First-year follow-up costs of myocardial infarction management in Poland from the payer's perspective.

BACKGROUND: Myocardial infarction (MI) remains a major burden for healthcare systems. Therefore, we intended to analyze the determinants of cost management of patients hospitalized for MI in Poland. METHODS: Data on patients hospitalized and discharged with the diagnosis of acute MI were derived from the public payer claims database. Adult patients, reported between October 1, 2017 and December 31, 2019, were included. Costs of hospitalization for acute MI and cumulative one-year follow-up were analyzed. RESULTS: The median (IQR) of the total direct cost was €3804.7 (2674.1-5712.7) per patient and 29% (€1113.6 [380.5-2490.4]) of these were costs related to the use of post-hospitalization healthcare resources. The median cost of cardiovascular disease management was €3624.7 (2582.1-5258.5), and 26% of this sum were follow-up costs. The analysis of the total cost for individual years showed a slight increase in median costs in subsequent years: €3450.7 (2407.8-5205.2) in 2017, €3753.8 (2642.6-5681.9) in 2018, and €3944.9 (2794.8-5844.4) in 2019. Male sex, heart failure, atrial fibrillation, diabetes, kidney disease, chronic obstructive pulmonary disease, and history of stroke in addition to hospitalization in a department other than cardiology or internal disease were independently related to the cost of MI patient management. CONCLUSIONS: The high cost of management of MI patients was independently related to sex, heart failure, atrial fibrillation, diabetes, kidney disease, chronic obstructive pulmonary disease, and history of stroke as well as hospitalization in other than cardiology or internal disease department.

Trajectories in physical functioning at older age in relation to childhood and adulthood SES and social mobility: a population-based cohort study.

Introduction: Older age is associated with the deterioration of physical functioning (PF), and low PF is strongly related to poor quality of life among older people. We conducted a study to examine the trajectories of PF between middle and old age, considering sex differences as well as the association between socioeconomic status (SES) at different life stages and changes in PF. Methods: We analyzed data from the Polish arm of the HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) study, including 1,116 men and 1,178 women aged 45-64 years at baseline. Adult and childhood SES and social mobility were assessed using a retrospectively focused questionnaire. PF was assessed using the 10-question SF-36 scale at baseline examination, face-to-face re-examination, and three postal surveys, covering up to 20 years (on average, 18 years). We employed Generalized Estimating Equations models to assess changes in PF scores over time and compare PF trajectories across different SES categories. Results: After adjusting for age and other covariates, we found that, in both sexes, participants with always middle or high SES, as well as those who reported upward mobility, had higher PF scores at baseline compared to those with always low SES. A decline in PF between middle and old age was observed in all SES groups; however, the decline was slower in participants with always middle or high SES compared to those with always low SES. Conclusion: This cohort study revealed that lower SES and downward social mobility were cross-sectionally associated with poorer PF, while upward social mobility seemed to largely reverse the effect of low childhood SES. In addition to the cross-sectional associations observed at baseline, advantaged SES was also significantly associated with a slower decline in PF over an 18-year follow-up period.

Heart failure with reduced, mildly reduced, and preserved ejection fraction: outcomes and predictors of prognosis.

INTRODUCTION: Recently, a stratification of the heart failure (HF) phenotypes, which classifies HF into 3 subtypes based on ejection fraction, has been introduced. Before that, clinical trials and registries have been mainly devoted to HF with reduced ejection fraction (HFrEF). As a result, data on long­term survival trends for individual HF phenotypes are scarce. OBJECTIVES: The study aimed to evaluate survival according to the HF phenotype and to identify predictors of mortality. PATIENTS AND METHODS: Patients hospitalized for HF in our referral center between January 2014 and May 2019 were included in the analysis. HF phenotyping was based on EF: reduced (HFrEF with EF <40%), mildly reduced (HFmrEF with EF = 40%-49%), and preserved (HFpEF with EF ≥50%). RESULTS: Of 2601 patients included in the study, 1608 individuals (62%) presented with HFrEF, 331 patients with HFmrEF (13%), and 662 patients with HFpEF (25%). The median follow­up was 2.43 years (interquartile range, 1.56-3.49). The risk of death was 61% higher in HFrEF than in HFpEF (P <0.001), while in HFmrEF and HFpEF it was similar. Survival rates at 1 and 5 years in HFrEF, HFmrEF, and HFpEF were 81%, 84%, 84%, and 47%, 61%, and 59%, respectively. The HF phenotypes differed in most of the parameters that affect prognosis. Only the use of inotropes, which was linked to an increased risk of death, and the use of angiotensin­converting enzyme inhibitors, which reduced this risk, were independent of the HF phenotype. CONCLUSIONS: Survival in HFrEF is worse as compared with HFmrEF and HFpEF, where it is similar. The HF phenotypes differ in most of the parameters that affect survival.

Epidemiology and clinical characteristics of hospitalized patients with heart failure with reduced, mildly reduced, and preserved ejection fraction.

INTRODUCTION: There is still little information regarding a detailed description and predictors of different subtypes of heart failure (HF) in the Polish population. OBJECTIVES: This study sought to characterize the differences between hospitalized patients with HF divided into HF with preserved ejection fraction (HFpEF; EF ≥50%), mildly reduced EF (HFmrEF; EF 40%-49%), and reduced EF (HFrEF; EF <40%), and to identify factors related to each HF subtype. PATIENTS AND METHODS: Patients from the hospital database whose hospitalization was coded as HF­related between 2014 and 2019 were included in the analysis. RESULTS: A total of 2601 patients were included, of whom 62% had HFrEF, 13% had HFmrEF, and 25% had HFpEF. The patients with HFpEF, as compared with those with HFrEF and HFmrEF, were older (70.5 vs 61.6 vs 66.5 years, P <0.001), less often male (44% vs 68.3% vs 81.3%, P <0.001), and less likely to have an ischemic etiology of HF (19.3% vs 49.8% vs 34.4%, P <0.001) but they were more likely to have hypertension (87.3% vs 78.2% vs 78.2%, P <0.001), atrial fibrillation (64.5% vs 55.6% vs 59.5%, P <0.001), cancer (32.2% vs 19.6% vs 28.7%; P <0.001), and anemia (25.5% vs 15.9% vs 20.5%, P <0.001). Of 3 multivariable models, the one predicting HFpEF was the strongest (P <0.001, area under the curve, 0.79), and included age, sex, aortic stenosis, hypertension, anemia, cancer, thyroid abnormality, atrial fibrillation, longer history of HF, ischemic etiology, coronary artery disease, diabetes mellitus, and liver failure. CONCLUSIONS: HFrEF and HFpEF differed significantly in terms of baseline characteristics, while HFmrEF was in the middle of the HF spectrum, tending to be a mixture of HFpEF and HFrEF characteristics.

Alcohol use disorder increases the risk of nonfatal and fatal cardiovascular disease: an 11-year follow-up of a Polish population-based cohort. The HAPIEE study.

INTRODUCTION: Self­reported alcohol intake is an inaccurate measure, especially in heavy drinkers. The simple 4­item CAGE questionnaire assessing alcohol use disorder was found to be positively associated with alcohol consumption and mortality. OBJECTIVES: This study aimed to investigate the relationship between alcohol use disorder assessed with the CAGE questionnaire and the incidence of cardiovascular disease (CVD) in a population­based Polish sample. PATIENTS AND METHODS: A cohort study with an 11­year follow­up was conducted. A random sample of 10 728 residents of Kraków aged 45 to 69 years completed baseline examination, including the CAGE questionnaire. Information on new cases of CVD was obtained from further questionnaires and confirmed by clinical diagnosis. Data on mortality and causes of death were obtained from the local registry, the Central Statistical Office, and the participants' families. The effect of the CAGE score on the risk of CVD was assessed using Cox proportional hazard models. RESULTS: The analysis included 7112 individuals who completed the CAGE questionnaire and were free of CVD at baseline. No alcohol use disorder was reported in 94% of the participants. There was a positive association between the CAGE score and the risk of CVD. In the fully adjusted model, compared with participants scoring 0, the hazard ratios among those scoring 3 and 4 points were 2.19 (95% CI, 1.43-3.37) and 2.79 (95% CI, 1.65-4.73), respectively. The association was somewhat stronger for fatal CVD. CONCLUSIONS: We found a strong, graded association between the CAGE score and the risk of CVD incidence, which was independent of other risk factors for CVD. The CAGE questionnaire might be considered as an additional tool to identify individuals at high risk of CVD.

Longitudinal effects of a nurse-managed comprehensive cardiovascular disease prevention program for hospitalized coronary heart disease patients and primary care high-risk patients.

BACKGROUND: The EUROACTION study (nurse­coordinated multidisciplinary, family­based cardiovascular disease prevention program) documented the efficacy of a nurse­managed, comprehensive prevention program in reducing risk factors for cardiovascular disease (CVD). No information was available on survival. AIMS: The aim of the study was to assess the effects of EUROACTION intervention on CVD risk factors and 12­year survival in the Polish component of the study. METHODS: Two district hospitals and 2 primary care practices were allocated randomly to intervention (INT) or usual care (UC). The primary endpoints were lifestyle and risk factors changes at 1­year follow­up. Differences in survival were analyzed using the multivariable Cox proportional hazards regression models. RESULTS: The study involved 628 patients with coronary heart disease (CHD) and 711 high­risk patients. Compared to UC, INT patients achieved healthier lifestyles and a larger reduction of risk factors at 1 year but these differences were not maintained 12 years after the intervention. Less deaths occurred in patients from the INT hospital and from INT primary practice (hazard ratio [HR], 0.58; 95% CI, 0.42-0.82 and HR, 0.53; 95% CI, 0.3-0.95, respectively). Adjustment for the covariates slightly attenuated the estimates and removed significance (HR, 0.74; 95% CI, 0.52-1.04 and HR, 0.66; 95% CI, 0.36-1.24, respectively). For combined CHD and high­risk patient groups, compared with UC, INT patients had a 36% lower risk of death after adjustment for age, sex, and history of CHD (HR, 0.64; 95% CI, 0.48-0.86). CONCLUSIONS: The impact of the EUROACTION intervention on lifestyle and CVD risk factors could have contributed to lower mortality in INT coronary and high­risk patients. These results emphasize the need for sustaining the interventions to help patients maintain a healthy lifestyle.

Do participants with depression receive more counseling on cardiovascular disease risk factors? The results of the WOBASZ II study.

Background Depression was found to increase the risk of cardiovascular disease (CVD). In terms of CVD prevention in people with depressive symptoms, the main goal is to successfully control classic CVD risk factors. Aims: The aim of the study was to assess the relationship between depression and 1) the frequency of healthcare utilization, 2) counseling on main CVD risk factors during usual medical visits, 3) compliance with pharmacotherapy in primary and secondary prevention. Methods WOBASZ II was a cross­sectional study targeting a representative sample of the Polish population. Trained nurses obtained information on depression (using the Beck Depression Inventory), education, healthcare utilization, counseling on CVD risk factors, and compliance with the recommended pharmacotherapy. Results As many as 5531 participants completed the Beck Depression Inventory questionnaire and provided information on CVD. After adjustment for age, sex, and education, participants without CVD but with depression had blood pressure measured slightly more often and received more frequent counseling on: nutrition (40% more), physical activity (43% more), and smoking cessation (nearly 30% more). Counseling on main CVD risk factors during typical visits and compliance with the recommended  pharmacotherapy did not differ with regards to depression in patients with a history of CVD. Conclusions The recommendations from the European Society of Cardiology for particularly careful control of CVD risk factors in people with depression are to some extent reflected in primary prevention. The relationship between depression and counseling on CVD risk factors in patients with CVD was insignificant. Compliance with the recommended pharmacotherapy was not related to depression.

Accumulation of psychosocial risk factors and incidence of cardiovascular disease: a prospective observation of the Polish HAPIEE cohort.

BACKGROUND: Psychosocial risk factors for cardiovascular disease (CVD) are known to cluster in individuals, but the effect of cumulative exposure has not been thoroughly described in terms of CVD risk. AIMS: The aim of the study was to assess the relationship between accumulation of psychosocial risk factors such as low education, material deprivation, depressive symptoms, and low perceived control and the risk of incident CVD. METHODS: This cohort study with 11­year follow­up included a random population sample (age, 45-69 years). Psychosocial factors were assessed using standard tools. Accumulation of psychosocial risk factors was determined by summing up the number of psychosocial factors experienced. The risk of incident CVD depending on the number of psychosocial factors was estimated (reference, no psychosocial factors). Cox proportional hazards models were fitted. RESULTS: In total, 43 572 and 51 772 person­years were analyzed. There were 479 and 291 new CVD cases in men and women, respectively. An age­adjusted model showed an increase in CVD risk in men exposed to 3 and 4 psychosocial risk factors by nearly 60% and 125%, respectively (P <0.05). Further adjustment waved the association in individual strata, but a significant linear trend was observed. In women, in a fully adjusted model, the second and subsequent risk factors increased the risk of CVD by nearly 70% up to over 2­fold (P <0.001). The total population attributable risk associated with exposure to psychosocial risk factors in women was 34.1%. CONCLUSIONS: The accumulation of psychosocial risk factors was associated with increased risk of CVD. In men, the relation was substantially explained by classic risk factors. In women, about one-third of incident CVD cases could be attributed to psychosocial risk factors.

Association between plasma bilirubin and mortality.

INTRODUCTION AND AIM: It has been proposed that plasma concentration of bilirubin, an endogenous antioxidant, is protective against diseases mediated by increased oxidative stress, including cardiovascular diseases (CVD) and cancer. To examine this hypothesis, we investigated the relationship between plasma bilirubin concentrations and bilirubin UDP-glucuronosyl transferase (UGT1A1) promoter gene variations (associated with increased bilirubin concentrations) with total/CVD and cancer mortality. MATERIALS AND METHODS: A nested case-control study was conducted within the Polish arm of the HAPIEE cohort. At baseline in 2002-2005, participants were examined in detail. Mortality follow-up (median (IQR) between blood draw and death was 3.7 (2.1-5.1) years) was performed by linkage with regional and national death registers. Plasma biomarkers were analysed in all subjects who died from any cause (cases, n=447) and in a random subsample of survivors (controls, n=1423). RESULTS: There was a strong negative association between plasma bilirubin levels and total and cancer mortality, expressed more profoundly in men. The adjusted OR of deaths from all causes and cancer, comparing the highest vs. lowest plasma bilirubin categories were 0.61 (95% CI: 0.42-0.87) and 0.39 (0.24-0.65), respectively. There was no association of bilirubin with CVD mortality. The UGT1A1*28 allele, a genetic marker of raised bilirubin, was also negatively associated with total/cancer mortality, although the associations were not statistically significant. DISCUSSION: Both the observational and genetic associations support the negative relationship between bilirubin and total mortality; this association appears to be driven by cancer mortality, while that with CVD mortality is not evident.

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.

Cardiovascular risk assessment, cardiovascular disease risk factors, and lung function parameters.

BACKGROUND: Decreased lung function is related to higher cardiovascular disease (CVD) incidence and mortality. However, little is known about the relationship between the risk factors of CVD and pulmonary function. AIM: The aim of the study was to assess the relationship between the prevalence of cardiovascular risk factors, the total CVD risk, and pulmonary function. METHODS: The analysis included 4104 men and women aged 45 to 69 years, participants of the Polish part of the Health, Alcohol, and Psychosocial factors In Eastern Europe (HAPIEE) Project, who provided valid measurements of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) using a Micro-Medical Microplus spirometer. The prevalence of CVD risk factors was defined as follows: hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or taking hypertension medication), diabetes (glucose ≥ 7.1 mmol/L or self-reported diabetes), and hypercholesterolaemia (total cholesterol ≥ 5 mmol/L or low-density lipoprotein-cholesterol ≥ 3 mmol/L or taking lipid lowering medication). Categories of total CVD risk were defined according to the 2016 European Guidelines on CVD prevention in clinical practice. The analysis of covariance was used to compare the lung function in the CVD risk factors and the total CVD risk categories. RESULTS: Mean values of FEV1 and FVC, adjusted for age and height, were significantly higher in men than in women (3.02 L; 95% confidence interval [CI] 2.96-3.08 L vs. 2.52 L; 95% CI 2.45-2.63 L for FEV1 and 3.62 L; 95% CI 3.56-3.69 L vs. 3.05 L; 95% CI 2.98-3.12 L for FVC). Obesity was significantly associated with FVC in men and women; it was associated with FEV1 only in men. Compared with participants with normal body mass index, obese men and women had 280 mL and 112 mL lower mean FVC, respectively. Men without hypertension had almost 100 mL higher mean FVC than those with hypertension. The difference in FVC in women was approximately 80 mL. Diabetes was associated with lower values of FVC in both sexes and with FEV1 in women. A significant negative trend was observed in the mean FVC and FEV1 by the considered CVD risk categories. CONCLUSIONS: Impaired lung function was associated with higher CVD risk, which could be explained partly by an adverse association between lung function and prevalence of obesity, hypertension, and diabetes.

Socioeconomic status and cardiovascular risk SCORE.

BACKGROUND: Cardiovascular diseases (CVD) are one of the most frequent causes of morbidity and death both in men and women. The influence of the following factors on the occurrence and progression of atherosclerosis is well known: hyperten-sion, hypercholesterolaemia, tobacco smoking, obesity, diabetes, age, and sex. As well as the typical risk factors of CVD, there is also a significant association between the incidence of those diseases and socioeconomic status (SES). AIM: The aim of this study was to establish the correlation between SES status and CVD risk assessed according to the SCORE algorithm. METHODS: The study encompassed 516 participants (207 men and 309 women) aged 40-74 years, who had never been diagnosed with any CVD. The SES was calculated by multiplying the patient's education and net monthly income. The cor-relation between the SES and SCORE was established using linear and logistic regression analysis. RESULTS: After considering the influence of age, an inverse correlation between the SCORE risk value and the SES index was established, both in the entire group (p = 0.006) and in the men's group (p = 0.007). In the analysis of individual age subgroups, this correlation was demonstrated in the following groups: 55-59-year-olds (p = 0.011), 60-64-year-olds (p = 0.014), and 65-69-year olds (p = 0.034). A similar relationship was established in men aged 65-69 years (p = 0.038) and women aged 40-44 years (p = 0.003). The logistic regression analysis demonstrated that, after considering the influence of age, the odds of the SCORE risk value being ≥ 10% were becoming smaller along with the increase in the SES index value in the entire group (p = 0.048) and in the men's group (p = 0.011). The odds ratio (OR) for the SCORE risk value being ≥ 10% depending on the SES index value was OR = 0.978 (95% confidence interval [CI] 0.956-0.999) in the entire group and OR = 0.964 (95% CI 0.938-0.992) in men. Furthermore, we also established that the risk of SCORE ≥ 5% decreased with the increase in the SES index value in the women's group (OR = 0.970; 95% CI 0.941-0.999; p = 0.042). CONCLUSIONS: 1. We demonstrated a statistically significant correlation between the SES and the CVD risk assessed according to the SCORE algorithm. 2. The value of the CVD risk according to SCORE was inversely correlated with SES status.

Risk factors for work-related eczema and urticaria among vocational students of agriculture.

INTRODUCTION AND OBJECTIVE: Farmers are at high risk of occupational skin diseases which may start already during vocational training. This study was aimed at identification of risk factors for work-related skin diseases among vocational students of agriculture. MATERIAL AND METHODS: The study involved 440 students (245 males, 195 females aged 17-21 years) in 11 vocational schools which were at least 100 km from each other. The protocol included a physician-managed questionnaire and medical examination, skin prick tests, patch tests, total IgE and Phadiatop. Logistic regression model was used for the identification of relevant risk factors. RESULTS: Work-related dermatoses were diagnosed in 29 study participants (6.6%, 95%CI: 4.3-8.9%): eczema in 22, urticaria in 14, and co-existence of both in 7 students. Significant risk factors for work-related eczema were: history of respiratory allergy (OR=10.10; p<0.001), history of eczema (itchy rash) provoked by wet work and detergents before entering the school (OR=5.85; p<0.001), as well as history of contact dermatitis to metals, rubber or cosmetics prior to inscription (OR=2.84; p=0.016), and family history of any skin disease (OR=2.99; p=0.013). Significant risk factors for work-related urticaria were: history of allergic rhinitis and asthma prior to inscription (OR=7.29; p=0.006), positive skin prick tests to work place allergens (OR=4.65; p=0.002) and to environmental allergens (OR=3.79; p=0.009), and positive Phadiatop test (OR=3.61; p=0.013). CONCLUSIONS: Work-related skin diseases are common among vocational students of agriculture. Atopy, past history of asthma, allergic rhinitis, and eczema (either atopic, allergic or irritant) are relevant risk factors for work-related eczema and urticaria in young farmers, along with family history of any skin disease. Positive skin prick tests seem relevant, especially in the case of urticaria. Asking simple, aimed questions during health checks while enrolling students into agricultural schools would suffice to identify students at risk for work-related eczema and urticaria, giving them the chance for selecting a safer profession, and hopefully avoiding an occupational disease in the future.

Cardiovascular disease (CVD) risk factors in Kraków and in the whole Poland adult population. Results from the WOBASZ study and Polish arm of the HAPIEE project.

In Kraków, the second largest town in Poland, cardiovascular disease (CVD) mortality rate is lower than in most top largest towns in Poland and lower than the rate for total Polish population. AIM: The aim of the present analysis was to compare socioeconomic status (SES), prevalence of CVD risk factors and SCORE assessment of risk in Krakow with residents of other big towns in Poland and with general Polish population. MATERIALAND METHODS: We used data from the two large, population studies which used comparable methods for risk factors assessment: 1) Polish part of the HAPIEE Project in which 10 615 residents of Krakow at age between 45-69 years were examined, and (2) The WOBASZ Study which contributed with a sub-sample 6 888 of residents of Poland at corresponding age group. WOBASZ sample included 992 residents of big towns other than Krakow. Age-standardized proportions of persons with CVD risk factors were compared between Krakow and the other big towns in Poland and between Krakow and the whole Poland using χ2 test. RESULTS: The striking observation was that in Krakow proportions of participants with university education were substantially higher than average for the other big towns and the whole Poland. Also, the proportion of occupationally active men and women was the highest in Krakow. In both sexes, prevalence of smoking, hypercholesterolemia and hypertension in Krakow was similar to the other big towns but the prevalence of hypercholesterolemia and hypertension (in men only) was lower than average for Poland. The distribution by SCORE risk categories were similar in all three samples studied. In general, the distribution by BMI categories was less favourable but the prevalence of central obesity was lower among residents of Kraków than among residents of the other big towns and citizens of the whole Poland. Prevalence of diabetes was higher in Krakow than in the other samples studied. The differences between population of Krakow and population of other parts of Poland in the exposure to the main risk factors were found diverse and not big enough to be followed by differences in the distribution by the categories of SCORE risk assessment. The study suggested the importance of obesity and diabetes which are not used for the SCORE risk assessment and especially the importance of psychosocial and economic factors which may influence CVD risk and contribute more to the explanation of the regional differences in CVD mortality.

Perceived control as a predictor of cardiovascular disease mortality in Poland. The HAPIEE study.

BACKGROUND: Neither the development in methods of treatment of coronary heart disease nor the changes in exposure to main cardiovascular disease (CVD) risk factors do not fully explain the trends in CVD mortality in Poland. An influence of psychosocial factors is considered. The aims of the study were: (1) to assess the relationship between perceived control and the prevalence of classic CVD risk factors; (2) to assess the relationship between perceived control and the risk of death from all causes and from CVD. METHODS: A cohort study with 5-year follow-up was conducted. Random sample of 10,728 permanent residents of Krakow aged 45-69 was examined. Perceived control was measured using a standard 11-item scale. The studied group was divided into four subgroups of people with very high, high, moderate, and low perceived control according to quartile values. Data on deaths and causes were obtained from the local register, death certificates and participants' families. An independent effect of perceived control on CVD mortality was assessed using Cox proportional hazards models. RESULTS: Low perceived control was strongly associated with a higher CVD mortality, independently of age, education, marital status, history of CVD, hypertension, hypercholesterolemia, smoking, body mass index, physical activity or diabetes in both men and women (HR 2.68, 95% CI 1.36-5.31 and HR 5.18, 95% CI 1.17-22.96, respectively). After adjustment for age, both in men and women, the highest risk of death from all causes was observed in persons with low perceived control. Further adjustment for covariates attenuated the relationship. CONCLUSIONS: Perceived control is a strong independent predictor of CVD mortality and may be considered a CVD risk factor in the Polish urban population.

Socioeconomic circumstances, health behaviours and functional limitations in older persons in four Central and Eastern European populations.

OBJECTIVES: to investigate functional limitations and their association with socioeconomic factors in four Central and Eastern European populations. METHODS: a cross-sectional study of random population samples in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and six Czech towns participating in the HAPIEE study. Functional limitations (classified into tertiles of the SF-36 physical functioning subscale), socioeconomic circumstances and health behaviours were available for 34,431 subjects aged 45-69 years. RESULTS: the proportion of subjects in the worst tertile of the functional limitations score (≤80% of the maximum score) ranged from 21% of the men in Kaunas to 48% in Krakow women. In multivariate ordered logistic regression, functional limitations were strongly inversely associated with education and positively with material deprivation and with being economically inactive. Functional limitations were more common in male smokers and less common in alcohol drinkers. Socioeconomic characteristics explained some of the differences in functional limitations between populations. Health behaviours explained some of the differences between social groups in both genders and between populations in women. CONCLUSION: unexpectedly, functional limitations were not most common in the sample from Russia, the country with the highest mortality rates. All socioeconomic measures were strongly associated with functional limitations and made some contribution towards explaining differences in limitations between populations.

[Patterns of drug consumption and the occurrence of adverse drug reactions among students of public health]. / Wzorce konsumpcji leków oraz wystepowanie polekowych dzialan niepozadanych wsród studentów kierunku zdrowie publiczne.

UNLABELLED: The research of drug consumption is focused mainly upon the elderly, while the knowledge of drug consumption patterns among young people remains insufficient. Public health students (PHS) seem of particular interest as future opinion leaders and drug policy makers. The aim of the study was to analyze opinions and patterns of drug consumption, and adverse drug reactions (ADR) in this group. MATERIAL AND METHODS: 130 PHS took part in the anonymous questionnaire survey. RESULTS: All students admitted to using some drug at least once in their lives. While purchasing over-the-counter (OTC) drugs, 51.6% students trusted their own knowledge and experience. Women more often relied on a pharmacist's recommendation (47.2% vs 21.7% men; p = 0.045), while men were more influenced by advertising (34.8% vs 12.3% women, p = 0.008). Strict adherence to recommended dosage of OTC and prescription drugs (Rx) was declared by 41.1% and 71.9% students, respectively. Every fourth student (24.8%) admitted to having purchased a Rx drug at least once without having the prescription. Past episodes of ADR to OTC were reported by 7.8% students and to Rx by 38.4% (p < 0.001). Respectively 27.2% and 34.4% students were never, or hardly ever asked about past ADR by prescribing physicians. According to 89.2% students, drug advertising should be subject to regulation and policing, and 66.1% considered it inaccurate and unreliable. Forty-five percent of students had an OTC drug on them while responding the questionnaire, 20.0% had a prescription drug. CONCLUSIONS: Students of public health seem to be notorious consumers of drugs and their attitude seems not fully rational.

Laboratory markers of mast cell and basophil activation in monitoring rush immunotherapy in bee venom-allergic children.

AIM: To evaluate markers of mast cell and basophil activation in children undergoing the initial phase of honeybee venom immunotherapy (VIT). PATIENTS & METHODS: Five children (four boys and one girl) aged 9.5-18 years with severe systemic bee sting reactions and confirmed IgE-mediated allergy were enrolled. Plasma and urine concentrations of 9α,11ß-PGF2 and serum tryptase levels were measured at four time points and peripheral blood basophil count and CD63 expression were measured at three time points in the course of VIT, including 5-day rush initial immunotherapy (cumulative dose of 223 µg of bee venom allergen) and two subsequent maintenance doses of 100 µg. RESULTS: In the first 40 days of VIT, there was a decrease in mean plasma levels of 9α,11ß-PGF2 (from 41.5 to 27.9 pg/ml; p < 0.05), accompanied by an increase in baseline basophil activation (from 2 to 15%; p < 0.05). The median serum tryptase levels increased from 3.45 to 4.40 ng/ml during rush phase and subsequently returned to initial values (statistically not significant). In four patients, the basophil activation test in response to bee venom allergens remained positive throughout the study. The fifth patient was basophil activation test-negative at all three measurements, and a post hoc analysis revealed clinical peculiarities that are discussed in the paper. CONCLUSIONS: Our preliminary results indicate that plasma levels of 9α,11ß-PGF2 decrease while numbers of activated basophils increase during the initial phase of bee venom rush immunotherapy in children.