How does gender influence the recognition of cardiovascular risk and adherence to self-care recommendations?: A study in Polish primary care.

BACKGROUND: Studies have shown a correlation between gender and an ability to change lifestyle to reduce the risk of disease. However, the results of these studies are ambiguous, especially where a healthy lifestyle is concerned. Additionally, health behaviors are strongly modified by culture and the environment. Psychological factors also substantially affect engagement with disease-related lifestyle interventions. This study aimed to examine whether there are differences between men and women in the frequency of health care behavior for the purpose of reducing cardiovascular risk (CVR), as well as cognitive appraisal of this type of risk. We also aimed to identify the psychological predictors of engaging in recommended behavior for reducing the risk of cardiovascular disease after providing information about this risk in men and women. METHODS: A total of 134 consecutive eligible patients in a family practice entered a longitudinal study. At initial consultation, the individual's CVR and associated health burden was examined, and preventive measures were recommended by the physician. Self-care behavior, cognitive appraisal of risk, and coping styles were then assessed using psychological questionnaires. Six months after the initial data collection, the frequency of subjects' self-care behavior was examined. RESULTS: We found an increase in health care behavior after providing information regarding the rate of CVR in both sexes; this increase was greater for women than for men. Women followed self-care guidelines more often than men, particularly for preventive measures and dietary advice. Women were more inclined to recognize their CVR as a challenge. Coping style, cognitive appraisal, age, level of health behaviors at baseline and CVR values accounted for 48% of the variance in adherence to self-care guidelines in women and it was 52% in men. In women, total risk of CVD values were most important, while in men, cognitive appraisal of harm/loss was most important. CONCLUSIONS: Different predictors of acquisition of health behavior are encountered in men and women. Our results suggest that gender-adjusted motivation models influencing the recognition process need to be considered to optimize compliance in patients with CVR.

Bacteriological profile of the nasopharynx in patients with type 2 diabetes.

INTRODUCTION: Caring for people with diabetes is a challenge for doctors. GPs should be diagnostically vigilant and pay attention even to unusual symptoms reported by the patient, as they can progress quickly, impeding effective treatment. Targeted treatment of the bacteriological infection improves the prognosis in this group of patients. Its condition is to perform bacteriological tests. Statistics show that the infectious flora differ between people with diabetes and the general population. OBJECTIVE: The aim of the study was to evaluate in a group of patients with type 2 diabetes without symptoms of active infection, the following: 1) composition of microflora in the nasal cavity and throat, with particular emphasis on the frequency and type of opportunistic and pathogenic microorganisms; 2) carrier status of Staphylococcus aureus bacteria in the nose, and its relationship to diabetes control/ other comorbidities predisposing to immuno-suppression. MATERIAL AND METHODS: The study included 88 patients diagnosed with type 2 diabetes who were interviewed in the form of a questionnaire. Patients with additional systemic diseases and taking antibiotics within the last 6 weeks were excluded from the study. Microbiological tests required the collection of nasal and throat swabs from all enrolled patients. RESULTS: The bacteriological analysis included 176 nasal and throat swabs taken from 88 patients with type 2 diabetes. A total of 627 species of microorganisms were identified, and 90 potentially pathogenic strains present in the nasal cavity and throat of the subjects were isolated and identified. CONCLUSIONS: People with type 2 diabetes who do not show symptoms of infection are often carriers of potentially pathogenic bacteria in the nasopharynx.

Assessment of serum visfatin levels in girls with anorexia nervosa.

OBJECTIVE: Visfatin (VISF) is a recently described peptide regulating the process of adipocyte differentiation. Only one pilot study of VISF expression in the fat tissue and its circulating concentrations in a small group of patients with anorexia nervosa (AN) have been published, yet. DESIGN AND PATIENTS: Cross-sectional assessment of VISF serum concentrations in 195 girls aged 11-18·9 years with AN (n = 87), eating disorders not otherwise specified (NOS; n = 17), simple obesity (OB; n = 30), and healthy controls (H; n = 61). MEASUREMENTS: Blood samples were collected during the fasting state between 7:00 am-8:30 am. VISF serum concentrations were determined using enzyme immunoassay. Comparisons of VISF levels between groups were performed. RESULTS: Mean serum VISF concentrations in girls with AN and NOS were significantly lower than those in the H and OB groups. Serum VISF concentrations were higher in the OB than in the H groups. When were calculated per body mass index (BMI), VISF concentrations were significantly lower in the AN, NOS, and OB groups than in healthy controls. Among participants with a normal BMI, serum VISF concentrations correlated positively with BMI (r = 0·27; P < 0·05). In the OB group, a significant, negative correlation between BMI and VISF levels (r = -0·38; P = 0·04) was observed. CONCLUSIONS: Compared with healthy girls, serum VISF concentrations are decreased in girls with AN. Conversely, obese girls have elevated VISF levels. When calculated per BMI (VISF/BMI), the results in AN and OB groups were lower than in healthy participants.

Prevention of coronary heart disease in primary medical care in Poland: results from the LIPIDOGRAM study.

AIMS: To determine: (1) achievement of cholesterol therapy goals in patients receiving lipid-lowering drugs in Polish primary care between the years 2004 and 2006; (2) the characteristics of patients that are associated with attainment of these goals. DESIGN: Cross-sectional study in randomly selected Polish primary care practices. METHOD: 5248 patients aged over 30 years in 2004 and 5386 patients in 2006, who were taking cholesterol-lowering treatment took part in the study. Physicians recorded demographic and medical history data using a standardized questionnaire, including weight and height, and collected blood samples of patients to determine their cholesterol level. RESULTS: 18.5% of patients attained their optimal goals of therapy (total cholesterol, TC; low-density lipoprotein cholesterol, LDL-C) in 2004 compared to 25.2% in 2006 (p < 0.001). In both 2004 and 2006, more patients achieved their target levels for LDL-C than for TC and statins were the most commonly used medication (85% and 91%, respectively). Male sex, smoking, and higher education were the strongest correlates of the therapeutic outcome. The odds ratio of achieving cholesterol therapy goals in men, non-smokers, and university graduates was estimated at 1.51, 0.70, 1.38 in 2004 and 1.50, 0.73, 1.34 in 2006, respectively. CONCLUSION: There was a measurable improvement in the effectiveness of hypercholesterolaemia treatment between 2004 and 2006 but the majority of patients remain inadequately treated, with goals not being achieved. There is a need to raise the standard of lipid-lowering management in Poland.

[Uncomplicated lower urinary tract infections in females--clinical aspects, aetiology and antimicrobial resistance epidemiology. Results of the ARESC (Antimicrobial Resistance Epidemiological Survey on Cystitis) study in Poland and their implications for empiric therapy]. / Niepowiklane zakazenia dolnych dróg moczowych u kobiet- -obraz kliniczny, etiologia i wrazliwosc na antybiotyki najczestszych patogenów. Wyniki badania Aresc (Antimicrobial Resistance Epidemiological Survey on Cystitis) w Polsce i ich znaczenie w wyborze terapii empirycznej.

UNLABELLED: The Polish results of the international ARESC study are reported concerning clinical aspects, epidemiology, and antimicrobial susceptibility of uropathogens. METHODS: Patients between 18 and 65 years with symptoms of uncomplicated cystitis were consecutively enrolled and investigated clinically including urinalysis and urine culture. Uropathogens were identified and their susceptibility was tested for nine antimicrobials RESULTS: In Poland a total of 212 patients were enrolled and 119 uropathogens from 118 patients were identified. Escherichia coli was the most frequent (90; 75.6%), followed by Staphylococcus saprophyticus (5; 4.2%), Staphylococcus aureus (4; 3.4%), Proteus mirabilis (4; 3.4%), Klebsiella pneumoniae (3; 2.5%), E. coli showed the highest rate of susceptibility to fosfomycin (98.9%) followed by mecillinam (97.8%), nitrofurantoin (92.2%), and ciprofloxacin (92.2%). The lowest rate was found for ampicillin (40.0%) followed by cotrimoxazole (80.0%). For the total spectrum the order was fosfomycin (97.1%), ciprofloxacin (93.1%), and nitrofurantoin (85.2%). The lowest rates were found again for ampicillin (43.2%) and cotrimoxazole (80.7%). CONCLUSIONS: The results indicate that fosfomycin, ciprofloxacin, nitrofurantoin and amoxicillin/clavulanate have preserved their good in vitro activity (> 80%) against both E. coli and the total spectrum of uropathogens.

The prevalence rate of overweight and obesity among adult patient population in Poland, according to the LIPIDOGRAM2004 and LIPIDOGRAM2006 studies, in context of previous Polish national screening surveys.

An increase of the body mass often aggravates cardiovascular risk factors. In Poland, over the past 25 years, some epidemiological studies, focused on body mass disorders were conducted. Their results suggest an increase of the prevalence rate of overweight and obesity. The goal of the studies LIPIDOGRAM2004 and LIPIDOGRAM2006 was to assess the prevalence rate of abnormal body mass among adult patients remaining under the care of family physicians in Poland. 17.065 patients in 2004 and 17.152 in 2006, older than 30 years, recruited by 675 study physicians in 444 sites across Poland, were involved into these studies. It was found that approximately 3/4 of the patients included into these studies had BMI > or = 25 kg/m2. Overweight rate was much more prevalent among men than women (48,0% vs. 39,2% in 2004, p<0,0001; 47,4% vs. 39,7% in 2006, p<0,0001). In 2004, obesity was present in above 30% of the participants, including small, but statistically significant difference in the population of men (32,8% vs. 31,2%, p<0,05). In 2006, an increase in the prevalence of obesity in men, compared to women was reported (34,7% vs. 31,6%, p<0,001). Health care actions aimed at decreasing these phenomena would require targeted efforts of family physicians, in collaboration with a multidisciplinary team of specialists.

An analysis of factors determining serum leptin concentration in healthy and infected newborns.

OBJECTIVE: The effect leptin on fetal growth in healthy and infected newborns is not well known. This study is aimed at: 1) evaluating serum leptin concentration in full term and preterm, healthy and infected newborns, according to their gender, birth asphyxia, intrauterine and neonatal infections, and 2) assessing the correlation between serum leptin levels and anthropometric parameters among healthy and infected newborns. MATERIALS AND METHODS: The study involved 146 newborns: 73 full-term and 73 preterm, 86 male and 60 female, 56 healthy and 90 infected, aged from 2nd to 4th day of life. Anthropometric parameters, including: birth weight, length, head and chest circumference, and serum leptin concentration were measured in all the subjects. Intrauterine and neonatal infections were diagnosed by the standard criteria. RESULTS: In this study, it was found that both healthy and infected, but full-term newborns had significantly higher mean leptin concentration than the premature ones (p<0.05). Statistically significant (p<0.05), positive correlations were found between serum leptin level and gestational age, birth weight, head and chest circumference, both in healthy, and in infected newborns. CONCLUSIONS: Findings of this study suggest that the serum leptin concentration in full term newborns is higher than in the preterm ones, and in females it is higher than in males, 2) among both healthy and infected newborns, there is a positive, linear correlation between the serum leptin concentration and anthropometric parameters, 3) intrauterine and neonatal infections do not have a significant influence on serum leptin concentration. The role of leptin in fetal growth deserves further research.

[Prophylaxis of vitamin D deficiency--Polish recommendation 2009]. / Stanowisko Zespolu Ekspertów. Polskie zalecenia dotyczace profilaktyki niedoborów witaminy D - 2009.

Adequate vitamin D intake and its status are important not only for bone health and Ca-P metabolism, but for optimal function of many organs and tissues throughout the body. Due to documented changes in dietary habits and physical activity level, both observed in growing children and adults, the prevalence of vitamin D insufficiency is continuously increasing. Basing on current literature review and opinions of National Consultants and experts in the field, polish recommendations for prophylactic vitamin D supplementation in infants, toddlers, children and adolescents as well as in adults, including pregnant and lactating women have been established.

[Prophylaxis of vitamin D deficiency--Polish recommendations 2009]. / Polskie zalecenia dotyczace profilaktyki niedoborów witaminy D--2009.

Appropriate state procurement system for vitamin D is important not only for the proper functioning of the skeletal, maintaining calcium and phosphorus homeostasis, but also for a number of other organs and tissues in our body. In connection with the change in lifestyle including dietary habits change, the widespread use of UV filters and less outdoor activity, observed an increase in the percentage of vitamin D deficiency, both in population and developmental age and adults. Based on the results of recent scientific research team of experts provides recommendations for preventive Polish supply of vitamin D in infants, children, adolescents and adults, including pregnant women and nursing mothers.

Occurrence of overweight and obesity among adult rural population in Eastern Poland. Relationship between obesity and selected socio-economic factors.

The objective of the study was evaluation of the prevalence of overweight, obesity and abdominal obesity among adult rural population in the Lublin Region, and the relationship between the occurrence of obesity, and selected socio-economic factors. The study covered a random sample of 2,260 rural inhabitants - 1,390 females and 870 males; mean age 51.6. Overweight and obesity was diagnosed in 60% of the total number of the population examined (63.1% of males and 58% of females). Overweight was more frequently observed in males, while obesity more often occurred in females. The number of people with overweight and obesity increased with age. No statistically significant relationship was noted between the occurrence of obesity and abdominal obesity, and the occupation performed, occupational activity and source of maintenance of the people examined. Obesity and abdominal obesity was more often observed in those who were married.

Prevalence of dyslipidemia and general ineffectiveness of its treatment in both primary and secondary prevention of coronary heart disease within family medicine framework--results of LIPIDOGRAM 2005--a nationwide epidemiological study. Dyslipidemia in Poland--ineffective treatment.

PURPOSE: Despite major advances in cardiology dyslipidemia continues to be underdiagnosed and undertreated. The study aimed to evaluate current prevalence of dyslipidemia and treatment efficacy in both coronary and non-coronary subjects. METHODS: 17,065 subjects aged 30-95 years (20.51%--coronary heart disease (CHD) patients), seeking medical help for disparate reasons from 675 family physicians, were randomly enrolled. Family physicians completed pertinent questionnaires against available medical records and measured patients' lipid levels during a single appointment. RESULTS: Dyslipidemia was detected in 73% of the CHD subjects vs. 46% of the non-CHD ones (p = 0.00001); its severity differing regionally. Hypolipemic treatment was administered to 82% of the CHD subjects vs. 12% of the non-CHD ones (p = 0.00001). Mean concentrations of LDL-cholesterol were higher in the treated subjects (p = 0.00002). Only 10% of the CHD subjects and 20% of the non-CHD ones were treated effectively for dyslipidemiae. CONCLUSIONS: Dyslipidemia was found widely prevalent nationwide, as well as poorly pharmacologically controlled in both primary and secondary prevention. Diversity of economic factors notwithstanding, this was mainly attributable to ineffective patient educational policies, meriting therefore immediate expansion and enhancement of existing disease management system in terms of adequate monitoring and effective treatment of key coronary risk factors.

Empirical first-line antibioticotherapy in adult rural patients with acute respiratory tract infections.

The objective of the study was the evaluation of the frequency of occurrence of acute respiratory infections among rural population from the Lublin Region, and verification of the appropriateness of the use of antibiotics in empirical first-line therapy of these diseases. The analysis covered medical records concerning 1,839 patients selected from 27 rural health centres within the period of one year (1 September 2005-31 August 2006). As many as 656 patient visits were recorded, the reasons for which were qualified by physicians as infections of the upper and lower airways. These disorders were diagnosed in 450 patients, which constituted 24.46% of the population examined. The following diagnoses were most frequently made: acute pharyngitis and tonsillitis (31.25% of the total number of diagnoses), acute upper respiratory infections of multiple and unspecified sites (22.25%), and common cold (21.64%). Antibiotics were used in empirical first-line therapy in as many as 82% of the total number of patients. The analysis showed that in the great majority of cases the use of antibiotics was inappropriate. If this situation persists, in the near future it will lead to an increase in the phenomenon of antibiotic resistance in Poland. In order to prevent this situation, it is necessary to carry out an extensive educational action concerning the hazardous effect of excessive use of antibiotics, both among physicians and the whole society.

Prevention of cardiovascular disease in a rural general practice.

INTRODUCTION: Cardiovascular disease (CVD) prophylaxis in general practice, especially in rural areas, is a major organizational challenge. OBJECTIVE: The aim of this study was to determine the prevalence of CVD risk factors in the studied population, and to identify the effect of the number of planned prophylactic consultations on selected clinical parameters, risk factors, and total cardiovascular risk on the SCORE scale (Systemic Coronary Risk Evaluation). MATERIALS AND METHOD: The study included patients of a rural general practice, aged 35-55 years, with at least one modifiable CVD risk factor. Medical history was obtained, a physical examination performed, blood glucose levels, lipid profile, BMI, waist circumference and blood pressure measured and the SCORE cardiovascular risk at baseline and at the end of the study calculated. All participants were provided with targeted specific education. Analysis was performed in two groups of patients (1 and 2), where group 1 had one more prophylactic consultation than Group 2. RESULTS: The results at baseline and a year later were compared in pharmacologically untreated patients, 26 in Group 1 and 34 in Group 2. In Group 1, which had had more prophylactic consultations, a statistically significant decrease was found in the mean systolic blood pressure: 131.000-124.782 (p= 0.02721), mean diastolic blood pressure: 86.846-83.462 (p=0.01111), and a statistically significant decrease in total cardiovascular risk on the SCORE scale (p=0.0478). CONCLUSIONS: The higher number of preventive consultations had an impact on a statistically significant decrease in mean blood pressure and mean SCORE value. The year-long cardiovascular disease prophylaxis programme proved less effective than expected, and neither a decrease in body weight nor an improvement in lipid metabolism was achieved in any of the groups.

The attractiveness of family medicine among Polish medical students.

BACKGROUND: In many developed countries tuning supply and demand of medical doctors is a continuous challenge to meet the ever changing needs of community and individual patients. The long study period for medical doctors creates the opportunity to observe the current career preferences of medical students and evolution in time. OBJECTIVES: To investigate the career choices of Polish students in different stages of their medical education. METHODS: Medical students at five Polish medical universities were questioned about their career aspirations in the first, third and sixth year. RESULTS: A total of 2020 students were recruited for the survey. Among first year students 17% preferred family medicine as final career option, compared to 20% in the third year, and 30% in the sixth year (significant trend, P < 0.0001). In particular, female students prefer family medicine: 71% women versus 62% women in the group with a preference for a non-family medicine orientation (P = 0.008). Medical students rejecting a career as a family doctor stated that the impossibility to work in a hospital environment was the determining factor. CONCLUSION: The opportunity for professional development seems to be an important determining factor in the choice of a medical specialty in Poland. The proportion of Polish students choosing family medicine increases during their progress in medical education, with one third of students interested in a career in family medicine by year six.

The relation of rapid changes in obesity measures to lipid profile - insights from a nationwide metabolic health survey in 444 Polish cities.

OBJECTIVE: The impact of fast changes in obesity indices on other measures of metabolic health is poorly defined in the general population. Using the Polish accession to the European Union as a model of political and social transformation we examined how an expected rapid increase in body mass index (BMI) and waist circumference relates to changes in lipid profile, both at the population and personal level. METHODS: Through primary care centres in 444 Polish cities, two cross-sectional nationwide population-based surveys (LIPIDOGRAM 2004 and LIPIDOGRAM 2006) examined 15,404 and 15,453 adult individuals in 2004 and 2006, respectively. A separate prospective sample of 1,840 individuals recruited in 2004 had a follow-up in 2006 (LIPIDOGRAM PLUS). RESULTS: Two years after Polish accession to European Union, mean population BMI and waist circumference increased by 0.6% and 0.9%, respectively. This tracked with a 7.6% drop in HDL-cholesterol and a 2.1% increase in triglycerides (all p<0.001) nationwide. The direction and magnitude of the population changes were replicated at the personal level in LIPIDOGRAM PLUS (0.7%, 0.3%, 8.6% and 1.8%, respectively). However, increases in BMI and waist circumference were both only weakly associated with HDL-cholesterol and triglycerides changes prospectively. The relation of BMI to the magnitude of change in both lipid fractions was comparable to that of waist circumference. CONCLUSIONS: Moderate changes in obesity measures tracked with a significant deterioration in measures of pro-atherogenic dyslipidaemia at both personal and population level. These associations were predominantly driven by factors not measureable directly through either BMI or waist circumference.

Prevalence of cigarette smoking among adult population in eastern Poland.

Cigarette smoking is the strongest modifiable factor, which shortens the life span and deteriorates the quality of life. It increases the risk of development of cancer, cardiovascular and respiratory system diseases. The objective of the study was evaluation of the prevalence of cigarette smoking among the adult population of the Lublin Region, and investigation of the relationship between nicotinism and respondents? place of residence, and other selected socio-economic factors. Data concerning the cigarette smoking habit was obtained from 3,993 people - 2,447 females and 1,546 males; 23.0 percent of respondents in the study were smokers - 35.6 percent of males and 15.1 percent of females. The percentage of male smokers was similar in rural and urban areas. Urban females were smokers more often than those living in rural areas. A decrease was noted in the difference which has been observed to-date between the percentage of urban and rural female smokers. The highest percentage of smokers occurred among the population aged 41-50, while the lowest - among the youngest and the oldest respondents. The percentage of smoking farmers was lower than that of respondents performing non-agricultural occupations, also among rural inhabitants. Those who were occupationally active were smokers more frequently than those not engaged in occupational activity. The lowest percentage of smokers was noted among respondents who had the highest education level, while the highest percentage was observed among those who had vocational education.

[Recommendations of prophylaxis of vitamin D deficiency in Poland (2009)]. / Zalecenia dotyczace profilaktyki niedoborów witaminy D w polsce (2009).

Adequate vitamin D intake and its status as well outdoor physical activity are important not only for normal bone development and Ca-P metabolism, but for optimal function of many organs and tissues throughout the body. Due to documented changes in dietary habits and physical activity level, both observed in growing children and adults, the prevalence of vitamin D insufficiency is continuously increasing. National Consultants and experts in this field established the Polish recommendations for prophylactic vitamin D supplementation in infants, toddlers, children and adolescents as well as in adults, including pregnant and lactating women based on current literature review. Taking into consideration pleyotropic vitamin D action and safety aspects serum 25-hydroxyvitamin D (25-OHD) level of 20-60 ng/ml (50-750 nmol/l) in children and 30-80 ng/ml (75-200 nmol/I) in adults is considered as optimal. Sunlight exposure inducing vitamin D production in the skin is main endogen source of vitamin D in the body but sunscreens may reduce skin synthesis by 90%. In Poland, skin synthesis is effective only from April to September so other sources of vitamin D such as diet and supplements play an important role. All newborns should be supplemented with 400 IU/d of vitamin D beginning from the first few days of life and continue during infancy. In formula fed infants vitamin D intake from the diet should be taken into account. In preterm infants higher total vitamin D intake (400-800 IU/day) is recommended till 40 weeks post conception. Total vitamin D intake in children and adolescents required from all sources (diet and/or supplements) should be 400 IU/d between October and March and throughout the whole year in case of inadequate vitamin D skin synthesis during the summer months. In overweight/obese children supplementation with higher dosage of vitamin D up to 800-1000 IU/d should be considered. Adults require 800-1000 IU/d of vitamin D. In pregnant and lactating women such supplementation is recommended in case of inadequate intake from diet and/or skin synthesis supplementation. Monitoring of serum 25-OHD level to define optimal dosage should be considered.