Premature Mortality Due to Chronic Obstructive Pulmonary Disease (COPD) in Poland.

Background and objectives: Chronic obstructive pulmonary disease (COPD) is responsible for 5.3% of deaths worldwide and constitutes the third most common cause of death. The deaths from this cause occur over 10times more often in smokers than in non-smokers. Fortunately, for nearly 30 years, the proportion of people smoking tobacco in Poland has been decreasing. This study aims to analyse the change in premature mortality rates of men and women due to COPD in Poland during 2008-2017. Materials and Methods: The time trends of deaths occurring under 65 were analysed. Standardised premature mortality rates were used, as well as the mortality rates for the five-year age ranges, with a breakdown by gender. The Joinpoint model was used to determine time trends. Results: Over the period analysed, premature mortality in the female population decreased by 2.6% from year to year, albeit without statistical significance, and in the male population there was a decrease by statistically significant 5.2% per year. The biggest drop in mortality, almost 10% per year, was observed in the group of females aged between 50 and 54. Among males, the most significant reduction in mortality was observed in groups between the ages of 40 and 54, and it amounted to approximately 8% annually. With increasing age, the dynamics of mortality reduction decreased. Conclusions: The study showed a steady downward trend in premature mortality due to chronic obstructive pulmonary disease in Poland in both genders. The reduction in mortality was at a high level, despite the lower mortality due to this cause than in other European countries.

Trends in the Incidence of Acute Hepatitis B in the Polish Population and Their Determinants.

Introduction: The World Health Assembly adopted the Global Health Strategy and aims to reduce the incidence of Hepatitis from up to 10 million cases per year to 0.9 million cases and to reduce deaths from 1.4 million to 0.5 million per year by 2030. However, given the prevalence of chronic Hepatitis B in many countries and the incidence of new cases of acute Hepatitis B, the task is not easy. This study investigates the trends and determinants of the incidence of acute Hepatitis B in Poland in 2005-2019. Materials and Methods: Data on the incidence of acute hepatitis B (AHBV) were obtained from the National Institute of Public Health. A case definition for AHBV was consistent with the EU definition. The incidence trends were determined by considering the sex, age and place of residence. Due to the exponential dependence model, the computations were based on the logarithm of the incidence rate. This allowed for the transformation to linear form and analysis could be conducted using linear models. Pearson's correlation was used to determine the linear trend of incidence in general and according to sex and place of residence. The values of incidence rates (independent proportions test) and the coefficients illustrating the trends under study were also compared among males and females as well as urban and rural residents. Results: The incidence of AHBV in the Polish population decreased with similar slopes in both sexes. The newly reported cases of AHBV were more frequent in the male population. The incidence of acute Hepatitis B in the urban population was significantly higher than in the rural population. The significant decreasing trends in incidence were observed in all age ranges, with the exception of two age ranges 0-4 and 10-14, where the total incidence during the whole study period was negligible. Conclusion: Despite the significant decrease in the incidence of AHBV in Poland and its position among the European countries with the lowest hepatitis B (HBV) incidence, the alarmingly high proportion of iatrogenic infections requires further improvement in the sanitary condition of health care facilities. It is also necessary to decrease the number of unvaccinated individuals.

The prevalence of Epilepsy and its co-occurrence with alcohol dependence among polish prisoners.

BACKGROUND: For a large part of the prisoners population, the prevalence of many diseases and the number of risk factors are greater than for the general population. In this work, we present an analysis of the prevalence of epilepsy and its co-occurrence with alcohol dependence among prisoners in a Polish penitentiary. METHODS: One and multidimensional logistic regression was used to present the relationship between epilepsy and the co-occurrence of alcohol dependence and of other variables like: the prisoners' age, their classification, the unit type, the length of the stay in the penitentiary, and professional activity. RESULTS: More than 7% of the prisoners had epilepsy. The prevalence was significantly higher in the 40-49 age group and among prisoners aged 50 and older. For prisoners suffering from alcohol dependence, the probability of epilepsy was over four times higher than for prisoners who did not suffer from that condition (OR [95%CI] = 4.09 [1.82-9.17], p = 0.001]. CONCLUSIONS: The obtained results show that the prevalence of epilepsy and alcohol dependence in the studied prisoner population was much higher than in the general population of Poles and that alcohol dependence was strongly correlated with epilepsy, independent from other variables. The research allowed to assess the size of the analyzed problem among convicts, however, bearing in mind the multifactorial etiology of epilepsy, the cause and effect relationship between exposure to alcohol and its occurrence would require further in-depth analytical studies taking into account other etiological factors of this disease.

Establishing International Blood Pressure References Among Nonoverweight Children and Adolescents Aged 6 to 17 Years.

BACKGROUND: Several distributions of country-specific blood pressure (BP) percentiles by sex, age, and height for children and adolescents have been established worldwide. However, there are no globally unified BP references for defining elevated BP in children and adolescents, which limits international comparisons of the prevalence of pediatric elevated BP. We aimed to establish international BP references for children and adolescents by using 7 nationally representative data sets (China, India, Iran, Korea, Poland, Tunisia, and the United States). METHODS AND RESULTS: Data on BP for 52 636 nonoverweight children and adolescents aged 6 to 19 years were obtained from 7 large nationally representative cross-sectional surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. BP values were obtained with certified mercury sphygmomanometers in all 7 countries by using standard procedures for BP measurement. Smoothed BP percentiles (50th, 90th, 95th, and 99th) by age and height were estimated by using the Generalized Additive Model for Location Scale and Shape model. BP values were similar between males and females until the age of 13 years and were higher in males than females thereafter. In comparison with the BP levels of the 90th and 95th percentiles of the US Fourth Report at median height, systolic BP of the corresponding percentiles of these international references was lower, whereas diastolic BP was similar. CONCLUSIONS: These international BP references will be a useful tool for international comparison of the prevalence of elevated BP in children and adolescents and may help to identify hypertensive youths in diverse populations.

Prevalence of incorrect body posture in children and adolescents with overweight and obesity.

The ever increasing epidemics of overweight and obesity in school children may be one of the reasons of the growing numbers of children with incorrect body posture. The purpose of the study was the assessment of the prevalence of incorrect body posture in children and adolescents with overweight and obesity in Poznan, Poland. The population subject to study consisted of 2732 boys and girls aged 3-18 with obesity, overweight, and standard body mass. The assessment of body mass was performed based on BMI, adopting Cole's cutoff values. The evaluation of body posture was performed according to the postural error chart based on criteria complied by professor Dega. The prevalence rates of postural errors were significantly higher among children and adolescents with overweight and obesity than among the group with standard body mass. In the overweight group, it amounted to 69.2% and in the obese group to 78.6%. CONCLUSION:  The most common postural deviations in obese children and adolescents were valgus knees and flat feet. Overweight and obesity in children and adolescents, predisposing to higher incidence of some types of postural errors, call for prevention programs addressing both health problems. What is Known: • The increase in the prevalence of overweight and obesity among children and adolescents has drawn attention to additional health complications which may occur in this population such as occurrence of incorrect body posture. What is New: • The modified chart of postural errors proved to be an effective tool in the assessment of incorrect body posture. • This chart may be used in the assessment of posture during screening tests and prevention actions at school.

Malignant testicular tumour incidence and mortality trends.

AIM OF THE STUDY: In Poland testicular tumours are the most frequent cancer among men aged 20-44 years. Testicular tumour incidence since the 1980s and 1990s has been diversified geographically, with an increased risk of mortality in Wielkopolska Province, which was highlighted at the turn of the 1980s and 1990s. The aim of the study was the comparative analysis of the tendencies in incidence and death rates due to malignant testicular tumours observed among men in Poland and in Wielkopolska Province. MATERIAL AND METHODS: Data from the National Cancer Registry were used for calculations. The incidence/mortality rates among men due to malignant testicular cancer as well as the tendencies in incidence/death ratio observed in Poland and Wielkopolska were established based on regression equation. The analysis was deepened by adopting the multiple linear regression model. A p-value < 0.05 was arbitrarily adopted as the criterion of statistical significance, and for multiple comparisons it was modified according to the Bonferroni adjustment to a value of p < 0.0028. Calculations were performed with the use of PQStat v1.4.8 package. RESULTS: The incidence of malignant testicular neoplasms observed among men in Poland and in Wielkopolska Province indicated a significant rising tendency. The multiple linear regression model confirmed that the year variable is a strong incidence forecast factor only within the territory of Poland. A corresponding analysis of mortality rates among men in Poland and in Wielkopolska Province did not show any statistically significant correlations. CONCLUSIONS: Late diagnosis of Polish patients calls for undertaking appropriate educational activities that would facilitate earlier reporting of the patients, thus increasing their chances for recovery. Introducing preventive examinations in the regions of increased risk of testicular tumour may allow earlier diagnosis.

Who is at higher risk of hypertension? Socioeconomic status differences in blood pressure among Polish adolescents: a population-based ADOPOLNOR study.

UNLABELLED: In Poland, there is no data on parental socioeconomic status (SES) as a potent risk factor in adolescent elevated blood pressure, although social differences in somatic growth and maturation of children and adolescents have been recorded since the 1980s. This study aimed to evaluate the association between parental SES and blood pressure levels of their adolescent offspring. A cross-sectional survey was carried out between 2009 and 2010 on a sample of 4941 students (2451 boys and 2490 girls) aged 10-18, participants in the ADOPOLNOR study. The depended outcome variable was the level of blood pressure (optimal, pre- and hypertension) and explanatory variables included place of residence and indicators of parental SES: family size, parental educational attainments and occupation status, income adequacy and family wealth. The final selected model of the multiple multinomial logistic regression analysis (MLRA) with backward elimination procedure revealed the multifactorial dependency of blood pressure levels on maternal educational attainment, paternal occupation and income adequacy interrelated to urbanization category of the place of residence after controlling for family history of hypertension, an adolescent's sex, age and weight status. Consistent rural-to-urban and socioeconomic gradients were found in prevalence of elevated blood pressure, which increased with continuous lines from large cities through small- to medium-sized cities to villages and from high-SES to low-SES familial environments. The adjusted likelihood of developing systolic and diastolic hypertension decreased with each step increase in maternal educational attainment and increased urbanization category. The likelihood of developing prehypertension decreased with increased urbanization category, maternal education, paternal employment status and income adequacy. Weight status appeared to be the strongest confounder of adolescent blood pressure level and, at the same time, a mediator between their blood pressure and parental SES. CONCLUSION: The findings of the present study confirmed socioeconomic disparities in blood pressure levels among adolescents. This calls for regularly performed blood pressure assessment and monitoring in the adolescent population. It is recommended to focus on obesity prevention and socioeconomic health inequalities by further trying to improve living and working conditions in adverse rural environments.

Excess Mortality of Males Due to Chronic Obstructive Pulmonary Disease (COPD) in Poland.

At present, female life expectancy exceeds male life expectancy almost worldwide. However, numerous studies indicate that this disparity is gradually decreasing. In Poland, the gender gap in life expectancy peaked in 1991 when it amounted to 9.2 years. Since then, a narrowing of the gap has been observed, reaching 8 years in 2021. Decreasing differences in life expectancy between men and women in Poland were mainly the result of a reduction in mortality due to ischaemic heart disease, cerebrovascular disease, and a number of malignancies.Less attention has been paid to chronic obstructive pulmonary disease (COPD) although it is the third leading cause of death worldwide. This paper includes an analysis of mortality due to chronic obstructive pulmonary disease COPD. The male excess mortality was calculated as the ratio of mortality rates in the male population scaled up to the corresponding rates in the female population using both crude and standardised detailed mortality rates. The Joinpoint model was used to determine time trends. It was shown that from 2008 to 2021, the excess mortality of men due to COPD in Poland decreased by 3.3% per year from 2.4 to 1.7 when using crude coefficients, while when standardised coefficients were applied, it decreased significantly by 3.9% per year from 3.8 to 2.4. The decrease in the excess mortality of men in Poland was due to a simultaneous decrease in mortality in the population in general; however, a greater decrease was observed in the male population. The mortality of men and women, and, at the same time, the excess mortality of men caused by COPD in Poland decreased faster in the period studied than in other European countries.

The Impact of Meteorological Parameters and Seasonal Changes on Reporting Patients with Selected Cardiovascular Diseases to Hospital Emergency Departments: A Pilot Study.

(1) Background: So far, research results have confirmed the relationship between heat and cold stress, the fluctuations in atmospheric pressure and high relative humidity, and the vulnerability of patients with so-called "weather-dependent" diseases which could lead to death. This study aimed to determine the meteorological parameters, their interactions, and the seasonal changes of the most significant factors in predicting the number of patients reporting to the Emergency Departments (EDs) in Poznan (Poland) during 2019. (2) Methods: The analysis included the meteorological parameters and data of 3606 patients diagnosed with essential or complicated arterial hypertension, myocardial infarction, chronic ischemic heart disease, and ischemic or unspecified stroke by the International Classification of Diseases (ICD-10). The meteorological data (days per week and seasonal data) were used to build a linear regression model to assess the changes in the daily number of reporting patients. The input data for the final model were selected based on the principal component analysis (PCA), and built for each delay and acceleration (reporting up to 3 days before the change or up to 3 days after the change of the meteorological parameter). (3) Results: A significantly lower number of reports was observed during weekends compared to working days (standardised b = -0.254, p-value < 0.0001) and three days before the maximum daily air temperature in the spring and summer period (standardised b = -0.748, p-value < 0.0001), while two days after the increase in the daily amplitude of atmospheric pressure (standardised b = 0.116, p-value = 0.0267), and also on the day of occurrence of the unfavourable interdiurnal air temperature change, an increase in the number of patients was noted (standardised b = 0.115, p-value = 0.0186). The changes in the last two parameters were statistically insignificant. Based on the obtained results, the negative impact of the changes in the meteorological conditions on the number of reports to the EDs in Poznan was determined.

Changes in the Level of Premature Mortality in the Polish Population Due to Selected Groups of Cardiovascular Diseases before and during the Pandemic of COVID-19.

BACKGROUND: In the years 2020 and 2021, the COVID-19 pandemic disrupted Poland's health care system and caused a high number of excess deaths. After nearly 30 years of continuous dynamic increase in the life expectancy of the Polish population and a decrease in premature mortality that led to a reduction in the health gap between Poland and Western European countries, regrettably, a decline in life expectancy was recorded. For males, the decline amounted to 2.3 years and, for females, to 2.1 years. AIM: The aim of this study was to assess changes in the level of premature mortality due to selected cardiovascular diseases in Poland before and during the COVID-19 pandemic. METHOD: Time trends of deaths of patients under the age of 65 due to ischemic heart disease, cerebrovascular disease and aortic aneurysm were analyzed by gender and age groups. The joinpoint model was used in determining time trends. RESULTS: Premature mortality due to all of the cardiovascular diseases analyzed had been declining steadily by about 5% per year since 2008. However, at the end of the second decade of the 21st century, a significant change in the dynamics of the trend was observed, particularly with regard to deaths from ischemic heart disease, which since 2018 caused premature mortality increases of 10% per year in the female population. In the male population, an increase of nearly 20% per year has been observed since 2019. The changes also affected premature mortality due to cerebrovascular disease. CONCLUSIONS: After nearly three decades of significant decline in premature mortality from cardiovascular diseases in Poland, there was a reversal in the trend, in particular as regards ischemic heart disease. The unfavorable changes intensified in the subsequent two years. The simultaneous increase in the number of cardiovascular incidents ending in death and the decline in access to prompt diagnosis and effective treatment may explain the unfavorable changes in the deaths caused by cardiovascular disease and the increase in premature mortality due to cardiovascular disease.

Trends in premature mortality rates among the Polish population due to cardiovascular diseases.

OBJECTIVES: At the end of the 20th century, after years of negligence in the prevention of cardiovascular diseases, Poland was struggling with very high premature mortality. The period of 1991-2005 brought significant improvements since the general public introduced beneficial dietary modifications. This paper aims to analyze the changes in the rate of premature mortality due to tobacco-dependent cardiovascular diseases in Poland in 2008-2017. MATERIAL AND METHODS: The time trends of deaths occurring under the age of 65 years caused by ischemic heart disease, cerebrovascular disease, atherosclerosis and aortic aneurysm were analyzed. Both standardized and crude premature mortality rates were used, as well as mortality rates for patients grouped into 5-year age ranges with a breakdown by gender. The joinpoint model was used to determine these time trends. RESULTS: Premature mortality due to the analyzed cardiovascular diseases decreased linearly in 2008-2017. In the case of ischemic heart disease and cerebrovascular diseases, the decrease amounted to approx. 5% per year, both in the female and male population. However, in the case of atherosclerosis and aortic aneurysms, the rate of mortality reduction ranged 4-7% per year. The reduction concerned all the examined age groups, but with different dynamics. The most considerable annual decrease was observed in the group of patients aged 40-44 years (7.9% for females and 8.9% for males). Along with the increase in age, the dynamics of reduction decreased. CONCLUSIONS: In 2008-2017, Poland experienced a decline in premature mortality due to tobacco-related cardiovascular diseases, particularly in the age group of 40-44 years. The decline may have been associated, among other things, with a reduction in exposure to tobacco smoke, one of the cardiovascular risk factors. Int J Occup Med Environ Health. 2022;35(1):27-38.

Cohen's Kappa Coefficient as a Measure to Assess Classification Improvement following the Addition of a New Marker to a Regression Model.

The need to search for new measures describing the classification of a logistic regression model stems from the difficulty in searching for previously unknown factors that predict the occurrence of a disease. A classification quality assessment can be performed by testing the change in the area under the receiver operating characteristic curve (AUC). Another approach is to use the Net Reclassification Improvement (NRI), which is based on a comparison between the predicted risk, determined on the basis of the basic model, and the predicted risk that comes from the model enriched with an additional factor. In this paper, we draw attention to Cohen's Kappa coefficient, which examines the actual agreement in the correction of a random agreement. We proposed to extend this coefficient so that it may be used to detect the quality of a logistic regression model reclassification. The results provided by Kappa's reclassification were compared with the results obtained using NRI. The random variables' distribution attached to the model on the classification change, measured by NRI, Kappa, and AUC, was presented. A simulation study was conducted on the basis of a cohort containing 3971 Poles obtained during the implementation of a lower limb atherosclerosis prevention program.

Premature Mortality Due to Tobacco-Related Malignancies in Poland.

INTRODUCTION: Although in Poland at the turn of the 20th and 21st centuries, tobacco consumption per capita was one of the highest in the world as a result of specific political and social conditions, nicotinism was the most common preventable cause of death that reduced life expectancy by 10 years on average. The aim of this study is to determine the level of premature mortality and its trends by age and sex for tobacco-related malignancies in Poland in the years 2008-2017. METHODS: The standardised premature mortality rates as well as mortality rates for five-year age ranges according to the patients' sex were used. The Joinpoint model was used to determine the time trends. RESULTS: Premature mortality due to all tobacco-dependent cancers analysed decreased in Poland throughout the analysed period in both male (2.5% per year) and female (1% per year) populations. A detailed analysis of individual diseases showed that a decrease in premature mortality was observed for almost all malignancies with the exception of malignant liver cancer among males, malignant oesophageal cancer among females and malignant lip, oral cavity and oropharyngeal cancer in both sexes. The reduction in mortality from all tobacco-related cancers in the male population was greatest between 40 and 44 years of age, reaching 5.6% year on year. Similarly, in the case of females, the decline in mortality was greater in the younger age cohorts and decreased in those aged over 50. CONCLUSION: The favourable phenomenon of decreasing the level of premature mortality caused by tobacco-related malignancies may be associated, among others, with the policy of primary prevention of these diseases in the form of a widespread ban on smoking in public places, intensive information campaigns on the harmfulness of tobacco smoking and increasing taxation on tobacco products.

Excess Mortality of Males Due to Malignant Lung Cancer in OECD Countries.

Excess mortality of men has been observed since the beginning of the 20th century. One of the main causes of this phenomenon is malignant cancers, with lung cancer as the main reason. At the turn of the 20th and 21st centuries, a decline in male excess mortality was observed in most developed countries. This study aimed to analyze the changes in the level of excess mortality of men caused by lung cancer between 2002 and 2017 in the countries associated with the Organization for Economic Cooperation and Development (OECD). In order to compare changes in male mortality rates across countries, the annual average percent change (AAPC) in male excess mortality rate for a given country was calculated. A decrease in excess male mortality due to lung cancer between 2002 and 2017 was recorded in 33 of the 35 countries analyzed. The highest rate of decline was observed in Spain (4.9% per year), Belgium (4.7% per year), Slovakia (4.4% per year) and other European OECD member countries. In most OECD countries, the decrease in excess male mortality was the result of a decrease in mortality in the male population as well as the increase in female mortality. In 10 member countries of the OECD, there was a simultaneous increase in the mortality of men and women, though the increase was higher in the female population. Only in two countries was the decrease in excess mortality of males due to a greater decline in the mortality of men. The decline in male mortality from lung cancer primarily associated with a reduction in tobacco consumption in this population initiated in the 1980s or 1990s (depending on the country) was not observed in the female population.

The Prevalence of Generalised Anxiety Disorder Among Prisoners of the Penitentiary Institution in North-Eastern Poland.

Introduction: Generalised anxiety disorder (GAD) is one of the most common mental disorders. The psychosocial factors that may lead to generalised anxiety disorders include stress, traumatic events, conscious and unconscious internal conflicts, and low social and economic status. Imprisonment and forced isolation may favour the development of depression or anxiety disorders in inmates. Thus, this study aimed to analyse the prevalence of generalised anxiety disorder (GAD) in the population of inmates detained in one of the largest penitentiary units in north-eastern Poland. Materials and Methods: The data comes from 2017 and includes information on 635 male inmates incarcerated at the Czerwony Bór Prison. The information comes from the health records of individual inmates, kept by the prison outpatient clinician, and documented consultations with doctors of units outside the prison. The classification of generalised anxiety disorders (F41.1) was made in accordance with the 10th Revision of the International Statistical Classification of Diseases and Health Problems and the clinical diagnosis made by a psychiatrist. The Mann-Whitney test was used to compare quantitative data without normal distribution, chi-squared test or Fisher exact test for comparing qualitative data. A one-dimensional and multi-dimensional logistic regression model was used to examine the impact of the prison type on the prevalence of generalised anxiety disorder. Results: Generalised anxiety disorder was observed among 44 prisoners (6.9%), most often in the age range 30-39 years and among men younger than 30 years, respectively 40.9 and 31.8% of all diagnosed. The average age of patients was 34.6 years. The least number of prisoners with GAD was in the age group 50-59 (2.3%). Nearly 66% of patients were prisoners detained in a closed type prison; the chance of generalised anxiety disorder was three times higher than among the prisoners in a half-open and open type facility. Generalised anxiety disorder was diagnosed significantly more often with those currently serving a prison sentence than those before incarceration. Conclusions: In Polish conditions, the importance of the problem associated with GAD is evidenced by a significant increase in its prevalence in the prison environment and a three times higher chance of developing generalised anxiety disorder among prisoners in a closed type institution, which calls for highly organised psychiatric care and increased availability of psychological assistance for prisoners.

Body mass index percentiles and elevated blood pressure among children and adolescents.

It is well established that obesity is associated with an increased risk of elevated and high blood pressure (BP) in children and adolescents. However, it is uncertain whether there is an increase in the risk of elevated and high BP associated with an increase of body mass index (BMI) among children and adolescents whose BMI is in the accepted normal range. Data were available for 58 899 children and adolescents aged 6-17 years from seven national cross-sectional surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. The subjects were divided into eight percentile subgroups according to their BMI levels based on the World Health Organization recommendations. Elevated BP and high BP were defined using the 2016 international child BP criteria. Compared with the reference subgroup of the 5th-24th percentiles, the odds ratios (ORs) for high BP were 1.27 (95% confidence interval [CI], 1.14-1.41; P < 0.001) in the 25th-49th percentile subgroup, 1.55 (95% CI, 1.39-1.73; P < 0.001) in the 50th-74th percentile subgroup, and 2.17 (95% CI, 1.92-2.46; P < 0.001) in the 75th-84th percentile subgroup, respectively, after adjustment for sex, age, race/ethnicity, height and country. Additionally, the corresponding ORs for elevated BP were 1.21 (95% CI, 1.10-1.32; P < 0.001), 1.55 (95% CI, 1.42-1.69; P < 0.001), and 1.80 (95% CI, 1.62-2.01; P < 0.001), respectively. In conclusion, a BMI in the 25th-84th percentiles, within the accepted normal weight range, was associated with an increased risk of elevated and high BP among children and adolescents. It is important for children and adolescents to keep a BMI at a low level in order to prevent and control hypertension.

International Waist Circumference Percentile Cutoffs for Central Obesity in Children and Adolescents Aged 6 to 18 Years.

CONTEXT: No universal waist circumference (WC) percentile cutoffs used have been proposed for screening central obesity in children and adolescents. OBJECTIVE: To develop international WC percentile cutoffs for children and adolescents with normal weight based on data from 8 countries in different global regions and to examine the relation with cardiovascular risk. DESIGN AND SETTING: We used pooled data on WC in 113,453 children and adolescents (males 50.2%) aged 4 to 20 years from 8 countries in different regions (Bulgaria, China, Iran, Korea, Malaysia, Poland, Seychelles, and Switzerland). We calculated WC percentile cutoffs in samples including or excluding children with obesity, overweight, or underweight. WC percentiles were generated using the general additive model for location, scale, and shape (GAMLSS). We also estimated the predictive power of the WC 90th percentile cutoffs to predict cardiovascular risk using receiver operator characteristics curve analysis based on data from 3 countries that had available data (China, Iran, and Korea). We also examined which WC percentiles linked with WC cutoffs for central obesity in adults (at age of 18 years). MAIN OUTCOME MEASURE: WC measured based on recommendation by the World Health Organization. RESULTS: We validated the performance of the age- and sex-specific 90th percentile WC cutoffs calculated in children and adolescents (6-18 years of age) with normal weight (excluding youth with obesity, overweight, or underweight) by linking the percentile with cardiovascular risk (area under the curve [AUC]: 0.69 for boys; 0.63 for girls). In addition, WC percentile among normal weight children linked relatively well with established WC cutoffs for central obesity in adults (eg, AUC in US adolescents: 0.71 for boys; 0.68 for girls). CONCLUSION: The international WC cutoffs developed in this study could be useful to screen central obesity in children and adolescents aged 6 to 18 years and allow direct comparison of WC distributions between populations and over time.

Blood pressure references for Polish children and adolescents.

The objective of this study was to develop age- and gender-specific reference ranges for blood pressure in a large national database on blood pressure levels throughout childhood and adolescence in young Poles. A prospective cross-sectional study was performed in 2002-2005 in the representative sampling sites, selected randomly from the entire Poland. Altogether, 6,447 school pupils, aged 7-18 years, were involved in the study of which 3,176 were boys and 3,271 were girls. Statistical analysis was performed using STATISTICA for Windows 7.1. The normal range of blood pressure, determined by age and the category of body height percentiles, revealed percentiles values which might serve as reference values to identify cases of high normal blood pressure (the mean blood pressure between 90th and 95th percentiles for age and gender) and hypertension (the mean blood pressure equals or exceeds the 95th percentiles on at least three occasions).

Searching for space-time clusters: The CutL method compared to Kulldorff's scan statistic.

Both epidemiology and health care planning require analytical tools, especially for cluster detection in cases with unusually high rates of disease incidence. The aim of this work was to extend the application of the CutL method, which is used for detecting spatial clusters of any shape, to detecting space-time clusters, and to show how the method works compared to Kulldorff's scan statistic. In the CutL method, clusters with disease incidence rates higher than the one entered by the researcher are searched for. The way in which the space-time version of that method works is illustrated with the example of data simulating the distribution of people affected by health problems in Polish counties in the period 2013- 2017. With respect to detection of irregularly shaped space-time clusters, the CutL method turned out to be more effective than Kulldorff's scan statistic; for cylinder-shaped space-time clusters, the two methods produced similar results. The CutL method has also the important advantage of being widely accessible through the PQScut and PQStat programmes (PQStat Software Company, Poznan, Poland).

Height-specific blood pressure cutoffs for screening elevated and high blood pressure in children and adolescents: an International Study.

Pediatric blood pressure (BP) reference tables are generally based on sex, age, and height and tend to be cumbersome to use in routine clinical practice. In this study, we aimed to develop a new, height-specific simple BP table according to the international child BP reference table based on sex, age and height and to evaluate its performance using international data. We validated the simple table in a derivation cohort that included 58,899 children and adolescents aged 6-17 years from surveys in 7 countries (China, India, Iran, Korea, Poland, Tunisia, and the United States) and in a validation cohort that included 70,072 participants from three other surveys (China, Poland and Seychelles). The BP cutoff values for the simple table were calculated for eight height categories for both the 90th ("elevated BP") and 95th ("high BP") percentiles of BP. The simple table had a high performance to predict high BP compared to the reference table, with high values (boys/girls) of area under the curve (0.94/0.91), sensitivity (88.5%/82.9%), specificity (99.3%/99.7%), positive predictive values (93.9%/97.3%), and negative predictive values (98.5%/97.8%) in the pooled data from 10 studies. The simple table performed similarly well for predicting elevated BP. A simple table based on height only predicts elevated BP and high BP in children and adolescents nearly as well as the international table based on sex, age, and height. This has important implications for simplifying the detection of pediatric high BP in clinical practice.