year was a decrease of 44.9%, and in relation to the median of 2010-2014 by 81.2%. No congenital rubella was reported. For many years, Poland has been free of native measles. The measles cases are infections imported from abroad and secondary cases of people who have contacted them in the country. In 2016, cases were 133 (0.35 / 100 000). The number of invasive infections caused by Streptococcus pneumoniae in 2016 was 967. In comparison with 2015, it was a non-significant decrease of 1.2%. In 2016, there were 3 806 (9.9 / 100 000) reported cases of hepatitis B, which in relation to the median of 2010- 2014 is an increase of 141.0%. Number of newly diagnosed cases of hepatitis C was 4 261 (11.1 / 100 000), which in relation to the median from 2010-2014 is an increase of 88.2%. This increase in incidence remains in a relationship. with the introduction in 2014 of a new, more sensitive case definition. 21 200 cases of Lyme disease were reported (55.2 / 100 000), which in comparison with the previous year, is an increase of 55.7%. As compared to the median of 2010-2014 it was increase by 132.1%. In 2016, number of cases of newly diagnosed HIV was 1318 (3.43 / 100 000). And number of reported AIDS cases was 102. The increase in the incidence of HIV infection was not significant. The number of cases of AIDS fell by 20.3% as compared to the previous year. Registered cases of malaria refer to people who have been infected abroad in endemic countries. There were 38 such cases in 2016. In 2015, no diphtheria, poliomyelitis, rabies and viral hemorrhagic fevers were found in Poland except for dengue, of which 41 cases of infections acquired in endemic areas were reported for epidemiological surveillance. The number of deaths from infectious and parasitic diseases in 2016 was 2 242 people. The share of deaths from these causes in the total number of deaths in Poland (388 009) was 0.58%. The highest number of deaths was caused by tuberculosis ­ 543 and intestinal infections caused by Clostridium difficile ­ 540.

Association between continuity of care in Swedish primary care and emergency services utilisation: a population-based cross-sectional study.

OBJECTIVE: The primary objective of this study was to determine the association between longitudinal continuity of care (CoC) in Swedish primary care (PC) and emergency services (ES) utilisation. STUDY DESIGN: A cross-sectional analysis of longitudinal population data. SETTING: PC centres, out-of-hours PC facilities and emergency departments (EDs) in Blekinge County in southern Sweden. SUBJECTS: People of all ages who lived in Blekinge County and who had made two or more visits per year to a general practitioner (GP) during office hours from 1 January 2012 to 31 December 2014. MAIN OUTCOME MEASURE: ES utilisation. RESULTS: Eight-thousand one-hundred and eighty-five people were included in the study. CoC was quantified using three different indices-Usual Provider of Care index (UPC), Continuity of Care index (CoCI), and Sequential Continuity index (SECON). The CoC that the PC centres could offer their enrolled patients varied significantly between the different centres, ranging from 0.23-0.57 for UPC, 0.12-0.43 for CoCI, and 0.25-0.52 for SECON. Association between the three CoC indices and ES utilisation was computed as an incidence rate ratio which ranged between 0.50 and 0.59. CONCLUSION: Longitudinal CoC was shown to have a negative association with ES utilisation. The association was significant and of a magnitude that implies clinical relevance. Computed incidence rate ratios suggest that patients with the lowest CoC had twice as many ES visits compared to patients with the highest CoC.

Tetanus in Poland in 2015

The number of tetanus in the 21st century shows a slight declining trend, but each year there is reported fatal cases of this disease. THE PURPOSE of the STUDY: The purpose of the study is to provide data on epidemiological surveillance of the tetanus in 2015. MATERIAL AND METHODS: The study is based on the individual forms of tetanus cases submitted to the NIZP-PZH Epidemiology Department and the data of the bulletin "Infectious Diseases and Poisoning in Poland in 2015. RESULTS: In 2015, 12 cases of tetanus were reported. Six men and six women became ill. 4 people died after 69 years of age. SUMMARY AND CONCLUSIONS: Tetanus is an infectious disease acquired in the environment and associated with wound contamination. Infections can be prevented by vaccination. Particularly threat to life and health carries disease in the late age.

The problem of elimination of HCV infections in Poland

The article concerns abbreviated presentation of the results obtained in the Project KIK / 35 "Prevention of HCV infection," sponsored by the Government of the Swiss Federation and the Ministry of Health of the Republic of Poland. The Project concerned the analysis of the prevalence of HCV infection in the adult population in Poland, the risk factors and groups at risk of these infections. Two sub-projects were related to separate subpopulations: pregnant women and drug users. Research in one sub-project focused on the hazards of HCV infections in medical institutions and non-medical facilities, where the procedures are performed with the interruption of tissue. In all sub-projects were carried out surveys, which served to check the knowledge ofn HCV infections, but also practical measures aimed at preventing these infections. One of the sub projects KIK / 35 "Education of medical staff and nonmedical as a key element in the prevention of blood-borne infections" was devoted entirely to the education of professionals responsible for the proper, safety, performance of procedures running with interruption of tissues." The results of these studies revealed significant shortcomings in the detection of existing infections and large gaps in knowledge about prevention. Taking into account the range of expertise needed, it turned out that the lack of information applies to both the general public and to many professionals. The project KIK / 35 in its summary refers to the risks of HCV infection, both known from the literature and disclosed the specificity of our country. The ultimate result of the Project NCI / 35 is to develop a strategy for the elimination of HCV infections in Poland. This strategy, strongly linked to the WHO strategy includes integrated, permanent preventive measures related tot he introduction of screening programs for early detection of HCV infections and treat them as important element in prevention. Special emphasis was put on universal access to diagnosis and treatment for all social groups.

Infectious diseases in Poland in 2015

PURPOSE OF THE STUDY: This is the next annual analysis of the situation of infectious and parasitic diseases in Poland in 2015 within the framework of the Epidemiological Chronicle of Przeglad Epidemiologiczny - Epidemiological Review. Its purpose is to identify potential threats to the health of populations from infectious diseases occurring in Poland with reference to other parts of the globe. MATERIAL AND METHODS: This paper is an introduction to more detailed studies of the epidemiological situation of selected infectious diseases and summarizes the results of the surveillance of infectious diseases in Poland in 2015. References to epidemiological situation in other countries are limited to situations that may affect current or potential occurrence of the disease in Poland. The main source of epidemiological information for this summary is the data from the reports of the State Sanitary Inspection included in the annual bulletins "Infectious Diseases and Poisonings in Poland in 2015" and "Vaccination in Poland in 2015" (1, 2). The epidemiological situation of particular diseases is further elaborated in the Epidemiological Chronicle of the same issue of the Epidemiological Review. Data on deaths are based on the presentation of the Demographic and Labor Market Department of the Central Statistical Office on deaths from infectious and parasitic diseases registered in Poland in 2015 and earlier. RESULTS: For a long time, the most common diseases among epidemiological surveillance it is upper respiratory tract infections classified as "influenza and suspected influenza". In 2015, the number of cases was 3,843,438 (9 994,7 / 100,000). As to compare with the 2014's incidence, this was an increase of 22.6%. In 2015, incidence of intestinal infections with etiology of salmonella increased by 2.8% compared to the previous year, but compared to the median of 2009-2013 was 2.5% lower. A serious epidemiological problem is a strong upward trend in nosocomial infections including infections caused by Clostridium difficile. In 2015, 8.976 (23.3 / 100,000) of these cases were reported. They caused 491 deaths. Compared to the previous year, the increase in incidence was 39.8%. Compared with the median of 2009-2013 it was an increase of 89.7%. In 2015, there was a continuation of observed for more than a dozen years the unfavorable trend of intestinal infections caused by noroviruses. There were recorded at 3,637 (9.5 / 100,000) of those infections. Among viral intestinal infections, rotavirus infections in children are a particularly important problem. In 2015, as compared with 2014, the increase of incidence in the general population was not high, only 0.5%, but to the median of 2009-2013 it was 44.4%. An important group of intestinal infections, diarrhea in children under 2 years of age, had a slight decrease (by 0.3%) in the category of bacterial infections in 2015, but increased by 26.7% in the category of bacterial poisonings and 5.9% in the category of viral infections. In 2015, there were 4956 cases of pertussis (512.9 / 100,000), which was an increase in the incidence compared with the previous year by 136.2%, and compared with the 2009-2013 median by 127.4%. After the epidemic of rubella outbreaks in 2013, in the year 2014, the incidence dropped by 84.7% and in 2015, the decrease was 65.9%. One case of congenital rubella has been reported. Most measles infections are imported infections or in contact with them in the country. In 2015 the number of cases was 48 (0.12 / 100,000). In 2015, the number of invasive diseases caused by H. influenzae was 62 (0.16 / 100,000). Compared to the previous year, this was an increase of 51.3%. The number of invasive diseases caused by Streptococcus pneumoniae in 2015 was 979 cases. Compared to 2014, this was an increase of 39.0%. When compared with the median of 2009-2013, increase was 128.1%. In 2015, number of reported cases of hepatitis B was 3,518 (9.1 / 100,000), which was 122.7% higher than the median of 2009-2013. Newly diagnosed C-type infections were reported to be 4,285 (11.1 / 100,000), an increase of 91.6% over the median of 2009-2013. Such a large increase in reported cases is related, inter alia to the introduction a new, more sensitive case definition in 2014. The incidence of Lyme disease has been on the rise in the last fifteen years. In 2015, 13,625 cases (35.4 / 100,000) were reported, which, with an insignificant decrease compared to 2014, gives rise to 49.1% over the median of 2009-2013. The downward trend in the incidence of tuberculosis (all forms of tuberculosis) is clearly persistent. In 2015, the incidence of this disease decreased compared to the previous year from 17.4 to 16.7 / 100,000. In 2015 were reported 1,281 cases of newly diagnosed HIV (3,33 / 100,000). It was an increase of 13.0%. The number of AIDS cases decreased by 13.5% compared to the previous year. Reported cases of malaria involve people who have been infected abroad in endemic malaria areas. In 2015 there were reported 29 such cases. None of the cases of diphtheria, chronic childhood paralysis, rabies and viral hemorrhagic fever except for dengue have been reported in 2015. There were reported 12 cases of dengue imported from endemic regions. In Poland in 2015 number of deaths from all infectious and parasitic diseases was 2,199. The share of deaths due to infectious diseases in the total number of deaths was 0.54% and mortality was 5.5 per 100,000 population. The majority of deaths were caused by tuberculosis and its consequences (25.7%) and intestinal infections caused by Clostridium difficile (23.2%).

Tetanus in Poland in 2014

For many years the number of tetanus cases reported in Poland remaing below fifty with marked random variations. Almost all disease occur in people unvaccinated. Some of them, especially in people over age 60, are fatal. THE AIM OF THE STUDY: The aim of the study is to present the data of epidemiological surveillance of tetanus in Poland in 2014. MATERIAL AND METHODS: Analyzed material are the individual reports of cases of tetanus sent to the Department of Epidemiology at NIPH-PZH and bulletin data "Infectious diseases and poisoning in Poland in 2014". RESULTS: In 201 number of tetanus cases recorded in Poland was 13. It amounted to six men and seven women. Among those 9 was over 59 years of age. Out of them 4 people died. All were women over 69 years of age. SUMMARY AND CONCLUSIONS: Tetanus is an infectious disease acquired in the environment and associated with the contamination of wounds. Infections and deaths could be prevented by vaccination. Particular risk life and health carries illness after 60 years of age.

Infectious diseases in Poland in 2014

PURPOSE of the STUDY: The aim of the study is to assess epidemiological situation of infectious and parasitic diseases in Poland in 2014, and an indication of the potential health risks from communicable diseases occurring in other areas of the globe. MATERIAL AND METHODS: This paper is a summary of the analysis and evaluation of the results of epidemiological surveillance of infectious diseases in Poland in 2014, and those elements of European and global epidemiological background, which in this period had an impact on the epidemiological situation in Poland or constituted a threat. The main source of data for this study are statistical reports included in annual bulletins "Infectious diseases and poisoning in Poland in 2014" and "Immunizations in Poland in 2014" (NIPH-PZH, GIS, Warsaw 2015) and the data contained in the articles of "Epidemiological chronicle" presented in the Data on deaths are based on the statement of the Department for Demographic Research and Labour Market CSO presenting numbers of deaths from infectious and parasitic diseases registered in Poland in 2014, and in the previous years. RESULTS: Upper respiratory tract infection classified as "suspected flu and the flu season" in the since many years are the largest position among the diseases subject to disease surveillance. In the last decade, particularly large increase in the incidence of upper respiratory tract infection was reported in the flu season 2013., when the increase in comparison to the median of years 2008-2012 amounted to 189.8%. In 2014. Number of reported cases was 3 137 056 which represented a nonsignificant decrease of 0.8% compared with the previous year. However, compared to the median of the years 2008-2012 it was an increase of 187.4%. Better then based on calendar year is a picture obtained by examining the incidence of seasonal periods in the annual, but counted from 1 September to 31 August of the following year. In such a setup, in the 2012/2013 season were recorded 3 025 258 of cases, and in the season 2013/2014 recorded number was 2 780 945. In such a way in the 2013/2014 season decrease in the number of cases as compared to the season 2012/2013 was 8%. Another group of infections with a high incidence are intestinal ones. In 2014. Incidence of intestinal infections with Salmonella etiology increased in comparison with the previous year by 10.8%, but in relation to the median of 2008-2012 was lower by 7.3%. Incidence of an important group of intestinal infections, which are diarrhea cases in children under 2 years, increased in 2014. in the category of infections of viral etiology and a decreased among bacterial ones. In 2014. upward trend of intestinal infections caused by viruses persited. Among these infections dominated rotavirus infections in children. Number of reported foodborne infections of viral etiology was 51 561 (134.0/100 000). Most of them were caused by rotavirus: 33 789 (87.8/100 000). Number of cases of whooping cough reported in 2014 was 2 101 (5.5/100 000), it was a decrease of incidence as compared with the previous year by 3.7%. After the epidemic increase in cases of rubella in 2013. there has been a decline in the incidence of the disease by 84.7%. No single case of congenital rubella was reported. In 2014. it were reported 110 cases of measles (0.29 / 100 000). In 2014. Number of cases of invasive diseases caused by H. influenzae was 41, incidence: (0.11 / 100 000). This was an increase of 64.1%, as compared with the previous year. Among them, the number of sepsis cases increased by 150% from 10 to 25. None of these cases was fatal. The number of invasive diseases caused by Streptococcus pneumoniae in 2014. amounted to 704. In comparison with 2013. This was an increase of 30.4%, but as compared with the median of the 2008-2012 period it was 91.9%. Among the cases of invasive S. pneumoniae infections 59 were fatal. The downward trend in the incidence of tuberculosis in total (all forms of TB) is clearly sustainable. In 2014. Incidence of this disease has decreased in comparison with the previous year from 18.8 / 100 000 to 17.4 and pulmonary tuberculosis from 17.8 to 16.4 / 100 000. In 2014. There were reported 1 157 cases of newly diagnosed HIV infections (3.01 / 100 000). And it was not a significant increase in the incidence of 4.5%, as compared with the previous year. The number of reported new AIDS cases decreased by 8.6%. In recent decades, there were no indiginus cases of malaria in Poland. Registered cases of malaria apply to persons who acquired it abroad in endemic areas. 19 such cases were reported in 2014. In 2014. there were no cases of diphtheria, poliomyelitis, rabies and viral haemorrhagic fevers with exception of dengue, of which 15 cases acquired in endemic areas were reported. Total number of deaths due to infectious and parasitic diseases in 2014 in Poland. was 2 169. The share of deaths from these causes in reference to the total number of deaths was 0.58%, and mortality due to infectious diseases was 5.6 per 100 000. Most deaths (24.6%) were caused by tuberculosis and its consequences.

[White adipose tissue dysfunction observed in obesity]. / Dysfunkcja tkanki tluszczowej zóltej obserwowana w otylosci.

Obesity is a disease with continuingly increasing prevalence. It occurs worldwide independently of age group, material status or country of origin. At these times the most common reasons for obesity are bad eating habits and dramatic reduction of physical activity, which cause the energy imbalance of organism. Fundamental alteration observed in obese subjects is white adipose tissue overgrowth, which is linked to increased incidence of obesity-related comorbidities, such as: cardiovascular diseases, type 2 diabetes or digestive tract diseases. What is more, obesity is also a risk factor for some cancers. Special risk for diseases linked to excessive weight is associated with overgrowth of visceral type of adipose tissue. Adipose tissue, which is the main energy storehouse in body and acts also as an endocrine organ, undergoes both the morphological and the functional changes in obesity, having a negative impact on whole body function. In this article we summarize the most important alterations in morphology and function of white adipose tissue, observed in obese subjects.

[The correlation between testosterone levels and C-reactive protein in acute bacterial epididymo-orchitis]. / Korelacja stezenia testosteronu i bialka C-reaktywnego w ostrym zapaleniu jadra i najadrza.

UNLABELLED: Acute bacterial epididymo-orchitis is common urological condition that usually originates from ascending infection of lower urinary tract. It is characterized by infection of testis combined with spermatogenesis and steroidogenesis impairment. There is also a component of local and systemic inflammation. AIM: The aim of this study was to assess the effect of systemic inflammation associated with acute epididymo-orchitis on testis steroidogenesis. MATERIALS AND METHODS: 30 patients with acute bacterial epididymoorchitis treated in our ward without any oncologic involvement or other systemic inflammatory conditions were considered for the study. Total serum levels of testosterone and C-reactive protein measured within 12 hours of admission. RESULTS: Low total testosterone levels regarding to random laboratory population norms were noticed in 11 patients. Diminished serum total testosterone levels regarding to medium age levels were identified in 24 patients (80%). 29 patients had serum CRP levels elevated what gives average 22x fold. There is a statistically significant negative correlation between serum total testosterone levels and CRP serum levels were found (R - 0.75; p<0.000002 Spearman's correlation). CONCLUSIONS: There is a strong influence of ongoing systemic inflammation caused by bacterial infection on steroidogenesis in testis in acute epididymo-orchitis patients.

Reliability and applicability of the Patient Enablement Instrument (PEI) in a Swedish general practice setting.

BACKGROUND: The Patient Enablement Instrument (PEI), which has been used to evaluate core ingredients in primary care consultations, has been proposed as a means of moving beyond patient satisfaction evaluations. The aim of the present study was to examine the reliability and applicability of the PEI to the Swedish context. METHODS: The original PEI was translated to Swedish and included in a questionnaire that was given to consecutively scheduled patients in four primary care settings. Respondents completed identical questionnaires immediately after a consultation, as well as two days and two weeks later. The analysis focused on internal reliability, test-retest reliability and internal construct validity. RESULTS: Mean PEI scores declined significantly between baseline (3.48, SD 3.21) and the first follow-up questionnaire (3.06, SD 3.37). All three questionnaires showed high internal consistency (Cronbach's alpha >0.85). Test-retest showed moderate agreement for all questions when comparing baseline and the first follow-up (kappa 0.54-0.65) and greater consistency between the two follow-up questionnaires (kappa 0.65-0.75). A large proportion of respondents characterized at least one of the questions as irrelevant (39%). CONCLUSIONS: The Swedish version of the PEI instrument has high internal consistency and moderate to good reliability. It can be used in research but is not recommended as a measure of quality of care. The instrument could benefit from further development and validity testing.

Inequalities in health and social policy.

WHO and the European Commission impart great importance to promoting activities aimed at reducing inequalities in health. The article raised methodological problems of studies on the causes of inequalities in health. Author draws attention to the need for field studies focused on comparing well-specified population groups in order to achieve greater accuracy of studies to obtain preventive actions better fit to the specific needs of a given population. He also indicates the difficulties related to the comparisons made on an international scale due to the large number of variables that could interfere with investigated exposure. A significant part of the article is devoted to the interpretation of the measurement of poverty and the relationship between economic inequality and inequities in health. The author points out that there are no simple relations in this area, but the impact of economic inequality is particularly pronounced where inequalities in income of families bring large fractions of a society below the threshold of poverty.