The national burden of frailty and disproportionate distribution of its components-the predominance of slow gait speed: a 2018-19 face-to-face epidemiologic assessment representative of population of older Poles.

BACKGROUND: The prevalence of frailty and its components may be affected by age, diseases and geriatric deficits. However, the current operational definition of frailty assigns equal weight to the five components of frailty. AIMS: To perform a population-based assessment of physical frailty, its prevalence, and distribution of its components across different age, disease and deficit spectrum. METHODS: From 2018 to 2019, we conducted a face-to-face cross-sectional assessment of a representative sample of older Poles. We obtained data on frailty components, chronic disease burden, and prevalence of particular diseases and geriatric deficits. We calculated weighted population estimates, representative of 8.5 million older Poles, of prevalence of frailty and its components across the disease burden, associated with the particular diseases and the geriatric deficits present. RESULTS: Of 10,635 screened persons ≥ 60 years, 5987 entered the face-to-face assessment. Data of 5410 have been used for the present analysis. Seventy-two percent of the population are burdened with at least one frailty component. The estimated weighted population prevalence (95% CI) of frailty was 15.9% (14.6-17.1%), and of pre-frailty 55.8% (53.3-58.2%). Slow gait speed predominated across disease burden, specific diseases, geriatric deficits and the age spectrum. Overall, the prevalence of slow gait speed was 56.3% (52.7-60.0%), followed by weakness 26.9% (25.4-28.4%), exhaustion 19.2% (17.6-20.8%), low physical activity 16.5% (14.8-18.3%), and weight loss 9.4% (8.4-10.3%). CONCLUSIONS: Slow gait speed predominates among the components of frailty in older Poles. This may affect the component-tailored preventive and therapeutic actions to tackle frailty.

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.

Polypharmacy among elderly patients in Poland: prevalence, predisposing factors, and management strategies.

INTRODUCTION: The world's elderly population is growing dramatically. Pharmacotherapy in seniors is particularly challenging due to changes in metabolism, multimorbidity, and a great interest in nonprescription drugs. OBJECTIVES: We aimed to provide up­to­datedata on pharmacotherapy in the geriatric population of Poland, to determine factors predisposing to polypharmacy and excessive polypharmacy, and to identify seniors who are most likely to require multidisciplinary interventions in the field of pharmacotherapy. PATIENTS AND METHODS: We analyzed the use of all prescription and nonprescription drugs taken within 2 weeks preceding the study in a representative national sample of 3014 home­dwelling seniors aged over 65 years. The variables of age, sex, place of residence, level of education, and multimorbidity were considered. Poststratification was used to balance the sample structure to match the Polish population of 2017. RESULTS: Consumption of at least 1 drug was reported by 90.7% of the participants, and the mean number of drugs used was 5.01 (95% CI, 4.87-5.15). At least 1 nonprescription drug was used by 44.2% of the respondents, with a mean number of 0.52 (95% CI, 0.49-0.55). More than 5 drugs were taken by 53.5% of the entire population, while the use of more than 10 drugs was reported by 8.7% of the respondents, with multimorbidity as the most predisposing factor. Single­pill combinations accounted for 27.2% of medications. CONCLUSIONS: The high prevalence of polypharmacy resulting from multimorbidity confirms the need for the implementation of combined medical and pharmaceutical care of the geriatric patients.

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.

Socioeconomic correlates and biochemical profiles of smokers in Poland: a cross-sectional study.

INTRODUCTION: Epidemiological studies have shown a fairly constant association between the socioeconomic status and smoking. However, associations between smoking and the biological indicators of health status have not been well described yet. OBJECTIVES: This study aimed to determine the relationship among smoking, biochemical risk factors, and sociodemographic characteristics in the Polish population. PATIENTS AND METHODS: A survey was carried out in a representative sample of Polish residents aged 18 to 79 years. A total of 2413 randomly selected subjects participated in the survey. Logistic regression analysis as well as parametrical and nonparametrical tests were performed. RESULTS: Significantly higher cholesterol, apolipoprotein B, and potassium levels were observed in smoking women and men compared with the nonsmoking population. Significantly lower bilirubin levels were noted in smoking individuals. Higher C­reactive protein and lower creatinine levels were reported only in the smoking male population compared with nonsmokers. There was a significant inverse gradient in the relationship between income and smoking. Single women and men were at greater risk of being smokers (odds ratio [OR], 1.9 and 2.39, respectively). Individuals from small towns (less than 50 000 inhabitants) were at significantly greater risk of smoking compared with those living in rural areas (OR, 1.45 and 1.64 in women and men, respectively). CONCLUSIONS: We found differences regarding socioeconomic characteristics and major biochemical parameters between smokers and nonsmokers in Poland. However, it is difficult to establish which associations are causal for cardiovascular risk owing to the cross­sectional design of this study.

Assessment of quality of care of patients with ST-segment elevation myocardial infarction.

AIMS: The 2017 European Society of Cardiology guidelines for the management of ST-elevation myocardial infarction recommended assessing quality of care to establish measurable quality indicators in order to ensure that every ST-elevation myocardial infarction patient receives the best possible care. We investigated the quality indicators of healthcare services in Poland provided to ST-elevation myocardial infarction patients. METHODS AND RESULTS: The Polish Registry of Acute Coronary Syndromes is a nationwide, multicentre, prospective study of acute coronary syndrome patients in Poland. For the purpose of assessing quality indicators, we included 8279 patients from the Polish Registry of Acute Coronary Syndromes hospitalised with ST-elevation myocardial infarction in 2018. Four hundred and eight of 8279 patients (4.9%) arrived at percutaneous coronary intervention centre by self-transport, 4791 (57.9%) arrived at percutaneous coronary intervention centre by direct emergency medical system transport, and 2900 (37.2%) were transferred from non-percutaneous coronary intervention facilities. Whilst 95.1% of ST-elevation myocardial infarction patients arriving in the first 12 h received reperfusion therapy, the rates of timely reperfusion were much lower (ranging from 39.4% to 55.0% for various ST-elevation myocardial infarction pathways). The median left ventricular ejection fraction was 46% and was assessed before discharge in 86.0% of patients. Four hundred and eighty-nine of 8279 patients (5.9%) died during hospital stay. Optimal medical therapy is prescribed in 50-85% of patients depending on various clinical settings. Only one in two ST-elevation myocardial infarction patients is enrolled in a cardiac rehabilitation program at discharge. No patient-reported outcomes were recorded in the Polish Registry of Acute Coronary Syndromes. CONCLUSIONS: The results of this study identified areas of healthcare system that require solid improvement. These include direct transport to percutaneous coronary intervention centre, timely reperfusion, guidelines-based medical therapy (in particular in patients with heart failure), referral to cardiac rehabilitation/secondary prevention programs. Also, there is a need for recording quality indicators associated with patient-reported outcomes.

Relationship between the dietary glycemic load of the adult Polish population and socio-demographic and lifestyle factors - results of the WOBASZ II study.

BACKGROUND: Cardiovascular disease (CVD) occurs more often among people with a low sociodemographic status, so it is worth knowing if any sociodemographic factor also has an impact on diet quality, defined by glycemic load (GL). OBJECTIVES: Assessment of the relationship between the sociodemographic and lifestyle factors, health status self-assessment and dietary GL of the adult Polish population based on WOBASZ II study results. MATERIAL AND METHODS: The study included a representative group of the Polish population aged ≥20 years (2,554 men and 3,136 women). A 24-hour dietary recall was collected to assess the dietary intake. The total GL was calculated by summing the GL values of the consumed food. RESULTS: The average GL/1,000 kcal was significantly higher in women's than in men's diets (74.0 ±15.9 vs 71.2 ±15.7). Dietary GL/1,000 kcal increased with age (men: aged <35 - 70.3 and aged ≥65 - 73.9, women: 73.5 and 76.5, respectively). The lowest dietary GL/1,000 kcal was found among people living in large population centers. Dietary GL/1,000 kcal decreased with education level (men with primary, secondary and higher education: 73.4, 69.5 and 68.9, respectively, and women: 76.7, 73.4 and 70.9, respectively). Dietary GL decreased as an income increased. The highest GL/1,000 kcal was observed in the diets of participants who performed less physical activity. The highest GL/1,000 kcal was observed in the participants who defined their health status as very poor/poor and the lowest among those who defined their health status as good/very good. CONCLUSIONS: Nutritional education about the proper selection of products that are sources of carbohydrates in the diet should be addressed mainly to people with low sociodemographic status, such as: people in the older age group, living in small population centers, and with lower levels of education and lower income. It should also be directed to people with a lower level of physical activity. Greater awareness of the choices of carbohydrate products is recommended to improve diet quality in these groups of people.

How does the risk of cardiovascular death and cardiovascular risk factor profiles differ between socioeconomic classes in Poland: A country in transition.

BACKGROUND: Socioeconomic status (SES) is an important factor for cardiovascular diseases (CVD) development. A decline in death rate from CVD among subjects with high SES is observed in developed countries. The aim of this study was to assess differences in cardiovascular risk (CV) between socioeconomic classes in Poland, a country currently in transition. METHODS: A sample of 15,200 people was drawn. A three stage selection was performed. Eventually, 6170 patients were examined (2013/2014). Data was collected using a questionnaire in face-to-face interviews, anthropometric data and blood tests were also obtained. Education was categorized as incomplete secondary, secondary and higher than secondary school. Monthly income per person was categorized as low (≤ 1000 PLN), medium (1001-2000 PLN) and high (≥ 2001 PLN). Education and income groups were analyzed by prevalence of CVD risk factors and high CVD risk (SCORE ≥ 5%). RESULTS: Higher education was associated with lower prevalence of all analyzed CVD risk factors (p < 0.001), having the highest income with lower prevalence of hypertension, currently smoking, obesity and lower high density lipoprotein cholesterol. Multivariable analysis showed that frequency of high CVD risk decreased with increasing education level (OR 0.61; 95% CI 0.49-0.76; p < 0.01), a similar favorable impact of higher income on high CVD risk was demonstrated in the whole group (OR 0.81; 95% CI 0.67-0.99; p = 0.04). CONCLUSIONS: Socioeconomic status is an independent predictor of high CV risk of death. A favorable impact on the prevalence of high CV risk was demonstrated for education and partly for income in the whole group. It may reflect a transition being undergone in Poland, moreover, it predicts how socioeconomic factors may generate health inequalities in other transitioning countries.

[Coordinated heart failure care in Poland: towards optimal organisation of the health care system]. / Coordinated heart failure care in Poland: towards optimal organisation of the health care system.

Heart failure has becoming an increasing medical, economic, and social problem globally. The prevalence of this syndrome is rising, and despite unequivocal positive effects of modern therapy, reduction of mortality has been achieved at the cost of more frequent hospitalisations. Unlike in many European countries, in Poland heart failure is usually recognised later, at a more advanced stage of the disease, leaving less time for ambulatory treatment and resulting in a high number of hospitalisations. The current paper presents the most important data regarding morbidity and mortality due to heart failure in Poland. The experts in the field focus on the key source of high costs of therapy and highlight several critical organisational deficits present in the Polish health care system. This background information builds a basis for a concept of coordinated care for patients with heart failure. The paper discusses the fundamental elements of the system of coordinated care for patients with heart failure necessary to enhance the diagnosis, improve therapeutic effects, and reduce medical, economic, and social costs.

An assessment of health status and health behaviours in adolescents: main points and methods of the SOPKARD-Junior programme.

INTRODUCTION: The study involved preparing and implementation a model of complex screening programme for adolescents and comparison of anthropometric examinations between the population of the SOPKARD-Junior programme and representative sample of Polish children in the same age. MATERIAL AND METHODS: The screening programme in 14-15 year old pupils (n = 282) included: anthropometric, blood pressure, echocardiographic, electrocardiographic, carotid arteries, kidney and thyroid ultrasound examinations, as well as respiratory, dental and masticatory system, orthopaedic, psychological and psychiatric assessment. Blood and urine tests were also performed. The results of anthropometric examinations from the SOPKARD-Junior and OLAF programmes were used for comparative analysis. RESULTS: Statistically significant (p < 0.001) differences between young people from Sopot and their peers in the general Polish population were found in height (+3.61 cm for boys), body mass (+5.19 kg for boys and +3.99 kg for girls), body mass index (+0.99 kg/m2 for boys and +1.33 kg/m2 for girls), waist circumference (+4.52 cm for boys and +4.52 cm for girls) and hip circumference (+2.51 cm for boys). The highest attendance rate was achieved for examinations performed in school (e.g. anthropometric and blood pressure measurements - n = 268; 95%) and the lowest for the echocardiograpy performed in local hospital (n = 133; 47%). The mean score of the programme quality (scale 1-6) assessed by children was 4.63. CONCLUSIONS: The SOPKARD-Junior programme represents an attempt to develop a model of screening assessments for teenagers in Poland. Preliminary results of the SOPKARD-Junior programme indicate small differences in the biological development of Sopot youth in comparison with their peers from Polish population of the OLAF programme. The high attendance rate on research conducted at the school indicate that proposed health examinations in adolescents are acceptable and feasible.

Chronic heart failure management in primary healthcare in Poland: Results of a nationwide cross-sectional study.

BACKGROUND: Organizational and educational activities in primary care in Poland have been introduced to improve the chronic heart failure (CHF) management. OBJECTIVES: To assess the use of diagnostic procedures, pharmacotherapy and referrals of CHF in primary care in Poland. METHODS: The cross-sectional survey was conducted in 2013, involving 390 primary care centres randomly selected from a national database. Trained nurses contacted primary care physicians who retrospectively filled out the study questionnaires on the previous year's CHF management in the last five patients who had recently visited their office. The data on diagnostic and treatment procedures were collected. RESULTS: The mean age ± SD of the 2006 patients was 72 ± 11 years, 45% were female, and 56% had left ventricular ejection fraction <50%. The percentage of the CHF patients diagnosed based on echocardiography was 67% and significantly increased during the last decade. Echocardiography was still less frequently performed in older patients (≥80 years) than in the younger ones (respectively 50% versus 72%, Ρ <0.001) and in women than in men (62% versus 71%, P <0.001). The percentage of the patients treated with ß-blocker alone was 88%, but those with a combination of angiotensin inhibition 71%. The decade before, these percentages were 68% and 57%, respectively. Moreover, an age-related gap observed in the use of the above-mentioned therapy has disappeared. CONCLUSION: The use of echocardiography in CHF diagnostics has significantly improved in primary care in Poland but a noticeable inequality in the geriatric patients and women remains. Most CHF patients received drug classes in accordance with guidelines.

Long-term outcomes after acute myocardial infarction in countries with different socioeconomic environments: an international prospective cohort study.

BACKGROUND: Hospital-based data on the impact of socioeconomic environment on long-term survival after myocardial infarction (MI) are lacking. We compared outcome and quality of secondary prevention in patients after MI living in three different socioeconomic environments including patients from three tertiary-care teaching hospitals with similar service population size in Switzerland, Poland and Ukraine. METHODS: This is a prospective cohort study of patients with a first MI in three different tertiary-care teaching hospitals in Bern (Switzerland), Gdansk (Poland) and Lutsk (Ukraine) during the acute phase in the year 2010 and follow-up of these patients with a questionnaire and, if necessary, telephone interviews 3.5 years after the acute event. The study cohort comprises all consecutive patients hospitalised in every one of the three study centres during the year 2010 for a first MI in the age ≤75 years who survived ≥30 days. RESULTS: The proportion of patients with ST-segment elevation myocardial infarction (STEMI) was high in Gdansk (Poland) (80%) and in Lutsk (Ukraine) (74%), while the ratio of STEMIs to non-STEMIs was nearly 50:50 in Bern (Switzerland) (50.6% STEMIs). Percutaneous coronary intervention (PCI) was the first choice therapy both in Bern (Switzerland) (100%) and in Gdansk (Poland) (92%), while it was not performed at all in Lutsk (Ukraine). We found substantial differences in treatment and also in secondary prevention interventions including cardiac rehabilitation. All-cause mortality at 3.5 year follow-up was 4.6% in Bern (Switzerland), 8.5% in Gdansk (Poland) and 14.6% in Lutsk (Ukraine). CONCLUSION: Substantial differences in treatment and secondary prevention measures according to low-income, middle-income and high-income socioeconomic situation are associated with a threefold difference in mortality 3.5 years after the acute event. Countries with low socioeconomic environment should increase efforts and be supported to improve care including secondary prevention in particular for MI patients. A greater number of PCIs per million inhabitants itself does not guarantee lower mortality scores.

Factors Associated With Quitting Among Smoking Pregnant Women From Small Town and Rural Areas in Poland.

INTRODUCTION: Smoking rates among women in Poland are high, and access to specialized smoking cessation services in rural areas are limited. The aim of this study was to assess factors related to quitting among pregnant women who smoke in rural areas of Poland. METHODS: Data were collected during interviews conducted by midwives among 4512 women at various stages of their pregnancy. The interviews took place in small towns with populations having less than 8000 residents, located within 12 out of 16 voivodships (provinces). We used exhaled carbon monoxide to verify self-reported smoking status. RESULTS: Overall, 38% of women interviewed (n = 1578) smoked before they found out they were pregnant. Among these women, 33% quit just after they had become aware of their pregnancy. The main predictors of early quitting were: higher educational attainment among pregnant women (adjusted odds ratio [AOR] 3.21; 95% confidence interval [CI] = 1.81-5.68), secondary educational attainment among their partners (AOR 1.63; 95% CI = 1.06-2.48), and not having children (AOR 1.71; 95% CI = 1.31-2.24). The main barriers to early quitting were: living with at least one current smoker (AOR 0.55, 95% CI = 0.39-0.76), being single (AOR 0.45; 95% CI = 0.29-0.71), and having both parents smoke cigarettes (AOR 0.67; 95% CI = 0.46-0.97). CONCLUSIONS: A modest proportion of women included in this study quit after they became aware of their pregnancy. However, women faced multiple barriers to quitting, including the smoking status of their family members. The factors identified in the study can inform the design of tailored interventions for pregnant women in rural areas. IMPLICATIONS: Smoking rates among women in Poland are high, and access to specialized smoking cessation services in rural areas are limited. This study found that women were motivated to quit smoking, and many quit after they had become aware of their pregnancy. However, women faced multiple barriers to quitting, including the smoking status of their family members. The factors identified in the study can inform the design of tailored interventions for pregnant women in rural areas.

Quality of care of hospitalised patients with heart failure in Poland in 2013: results of the second nationwide survey.

BACKGROUND: Optimal management of heart failure (HF) patients is crucial to reduce both mortality and the number of hospital admissions, at the same time improving patients' quality of life. AIM: The aim of the study was to assess the quality of care of hospitalised patients with HF in Poland in 2013 and compare it with the results of a similar survey performed in 2005. METHODS: The presented study was conducted from April to November 2013 in a sample of 260 hospital wards in Poland, recruited by stratified proportional sampling. Similarly to the first study edition in 2005, a trained nurse contacted physicians, who filled out the study questionnaires on the last five patients with HF, who had been discharged from an internal or cardiological ward. HF did not have to be a major cause of hospital admission. RESULTS: The mean age of the 1300 hospitalised patients was 72.1 years, an increase of 2.3 years since the 2005 survey. The proportion of patients classified as New York Heart Association IV decreased from 28.5% in 2005 to 22.1% in 2013. In comparison with 2005, more patients had concomitant disorders such as hypertension (79.5% vs. 71.0%), diabetes (46.2% vs. 33.2%), and chronic renal failure (33.4% vs. 19.4%). Access to echocardiography has improved in recent years: it was available for 98.9% of the surveyed hospital wards (93% in 2005) and it was performed during the hospitalisation in 60.2% of the patients (58.8% in 2005). In 2013 N-terminal pro-B-type natriuretic peptide was accessible for 80.8% of hospital wards (12.8% in 2005) and the test was performed in 31.3% of the hospitalised patients (3.3% in 2005). Angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blockers (ARB) were administered in 68.9% of HF discharged patients, beta-blockers in 84.8%, mineralocorticoid receptor antagonist (MRA) in 57.9%, diuretics in 85.9%, and digoxin in 23%. The respective numbers in 2005 were 85.9%, 76.0%, 65.4%, 88.9%, and 38.4%. The decrease in prescription of ACEI or ARB resulted from lesser usage of these drugs in internal medicine wards (from 84.3% in 2005 to 55.6% in 2013). CONCLUSIONS: In comparison to the analogous project run in 2005, an improvement in some areas of HF treatment was observed in Polish hospitals, such as accessibility to echocardiography and natriuretic peptide measurement as well as beta-blocker and MRA use. At the same time, a meaningful decrease in ACEIs or ARBs usage in internal wards was observed, which might be the result of the ageing of the HF population and an increased number of comorbidities.

Subjective daytime functioning assessment in people with insomnia. / Subiektywna ocena funkcjonowania w ciagu dnia przez osoby cierpiace na bezsennosc.

OBJECTIVES: The aim of this study was to assess the prevalence and severity of subjective daytime functioning impairment among people with insomnia complaints. Another goal was to establish its relationships with age, gender, type and duration of subjective insomnia. METHODS: Study group consisted of NATPOL study participants - 2,413 people (1,245 women and 1,168 men) aged 18-79. We extracted group with declared insomnia complaints, consisting of 1,221 people (736 women and 485 men) aged 18-79. Data on insomnia symptoms characteristics, their duration and subjective functioning impairment were further analyzed. RESULTS: Functioning impairment was declared by 825 people (67.7% of those who declared subjective insomnia) and it was more common in women. It was most common among people with insomnia complaints lasting over two weeks - 72.4%. In people with symptoms lasting less than two weeks or for a few days it was 70.7% and 64.9% respectively. People with insomnia symptoms lasting over two weeks accounted for 20% of group with severe functioning impairment. For shorter duration of symptoms it was 8.6% and 6.9% respectively. Among people with mild functioning impairment, persons with symptoms lasting for a few days and less than two weeks were predominant - 32.5% and 35.3% respectively. In people aged 18-24 years mild functioning impairment was predominant (66.66%). CONCLUSIONS: Subjective daytime functioning impairment is common in people declaring insomnia symptoms. It is more common in women and its prevalence and intensity are greater in people with longer duration of sleep problems. Its prevalence is not correlated with age and it is the mildest in people aged 18-24.

Health outcomes and economic consequences of using angiotensin-converting enzyme inhibitors in comparison with angiotensin receptor blockers in the treatment of arterial hypertension in the contemporary Polish setting.

BACKGROUND: Arterial hypertension (AH) represents a public health problem in Poland, firstly due to the huge, still growing population of patients (10.45 million patients based on NATPOL 2011 and PolSenior Surveys), and secondly because of the substantial cost of reimbursement from the National Health Fund (NHF). The most commonly used drugs in the treatment of AH include angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), the latter being associated with significantly higher unit reimbursement cost. Recent meta-analyses of randomised, controlled trials indicate that there is no medical reason to favour ARBs over ACEIs in AH treatment. AIM: To assess the clinical benefit of using ACEIs instead of ARBs and to calculate the potential savings for the payer and patients associated with changing the treatment paradigm to preferential use of ACEIs. METHODS: The assessment of clinical consequences includes differences between ACEIs and ARBs in terms of average life expectancy and quality-adjusted life years (QALYs) gained. The impact of these drugs on general mortality was estimated based on the meta-analysis carried out by van Vark et al. in 2012. Patients' health-related quality of life was adjusted with Polish population utility norms derived for the EQ-5D-3L questionnaire and additionally for ACEI-induced cough-related utility decrease. Potential savings for the payer on a yearly basis were calculated for a hypothetical cohort of patients who are currently treated with ARBs and might be switched to ACEIs. The number of patients treated with ARBs and ACEIs was estimated based on NHF and IMS Health data. RESULTS: ACEIs were associated with a statistically significant 10% reduction in all-cause mortality, which results in extra life gained of 0.354 years (4.2 months) or an additional 0.201 QALY (2.4 months). Potential annual savings could amount to 112.0 million PLN (25.7 million EUR) and 10.5 million PLN (2.4 million EUR) for the public payer (NHF) and patients, respectively; and 1768 cardiovascular deaths per year could be prevented. CONCLUSIONS: Preferential use of ACEIs in comparison with ARBs in the treatment of AH is associated with substantial extension of life (including quality-adjusted life), reduction of cardiovascular deaths, and savings for the NHF and patients.

Assessment of Cardiovascular Risk Factors in Patients with Psoriasis.

Psoriasis is a chronic inflammatory skin disorder associated with increased cardiovascular risk. Aim of this work was to evaluate the association between psoriasis and chosen cardiovascular risk factors, echocardiographic parameters, and carotid intima-media thickness. A total of 50 patients with psoriasis and 50 controls were enrolled in the study. Psoriasis area severity index was calculated in the study group. Systolic and diastolic blood pressure, body mass index, waist circumference, lipids, fasting glucose, and D-dimer levels were assessed in all patients. In addition, echochardiographic parameters and carotid intima-media thickness were measured. Patients with psoriasis had higher blood pressure (P=0.001), elevated triglycerides (P=0.0218), lower high-density lipoprotein cholesterol (HDL-C) (P=0.0014), elevated D-dimer levels (p=0.0009), and were more frequently overweight (P=0.0198) in comparison to controls. There were no differences in echocardiographic parameters and carotid intima-media thickness between the psoriasis and control groups. Moreover, a positive correlation between psoriasis area severity index and blood pressure was observed (P=0.0088). The study confirmed that psoriasis is associated with increased cardiovascular risk. The association between psoriasis, intima-media thickness, and echocardiographic parameters should be evaluated in large prospective studies.